Arterial Topographic Anatomy Near the Femoral Head-Neck Perforation with Surgical Relevance

Abstract

The information is taken from normal hips and may not be directly applicable to the deformed hip. Nevertheless, it is a prerequisite for a surgeon to understand the normal anatomy and use those boundaries to prevent mistakes during intra-articular joint-preserving hip surgical procedures.

Femoroacetabular Impingement: What the Surgeon Wants to Know

“…A recent study established the safe margin of bone resection in the perforating area of retinacular vessels at a depth of 2.5 mm and 2 mm from the cartilage margin. 18 The same study also reported the anterior limit of the vascular synovial fold lying more anteriorly than initially thought. It is advisable to be cautious when performing bone resection from the 1 o'clock to 10 o'clock areas of the head-neck junction (►Fig.…”

“…26 With recent detailed knowledge of the vascular supply to the femoral head, resection of lateral cam deformities overlapping the vascular area is no longer an absolute isolated indication for open surgery. 17,18 The literature is very scarce concerning recommendations for the amount and shape of resection at the head-neck junction and acetabular margin. Few publications define the amount of safe bone resection on the femoral side before creating an increased risk of stress fracture, and there is no consensus about the depth and extension of resection.…”

“…Femoral head osteoplasty can then be performed 360 degrees, respecting the superior retinaculum margins and the safe depth of resection recommendations in the vascular perforating area. 18 Intraoperatively it is possible to test for full range of motion (ROM) before performing acetabular osteoplasty or to opt for a subtrochanteric derotation osteotomy if needed. 59 Surgical hip dislocation also allows for a full labrum reconstruction using fascia lata, hamstrings tendons, or ligamentum teres.…”

“…For example, in cam impingement, the surgical treatment goal of restoring head sphericity can be difficult to accomplish considering the frequent overlap of cam deformity with the area of perforation of the superior retinacular arteries. [15][16][17][18] In the last decade, the number of performed hip arthroscopies has increased dramatically, much more than osteotomies or other hip-preserving procedures. Some studies point to an increase of 250 to 365% in the last 10 years.…”

Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls

“…The rationale for head-preserving procedures is the desire to provide sufficient and long-lasting support to necrotic subchondral bone and cartilage [38] , in order to prevent collapse and subsequent osteoarthrosis of the joint. A tantalum rod was used to provide direct mechanical support [16] ; a bone graft was aimed to replace dead bone with viable bone [12][13][14] .…”