Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery

Wang, Ta-I; Chen, Huiyi; Tsai, Chun‐Hao; Hsu, Horng‐Chaung; Lin, Tsung-Li

doi:10.1186/s13018-016-0365-2

Cited by 35 publications

(24 citation statements)

References 46 publications

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“…Several previous studies have examined the FN to AA distance in normal hips, using CT, MRI or cadavers. At the 3 or 9 o’clock position, an almost similar level as the tip of the greater trochanter, the mean distance to the FN ranged from 18.0 to 23.6 mm [ 5 , 15 , 19 – 21 ]. At the anterosuperior acetabulum, which is approximately the level of the bottom of the AIIS, the mean distance was 26.5 to 33.2 mm [ 5 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…At the anterosuperior acetabulum, which is approximately the level of the bottom of the AIIS, the mean distance was 26.5 to 33.2 mm [ 5 , 15 ]. In OA hips, Wang et al [ 21 ] found a mean distance at the 3 or 9 o’clock position of 20.6 mm, with no difference between pathologic and normal hips. Our results are consistent with these reports on both normal and OA hips, which indicates the reliability of the measurements in the present study with a coordinate system reconstructed in axial planes along the anterior pelvic plane and 3D-NerveVIEW imaging.…”

Section: Discussionmentioning

confidence: 99%

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The distance between the femoral nerve and anterior acetabulum is significantly shorter in hip osteoarthritis than in non-osteoarthritis hip

Yoshino

Hagiwara

Nakamura

et al. 2021

BMC Musculoskelet Disord

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Background The appropriate position of retractors to minimize the risk of femoral nerve palsy remains uncertain. The purpose of this imaging study was to evaluate the distance between the femoral nerve (FN) and anterior acetabulum (AA) in hip osteoarthritis (OA). Methods Forty-one patients with unilateral hip OA underwent magnetic resonance imaging. Three measurement levels were defined and the minimum distance between the femoral nerve (FN) margin and anterior acetabulum (AA) rim was measured on axial T1-weighted images on the OA and normal sides at each level, with reference to an advanced neurography view. The cross-sectional area (CSA) of the iliopsoas muscle was also measured at each level bilaterally by three observers. Distances and CSAs were compared between the OA and normal side. Multiple regression analysis was performed to identify variables associated with the distance in OA. Results The mean minimum FN to AA distances in OA were 19.4 mm at the top of the anterior inferior iliac spine (AIIS), 24.3 mm at the bottom of the AIIS, and 21.0 mm at the tip of the greater trochanter. These distances were significantly shorter than in normal hips at the top and bottom of the AIIS, with mean differences of 1.6 and 5.8 mm, respectively (p = 0.012, p < 0.001). CSAs of the iliopsoas in OA were significantly smaller at all levels (all p < 0.001), with reductions of 10.5 to 17.9%. The CSA of the iliopsoas at the bottom of the AIIS was associated with the FN to AA distance at the same level (p = 0.026). Interobserver reliabilities for measurements were very good to perfect (intraclass correlation coefficients 0.897 to 0.966). Conclusions To minimize the risk of femoral nerve palsy, surgeons should consider the change of the femoral nerve to anterior acetabulum distance in osteoarthritic hip surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The distance between the femoral nerve and anterior acetabulum is significantly shorter in hip osteoarthritis than in non-osteoarthritis hip

Yoshino

Hagiwara

Nakamura

et al. 2021

BMC Musculoskelet Disord

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“…Many postulate there is a “safe zone” in relation to the tip of the greater trochanter [ 17 ]. The original 50-mm zone defined by Jaccobs and Bruxton has been challenged more recently with some authors speculating this to be as low as 30 mm [ 7 , 9 , 12 , [19] , [20] , [21] , [22] , [23] ].…”

Section: Introductionmentioning

confidence: 99%

Do Acetabular Buttress Augment Pose Risk to the Superior Gluteal Nerve? A Cadaveric Study

2021

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Background: Management of acetabular defects in total joint reconstruction can be challenging. Various algorithmic approaches have been developed, with some recommending using posterosuperior acetabular buttress augments for severe defects. The superior gluteal nerve lies in close proximity to their application, and damage to it results in deterioration of hip stability and gait mechanics. There has been investigation into the relationship of the superior gluteal nerve to various anatomic points. To our knowledge, no study exists examining the relationship between the acetabular rim and the superior gluteal nerve for the application of these particular devices. Methods: Ten adult cadaver specimens were examined. A reproducible technique in relation to the typical placement of a buttress augment was used. From a distance of 20 millimeters (mm) lateral to the greater sciatic notch, the distance from the superior gluteal nerve to the posterosuperior acetabular rim was measured. Results: The average distance between the posterosuperior acetabular rim and the superior gluteal nerve was found to be 52 mm, ranging from 48 mm to 60 mm. Conclusion: With proprietary acetabular augments measuring up to 68 mm in length, the superior gluteal nerve could be at substantial risk with placement of these devices. Surgeons should take great care with dissection for and intraoperative placement of these devices, and particularly strive for optimized prosthetic hip stability to mitigate the risk of dislocation from nerve injury. To our knowledge, this study is the first of its kind and provides valuable anatomic and operative knowledge during these highly complex cases.

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“…Such injuries have severe effects on patients' prognoses and reduce their quality of life [9]. Thus prevention is the first principle in managing nerve injuries associated with THA [3]. In order to preserve the SGN during THA, the surgeons must have a sound knowledge of its course, relation and distance to clinically useful landmarks such as the superior rim of acetabulum.…”

Section: Introductionmentioning

confidence: 99%

“…During this surgery inappropriate placement of retractors is a leading cause of nerve injury. The nerve may be contused, compressed or penetrated by the tips of the retractors [2,3].…”

Section: Introductionmentioning

confidence: 99%

Biometric Assessment of Superior Gluteal Neurovascular Bundle to Acetabulum of Hip Joint

Mangla¹,

Das²,

Mishra³

et al. 2021

IJAR

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Introduction: The superior gluteal nerve (SGN) is a branch of sacral plexus with root value of L4, L5 and S1. It leaves pelvic cavity through greater sciatic foramen along with superior gluteal artery above piriformis. This neurovascular bundle lies in close proximity to superior acetabular rim. Iatrogenic damage to SGN is common during hip arthroplasties and may be primarily attributed to inappropriate placement of retractors. Alarmingly high percentage of affected individuals are stuck with persistent irreversible damage to SGN. Vascular injuries are not as common but pose a challenging scenario to surgeons. Hence in both situations prevention is of supreme importance. Precise knowledge of course and relation of superior gluteal neurovascular bundle (SGNVB) to clinically useful landmarks such as the superior rim of acetabulum is desired. With an aim to provide baseline data for the Indian population we conducted this study. Material and methods: 200 dry adult Indian hip bones {Left side -109(male:66, female:43); Right side-91(male:66, female:43)} were photographed in anatomical position. Two lines- line A and line B were drawn. Line A corresponded to a horizontal passing through the anterior inferior iliac spine (AIIS) and roof of GSN while line B passed tangentially through the highest point on the acetabular rim parallel to line A. The vertical distance (white line) between the 2 lines was measured (Fig.2) was measured using Image J software. Results: The mean distance calculated was 0.62 ± 0.16 cm (0.68 ± 0.38 cm in right hip bones and 0.60 ± 0.30 cm in left side hip bones). The difference between the two sides and the two genders were compared and found to be statistically non- significant. Conclusion: A safe zone of 0.5 to 0.7 cm beyond the superior acetabular rim should be considered during surgeries around hip joint. The safe zone can be easily measured by the surgeons intraoperatively and be used as a guide to careful positioning of the retractors while performing surgeries around the hip joint. Better localization of SGNVB using the anatomic landmark defined in this study may be used to decrease surgical morbidity. KEY WORDS: Superior Gluteal, Acetabulum, Hip Joint, Total hip arthroplasty, Safe Zone.

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Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery

Cited by 35 publications

References 46 publications

The distance between the femoral nerve and anterior acetabulum is significantly shorter in hip osteoarthritis than in non-osteoarthritis hip

The distance between the femoral nerve and anterior acetabulum is significantly shorter in hip osteoarthritis than in non-osteoarthritis hip

Do Acetabular Buttress Augment Pose Risk to the Superior Gluteal Nerve? A Cadaveric Study

Biometric Assessment of Superior Gluteal Neurovascular Bundle to Acetabulum of Hip Joint

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