Neurovascular Structure Proximity to Acetabular Retractors in Total Hip Arthroplasty

Shubert, Daniel; Madoff, Samuel D.; Milillo, Ralph; Nandi, Sumon

doi:10.1016/j.arth.2014.08.024

Cited by 41 publications

(45 citation statements)

References 32 publications

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“…Tagliafico et al [ 20 ] and Hurd et al [ 21 ] also used in vivo imaging to identify aetiologic factors for sciatic nerve palsy following total hip arthroplasty. In this study, the position of the sciatic nerve in the hip was identified using CT images of DDH patients, CT images have been used to observe the nerve in the hip region [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Sciatic nerve course in adult patients with unilateral developmental dysplasia of the hip: implications for hip surgery

et al. 2015

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BackgroundSciatic nerve injury is a disastrous adverse complication of surgery and can cause debilitating pain, functional impairment and poor quality of life. Patients with developmental dysplasia of the hip (DDH) have a high incidence of sciatic nerve injury after total hip arthroplasty (THA). A better understanding of the course of the sciatic nerve in patients with DDH may help minimise the risk of sciatic nerve injury after THA.MethodsA total of 35 adult patients with unilateral DDH were enrolled in this retrospective study. We reviewed the patients’ computed tomography (CT) scans, which included the area from the iliac crest to below the lesser trochanter. The distance between the sciatic nerve and regional anatomic landmarks in four different sections on CT scans was measured to identify the course of the sciatic nerve.ResultsThe distance from the sciatic nerve to the spine’s midline was shorter on the affected side than on the healthy side (p < 0.05); the same difference was also detected in the distance to the ilium/ischium outside the true pelvis (p < 0.05). The distance to the greater trochanter was longer on the affected side (p < 0.05). However, the two sides showed no significant difference in the distance from the sciatic nerve to the lesser trochanter (p > 0.05).ConclusionsFor patients with unilateral DDH, the sciatic nerve was located near the ischium and ilium but relatively far from the femur of the affected hip joint, compared to its location on the healthy side. These findings reveal that sciatic nerve becomes shorter in the affected low-limb and is relatively unlikely to be directly injuried using the posterolateral approach in patients with unilateral DDH.

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Section: Discussionmentioning

confidence: 99%

Sciatic nerve course in adult patients with unilateral developmental dysplasia of the hip: implications for hip surgery

et al. 2015

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“…In some reports, gender biasing has also been observed as one of the causes of vessel injury. In several retrospective studies, the female dominance of vessel injury as compared to male (3:2) has been confirmed [1,4,5,16,24].…”

Section: Introductionmentioning

confidence: 91%

“…In particular, the primitive cause of injuries includes reaming during acetabular preparation, and retractor induced injury, drilling holes for fixation of screws in cementless acetabular cups, excessive traction in surgery, postoperative cup migration (Figure 2a and b). Also, cement erosion, excessive local heating by methyl methacrylate in cemented total hip replacement are further reasons of occurrence of arterial injuries during total hip replacement [4,[14][15][16][17][18][19][20]. However, there are many reported reasons in which symptoms of vessel injury were not evident.…”

Section: Introductionmentioning

confidence: 99%

Vascular Injury in Total Hip Replacement: Management and Prevention

Singh¹,

Rai²,

Rastogi³

2018

Total Hip Replacement - An Overview

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This chapter analyzed the vascular complications in total hip replacement. Vascular injuries are the uncommon but well recognized and serious issue. During total hip replacement, laceration of major blood vessels has been reported which even cause morbidity and mortality. The injury to vascular structures occurs due to the placement of screws to fix acetabular components, structural grafts, and protrusio cages or rings. Massive hemorrhage resulting in immediate exsanguination may be caused due to the damage of any of these vessels by processes such as drilling, reaming, retraction, or dissection. The majority of these vascular injuries might be better prevented or even more proficiently treated by comprehensive preoperative assessment, better instrumentation, and careful postoperative monitoring.

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“…7 The reported range of incidence of nerve and arterial injury is 0.09 to 3.7% and 0.1 to 0.2%, respectively. 83 Injuries are more common on the left side, and the structures at risk include external iliac, femoral, and obturator vessels. The femoral, sciatic, superior gluteal, and lateral femoral cutaneous nerves are all at risk.…”

Section: Neurovascular Injurymentioning

confidence: 99%

“…Knowledge of retractor placement is crucial as even properly placed retractors can be less than 1 cm from an important neurovascular structure. 83…”

Section: Neurovascular Injurymentioning

confidence: 99%

Evaluation of the Painful Total Hip Arthroplasty

2018

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The total hip arthroplasty (THA) remains as one of the most successful procedures improving function and quality of life. However, despite its success, failures do occur. The workup of a painful THA should be methodical, prioritizing the most likely to least likely etiologies. Intrinsic and extrinsic sources of pain must be evaluated from data collected through an accurate history, detailed physical examination, laboratory analysis, and imaging interpretation.

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Neurovascular Structure Proximity to Acetabular Retractors in Total Hip Arthroplasty

Cited by 41 publications

References 32 publications

Sciatic nerve course in adult patients with unilateral developmental dysplasia of the hip: implications for hip surgery

Sciatic nerve course in adult patients with unilateral developmental dysplasia of the hip: implications for hip surgery

Vascular Injury in Total Hip Replacement: Management and Prevention

Evaluation of the Painful Total Hip Arthroplasty

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