The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury

Abstract

BackgroundIatrogenic injury to the femoral neurovascular bundle is not uncommon during primary and revision total hip replacement (THR) and can result in permanent weakness, pain and poor function. Prevention of injury to these structures relies on a sound knowledge of their relationships to the hip joint.MethodsWe studied 115 consecutive hip magnetic resonance imaging (MRI) results in order to identify objective relationships between these structures and the hip joint that can be used intraoperatively.ResultsWe determined that the shortest mean distances of the femoral nerve, artery and vein from the hip joint are 23.62 (standard deviation, SD = 5.44), 19.62 (SD = 4.17) and 17.47 (SD = 4.41) mm, respectively. The femoral nerve was lateral to the hip joint in 30 (55.5%) left- and 37 (60.7%) right-sided hip joints. The femoral artery was located medial to the hip joint in 28 (51.9%) left- and 34 (55.7%) right-sided hips. The femoral vein was medial to the hip joint in 52 (96.3%) left- and 58 (95.1%) right-sided hips.ConclusionWe have identified objective relationships between the hip joint and femoral neurovascular bundle that can be used with ease intraoperatively during THR. Our data show that patients with a low body weight and the elderly may be at a higher risk of iatrogenic injury due to increased proximity of the neurovascular structures to the hip. Application of this knowledge may serve to reduce the risk of iatrogenic injury to these structures and thereby improve patient satisfaction and outcomes.

Optimal retractor insertion point for nerve safety during total hip arthroplasty: an anatomical study on the femoral and sciatic nerves in relation to hip motion

“…At the 3 or 9 o'clock position, an almost similar level as the point of 90°, the mean distance to the femoral nerve ranged from 18.0 mm to 23.6 mm. 10,12,17–19 In the present study, the mean distance to the femoral nerve from the 90° point of the anterior acetabulum was 21.1 ± 7.4 mm. This result is consistent with data from previous studies.…”

Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up

“…In addition to the relative relationship between the femoral head and the acetabulum, other factors may affect the distance between the neurovascular bundle and hip joint. Mehta et al found that patients with a low body weight may be at a higher risk of iatrogenic injury due to the reduced distance of the neurovascular structures to the hip [ 25 ]. The children in this study are only one to two years old and thus obviously weigh less than adults, and this will cause the neurovascular bundle to be closer to the hip capsule.…”

The Course and Anatomical Characteristics of Sciatic and Femoral Nerves in Unilateral Crowe Type IV Hip Dysplasia

“…Previous studies on peripheral nerve anatomy and course were mainly based on magnetic resonance imaging (MRI) or cadaveric specimens. However, CT might be a better choice of evaluating nerve course for DDH [20][21][22][23][24][25]. On the one hand, MRI was not a routine examination for DDH patients and cannot clearly show bony landmarks; it would increase patients' medical costs purely for the purpose of observing nerve course.…”