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.
Highlights
Iatrogenic 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
We identified objective relationships between the femoral neurovascular bundle to the hip joint based on magnetic resonance imaging (MRI) results
We determined that the shortest mean distances of the femoral nerve, artery and vein from the hip joint are 23.62 (SD = 5.44), 19.62 (SD = 4.17) and 17.47 (SD = 4.41) mm, respectively
Summary
Iatrogenic 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. Iatrogenic injury to the femoral neurovascular bundle is a rare but well documented complication of total hip replacement (THR). The incidence of injury to the femoral nerve varies in the literature between 0.2–2.4% of cases in primary THR and 1.4 to 3.8% in the revision setting [1,2,3,4,5]. Injury to the femoral vessels has been reported during internal fixation of intertrochanteric fractures of Prevention of iatrogenic femoral neurovascular injury requires a sound knowledge of the anatomy of the native hip joint and constant vigilance intraoperatively to prevent inadvertent damage. There is significant anatomic variation in the location and course of the nerve and vessels [13]
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