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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.
- Source :
-
Hip international : the journal of clinical and experimental research on hip pathology and therapy [Hip Int] 2024 Jul; Vol. 34 (4), pp. 459-466. Date of Electronic Publication: 2024 Feb 19. - Publication Year :
- 2024
-
Abstract
- Background: Nerve injury is one of the most serious complications of total hip arthroplasty (THA). It is suspected to be a result from nerve compression or direct injury caused by an acetabular retractor. The anatomical relationship between the acetabular rim and the femoral and sciatic nerves, including hip motion, has not been investigated. This study aimed to identify the optimal position for retractor insertion during THA to prevent nerve damage.<br />Methods: A total of 28 hip joints from 14 freshly frozen cadavers were used. Using an anterolateral approach, each cadaver was immobilised in the lateral decubitus position and deployed to measure the distance between the nerves and the acetabular rim, while the hip joint was changed to the extension, neutral, and flexion positions.<br />Results: Three femoral nerves were closest to the anterior margin of the acetabulum at 90° and 120° of extension and farthest away at 30° of flexion. The sciatic nerve was closest to the posterior margin of the acetabulum at 90° and 120° of flexion and farthest away at 30° and 150° of extension compared with the other points.<br />Conclusions: To prevent nerve damage during THA, we suggest that the retractor be inserted at the points where the nerves are the farthest away, such as at 30° and 150°. The femoral and sciatic nerves vary in their movements depending on the hip position. Therefore, the safe insertion of a retractor is recommended for hip flexion of the femoral nerve and extension of the sciatic nerve. Additionally, it is important to carefully insert the retractor along the acetabular margin without penetrating the joint capsule. Overall, this study provides valuable insights into the anatomical location and movement of the femoral and sciatic nerves in relation to hip motion and can help inform surgical techniques for safer THA.<br />Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Subjects :
- Humans
Male
Female
Aged
Peripheral Nerve Injuries prevention & control
Peripheral Nerve Injuries etiology
Aged, 80 and over
Middle Aged
Acetabulum surgery
Sciatic Nerve anatomy & histology
Arthroplasty, Replacement, Hip methods
Femoral Nerve anatomy & histology
Cadaver
Range of Motion, Articular
Hip Joint surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1724-6067
- Volume :
- 34
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Hip international : the journal of clinical and experimental research on hip pathology and therapy
- Publication Type :
- Academic Journal
- Accession number :
- 38372085
- Full Text :
- https://doi.org/10.1177/11207000241227399