Potential damage to the femoral neurovasculature during approach to the hip

Abstract Introduction Femoral neurovascular injury is an uncommon, but potentially devastating complication following surgical approaches to the hip. The intraoperative misplacement of the anterior acetabular retractor is the most commonly cited mechanism for this injury yet there is no gold standard for a proper insertion location in the literature We examined the course of the femoral neurovasculature about the hip to identify safest location for retractor insertion and furthermore demographic populations who are at-risk for injury due to a decreased distance between the hip joint and the femoral neurovasculature. Methods A total of 100 non-pathologic hip magnetic resonance imaging (MRI) studies from adult patients were included. Patients were chosen at random from our medical center's digital radiographic archive and their demographic data recorded. Mean distances between the anterior acetabular wall and the femoral artery were measured at three axial levels (acetabular dome, superior iliopectineal ridge, and inferior iliopectineal ridge). Results Our data showed the femoral neurovascular structures pass closer in proximity to the acetabular wall as they progress distally about the hip. An average direct separation distance of 40.1 mm was seen at the acetabular dome while measurements at the inferior iliopectineal ridge demonstrated an average distance of 20.5 mm. Additionally, statistically significant (p  45 years-old, Discussion By undertaking a large-scale MRI evaluation of the femoral neurovasculature about the hip, not only were we able to approximate the location of the femoral neurovascular bundle as it passes the hip joint, but also the safest location for insertion of anterior acetabular retractors at the level of the acetabular dome or above in close proximity to the bony cortex. Additional care should be taken placing retractors in patients when demographic risk factors including female gender, age >45 years old, stature