Does surgical body position influence the risk for neurovascular injury in total hip arthroplasty? A magnetic resonance imaging study.

Acetabulum / surgery Arthroplasty, Replacement, Hip / adverse effects Case-Control Studies Humans Magnetic Resonance Imaging Prospective Studies
Femoral neurovascular injury Lateral position Magnetic resonance imaging Supine position Total hip arthroplasty

Journal

Orthopaedics & traumatology, surgery & research : OTSR
ISSN: 1877-0568
Titre abrégé: Orthop Traumatol Surg Res
Pays: France
ID NLM: 101494830

Informations de publication

Date de publication:
12 2021
Historique:
received: 20 09 2020
revised: 26 10 2020
accepted: 29 10 2020
pubmed: 24 1 2021
medline: 11 3 2022
entrez: 23 1 2021
Statut: ppublish

Résumé

Neurovascular injury is a critical complication in total hip arthroplasty (THA). However, neurovascular geographic variations around the hip joint in different body positions have not been examined. This study investigated the differences in hip neurovascular geography in the supine and lateral positions using magnetic resonance imaging (MRI). The neurovascular geography of the hip is influenced by differences in surgical body position. This was a single-center prospective study of 15 healthy volunteers enrolled between January 2018 and March 2019. Each subject's bilateral hips were scanned with a 3-T MRI scanner in both the supine and lateral positions. In T1-weighted axial images at the level of the hip center, the anterior and posterior acetabular edges were defined as reference points at which retractors are commonly placed during surgery. We measured the distance between the anterior acetabular edge and the femoral nerve (dFN), femoral artery (dFA), and femoral vein (dFV), as well as that between the posterior acetabular edge and the sciatic nerve (dSN). The primary outcome measures were the distances in both the supine and lateral positions. dFN, dFA, and dFV in the supine and lateral positions (mm, mean±standard deviation) were 25.8±5.6 and 32.4±6.4 (p<0.0001), 25.7±4.5 and 32.2±5.0 (p<0.0001), and 26.5±4.8 and 32.3±5.1 (p<0.0001), respectively. Most of these elements moved anteromedially in the lateral position compared to the supine position. There was no significant difference in dSN between the supine and lateral positions (23.7±4.9 and 24.5±6.5 (p=0.46). THA in the supine position may be accompanied by a higher risk of femoral neurovascular injury than that in the lateral position. The application of our findings could reduce the risk of femoral neurovascular injury during THA. III; prospective diagnostic case control study.

Sections du résumé

BACKGROUND
Neurovascular injury is a critical complication in total hip arthroplasty (THA). However, neurovascular geographic variations around the hip joint in different body positions have not been examined. This study investigated the differences in hip neurovascular geography in the supine and lateral positions using magnetic resonance imaging (MRI).
HYPOTHESIS
The neurovascular geography of the hip is influenced by differences in surgical body position.
PATIENTS AND METHODS
This was a single-center prospective study of 15 healthy volunteers enrolled between January 2018 and March 2019. Each subject's bilateral hips were scanned with a 3-T MRI scanner in both the supine and lateral positions. In T1-weighted axial images at the level of the hip center, the anterior and posterior acetabular edges were defined as reference points at which retractors are commonly placed during surgery. We measured the distance between the anterior acetabular edge and the femoral nerve (dFN), femoral artery (dFA), and femoral vein (dFV), as well as that between the posterior acetabular edge and the sciatic nerve (dSN). The primary outcome measures were the distances in both the supine and lateral positions.
RESULTS
dFN, dFA, and dFV in the supine and lateral positions (mm, mean±standard deviation) were 25.8±5.6 and 32.4±6.4 (p<0.0001), 25.7±4.5 and 32.2±5.0 (p<0.0001), and 26.5±4.8 and 32.3±5.1 (p<0.0001), respectively. Most of these elements moved anteromedially in the lateral position compared to the supine position. There was no significant difference in dSN between the supine and lateral positions (23.7±4.9 and 24.5±6.5 (p=0.46).
DISCUSSION
THA in the supine position may be accompanied by a higher risk of femoral neurovascular injury than that in the lateral position. The application of our findings could reduce the risk of femoral neurovascular injury during THA.
LEVEL OF EVIDENCE
III; prospective diagnostic case control study.

Identifiants

DOI: 10.1016/j.otsr.2021.102817 PMID: 33484902
pubmed: 33484902
pii: S1877-0568(21)00023-2
doi: 10.1016/j.otsr.2021.102817
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

102817

Informations de copyright

Copyright © 2021 Elsevier Masson SAS. All rights reserved.

Auteurs

Ryohei Takada (R)

Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan. Electronic address: takada.orth@tmd.ac.jp.

Tetsuya Jinno (T)

Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.

Kazumasa Miyatake (K)

Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.

Masanobu Hirao (M)

Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.

Toshitaka Yoshii (T)

Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.

Shigenori Kawabata (S)

Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.

Atsushi Okawa (A)

Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.

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Classifications MeSH

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questionsmedicales.fr › Procédures de chirurgie opératoire › Implantation de prothèse › Arthroplastie prothétique › Arthroplastie prothétique de hanche › Does surgical body position influence the risk...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études cas-témoins › Does surgical body position influence the risk...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Does surgical body position influence the risk...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Imagerie par résonance magnétique › Does surgical body position influence the risk...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Does surgical body position influence the risk...