- See:
-
Total Hip Replacement Menu:
-
Anastomosis of Lower Limb Arteries
-
Nerve Injuries in THR:
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Acetabular Screw Placement:
- Discussion:
- arterial injuries have been reported in 0.1% to 0.2% of all total hip replacements;
- vascular injury is more common w/ the anterior approach, possibly because of retractor placement;
- Vessel Injury from Acetabular Screws:
- see:
acetabular screw placement
- use of screws to fix an uncemented acetabular cup may injure intrapelvic vessels;
- anterior & anterosuperior quadrants of the acetabular wall should not be perforated because of their close proximity
to the neurovascular structures;
- Injury to External Iliac Artery and Vein:
-
screw placement: for
acetabular component;
- artery may be damaged by drilling into anterior superior quadrant of acetabulum;
- external iliac vein accompanies the artery;
- veins lies opposite the anterosuperior quadrant;
- this has been lacerated during
screw placement, resulting in large retroperitoneal hematoma;
-
injury from retractors:
-
psoas is interposed between anterior column of acetabulum and iliac artery;
- as the psoas runs distally, the muscle thins and becomes more tendinous;
- risk of vessel injury is decreased by placing retractors more proximally along anterior column where vessels are
protected by muscular portion of
psoas;
- risk of injury is increased when retractors are placed too far medially over anterior acetabulum proximal to transverse acetabular ligament;
- Obturator Artery:
-
obturator nerve, artery, and vein most frequently traverse lateral wall (quadrilateral surface) of the pelvis together,
covered by parietal peritoneum, w/ nerve located most superior & vein most inferior;
- neurovascular bundle lies opposite interoinferior quadrant of acetabulum;
- injury to this artery may occur if the anterior inferior quadrant is instrumented, such as w/ placement of a retractor under
the transverse acetabular ligament into the superolateral aspect of the obturator foramen;
- Superior Gluteal Vessels:
- injury to the superior gluteal artery can occur from screws placed in the area of
sciatic notch;
- to avoid damage notch should be gently palpated and protected w/ the surgeon's digit to avoid instrument protrusion into this area;
Mechanisms of arterial injuries associated with total hip replacement.
Aust JC, Bredenburg CE, Murray DG.
Arch Surg 116: 345, 1981.
Vascular complications after total hip arthroplasty.
Bergqvist D, Carlsson AS, Ericsson BF.
Acta Orthop Scand 54: 157, 1983.
Neural and Vascular Injury in Total Hip Arthroplasty.
RC Wasielewski MD, LS Crossett MD, and HE Rubash MD.
Orthopedic Clinics of North America. Vol 23. No 2. p 219. April 1992.
Thrombosis of the external iliac artery following total hip arthroplasty.
Crispin HA, Boghemans JPM,
JBJS 62-A: 462, 1980.
