The role of retraction in direct nerve injury in total hip replacement: an anatomical study

McConaghie, F.A., Payne, A. and Kinninmonth, A.W.G. (2014) The role of retraction in direct nerve injury in total hip replacement: an anatomical study. Bone and Joint Research, 3(6), pp. 212-216. (doi: 10.1302/2046-3758.36.2000255) (PMID:24973358) (PMCID:PMC4112776)

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Objectives Acetabular retractors have been implicated in damage to the femoral and obturator nerves during total hip replacement. The aim of this study was to determine the anatomical relationship between retractor placement and these nerves.

Methods A posterior approach to the hip was carried out in six fresh cadaveric half pelves. Large Hohmann acetabular retractors were placed anteriorly, over the acetabular lip, and inferiorly, and their relationship to the femoral and obturator nerves was examined.

Results If contact with bone was not maintained during retractor placement, the tip of the anterior retractor had the potential to compress the femoral nerve by passing superficial to the iliopsoas. If pressure was removed from the anterior retractor, the tip pivoted on the anterior acetabular lip, and passed superficial to the iliopsoas, overlying and compressing the femoral nerve, when pressure was reapplied. The inferior retractor pierced the obturator membrane in all specimens medial to the obturator nerve, with subsequent retraction causing the tip to move laterally, making contact with the nerve.

Conclusion Iliopsoas can only offer protection to the femoral nerve if the retractor passes deep to the muscle bulk. The anterior retractor should be reinserted if pressure is removed intra-operatively. Vigorous movement of the inferior retractor should be avoided.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Payne, Professor Anthony
Authors: McConaghie, F.A., Payne, A., and Kinninmonth, A.W.G.
College/School:College of Medical Veterinary and Life Sciences > School of Life Sciences
Journal Name:Bone and Joint Research
Publisher:British Editorial Society of Bone and Joint Surgery
ISSN (Online):2046-3758

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