Abstract
Introduction: When performing a hip resurfacing procedure through the postero-lateral approach, concern has been expressed as to the proximity of the femoral neurovascular bundle during the anterior capsulotomy. We aimed to identify the proximity of the femoral nerve, artery and vein during an anterior capsulotomy.
Methods: 5 fresh frozen cadaveric limbs were used. A standard postero-lateral approach was performed. An anterior incision was then made to identify the femoral neurovascular bundle. Measurements were taken prior to hip dislocation. The femoral head was dislocated, capsulotomy scissors were inserted though the posterior incision and positioned to cut the superior and then inferior aspects of the anterior capsule. The distance from the scissors to each of the neurovascular structures were recorded. Measurements were made with the hip in flexion and extension.
Results: Prior to dislocation the mean distance from the capsule was 25mm for the femoral nerve, 21mm for the artery and 21mm for the vein. Following dislocation, with the hip in extension the distance during cutting of the antero-superior capsule to the nerve, artery and vein was 31mm. With the hip in a flexed position, the distance from all three neurovascular structures increased by a mean of 5mm. When the scissors were positioned to cut the antero-inferior capsule in extension, the mean distances to the nerve, artery and vein were 31mm, 28mm and 28mm. When the hip was flexed, the distance to the nerve decreased by 2mm.
Discussion: Our study suggests that the neurovascular structures are relatively well protected during an anterior capsulotomy performed during hip resurfacing. The procedure may be safer if the capsulotomy is performed with the hip dislocated and the hip in a flexed position while cutting the antero-superior aspect and in an extended position while cutting the antero-inferior aspect.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
