Advertisement

Vascular Preservation During Arthroscopic Osteoplasty of the Femoral Head-Neck Junction: A Cadaveric Investigation

      Purpose: The goal of this study was to evaluate the risk of vascular injury with arthroscopic osteoplasty of the femoral head-neck junction in a cadaveric model. Methods: Eight fresh-frozen cadaveric pelvi were used for arthroscopic osteoplasty of a predetermined 150° arc of resection along the anterior femoral head-neck junction. Postoperatively, injection studies of the deep femoral arteries were performed on all specimens to identify local extravasation of neoprene latex before polymerization as a reproducible indicator of vascular injury. Control specimens included 1 specimen without an osteoplasty and 1 specimen after an “aggressive” open osteoplasty with intention to violate the superior retinacular vessels. Results: The first control specimen showed complete filling of the superior retinacula branches, whereas the second control specimen had evidence of intracapsular latex extravasation. In 7 of 8 experimental specimens, there was near-to-complete filling of the superior and inferior retinacula branches with no signs of latex extravasation. In 1 specimen, no superior retinacular branches were identified; however, no extravasation of the latex material was noted. No injury to the main extracapsular branches of the medial or lateral femoral circumflex vessels was noted. We noted on average 3 superior retinacular vessels penetrating the posterior-superior head-neck junction. Conclusions: There was no evidence of vascular injury to the main blood supply of the femoral head in any of the 8 experimental specimens as noted by latex extravasation. These findings show that arthroscopic osteoplasty can be performed without disrupting the vascular supply to the femoral head. Clinical Relevance: This article has important information on the relation of vascular structures and the resection limit with arthroscopic osteoplasty of the femoral head-neck junction.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ganz R.
        • Buly R.
        • Kim Y.-J.
        • Murphy S.
        • Millis M.
        Instructional course lecture: Joint preserving procedures of the hip. American Academy of Orthopedic Surgeons, Chicago, IL2005
        • Beck M.
        • Leunig M.
        • Parvizi J.
        • Boutier V.
        • Wyss D.
        • Ganz R.
        Anterior femoroacetabular impingement: Part II.
        Clin Orthop Relat Res. 2004; 418: 67-73
        • Eijer H.
        • Myers S.R.
        • Ganz R.
        Anterior femoroacetabular impingement after femoral neck fractures.
        J Orthop Trauma. 2001; 15: 475-481
        • Ganz R.
        • Gill T.J.
        • Gautier E.
        • Ganz K.
        • Krugel N.
        • Berlemann U.
        Surgical dislocation of the adult hip: A technique with full access to the femoral head and acetabulum without the risk of avascular necrosis.
        J Bone Joint Surg Br. 2001; 83: 1119-1124
        • Ganz R.
        • Parvizi J.
        • Beck M.
        • Leunig M.
        • Notzli H.
        • Siebenrock K.A.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop Relat Res. 2003; 417: 112-120
        • Lavigne M.
        • Parvizi J.
        • Beck M.
        • Siebenrock K.A.
        • Ganz R.
        • Leunig M.
        Anterior femoroacetabular impingement: Part I.
        Clin Orthop Relat Res. 2004; 418: 61-66
        • Leunig M.
        • Beck M.
        • Woo A.
        • Dora C.
        • Kerboull M.
        • Ganz R.
        Acetabular rim degeneration: A constant finding in the aged hip.
        Clin Orthop Relat Res. 2003; 413: 201-207
        • Murphy S.
        • Tannast M.
        • Kim Y.-J.
        • Buly R.
        • Millis M.
        Debridement of the adult hip for femoracetabular impingement.
        Clin Orthop Relat Res. 2004; 429: 178-181
        • Gautier E.
        • Ganz K.
        • Krugel N.
        • Gill T.
        • Ganz R.
        Anatomy of the medial femoral circumflex artery and its surgical implications.
        J Bone Joint Surg Br. 2000; 82: 679-683
        • Notzli H.P.
        • Siebenrock K.A.
        • Hempfing A.
        • Ramseier L.E.
        • Ganz R.
        Perfusion of the femoral head during surgical dislocation of the hip.
        J Bone Joint Surg Br. 2002; 84: 300-304
        • Lavigne M.
        • Kalhor M.
        • Beck M.
        • Ganz R.
        • Leunig M.
        Distribution of vascular foramina around the femoral head and neck junction: Relevance for conservative intracapsular procedures of the hip.
        Orthop Clin N Am. 2005; 36: 171-176
        • Bare A.A.
        • Guanche C.A.
        Hip impingement: The role of arthroscopy.
        Orthopedics. 2005; 28: 266-273
        • Guanche C.A.
        • Bare A.A.
        Arthroscopic treatment of femoroacetabular impingement.
        Arthroscopy. 2006; 22: 95-106
        • Dienst M.
        • Godde S.
        • Seil R.
        • Hammer D.
        • Kohn D.
        Hip arthroscopy without traction: In vivo anatomy of the peripheral hip joint cavity.
        Arthroscopy. 2001; 17: 924-931
        • Ranawat A.S.
        • Kelly B.T.
        Anatomy of the hip: Open and arthroscopic structure and function.
        Oper Tech Orthop. 2005; 15: 160-174
        • Mardones R.M.
        • Gonzalez C.
        • Chen Q.
        • Zobitz M.
        • Kaufman K.R.
        • Trousdale R.T.
        Surgical treatment of femoroacetabular impingement: Evaluation of the effect of the size of the resection.
        J Bone Joint Surg Am. 2005; 87: 273-279
        • Beck M.
        • Kalhor M.
        • Ganz R.
        Hip morphology influences the pattern of damage to the acetabular cartilage.
        J Bone Joint Surg Br. 2005; 87: 1012-1018
        • Tanzer M.
        • Noiseux N.
        Osseous abnormalities and early osteoarthritis: The role of hip impingement.
        Clin Orthop Relat Res. 2004; 429: 170-177
        • Beck M.
        • Siebenrock K.A.
        • Affolter B.
        • Notzli H.
        • Parvizi J.
        • Ganz R.
        Increased intraarticular pressure reduces blood flow to the femoral head.
        Clin Orthop Relat Res. 2004; 424: 149-152
        • Sussmann P.S.
        • Ranawat A.S.
        • Lipman J.
        • Lorich D.G.
        • Padgett D.E.
        • Kelly B.T.
        Arthroscopic versus open osteoplasty of the head neck junction: A cadaveric investigation. 2006 (Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Chicago, IL, March)
        • Sevitt S.
        • Thompson R.G.
        The distribution and anastomoses of arteries supplying the head and neck of the femur.
        J Bone Joint Surg Br. 1965; 47: 560-573
        • Clarke M.T.
        • Arora A.
        • Villar R.N.
        Hip arthroscopy: Complications in 1054 cases.
        Clin Orthop Relat Res. 2003; 406: 84-88
        • Sampson T.G.
        Complications of hip arthroscopy.
        Clin Sports Med. 2001; 20: 831-835