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
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References
- Instructional course lecture: Joint preserving procedures of the hip. American Academy of Orthopedic Surgeons, Chicago, IL2005
- Anterior femoroacetabular impingement: Part II.Clin Orthop Relat Res. 2004; 418: 67-73
- Anterior femoroacetabular impingement after femoral neck fractures.J Orthop Trauma. 2001; 15: 475-481
- 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
- Femoroacetabular impingement: A cause for osteoarthritis of the hip.Clin Orthop Relat Res. 2003; 417: 112-120
- Anterior femoroacetabular impingement: Part I.Clin Orthop Relat Res. 2004; 418: 61-66
- Acetabular rim degeneration: A constant finding in the aged hip.Clin Orthop Relat Res. 2003; 413: 201-207
- Debridement of the adult hip for femoracetabular impingement.Clin Orthop Relat Res. 2004; 429: 178-181
- Anatomy of the medial femoral circumflex artery and its surgical implications.J Bone Joint Surg Br. 2000; 82: 679-683
- Perfusion of the femoral head during surgical dislocation of the hip.J Bone Joint Surg Br. 2002; 84: 300-304
- 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
- Hip impingement: The role of arthroscopy.Orthopedics. 2005; 28: 266-273
- Arthroscopic treatment of femoroacetabular impingement.Arthroscopy. 2006; 22: 95-106
- Hip arthroscopy without traction: In vivo anatomy of the peripheral hip joint cavity.Arthroscopy. 2001; 17: 924-931
- Anatomy of the hip: Open and arthroscopic structure and function.Oper Tech Orthop. 2005; 15: 160-174
- Surgical treatment of femoroacetabular impingement: Evaluation of the effect of the size of the resection.J Bone Joint Surg Am. 2005; 87: 273-279
- Hip morphology influences the pattern of damage to the acetabular cartilage.J Bone Joint Surg Br. 2005; 87: 1012-1018
- Osseous abnormalities and early osteoarthritis: The role of hip impingement.Clin Orthop Relat Res. 2004; 429: 170-177
- Increased intraarticular pressure reduces blood flow to the femoral head.Clin Orthop Relat Res. 2004; 424: 149-152
- 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)
- The distribution and anastomoses of arteries supplying the head and neck of the femur.J Bone Joint Surg Br. 1965; 47: 560-573
- Hip arthroscopy: Complications in 1054 cases.Clin Orthop Relat Res. 2003; 406: 84-88
- Complications of hip arthroscopy.Clin Sports Med. 2001; 20: 831-835
Article info
Footnotes
Supported by an Unrestricted Education Grant from Synthes, Paoli, Pennsylvania, and a Grant from Smith & Nephew, Boston, Massachusetts. The authors report no conflict of interest.
Identification
Copyright
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
