Possible Vascular Injury Due to Screw Eccentricity in Minimally Invasive Total Hip Arthroplasty

Singh, Nishant; Kumar, Sanjay; Rastogi, Amit

doi:10.4103/ortho.ijortho_224_16

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…The interindividual variation is low — regardless of gender — so that the values determined can be used to position screws safely in the ischium and pubis. This not only increases the desired stability of the acetabular construct, but may also help to reduce the risk of vascular and nerve injury [ 9 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Defining the canal for ischial and pubic screws in cup revision surgery

Brodt

Boersch

Strube

et al. 2022

International Orthopaedics (SICOT)

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Purpose When revising acetabular cups, it is often necessary to provide additional stabilisation with screws. In extensive defect situations, the placement of screws caudally in the ischium and/or pubis is biomechanically advantageous. Especially after multiple revision operations, the surgeon is confronted with a reduced bone stock and unclear or altered anatomy. In addition, screw placement caudally is associated with greater risk. Therefore, the present study aims to identify and define safe zones for the placement of caudal acetabular screws. Methods Forty-three complete CT datasets were used for the evaluation. Sixty-three distinctive 3D points representing bone landmark of interests were defined. The coordinates of these points were then used to calculate all the parameters. For simplified visualisation and intra-operative reproducibility, an analogue clock was used, with 12 o’clock indicating cranial and 6 o’clock caudal. Results A consistent accumulation was found at around 4.5 ± 0.3 hours for the ischium and 7.9 ± 0.3 hours for the pubic bone. Conclusions The anatomy of the ischium and pubis is sufficiently constant to allow the positioning of screws in a standardised way. The interindividual variation is low — regardless of gender — so that the values determined can be used to position screws safely in the ischium and pubis. The values determined can provide the surgeon with additional orientation intra-operatively when placing caudal acetabular screws.

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Section: Discussionmentioning

confidence: 99%

Defining the canal for ischial and pubic screws in cup revision surgery

Brodt

Boersch

Strube

et al. 2022

International Orthopaedics (SICOT)

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“…The use of screws can lead to an extension and a prolongation of the operation. Additionally it still entails certain risks such as imprecise or unsuccessful screw placement with penetration of the bone and consecutively injury of nerves or vessels [22,23]. However, attention must be paid to a precise placement of the screws here, as they may not only endanger the patient but may even reduce stability if they are not correctly placed.…”

Section: Discussionmentioning

confidence: 99%

The use of acetabular screws in total hip arthroplasty and its influence on wear and periacetabular osteolysis in the long-term follow-up

Brodt

Bischoff

Schulze

et al. 2021

International Orthopaedics (SICOT)

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Purpose The cementless implantation of hip replacement cups may be performed with and without the additional use of acetabular screws. If the surgeon uses screws or not depends on variable factors. In general, the use of screws is intended to increase the primary stability of the cup. Whether screws increase the initial stability of the cup construct, or even reduce it in part, is the subject of considerable debate in the literature. It is also unclear whether the additional screws lead to increased wear or increased periacetabular osteolysis over the long-term course. Methods Two hundred eleven patients from a previous study with a minimum follow-up of 10.7 years were included. Of these, 68 patients with 82 total hip arthroplasties (THA) were given clinical and radiological follow-up examinations. Of these, 52 had been fitted without screws and 30 with screws. On the basis of radiographs, annual wear and osteolysis were quantified. The clinical results were recorded by means of VAS, HHS, and WOMAC scores. Results Significantly more periacetabular osteolysis was found if additive acetabular screws had been used. No difference was found in relation to the volumetric wear per year. Likewise, no difference was found with regard to the clinical scores. Conclusions The use of additive acetabular screws leads to increased osteolysis in the periacetabular bone stock. Insofar as the primary stability of the cementless cup construct allows it, no additional acetabular screws should be used.

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“…Contiguous arteries to the acetabulum that are susceptible to be injured during total hip replacement are mostly branches of common iliac vessels; external iliac vessels, obturator vessels, superior and inferior gluteal artery, and internal pudendal arteries and veins as shown in Figure 1 [6][7][8][9][10][11][12]. Indeed, many vascular structures surrounding the acetabulum may be injured by direct and indirect trauma have been reported [12,13].…”

Section: Introductionmentioning

confidence: 99%

Vascular Injury in Total Hip Replacement: Management and Prevention

Singh¹,

Rai²,

Rastogi³

2018

Total Hip Replacement - An Overview

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This chapter analyzed the vascular complications in total hip replacement. Vascular injuries are the uncommon but well recognized and serious issue. During total hip replacement, laceration of major blood vessels has been reported which even cause morbidity and mortality. The injury to vascular structures occurs due to the placement of screws to fix acetabular components, structural grafts, and protrusio cages or rings. Massive hemorrhage resulting in immediate exsanguination may be caused due to the damage of any of these vessels by processes such as drilling, reaming, retraction, or dissection. The majority of these vascular injuries might be better prevented or even more proficiently treated by comprehensive preoperative assessment, better instrumentation, and careful postoperative monitoring.

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Possible Vascular Injury Due to Screw Eccentricity in Minimally Invasive Total Hip Arthroplasty

Cited by 5 publications

References 25 publications

Defining the canal for ischial and pubic screws in cup revision surgery

Defining the canal for ischial and pubic screws in cup revision surgery

The use of acetabular screws in total hip arthroplasty and its influence on wear and periacetabular osteolysis in the long-term follow-up

Vascular Injury in Total Hip Replacement: Management and Prevention

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