|Beitragstitel||Does the anterior approach to the hip jeopardize vascularisation of the proximal femur?|
Introduction: Branches of the lateral femoral circumflex artery (LCFA) provide the main blood supply of the proximal metaphysis of the femur. This study aims at determining if a surgical approach to the hip influences the blood supply of the trochanter major, as can be determined in digital subtraction femoral arteriography. This is particularly relevant as the anterior approach becomes more popular for hip arthroplasty, and as it requires ligation of the ascending branch of the LCFA.
Methods: We reviewed 1280 femoral digital subtraction arteriograms performed for vascular indications between 30.06.2014 and 30.06.2016. Exclusion criteria were relevant vascular disease of the femoral vessels and previous vascular interventions or surgery. Arteriograms with insufficient field of view or without filling of the LFCA were excluded too. The recruited cases were split into 4 groups: Status after hip surgery through an anterior approach (n=10), respectively a lateral approach (n=31), status after fracture fixation of the proximal femur (n=5), and a control group of 50 continuous patients without previous surgery. Time until perfusion of the greater trochanter was noted as a number of frames after injection of the contrast media into the deep femoral artery (DFA). The frame rate was standardised.
Results: The number of frames until the trochanter major is supplied with contrast was 3.6+/-0.9 (mean+/-SD) in patients without hip surgery, after fracture fixation 4.8+/-1.5, after a lateral approach 5.2+/-1.1, while it was 7.0+/-1.9 in patients who had underwent an anterior approach. While there was a statistically significant delay in all operated patients (p<0.0001) compared to the control group, there mainly was a significant increase in the number of frames until perfusion of the greater trochanter in the group of the anterior approach (p=0.0004) compared to all other operated cases.
Conclusion: After an anterior approach to the hip, perfusion of the proximal femur is delayed, compared to control cases and hip surgery through another approach. The clinical relevance of this finding still needs to be determined. However, early femoral complications after hip arthroplasty might require a transfemoral approach, particularly fractures. This might critically jeopardize blood supply to the proximal femur, as the trochanteric branch coming from the medial femoral circumflex artery is the interrupted too.