Vascular safe zones in hip arthroscopy

Area of Science:

• Orthopedic Surgery
• Vascular Anatomy
• Hip Arthroscopy

Background:

• Hip arthroscopy is increasingly performed due to surgical advancements and patient demand.
• Identifying vascular safe zones is vital to protect the femoral head blood supply during procedures like osteoplasty and psoas tendon release.

Purpose of the Study:

• To identify and define vascular safe zones for hip arthroscopy procedures.
• To provide intraoperative guidance for surgeons to minimize risks to the femoral head's blood supply.

Main Methods:

• Analysis of 76 contrast-enhanced MRI scans of patients with femoroacetabular impingement.
• 3D image reconstruction to visualize the medial femoral circumflex artery (MFCA) and retinacular vessels.
• Detailed tracing of the MFCA course and its relation to the femoral neck and psoas tendon.

Main Results:

• The MFCA typically inserts on the posterior superior femoral neck (10:30-12 o'clock position).
• Ninety-seven percent of vessels were posterior to the 12 o'clock position.
• The MFCA was consistently located in the middle third zone, a mean of 15 mm medial to the femoral neck cortex.

Conclusions:

• Defined two primary vascular safe zones for hip arthroscopy.
• Femoral neck osteoplasty safe zone: anterior half of the femoral neck.
• Psoas tendon release safe zone: middle third of the medial hip capsule.