Neurovascular structure proximity to acetabular retractors in total hip arthroplasty

Neurovascular injury during total hip arthroplasty (THA) may result in considerable morbidity or mortality. The most common cause of intraoperative neurovascular injury during THA is retractor compression. Our aims were to: 1) determine proximity of common acetabular retractor positions during THA to adjacent neurovascular structures; and 2) determine effect of patient gender on these measurements. Retractor to neurovascular structure distances were measured on 32 preoperative computed tomography images and 16 cadavers. Our data suggest the anterior inferior iliac spine is the safest anterior acetabular retractor position. With inferior progression along the anterior wall, the distance to the femoral neurovascular bundle decreases. Due to its proximity to the sciatic nerve, the position of the posterior retractor should be monitored during acetabular preparation, particularly in women.