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Identifying a Reliable Intra-articular Landmark to Avoid Vascular Injury During Transacetabular Screw Fixation: A 3D
Hansel E Ihn1, Brian C Chung, Luke Lovro
1From the Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, CA (Ihn, Chung, Lovro, Patterson, Christ, and Heckmann), the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN (Chen), the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA (Tucker), and the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles, CA (White, and Hwang).
Acetabular screw fixation in hip replacement carries risks of vascular injury. This study maps external iliac artery proximity to aid surgeons in safe screw placement, especially for elderly female patients.
Area of Science:
- Orthopedic Surgery
- Vascular Anatomy
- Radiology
Background:
- Vascular injury during acetabular screw fixation is a critical complication in total hip arthroplasty.
- Accurate anatomical knowledge is crucial for preventing life-threatening hemorrhage.
Purpose of the Study:
- To measure the distance from the external iliac artery (EIA) to the acetabulum.
- To assess available bone stock along the EIA.
- To develop a risk map for acetabular vascular injury.
Main Methods:
- Retrospective analysis of 3D CT scans from 50 patients (100 hips).
- Simulation of 6.5-mm screw placement towards the EIA.
- Measurement of absolute distance (AD) and bone depth (BD) to the EIA.
Main Results:
- Mean AD increased from 25.1 mm at the initial screw position to 71.5 mm.
- Mean BD increased from 4.6 mm to 20.1 mm along the screw path.
- Male patients had greater AD and BD; older age and higher weight correlated with reduced AD.
Conclusions:
- The cotyloid fossa tip is a reliable intra-articular landmark.
- Surgeons must be cautious of vascular injury during screw fixation.
- Elderly, female patients represent a higher-risk group for vascular complications.
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