The appropriate position of retractors to minimize the risk of femoral nerve palsy remains uncertain. The purpose of this imaging study was to evaluate the distance between the femoral nerve (FN) and anterior acetabulum (AA) in hip osteoarthritis (OA).
Forty-one patients with unilateral hip OA underwent magnetic resonance imaging. Three measurement levels were defined and the minimum distance between the femoral nerve (FN) margin and anterior acetabulum (AA) rim was measured on axial T1-weighted images on the OA and normal sides at each level, with reference to an advanced neurography view. The cross-sectional area (CSA) of the iliopsoas muscle was also measured at each level bilaterally by three observers. Distances and CSAs were compared between the OA and normal side. Multiple regression analysis was performed to identify variables associated with the distance in OA.
The mean minimum FN to AA distances in OA were 19.4 mm at the top of the anterior inferior iliac spine (AIIS), 24.3 mm at the bottom of the AIIS, and 21.0 mm at the tip of the greater trochanter. These distances were significantly shorter than in normal hips at the top and bottom of the AIIS, with mean differences of 1.6 and 5.8 mm, respectively (p = 0.012, p < 0.001). CSAs of the iliopsoas in OA were significantly smaller at all levels (all p < 0.001), with reductions of 10.5 to 17.9%. The CSA of the iliopsoas at the bottom of the AIIS was associated with the FN to AA distance at the same level (p = 0.026). Interobserver reliabilities for measurements were very good to perfect (intraclass correlation coefficients 0.897 to 0.966).
To minimize the risk of femoral nerve palsy, surgeons should consider the change of the femoral nerve to anterior acetabulum distance in osteoarthritic hip surgery.