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Possible Vascular Injury Due to Screw Eccentricity in Minimally Invasive Total Hip Arthroplasty

  • Symposium - Total Hip Arthroplasty
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background:

Vascular injury during minimally invasive total hip arthroplasty (THA) is uncommon, yet a well-recognized and serious issue. It emerges because of non-visibility of vascular structures proximal to the pelvic bone during reaming, drilling holes, and fixing of screws. Numerous studies have found that screw fixation during cementless THA is beneficial for the initial stability of cup; yet, no anatomical guidelines support angular eccentric screw fixation.

Materials and Methods:

In this study, we obtained the pelvic arterial-phase computed tomographic data of thirty eight humans and reconstructed the three-dimensional models of osseous and vessel structures. We performed the surgical simulation to fix these structures with cementless cups and screws with angular eccentricities.

Results:

The effect of screw eccentricities (angular eccentricities of ±17° and ±34°) on the vascular injury was determined. Measurement between screw and adjoining vessels was performed and analyzed statistically to ascertain a comparative risk study for blood vessels that are not visible during surgery.

Conclusion:

Authors similarly discussed the significant absence of appreciation of quadrant systems proposed by Wasielewski et al. on eccentric screws. Adjustment of quadrant systems provided by Wasielewski et al. is required for acetabular implants with eccentric holes for fixation of acetabular screws.

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Authors and Affiliations

  1. Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

    Amit Rastogi

  2. School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, Uttar Pradesh, India

    Nishant Kumar Singh & Sanjay Kumar Rai

Authors
  1. Nishant Kumar Singh
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  2. Sanjay Kumar Rai
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  3. Amit Rastogi
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Correspondence to Sanjay Kumar Rai.

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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Singh, N.K., Rai, S.K. & Rastogi, A. Possible Vascular Injury Due to Screw Eccentricity in Minimally Invasive Total Hip Arthroplasty. IJOO 51, 447–454 (2017). https://doi.org/10.4103/ortho.IJOrtho_224_16

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  • DOI: https://doi.org/10.4103/ortho.IJOrtho_224_16

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