{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:40:51Z","timestamp":1787755251340,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2020,1,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Femoral nerve palsy is a serious neurological complication following total hip arthroplasty (THA) via a direct anterior approach. One hypothesis is that the nerve injury is caused by malpositioning of retractors over the anterior wall of the acetabulum. The purpose of this cadaveric study was to clarify the anatomical features of the femoral nerve around the anterior acetabular rim and the potential risk of nerve injury during a direct anterior approach to THA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We dissected 84 cadaveric hips from 44 formalin-embalmed cadavers. When the cadavers were supine, the iliopsoas muscle and the femoral nerve were exposed and the anterior joint capsule and labrum were resected. The measurement points were determined along the acetabular rim every 30\u00b0, and a reference line was drawn from the anterior superior iliac spine to the center of the acetabulum, with the intersection of the rim at 0\u00b0. The minimum distance to the femoral nerve margin was measured from 0\u00b0 to 150\u00b0 (6 points). Other anatomical structures were measured to determine their association with the distance of the shortest measurement points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The mean minimum distances to the femoral nerve were 33.2 mm at 0\u00b0, 24.4 mm at 30\u00b0, 18.4 mm at 60\u00b0, 16.6 mm at 90\u00b0, 17.9 mm at 120\u00b0, and 23.2 mm at 150\u00b0, showing that the distance at 90\u00b0 was the shortest (p &lt; 0.001). The thickness of the iliopsoas muscle and the femoral length were positively associated with the distance to the femoral nerve at 90\u00b0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this cadaveric study, the femoral nerve was within 16.6 to 33.2 mm of the acetabular rim at points from 0\u00b0 to 150\u00b0 of a line drawn from the anterior superior iliac spine. The nerve was closest to the rim at 90\u00b0, indicating that this is an area of high risk during retractor placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Retractor placement at 90\u00b0 to the anterior acetabular rim should be avoided to reduce the risk of femoral nerve injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.19.00667","type":"journal-article","created":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T05:23:50Z","timestamp":1573536230000},"page":"137-142","source":"Crossref","is-referenced-by-count":28,"title":["Anatomical Implications Regarding Femoral Nerve Palsy During a Direct Anterior Approach to Total Hip Arthroplasty"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3543-5074","authenticated-orcid":false,"given":"Kensuke","family":"Yoshino","sequence":"first","affiliation":[{"name":"Departments of Orthopaedic Surgery (K.Y., J.N., S.H., and S.O.) and Bioenvironmental Medicine (T.S.), Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4005-8832","authenticated-orcid":false,"given":"Junichi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery (K.Y., J.N., S.H., and S.O.) and Bioenvironmental Medicine (T.S.), Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2734-8408","authenticated-orcid":false,"given":"Shigeo","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery (K.Y., J.N., S.H., and S.O.) and Bioenvironmental Medicine (T.S.), Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0365-2544","authenticated-orcid":false,"given":"Takane","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery (K.Y., J.N., S.H., and S.O.) and Bioenvironmental Medicine (T.S.), Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7474-7647","authenticated-orcid":false,"given":"Yohei","family":"Kawasaki","sequence":"additional","affiliation":[{"name":"Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5738-6184","authenticated-orcid":false,"given":"Seiji","family":"Ohtori","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery (K.Y., J.N., S.H., and S.O.) and Bioenvironmental Medicine (T.S.), Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,11,12]]},"reference":[{"issue":"12","key":"bib1-20230912","doi-asserted-by":"crossref","first-page":"2619","DOI":"10.2106\/00004623-200512000-00004","article-title":"Motor nerve palsy following primary total hip arthroplasty","volume":"87","author":"Farrell","year":"2005","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib2-20230912","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1016\/j.arth.2017.10.050","article-title":"Femoral nerve palsy following total hip arthroplasty: incidence and course of recovery","volume":"33","author":"Fleischman","year":"2018","journal-title":"J Arthroplasty."},{"issue":"Suppl","key":"bib3-20230912","first-page":"S57","article-title":"Femoral neuropathy following total hip arthroplasty. Anatomic study, case reports, and literature review","volume":"6","author":"Simmons","year":"1991","journal-title":"J Arthroplasty."},{"issue":"1","key":"bib4-20230912","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s12891-017-1427-2","article-title":"Direct anterior approach for total hip arthroplasty with a novel mobile traction table -a prospective cohort study","volume":"18","author":"Nakamura","year":"2017","journal-title":"BMC Musculoskelet Disord."},{"issue":"6","key":"bib5-20230912","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1302\/0301-620X.78B6.0780899","article-title":"Nerve injury after posterior and direct lateral approaches for hip replacement. A clinical and electrophysiological study","volume":"78","author":"Weale","year":"1996","journal-title":"J Bone Joint Surg Br."},{"key":"bib6-20230912","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/00003086-198310000-00034","article-title":"Nerve injury in total hip arthroplasty","volume":"179","author":"Johanson","year":"1983","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib7-20230912","first-page":"191","article-title":"Neurologic injuries after total hip arthroplasty","volume":"37","author":"Brown","year":"2008","journal-title":"Am J Orthop (Belle Mead NJ)."},{"issue":"7","key":"bib8-20230912","doi-asserted-by":"crossref","first-page":"572","DOI":"10.2106\/JBJS.17.00679","article-title":"Motor-evoked potential analysis of femoral nerve status during the direct anterior approach for total hip arthroplasty","volume":"100","author":"Ishimatsu","year":"2018","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib9-20230912","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1302\/2046-3758.36.2000255","article-title":"The role of retraction in direct nerve injury in total hip replacement: an anatomical study","volume":"3","author":"McConaghie","year":"2014","journal-title":"Bone Joint Res."},{"issue":"4","key":"bib10-20230912","first-page":"231","article-title":"Pressure monitoring of the femoral nerve during total hip replacement: an explanation for iatropathic palsy","volume":"45","author":"Slater","year":"2000","journal-title":"J R Coll Surg Edinb."},{"issue":"4","key":"bib11-20230912","doi-asserted-by":"crossref","first-page":"501","DOI":"10.2106\/00004623-199072040-00005","article-title":"Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty","volume":"72","author":"Wasielewski","year":"1990","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib12-20230912","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-E","article-title":"Sample size and optimal designs for reliability studies","volume":"17","author":"Walter","year":"1998","journal-title":"Stat Med."},{"issue":"5","key":"bib13-20230912","doi-asserted-by":"crossref","first-page":"488","DOI":"10.3109\/s10165-011-0430-y","article-title":"Inter-observer and intra-observer reliabilities of the Japanese Ministry of Health, Labor and Welfare type classification system for osteonecrosis of the femoral head","volume":"21","author":"Nakamura","year":"2011","journal-title":"Mod Rheumatol."},{"issue":"3","key":"bib14-20230912","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.3390\/ijerph7031047","article-title":"Leg length, body proportion, and health: a review with a note on beauty","volume":"7","author":"Bogin","year":"2010","journal-title":"Int J Environ Res Public Health."},{"issue":"1","key":"bib15-20230912","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.arth.2014.08.024","article-title":"Neurovascular structure proximity to acetabular retractors in total hip arthroplasty","volume":"30","author":"Shubert","year":"2015","journal-title":"J Arthroplasty."},{"issue":"3","key":"bib16-20230912","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.arth.2009.02.014","article-title":"Proximity of the femoral neurovascular bundle during hip resurfacing","volume":"25","author":"Davis","year":"2010","journal-title":"J Arthroplasty."},{"key":"bib17-20230912","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13018-016-0365-2","article-title":"Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery","volume":"11","author":"Wang","year":"2016","journal-title":"J Orthop Surg Res."},{"issue":"1","key":"bib18-20230912","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s13018-018-0847-5","article-title":"The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury","volume":"13","author":"Mehta","year":"2018","journal-title":"J Orthop Surg Res."},{"issue":"3","key":"bib19-20230912","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s004020050216","article-title":"Femoral nerve lesion in total hip replacement: an experimental study","volume":"117","author":"Heller","year":"1998","journal-title":"Arch Orthop Trauma Surg."},{"issue":"4","key":"bib20-20230912","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1080\/14397595.2018.1484545","article-title":"Diffusion tensor imaging of the sciatic and femoral nerves in unilateral osteoarthritis of the hip and osteonecrosis of femoral head: comparison of the affected and normal sides","volume":"29","author":"Wako","year":"2019","journal-title":"Mod Rheumatol."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.00667","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:40:09Z","timestamp":1787751609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.00667"}},"subtitle":["A Cadaveric Study"],"short-title":[],"issued":{"date-parts":[[2019,11,12]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.19.00667","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,12]]}}}