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Where is the origin of the muscle located between the anterior acetabulum and iliac vessels?
Anterior superior iliac spine
Anterior inferior iliac spine
Lumbar transverse processes
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The psoas muscle serves to protect the iliac vessels from retractors/instruments anterior to the acetabulum, and this muscle originates off the transverse processes of L1-L5. The referenced article by Skaggs et el found that the iliac vessels were on average 1 cm away from the iliopsoas at the level of the pelvic brim, but could be as close as 4mm in children. They also found that the neurovascular structures were on average 3.1 cm away from the iliopsoas at the level of its insertion at the lesser trochanter.
Skaggs DL, Kaminsky CK, Eskander-Rickards E, Reynolds RA, Tolo VT, Bassett GS.
Clin Orthop Relat Res. 1997 Jun;(339):174-9. PMID: 9186216 (Link to Abstract)
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The medial femoral circumflex artery and first perforating branch of the profunda femoris artery anastamose at which of the following locations?
Medial to the gluteus medius insertion
Medial to the gluteus maximus insertion
Anterior to the adductor magnus
Within the gluteus minimus muscle belly
Medial to the ischial tuberosity
The medial femoral circumflex artery is the primary blood supplier to the adult femoral head. This artery anastamoses with the first perforating branch of the profunda femoris just medial to the gluteus maximus insertion. This is important, as sectioning the gluteus maximus tendon during posterior approaches can put both of these vessels (and the anastamosis) at risk.
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A 57-year-old female with degenerative hip arthritis has questions regarding mini-incision total hip arthroplasty (THA) with comparison to traditional THA. Which of the following statements is true regarding the mini-incision technique?
Reduced rate of hip dislocation
Increased hip range motion at 1 year
No significant difference in hip function at 1 year
Less chance of surgical complications
Less chance of limping at 1 year
Mini-incision THA has not been shown to have any clinical benefit in terms of hip function at long term followup. Proponents of this technique claim less soft tissue damage may allow for faster recovery. Digioia et al, looked at mini-incision THA vs standard THA using navigation. Although limp, distance walked, and stair function was better at 6 months with mini-incision THA, there were no significant differences in pain, function, or motion at 1 year.
DiGioia AM, Plakseychuk AY, Levison TJ, Jaramaz B
J Arthroplasty. 2003 Feb;18(2):123-8. PMID: 12629599 (Link to Abstract)
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Posterior approach for total hip arthroplasty