Intra-operative femoral head vascularity assessment: An innovative and simple technique.

Abstract

Documentation of femoral head blood flow before, during and after head preserving surgery is important for safeguarding vascularity to the femoral head and for documentation in patients in whom the blood flow is compromised. Laser Doppler flowmetry and microsensor intracranial pressure (ICP) transducers have been used to satisfactorily depict such changes. However, these devices are expensive and not universally available in orthopedic operating rooms. We describe a new technique for the assessment of intra-operative blood flow to the femoral head. This is a technical description of a simple system utilized in eight patients to assess the femoral head vascularity using equipment available with the anesthetist. A standard epidural catheter attached to an arterial pressure transducer is introduced into the femoral head from the margin of the articular surface via a small hole drilled with a K wire. The pressure wave within the epiphysis is detected on the anesthesia monitor. Pressure within the femoral head is used as a surrogate for blood flow. The pressure and the wave form are correlated with the electrocardiogram (ECG) wave on the anesthetic machine. The technique was used in eight children with hip pathology requiring hip dislocation for documenting the hip vascularity status. There was good correlation between the pressure wave and the ECG for a patient with presumed normal femoral head vascularity, whereas the pressure measurements were greatly reduced and the wave form was absent in a femoral head wih radiographic or bone scan evidence of avascular necrosis. This new technique is a cheap and readily accessible alternative to Laser Doppler flowmetery and ICPs monitoring probes for the assessment of blood flow to the femoral head.