An anatomical study of avascular necrosis of the femoral head after hip-salvage operation

Objective To provide an anatomical evidence for the prevention of avascular necrosis of the femoral head( AVN-FH) after hip-salvage operation through an anatomical study of vascular tissues around the femoral head. Methods Two fresh adult carcasses( 4 hips) were dissected to confirm the trend of vessels around the femoral head, especially the deep branch of medial femoral circumflex artery. The femoral head was scanned by CT and X-ray after contrast agents were injected into the deep branch of medial femoral circumflex artery to observe its blood supply. Results The blood supply of the femoral head depends on branches of the medial and lateral femoral circumflex arteries and obturator artery, and mostly depends on the deep branch of medial femoral circumflex artery. The lateral ascending cervical artery extending from the deep branch of medial femoral circumflex artery also plays an important role. The X-ray images and CT scans of the femoral head with contrast agents in the integrated and injured deep branches of medial femoral circumflex artery showed the blood supply distribution in the deep branch of medial femoral circumflex artery. About 2 / 3 or 3 / 4 blood of the femoral head was supplied by the lateral ascending cervical artery, especially that of the weight-bearing area, which occupied a very important role in the blood supply of the femoral head. About 1 / 4 or 1 / 3 blood of the femoral head was supplied by the medial ascending cervical artery, which played a less important role in the blood supply of the femoral head. A small proportion of blood of the femoral head was supplied by the anterior ascending cervical artery and the posterior ascending cervical artery. The femoral head ligament artery also supplied a small proportion of blood of the femoral head. They were not the main blood vessels. Conclusions Through the anatomical study of vascular tissues around the femoral head, the adjacent relationship of main blood supply arteries of the femoral head is confirmed. The damage to the deep branch of medial femoral circumflex artery should be avoided in order to prevent AVN-FH, which is of important significance in directing hip-salvage operation.