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Background  Iatrogenic injury to the femoral neurovascular bundle is not uncommon during primary and revision total hip replacement (THR) and can result in permanent weakness, pain and poor function. Prevention of injury to these structures relies on a sound knowledge of their relationships to the hip joint.    Methods  We studied 115 consecutive hip magnetic resonance imaging (MRI) results in order to identify objective relationships between these structures and the hip joint that can be used intraoperatively.    Results  We determined that the shortest mean distances of the femoral nerve, artery and vein from the hip joint are 23.62 (standard deviation, SD = 5.44), 19.62 (SD = 4.17) and 17.47 (SD = 4.41) mm, respectively. The femoral nerve was lateral to the hip joint in 30 (55.5%) left- and 37 (60.7%) right-sided hip joints. The femoral artery was located medial to the hip joint in 28 (51.9%) left- and 34 (55.7%) right-sided hips. The femoral vein was medial to the hip joint in 52 (96.3%) left- and 58 (95.1%) right-sided hips.    Conclusion  We have identified objective relationships between the hip joint and femoral neurovascular bundle that can be used with ease intraoperatively during THR. Our data show that patients with a low body weight and the elderly may be at a higher risk of iatrogenic injury due to increased proximity of the neurovascular structures to the hip. Application of this knowledge may serve to reduce the risk of iatrogenic injury to these structures and thereby improve patient satisfaction and outcomes.

The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury