Vascular Supply To The Femoral Head

Intraarticular isolation of the femoral head and neck makes it highly dependent on its tenuous vascular supply. Its susceptibility to circulatory compromise is an ongoing source of concern to physicians who treat hip pathology. Ischemic insult followed by avascular necrosis (AVN) of the femoral head, similar to other forms of osteonecrosis, has been clearly linked to certain disease states and types of exposure although it is less clearly associated with others and often purely idiopathic.10 AVN has been associated with previous trauma including fracture and dislocation and may occur iatrogenically in association with surgical procedures that violate the vascular pattern.

Ligamentum teres

Zona orbicularis

Ligamentum teres

Zona orbicularis

Ligamentum Teres Hip
FIGURE 6.12. The ligamentum teres is redundant and weak and contributes little to the capsular stability of the hip. Encased in synovium, it is intracapsular, yet extrasynovial.
Femoral Head Arterial
FIGURE 6.13. The femoral head receives arterial blood flow from an anastomosis of three sets of arteries: (1) the retinacular vessels, primarily from the medial circumflex femoral artery and, to a lesser extent, the lateral circumflex femoral artery; (2) terminal

branches of the medullary artery from the shaft of the femur; and (3) the artery of the ligamentum teres from the posterior division of the obturator artery.

The poorly defined and uncertain nature of AVN is reflected in the myriad surgical procedures that have been described in its management, none of which has proven to be superior, and few of which have even been shown to be truly effective in altering the natural course of the process.11

Arterial blood supply to the femoral head is achieved through an anastomosis of three sets of arteries (Figure 6.13). The principal vessels ascend in the synovial retinaculum, which is a reflection of the lig-amentous capsule onto the neck of the femur. These vessels arise mainly posterior superiorly and posterior inferiorly from the medial circumflex femoral artery, which is supplemented to a lesser extent from the lateral circumflex femoral artery. These vessels anastomose with the terminal branches of the medullary artery from the shaft of the femur. The third source is the anastomosis within the femoral head from the artery of the ligamentum teres, which arises from a posterior division of the obturator artery. This vessel may persist with advanced age, but in approximately 20% of the population it never develops.

References

1. Anderson JE: Grant's Atlas of Anatomy, 7th ed. Baltimore: Williams & Wilkins, 1978.

2. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics. The Anatomic Approach. Philadelphia: Lippincott, 1984.

3. Byrd JWT: Hip arthroscopy utilizing the supine position. Arthroscopy 1994;10:275-280.

4. Byrd JWT, Pappas JN, Pedley MJ: Hip arthroscopy: an anatomic study of portal placement and relationship to the extra-articular structures. Arthroscopy 1995;11:418-423.

5. Glick JM: Hip arthroscopy using the lateral approach. Instr Course Lect 1988;37:223-231.

6. Johnson L: Hip joint. In: Johnson L (ed). Diagnostic and Surgical Arthroscopy, 3rd ed. St. Louis: Mosby, 1986:1491-1519.

7. Ide T, Akamatsu N, Nakajima I: Arthroscopic surgery of the hip joint. Arthroscopy 1991;7:204-211.

8. Henry AK: Extensile Exposure, 2nd ed. New York: Churchill Livingstone, 1973.

9. Gross RH: Arthroscopy in hip disorders in children. Orthop Rev 1977;6:43-49.

10. Jones JP: Concepts of etiology and early pathogenesis of os-teonecrosis. Instr Course Lect 1994;43:499-512.

11. Steinberg ME: Early diagnosis, evaluation and staging of os-teonecrosis. Instr Course Lect 1994;43:513-518.

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Responses

  • antje
    Is the femoral head highly vascular?
    4 years ago
  • RACHELE
    What forms the retinacular artery for the head of femur?
    2 years ago
  • gigliola
    What are medullary arteries of femur neck?
    2 years ago
  • alaric
    What are the nurovascular supplay for feumer?
    2 years ago
  • Simone
    What is the main blood supply to the head of femur is from?
    1 year ago
  • anne
    What is the blood supply of the femoral head?
    1 year ago
  • patricia
    How to make blood supply in femoral neck ?
    1 year ago
  • mike
    What is the aterial supply to the head of femur?
    10 months ago
  • FRE-WEINI
    What is the main blood supply to femoral head?
    8 months ago
  • adelmio
    What blood supply innervates head of femur?
    7 months ago
  • olli
    Which artery supplies the femoral head?
    7 months ago
  • Casey Ferguson
    What artery supplies the head of the femur?
    7 months ago
  • Valentino
    What is vascular supply?
    7 months ago
  • Donna Yuhas
    What supplies blood flow to head of femur?
    6 months ago
  • claudia
    What are 2 main arterial sources of the vascular supply of the breast?
    4 months ago
  • matthew rogers
    Which arteries supply the head of the femur?
    4 months ago
  • jose
    Is the femoral artery a concern in hip arthroscopy?
    18 days ago
  • SARA
    What is the vascular supply if the femiral head?
    14 days ago

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