Characterization of the Neural Anatomy in the Hip Joint to Optimize Periarticular Regional Anesthesia in Total Hip Arthroplasty

The purpose of the current study was to identify and map the periarticular neural anatomy of the hip
to optimize periarticular injection techniques in total hip arthroplasty. A literature review of common
search engines was performed using terms associated with hip innervation and 17 met the inclusion
criteria. The studies addressed both gross and microscopic neural anatomy of the human hip joint,
and the findings summarize key areas of hip mechanoreceptors and free nerve endings to provide a framework for targeted periarticular hip infiltration. Grossly, the hip joint is supplied by the femoral, obturator, sciatic, and superior gluteal nerves, as well as the nerve to the quadratus femoris. The greatest concentration of sensory nerve endings and mechanoreceptors is found at the anterior hip capsule, especially superiorly. The labrum is most highly innervated from the 10 to 2 o’clock position. After the cup and liner are placed, periarticular injections should be infiltrated toward the remnant labrum from 10 to 2 o’clock. Before stem insertion, the visible periosteum may then be injected circumferentially about the femur. The anterior and superior capsular tissue, if retained, is routinely infiltrated at the time of capsular repair. Depending on surgical approach, the fascia and incised soft tissue are infiltrated before final closure. (Journal of Surgical Orthopaedic Advances 24(4):221–224, 2015)

Key words: anesthesia, injection, innervation, nerve anatomy, periarticular, total hip arthroplasty