Iatrogenic Iliopsoas Tendon Injury May Occur during Femoral Head and Neck Ostectomy—An Ex-Vivo Study in Dogs

Abstract

Objective The aim of this study was to determine if inadvertent iatrogenic damage to the iliopsoas tendon can occur during routine femoral head and neck ostectomy (FHO), using a cadaveric dog model. Study Design Four cadaveric specimens (eight hindlimbs total) of dogs that were humanely euthanatized for reasons unrelated to this study. Pre-experimental radiography confirmed absence of pelvic or femoral comorbidities. Each limb of each paired sample was randomly assigned as either dissection-only control or FHO. The simulated FHO procedures were performed by an American College of Veterinary Surgeons diplomate, and post-procedure radiography confirmed appropriate ostectomy. The FHO limbs underwent pre- and postoperative ultrasonographic investigation by an American College of Veterinary Radiology diplomate. Finally, the FHO limbs were grossly dissected, and abnormalities were documented. Results Gross visual damage was seen on all postoperative FHO limbs. The damage was most apparent in extreme external rotation of the limb at dissection. Yet, ultrasound investigation did not reveal changes associated with these gross lesions. Conclusion Iatrogenic inadvertent damage to the iliopsoas tendon may occur during routine FHO, as demonstrated in this ex vivo model; however, this result is not evidence for clinical relevance. A prospective clinical study is needed to assess if iliopsoas injury secondary to FHO has any clinical impact on recovery and limb function.