Incidence of lateral femoral cutaneous nerve lesions after direct anterior approach primary total hip arthroplasty – a literature review

Dahm, Falko; Aichmair, Alexander; Dominkus, Martin; Hofstaetter, Jochen G.

doi:10.1016/j.otsr.2021.102956

Cited by 20 publications

(9 citation statements)

References 54 publications

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“…Ozaki et al [ 33 ] demonstrated that LFCN neuropraxia mainly resolves spontaneously overtime after THA. The incidence in the present study was similar to the previously reported range in the literature [ 3 , 34 , 35 ]. There were no connections between LFCN neuropraxia and 6MWT or JOA scores; however, higher FJS-12 scores were found in MAA group.…”

Section: Discussionsupporting

confidence: 92%

Minimally invasive anterolateral approach versus direct anterior approach total hip arthroplasty in the supine position: a prospective study based on early postoperative outcomes

Liu

Liang

et al. 2022

J Orthop Surg Res

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Background Minimally anterolateral approach (MAA) and direct anterior approach (DAA) have been reported as beneficial for total hip arthroplasty (THA) due to their ability to reduce postoperative pain and lead to quicker rehabilitation by preserving muscle insertions. As there is an ongoing debate on the effect of these two approaches on early postoperative outcomes, this prospective study aimed to assess the difference in early clinical, radiological, and patient-reported outcomes between the two minimally invasive approaches. Methods A total of 98 patients, 50 in the MAA group and 48 in the DAA group, were included in the study. Patients with complete data were evaluated preoperatively and postoperatively at 2, 6, and 12 weeks. Clinical measurements, including the ability to climb stairs and walk, 6-min walk test (6MWT), the Forgotten Joint Scale (FJS-12), Japanese Orthopedic Association (JOA) Hip scores, radiological evaluation, and complications were analyzed. Results There were no significant differences in clinical outcomes and implant alignments between MAA and DAA groups. In regards to patient-reported outcomes, the FJS-12 was significantly higher in the MAA group compared to group DAA at 2 and 6 weeks postoperatively. However, there was no significant difference in the FJS-12 between the two groups 12 weeks after surgery. The differences also included shorter operative times (62.4 ± 9.05 min vs. 71 ± 8.01 min), less blood loss (132.6 ± 43.31 ml vs. 159.23 ± 37.25 ml), lower Hb drop (29.56 ± 8.02 g/L vs. 36.4 ± 7.12 g/L), and fewer blood transfusions in the MAA group (4.0% vs. 18.8%). The incidence of the lateral femoral cutaneous nerve (LFCN) neuropraxia after surgery was 7 (14.6%) in the DAA group and 0 in the MAA group. One fracture was found in each group and managed conservatively. Conclusion MAA and DAA approach yielded excellent and similar early clinical outcomes. However, better patient-reported outcomes could be achieved by MAA THA. The MAA resulted in a safer approach associated with shorter operative times, less blood loss, lower Hb drop, fewer blood transfusions, and LFCN neuropraxia than DAA. A longer follow-up is needed to further examine differences between these procedures.

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Section: Discussionsupporting

confidence: 92%

Minimally invasive anterolateral approach versus direct anterior approach total hip arthroplasty in the supine position: a prospective study based on early postoperative outcomes

Liu

Liang

et al. 2022

J Orthop Surg Res

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“…Orthopaedic procedure where injury to LFCN has been reported includes iliac crest bone graft harvesting, acetabular fixation, pelvic osteotomies and anterior approach to the hip joint [1,3]. Incidence of injury to LFCN in iliac crest bone harvesting, acetabular fixation, and pelvic osteotomies has been reported up to 30% [15]; however, during hip replacement surgeries using the anterior approach, this incidence ranges from 0 to 83% [16].…”

Section: Discussionmentioning

confidence: 99%

Surgical course of lateral femoral cutaneous nerve during anterior exposure of paediatric hips: an observational study

Gupta

Kanojia

et al. 2023

Journal of Pediatric Orthopaedics B

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Anterior approach to the hip joint is commonly used for paediatric hip disorders. Lateral femoral cutaneous nerve (LFCN) is always exposed and dissected in this approach before deep dissection is carried out. The course of this nerve has been described in adults but there is a lack of literature regarding this in the paediatric age group. This study aimed to find the surgical anatomy of LFCN in children during the anterior approach to the hip. A total of 51 paediatric hip surgeries were done in 45 children for various hip disorders. The anterior exposure was done by the Somerville approach (Bikini incision). During surgical exposure, LFCN was exposed and its relationship to anterior superior iliac spine (ASIS), inguinal ligament and sartorius muscle was observed. In most of the cases (45/51) it was found as a single trunk below the inguinal ligament and medial to the ASIS. In one hip, multiple branches of the nerve were found just below the inguinal ligament. In four hip exposures, the nerve was not found in the surgical field and in one case nerve was accidentally cut during surgery as it was lying adherent to ASIS. There was no significant correlation between the observational parameters of the nerve with anthropometric variables. Nerve was mostly seen in area 5-25 mm medial to ASIS and 10-50 mm below the ASIS in 80% of our surgical exposures where the nerve was isolated. We observed that once LFCN is dissected, the injury during further surgical procedures can be prevented.

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“…occurrence of nerve injuries in such procedures are very variable throughout the literature, ranging from 14.8 to 81% and thus represent a frequent and underestimated presentation. (48,53) Sonographic findings in positive cases include nerve enlargement (mean cross-sectional area 9 mm² vs 3 mm² in normal controls), nerve hypoechogenicity in 86%, and focal lesions in 20%, according to a study by Powell et al (54) (Figure 8) Interestingly this nerve may be affected not only at the anterior superior iliac spine but at different levels along its course, where multiple US guided injections might be recommended (55).…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Nerve entrapment syndromes: detection by ultrasound

Schwabl¹,

Schmidle²,

Kaiser³

et al. 2023

Ultrasonography

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Nerve entrapment syndromes are commonly encountered in clinical practice. Accurate diagnosis and management require knowledge of peripheral neuroanatomy and recognition of key clinical symptoms and findings.Nerve entrapment syndromes are frequently associated with structural abnormalities of the affected nerve. Therefore, imaging allows for the evaluation of the cause, severity, and etiology of the entrapment. High resolution ultrasonography can depict early and chronic morphological changes within the entire nerve course and is therefore an ideal modality for the diagnosis of various nerve entrapment syndromes at different regions. This review article presents some of the most common nerve entrapments, with special focus on ultrasound imaging and key findings.

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Incidence of lateral femoral cutaneous nerve lesions after direct anterior approach primary total hip arthroplasty – a literature review

Cited by 20 publications

References 54 publications

Minimally invasive anterolateral approach versus direct anterior approach total hip arthroplasty in the supine position: a prospective study based on early postoperative outcomes

Minimally invasive anterolateral approach versus direct anterior approach total hip arthroplasty in the supine position: a prospective study based on early postoperative outcomes

Surgical course of lateral femoral cutaneous nerve during anterior exposure of paediatric hips: an observational study

Nerve entrapment syndromes: detection by ultrasound

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