Small femoral offset is a risk factor for lateral femoral cutaneous nerve injury during total hip arthroplasty using a direct anterior approach

Ozaki, Yu; Homma, Yasuhiro; Sano, Kei; Baba, Tomonori; Ochi, Hironori; Desroches, Asuka; Matsumoto, M; Yuasa, Takahito

doi:10.1016/j.otsr.2016.08.019

Cited by 29 publications

(17 citation statements)

References 25 publications

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“…The LFCN of the two patients had three branches at the end, and the lateral branch passed the TFL. In the control group, 15 (24.2%) patients described abnormal symptoms in the anterolateral thigh, including numbness (15), dull sensation (15), and tingling or pain (4) in the 1st month follow-up, which was signi cantly higher than that in the ultrasound group. The area of abnormal symptoms of the control group was 133.1 ± 104.9 (49 ~ 375) cm 2 , which was signi cant larger than that of ultrasound guiding group.…”

Section: Statisticsmentioning

confidence: 87%

“…Some studies from the clinic or cadaveric hips reported that the rate of LFCN injury was 3.29%-81.00% [10,11,13,14]. This huge gap between different studies may be partially caused by surgical technique, including nerve stretching, compression, laceration, and suturing; however, the high anatomical variant rate of LFCN distribution and femoral offset, was at a higher risk for surgical injury [15][16][17]. The LFCN, derived from the lumbar nerve 2-3, crosses the iliacus obliquely, and then runs toward the anterior superior iliac spine (ASIS).…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Yao

Wang

Zhuang

et al. 2021

Preprint

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Background：The postoperative complaints of hypoaesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients is not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods： A total of 59 patients were allocated to the ultrasound group and 58 patients were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months post-surgery, the rate of LFCN injury and abnormal sensitive area were evaluated in both groups. Results： Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8±2.6 (3.0 ~12.0) mm to 11.1±3.4 (4.0 ~17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3±4.6 (-5.0 ~10.0) mm at proximal part and -2.7±4.7 (-10.0 ~8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group were significantly lower than those in the control group (3.4% VS 25.9%, P=0.001, χ21=11.893, at 1 month; 3.4% VS 22.4%, P=0.005, χ21=9.471, at 3 months).Conclusions： LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.

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Section: Statisticsmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Yao

Wang

Zhuang

et al. 2021

Preprint

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“…The stem comes in 12 sizes [1][2][3][4][5][6][7][8][9][10][11]14 and a 12 to 14 mm cone. The stem sizes are offered in two offset types: standard and lateral.…”

Section: Surgerymentioning

confidence: 99%

“…An under-correction of the FO will lead to a weakness in the abductor muscles, resulting in a disturbed gait pattern and a high risk of dislocation, whereas an overcorrection will provide an increased tension on the soft tissues surrounding the hip, which can lead to postoperative pain and trochanteric bursitis. 5,6 Ozaki et al 7 described that a small FO causes a significant risk for the lateral femoral cutaneous nerve injury following THA with DAA. As DAA is becoming an increasingly popular approach for THA, it is important to know the risks when applying this technique and the importance of the FO.…”

mentioning

confidence: 99%

The Accuracy and Ability of Preoperative Templating to Restore Femoral Offset in Calcar-Guided Short-Stem Total Hip Prosthesis through Direct Anterior Approach

Favier¹,

Beek²,

Tengrootenhuysen³

2021

The Journal of Hip Surgery

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The aim of this study was to assess the applicability and ability of preoperative templating to restore femoral offset and hip length with a calcar-guided short-stem implant design in total hip arthroplasty through the direct anterior approach. Preoperative measurements were performed of femoral offset, hip length, and stem size and compared with the perioperative placed prosthesis in 100 patients undergoing primary total hip replacement through direct anterior approach. Additionally, the pre- and postoperative femoral offset and hip length were compared to evaluate the ability to restore the offset and hip length with this kind of femoral short stem. With an acceptance of 1 size difference pre- and postoperatively, a 94% accuracy of predicting the size of the calcar-guided short stem was achieved with templating. Femoral offset was within means of 5 mm in 82.2% of the patients. Postoperative hip length was within 6 mm in 90% of the patients compared with the preoperative length.The use of preoperative templating for total hip arthroplasty with calcar-guided short-stem implants was proven to be a useful tool to predict the definite implanted size of the femoral prosthesis. Our results show that this new stem design does not significantly differ from previous reported outcomes with other stem designs and is competent to restore the femoral offset and hip length within clinical acceptable range. Level of evidence Level 3 retrospective case study.

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Section: Introductionmentioning

confidence: 99%

Preoperative Ultrasound to Map the Three-dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Yao

Wang

Zhuang

et al. 2021

Preprint

View full text Add to dashboard Cite

Background：The postoperative complaints of hypoaesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients is not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods： A total of 59 patients ( 28 males and 31 females, age 69.0 ± 4.6 years，BMI 24.7 ± 3.0 kg/m2) were randomly allocated to the ultrasound group and 58 patients ( 28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m2) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months post-surgery, the rate of LFCN injury and abnormal sensitive area were evaluated in both groups. Results： There was a significant consistency in gender, age and BMI of these two groups (P>0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8±2.6 (3.0 ~12.0) mm to 11.1±3.4 (4.0 ~17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3±4.6 (-5.0 ~10.0) mm at proximal part and -2.7±4.7 (-10.0 ~8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group were significantly lower than those in the control group (3.4% VS 25.9%, P=0.001, at 1 month; 3.4% VS 22.4%, P=0.005, at 3 months).Conclusions： LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.

show abstract

Small femoral offset is a risk factor for lateral femoral cutaneous nerve injury during total hip arthroplasty using a direct anterior approach

Abstract: IV, retrospective historical cohort study.

Cited by 29 publications

References 25 publications

Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

The Accuracy and Ability of Preoperative Templating to Restore Femoral Offset in Calcar-Guided Short-Stem Total Hip Prosthesis through Direct Anterior Approach

Preoperative Ultrasound to Map the Three-dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

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