The Anatomical Course of the Lateral Femoral Cutaneous Nerve in Relation to Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach

Thaler, Martin; Dammerer, Dietmar; Hechenberger, Faro; Hörmann, Romed; Beeck, Annelies Van; Stofferin, Hannes

doi:10.1016/j.arth.2020.07.052

Cited by 27 publications

(17 citation statements)

References 30 publications

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“…Recent studies differentiated the LFCN branching in three types with nearly equal prevalence. The fibers of the 'fan-type', characterized by multiple thin branches, cannot be protected effectively during PAO [25,26]. We observed a postoperative LFCN dysesthesia rate of 50% and 57% in the RASS and the RS group, respectively.…”

Section: Discussionmentioning

confidence: 72%

A New Rectus and Sartorius Sparing Approach for Periacetabular Osteotomy in Patients with Developmental Dysplasia of the Hip

Löchel

Janz

Perka

et al. 2021

JCM

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Background: periacetabular osteotomy (PAO) is known as the gold standard surgical treatment in young adults with symptomatic hip dysplasia. With the aim of reducing soft tissue trauma, we developed a new rectus and sartorius sparing (RASS) approach. We hypothesized that this new PAO technique was equal regarding acetabular reorientation, complication rate, and short-term clinical outcome parameters, compared to our conventional, rectus sparing (RS) approach. Patients and Methods: we retrospectively assessed all PAO procedures performed by a single surgeon between 2016 and 2019 (n = 239 hips in 217 patients). The cases in which the new RASS technique were used (n = 48) were compared to the RS cases for acetabular orientation parameters, surgical time, perioperative reduction of hemoglobin level, and length of hospital stay (LOHS). Inclusion criteria were a lateral center-edge angle (LCEA) <25° and osteoarthritis Tönnis grade ≤1. Patients with acetabular retroversion or additional femoral osteotomy were excluded. Results: the mean patient age at the time of surgery was 29 years (14 to 50, SD ± 8.5). Females accounted for 79.5% in this series. The mean preoperative LCEA were 16° (7 to 24°, SD ± 4.4) and 15° (0 to 23°, SD ± 6) in the RASS and the RS group, respectively (p = 0.96). The mean preoperative acetabular index (AI) angles were 14° (2 to 25°, SD ± 4) and 14° (7 to 29°, SD ± 4.3), respectively (p = 0.67). The mean postoperative LCEA were significantly improved to 31° (25 to 37°, SD ± 3.5, p < 0.001) and 30.2° (20 to 38°, SD ± 4, p < 0.001), respectively. The mean postoperative AI angles improved to 2.8° (−3 to 13°, SD ± 3.3, p < 0.001) and 3° (−2 to 15°, SD ± 3.3, p < 0.001), respectively. There were no significant differences between the RASS and the RS group for surgical time, perioperative reduction in hemoglobin level, and LOHS. No blood transfusions were necessary perioperatively in either group. No major perioperative complication occurred in either group. We observed one surgical site infection (SSI) requiring superficial debridement in the RS group. Conclusion: the RASS approach for PAO showed to be a safe procedure with equivalent acetabular reorientation and equivalent clinical outcome parameters compared to the RS approach. Additionally, patients have fewer postoperative restrictions in mobilization with the RASS approach.

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Section: Discussionmentioning

confidence: 72%

A New Rectus and Sartorius Sparing Approach for Periacetabular Osteotomy in Patients with Developmental Dysplasia of the Hip

Löchel

Janz

Perka

et al. 2021

JCM

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“…Surgeons should be aware of the anatomical course of the LFCN in relation to the bikini incision. With the help of precise anatomical knowledge as shown in our study [1], surgeons may adapt their surgical skills to provide better outcomes for their patients.…”

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confidence: 90%

“…We are grateful to the letter on our article titled "The Anatomical Course of the Lateral Femoral Cutaneous Nerve in Relation to Various Skin Incisions used for Primary and Revision Total Hip Arthroplasty with the Direct Anterior Approach" [1]. The authors of this letter to the editor raised a pertinent issue concerning the clinical aspects of lateral femoral cutaneous nerve (LFCN) lesions using a bikini incision for the direct anterior approach (DAA) for total hip arthroplasty (THA).…”

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confidence: 99%

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Response to Letter to Editor on “The Anatomical Course of the Lateral Femoral Cutaneous Nerve in Relation to Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach”

Thaler

2021

The Journal of Arthroplasty

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“…To the editor, With interest, we read the article by Thaler et al [1] reporting the results of a cadaveric study on the topographic relation of the branches of the lateral cutaneous nerve (LCFN) with various types of skin incisions used in the direct anterior approaches. As the bikini incision [2] crossed the main branch of the LCFN in all cases, the authors concluded that "the chances are high that LCFN branches could be jeopardized with a bikini-type incision".…”

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confidence: 99%

Letter to the Editor on “The Anatomical Course of the Lateral Cutaneous Nerve in Relation to the Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach”

Rüdiger

Leunig

2021

The Journal of Arthroplasty

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The Anatomical Course of the Lateral Femoral Cutaneous Nerve in Relation to Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach

Cited by 27 publications

References 30 publications

A New Rectus and Sartorius Sparing Approach for Periacetabular Osteotomy in Patients with Developmental Dysplasia of the Hip

A New Rectus and Sartorius Sparing Approach for Periacetabular Osteotomy in Patients with Developmental Dysplasia of the Hip

Response to Letter to Editor on “The Anatomical Course of the Lateral Femoral Cutaneous Nerve in Relation to Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach”

Letter to the Editor on “The Anatomical Course of the Lateral Cutaneous Nerve in Relation to the Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach”

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