Natural history of lateral femoral cutaneous nerve neuropraxia after anterior approach total hip arthroplasty

2019 ◽  
Vol 29 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Luca Gala ◽  
Paul R Kim ◽  
Paul E Beaulé
Keyword(s):  
Natural History ◽  
Functional Outcomes ◽  
Anterior Approach ◽  
Functional Limitations ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Total Hip ◽  
Femoral Cutaneous Nerve ◽  
History Of

Aim: The aim of this study was to examine the natural history of lateral femoral cutaneous nerve (LFCN) neuropraxia in a previously reported cohort of individuals after direct anterior approach (DAA). Methods: 99 patients (107 hips) with LFCN neuropraxia were identified, out of which 82 patients (87 hips) (83.1%) completed functional outcomes questionnaires at mean follow-up of 5.5 years (4.4–6.9 years). 5 patients were excluded from the study due to intra-articular source of pain and/or revision surgery. The total sample was composed of 77 patients (31 total hip replacements and 51 hip resurfacings) and functional outcomes scores were obtained for all patients. Results: At average 5.46-year follow-up, 55 patients (60 hips 73%) still reported symptoms of LFCN neuropraxia but their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were not inferior to those who had resolution for pain, function and stiffness: p values of 0.716, 0.171, and 0.238, respectively. The mean score on visual analogue scale decreased from 2.32 (SD 2.11) to 1.76 (SD 1.99). 1 patient (1.2%) reported his activities were limited by his symptoms. Conclusion: Although the majority of patients still report symptoms related to LFCN neuropraxia, symptoms do improve over time and there are no functional limitations. Even if LFCN neuropraxia following DAA does not lead to functional limitations, all patients should be made aware in order to alleviate any long-term functional concerns.

scholarly journals Lateral versus conventional fasciotomy for prevention of lateral femoral cutaneous nerve injury in total hip arthroplasty with direct anterior approach: a study protocol for dual-center, single-blind, randomized controlled trial

2021 ◽  
Author(s):  
Hiroki Tanabe ◽  
Tomonori Baba ◽  
Yu Ozaki ◽  
Naotake Yanagisawa ◽  
Sammy Banno ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Total Hip ◽  
Randomized Controlled ◽  
Femoral Cutaneous Nerve ◽  
Tensor Fasciae Latae

Abstract Background; An incision for total hip arthroplasty (THA) via the direct anterior approach (DAA) is generally made outside of the space between sartorius and tensor fasciae lataea muscles to prevent lateral femoral cutaneous nerve (LFCN) injury. Recent anatomical studies have revealed that the LFCN not only courses between the sartorius and tensor fasciae latae muscles, but it also branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle. The latter is called the fan type, and studies suggest that damage to the fan type LFCN is unavoidable by conventional fasciotomy. We previously demonstrated that injury to non-fan type LFCN occurred in 28.6% of patients who underwent THA by fasciotomy performed 2 cm away from the intermuscular space. This suggests that the conventional approach also poses a risk of LFCN injury for non-fan type LFCN. LFCN injury is rarely reported in the anterolateral approach (ALA), which involves incision of fascia further away than DAA. The purpose of this study is to investigate how the position of fasciotomy in DAA affects the risk of LFCN injury. Methods; This is a prospective, randomized, controlled study. All patients are divided into the fan type and non-fan type using ultrasonography before surgery. Patients with the non-fan type LFCN will be performed by the conventional fasciotomy and the lateral fasciotomy in the order specified in the allocation table created in advance by our clinical trial center. The primary endpoint is the presence of LFCN injury. The secondary endpoints will be assessed based on patient-reported outcomes (PROs) at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), and the Forgotten-Joint Score-12 (FJS-12). Discussion; We hypothesize that the incidence of LFCN injury due to DAA-THA can be reduced by making the incision further away from where it is typically made in conventional fasciotomy. If our hypothesis is confirmed, it will reduce the disadvantages of DAA, improve patient satisfaction. Trial registration; UMIN Clinical Trials Registry, UMIN000035945.Registered on 20 Feburary 2019.

Anterior approach to hip replacement and associated complications: an independent review

2020 ◽  
pp. 112070002094845
Author(s):  
Praveen Vasantharao ◽  
David Fenbury ◽  
Riaz Khan ◽  
Daniel Fick ◽  
Stephen Dalgleish ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Hip Replacement ◽  
Anterior Approach ◽  
Case Series ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Early Recovery ◽  
Femoral Cutaneous Nerve ◽  
The Mean

Background: Direct anterior approach (DAA) to hip replacement is increasingly popular. Despite the well-published benefits of early recovery, the approach can be associated with a number of complications that may be underreported. We aim to report the incidence of some of these complications in a large retrospective case series. Methods: 270 consecutive DAA hip replacements are studied which are performed by a single high-volume hip surgeon from 2013 to 2015, not including the surgeon’s learning curve. Operation and consultation records were screened, and focused questioning via telephone was employed to capture specific complications including dislocations, wound infections, lateral femoral cutaneous nerve (LFCN) injury and revision surgery. Results: 240 of 270 patients or family were contactable. The mean age and body mass index of the cohort was 66 (range 30–89) years and 27 (range 18–40) kg/m2 respectively. The mean follow-up was 3.7 years. Wound issues were encountered in 24 patients (8.8%). There were 9 dislocations (3%). 27 (10%) patients needed revision surgery in the follow-up period. Reasons for revision included leg-length discrepancies, dislocations, ongoing pain and aseptic loosening. 9 (3.4%) patients had to return to operating theatre for reasons other than revision surgery. Symptoms of lateral femoral cutaneous nerve injury was reported by 54 patients (21%). Conclusions: While the short-term benefits of DAA have been widely reported, our review shows a relatively high rate of revision surgery. We feel that the enthusiasm for DAA should be tempered until further evidence is available.

Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty

2015 ◽  
Vol 40 (8) ◽  
pp. 1587-1593 ◽  
Author(s):  
Yasuhiro Homma ◽  
Tomonori Baba ◽  
Kei Sano ◽  
Hironori Ochi ◽  
Mikio Matsumoto ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Nerve Injury ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Total Hip ◽  
Femoral Cutaneous Nerve

scholarly journals Preoperative ultrasound to identify distribution of the lateral femoral cutaneous nerve in total hip arthroplasty using the direct anterior approach

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 42 ◽  
Author(s):  
Yu Ozaki ◽  
Tomonori Baba ◽  
Yasuhiro Homma ◽  
Hiroki Tanabe ◽  
Hironori Ochi ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Preoperative Ultrasound ◽  
Femoral Cutaneous Nerve ◽  
Direct Injury ◽  
Radial Spreading ◽  
Tensor Fasciae Latae

Introduction: Recently, the branching pattern of the lateral femoral cutaneous nerve (LFCN) named Fan type has been reported that LFCN injury cannot be avoided in surgical dissections that use the direct anterior approach to the hip joint in the cadaveric study. We hypothesized that the Fan type can be identified by ultrasound The aim of this study was to investigate whether LFCN injury occurs in DAA-THA in cases identified as the Fan type based on preoperative ultrasound of the proximal femur. Methods: Ultrasonography of the proximal femur on the surgical side was performed before surgery and the LFCN distribution was judged as the Fan type or Non-Fan type. A self-reported questionnaire was sent to the patients at two months after surgery, and the presence or absence of LFCN injury was prospectively surveyed. Results: After application of exclusion criteria, 45 hips were included. LFCN injury was observed after surgery in 9 of the 10 patients judged as the Fan type based on the ultrasound of the proximal femur (positive predictive value: 90%), and no LFCN disorder was actually observed in 25 of the 26 patients judged as Non-Fan type (specificity: 96.2%). Conclusions: To prevent injury of the LFCN in patients judged as the Fan type on the ultrasound test before surgery, the risk of direct injury of the LFCN may be reduced through the approach in which an incision is made in the fascia which is opposite to the radial spreading, i.e., between the sartorius and tensor fasciae latae muscles or slightly medial from it.

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