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.

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.

Lateral Femoral Cutaneous Nerve Radiofrequency Ablation for Long-term Control of Refractory Meralgia Paresthetica

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1433-1436
Author(s):  
Alaa Abd-Elsayed ◽  
Michael J Gyorfi ◽  
Sung P Ha
Keyword(s):  
Radiofrequency Ablation ◽  
Abdominal Cavity ◽  
Case Series ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Meralgia Paresthetica ◽  
Pain Scores ◽  
Femoral Cutaneous Nerve ◽  
Average Pain

Abstract Background Meralgia paresthetica is a term used to describe a clinical pain syndrome related to the compression or irritation of the lateral femoral cutaneous nerve (LFCN). The LFCN is a pure sensory nerve that is susceptible to compression injury. The most common compression locations are: as it courses from the lumbosacral plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh. Methods This case series is a retrospective single-center review of six patients with medically intractable meralgia paresthetica who were treated with radiofrequency ablation. To be considered for radiofrequency ablation, the patient must have been unsuccessful with medical management alone for more than two months and have a clinical diagnosis of meralgia paresthetica. Temporary relief of pain of 50% or greater was considered a positive result. Average pain scores were measured pre- and postprocedure, along with one-, two-, three-, and six-month intervals postoperation. Results All patients demonstrated immediate relief in self-reported pain scores, averaging a 75.5% reduction in pain. At the one-, two-, three-, and six-month follow-ups, patients averaged a reduction of 60.0%, 58.0%, 51.4%, and 40.5%, respectively. Both the postop and one-month follow-up pain scores were lower, statistically significantly so (P < 0.05), whereas the two-, three-, and six-month follow-ups were not statistically different from pretreatment scores. Conclusions Although our study was small, radiofrequency ablation showed a clear reduction in average pain scores in a subset of patients who had failed standard medical therapy with a reduction in pain at one-month follow-up with relief of symptoms sometimes lasting longer than 12 months.

Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica

2009 ◽  
Vol 110 (4) ◽  
pp. 768-774 ◽  
Author(s):  
Olaf Alberti ◽  
Jürgen Wickboldt ◽  
Ralf Becker
Keyword(s):  
Surgical Treatment ◽  
Complete Remission ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Retroperitoneal Approach ◽  
Meralgia Paresthetica ◽  
Female Ratio ◽  
Femoral Cutaneous Nerve ◽  
The Mean

Object Neurosurgical textbooks describe an infrainguinal approach as the standard or preferred option for the surgical treatment of meralgia paresthetica (MP), the most frequent entrapment neuropathy of the lower limb. However, inhomogeneous results led the authors to adopt a suprainguinal, retroperitoneal approach for decompression of the lateral femoral cutaneous nerve. In this paper the authors' aim was to study the outcome of patients harboring MP treated via this different surgical approach. Methods The outcome of 55 consecutive patients who underwent surgery for MP via the suprainguinal retroperitoneal approach during a 15-year period was ascertained through postal questionnaires (in 47 patients) and follow-up visits (in 8 patients). The male to female ratio was 1:0.67, and the mean patient age was 50 ± 12.9 years. The mean follow-up was 3.2 ± 3.3 years. Seven of the patients underwent bilateral surgery. Results Intraoperatively the lateral femoral cutaneous nerve was consistently found in close anatomical relationship to the anterior superior iliac spine, although some variations regarding the diameter, number of branches, and underlying pathological entity were observed. Eighty-seven percent of patients showed improvement (21 patients) or complete remission (27 patients) of painful dysesthesia in the anterolateral thigh, and 13% (7 patients) remained unchanged. In addition 82% had improvement (31 patients) or complete remission (14 patients) of hypesthesia, leaving 18% with unchanged (9 patients) or worsened (1 patient) hypesthesia. In the patient-evaluated group 66% (31 of 47) were completely satisfied with the outcome, 23% (11 of 47) were partially satisfied, and 11% (5 of 47) were not satisfied with the outcome. Two cases each of recurrence, seroma, wound infection, and 1 case of hematoma requiring revision were encountered as complications. Conclusions The suprainguinal retroperitoneal approach is a viable first-choice option for the surgical relief of MP.

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

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.

scholarly journals Transposition of the lateral femoral cutaneous nerve

2019 ◽  
Vol 130 (2) ◽  
pp. 496-501 ◽  
Author(s):  
Amgad Hanna
Keyword(s):  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Meralgia Paresthetica ◽  
Femoral Cutaneous Nerve ◽  
Simple Decompression ◽  
Reoperation Rates ◽  
Numeric Rating

OBJECTIVEMeralgia paresthetica causes pain, burning, and loss of sensation in the anterolateral thigh. Surgical treatment traditionally involves neurolysis or neurectomy of the lateral femoral cutaneous nerve (LFCN). After studying and publishing data on the anatomical feasibility of LFCN transposition, the author presents here the first case series of patients who underwent LFCN transposition.METHODSNineteen patients with meralgia paresthetica were treated in the Department of Neurological Surgery at University of Wisconsin between 2011 and 2016; 4 patients underwent simple decompression, 5 deep decompression, and 10 medial transposition. Data were collected prospectively and analyzed retrospectively. No randomization was performed. The groups were compared in terms of pain scores (based on a numeric rating scale) and reoperation rates.RESULTSThe numeric rating scale scores dropped significantly in the deep-decompression (p = 0.148) and transposition (p < 0.0001) groups at both the 3- and 12-month follow-up. The reoperation rates were significantly lower in the deep-decompression and transposition groups (p = 0.0454) than in the medial transposition group.CONCLUSIONSBoth deep decompression and transposition of the LFCN provide better results than simple decompression. Medial transposition confers the advantage of mobilizing the nerve away from the anterior superior iliac spine, giving it a straighter and more relaxed course in a softer muscle bed.

Bikini versus Traditional Incision Direct Anterior Approach: Is There any Difference in Soft Tissue Damage?

2017 ◽  
Vol 27 (4) ◽  
pp. 397-400 ◽  
Author(s):  
Brent A. Lanting ◽  
Kirk C. Hartley ◽  
Adam J. Raffoul ◽  
Timothy A. Burkhart ◽  
Lyndsay Sommerville ◽  
...  
Keyword(s):  
Muscle Damage ◽  
Anterior Approach ◽  
Gluteus Medius ◽  
Direct Anterior Approach ◽  
Skin Incision ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Femoral Cutaneous Nerve ◽  
Muscle Groups ◽  
Tensor Fasciae Latae

Introduction The direct anterior approach for total hip replacements has reported advantages of improved early function and muscle preservation. In an effort to improve healing and cosmesis, a change in the orientation of the incision has been proposed. Traditionally, the skin incision is in-line with the tensor fasciae latae muscle belly. The bikini incision is orthogonal to this orientation. The hypothesis was that muscle damage would be increased by using the bikini incision. Methods A traditional or bikini incision was performed on 18 cadaveric hips. On each of the 9 specimens, the traditional incision was performed on 1 side, and a bikini incision on the contralateral hip, with an even distribution of right or left side. Blinded anatomists performed the hip dissections, and assessed for muscle damage as well as for damage to the lateral femoral cutaneous nerve. Results No difference in muscle damage was identified in the tensor fasciae latae between muscle groups. Muscle damage was very minimal to the gluteus medius and minimus. Damage to the lateral femoral cutaneous nerve occurred equally for both the bikini and traditional skin incisions. Conclusions The bikini incision for the direct anterior approach to the hip can be performed safely, with no increase in muscle damage or damage to the lateral femoral cutaneous nerve compared to the traditional incision.

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.

Sign in / Sign up

Export Citation Format

Share Document