Abstract
Background; Lateral cutaneous nerve (LFCN) injury is one of the complication specific to total hip arthroplasty via the direct anterior approach. 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, in which injury of the LFCN is almost unavoidable using the conventional site for incision of the fascia. In order to reduce LFCN injury in the fan type, we devised a new approach of incising the fascia at a side 2 cm medial from the conventional site of incision. The purpose of this study is to examine how the site of incision of the fascia influences 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 fan type LFCN will be performed by the conventional approach and the medial approach in the order specified in the allocation table created in advance by our clinical trial center. The conventional approach involves incision of the skin, followed by incision of the fascia just below the site of skin incision. The medial approach proceeds medially from the site of skin incision, and involves incision of the fascia at a site 2 cm medial from the conventional site of incision. The primary endpoint is the presence of LFCN injury. The secondary endpoints will be assessed based on 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 fan type LFCN can be protected from injury by incising the fascia at a more medial site than conventional site. If the usefulness of this surgical procedure is confirmed, the disadvantages of the DAA will be eliminated, potentially being highly beneficial to patients.Trial registration; UMIN Clinical Trials Registry, UMIN000035944.Registered on 20 Feburary 2019.