Abstract
Purpose
Iatrogenic femoral nerve injury is a recognized complication of abdominal and pelvic surgery. It causes distress and disability and may lead to permanent motor and/or sensory sequelae. The aim of this systematic review was to explore the contemporary spectrum of this injury reported in the literature.
Methods
A systematic review of iatrogenic femoral nerve injuries reported between 2000 and October 2010 was undertaken using the electronic databases Medline, PubMed, Cochrane Library, and Google Scholar. The context, frequency, mechanism of injury, and outcome were recorded. Relevant clinical and anatomical literature was reviewed to provide an overview of the surgical anatomy.
Results
Iatrogenic femoral nerve injury is not rare, occurring as a complication of common abdominal, pelvic, and orthopedic operations and after femoral nerve blocks and femoral artery puncture. Mechanisms of injury are diverse and include direct trauma and ischemia from retraction or stretching of the nerve. Variant anatomy is very rarely the source of the problem. Although the prognosis in most cases is good some affected patients require nerve repair or grafting and some are left with permanent residual neurologic deficits.
Conclusions
A wider awareness of this complication, particularly the context in which it may occur, together with an appropriate understanding of the anatomy of the femoral nerve may help to reduce the frequency of this distressing and disabling iatrogenic complication.
Similar content being viewed by others
References
Al Hakim M, Katirji B (1993) Femoral mononeuropathy induced by the lithotomy position: a report of 5 cases with a review of literature. Muscle Nerve 16:891–895
Al-Nasser B, Palacios JL (2005) Femoral nerve injury complicating continuous psoas compartment block. Reg Anest Pain Med 29:361–363
Auroy Y, Benhamou D, Bargues L et al (2002) Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology 97:1274–1280
Azuelos A, Corò L, Alexandre A (2005) Femoral nerve entrapment. Acta Neurochir Suppl 92:61–62
Bergman RA, Thompson SA, Afifi AK (1984) Catalog of human variation. Urban & Schwarzenberg, Baltimore, p 159
Bohrer JC, Walters MD, Park A et al (2009) Pelvic nerve injury following gynecologic surgery: a prospective cohort study. Am J Obstet Gynecol 201:531–537
Boontje AH, Haaxma R (1987) Femoral neuropathy as a complication of aortic surgery. J Cardiovasc Surg 28:286–289
Brasch RC, Bufo AJ, Kreienberg PF, Johnson GP (1995) Femoral neuropathy secondary to the use of a self-retaining retractor. Report of three cases and review of the literature. Dis Colon Rectum 38:1115–1118
Brown SR, Shorthouse AJ (2002) Femoral nerve palsy after colorectal surgery. Colorectal Dis 4:487
Capdevila X, Pirat P, Bringuier S et al (2005) Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients. Anesthesiology 103:1035–1045
Cardosi RJ, Cox CS, Hoffman MS (2002) Postoperative neuropathies after major pelvic surgery. Obstet Gynecol 100:240–244
Celebrezze JP, Pidala MJ, Porter JA, Slezak FA (2000) Femoral neuropathy: an infrequently reported postoperative complication. Report of four cases. Dis Colon Rectum 43:419–422
Chan JK, Manetta A (2002) Prevention of femoral nerve injuries in gynecologic surgery. Am J Obstet Gynecol 186:1–7
Clarke MT, Arora A, Villar RN (2003) Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res 406:84–88
Cuvillon P, Ripart J, Lalourcey L et al (2001) The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 93:1045–1049
Darmanis S, Pavlakis D, Papanikolaou A, Apergis E (2004) Neurovascular injury during primary total hip arthroplasty caused by a threaded acetabulum cup. J Arthroplasty 19:520–524
Della Valle CJ, Di Cesare PE (2001) Complications of total hip arthroplasty: neurovascular injury, leg-length discrepancy, and instability. Bull Hosp Jt Dis 60:134–142
Diab M, Smith AR, Kuklo TR, Spinal Deformity Study Group (2007) Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine 32:2759–2763
Ducic I, Dellon L, Larson E (2005) Treatment concepts for idiopathic and iatrogenic femoral nerve mononeuropathy. Ann Plast Surg 55:397–401
Ertem K, Karakoç Y, Cetin A, Bora A (2010) An iatrogenic femoral nerve injury after open reduction and displacement iliac osteotomy for hip dysplasia: a case report. Eur J Orthop Surg Traumatol 20:339–342
Farrell CM, Springer BD, Haidukewych GJ, Morrey BF (2005) Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 87:2619–2625
Farrow A, Morrison R, Pickersgill T, Currie R, Hammersley N (2004) Transient femoral neuropathy after harvest of bone from the iliac crest. Br J Oral Maxillofac Surg 42:572–574
Feibel RJ, Dervin GF, Kim PR, Beaulé PE (2009) Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution. J Arthroplasty 24(6 Suppl):132–137
García-Ureña MA, Vega V, Rubio G, Velasco MA (2005) The femoral nerve in the repair of inguinal hernia: well worth remembering. Hernia 9:384–387
Ghani KR, McMillan R, Paterson-Brown S (2002) Transient femoral nerve palsy following ilio-inguinal nerve blockade for day case inguinal hernia repair. J R Coll Surg Edinb 47:626–629
Goldman JA, Feldberg D, Dicker D, Samuel N, Dekel A (1985) Femoral neuropathy subsequent to abdominal hysterectomy. A comparative study. Eur J Obstet Gynecol Reprod Biol 20:385–392
Gruson KI, Moed BR (2003) Injury of the femoral nerve associated with acetabular fracture. J Bone Joint Surg Am 85-A:428–431
Gupta R, Valecha V, Walia S (2006) Femoral neuropathy after lithotomy position - its treatment modalities. Indian J Anaesth 50:143–144
Ha YC, Ahn IO, Jeong ST, Park HB, Koo KH (2001) Iliacus hematoma and femoral nerve palsy after revision hip arthroplasty: a case report. Clin Orthop Relat Res 385:100–103
Haber M, Kovan E, Andary M, Honet J (2000) Postinjection vastus lateralis atrophy: 2 case reports. Arch Phys Med Rehabil 81:1229–1233
Huang WS, Lin PY, Yeh CH et al (2007) Iatrogenic femoral neuropathy following pelvic surgery: a rare and often overlooked complication—four case reports and literature review. Chang Gung Med J 30:374–379
Kargel J, Dimas V, Dimas V et al (2006) Femoral nerve palsy as a complication of anterior iliac crest bone harvest: report of two cases and review of the literature. Can J Plast Surg 14:239–242
Kell MR, O’Connell PR (2000) Femoral nerve neuropraxia after abdominoperineal resection. Dis Colon Rectum 43:726
Khan R, Birch R (2001) Iatropathic injuries of peripheral nerves. J Bone Join Surg Br 83:1145–1148
Kim DH, Kline DG (1995) Surgical outcome for intra- and extrapelvic femoral nerve lesions. J Neurosurg 83:783–790
Kim DH, Murovic JA, Tiel RL, Kline DG (2004) Intrapelvic and thigh-level femoral nerve lesions: management and outcomes in 119 surgically treated cases. J Neurosurg 100:989–996
Kornbluth ID, Freedman MK, Sher L, Frederick RW (2003) Femoral, saphenous nerve palsy after tourniquet use: a case report. Arch Phys Med Rehabil 84:909–911
Kretschmer T, Heinen CW, Antoniadis G, Richter HP, Konig RW (2009) Iatrogenic nerve injuries. Neurosurg Clin N Am 20:73–90
Kuo LJ, Penn IW, Feng SF, Chen CM (2004) Femoral neuropathy after pelvic surgery. J Chin Med Assoc 67:644–646
Lange B, Langer C, Markus PM, Becker H (2003) Paralysis of the femoral nerve following totally extraperitoneal laparoscopic inguinal hernia repair. Surg Endosc 17:1157
McMinn RMH (1998) Last’s anatomy. Regional and applied, 9th edn. Elsevier, Philadelphia, p 156
Meier G, Buettner J (2007) Peripheral regional anesthesia. An atlas of anatomy and techniques, 2nd edn. Thieme, Stuttgart, p 114
Nobel W, Marks SC, Kubik S (1980) The anatomical basis for femoral nerve palsy following iliacus hematoma. J Neurosurg 52:533–540
Orebaugh SL (2006) The femoral nerve and its relationship to the lateral circumflex femoral artery. Anesth Analg 102:1859–1862
Özçakar L, Isik M, Erol O, Dogan S, Onat AM (2003) Iliopsoas muscle injury during a femoral artery puncture: benign but disabling. J Crit Care 18:259–260
Pechter EA, Smith PB (2008) Transient femoral neuropathy after abdominoplasty. Ann Plast Surg 61:492–493
Peters CL, Erickson JA, Hines JL (2006) Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am 88:1920–1926
Porzionato A, Macchi V, Fenato F, Parenti A, De Caro R (2008) Femoral nerve injury after gynecologic laparoscopy. J Minim Invasive Gynecol 15:105–107
Rosario DJ, Jacob S, Luntley J, Skinner PP, Raftery AT (1997) Mechanism of femoral nerve palsy complicating percutaneous ilioinguinal field block. Br J Anaesth 78:314–316
Sampson TG (2001) Complications of hip arthroscopy. Clin Sports Med 20:831–835
Schafhalter-Zoppoth I, Zeitz ID, Gray AT (2004) Inadvertent femoral nerve impalement and intraneural injection visualized by ultrasound. Anesth Analg 99:627–628
Sharma KR, Cross J, Santiago F, Ayyar DR, Burke G (2002) Incidence of acute femoral neuropathy following renal transplantation. Arch Neurol 59:541–545
Simmons C Jr, Izant TH, Rothman RH, Booth RE Jr, Balderston RA (1991) Femoral neuropathy following total hip arthroplasty. Anatomic study, case reports, and literature review. J Arthroplast 6:59–66
Singelyn F (2007) Femoral nerve block. In: Hadzic A (ed) Textbook of regional anesthesia and acute pain management. Mc-Graw Hill, New York, p 501
Slater N, Singh R, Senasinghe N et al (2000) Pressure monitoring of the femoral nerve during total hip replacement: an explanation for iatropathic palsy. J R Coll Surg Edinb 45:231–233
Standring S (2008) Gray’s anatomy. The anatomical basis of clinical practice, 40th edn. Elsevier, Philadelphia, pp 1382–1383
Thoms RJ, Kondrashov D, Silber J (2009) Iatrogenic femoral nerve palsy masquerading as knee extensor mechanism rupture. Am J Orthop 38:142–144
Tsuchihara T, Nemoto K, Arino H et al (2008) Sural nerve grafting for long defects of the femoral nerve after resection of a retroperitoneal tumour. J Bone Joint Surg Br 90:1097–1100
Vloka JD, Hadzic A, Drobnik L et al (1999) Anatomical landmarks for femoral nerve block: a comparison of four needle insertion sites. Anesth Analg 89:1467–1470
Vosburgh LF, Finn WF (1961) Femoral nerve impairment subsequent to hysterectomy. Am J Obstet Gynecol 82:931–937
Warner MA (2006) Perioperative neuropathies, blindness, and positioning problems. ASA Refresh Courses Anesthesiol 34:195–205
Winnie AP, Ramamurthy S, Durrani Z (1973) The inguinal paravascular technique of lumbar plexus anesthesia; the “3-in-1” block. Anesth Analg 52:989–996
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moore, A.E., Stringer, M.D. Iatrogenic femoral nerve injury: a systematic review. Surg Radiol Anat 33, 649–658 (2011). https://doi.org/10.1007/s00276-011-0791-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-011-0791-0