Incidence of Lateral Femoral Cutaneous Nerve Neuropraxia After Anterior Approach Hip Arthroplasty
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Although injury to the lateral femoral cutaneous nerve (LFCN) is a known complication of anterior approaches to the hip and pelvis, no study has quantified its’ incidence in anterior arthroplasty procedures.
We therefore defined the incidence, functional impact, and natural history of LFCN neuropraxia after an anterior approach for both hip resurfacing (HR) and primary total hip arthroplasty (THA).
We followed 132 patients who underwent an anterior hip approach (55 THA; 77 HR). We administered self-reported questionnaires for sensory deficits of LFCN, neuropathic pain score (DN4), visual analog scale, as well as SF-12, UCLA, and WOMAC scores at one year postoperatively. A subset of 60 patients (30 THA; 30 HR) was evaluated at two time intervals.
One hundred seven patients (81%) reported LFCN neuropraxia with a mean severity score of 2.32/10 and a mean DN4 score of 2.42/10. Hip resurfacing had a higher incidence of neuropraxia as compared with THA: 91% versus 67%, respectively. No functional limitations were reported on SF-12, WOMAC, or UCLA scores. Of the subset of 60 patients followed over an average of 12 months, 53 (88%) reported neuropraxia at the first followup interval with only three (6%) having complete resolution at second followup. Improvement in DN4 scores was observed over time: 3.6 versus 2.5, respectively.
Although LFCN neuropraxia was a frequent complication after anterior approach THA, it did not lead to functional limitations in our patients. A decrease in symptoms occurred over time but only a small number of patients reported complete resolution.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
KeywordsNeuropathic Pain Anterior Approach Pelvic Osteotomy Lateral Femoral Cutaneous Nerve Direct Anterior Approach
We thank Heather Belanger RN, BScN, and Gillian Parker, BSc (Ottawa Hospital–General Campus, Ottawa, ON, Canada) for their assistance with data collection and the coordination of this research project.
- 1.Abbott LC, Carpenter WF. Surgical approaches to the knee joint. J Bone Joint Surg Am. 1945;27:277–310.Google Scholar
- 6.Beaule PE, Dorey FJ, LeDuff M, Amstutz HC. Validation of activity level in the assessment of the clinical outcome of total hip arthroplasty. J Bone Joint Surg Br. 2005;87(Suppl 3):360.Google Scholar
- 7.Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
- 13.Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29–36.CrossRefPubMedGoogle Scholar
- 39.Lovell TP. Single incision direct anterior approach for total hip arthroplasty using a standard orthopaedic table. J Arthroplasty. 2008;23(7): Suppl 1:64–68.Google Scholar
- 40.Luo H, Yu JK, Ao YF, Yu CL, Peng LB, Lin CY, Zhang JY, Fu X. Relationship between different skin incisions and the injury of the infrapatellar branch of the saphenous nerve during anterior cruciate ligament reconstruction. Chin Med J (Engl). 2007;120:1127–1130.Google Scholar
- 49.Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective randomized study of 2 surgical approaches in total hip arthroplasty. J Arthroplasty. 2010 April 7. [Epub ahead of print].Google Scholar
- 51.Roth WK. Meralgia Paresthetica. Berlin, Germany: S Karque; 1895.Google Scholar
- 56.Seddon HJ. Surgical Disorders of the Peripheral Nerves. 2nd Ed. Edinburgh, Scotland: Churchill Livingstone; 1975.Google Scholar
- 61.The Anterior Total Hip Arthroplasty Collaborative (ATHAC) Investigators. Outcomes following the single-incision anterior approach to total hip arthroplasty: a multicenter observational study. Orthop Clin N Am. 2009;40:329–342.Google Scholar
- 63.Wall PD, Devor M. Physiology of sensation after peripheral nerve injury, regeneration, and neuroma formation. In: Waxman G, ed. Physiology and Pathohistology of Axons. New York, NY: Raven Press; 1978:377–388.Google Scholar