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

International Orthopaedics volume 40, pages 1587–1593 (2016)Cite this article

Abstract

Purpose

Although injury of the lateral femoral cutaneous nerve (LFCN) is a known complication after total hip arthroplasty (THA) via the direct anterior approach (DAA), the impact of this complication on postoperative quality of life (QOL) is unclear. This study aims to investigate the incidence of LFCN injury after DAA for THA, and to determine the impact of LFCN injury on QOL and hip function.

Methods

We prospectively investigated 122 hips operated upon using the DAA regarding the incidence of LFCN injury using self-reported questionnaires, hip functional scores such as the Harris Hip Score (HHS) and the Japanese Orthopaedic Association (JOA) score, and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS).

Results

LFCN injury was seen in 39 hips (31.9 %). In affected hips, the leading symptom was hypo-aesthesia (46.2 %), followed by tingling or jolt-like sensation (28.2 %). There was no difference in the HHS and JOA score between those with LFCN injury and those without. There was a significant difference in the FJS-12 between the two groups (50.9 ± 25.3 for hips with LFCN injury vs 64.3 ± 25.7 without, p = 0.01). There was a non-significant tendency for patients with LFCN injury to have a lower JHEQ than those without (63.6 ± 19.6 for hips with LFCN injury vs 70.8 ± 22.9 without, p = 0.13).

Conclusions

The incidence of LFCN injury decreased QOL but not hip function after DAA for THA.

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References

  1. Hueter C (1883) Funfte Abtheilung: die Verletzung und Krankheiten des Hüftgelenkes, neunundzwanzigstes Capitel. In: Hueter C (ed) Grundriss der chirurgie, 2nd edn. FCW Vogel, Leipzig, pp 129–200

    Google Scholar 

  2. Rachbauer F, Kain MS, Leunig M (2009) The history of the anterior approach to the hip. Orthop Clin N Am 40(3):311–320

    Article  Google Scholar 

  3. Judet J, Judet H (1985) Voie d’abord antérieur dans l’arthroplastie totale de la hanche. Presse Med 14:1031–1033

    CAS  PubMed  Google Scholar 

  4. Baba T, Shitoto K, Kaneko K (2013) Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach. World J Orthop 4(2):85

    Article  PubMed  PubMed Central  Google Scholar 

  5. Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124

    Article  PubMed  Google Scholar 

  6. Paillard P (2007) Hip replacement by a minimal anterior approach. Int Orthop 31(Suppl 1):S13–S15

    Article  PubMed  Google Scholar 

  7. Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 25(5):671–679

    Article  PubMed  Google Scholar 

  8. Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Nöth U (2011) Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 36(3):491–498

    Article  PubMed  PubMed Central  Google Scholar 

  9. Seng BE, Berend KR, Ajluni AF, Lombardi AV (2009) Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin N Am 40(3):343–350

    Article  Google Scholar 

  10. Woolson ST, Pouliot MA, Huddleston JI (2009) Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplasty 24(7):999–1005

    Article  PubMed  Google Scholar 

  11. Barton C, Kim PR (2009) Complications of the direct anterior approach for total hip arthroplasty. Orthop Clin N Am 40(3):371–375

    Article  Google Scholar 

  12. Goulding K, Beaulé PE, Kim PR, Fazekas A (2010) Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res 468(9):2397–2404

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bhargava T, Goytia RN, Jones LC, Hungerford MW (2010) Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedics 33(7):472

    PubMed  Google Scholar 

  14. Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 25(24):3186–3191

    CAS  Article  Google Scholar 

  15. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) 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 15:1833–1840

    CAS  PubMed  Google Scholar 

  16. Seki T, Hasegawa Y, Ikeuchi K, Ishiguro N, Hiejima Y (2013) Reliability and validity of the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) for patients with hip disease. J Orthop Sci 18(5):782–787

    Article  PubMed  Google Scholar 

  17. Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty 27(3):430–436

    Article  PubMed  Google Scholar 

  18. Den Hartog YM, Mathijssen NM, Peters SJ, Vehmeijer SB (2015) The anterior supine intermuscular approach for total hip arthroplasty: reducing the complication rate by improving the procedure. Hip Int 25(1):28–33

    Article  Google Scholar 

  19. Leunig M, Faas M, von Knoch F, Naal FD (2013) Skin crease ‘bikini’ incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res 471(7):2245–2252

    Article  PubMed  PubMed Central  Google Scholar 

  20. The Anterior Total Hip Arthroplasty Collaborative (ATHAC) Investigators (2009) Outcomes following the single-incision anterior approach to total hip arthroplasty: a multicenter observational study. Orthop Clin N Am 40:329–342

    Article  Google Scholar 

  21. Ware JE, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233

    Article  PubMed  Google Scholar 

  22. Beaule PE, Dorey FJ, LeDuff M, Amstutz HC (2005) Validation of activity level in the assessment of the clinical outcome of total hip arthroplasty. J Bone Joint Surg (Br) 87(Suppl 3):360

    Google Scholar 

  23. Brokelman RB, van Loon CJ, Rijnberg WJ (2003) Patient versus surgeon satisfaction after total hip arthroplasty. J Bone Joint Surg (Br) 85(4):495–498

    CAS  Google Scholar 

  24. Lieberman JR, Dorey F, Shekelle P, Schumacher L, Thomas BJ, Kilgus DJ, Finerman GA (1996) Differences between patients’ and physicians’ evaluations of outcome after total hip arthroplasty. J Bone Joint Surg Am 78(6):835–883

    CAS  PubMed  Google Scholar 

  25. Marx RG, Jones EC, Atwan NC, Closkey RF, Salvati EA, Sculco TP (2005) Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. J Bone Joint Surg 87(9):1999–2005

    Article  PubMed  Google Scholar 

  26. Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D (2010) The Harris hip score: do ceiling effects limit its usefulness in orthopedics? Acta Orthop 81(6):703–707

    Article  PubMed  PubMed Central  Google Scholar 

  27. Giesinger JM, Kuster MS, Behrend H, Giesinger K (2013) Association of psychological status and patient-reported physical outcome measures in joint arthroplasty: a lack of divergent validity. Health Qual Life Outcomes 11(64):64

    Article  PubMed  PubMed Central  Google Scholar 

  28. Matsumoto M, Baba T, Homma Y, Kobayashi H, Ochi H, Yuasa T, Behrend H, Kaneko K (2015) Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure. Eur J Orthop Surg Traumatol. July 7, 2015 [Epub ahead of print]

  29. Oinuma K, Eingartner C, Saito Y, Shiratsuchi H (2007) Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 19:310–326

    Article  PubMed  Google Scholar 

  30. Ropars M, Morandi X, Huten D, Thomazeau H, Berton E, Darnault P (2009) Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement. Surg Radiol Anat 31(3):199–204

    Article  PubMed  Google Scholar 

  31. Tagliafico A, Serafini G, Lacelli F, Perrone N, Valsania V, Martinoli C (2011) Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med 30(10):1341–1346

    PubMed  Google Scholar 

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Acknowledgments

No funds were received in support of this study. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Affiliations

  1. Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Yasuhiro Homma, Tomonori Baba, Kei Sano, Hironori Ochi, Mikio Matsumoto, Hideo Kobayashi, Takahito Yuasa & Kazuo Kaneko

  2. Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Uyayasusi, Chiba, Japan

    Yuichiro Maruyama

Authors
  1. Yasuhiro Homma
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  2. Tomonori Baba
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  3. Kei Sano
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  4. Hironori Ochi
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  5. Mikio Matsumoto
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  6. Hideo Kobayashi
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  7. Takahito Yuasa
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  8. Yuichiro Maruyama
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  9. Kazuo Kaneko
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Correspondence to Yasuhiro Homma.

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Homma, Y., Baba, T., Sano, K. et al. Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty. International Orthopaedics (SICOT) 40, 1587–1593 (2016). https://doi.org/10.1007/s00264-015-2942-0

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  • DOI: https://doi.org/10.1007/s00264-015-2942-0

Keywords

  • Direct anterior approach
  • Lateral cutaneous femoral nerve
  • Quality of life
  • Patient reported outcomes
  • Forgotten joint score
  • JHEQ