Preoperative ultrasound to identify distribution of the lateral femoral cutaneous nerve in total hip arthroplasty using the direct anterior approach.

Yu Ozaki,Taiji Watari,Hiroki Tanabe,Sammy Bannno,Kazuo Kaneko,Yasuhiro Homma,Tomonori Baba,Hironori Ochi

doi:10.1051/sicotj/2018037

Yu Ozaki, Taiji Watari + Show 6 more

Open Access

https://doi.org/10.1051/sicotj/2018037

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Journal: SICOT-J	Publication Date: Jan 1, 2018
Citations: 11	License type: CC BY 4.0

Affiliation: Juntendo University

Abstract

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.

Highlights

Of approaches for total hip arthroplasty (THA), the direct anterior approach (DAA) is the only soft tissuepreserving approach using the inter-muscular and internervous plane [1,2]
We examined the proximal femur of the 45 hips by the ultrasound test before surgical treatment with THA through DAA and surveyed the presence or absence of lateral femoral cutaneous nerve (LFCN) injury 2 months after surgery
LFCN injury was observed after surgery in 9 of the 10 patients identified as the Fan type based on the ultrasound of the proximal femur, and no LFCN injury was observed in 25 of the 26 patients judged as Non-Fan type

Summary

Introduction

Of approaches for total hip arthroplasty (THA), the direct anterior approach (DAA) is the only soft tissuepreserving approach using the inter-muscular and internervous plane [1,2]. DAA-specific complications have been pointed out [6,7,8], and one of these is lateral femoral cutaneous nerve (LFCN) injury. The LFCN is a pure sensory nerve supplying the cutaneous area of the anterolateral thigh. Injury to the LFCN can result in hypesthesia or, in some patients, pain or dysesthesia in the anterolateral aspect of the thigh, and reduction of QOL due to LFCN injury after surgery despite the hip joint function being recovered by THA has been reported [9]. It is considered that LFCN injury is caused by direct injury of the nerve and by retraction with a retractor [10]

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