Research progress of the lateral femoral cutaneous nerve injury during total hip arthroplasty with a direct anterior approach

Abstract

Objective To investigate the causes of palsy complications in minimally invasive total hip arthroplasty via a anterior and its prevention strategy. Methods A computer-based search was conducted in PubMed and CNKI databases for literatures related to minimally invasive total hip arthroplasty via a anterior from January 2005 to November 2016 with the key words direct anterior approach , femoral cutaneous nerve in English and 直接前侧入路 , 股外侧皮神经 in Chinese. As a result, 28 articles were carefully reviewed. Analysis was conducted for the anatomical features of anterior approach, Hueter interval and lateral femoral cutaneous as well as the prevention strategies for never injury based on the selected articles. Results Lateral femoral cutaneous injury is one of common complications of anterior for total hip replacement, and the incidence is between 0.9%-3.4%. Total hip arthroplasty through the Hueter interval is the fittest procedure, which meet the standard of minimally invasive surgery. Unfortunately, lateral femoral cutaneous is constantly injuried during splitting subcutaneous soft tissue when skin incision is carried. To alleviate the injury to the lateral femoral cutaneous nerve, surgeons can choose suitable incision location, make surgical procedures exquisite, pull the retractor in a longitudinal direction, and locate the intermuscular septum perforating branches. Conclusions Compared with traditional total hip arthroplasty, anterior has less soft tissue injury theoretically, and, meanwhile, there are prevention strategies to alleviate lateral femoral cutaneous injuries which occur in this surgical procedures. Key words: Arthroplasty, replacement, hip; Direct anterior approach; Minimally invasive; Lateral femoral cutaneous nerve; Prevent