Incidence and clinical outcome of lateral femoral cutaneous nerve injury after periacetabular osteotomy.

Aims Lateral femoral cutaneous nerve (LFCN) injury is a complication after periacetabular osteo-tomy (PAO) using an anterior approach, which might adversely affect the outcome. However, no prospective study has assessed the incidence and severity of this injury and its effect on the clinical outcomes over a period of time for longer than one year after PAO. The aim of this study was to assess the incidence and severity of the symptoms of LFCN injury for ≥ three years after PAO and report its effect on clinical outcomes. Methods A total of 40 hips in 40 consecutive patients who underwent PAO between May 2016 and July 2018 were included in the study, as further follow-up of the same patients from a previous study. We prospectively evaluated the incidence, severity, and area of symptoms following LFCN injury. We also recorded the clinical scores at one year and ≥ three years postoperatively using the 36-Item Short Form Health Survey (SF-36) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores. Results A total of 20 patients (50%) had symptoms of a LFCN injury at one year after PAO. At ≥ three years postoperatively, the symptoms had completely resolved in seven of these patients and 13 (33%) had persistent symptoms. The severity and area of symptoms did not significantly differ between one and ≥ three years postoperatively. The JHEQ showed significant differences in the patient satisfaction and mental scores between those with and those without sypmtoms of LFCN injury at ≥ three years postoperatively, while there was no significant difference in the mean SF-36 scores. Conclusion The incidence of LFCN injury after PAO using an anterior approach is high. The outcome of PAO, ≥ three years postoperatively, is poorer in patients with persistent symptoms from a perioperative LFCN injury, in that patient satisfaction and mental health scores are adversely affected.

[1]  Mahmoud M. Abdelwahab,et al.  Periacetabular osteotomy: A novel application of modified Stoppa approach , 2022, SICOT-J.

[2]  J. Hui,et al.  Hip survivorship following the Bernese Periacetabular Osteotomy for the treatment of Acetabular Dysplasia: A Systematic Review and Meta-analysis. , 2022, Orthopaedics & traumatology, surgery & research : OTSR.

[3]  Xinfeng Yan,et al.  Analysis of Factors Affecting Early Functional Recovery of Bernese Periacetabular Osteotomy , 2021, Orthopaedic surgery.

[4]  D. Setoguchi,et al.  Incidence and clinical outcome of lateral femoral cutaneous nerve injury after periacetabular osteotomy. , 2021, The bone & joint journal.

[5]  M. Thaler,et al.  The Anatomical Course of the Lateral Femoral Cutaneous Nerve in Relation to Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach. , 2020, The Journal of arthroplasty.

[6]  M. Noble,et al.  Peripheral nerve injury and myelination: Potential therapeutic strategies , 2020, Journal of neuroscience research.

[7]  P. Beaulé,et al.  What Is the Impact of Periacetabular Osteotomy Surgery on Patient Function and Activity Levels? , 2020, The Journal of arthroplasty.

[8]  A. Malviya,et al.  Complications and outcome after periacetabular osteotomy - influence of surgical approach , 2020, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[9]  A. Boon,et al.  Prospective evaluation of lateral femoral cutaneous nerve injuries during periacetabular osteotomy , 2019, Journal of hip preservation surgery.

[10]  J. Baty,et al.  Patient-Reported Outcomes of Periacetabular Osteotomy from the Prospective ANCHOR Cohort Study , 2017, The Journal of bone and joint surgery. American volume.

[11]  K. Kaneko,et al.  Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty , 2016, International Orthopaedics.

[12]  O. Ullrich,et al.  The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint. , 2016, The Journal of bone and joint surgery. American volume.

[13]  J. Clohisy,et al.  Surgical Treatment of Adolescent Acetabular Dysplasia With a Periacetabular Osteotomy: Does Obesity Increase the Risk of Complications? , 2015, Journal of pediatric orthopedics.

[14]  M. Naito,et al.  Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips , 2014, Clinics in orthopedic surgery.

[15]  N. Ishiguro,et al.  Reliability and validity of the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) for patients with hip disease , 2013, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[16]  J. Elfar,et al.  Nerve physiology: mechanisms of injury and recovery. , 2013, Hand clinics.

[17]  David Zurakowski,et al.  Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. , 2009, The Journal of bone and joint surgery. American volume.

[18]  A. Maeyama,et al.  Ischemia of the lateral femoral cutaneous nerve during periacetabular osteotomy using Smith-Petersen approach , 2009, Journal of Orthopaedics and Traumatology.

[19]  R. Baron,et al.  painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain , 2006, Current medical research and opinion.

[20]  Masatoshi Naito,et al.  Curved Periacetabular Osteotomy for Treatment of Dysplastic Hip , 2005, Clinical orthopaedics and related research.

[21]  A. Heinecke,et al.  Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. , 1999, The Journal of bone and joint surgery. American volume.

[22]  J. E. Brazier,et al.  Validating the SF-36 health survey questionnaire: new outcome measure for primary care. , 1992, BMJ.

[23]  C. Goldsmith,et al.  Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. , 1988, The Journal of rheumatology.

[24]  R. Ganz,et al.  A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. , 1988, Clinical orthopaedics and related research.

[25]  S SUNDERLAND,et al.  A classification of peripheral nerve injuries producing loss of function. , 1951, Brain : a journal of neurology.

[26]  WILLIAM K. Massie,et al.  Congenital dislocation of the hip. Part I. Method of grading results. , 1950, The Journal of bone and joint surgery. American volume.

[27]  J. Clohisy,et al.  Obesity is a major risk factor for the development of complications after peri-acetabular osteotomy. , 2015, The bone & joint journal.

[28]  M. Smith-Petersen Approach to and exposure of the hip joint for mold arthroplasty. , 1949, The Journal of bone and joint surgery. American volume.