Injury to the lateral femoral cutaneous nerve during minimally invasive hip surgery: a cadaver study.
BACKGROUND
A smaller skin incision as part of minimally invasive surgery (MIS) for total hip arthroplasty (THA) is thought to reduce local tissue trauma. Preservation of cutaneous nerves may reduce postoperative pain and improve rehabilitation. The standard lateral approach (SLA) and two MIS approaches (anterolateral [ALA] and posterior [PA]) were compared to determine which incision preserved cutaneous nerves.


METHODS
Fifteen cadaveric hip specimens were dissected to establish the course of branches of the lateral femoral cutaneous nerve. The number of branches divided by each of the three incisions was recorded.


RESULTS
The MIS incisions resulted in significantly less nerve division compared with the SLA. The mean difference between the SLA and the ALA was 4.4 (P < 0.0001), and between the SLA and the PA was 1.4 (P = 0.0005). The ALA divided significantly fewer nerves compared with the PA (mean difference = 3; P = 0.0001).


CONCLUSIONS
There is little evidence of the benefit of one MIS approach over another in the literature. The ALA preserved significantly more cutaneous nerves in this study. These results need corroboration with clinical outcomes to determine their significance.
Jameson
Simon S
SS
Department of Anatomy and Clinical Skills, Newcastle University, Newcastle upon Tyne, UK. simonjameson@doctors.org.uk
Howcroft
Daniel W J
DW
McCaskie
Andrew W
AW
Gerrand
Craig H
CH
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D002102:Cadaver; D004210:Dissection; D005260:Female; D005267:Femoral Nerve / Q000293:injuries* / Q000473:pathology; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015207:Osteoarthritis, Hip / Q000473:pathology / Q000601:surgery; D010149:Postoperative Pain / Q000209:etiology; D012867:Skin / Q000294:innervation*