Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Abstract

Background：The postoperative complaints of hypoaesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients is not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods： A total of 59 patients were allocated to the ultrasound group and 58 patients were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months post-surgery, the rate of LFCN injury and abnormal sensitive area were evaluated in both groups. Results： Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8±2.6 (3.0 ~12.0) mm to 11.1±3.4 (4.0 ~17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3±4.6 (-5.0 ~10.0) mm at proximal part and -2.7±4.7 (-10.0 ~8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group were significantly lower than those in the control group (3.4% VS 25.9%, P=0.001, χ21=11.893, at 1 month; 3.4% VS 22.4%, P=0.005, χ21=9.471, at 3 months).Conclusions： LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.