The Lateral Femoral Cutaneous Nerve is at High Risk During Direct Anterior Approach to the Hip Joint Due to Proximity and Anatomic Variations: A Cadaveric Study.

Abstract

Objective: In direct anterior approach (DAA) to the hip joint, the risk of lateral femoral cutaneous nerve (LFCN) injury is high. This study on cadavers aimed to identify variations in the anatomy and route of the LFCN and its relationship with the DAA.

Methods: The cross-sectional study was conducted on 15 adult formalin-embalmed cadavers [8 males and 7 female (15 paired hips)]. The anterior superior iliac spine, pubic tubercle, and fibular head were used as anatomical reference points.

Results: All 30 portals were inserted completely without damage or complications at the anatomical sites. The mean age standard deviation was 72.0 (16.8) range: 26-91 years old. Nineteen nerves crossed the incision. The branching pattern of the lateral cutaneous nerve of the thigh below the inguinal ligament is predominantly fan type (12 nerves, 40.0%), followed by sartorius type (11 nerves, 37.0%), with a lower percentage being posterior type (7 nerves, 23.3%). The average distance from the initial point to the location where the lateral cutaneous nerve of the thigh crosses the surgical incision was 35.3 (16.4-62.9) mm, with a range of 2.3-92.2 mm.

Conclusions: The risk of LFCN injury was 50%. Understanding variations in the anatomy and route of the LFCN and its proximity to the incision of the DAA to the hip joint may reduce the risk of injury.