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Hip

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

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    Published Online:1 Apr 2021https://doi.org/10.1302/0301-620X.103B4.BJJ-2020-0990.R2

    Abstract

    Aims

    Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ).

    Methods

    The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively.

    Results

    LFCN injury was observed in 31 of 42 (74%) patients at ten days, of which 11 resolved completely by one year. Incidence decreased gradually, to 25 of 42 (60%) patients at three months, 24 of 42 patients (57%) at six months, and 20 of 42 (48%) patients at one year postoperatively. There was no significant difference in the HHS between patients with and without LFCN injury at one year postoperatively. Regarding the SF-36 and JHEQ, a significant difference in the mental score was recognized between patients with and without LFCN injury, but there were no significant differences in the other clinical scores.

    Conclusion

    The incidence of LFCN injury was 74% at ten days after PAO, and subsequently decreased to 48% at one year. LFCN injury did not influence the hip function as assessed by the HHS, but had a negative impact on mental health at one year.

    Cite this article: Bone Joint J 2021;103-B(4):659–664.

    References

    • 1. Aronson J. Osteoarthritis of the young adult hip: etiology and treatment. Instr Course Lect. 1986;35:119–128. Medline, Google Scholar
    • 2. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. technique and preliminary results. Clin Orthop Relat Res. 1988;232:26–36. Google Scholar
    • 3. Naito M, Shiramizu K, Akiyoshi Y, Ezoe M, Nakamura Y. Curved periacetabular osteotomy for treatment of dysplastic hip. Clin Orthop Relat Res. 2005;433 129–135. Crossref, ISI, Google Scholar
    • 4. Nishio A. Transposition osteotomy of the acetabulum in the treatment of congenital dislocation of the hip. J Jpn Orthop Assoc. 1956;30:483. Google Scholar
    • 5. Ninomiya S, Tagawa H. Rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Am. 1984;66-A(3):430–436. Crossref, ISI, Google Scholar
    • 6. Clohisy JC, Pascual-Garrido C, Duncan S, Pashos G, Schoenecker PL. Concurrent femoral head reduction and periacetabular osteotomies for the treatment of severe femoral head deformities. Bone Joint J. 2018;100-B(12):1551–1558. Link, ISI, Google Scholar
    • 7. Trumble SJ, Mayo KA, Mast JW. The periacetabular osteotomy. minimum 2 year followup in more than 100 hips. Clin Orthop Relat Res. 1999;363:54–63. Crossref, Google Scholar
    • 8. Smith-Petersen MN. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am. 1949;31-A(1):40–46. Crossref, ISI, Google Scholar
    • 9. Livermore AT, Anderson LA, Anderson MB, Erickson JA, Peters CL. Correction of mildly dysplastic hips with periacetabular osteotomy demonstrates promising outcomes, achievement of correction goals, and excellent five-year survivorship. Bone Joint J. 2019;101-B(6_Supple_B):16–22. Link, ISI, Google Scholar
    • 10. Biedermann R, Donnan L, Gabriel A, Wachter R, Krismer M, Behensky H. Complications and patient satisfaction after periacetabular pelvic osteotomy. Int Orthop. 2008;32(5):611–617. Crossref, Medline, ISI, Google Scholar
    • 11. Thawrani D, Sucato DJ, Podeszwa DA, DeLaRocha A. Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents. J Bone Joint Surg Am. 2010;92-A(8):1707–1714. Crossref, Google Scholar
    • 12. Zaltz I, Baca G, Kim Y-J, et al. Complications associated with the periacetabular osteotomy: a prospective multicenter study. J Bone Joint Surg Am. 2014;96-A(23):1967–1974. Crossref, Google Scholar
    • 13. Davey JP, Santore RF. Complications of periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:33–37. Crossref, Google Scholar
    • 14. Toki S, Nagamachi A, Yonezu H, Adachi K, Inoue K, Naito M. Injury to the obturator artery during periacetabular osteotomy: a case report. JBJS Case Connect. 2016;6(1):e9. Crossref, Medline, Google Scholar
    • 15. Matta JM, Stover MD, Siebenrock K. Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res. 1999;363:21–32. Google Scholar
    • 16. Murphy S, Deshmukh R. Periacetabular osteotomy: preoperative radiographic predictors of outcome. Clin Orthop Relat Res. 2002;405:168–174. Crossref, Google Scholar
    • 17. Ko J-Y, Wang C-J, Lin C-FJ, Shih C-H. Periacetabular osteotomy through a modified Ollier transtrochanteric approach for treatment of painful dysplastic hips. J Bone Joint Surg Am. 2002;84-A(9):1594–1604. Crossref, Google Scholar
    • 18. Mei-Dan O, Welton KL, Kraeutler MJ, Young DA, Raju S, Garabekyan T. The Cu PAO: a minimally invasive, 2-incision, interlocking periacetabular osteotomy: technique and early results. J Bone Joint Surg Am. 2019;101-A(16):1495–1504. Crossref, ISI, Google Scholar
    • 19. Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81-A(12):1747–1770. Crossref, Google Scholar
    • 20. Wiberg G. The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand. 1939;83:7–38. Google Scholar
    • 21. Naito M, Nakamura Y. Curved periacetabular osteotomy for the treatment of dysplastic hips. Clin Orthop Surg. 2014;6(2):127–137. Crossref, Medline, Google Scholar
    • 22. Teratani T, Naito M, Kiyama T, Maeyama A. Periacetabular osteotomy in patients fifty years of age or older. J Bone Joint Surg Am. 2010;92-A(1):31–41. Crossref, Google Scholar
    • 23. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51-A(4):737–755. Crossref, ISI, Google Scholar
    • 24. Brazier JE, Harper R, Jones NM, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–164. Crossref, Medline, Google Scholar
    • 25. Seki T, Hasegawa Y, Ikeuchi K, Ishiguro N, Hiejima Y. Reliability and validity of the Japanese orthopaedic association hip disease evaluation questionnaire (JHEQ) for patients with hip disease. J Orthop Sci. 2013;18(5):782–787. Crossref, Medline, ISI, Google Scholar
    • 26. Massie WK, Howorth MB. Congenital dislocation of the hip. Journal Bone Joint Surg Am. 1950;32-A(3):519–531. Crossref, Medline, ISI, Google Scholar
    • 27. Menorca RMG, Fussell TS, Elfar JC. Nerve physiology: mechanisms of injury and recovery. Hand Clin. 2013;29(3):317–330. Crossref, Medline, ISI, Google Scholar
    • 28. Ali M, Malviya A. Complications and outcome after periacetabular osteotomy - influence of surgical approach. Hip Int. 2020;30(1):4–15. Crossref, Medline, ISI, Google Scholar
    • 29. Luo D, Zhang H, Zhang W. Comparison of three approaches of Bernese periacetabular osteotomy. Ther Clin Risk Manag. 2016;12:67–72. Crossref, Medline, ISI, Google Scholar
    • 30. Rudin D, Manestar M, Ullrich O, Erhardt J, Grob K. The anatomical course of the lateral femoral cutaneous nerve with special attention to the anterior approach to the hip joint. J Bone Joint Surg Am. 2016;98-A(7):561–567. Crossref, ISI, Google Scholar
    • 31. Lee S-H, Shin K-J, Gil Y-C, Ha T-J, Koh K-S, Song W-C. Anatomy of the lateral femoral cutaneous nerve relevant to clinical findings in meralgia paresthetica. Muscle Nerve. 2017;55(5):646–650. Crossref, Medline, ISI, Google Scholar
    • 32. Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911–1920. Crossref, Medline, ISI, Google Scholar

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