Total hip arthroplasty (THA) is among the most common orthopedic procedures worldwide. Multiple different approaches to the hip have been described, and the use of the anterior approach (AA) is now commonplace, along with the posterior and lateral approach. There are different skin incisions for the AA, namely the vertical skin incision (VA) and “Bikini” incision along langers lines. Lateral Femoral Cutaneous nerve (LFCN) injury is known to be a reported post operative complaint with the AA, but can also take place with all approaches (due to pressure on ASIS). This study aims to evaluate the rate of LFCN injury and long term postoperative neuropraxia following different approaches to the hip and compare the VA and Bikini AA skin incisions. This is an IRB-approved, retrospective cohort study. Patients were recruited from a tertiary academic center, six fellowship trained arthroplasty surgeons performed the arthroplasty procedures. Patients, at least 12-months post-THA, were contacted and were asked to report on patient reported outcome measures (Oxford Hip Score, EQ-5d), including the Douleur Neuropathique 4 Questions (DN-4) questionnaire if greater than 12 months post THA. Demographic information was recorded, as well as specific approach (VA, Bikini, Lateral, or Posterior). 310 patients were recruited, 37% (115) had the VA, 27.5% (85) had the Bikini, 35.5% (110) had a lateral or posterior approach. The DN-4 is indicative of chronic neuropathic pain if scores are > 4. The mean DN-4 was 0.6±1.5. There was a weak association between DN-4 and OHS (rho=0.3, p 4. The rates of neuropathic pain per approach were 8.6% (N=10) for the VA-AA, 5.8% (N=5) for the Bikini-AA approach, and 4.5% (n=5) with a lateral or posterior approach (p=.434). There is no significant difference between VA and Bikini anterior skin incisions for chronic LCFN neuropraxia post THA at one year or greater follow up. Further study with a larger patient cohort is warranted to determine the optimal skin incision for AA THA. The rate of LCFN neuropraxia with lateral based incisions is somewhat surprising given the anatomic location of the incision away from the course of the LFCMN, although this could potentially be explained by anterior bolster placement.
Benavides et al. (Wed,) studied this question.