Lateral Femoral Cutaneous Nerve Neuroma Resection and Nerve Capping after Direct Anterior Approach: A Case Report

Introduction: The direct anterior approach (DAA) for primary and revision total hip arthroplasty (THA) has been growing in popularity due to reported less soft tissue disruption, less post-operative pain, earlier post-operative functional recovery, and lower dislocation rate. One potential complication of this approach is damage to the lateral femoral cutaneous nerve (LFCN). The incidence of damage to the LFCN in the literature ranges from 14.8% to 81%. Documented treatments consist mainly of conservative measures; however, here, we describe a case where operative intervention was pursued due to failure of conservative measures. Case Report: A 59-year-old male with a history of primary and revision DAA THA was referred to the upper extremity clinic for evaluation and treatment of painful LFCN neuroma. After failing non-operative management, the patient underwent LFCN exploration, neuroma excision, and placement of nerve cap. The patient demonstrated significant improvement in subjective and objective measures at the 1-year post-operative time point. Conclusion: Care must be taken during proximal incision extent in DAA THA due to anatomic variations of the LFCN. Although there is not an abundance of evidence, nerve capping may be a reasonable solution for those patients with severe LFCN neuropathy who have failed conservative modalities.