JBJS Editor’s Choice—Prevent Nerve Damage During Anterior Hip Approaches
While anatomy is the foundation of all surgical practice, we at The Journal do not often publish an-
atomic manuscripts. We make exceptions when papers have the potential to influence the practice of orthopaedic surgery in a major way. Such an exception is the cadaver study by Rudin et al. in the April 6, 2016 JBJS.
The authors focus on the course of the lateral femoral cutaneous nerve (LFCN) of the thigh. This is a highly relevant anatomic structure because of the increasing interest in the anterior approach for hip arthroplasty, for anterior approaches to the hip for open reduction of femoral-head or proximal-femur fractures, and even for surgically treating femoroacetabular impingement.
The major take-home point is the extensive variability of this nerve in terms of where it exits the pelvis and its three different branching patterns from there (see illustration). These anatomic findings should alert the operating surgeon to make skin incisions as lateral as possible and to take extra caution when creating the interval deep to the fascial plane.
Rudin et al. have performed a service to the orthopaedic community by carefully defining the high degree of variability in the course of this nerve, which often is in harm’s way during common surgical exposures. Although injury to the sensory-only LFCN will not lead to major neurological complications, the authors conclude that patients undergoing anterior hip approaches should be informed of the risks of sensory loss or dysesthesia.
Marc Swiontkowski, MD