Femoral Nerve Palsy After Anterior Total Hip Arthroplasty: A Systematic Review
Abstract
Background: Femoral nerve palsy (FNP) is a rare but debilitating complication of total hip arthroplasty (THA). The direct anterior approach (DAA) has been gaining popularity in recent years. Concerns regarding the risk of FNP after DAA THA have been rising due to the anatomical proximity of the femoral nerve. This systematic review evaluates the risk and incidence of FNP after DAA THA.
Methods: A search was conducted using PubMed, Cochrane, Ovid Medline, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Data were extracted pertaining to incidence, comparison to other approaches and recovery. A qualitative analysis was done.
Results: Our study included 9 studies-1 randomized control trial, 3 retrospective reviews, 4 case series, and 1 case report. The total sample size of DAA THA patients was 16,258 with an incidence of 0.36% (95% confidence interval (CI), 0.28-0.47%). The 3 studies that compared DAA to other approaches reported a higher incidence of FNP with the DAA. Of the studies that included recovery, most cases of FNP demonstrated full motor recovery in 3-15 months.
Conclusions: FNP is a rare complication of THA that occurs more frequently in the DAA. Retractor placement, patient positioning, and patient related risk factors play a key role in increasing risk. Further high quality studies are needed to assess the risk and preventative measures.
Level of evidence: V.
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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