Treatment options for persistent lateral femoral cutaneous nerve lesions after total hip arthroplasty via the direct anterior approach: retrospective analysis with clinical assessment

Purpose: The direct anterior approach (DAA) in total hip arthroplasty (THA) has a risk of lateral femoral cutaneous nerve (LFCN) injury. Long-term outcomes and therapeutic options for such injuries are poorly investigated. This study evaluates the impact of iatrogenic LFCN lesions on long-term outcomes and investigates treatments like ultrasound-guided nerve infiltration or neurolysis. Methods: Our institutional database of primary THAs (2014–2022) was searched for patients with iatrogenic LFCN lesions after DAA, confirmed via ultrasound or electroneurography. First, retrospective analysis of the effects of ultrasound-guided nerve infiltration and neurolysis. Second, clinical-radiological assessment of pain, function, incision, and affected skin area. Patient-reported outcomes (OHS, COMI Hip, UCLA) were compared to a matched non-LFCN injury control group. Results: Of 8136 patients, 29 (0.36%) met inclusion criteria, with 22 undergoing ultrasound diagnostics. Eighteen received nerve infiltration (improvement after one (n = 7), two (n = 3) or three (n = 1) infiltrations), and two had neurolysis. After a mean follow-up of 4.95 years, 13 patients were assessed. Common symptoms included hypesthaesia (11), dysesthesia (6), and tingling (3), with a mean affected area of 253cm2 ± 64.8. 24-months questionnaires for the LFCN group (OHS 39.2 ± 8.6, COMI Hip 2.4 ± 2.7, UCLA 6.5 ± 1.6) were worse than the control group (OHS 46.2 ± 2.3, COMI Hip 0.6 ± 0.8, UCLA 7.2 ± 1.5), though differences were not statistically significant. Conclusion: Instrumentally proven LFCN lesions after DAA THA are rare but lead to worse long-term outcomes. Ultrasound-guided nerve infiltration shows favorable results for symptom management. © The Author(s) 2025.