Femoral neuropathy following total hip arthroplasty. Anatomic study, case reports, and literature review.

Femoral neuropathy is an uncommon yet debilitating complication of total hip arthroplasty (THA). Over a 1-year period, in 440 consecutive THAs performed at Pennsylvania Hospital, 10 (2.3%) femoral neuropathies occurred. Among primary arthroplasties, all neuropathies were associated with the Hardinge anterolateral approach. A retrospective case review as well as a detailed anatomic cadaveric study highlighted the characteristics of the femoral nerve that make it susceptible to injury. In addition, a review of the existing literature on this subject was performed. Placement and management of acetabular retractors were the factors most commonly associated with injury of the femoral nerve. All affected patients had significant initial disability. However, full femoral nerve. All affected patients had significant initial disability. However, full functional recovery occurred within 1 postoperative year. Clear understanding and awareness of the anatomy of the femoral triangle as well as accurate placement of anterior acetabular retractors can minimize the incidence of this complication.