Hip replacement surgery can be life-changing for people with hip pain that limits their mobility. However, like any surgical procedure, hip replacement surgery carries certain risks—including the potential for nerve-related complications.
Peripheral nerve surgeon Dr. Eric H. Williams treats patients who have nerve pain caused by damage to the lateral femoral cutaneous nerve as a complication of hip replacement surgery performed from an anterior approach. This pain can be debilitating, but surgical removal of the damaged nerve can help you get back to enjoying everyday activities free of pain.
About the Lateral Femoral Cutaneous Nerve
The lateral femoral cutaneous nerve is a branch of the lumbar plexus, specifically originating from the second and third lumbar nerves (L2 and L3). This nerve’s primary function is to provide sensory innervation to the skin on the front and side of the thigh, including the outer and upper parts of the thigh.
The lateral femoral cutaneous nerve travels from the spine and lumbosacral plexus behind the abdominal contents into the pelvis, crosses beneath the inguinal ligament (a band of connective tissue that runs from the anterior superior iliac spine to the pubic tubercle), and then continues to branch out to supply sensation to the skin on the lateral (outer) part of the thigh. It does not have a motor function, meaning it doesn't control any muscles but solely carries sensory information.
How Nerve Damage Can Lead to Meralgia Paresthetica After a Hip Replacement
Hip replacement surgery from an anterior approach involves making an incision on the front of the hip. While this approach has its benefits, it can pose unique challenges when it comes to nerve-related complications. The primary concern in anterior hip replacement surgery is the placement of the surgical scar, as it directly affects the nerves in the area. Surgeons must take great care to avoid damaging the lateral femoral cutaneous nerve when making the incision and using retractors to expose the surgical site.
When the lateral femoral cutaneous nerve is compressed or damaged, this can lead to severe pain in the outside of the thigh. This condition is known as meralgia paresthetica. People with meralgia paresthetica often experience a burning pain, typically radiating from the groin crease to the knee. This pain can be intense and may feel like battery acid, fire ants gnawing at the leg, or thumbtacks on the skin. It is often exacerbated when sitting or standing up and can persist over time.
It's crucial to note that while people with damage to the lateral cutaneous femoral nerve from a hip replacement may experience soreness and weakness in the affected leg, the ability to physically move the leg should remain intact. Weakness or inability to move the leg can indicate damage to the femoral nerve.
Diagnosing Nerve-Related Complications After an Anterior Hip Replacement
Before seeking specialized care for nerve-related complications, you’ll want to rule out problems with the hip replacement itself. Your orthopedic surgeon should verify that the hip replacement components are properly positioned and that there are no signs of infection or hardware loosening.
Dr. Williams recommends an ultrasound-guided injection of the lateral femoral cutaneous nerve as a diagnostic tool. If the pain subsides temporarily after the injection, it supports the diagnosis of nerve involvement.
Potential Treatment Options
Non-surgical treatment options for damage to the lateral femoral cutaneous nerve after an anterior hip replacement include:
- Steroid injections to reduce inflammation
- Pain management medications like gabapentin, Lyrica, Cymbalta, and amitriptyline
- Physical therapy, including water therapy in a pool
- Texture therapy using different types of fabrics to help patients become accustomed to sensations on the skin
For patients who continue to experience significant discomfort after conservative treatments, Dr. Williams may recommend the removal of the affected nerve. Since the nerve has already been injured and is not of paramount importance, removing it can provide relief without limiting your mobility. In most cases, patients experience numbness but no pain after nerve resection. Most patients prefer numbness of the lateral thigh over the severe pain that they are suffering from.
There may also be options other than removing the nerve that may be discussed, including nerve reconstruction with nerve grafting.