Lateral femoral cutaneous nerve neuroma treatment after hip arthroscopy: a case report and review of the literature

Abstract

INTRODUCTION I n 2018, over 1.7 million hip arthroscopies were performed, most often for treatment of femoracetabular impingement (FAI), labral tears, and chondral defects. With popularity of hip arthroscopy increasing, unique complications such as injury to the lateral femoral cutaneous nerve (LFCN) during portal placement are becoming more common. A recent systematic review of 36,761 hip arthroscopies showed LFCN injury was the second most common nerve injury with an incidence of 0.3%. Anatomic studies demonstrate the average distance of the LFCN to the direct anterior hip portal is 0.3 cm. Laceration or stretch injury of the LFCN during hip arthroscopy can lead to neuroma formation, which can lead to significant disability from chronic neuropathic pain. Treatment of painful neuromas is complex and controversial. Nonsurgical treatments such as gabapentinoid and neuromodulating medications have been described, along with serial lidocaine injections. Ablation and desensitization therapy have shown inconsistent results. Traditional surgical options include resecting the neuroma and capping the nerve end. More recently, targeted muscle reinnervation has emerged as feasible treatment for neuromas arising from amputations. This is borne out of the 1980s technique of neurotization in which painful neuromas are excised, and the remaining sensory nerve is transferred to an adjacent muscle motor endplate to give the nerve a new role and prevent neuroma recurrence. While previous studies have shown success of neurotization to be as high as 80% elsewhere in the body, no studies to date have examined the role of this technique for treatment of LFCN neuromas associated with hip arthroscopy. Therefore, the purpose of our study is to present a case of successful LFCN neuroma treatment with neurotization to highlight this technique as a durable treatment option for this challenging hip arthroscopy complication. The patient was informed data concerning the case would be submitted for publication and provided consent. Institutional review board approval was not required for this case report.