Incidence of Meralgia Paresthetica After Anterior Hip Replacement Surgery
Limited Direct Evidence Available
The provided evidence does not contain specific data on meralgia paresthetica incidence following anterior approach total hip arthroplasty. The available studies address this complication primarily in the context of posterior lumbar spine surgery performed in the prone position, which represents a fundamentally different surgical scenario and patient positioning.
Incidence Data from Related Procedures
The incidence of meralgia paresthetica varies dramatically by surgical approach and positioning:
Posterior lumbar spine surgery (prone position): 12-23.8% incidence 1, 2
Mechanism in prone positioning: External compression of the lateral femoral cutaneous nerve (LFCN) near the anterior superior iliac spine against surgical frame supports 1, 2
Why These Data May Not Apply to Anterior Hip Arthroplasty
Critical differences in surgical context:
- Patient positioning: Anterior hip replacement is performed with the patient supine, not prone 3
- Compression mechanism: The LFCN compression in prone spine surgery occurs from frame posts pressing against the anterior superior iliac spine—a mechanism not present in supine positioning 1, 2
- Surgical field: The anterior hip approach operates in proximity to the LFCN anatomically, but through direct surgical exposure rather than external compression
Risk Factors Identified (from spine surgery data)
When meralgia paresthetica does occur from positioning, risk factors include:
- Higher body mass index (23.6 vs 22.4 kg/m²) 2
- Overweight/obesity (odds ratio 1.83) 2
- Longer surgical duration (3.7 vs 3.2 hours) 2
- Thinner individuals in prone positioning due to less soft tissue padding 1
Clinical Course When It Occurs
Prognosis is universally excellent:
- 53% achieve complete recovery within the first week 2
- 92% asymptomatic at 6 months 1
- 100% recovery expected within 2 months 2
- Average recovery time: 10.5 days (range 2 days to 2 months) 2
Clinical Implications
The absence of procedure-specific data for anterior hip arthroplasty in the evidence base suggests:
- This complication may be sufficiently rare in anterior hip replacement that it has not been systematically studied
- The supine positioning used in anterior hip arthroplasty eliminates the primary mechanism (external compression from prone positioning) responsible for the 12-24% incidence seen in spine surgery
- Direct surgical injury to the LFCN during anterior hip approach remains theoretically possible but appears uncommon enough to lack dedicated literature
If meralgia paresthetica does occur postoperatively, conservative management is appropriate given the self-limited natural history, with surgical intervention reserved only for persistent symptoms beyond 3-6 months 4, 5, 6.