Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2024; 15(12): 1175-1182
Published online Dec 18, 2024. doi: 10.5312/wjo.v15.i12.1175
Femoral nerve palsy following Girdlestone resection arthroplasty: An observational cadaveric study
Dominik Spuehler, Lukas Kuster, Oliver Ullrich, Karl Grob
Dominik Spuehler, Karl Grob, Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Sankt Gallen, Sankt Gallen 9007, Switzerland
Lukas Kuster, Department of Orthopaedics Surgery, Sir Charles Gairdner Hospital, Perth 6009, Western Australia, Australia
Oliver Ullrich, Institute of Anatomy, University of Zurich, Zurich 8057, Switzerland
Author contributions: Spuehler D performed the dissection of the cadavers, and analysis and interpretation of the data, and wrote the first draft of the manuscript; Grob K managed the research team, designed the research question, performed the dissection of the cadavers, and revised the manuscript; Kuster L contributed to the systematic research for and revision of the paper; Ullrich O critically assessed the scientific approach and the final draft of the manuscript and data interpretation; All authors read, edited, and approved the final submitted manuscript.
Institutional review board statement: The Institutional Review Board of the Ethics Committee of the Canton Zurich (KEK) provided approval for this study (BASEC Application No. Req-2016-00096). Studies of the Human Anatomy and Implementation of Surgery Courses Aiming at Improvement of Undergraduate and Postgraduate Medical Education are unproblematic from an ethical perspective.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent before their body was donated to the Institute of Anatomy at the University of Zurich for research purposes.
Conflict-of-interest statement: Dominik Spuehler, Lukas Kuster, and Karl Grob have no conflicts of interest to disclose. Professor Oliver Ullrich is Vice President of the German Society for Aerospace Medicine (DGLRM), President of the Swiss SkyLab Foundation (Zurich, Switzerland), and he is a member of the following Editorial Boards: Scientific Reports (Nature), Acta Astronautica (Elsevier), International Journal of Molecular Science (MDPI), Flugmedizin, Reisemedizin, Tropenmedizin (Thieme).
Data sharing statement: There are no additional data available.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement - checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dominik Spuehler, MMed, Doctor, Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Sankt Gallen, Rorschacher Strasse 95, Sankt Gallen 9007, Switzerland. domi.spuehler@gmail.com
Received: June 15, 2024
Revised: November 12, 2024
Accepted: December 5, 2024
Published online: December 18, 2024
Processing time: 184 Days and 14.7 Hours
Abstract
BACKGROUND

When patients with a failed hip arthroplasty are unsuitable for reimplantation, Girdlestone resection arthroplasty (GRA) is a viable treatment option. We report on a patient who was treated with a GRA due to a periprosthetic infection. We discovered partial paralysis of the quadriceps muscle in this patient. We investigated the femoral nerve anatomy, particularly the nerve entry points, to better understand this phenomenon.

AIM

To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.

METHODS

Eight cadaveric hemipelves were investigated. The branches of the femoral nerve were dissected and traced distally. The GRA was performed by the direct anterior approach. Axial stress to the lower extremity was applied, and the relative movement of the femur was recorded. The femoral nerve and its entry points were assessed.

RESULTS

GRA led to a 3.8 cm shift of the femur in vertical direction, a 1.8 cm shift in the dorsal direction, and a 2.3 cm shift in the lateral direction. A 36.5° external shift was observed. This caused stress to the lateral division of the femoral nerve. We observed migration of the femoral nerve entry point at the following locations: (1) Vastus medialis (5.3 mm); (2) The medial part of the vastus intermedius (5.4 mm); (3) The lateral part of the vastus intermedius (16.3 mm); (4) Rectus femoris (23.1 mm); (5) Tensor vastus intermedius (30.8 mm); and (6) Vastus lateralis (28.8 mm).

CONCLUSION

Migration of the femur after GRA altered the anatomy of the femoral nerve. Stress occurred at the lateral nerve division leading to poor functional results.

Keywords: Girdlestone resection arthroplasty; Resection arthroplasty of the hip; Failed hip replacement; Femoral nerve palsy; Anatomy of the femoral nerve; Periprosthetic infection

Core Tip: Girdlestone resection arthroplasty (GRA) is a viable treatment option after a failed hip arthroplasty due to severe periprosthetic infections, poor bone stock, damaged pelvitrochanteric muscles, or comorbid disease. We initially treated a patient with bilateral GRA, who subsequently developed femoral nerve palsy. We investigated the femoral nerve anatomy after GRA in four cadavers (a total of eight hips). We detected migration of the femoral nerves, which caused stress at the lateral oblique femoral nerve division where the major psoas muscle acted as a hindrance. The partial femoral nerve palsy after GRA leads to poor functional outcomes.