Femoral nerve injury after transfemoral catheterization and total hip arthroplasty

Background: Nerve injury after total hip arthroplasty (THA) is a recognized complication and is included in informed consent. Ninety-five percent of femoral artery catheterizations (FACs) utilize a right-side approach, and scar can develop around the femoral nerve. The effect of prior FAC on femoral nerve injury during THA has not been investigated previously. Methods: The Medicare database was searched for patients who had primary THA after FAC between 2005 - 2015 (study group). Patients who underwent bilateral THA without prior FAC served as the control group. Proprietary software was used to query the database according to the International Classification of Diseases procedural and diagnostic codes and Common Procedural Technology Codes for primary THA and FAC. Chi-square testing was used to determine significance (P< 0.05). Results: There were 62,016 patients in the study group and 441,013 patients in the control group. The left femoral nerve injury rate in the control group was 0.55% and 0.51% in the study group. The right femoral nerve injury rate in the control group was 0.53% and 1.55% in the study group (P< 0.0001). This complication was not coded in the hospital record of 54% of patients. Greater and more complex secondary procedures were performed to treat the nerve injury in the study group (P <0.001), indicating a more severe injury. Conclusions: Patients with prior right FAC have significantly more severe right femoral nerve injuries during THA. Awareness of this risk may improve dialogue with and treatment of patients.