Meralgia paresthetica of the contralateral leg after total hip arthroplasty

In the United States, total hip arthroplasty (THA) is typically performed with the patient in the lateral decubitus position. Positioning of the morbidly obese patient can be technically challenging and may require special positioning equipment. Although the increased incidence of complications after THA in obese patients has been well documented, neurologic complications in the contralateral limb are rare. This article describes a case of a patient with impairment of the lateral femoral cutaneous nerve in the contralateral leg after THA. A 55-year-old woman with a body mass index of 34.24 kg/m² underwent THA in the right lateral decubitus position. Because of her body habitus, a bean-bag positioner was used. Total hip arthroplasty was performed using a direct lateral approach. Intraoperative surgical time was 2.5 hours, and total anesthesia time was 3.5 hours. A few days postoperatively, the patient began to experience "burning and shooting" pain in the contralateral hip, but she did not report this pain until 6 weeks postoperatively. She was treated initially with a single lidocaine injection. When this was ineffective, she was treated with topiramate (100 mg daily) and vitamin B6 (100 mg orally twice daily). The symptoms lessened markedly at 5 months and resolved completely at 9 months postoperatively. Meralgia paresthetica is an uncommon, but known, complication of THA. To our knowledge, it has been reported only in the operative limb. This report reinforces the need for careful positioning to avoid pressure over the anterior superior iliac spine intraoperatively. Neurologic complications after total hip arthroplasty (THA) are relatively uncommon, with a reported overall incidence of 1% to 2%.¹ Such complications usually involve the operated limb and are the direct result of internal physical disturbances intraoperatively. Nerve compression injuries as a result of positioning have also been reported,^2,3 usually as a result of inadequate padding of bony prominences such as the elbow or the knee intraoperatively. Peripheral nerve injuries can also result from excessively long surgeries or periods of hypoxia intraoperatively. ⁴ This article describes a case of a moderately obese woman with osteoarthritis who underwent a THA in the lateral decubitis position and in whom meralgia parasthetica subsequently developed in the contralateral leg.