Skip to main content

Advertisement

SpringerLink
Log in

Common peroneal nerve palsy after primary total hip arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The study wants to evaluate the incidence, the clinical evolution, and treatment of common peroneal nerve (CPN) palsy after primary total hip arthroplasty.

Methods

Our clinical prospective study was made between January 2016 and December 2020. The study group comprised 1240 total hip replacements over a period of five years. Six cases were diagnosed with CPN palsy (0.48%). Five were women and one man, aged from 52 to 71 years old. The common peroneal nerve lesion was diagnosed clinically and by electromyography.

Results

The follow-up period was at least 24 months post-operatively. In all six cases, there was a complete common peroneal nerve palsy, documented by electromyography. The poorest results were obtained in the older patients and those who had the highest body mass index, which at two years post-operatively achieved only a partial sensory rehabilitation, with complete motor deficit. All patients can walk unassisted, without support, with one case having complete rehabilitation achieved 18 months postoperatively and three with partial rehabilitation.

Conclusion

CPN palsy after primary THA is a very serious complication with poor functional outcome. There is no consensus regarding the treatment. The age and the intensity of the rehabilitation program are the only significant factors for the medical rehabilitation after this debilitating post-operative complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All the data and materials are available upon requests from the corresponding author.

References

  1. Edwards B, Tullos H, Noble P (1987) Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 218:136–141

    Article  Google Scholar 

  2. Johanson NA, Pellicci PM, Tsairis P, Salvati EA (1983) Nerve injury in total hip arthroplasty. Clin Orthop Relat Res 179:214–222

    Article  Google Scholar 

  3. Fjeld Solheim L, Hagen R (1980) Femoral and sciatic neuropathies after total hip arthroplasty. Acta Orthop Scand 51(1–6):531–534. https://doi.org/10.3109/17453678008990836

    Article  Google Scholar 

  4. Zechmann JP, Reckling FW (1989) Association of preoperative hip motion and sciatic nerve palsy following total hip arthroplasty. Clin Orthop Relat Res 241:197–199

    Article  Google Scholar 

  5. Lazansky MG (1973) Complications revisited. The debit side of total hip replacement. Clin Orthop Relat Res 95:96–103

    Google Scholar 

  6. Schmalzried TP, Amstutz HC, Dorey FJ (1991) Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am 73:1074–1080

    Article  CAS  Google Scholar 

  7. Zazgyva A, Zuh SG, Roman CO et al (2016) Acetabular reconstruction with a reinforcement device and bone grafting in revision arthroplasty—a mean five years of follow-up. Int Orthop 40:1631–1638. https://doi.org/10.1007/s00264-015-3030-1

    Article  PubMed  Google Scholar 

  8. Zuh SG, Zazgyva A, Gergely I, Pop TS (2015) Acetabuloplasty with bone grafting in uncemented hip replacement for protrusion. Int Orthop 39:1757–1763. https://doi.org/10.1007/s00264-015-2804-9

    Article  PubMed  Google Scholar 

  9. Schmalzried TP, Noordin S, Amstutz HC (1997) Update on nerve palsy associated with total hip replacement. Clin Orthop Relat Res 344:188–206

    Article  Google Scholar 

  10. Park JH, Hozack B, Kim P, et al (2013) Common peroneal nerve palsy following total hip arthroplasty: prognostic factors for recovery. J Bone Joint Surg - Series A 95: https://doi.org/10.2106/JBJS.L.00160

  11. Roman MD, Fleaca RS, Boicean A et al (2017) Assessment of synovial fluid pH in osteoarthritis of the HIP and knee. Revista de Chimie (Rev Chim) 68:1242–1244. https://doi.org/10.37358/RC.17.6.5649

    Article  CAS  Google Scholar 

  12. Sfeatcu R, Cernuşcă-Miţariu M, Ionescu C et al (2014) The concept of wellbeing in relation to health and quality of life. Eur J Sci Theol 10(4):123–128

    Google Scholar 

  13. Fleming P, Lenehan B, O’Rourke S et al (2003) Strain on the human sciatic nerve in vivo during movement of the hip and knee. J Bone Joint Surg - Series B 85:363–365. https://doi.org/10.1302/0301-620X.85B3.13220

    Article  CAS  Google Scholar 

  14. Tyson SF, Sadeghi-Demneh E, Nester CJ (2013) A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke. Clin Rehabil 27:879–891

    Article  CAS  Google Scholar 

  15. Hesse S, Werner C, Matthias K et al (1999) Non-velocity-related effects of a rigid double-stopped ankle-foot orthosis on gait and lower limb muscle activity of hemiparetic subjects with an equinovarus deformity. Stroke 30(9):855–861. https://doi.org/10.1161/01.str.30.9.1855

    Article  Google Scholar 

  16. Franz CK, Rutishauser U, Rafuse VF (2008) Intrinsic neuronal properties control selective targeting of regenerating motoneurons. Brain 131:1492–1505. https://doi.org/10.1093/brain/awn039

    Article  PubMed  Google Scholar 

  17. Cush G, Irgit K (2011) Drop foot after knee dislocation: evaluation and treatment. Sports Med Arthrosc Rev 19:139–146

    Article  Google Scholar 

  18. Standring S (2005) Gray’s anatomy e-book: the anatomical basis of clinical practice, 3rd edn. Elsevier Health Sciences, Churchill Livingstone

  19. Tomaszewski KA, Graves MJ, Henry BM et al (2016) Surgical anatomy of the sciatic nerve: a meta-analysis. J Orthop Res 34:1820–1827. https://doi.org/10.1002/jor.23186

    Article  PubMed  Google Scholar 

  20. Beaton LE, Anson J (1937) The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec 70:1–5. https://doi.org/10.1002/ar.1090700102

    Article  Google Scholar 

  21. Moore KL, Dalley AF (1999) Clinically oriented anatomy. Lippincott Williams & Wilkins

    Google Scholar 

  22. Isik C, Apaydin N, Acar HI et al (2014) The gluteal sling: an anatomical study. Surg Radiol Anat 36:595–599. https://doi.org/10.1007/s00276-013-1231-0

    Article  CAS  PubMed  Google Scholar 

  23. Klifto KM, Azoury SC, Gurno CF et al (2022) Treatment approach to isolated common peroneal nerve palsy by mechanism of injury: systematic review and meta-analysis of individual participants’ data. J Plast Reconstr Aesthet Surg 75:683–702. https://doi.org/10.1016/j.bjps.2021.09.040

    Article  PubMed  Google Scholar 

  24. Wang TI, Chen HY, Tsai CH, et al (2016) Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery. J Orthop Surg Res 11. https://doi.org/10.1186/S13018-016-0365-2

  25. De Fine M, Romagnoli M, Zaffagnini S, Pignatti G (2017) Sciatic nerve palsy following total hip replacement: are patients personal characteristics more important than limb lengthening? A systematic review. BioMed Res Int 15:361071. https://doi.org/10.1155/2017/8361071

  26. Brown GD, Swanson EA, Nercessian OA (2008) Neurologic injuries after total hip arthroplasty. Am J Orthop 37:191–197

    PubMed  Google Scholar 

  27. Su EP (2017) Post-operative neuropathy after total hip arthroplasty. Bone Joint J 99-B:46–49. https://doi.org/10.1302/0301-620X.99B1

    Article  CAS  PubMed  Google Scholar 

  28. Weale AE, Senior Orthopaedic Registrar F, Newman P et al (1996) Nerve injury after posterior and direct lateral approaches for hip replacement: a clinical and electrophysiological study. J Bone Joint Surg [Br] 78-B:899–902. https://doi.org/10.1302/0301-620X.78B6.0780899

    Article  Google Scholar 

  29. Navarro RA, Schmalzried TP, Amstutz HC, Dorey FJ (1995) Surgical approach and nerve palsy in total hip arthroplasty materials and methods. J Arthroplasty 10(1):1–5. https://doi.org/10.1016/s0883-5403(05)80093-2

    Article  CAS  PubMed  Google Scholar 

  30. Eftekhar NS, Stinchfield FE (1973) Experience with low-friction arthroplasty. A statistical review of early results and complications. Clin Orthop Relat Res 95:60–68

    Google Scholar 

  31. Nercessian OA, Macaulay W, Stinchfield FE (1994) Peripheral neuropathies following total hip arthroplasty. J Arthroplasty 9(6):645–651. https://doi.org/10.1016/0883-5403(94)90119-8

    Article  CAS  PubMed  Google Scholar 

  32. Song P, Kong X, Yang M, Ma M, Chai W (2022) The course and anatomical characteristics of sciatic and femoral nerves in unilateral Crowe type-iv hip dysplasia. Ther Clin Risk Manag 18:491–497. https://doi.org/10.2147/TCRM.S360087

    Article  PubMed  PubMed Central  Google Scholar 

  33. Weber CD, Lefering R, Sellei RM, Horst K, Migliorini F, Hildebrand F, Trauma Register DGU (2022) Traumatic hip dislocations in major trauma patients: epidemiology, injury mechanisms, and concomitant injuries. J Clin Med 11(3):472. https://doi.org/10.3390/jcm11030472

    Article  PubMed  PubMed Central  Google Scholar 

  34. Realyvasquez J, Singh V, Shah AK, Dionisio Ortiz III, Robin JX, Brash A, Kurapatti M, Davidovitch RI, Schwarzkopf R (2022) The direct anterior approach to the hip: a useful tool in experienced hands or just another approach? Arthroplasty 4:1. https://doi.org/10.1186/s42836-021-00104-5

    Article  PubMed  PubMed Central  Google Scholar 

  35. Murena L, Colin G, Dussi M, Canton G (2021) Is intraoperative neuromonitoring effective in hip and pelvis orthopedic and trauma surgery? A systematic review. J Orthop Traumatol 22:40. https://doi.org/10.1186/s10195-021-00605-8

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zappe B, Glauser PM, Majewski M et al (2014) Long-term prognosis of nerve palsy after total hip arthroplasty: results of two-year-follow-ups and long-term results after a mean time of 8 years. Arch Orthop Trauma Surg 134:1477–1482. https://doi.org/10.1007/s00402-014-2038-0

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

    Vlad Alexandru Georgeanu, Marius Nicolae Popescu & Vlad Predescu

  2. Clinic of Orthopaedics and Trauma Surgery, “St. Pantelimon” Hospital, Bucharest, Romania

    Vlad Alexandru Georgeanu

  3. Department of Orthopaedics and Traumatology, Clinical County Hospital, Tîrgu Mureș, Romania

    Octav Marius Russu

  4. Department of General Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, Tîrgu Mureș, Romania

    Octav Marius Russu

  5. Department of Orthopedics, Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania

    Bogdan Obada

  6. Department of Rehabilitation, Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania

    Madalina-Gabriela Iliescu

  7. Department of Rehabilitation, Elias Teaching Hospital, Bucharest, Romania

    Marius Nicolae Popescu

  8. Department of Anatomy, Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania

    Dan Marcel Iliescu

  9. Ponderas Academic Hospital, Bucharest, Romania

    Vlad Predescu

Authors
  1. Vlad Alexandru Georgeanu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Octav Marius Russu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bogdan Obada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Madalina-Gabriela Iliescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marius Nicolae Popescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dan Marcel Iliescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vlad Predescu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VAG is the main surgeon, having operated all of the cases included in this study. He is also responsible for the conception and design of the study. VP is secondary surgeon in some of the cases, also being responsible for the design of study; MGI, BO, and MNP are responsible for data analysis and article drafting. OMR and DMI provided critical review of the article. All authors read and approved the final manuscript. All authors contributed equally for this paper.

Corresponding author

Correspondence to Bogdan Obada.

Ethics declarations

Ethics approval

This research study was conducted retrospectively from the data obtained for clinical purpose. Approval from the ethical committee of Emergency Clinical Hospital “St. Pantelimon” of Bucharest, Romania, and written informed consent were obtained from all the patients prior to initiating data collection.

Informed consent

Informed consent was gathered before any clinical and pictorial data were collected. Consent to publish any personal data was also obtained before manuscript drafting.

Conflict of interest

All authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Georgeanu, V.A., Russu, O.M., Obada, B. et al. Common peroneal nerve palsy after primary total hip arthroplasty. International Orthopaedics (SICOT) 46, 1963–1970 (2022). https://doi.org/10.1007/s00264-022-05477-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-022-05477-z

Keywords

Search

Navigation