Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 10, pp 1477–1482 | Cite as

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

  • B. ZappeEmail author
  • P. M. Glauser
  • M. Majewski
  • H. R. Stöckli
  • P. E. Ochsner
Hip Arthroplasty



Nerve damage is a rare but serious complication after THA. There exist only little data about the outcome of these patients particularly regarding the long-term results later than 2 years postoperatively. Aim of this study is to answer the following questions: Is the recovery to be expected for light nerve lesions different from the severe ones? Is there a possibility of nerve recovery more than 2 years after THA? Is the potential of nerve recovery depending on the affected nerve?

Materials and methods

This study investigates 2,255 primary THA as well as revision surgeries performed from 1988 to 2003 relating to iatrogenic nerve lesion. We classified the nerve lesion according to the core muscle strength in severe (M0–M2) and light (M3–M4) nerve damage and differentiated between femoral, sciatic and superior gluteal nerve, according to the electromyography.


We found 34 cases of iatrogenic nerve damage representing an incidence of 1.5 %. 17 of 34 (50 %) patients showed a complete recovery after 2 years. Out of the remaining 17 patients, six out of seven patients with a final examination after a median time of 93 months achieved further improvement. The different nerves showed no significant different potential of recovery.


In contrast to the literature, an improvement beyond the limit of 2 years is probable and independent of the nerve affected.


Nerve lesion Total hip arthroplasty Long-term prognosis .Potential for recovery 



We want to thank Susanna Häfliger for the data research and support.

Conflict of interest

Authors have no conflicts of interest or financial ties to disclose.

Ethical standard

This study was approved by the local ethical committee (Ref. 192/13).


  1. 1.
    Bauer R, Kerschbaumer F, Poisel S, Oberthaler W (1979) The transgluteal approach to the hip joint. Arch Orthop Trauma Surg Archiv fur orthopadische und Unfall-Chirurgie 95(1–2):47–49CrossRefGoogle Scholar
  2. 2.
    Brown GD, Swanson EA, Nercessian OA (2008) Neurologic injuries after total hip arthroplasty. Am J Orthop 37(4):191–197PubMedGoogle Scholar
  3. 3.
    Daniels LWC (1986) Muscle testing: techniques of manual examination, 5th edn. Saunders, PhiladelphiaGoogle Scholar
  4. 4.
    DeHart MM, Riley LH Jr (1999) Nerve injuries in total hip arthroplasty. J Am Acad Orthop Surg 7(2):101–111PubMedGoogle Scholar
  5. 5.
    Farrell CM, Springer BD, Haidukewych GJ, Morrey BF (2005) Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 87(12):2619–2625PubMedCrossRefGoogle Scholar
  6. 6.
    Fox AJ, Bedi A, Wanivenhaus F, Sculco TP, Fox JS (2012) Femoral neuropathy following total hip arthroplasty: review and management guidelines. Acta Orthop Belg 78(2):145–151PubMedGoogle Scholar
  7. 7.
    Goetz MB, Seybold D, Gosse F, Muhr G, Roetman B (2010) The risk of nerve lesions in hip alloarthroplasty. Zeitschrift fur Orthopadie und Unfallchirurgie 148(2):163–167PubMedGoogle Scholar
  8. 8.
    Holzapfel BM, Heinen F, Holzapfel DE, Reiners K, Noth U, Rudert M (2012) Nerve lesions after minimally invasive total hip arthroplasty. Der Orthopade 41(5):354–364PubMedCrossRefGoogle Scholar
  9. 9.
    Kirschner S, Goronzy J, Storch A, Gunther KP, Hartmann A (2011) Avoidance, diagnostics and therapy of nerve lesions after total hip arthroplasty. Der Orthopade 40(6):491–499PubMedCrossRefGoogle Scholar
  10. 10.
    Navarro RA, Schmalzried TP, Amstutz HC, Dorey FJ (1995) Surgical approach and nerve palsy in total hip arthroplasty. J Arthroplasty 10(1):1–5PubMedCrossRefGoogle Scholar
  11. 11.
    Ochsner P, Brunazzi M (2003) Die Hüfttotalprothese: Implantationstechnik und lokale Komplikationen; eine Darstellung auf der Basis des Systems nach M. E. Müller unter Einbezug einer Langzeitkontrolle; mit 24 Tabellen. Springer, Berlin [u.a.]Google Scholar
  12. 12.
    Oldenburg M, Muller RT (1997) The frequency, prognosis and significance of nerve injuries in total hip arthroplasty. Int Orthop 21(1):1–3PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Paterson D (1993) The International Documentation and Evaluation System (IDES). Orthopedics 16(1):11–14PubMedGoogle Scholar
  14. 14.
    Pekkarinen J, Alho A, Puusa A, Paavilainen T (1999) Recovery of sciatic nerve injuries in association with total hip arthroplasty in 27 patients. J Arthroplasty 14(3):305–311PubMedCrossRefGoogle Scholar
  15. 15.
    Schoellner C, Schoellner D (2003) Nerve injuries in total hip arthroplasty—prophylactic strategies—quality assurance and risk management in orthopaedic and trauma surgery. Z Orthop Ihre Grenzgeb 141(3):289–295PubMedCrossRefGoogle Scholar
  16. 16.
    Sendtner E, Borowiak K, Schuster T, Woerner M, Grifka J, Renkawitz T (2011) Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip(R)) and the lateral, transgluteal (Bauer) approach for primary total hip replacement. Arch Orthop Trauma Surg. Archiv fur orthopadische und Unfall-Chirurgie 131(5):597–602CrossRefGoogle Scholar
  17. 17.
    Simmons C Jr, Izant TH, Rothman RH, Booth RE Jr, Balderston RA (1991) Femoral neuropathy following total hip arthroplasty. Anatomic study, case reports, and literature review. J Arthroplasty 6(Suppl):S57–S66PubMedGoogle Scholar
  18. 18.
    Solheim LF, Hagen R (1980) Femoral and sciatic neuropathies after total hip arthroplasty. Acta Orthop Scand 51(3):531–534PubMedCrossRefGoogle Scholar
  19. 19.
    Weber ER, Daube JR, Coventry MB (1976) Peripheral neuropathies associated with total hip arthroplasty. J Bone Joint Surg Am 58(1):66–69PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • B. Zappe
    • 1
    Email author
  • P. M. Glauser
    • 1
  • M. Majewski
    • 2
  • H. R. Stöckli
    • 3
  • P. E. Ochsner
    • 4
  1. 1.Department of TraumatologyUniversity HospitalBaselSwitzerland
  2. 2.Department of Orthopedic SurgeryUniversity HospitalBaselSwitzerland
  3. 3.Kantonsspital LiestalLiestalSwitzerland
  4. 4.Department for Orthopaedic SurgeryKantonsspital LiestalLiestalSwitzerland

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