- See:
TKR Menu:
Peroneal Nerve
- Discussion:
- peroneal nerve palsy following TKR usually presents acutely but in some cases
there will be a delayed presentation;
-
risk factors:
- use of epidural anesthesia;
- previous spinal surgery (double crush);
-
valgus knee deformity;
- flexion contracture more than 20 deg;
- it may also be more common following previous high tibial osteotomy, and patients who also have peripheral neuropathy;
-
prevention:
- postoperative dressings include Xeroform (vasiline gauze) and gauze padding over the fibular head region;
- keep knee flexed the first postoperative night inorder to reduce tension on the nerve;
- w/ a valgus knee, intraoperative dissection & mobilization of nerve will not decrease incidence of peroneal palsy;
- Exam:
- it is important to document the exact strength of each muscle innervated by the
peroneal nerve;
- peroneus longus, brevis, and tertius, EHL, TA, EDL, EDB;
- the exam should be able to distinguish between a
partial vs a
complete palsy;
- normal function of the peroneus brevis and longus indicates a partial palsy (deep branch only);
- EMG:
- useful to objectively document the conduction block;
- if possible should be performed w/ in one month of injury;
- Management:
- initial post op management consists of removal of circumferential dressings and partial flexion of the knee;
- w/ persistent palsy, use dropfoot brace and ROM exercises to prevent equinus deformity;
- if complete neurological deficit is present for more than 3 months then operative exploration and decompression is indicated;
- even following decompression, there may be persistent weakness of the
EHL;
-
operative treatment:
- if there is no neurologic improvement after 3-4 months, then operative decompression is consider;
- operative treatment invovles external neurolysis of peroneal nerve at the level of the fibular head;
- the nerve and its branches need to be freed from its adherence to the proximal
fibula, particularly at its most proximal 4 cm as well as a second region of
adherence which may lie between 7 and 15 cm from the fibular head;
Peroneal-nerve palsy following total knee arthroplasty. A review of The Hospital for Special Surgery experience.
J Bone Joint Surg 1982;64A:347-351. Rose HA, Hood RW, Otis JC, et al:
Peroneal nerve palsy after total knee arthroplasty.
Surgical decompression for peroneal nerve palsy after total knee arthroplasty.
Peroneal Nerve Palsy after Total Knee Arthroplasty. Assessment of Predisposing and Prognostic Factors.
