- See: Total Hip Replacement Menu:
- arterial injuries: in THR
- nerve injury
- nerve palsy from TKR
- incidence of sciatic (tibial and/or peroneal) &/or femoral palsies after THR ranges from 1-3%;
- incidence of nerve palsy is 1-2% of primary total hip replacement, 3-4% after revision, and 5-6% in THR for
congenitally dislocated hips;
- majority of these nerve deficits are partial, & many will resolve;
- Neurovascular injury: avoiding catastrophe
- Recovery of sciatic nerve injuries in association with total hip arthroplasty in 27 patients.
- Nerve Palsy Associated with Total Hip Arthroplasty
- The frequency, prognosis and significance of nerve injuries in total hip arthroplasty
- females seem to be at significantly higher risk;
- sciatic and superior gluteal nerve and vessels course opposite the posterior superior quadrant, and the inferior gluteal
and pudendal structures are opposite postero-inferior quadrant;
- w/ EMG evaluation, there is > 75% incidence of subclinical injury to superior and inferior gluteal innervated muscles
with use of posterior and lateral approaches;
- diff dx:
- revision total hip replacement;
- limb lengthening;
- female gender;
- broken trochanteric osteotomy wires;
- vascular insufficiency;
- ref: Delayed transient sciatic nerve palsy after total hip arthroplasty.
- recovery from mild injury that consists of transient conduction block may occur in days to wks;
- if injury is severe enough to cause axonal damage, recovery may not occur at all or may be incomplete after 1 to 2 yrs;
- consider electromyography;
- 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.
- Nerve palsy associated with total hip replacement. Risk factors and prognosis.
- if limb has been lengthened, & there is no other cause of injury, knee may be flexed to relieve stretch of sciatic nerve;
- hematoma: early ultrasound of the hip to evaluate for hematoma around the sciatic nerve;
- ref: Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement.
- prevention of decubiti
- EMG studies
- decompression / neurolysis:
- note the variant of the relationship between the sciatic nerve and the piriformis muscle;
- lateral part of the nerve penetrated the muscle and the medial half passes distal to it
- when the piriformis retracts after an external rotator tenotomy, the nerve will be stretced.
- treatment is to resect / release that part of tendon/ muscle compressing the nerve while the remainder of the nerve is
dissected from scar tissue;
- peroneal palsy:
- consideration of peroneal nerve decompression;
- Postarthroplasty "palsy" and systemic neuropathy: a peripheral-nerve management algorithm
- Isolated deep peroneal (fibular) nerve palsy in association with primary total hip arthroplasty.
- Sciatic neurostenalgia: caused by total hip arthroplasty, cured by late neurolysis
- Patient outcome after common peroneal nerve decompression
- Decompression of the Common Peroneal Nerve: Experience with 20 Consecutive Cases
- Exploration and neurolysis for the treatment of neuropathic pain in patients with a sciatic nerve palsy after total hip replacement.
- Sciatic nerve palsy after total hip replacement
- Sciatic nerve palsy after primary total hip arthroplasty: a new perspective
- Neurolysis for the treatment of sciatic nerve palsy associated with total hip arthroplasty
- Nerve Decompression Surgery After Total Hip Arthroplasty: What Are the Outcomes?
Delayed, transient sciatic nerve palsy after primary cementless hip arthroplasty: a report of two cases.
Femoral Nerve Palsy Associated with Iliacus Hematoma Following Pseudoaneurysm After Revision Hip Arthroplasty
Incidence of sciatic nerve palsy after revision hip arthroplasty through a posterior approach