Peripheral neuropathies following total hip arthroplasty |
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| Authors: | Ohannes A. Nercessian MD William Macaulay MD Frank E. Stinchfield MD |
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| Affiliation: | 2. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.;1. Interventional Cardiology, University of Genoa, Genoa, Italy;2. Radiology and Interventional Radiology, San Martino University Hospital and Scientific Institute for Cancer Research, Genoa, Italy;3. Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy;1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA;2. Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA;3. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA;4. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA;5. Rocky Mountain Scoliosis and Spine, Denver, CO, USA;6. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA;7. San Diego Center for Spinal Disorders, La Jolla, CA, USA;8. Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA;9. Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA;10. Department of Orthopedic Surgery, University of California, Davis, Davis, CA, USA;11. Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA;12. Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA;13. Rocky Mountain Scoliosis and Spine, Denver, CO, USA;14. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA;1. Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy;2. Division of Thoracic Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy |
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| Abstract: | The authors reviewed the complication records following total hip arthroplasty at their institution between January 1976 and July 1989. Forty-two patients (12 men and 30 women) with 45 neurologic complications were identified following 7,133 consecutive total hip arthroplasties; an incidence rate of 0.63%. The average age of these patients was 58 years (range, 27–81 years). Thirty-four nerve injuries were noted in the lower extremity (0.48% incidence rate) and 11 in the upper extremity (0.15% incidence rate). The majority of patients (64%) with neurologic injury to the upper extremity had the diagnosis of inflammatory arthritis. The common peroneal was most often involved in the lower extremity. The ulnar nerve was most commonly involved in the upper extremity. The pathogenetic factors leading to neurologic injury in the majority of patients were not clearly established. Leg lengthening did not seem to be a major cause. The prognosis of patients with nerve palsy of the upper extremity is favorable compared with injury to the lower extremity. Similarly, the percentage of patients with a permanent neurologic deficit was lower in the primary surgery group (27%) compared with the revision/reoperation group (43%). The overall percentage of permanent nerve palsy was 33%. Female patients, for unclear reasons, appear to have a higher risk for neurologic injury. Also, the risk of neurologic injury following total hip arthroplasty appears to be higher with revisions/reoperations and with an inexperienced surgeon. |
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| Keywords: | complications neurologic injury upper extremity lower extremity pathogenetic inflammatory arthritis |
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