Outcome of surgery for nerve injury following total hip arthroplasty
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During hip replacement, nerves in the operative field can be injured accidently. Additional surgical procedures can help restore function and reduce pain if there has been no recovery.
One-hundred sixty-two patients presented with nerve injuries, and 113 were candidates for surgical treatment. The author performed 91 procedures on the injured limb (80 patients; 11 had 2 procedures) consisting of shortening, sympathectomy, tendon transfer, neurolysis or nerve repair/graft and 30 spinal and three fibular-neck decompressions. A meaningful recovery was defined as an increase of >1 level in strength or a reduction of >2 points on the visual analogue (VAS) pain scale.
Of 21 shortening procedures, 15 improved; of 12 nerve repair/grafting procedures, four improved. No patient >55 years of age made a meaningful recovery from a nerve repair/graft. One obturator nerve was resected and did not improve, and two were buried in muscle and had less pain. Of seven sympathectomies, six had less dysesthetic pain. Of 28 nerves treated with neurolysis, 24 made a meaningful recovery, with 13 making a near complete recovery. Of three fibular decompressions, two recovered completely. Of 20 tendon transfers, 18 made a meaningful recovery. Of 30 spinal decompressions, 25 made a meaningful recovery. There were six (5.3%) surgical complications (2 worsening pain, 2 infections, 2 deformities from tendon transfer).
If a sciatic, femoral or obturator nerve injury due to hip replacement does not recover spontaneously, additional surgical procedures can be of benefit.
KeywordsTotal hip arthroplasty Nerve injury Complications Nerve injury management
Compliance with ethical standards
The author certifies that he has institutional approval for this study and the investigation was conducted in conformity with ethical principles of research and that informed consent was obtained.
Conflict of interest
The author certifies that he has no commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest with this article. There was no external funding source for this study.
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