Nerve Injury After Posterior and Direct Lateral Approaches for Hip Replacement

Abstract

N erve injury is a rare complication of total hip replacement which may be related to the exposure used for the operation. The posterior approach is traditionally associated with injury to the sciatic nerve. We have compared the incidence of nerve injury after primary total hip replacement (THR) using either a posterior or a direct lateral approach.We studied 42 consecutive patients undergoing primary total hip replacement. The surgeons used a posterior (22 patients) or direct lateral (20 patients) approach in accordance with their normal practice. The obturator, femoral, posterior tibial and common peroneal nerves were assessed clinically and electrophysiologically by electromyography (EMG) and measurement of the velocity of nerve conduction before operation and at four weeks after.All patients were free from symptoms of nerve injury after operation but five lesions were identified in four patients by the electrophysiological studies; the obturator nerve was involved in two, the femoral in one, the common peroneal in one and the posterior tibial in one. All these injuries occurred using the lateral approach. Clinical assessment alone underestimates the incidence of nerve injury complicating THR. Our study does not confirm the association of nerve injury with the posterior approach which had been described previously.

Review: Posterior Soft Tissue Repair in Primary Total Hip Arthroplasty

“…Although the posterior approach has been associated with an increased incidence in postoperative dislocation and sciatic nerve injury, its alternative-a direct lateral or anterolateral approach-results in an up to 10% incidence of abductor weakness as well as an increased incidence of heterotopic bone formation and obturator and femoral nerve injuries [3,16,17]. Although surgeons have used these statements to defend their preferred surgical approach, a more recent metanalysis and the Cochrane database find not sufficient data in the literature to support either one of the above statements [18,19].…”

Unipedal Balance Is Affected by Lower Extremity Joint Arthroplasty Procedure 1 Year Following Surgery

“…However, like any surgical procedure, LEJA is not without complications. Common complications reported after total hip arthroplasty (THA) include dislocation, abductor weakness, decreased range of motion, and a limp [15][16][17][18][19]. Similarly, common limitations reported after total knee arthroplasty (TKA) include diminished walking speed, difficulty ascending and descending stairs, and inability to return to sports played prior to surgery with up to 37% of patients reporting limited function post-operatively [20][21][22][23]9].…”

Sciatic Neuropathy: Case Report and Discussion of the Literature on Postoperative Sciatic Neuropathy and Sciatic Nerve Tumors

“…The Mayo Clinic data represent the largest series and one of the lowest incidences of hip arthoplasty and associated nerve palsy reported in the literature. The low incidence of postoperative motor nerve palsy contrasts with work carried out by Weber et al [16] in 1976 and repeated by Weale et al [17] in 1996 showing an incidence of subclinical nerve injury of up to 70%. The difference may lie in the distinction between subclinical nerve injury that resolves transiently and improves with rehabilitation, and with documented nerve palsy that is less likely to recover.…”