Nerve lesions after total hip replacement

Ahlgren, Sven-Arne; Elmqvist, D.; Ljung, Peter

doi:10.3109/17453678408992327

Cited by 15 publications

(5 citation statements)

References 5 publications

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“…It is of great importance to take intraoperative x-rays to avoid some cement spilling for example through transverse acetabular ligament. 8,12 In addition, after reaming of the acetabulum for implantation of the acetabular cup, it is important to directly visualize the bony structure of the acetabulum and consider bone grafting of the acetabulum. 13 In any patient with documented extrusion of cement, we recommend clinical evaluation, neurological exam with some imaging (i.e., CT-Scan).…”

Section: Discussionmentioning

confidence: 99%

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Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

Zwolak

Eysel²,

Michael³

2011

Orthop Rev

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Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan of the pelvis demonstrated a huge mass consisted of bone cement in close proximity of femoral and obturator nerves. The surgery charts reported shallow and weak bony substance in postero-superior aspect of the acetabulum. This weak bony acetabular substance may have caused extrusion of bone cement during press-fitting of the polyethylene cup into the acetabulum, and the following damage of the both nerves produced by polymerization of bone cement. The bone cement fragment has been surgically removed 3 weeks after arthroplasty. The female patient underwent intensive postoperative physical therapy and electro stimulation which resulted in full recovery of the patient to daily routine and almost normal electromyography results.

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Section: Discussionmentioning

confidence: 99%

“…Many patients after hip replacement with extruded bone cement into pelvis does not report any complaint and most surgeons accept this situation. 8 But in some cases the extruded bone cement during polymerization can cause heat related damages of the neighboring nerves. 9 …”

Section: Introductionmentioning

confidence: 99%

Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

Zwolak

Eysel²,

Michael³

2011

Orthop Rev

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“…No injury was seen with the posterior approach, but 20% of patients whose hips had been replaced by using the direct lateral approach, showed some evidence of nerve injury. Weber et al [9] found an incidence of 70% in hips replaced through the transtrochanteric approach, while Ahlgren, Elmqvist and Ljung [35] noted abnormality after 8% of operations performed through the posterior approach (Fig. 2).…”

Section: Frequency Of Nerve Injury After Thamentioning

confidence: 96%

The role of surgery in postoperative nerve injuries following total hip replacement

Chelly

Uskova

Plakseychuk

2010

Journal of Clinical Anesthesia

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“…No injury was seen with the posterior approach but 20% of patients whose hips had been replaced by the direct lateral approach, showed some evidence of nerve injury. Weber et al (1976) found an incidence of 70% in hips replaced through the transtrochanteric approach and Ahlgren, Elmqvist and Ljung (1984) noted abnormality after 8% of operations performed through the posterior approach. The declining incidence with time probably represents the influence of increasing expertise in total hip replacement.…”

Section: Discussionmentioning

confidence: 99%

Nerve Injury After Posterior and Direct Lateral Approaches for Hip Replacement

Weale

Newman

Ferguson

et al. 1996

The Journal of Bone and Joint Surgery. British volume

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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.

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Nerve lesions after total hip replacement

Cited by 15 publications

References 5 publications

Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

The role of surgery in postoperative nerve injuries following total hip replacement

Nerve Injury After Posterior and Direct Lateral Approaches for Hip Replacement

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