Risk Factors for Nerve Injury After Total Hip Arthroplasty: A Case-Control Study

Abstract

Keywords:total hip arthroplasty nerve injury risk factors age tobacco spine disease a b s t r a c t Background: Postsurgical acute nerve injury is rare but potentially devastating following total hip arthroplasty (THA). Previous literature suggests a wide range of incidence from 0.1% to 7.6%. Confirmed risk factors for these injuries remain unclear. Methods: THA patients at our institution who developed nerve injury during their admission for THA between January 1, 1998, and December 31, 2013, were systematically identified and matched with 2 control subjects by surgical date. Relevant patient and surgical data were obtained through review of patient charts and electronic health records. We identified potential risk factors and calculated odds ratios (OR) using a conditional logistic regression model with a parsimonious stepwise approach. Results: We identified 93 nerve injuries in 43,761 THAs (0.21%). The mean age of cases was 63 years. Adjusting for other factors in the model, patients <45 years were found to be at increased risk of developing nerve injury (OR, 7.17; P ¼ .033). Similarly, patients with a history of tobacco use (OR, 1.90; P ¼ .030) and a history of spinal surgery or disease (OR, 10.06; P < .001) were also associated with increased risk of nerve injury. For every 30-minute increase in surgery time after 1 hour, risk of nerve injury risk increased (OR, 1.48; P ¼ .034). Assignment as first operative case of the morning was associated with a decreased risk of nerve injury (OR, 0.37, P ¼ .043). Conclusion: This study demonstrates that nerve injury is a rare complication following THA at our institution. We found risk factors that are possibly modifiable factors such as lumbar spine disease, smoking, and time of surgical scheduling.

Patient Characteristics and Medical Provider Factors Are Associated With Length of Stay in Total Hip Arthroplasty Patients: a Retrospective Chinese Cohort Study

“…Previous studies reported that surgical techniques could reduce adverse outcomes [22]. Acute nerve injury is rare but potentially devastating following THA due to the schedule of surgery [23]. Our results are consistent with earlier reports and con rm the strong associations linking LOS to date of surgery.…”

Nerve lesions during arthroscopic procedure: a literature overview

“…Nerve injuries due to whatever surgery recognize an overall risk of 0.1 to 0.2 % of cases. 1 These lesions may also occur during arthroscopies and are mainly due to direct damage by nerve section while cutting for making the portals or during surgical maneuvers, or indirect damage due to traction or pressure mechanisms, especially for errors in patient positioning. Therefore it would be better to speak of perioperative lesions since the injury can occur before, during, or after the surgical intervention and involving various caregivers like nurses, anesthesiologists, and surgeons.…”

Incidence of tensor fascia lata muscle atrophy after using the modified Watson-Jones anterolateral approach in total hip arthroplasty

“…Our results indicated that high BMI can be a risk factor for TFL atrophy. Although high BMI can be a risk factor for various post-operative complications [17,18], it has never been identified as a risk factor for TFL atrophy. The modified Watson-Jones approach, as well as other minimally invasive approaches, provides less overview of the surgery and this disadvantage is more prominent in higher BMI cases [1,11,19].…”