The frequency, prognosis and significance of nerve injuries in total hip arthroplasty

Although the incidence of post-operative nerve palsy after total hip replacement is rare, it is an important complication for the patient. In a retrospective study the results of 2713 hip arthroplasties were reviewed. Sixty-one cases (2.24%) of post-operative neuropathy were identified, 13 of the sciatic nerve, 33 of the peroneal nerve and 15 of the femoral nerve. The risk is significantly higher in revisions (3.06%), especially when exchanging the acetabular component (8.5%) rather than in primary arthroplasties (2.13%). After an average period of 107 months (11-240) from operation, 41 patients with newe lesions were questioned about their subjective functional capacity: 17% had recovered completely, 39% had noticed an improvement and in 44% there was no change; 56.1% complained of weakness and had a complete paralysis. In all cases there was dysfunction of sensibility. Another 17.1% had a sensibility defect without weakness. There was pain in 51.2%, paraesthesia in 34.1% and areas of complete anaesthesia in 19.5%. Altogether 61% of the 41 patients had either gait problems or were dependent on orthotic devices. In summary only about a third of the patients studied achieved a satisfactory degree of functional recovery.