Common peroneal nerve palsy after TKA in valgus deformities; a systematic review

Abstract

Purpose The aim of this systematic review is to investigate the prevalence of Common Peroneal Nerve Palsy after total knee arthroplasty in valgus deformities. Furthermore, the effectiveness of a peroneal nerve release prior to arthroplasty to prevent the palsy will be investigated. Methods PubMed and Google Scholar were searched. Search terms regarding valgus deformity and total knee arthroplasty were used. Data analysis and extraction were performed using the web application ‘Rayyan QCRI’ according to PRISMA guidelines and screened according to the inclusion and exclusion criteria. Results Twenty-seven studies were included, representing 1397 valgus knees. Knee balancing was performed in 19 studies with lateral soft tissue releases (1164 knees) and 8 studies (233 knees) with an additional osteotomy. Two studies (41 knees) in the lateral soft tissue release group conducted a peroneal nerve release simultaneous to arthroplasty. Common peroneal nerve palsies occurred in 26 cases (1.9%). Overall, no significant difference in palsy ratio between studies was found by using a peroneal nerve release (p = 0.90), between lateral soft tissue releases and osteotomies (p = 0.11) or between releases of specific ligaments. Conclusion Common peroneal nerve palsies occur in 1.9% of the cases after total knee arthroplasty in valgus deformities. No difference in the number of palsies was seen when using a peroneal nerve release or using different balancing techniques. However, literature about peroneal nerve releases was very limited, therefore, the effectiveness of a peroneal nerve release remains unclear. Level of evidence LEVEL III: Systematic review.

Total Knee Arthroplasty in Valgus Knee

“…Due to the limited number of studies investigating FNR, no consensus has yet been reached on the value and indication of the procedure. A systematic review demonstrated no significant differences in FNP rate between valgus TKA with and without FNR (2.4% vs 2.1%) [18]. Therefore, the authors of this chapter do not recommend the routine use of FNR.…”

Total Knee Arthroplasty in the Valgus Knee

“…2 In a systematic review of the literature, Pujik et al assessed 27 studies that evaluated 1,397 valgus knees. 14 They found that the overall common peroneal nerve palsy rate was 1.9% after TKA for valgus deformity. They also found no significant differences in the nerve palsy rate between TKA with and without peroneal nerve release (2.4% vs. 2.1%), with lateral soft tissue release (2.2%) or with an osteotomy (0.4%).…”

Continuous Nerve Block

“…Tibial nerve becomes shallow to popliteal vessels and passes to the artery medial side at knee. In the distal popliteal fossa, two heads intersection of gastrocnemius covers it [14] .…”