Incidence, Injury Mechanisms, and Recovery of Iatrogenic Nerve Injuries During Hip and Knee Arthroplasty

Abstract

Iatrogenic nerve injury is a rare but potentially devastating complication in total joint arthroplasty of the hip and the knee. Multiple previous studies have evaluated the incidence, mechanisms of injury, recovery, and potential treatments for this complication. Injury in total hip arthroplasty generally involves direct injury of sensory nerves from the incision, direct or traction injury of during exposure, or limb lengthening. Injury in total knee arthroplasty generally involves direct injury of sensory nerves from incision, injury due to errant placement of retractors, during balancing, or from traction because of deformity correction. Treatment of iatrogenic nerve injuries has ranged from observation, intraoperative prevention by nerve monitoring, limb shortening postoperatively, medications, and decompression. The orthopaedic surgeon should be versed in these etiologies to advise their patients on the incidence of injury, to prevent occurrence by understanding risky intraoperative maneuvers, and to select appropriate interventions when nerve injuries occur.

Technical Considerations and Avoiding Complications in Total Hip Arthroplasty

“…Those with posttraumatic arthritis, dysplastic hips, and notable shortening are at increased risk of a nervous injury during THA. 15 The sciatic nerve exits the greater sciatic notch and has a variable relative to the piriformis. The incidence of sciatic nerve injury during posterior THA is 0.068% to 1.9%.…”

“…Lengthening a chronically shortened limb .2 cm can also create a traction injury. 15 The femoral nerve runs across the anterior hip, beneath the inguinal ligament. It is at greatest risk with anterior acetabular retractor placement.…”

“…Those with posttraumatic arthritis, dysplastic hips, and notable shortening are at increased risk of a nervous injury during THA. 15…”

“…The incidence of sciatic nerve injury during posterior THA is 0.068% to 1.9%. 15 Injury can occur during the approach with retractor placement of the Charnley retractor or posterior capsular retractors. When placing posterior acetabular retraction, the sciatic nerve can run within 2 cm of the posterior acetabulum.…”

“…The incidence is 0.01% to 2.3%. 15 Anterior retractor placement under direct visualization or with palpation of the anterior wall is recommended. Because the femoral nerve is at greater risk with inferior placement of this retractor, erring superior is recommended.…”