Nerve injury after hip arthroplasty: 5/600 cases after uncemented hip replacement, anterolateral approach versus direct lateral approach

Abstract

In 600 consecutive uncemented total hip replacements, 2 surgical approaches were used: the direct lateral Hardinge approach in supine position (group I: 241 cases) or in a lateral position (group II: 280 cases) and the anterolateral Watson-Jones approach in supine position (group III: 79 cases). 5 patients had clinically evident peripheral nerve injuries confirmed with EMG: none in group I, 1 lesion of the nervus ischiadicus and nervus femoralis in group II and 4 nervus femoralis lesions in group III, of which 1 was combined with an obturator nerve injury. The nerve injuries were evaluated with EMG. All 4 nervus femoralis lesions recovered spontaneously, but the one patients in group II had a persistent palsy of the peroneal nerve. The anatomical basis for the higher prevalence of nervus femoralis lesions in the anterolateral Watson-Jones approach is described.

The distance of the gluteal nerve in relation to anatomical landmarks: an anatomic study

“…Retraction of soft tissue can exert considerable forces on the surrounding tissues especially in minimally invasive approaches, where only a small incision is given [ 27 ]. Retraction can cause significant damage to the tissue and result in postoperative acute or chronic pain—due to compression neuropraxia [ 28 – 30 ]. It is highly recommended to use special care with surgical instruments, especially retractors, to avoid excessive retraction.…”

Anatomical study to avoid femoral nerve palsy in total hip arthroplasty

“…Therefore, to avoid femoral nerve injury during MIS-THA with the anterior approach, attention must be paid to the positioning of the retractor. Compression nerve palsy, the most common type of retractor-associated nerve injury, occurs when nerves are directly compressed by the tip of an anterior retractor not secured to the bone [13,19]. For this reason, a study recommended that the anterior retractor must be placed in contact with the anterior margin of the acetabulum without allowing the tip of the retractor to surpass the iliopsoas muscle [20].…”

Retracting Soft Tissue in Minimally Invasive Hip Arthroplasty Using a Robotic Arm

“…Also, if the anterior retractor is not kept on the bone, nerve lesions can result when it is pushed forward and hooked over the anterior rim of the acetabulum and pelvis. 7 To prevent nerve lesions, it is recommended to use surgical instruments with special care, especially retractors, to avoid excessive retraction, primarily during dislocation of the hip. Also, the limb should be supported throughout the operation and monitoring of the femoral nerve should be considered interoperatively in high-risk cases.…”