Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip

Abstract

We reviewed 508 consecutive total hip replacements in 370 patients with old developmental dysplasia of the hip, to relate the amount of leg lengthening to the incidence of nerve palsies after operation. There were eight nerve palsies (two femoral, six sciatic), two complete and six incomplete.We found no statistical correlation between the amount of lengthening and the incidence of nerve damage (p = 0.47), but in seven of the eight hips, the surgeon had rated the intervention as difficult because of previous surgery, severe deformity, a defect of the acetabular roof, or considerable flexion deformity. The correlation between difficulty and nerve palsy was significant (p = 0.041). We conclude that nerve injury is most commonly caused by direct or indirect mechanical trauma and not by limb lengthening on its own.

Lesser trochanteric osteotomy in total hip arthroplasty for treating CROWE type IV developmental dysplasia of hip

“…The result was parallel with the previous report that only four cases (5 %) suffered nerve palsies after THA for high dislocated hips without femoral shortening in 74 DDH patients [10]. In addition, other authors [2,11] did not find that sciatic nerve palsy was associated with the extent of limb lengthening. Risk of rotational instability may increase for cementless prosthesis when excessive proximal structures are sacrificed in performing lesser trochanteric osteotomy.…”

“…High dislocation of the hip up to six centimetres with severe contracture of soft tissue and potential leg lengthening of more than four centimetres [2,3], however, is always one of the major challenges and an indication for femoral shortening. Femoral shortening for CROWE type IV (DDH) is useful or sometimes necessary to assist the reduction without excessive soft tissue tension.…”

Reply to comment on Bao et al.: Lesser trochanteric osteotomy in total hip arthroplasty for treating CROWE type IV developmental dysplasia of hip

“…We agree with the statement that in general the soft tissue tension of the ipsilateral limb is higher after lesser trochanteric osteotomy than that after subtrochanteric osteotomy. Notwithstanding this consideration, the results of follow-up did show the low incidence rate of neurovascular injuries, which is in line with a previous study of the effect of lengthening the limb on the sciatic nerve [2]. In addition, shortening the femur when performing subtrochanteric osteotomy will cause a leg length discrepancy after surgery, which may be the reason for chronic low back pain [3].…”

Cemented Total Hip Arthroplasty With Subtrochanteric Osteotomy in Dysplastic Hips

“…Restoration of the proximal femoral anatomy is important to allow enhanced abductor function. In restoring the center of hip rotation, the leg may be lengthened by over 4 cm leading to difficulty in reducing the hip and a major risk of neurologic traction injury [7], particularly where there is scarring from previous surgery [15] which increases the risk of direct or indirect neurologic injury [12]. Furthermore, the femoral canal diameter is frequently narrow, which adds to the difficulty of obtaining stable implantation of an adequately sized femoral component [18,25,26,34].…”