No common peroneal nerve palsies found after a peroneal nerve release prior to TKA in fixed valgus deformities (a retrospective cohort study)

Abstract

PurposeThe main purpose of this study was to analyse the incidence of Common Peroneal Nerve Palsy (CPNP) after Total Knee Arthroplasty (TKA) for all alignments. Secondarily, the efficiency and safety of a Peroneal Nerve Release (PNR) prior to TKA in preoperative severe fixed valgus deformities were evaluated to prevent a CPNP. MethodsOverall, 7612 TKAs were performed in the institution from 2009 to 2021. 1913 TKAs were performed by three surgeons, who consistently performed a PNR in case of a fixed valgus deformity of (1) more than 15°, or (2) more than 10° but in combination with a flexion contracture of more than 15°. Patients with fixed valgus deformities of more than 10° were identified (81 knees) and a comparison was made between the patients who received a PNR (26 knees) and those who did not receive a PNR (55 knees). Data for the analysis were collected from patient medical files and were compared with the Chi2‐test or Fisher Exact test. ResultsA CPNP incidence of 0.2% (16/7612) was found after TKA for all alignments together. No CPNP cases (0%) were developed in the PNR‐group, compared to five (9%) in the non‐PNR group (p = NS). A larger preoperative valgus angle (17° vs 13°, p < 0.001) and flexion contracture (10° vs 3°, p < 0.001) was present in the PNR group compared with the non‐PNR group. No PNR‐related complications were reported. ConclusionThe CPNP incidence in this study is consistent with the previous literature. Furthermore, although not significant, the group that received a PNR procedure developed fewer CPNPs compared to the group without PNR. Level of evidenceRetrospective cohort study, III.

Prophylactic Common Peroneal Nerve Release for Total Arthroplasty of the Valgus Knee: Surgical Technique and Early Outcomes

“…Puijk et al. [ 11 ] recently published a retrospective study which compared patients with a valgus deformity of >15° or combined valgus deformity >10° and flexion contracture >15° who received a CPN release vs patients who did not receive a CPN release. Twenty-six knees received CPN release concurrently with TKA and there was no incidence of CPN palsy postoperatively.…”

“…Incidence of CPN palsy was 9% in the non-CPN group compared to no reported cases of CPN palsy in the prophylactic release group. In summary, prophylactic CPN release decreased the incidence of CPN palsy, although it was not significantly different [ 11 ].…”

“…CPN decompression at the time of arthroplasty appears to be a relatively safe procedure with few reported complications elsewhere in the literature [ [11] , [12] , [13] ]. In our population, there were 2 post-operative complications and only one that was related to the CPN decompression.…”

“…There has been a growing interest in prophylactic CPN release to avoid a postoperative nerve palsy in patients with valgus deformity. Three recent studies have shown promising results with CPN release, with all of the knees demonstrating preserved neurologic function postoperatively [ [11] , [12] , [13] ]. The goal of this study was to add to the current literature by describing the technique of prophylactic CPN release at the time of primary TKA in the severe valgus knee at our institution, analyzing the results, and augment the knowledge base utilized in determining the eligibility of patients for nerve release procedures.…”