Distal peroneal nerve decompression after sciatic nerve injury secondary to total hip arthroplasty

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OBJECTIVE

The sciatic nerve, particularly its peroneal division, is at risk for injury during total hip arthroplasty (THA), especially when a posterior approach is used. The majority of the morbidity results from the loss of peroneal nerve–innervated muscle function. Approximately one-third of patients recover spontaneously. The objectives of this study were to report the outcomes of distal decompression of the peroneal nerve at the fibular tunnel following sciatic nerve injury secondary to THA and to attempt to identify predictors of a positive surgical outcome.

METHODS

A retrospective study of all patients who underwent peroneal decompression for the indication of sciatic nerve injury following THA at the Mayo Clinic or Washington University School of Medicine in St. Louis was performed. Patients with less than 6 months of postoperative follow-up were excluded. The primary outcome was dorsiflexion strength at latest follow-up. Univariate and multivariate logistic regression analyses were performed to assess the ability of the independent variables to predict a good surgical outcome.

RESULTS

The total included cohort consisted of 37 patients. The median preoperative dorsiflexion grade at the time of peroneal decompression was 0. Dorsiflexion at latest follow-up was Medical Research Council (MRC) ≥ 3 for 24 (65%) patients. Dorsiflexion recovered to MRC ≥ 4− for 15 (41%) patients. In multivariate logistic regression analysis, motor unit potentials in the tibialis anterior (OR 19.84, 95% CI 2.44–364.05; p = 0.004) and in the peroneus longus (OR 8.68, 95% CI 1.05–135.53; p = 0.04) on preoperative electromyography were significant predictors of a good surgical outcome.

CONCLUSIONS

After performing peroneal nerve decompression at the fibular tunnel, 65% of the patients in this study recovered dorsiflexion strength of MRC ≥ 3 at latest follow-up, potentially representing a significant improvement over the natural history.

ABBREVIATIONS BMI = body mass index; EMG = electromyogram; MRC = Medical Research Council; MUP = motor unit potential; PL = peroneus longus; SHB = short head of the biceps; TA = tibialis anterior; THA = total hip arthroplasty.

Article Information

Correspondence Robert J. Spinner: Mayo Clinic, Rochester, MN. spinner.robert@mayo.edu.

INCLUDE WHEN CITING Published online February 2, 2018; DOI: 10.3171/2017.8.JNS171260.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References

1

Brown GDSwanson EANercessian OA: Neurologic injuries after total hip arthroplasty. Am J Orthop 37:1911972008

2

Cheng CJMackinnon-Patterson BBeck JLMackinnon SE: Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am 33:151815242008

3

Chughtai MKhlopas AGwam CUElmallah RKThomas MNace J: Nerve decompression surgery after total hip arthroplasty: what are the outcomes? J Arthroplasty 32:133513392017

4

Edwards BNTullos HSNoble PC: Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res (218):1361411987

5

Farrell CMSpringer BDHaidukewych GJMorrey BF: Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 87:261926252005

6

Gillenwater JCheng JMackinnon SE: Evaluation of the scratch collapse test in peroneal nerve compression. Plast Reconstr Surg 128:9339392011

7

Higuchi YHasegawa YIshiguro N: Leg lengthening of more than 5 cm is a risk factor for sciatic nerve injury after total hip arthroplasty for adult hip dislocation. Nagoya J Med Sci 77:4554632015

8

King JC: Peroneal neuropathy in Frontera WRSilver JKRizzo TD Jr (eds): Essentials of Physical Medicine and Rehabilitation. Philadelphia: Saunders2008 pp 389393

9

Kyriacou SPastides PSSingh VKJeyaseelan LSinisi MFox M: Exploration and neurolysis for the treatment of neuropathic pain in patients with a sciatic nerve palsy after total hip replacement. Bone Joint J 95-B:20222013

10

Mackinnon SE: Nerve Surgeryed 1. New York: Thieme2015

11

Millesi H: Lower extremity nerve lesions in Terzis JK (ed): Microreconstruction of Nerve Injuries. Philadelphia: Saunders1987

12

Park JHHozack BKim PNorton RMandel SRestrepo C: Common peroneal nerve palsy following total hip arthroplasty: prognostic factors for recovery. J Bone Joint Surg Am 95:e552013

13

Pekkarinen JAlho APuusa APaavilainen T: Recovery of sciatic nerve injuries in association with total hip arthroplasty in 27 patients. J Arthroplasty 14:3053111999

14

Regev GJDrexler MSever RDwyer TKhashan MLidar Z: Neurolysis for the treatment of sciatic nerve palsy associated with total hip arthroplasty. Bone Joint J 97-B:134513492015

15

Yang IH: Neurovascular injury in hip arthroplasty. Hip Pelvis 26:74782014

16

Zappe BGlauser PMMajewski MStöckli HROchsner PE: Long-term prognosis of nerve palsy after total hip arthroplasty: results of two-year-follow-ups and long-term results after a mean time of 8 years. Arch Orthop Trauma Surg 134:147714822014

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