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Mayo Clinic Investigates Nerve Palsy After Hip Replacement

Problems can occur after any operation. Nerve palsy after total hip replacement (THR) is one of the worst. Doctors at the Mayo Clinic reviewed 27,000 cases of THR to find out how often this happens. They also wanted to know what the risk factors are to help avoid the problem in the future.

Nerve damage resulting in nerve palsy can leave patients in pain and with weakness that affects their function. Motor nerve palsy doesn't happen very often. Studies report a range from 0.3 to 3.7 percent. In this study only 0.17 percent of the 27,000 patients had partial or complete nerve paralysis.

Patient chart were reviewed to find out what caused the problem. They looked at type of anesthesia, patient diagnosis, and type of implant used. They compared diagnosis and nerve function before the operation. The type of nerve palsy was recorded (which nerve was affected). They measured the severity of the nerve damage after the operation.

The results showed that half the motor nerve palsies were present within the first 24 hours after surgery. The other half was diagnosed in the first two to 74 days. They found a variety of reasons for the problem. In some patients bleeding put pressure on the nerve.

In a few cases the nerve was accidentally cut during the operation. Patients who had hip dysplasia or arthritis after an injury had a greater chance of nerve palsy. Other risk factors included a posterior incision, cementless implant, and making the leg too long.

Most of the patients didn't recover. Only about one-third had full recovery. The rest had only partial or no recovery. A large study of this type may help prevent complications of this type in the future.

References: Christopher M. Farrell, MD, et al. Motor Nerve Palsy Following Primary Total Hip Arthroplasty. In The Journal of Bone and Joint Surgery. December 2005. Vol. 87-A. No. 12. Pp. 2619-2625.

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