Clinical Review
Neurologic Injuries After Total Hip Arthroplasty
Am J Orthop. 2008 April;37(4):191-197
Author and Disclosure Information
Gabriel D. Brown, MD, Eli A. Swanson, MD, and Ohannes A. Nercessian, MD
Dr. Brown is Senior Resident, Department of Orthopaedic Surgery, New York Orthopaedic Hospital, Columbia University Medical Center, New York, New York.
Dr. Swanson is Junior Resident, Department of Orthopaedic Surgery, Harbor UCLA Medical Center, Los Angeles, California.
Dr. Nercessian is Associate Professor, Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, New York Orthopaedic Hospital, Columbia University Medical Center, New York, New York.
Neurologic injuries are a potentially devastating complication of total hip arthroplasty (THA). Review of the literature reveals that these injuries are uncommon. The reported incidence ranges from 0.08% to 7.6%. The incidence in primary THA ranges from 0.09% to 3.7% and in revision THA from 0% to 7.6%. Reported etiologies include intraoperative direct nerve injury, significant leg lengthening, improper retractor placement, cement extravasation, cement-related thermal damage, patient positioning, manipulation, and postoperative hematoma. Risk factors include developmental dysplasia of the hip, the female sex, posttraumatic arthritis, and revision surgery. However, no single risk factor has been consistently reported to be significant, and many patients with no known risk factors incur neurologic injuries.