A Lädermann1, D Ceroni, M Magistris, P Hoffmeyer. 1. Clinique d'Orthopédie et de Chirurgie de l'Appareil Moteur, Hôpitaux Universitaires et Faculté de Médecine de Genève, 24, rue Micheli-du-Crest, 1211 Genève 14, Suisse. alexandre.laedermann@hcuge.ch
Abstract
PURPOSE OF THE STUDY: The incidence of neurological lesions after hip surgery is underestimated because of variable clinical expression and functional disorders resulting from nerve injury and often considered to be the normal course after hip surgery. The incidence of nerve lesions after hip surgery for fractures of the proximal femur remains to be detailed. MATERIAL AND METHOD: This retrospective study included 20 cases of sciatic nerve injury following hip surgery (2554 THA, 394 revision THA, 4632 osteosyntheses or hemiarthroplasties of the proximal femur). We noted degree of recovery of the neurological deficit and deterioration of the patients' quality-of-life. The prognosis was determined on the basis of clinical and electromyographic data. RESULTS: The incidence of nerve injury after hip surgery was 0.5% after THA, 1% after revision THA, and 0.08% after osteosynthesis or hemiarthroplasty of the proximal femur. The etiological factor remained unknown in the majority of the cases. The prognosis was tightly related to the type of neurological lesion as defined by the electrophysiological study. Three revision procedures were performed: two for drainage of a compressive hematoma and one to release the sciatic nerve (neurolysis). The prognosis depended on the type of neurological lesion as established by the electroneuromyographic study. DISCUSSION: Severe axonotmesis is associated with late recovery, generally incomplete recovery, and poor long-term functional outcome.
PURPOSE OF THE STUDY: The incidence of neurological lesions after hip surgery is underestimated because of variable clinical expression and functional disorders resulting from nerve injury and often considered to be the normal course after hip surgery. The incidence of nerve lesions after hip surgery for fractures of the proximal femur remains to be detailed. MATERIAL AND METHOD: This retrospective study included 20 cases of sciatic nerve injury following hip surgery (2554 THA, 394 revision THA, 4632 osteosyntheses or hemiarthroplasties of the proximal femur). We noted degree of recovery of the neurological deficit and deterioration of the patients' quality-of-life. The prognosis was determined on the basis of clinical and electromyographic data. RESULTS: The incidence of nerve injury after hip surgery was 0.5% after THA, 1% after revision THA, and 0.08% after osteosynthesis or hemiarthroplasty of the proximal femur. The etiological factor remained unknown in the majority of the cases. The prognosis was tightly related to the type of neurological lesion as defined by the electrophysiological study. Three revision procedures were performed: two for drainage of a compressive hematoma and one to release the sciatic nerve (neurolysis). The prognosis depended on the type of neurological lesion as established by the electroneuromyographic study. DISCUSSION: Severe axonotmesis is associated with late recovery, generally incomplete recovery, and poor long-term functional outcome.