Jie Xu1, Hongwen Liu2, Fenqi Luo3, Yuan Lin3. 1. Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian Province, China. Electronic address: jiexu1520@163.com. 2. Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian Province, China; Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China. 3. Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian Province, China.
Abstract
BACKGROUND: Common peroneal nerve (CPN) palsy is a devastating complication that follows total knee arthroplasty (TKA). However, there are only a few studies on concrete measures for protecting the CPN in patients. This study aimed to put forward the CPN 'pre-release' method to protect the nerve. METHODS: A prospective study was conducted on 30 patients (34 knees) with severe valgus knees who underwent CPN pre-release. This was a two-incision approach, and required a separate dissection of about three centimeters from the TKA operation. Clinical measurements including pre- and postoperative motor and sensory nerve function of CPN, radiological evaluation, complications, and the revised data were analyzed and compared. RESULTS: The average preoperative femorotibial angle was 31.3 ± 8.0°. All patients had completely normal motor (grade 5) and sensory nerve function of CPN postoperatively, and there was no transient or late-onset CPN palsy. Patients had a routine rehabilitation with full weight bearing after recovery from anesthesia, including the knees with unconstrained extension/flexion motion. During the last follow-up visit, the visual analog scale, Knee Society Score, Hospital for Special Surgery knee-rating scale, and range of motion were 2.06 ± 1.13, 92.18 ± 5.57, 90.18 ± 3.70, and 115.59 ± 7.76°, respectively. There were no revisions for instability and recurrent valgus deformities during follow-up. Also, the femorotibial angle, hip-knee-ankle angle, condylar-hip angle, and plateau-ankle angle were 4.9 ± 2.0°, 179.09 ± 3.21°, 89.97 ± 2.41°, and 90.53 ± 1.26°, respectively. CONCLUSIONS: The CPN pre-release for severe valgus knees is an effective method for nerve protection, achieving an adequate and safe release of lateral soft tissue, and providing immediate and early functional rehabilitation with decreasing constrained implant.
BACKGROUND: Common peroneal nerve (CPN) palsy is a devastating complication that follows total knee arthroplasty (TKA). However, there are only a few studies on concrete measures for protecting the CPN in patients. This study aimed to put forward the CPN 'pre-release' method to protect the nerve. METHODS: A prospective study was conducted on 30 patients (34 knees) with severe valgus knees who underwent CPN pre-release. This was a two-incision approach, and required a separate dissection of about three centimeters from the TKA operation. Clinical measurements including pre- and postoperative motor and sensory nerve function of CPN, radiological evaluation, complications, and the revised data were analyzed and compared. RESULTS: The average preoperative femorotibial angle was 31.3 ± 8.0°. All patients had completely normal motor (grade 5) and sensory nerve function of CPN postoperatively, and there was no transient or late-onset CPN palsy. Patients had a routine rehabilitation with full weight bearing after recovery from anesthesia, including the knees with unconstrained extension/flexion motion. During the last follow-up visit, the visual analog scale, Knee Society Score, Hospital for Special Surgery knee-rating scale, and range of motion were 2.06 ± 1.13, 92.18 ± 5.57, 90.18 ± 3.70, and 115.59 ± 7.76°, respectively. There were no revisions for instability and recurrent valgus deformities during follow-up. Also, the femorotibial angle, hip-knee-ankle angle, condylar-hip angle, and plateau-ankle angle were 4.9 ± 2.0°, 179.09 ± 3.21°, 89.97 ± 2.41°, and 90.53 ± 1.26°, respectively. CONCLUSIONS: The CPN pre-release for severe valgus knees is an effective method for nerve protection, achieving an adequate and safe release of lateral soft tissue, and providing immediate and early functional rehabilitation with decreasing constrained implant.