Similar incidence of postoperative sciatic nerve palsy in direct anterior and posterior approach total hip arthroplasty

Abstract

Background:

Sciatic nerve palsy is a rare but devastating complication following total hip arthroplasty (THA). While the use of the direct anterior approach is increasing, limited data exist regarding sciatic nerve palsy and surgical approach. The purpose of this study was to determine the factors and outcomes associated with sciatic nerve palsy (SNP) after THA.

Methods:

A retrospective analysis was performed at a single institution of 7 SNP that occurred in 4045 THA via direct anterior approach and 10 SNP in 8854 THA via posterior approach, being operated between 01 January 2017 and 12 December 2021. SNP patients were matched 1:5 to patients without SNP. Medical records were reviewed for demographics including age, gender, body mass index (BMI), comorbidities, and preoperative indication. Additional workup of SNP patients including advanced imaging and reoperation were documented. Recovery grades were assigned to all SNP patients at most recent clinical follow-up.

Results:

5 of the SNP were complete and 12 partial. They occurred as frequently with the direct anterior (0.17%) and posterior approach (0.11%, p = 0.5). The presence of femur cables and reoperations were associated with SNP (p = 0.04 and p = 0.002, respecitvely). Age, gender, BMI, comorbidities, and surgical indication had no effect on SNP. 4 of the 17 affected patients had almost complete recovery at latest follow-up.

Conclusions:

The incidence of SNP was similar in direct anterior and posterior approach. Surgeons should counsel patients regarding the risks of SNP regardless of the used approach.

Keywords

Complication direct anterior approach nerve injury sciatic nerve palsy total hip arthroplasty

Get full access to this article

View all access options for this article.

References

Patel

Krumme

Golladay

. Incidence, injury mechanisms, and recovery of iatrogenic nerve injuries during hip and knee arthroplasty. J Am Acad Orthop Surg 2021; 29: e940–e949.

Upadhyay

York

Macaulay

, et al. Medical malpractice in hip and knee arthroplasty. J Arthroplasty 2007; 22(Suppl. 2): 2–7.

Farrell

Springer

Haidukewych

, et al. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87: 2619–2625.

Hurd

Potter

Dua

, et al. Sciatic nerve palsy after primary total hip arthroplasty: a new perspective. J Arthroplasty 2006; 21: 796–802.

Kurtz

Ong

Lau

, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89: 780–785.

Abdel

Berry

. Current practice trends in primary hip and knee arthroplasties among members of the American Association of Hip and Knee Surgeons: a long-term update. J Arthroplasty 2019; 34(Suppl.): S24–S27.

Martin

Masonis

Mason

. Anatomic total hip component position is more reproducible with the direct anterior approach using intraoperative fluoroscopy. Arthroplast Today 2020; 6: 777–783.

Hoskins

Bingham

Lorimer

, et al. Early rate of revision of total hip arthroplasty related to surgical approach: an analysis of 122,345 primary total hip arthroplasties. J Bone Joint Surg Am 2020; 102: 1874–1882.

Asopa

Al-Nammari

Spriggins

, et al. Sciatic nerve palsy following total hip replacement via direct anterior approach after recommencement of warfarin for prophylaxis in atrial fibrillation. Case Rep Orthop 2014; 2014: 810481.

10.

Macheras

Christofilopoulos

Lepetsos

, et al. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach. Hip Int 2016; 26: 338–343.

11.

Drinking levels defined. National Institute on Alcohol Abuse and Alcoholism, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking (2023, accessed 1 February 2023).

12.

Clark

Huddleston

Schoch

, et al. Leg-length discrepancy after total hip arthroplasty. J Am Acad Orthop Surg 2006; 14: 38–45.

13.

Naqvi

Sherman

. Muscle strength grading. In: StatPearls. Treasure Island: StatPearls Publishing; 2023.

14.

Firth

. Bias reduction of maximum likelihood estimates. Biometrika 1993; 80: 27–38.

15.

Huang

Liu

Jia

, et al. Comparisons between direct anterior approach and lateral approach for primary total hip arthroplasty in postoperative orthopaedic complications: a systematic review and meta-analysis. Orthop Surg 2021; 13: 1707–1720.

16.

De Fine

Romagnoli

Zaffagnini

, et al. Sciatic nerve palsy following total hip replacement: are patients personal characteristics more important than limb lengthening? A systematic review. Biomed Res Int 2017; 2017: 8361071.

17.

Singh

Jeyaseelan

Sicuri

, et al. Management of sciatic nerve injuries following total hip arthroplasty. Orthop Procs 2013; 95-B(Suppl. 12): 17.

18.

Zappe

Glauser

Majewski

, et al. 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 2014; 134: 1477–1482.