Elsevier

The Journal of Arthroplasty

Volume 16, Issue 8, December 2001, Pages 1048-1054
The Journal of Arthroplasty

Original Articles
Nerve injury after primary total knee arthroplasty*,**

https://doi.org/10.1054/arth.2001.26591Get rights and content

Abstract

There is controversy about the incidence of and predisposing factors to the development of peripheral nerve palsy after total knee arthroplasty (TKA). In this study, 19 patients with a documented neurologic complication were identified after a retrospective review of 1,476 primary TKAs performed between January 1970 and December 1998 at the New York Presbyterian Hospital at Columbia University, for an overall incidence of 1.3%. Contrary to previously published data, valgus deformity, flexion contracture, the use of postoperative epidural anesthesia, the prolonged use of pneumatic tourniquets, and preexisting neuropathy were not associated with the development of peripheral neuropathy after TKA based on our data. A larger percentage of rheumatoid knees experienced a neurologic injury than was expected, however. No other significant risk factors for peripheral neuropathy after TKA were identified based on data from our patients. Immediately after discovery of the nerve palsy, conservative treatment was employed for each of our patients. All patients showed at least a partial recovery at the end of follow-up, with most experiencing a complete recovery from symptoms.

Section snippets

Materials and methods

A total of 1,476 primary TKAs were performed by multiple surgeons in the Department of Orthopaedic Surgery at the Columbia Presbyterian Medical Center between January 1970 and December 1998. A retrospective review of the orthopaedic complication records identified 19 nerve palsies in primary TKA patients. Patient data were collected on these 19 patients, including gender, age, weight, diagnosis requiring TKA, degree of flexion contracture, and medical comorbidities (including diabetes mellitus,

Preoperative data

After the 1,476 TKAs performed at the Columbia Presbyterian Medical Center during the 29 years between January 1970 and December 1998, 19 peripheral neuropathies after primary TKA in 19 patients were identified. The average age of the 19 patients was 61.5 years (range, 35-84 years). Nine (47%) patients were men, and 10 (53%) were women. The average female weight was 68 kg (range, 59-80 kg), and the average male weight was 83 kg (range, 70-100 kg). Nine (47%) of the TKAs were performed on the

Discussion

Peripheral neuropathy after TKA is a rare and often unforeseen occurrence. Neurologic damage primarily involves the peroneal nerve, which is composed of fibers from the dorsal branches of the ventral rami of L4, L5, S1, and S2. The level of the division of the sciatic nerve to form the tibial and common peroneal nerves is variable. Most often, this split occurs in the posterior aspect of the midthigh. The peroneal nerve enters the popliteal space and winds lateral to the fibular head. At the

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*

No benefits or funds were received in support of this study.

**

Reprint requests: William Macaulay, MD, Department of Orthopaedic Surgery, 622 West 168th Street, PH 11th Floor, Room 1146, New York, NY 10032. E-mail: [email protected]

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