scholarly journals Risk Factors for the Development of Nerve Palsy Following Primary Total Hip Arthroplasty

2018 ◽  
Vol 12 (1) ◽  
pp. 164-172 ◽  
Author(s):  
Shunsuke Kawano ◽  
Motoki Sonohata ◽  
Masaru Kitajima ◽  
Masaaki Mawatari

Background:Nerve palsy following total hip arthroplasty (THA) is a complication that worsens the functional prognosis. The present study analyzed the risk factors of nerve palsy following THA.Methods:The subjects of this study included 6,123 cases in which primary THA was performed under spinal anesthesia with cementless implants used in the posterolateral approach.Results:Fourteen cases (0.22%) developed nerve palsy following THA, all of which involved palsy of the entire peroneal nerve region. The diagnoses included osteoarthritis due to subluxation (n=6), complete hip dislocation (n=3), osteonecrosis of the femoral head (n=2), primary osteoarthritis (n=1), osteoarthritis due to trauma (n=1), and multiple osteochondromatosis (n=1). Recovery from nerve palsy was confirmed in 10 cases; the longest recovery period was three years. A univariate analysis revealed significant differences in the osteoarthritis due to subluxation, osteonecrosis of the femoral head, complete hip dislocation, body weight and body mass index. However, none of the factors remained significant in multivariate analysis. Peroneal (ischiadic) nerve palsy following THA occurred in patients with osteonecrosis of the femoral head, complete hip dislocation, low body weight and a low body mass index. However, there were no cases of nerve palsy after the introduction of THA combined with shortening osteotomy of the femur for complete hip dislocation. patients.Conclusion:It is necessary to pay attention to direct pressure in cases of lower body weight and lower BMI because compression of the sciatic nerve during surgery and compression of the fibular head are considered to be risk factors.

2017 ◽  
Vol 68 (5) ◽  
pp. 974-976
Author(s):  
Alexandru Patrascu ◽  
Liliana Savin ◽  
Dan Mihailescu ◽  
Victor Grigorescu ◽  
carmen Grierosu ◽  
...  

In recent years, there has been an increase in the number of studies on the etiology of femoral head necrosis. We retrospectively reviewed all patients diagnosed with aseptic necrosis of the femoral in the period of 2010-2015. We recorded a total of 230 cases diagnosed with aseptic necrosis of the femoral head, group was composed of 65.7% men and 34.3% women, risk factors identified was 19.13% (post-traumatic), 13.91% (glucocorticoids), 26.52% (alcohol), 3.47% (another cause) and in 36 95% of the cases no risk factors were found. The results of the study based on the type of surgery performed on the basis of stages of disease progression, 8 patients (3.48%) benefited from osteotomy, 28 patients (12.17%) benefited of bipolar hemiarthroplasty prosthesis and 188 patients (81.74%) benefited of total hip arthroplasty. Osteonecrosis of the femoral head is characteristic to young patients between the age of 30-50 years old. Predisposing factors, alcohol and corticosteroid therapy remains an important cause of the disease. Total hip arthroplasty remains the best option for the patients with osteonecrosis of the femoral head.


Author(s):  
T. Bacon-Baguley ◽  
T. Mollan ◽  
P. Oleszkiewicz ◽  
D. Rispler

2012 ◽  
Vol 92 (11) ◽  
pp. 1386-1394 ◽  
Author(s):  
Emily J. Slaven

Background Recovery of function such as the ability to walk without an assistive device after total hip arthroplasty (THA) is not always automatic. Objective This study investigated whether predetermined variables could be used to identify patients who might have functional limitations at 6 months following THA. Design A prospective, observational cohort design was used. Method Demographics and baseline measures, including age, sex, and preoperative Lower Extremity Functional Scale (LEFS) score, were collected 1 to 3 weeks prior to surgery from 40 participants who were scheduled to undergo THA. Six weeks after surgery, a second LEFS score was recorded along with each participant's body mass index and the THA procedure performed; walking speed and balance also were assessed at this time using the 10-Meter Walk Test, the Timed “Up & Go” Test, and the Functional Reach Test. At 6 months following surgery, each participant's functional outcome was determined from the final LEFS score and the need for an assistive device. Classification and regression tree (CART) analyses and logistic regression were used to establish which of the variables could predict outcome at 6 months. Results Body mass index, sex, and age were identified by CART analysis as predictors to classify participants who did not reach successful outcome status. Logistic regression revealed that sex (female) was the only individual variable that predicted outcome at 6 months. Walking speed was the only performance variable identified as a predictor for outcome using CART analysis. Limitations Only a limited number of variables were observed due to the small sample size. Conclusion It is possible to identify those patients who are at risk for an unsuccessful outcome through the use of variables such as body mass index, age, and sex.


2021 ◽  
Vol 29 (2) ◽  
pp. 71-77
Author(s):  
Kareem J. Kebaish ◽  
Varun Puvanesarajah ◽  
Sandesh Rao ◽  
Bo Zhang ◽  
Taylor D. Ottesen ◽  
...  

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Babaji Thorat ◽  
Avtar Singh ◽  
Mohammad Arshad ◽  
Sharad Salokhe ◽  
Ravi Mavani

Introduction: Traumatic posterior hip dislocation with comminuted fracture of the ipsilateral acetabulum and femoral neck is a rare fracture pattern. These injuries are associated with high energy trauma and pose challenges during management. Controversy exists between hip preservation and replacement surgeries in middle-age patients. Open reduction and internal fixation (ORIF) have a high risk of non-union, avascular necrosis, and post-traumatic osteoarthritis of hip requiring total hip arthroplasty hip replacement (THA) as a secondary procedure later. Case Report: A 56-year-old male presented with posterior hip dislocation and comminuted fracture of ipsilateral wall and column of the acetabulum, and femoral neck following a high energy trauma. He was managed by acetabular reconstruction using femoral head structural autograft combined with acute primary uncemented THA. At 2-year follow-up, the patient had good functional outcome with a satisfactory range of motion without any difficulty in weight-bearing and doing his daily activities. Conclusion: Although uncommon, acetabular reconstruction using femoral head structural autograft and acute primary uncemented THA is a viable alternative treatment option compared to ORIF in middle-age patients with fracture of ipsilateral neck and acetabulum. This facilitates post-operative rehabilitation and avoids further operations for possible developing AVN or secondary arthritis. Keywords: Hip dislocation, acetabulum fracture, femur neck fracture, acute total hip arthroplasty, acetabular reconstruction, femoral head structural autograft.


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