Nerve Injury Management in Total Hip Arthroplasty

Nerve injury is a recognised complication of total hip arthroplasty, with the sciatic nerve most frequently affected, followed by the femoral and peroneal nerves. Such injuries may arise from direct trauma, excessive limb lengthening, compression by retractors or haematoma formation, and traction during joint realignment. Prevention begins with meticulous preoperative planning, including assessment of limb length discrepancy, identification of patient-specific anatomical variations and optimisation of positioning. Intraoperative strategies encompass judicious retractor placement, modulation of limb extension and rotation, and, where available, intraoperative neuromonitoring to detect early signs of neuropraxia. When nerve injury is suspected, prompt neurological assessment guides the choice between conservative management—rest, physiotherapy and serial electrophysiological monitoring—and surgical intervention such as neurolysis or targeted decompression. Postoperative rehabilitation is tailored to the severity of deficit, with multidisciplinary involvement to restore motor function and minimise chronic neuropathic pain. Advances in imaging, surgical navigation and enhanced recovery protocols continue to refine the balance between optimal implant positioning and neural preservation, underscoring the global significance of nerve-safe techniques in hip arthroplasty.

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Nerve Injury Management in Total Hip Arthroplasty publication trend

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Technical terms

Sciatic nerve palsy: Motor and sensory deficit resulting from damage to the sciatic nerve during or after surgery.

Peroneal nerve palsy: Dysfunction of the common peroneal nerve producing foot drop and sensory disturbance over the lateral leg and dorsum of the foot.

Revision total hip arthroplasty: A secondary procedure to replace or repair a failed hip implant, often associated with higher risk of nerve injury.

Neurolysis: Surgical liberation of a nerve from surrounding scar tissue or adhesions to restore conduction and function.

Distal nerve decompression: Surgical release of pressure on a peripheral nerve segment away from the primary surgical site, often to relieve compression neuropathy.

Haematoma: A localized collection of blood outside blood vessels that can compress adjacent neural structures.

References

1. Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery. Journal of Orthopaedic Surgery and Research (2016).
2. Is intraoperative neuromonitoring effective in hip and pelvis orthopedic and trauma surgery? A systematic review. Journal of Orthopaedics and Traumatology (2021).
3. Risk Factors for Peripheral Nerve Injury Following Revision Total Hip Arthroplasty in 112,310 Patients. Journal of Clinical Medicine (2024).
4. Leg position effects on the femoral neurovascular bundle location during a direct anterior approach total hip arthroplasty: a radiographic study. BMC Musculoskeletal Disorders (2023).
5. Common Peroneal Nerve Palsy at the Level of Proximal Fibula After Total Hip Arthroplasty: A Case Report. Cureus (2022).