Nerve injury after hip arthroplasty: 5/600 cases after uncemented hip replacement, anterolateral approach versus direct lateral approach

Abstract

In 600 consecutive uncemented total hip replacements, 2 surgical approaches were used: the direct lateral Hardinge approach in supine position (group I: 241 cases) or in a lateral position (group II: 280 cases) and the anterolateral Watson-Jones approach in supine position (group III: 79 cases). 5 patients had clinically evident peripheral nerve injuries confirmed with EMG: none in group I, 1 lesion of the nervus ischiadicus and nervus femoralis in group II and 4 nervus femoralis lesions in group III, of which 1 was combined with an obturator nerve injury. The nerve injuries were evaluated with EMG. All 4 nervus femoralis lesions recovered spontaneously, but the one patient in group II had a persistent palsy of the peroneal nerve. The anatomical basis for the higher prevalence of nervus femoralis lesions in the anterolateral Watson-Jones approach is described.