The causative factors and the clinical course of symptoms related to nerve injury in total hip arthroplasty were evaluated in 34 patients who underwent surgery during the period from 1969 to 1981. The overall incidence of this complication was 0.6%, with an incidence of 1.0% during the first seven years and of 0.3% during the following six years of the study. Female patients, particularly those with congenital hip dislocation, appeared to be at higher risk of sustaining nerve injury. Pathogenetic mechanisms of nerve injury identified in 47% of the patients included lengthening and/or lateral displacement of the proximal femur, subfascial hematoma formation, prosthetic dislocation, and partial nerve transection. Greater blood loss and longer surgical times were distinguishing features of the nerve injury group as compared with large series of total hip arthroplasties performed during similar periods by the same surgical approaches. Causalgic pain was a significant sequela of nerve injury, and its strong association with bleeding problems was observed. With the exception of causalgic pain, persistent neurologic dysfunction in 79% of these patients at an average of 3.7 years after operation did not cause significant disability.
* Clinical Associate in Orthopaedic Surgery, Cornell University Medical College, and Orthopaedic Resident, The Hospital for Special Surgery, New York, New York.
** Assistant Attending Orthopaedic Surgeon, The Hospital for Special Surgery, Assistant Clinical Professor of Orthopaedic Surgery, New York Hospital and Cornell University Medical College and Adjunct Instructor in Anatomy, Cornell University Medical College, New York, New York.
† Associate Professor, Clinical Neurology, Cornell University Medical College, Associate Attending Neurologist, New York Hospital, Cornell University Medical College and Attending Neurologist and Chief of Neurology, The Hospital for Special Surgery, New York, New York.
‡ Chief of Hip Clinic, The Hospital for Special Surgery, Clinical Associate Professor of Surgery (Orthopaedics), Cornell University Medical College and Associate Attending Orthopaedic Surgeon, The Hospital for Special Surgery and The New York Hospital, New York, New York.