Portal de Periódicos da CAPES

Peroneal Nerve Palsy After Total Knee Arthroplasty

2005; Elsevier BV; Volume: 20; Issue: 8 Linguagem: Inglês

10.1016/j.arth.2005.02.010

1532-8406

Ohannes A. Nercessian, Obinwanne F.C. Ugwonali, Sangdo Park,

Nerve Injury and Rehabilitation

Peroneal nerve palsy is a potentially devastating complication of total knee arthroplasty (TKA). Fortunately, review of the literature reveals that this is not a common problem. Retrospective studies examining a large number of consecutive TKAs (N 1000) performed at various institutes show an incidence ranging from 0.3% to 1.3% (Table 1). In smaller studies, the incidence can vary more widely. The reported incidences have been as low as 0% and as high as 10%. This variability may be caused by the specific patient population enrolled in the studies [5-7] or the specific prostheses used in the studies [8,9]. In addition, the number of surgeons involved and their experience may have a greater impact on the incidence in studies with small sample sizes. The reported clinical incidences may not represent the true incidence of peroneal nerve palsy. The actual incidence of nerve compromise may be underestimated because of the presence of subclinical palsy, which may only be diagnosed by means of electrodiagnostic tests such as electromyography (EMG) or nerve conduction studies. Moreover, the different methods of gathering data (chart review vs follow-up vs complication reports) may also result in discrepancies between reported and true incidences. We found no prospective studies specifically addressing these issues. Predisposing Factors Several preoperative, perioperative, and postoperative factors have been reported to be significant for the development of peroneal nerve palsy after TKA. However, no single entity has been consistently shown in all studies to be significant, and some patients without any known risk factor still develop peroneal nerve palsy. Because of the lack of establishment of a cause-effect relationship and yet unidentified risk factors, it is best to be aware of all of the following risk factors and avoid this troublesome complication. The etiology of peroneal nerve palsy is multiple, and the relative contributions of the different risk factors, if present within a single patient, are so far unknown.