604 - Hip, Hip, Oops! Navigating Femoral Nerve Palsy after Total Hip Arthroplasty

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

DM

Diane N. Moya, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Co-Author(s)

AR

Aniroodh Reddy, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
JL

Jack Leal, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
KS

Kanwardeep Singh, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
TP

Thomas Pobre, MD

Attending Physician
Nassau University Medical Center
East Meadow, New York, United States

Case Diagnosis: A 57-year-old female with hip osteoarthritis presented for elective right total hip arthroplasty (THA) with posterior approach.

Case Description: Postoperatively, she was made weight bearing as tolerated with posterior hip precautions. Right after the procedure, she was noted to have quadricep weakness and numbness with suspected femoral nerve palsy. CT ruled out hematoma. She was admitted to acute inpatient rehab where the admitting physical exam demonstrated right knee extensors 0/5 strength, right hip flexors 1/5 strength, and impaired sensation in the femoral and saphenous nerve distribution. On discharge from rehab, her hip flexion improved to 2/5 and knee extension to 1/5. She was evaluated for and received a solid ankle foot orthosis for ambulation assistance.

Discussions: The incidence of femoral nerve palsy after THA is relatively low, estimated to be about 2.3% of all nerve injuries. However, it is still a significant complication causing disability and functional impairment. Risk factors for femoral nerve palsy with THA include developmental dysplasia of the hip, female gender, cementless surgical technique, and revision surgery. The exact mechanism of nerve injury is not fully understood, however is believed to be due to mechanical compression or stretch injury to the nerve. THAs with posterior approach are more likely associated with sciatic nerve injuries whereas femoral nerve injuries are typically seen with an anterior approach. Treatment options include physical therapy, pain management, and, in severe cases, surgical exploration to identify and correct the underlying cause of the nerve damage.

Conclusions: This case demonstrates a unique etiology of femoral nerve palsy. Early detection and prompt intervention including intensive rehabilitation and orthoses can help minimize the risk of long-term complications.