Delayed Onset of Peroneal Nerve Palsy After Total Knee Arthroplasty

Peroneal nerve palsy (PNP) and peroneal nerve dysfunction (PND) are rare complications after total knee arthroplasty (TKA). Although PND tends to manifest as transient lateral leg paresthesias that are associated with knee motion, PNP has characteristic motor deficits, including loss of ankle dorsiflexion and eversion strength. Although PND can manifest days, weeks, or months after surgery, delayed cases of PNP have not been well documented. We describe a 72-year-old woman with a delayed case of sudden-onset PNP 10 weeks after TKA. She had no neurologic deficits preoperatively and was recovering uneventfully at 2 and 6 weeks postoperatively. At 10 weeks, she reported insidious onset of drop foot and sensory changes to the lateral leg and dorsum of the foot. Motor deficits included significant loss of ankle dorsiflexion and eversion strength. After a diagnosis of PNP was confirmed with electrodiagnostic studies and lumbar pathology was ruled out with lumbar magnetic resonance imaging, surgical decompression of the peroneal nerve was performed. By 7 weeks after surgical decompression, she had no sensory deficits and nearly full strength in ankle dorsiflexion and eversion. This case shows that PNP can occur several weeks to months outside of the currently documented timeline. Although PNP is an uncommon risk of TKA, it is important to recognize and treat it when it occurs among patients with significant motor and sensory deficits along the distribution of the peroneal nerve postoperatively. [Orthopedics. 2022;45(6):e342-e344.].