Postoperative footdrop following total hip arthroplasty: Epidemiology, risk factors, and associated complications

Footdrop is a relatively uncommon complication following total hip arthroplasty (THA) caused by injury to the sciatic and peroneal nerve. Few studies have evaluated the risk factors or trends for the development of this challenging complication. As such, this study aims to describe the epidemiology, procedural risk factors, and related complications of postoperative footdrop following THA.

Adult primary or revision THA patients were identified using the PearlDiver database. Eligible patients were filtered into cohorts based on the development of footdrop within 90 days of surgery and matched 1:1 by age, sex, and comorbidities. Epidemiological trends in footdrop were evaluated by age and year between 2010 and 2022. Patient demographics, comorbidities, procedural characteristics, hospital outcomes, and occurrence of intra- and post-operative complications were compared.

In total, 2282 footdrop (0.3 %) and 893,159 (99.8 %) no footdrop THA patients were included, with a mean age of 64.9 years and 56.2 % were women. The incidence of footdrop decreased from 0.3 % to 0.2 % between 2010 and 2022 and was not associated with age. Preoperatively, footdrop patients more frequently underwent revision THA (Footdrop = 12.3 % vs No footdrop = 5.7 %, P < 0.001) and had more medical comorbidities (P < 0.001). Intraoperatively, they had higher rates of hemorrhage (0.7 % vs 0.2 %, P = 0.034) and nerve injury (0.7 % vs 0.1 %, P < 0.001). Postoperatively, they frequently reported acute kidney injury, urinary tract infection, wound-related complications, hematoma, prosthetic joint infection, aseptic loosening, and revisions (all P < 0.004).

Patients developing footdrop following THA were more likely to be women, undergoing revision surgery, and had higher rates of prior lumbar fusion and medical comorbidities. They reported more postoperative complications and subsequent revisions following THA. This study informs us of the risk factors footdrop and may contribute to better patient counseling and surgical planning before undergoing THA.