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Motor Nerve Palsy After Primary Total Hip Arthroplasty: A Case-Control Analysis With Radiographic Review.

Michael W Seward1, Timothy S Brown1, Dirk R Larson2

  • 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

The Journal of Arthroplasty
|September 11, 2025
PubMed
Summary

Motor nerve palsy after total hip arthroplasty (THA) is rare (0.4%) and serious, with only 20% achieving full recovery. Lumbar spine disease significantly increases risk, necessitating careful consideration of patient comorbidities.

Keywords:
nerve injuryneurovascular injuryperoneal nerve palsysciatic nerve palsytotal joint arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Neurology
  • Biomedical Engineering

Background:

  • Motor nerve palsy is a significant complication following primary total hip arthroplasty (THA).
  • Understanding the incidence, risk factors, and prognosis of these palsies is crucial for patient outcomes.
  • This study addresses these aspects in a large patient cohort with radiographic analysis.

Purpose of the Study:

  • To determine the incidence of motor nerve palsies after primary THA.
  • To identify significant risk factors associated with these nerve injuries.
  • To evaluate the prognosis and recovery rates for patients experiencing motor nerve palsy post-THA.

Main Methods:

  • A retrospective review of 10,604 primary THAs performed between 2001 and 2014.
  • Identification of 40 cases of motor nerve palsy within 90 days of surgery.
  • Logistic regression, case-control analysis, and radiographic measurements were used to assess risk factors and outcomes.

Main Results:

  • The incidence of motor nerve palsy was 0.4%, with the peroneal branch of the sciatic nerve being most frequently affected (68%).
  • Leg lengthening occurred in 39 of 40 cases, with a median of 10 mm.
  • Lumbar spine disease was a significant risk factor (OR 21.3), while other factors like age, BMI, and surgical approach were not.

Conclusions:

  • Motor nerve palsies after THA are uncommon but associated with poor recovery rates (only 20% complete).
  • The peroneal nerve is most vulnerable, and leg lengthening is common in affected patients.
  • Pre-existing lumbar spine disease is a critical risk factor, requiring careful preoperative assessment.