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Nerve Injuries After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Abdullah A Alturki^1,2,3, Turki S Almugren^1,2, Ali A Alhandi^1,2

¹Department of Orthopedic Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.

Orthopedic Reviews

|June 17, 2026

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Nerve injuries after total knee arthroplasty (TKA) are uncommon but significant, with the common peroneal nerve most affected. Tourniquet use is a key risk factor, and most patients recover, though it may take time.

Area of Science:

Orthopedic Surgery
Neurosurgery
Biostatistics

Background:

Nerve injury is a rare but significant complication following total knee arthroplasty (TKA).
Incidence, patterns, predictors, and recovery of nerve injuries post-TKA are not well-defined.
This study systematically reviews and analyzes nerve injuries after TKA.

Purpose of the Study:

To determine the prevalence and types of nerve injuries after TKA.
To identify demographic and procedural risk factors for nerve injury.
To evaluate management strategies and recovery outcomes for TKA-related nerve injuries.

Main Methods:

Systematic review and meta-analysis of eight studies involving primary or revision TKA.
Pooled incidence and recovery rates using random-effects models.

Keywords:

Common peroneal nerve Nerve injury Recovery outcomes Total knee arthroplasty Tourniquet

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Meta-regression analysis for predictors and funnel plots for publication bias.

Main Results:

Pooled incidence of nerve injury was 12.86% across 1,599,948 TKAs, with high heterogeneity.
Common peroneal nerve injuries were most frequent; tourniquet use was a significant risk factor (p=0.0136).
Overall recovery rate was 73%, with recovery taking 10-22 months; conservative management was common.

Conclusions:

Nerve injuries post-TKA are uncommon but significant, primarily affecting the common peroneal nerve.
Tourniquet use is a modifiable risk factor; most patients achieve functional recovery, albeit prolonged.
Standardized prospective research is essential for improved prevention and management strategies.