Surgical approach and nerve palsy in total hip arthroplasty

A prospective study of the relation between nerve palsy and the surgical approach used for total hip arthroplasty was performed on 1,000 consecutive patients. A postoperative neuropathy was diagnosed in eight patients for an overall prevalence of 0.8%. The overall prevalence of nerve palsy with the posterior approach was 0.6% and 1.0% with the lateral transtrochanteric approach. In both primary and revision surgeries, there were no statistical differences between the two approaches. Our data suggest that it is the anatomic variations and complexity of the reconstruction that are associated with nerve injury and not the surgical approach per se. The increased prevalence of nerve palsy seen in revision surgeries (1.4%) regardless of the approach supports this position.