Neurologic injury in the upper extremity after total hip arthroplasty

The results of 7150 consecutive primary and revision total hip arthroplasties performed between 1976 and 1990 were reviewed retrospectively. Sixteen upper extremity neurologic palsies were identified in 16 patients. The incidence of upper extremity nerve palsies after total hip arthroplasty was 0.22%. There were five men and 11 women (average age, 59.5 years; range, 27-81 years). The neurologic injuries consisted of 10 ulnar palsies, four brachial plexopathies, one axillary nerve palsy, and one median nerve palsy. Patients were evaluated with respect to age, gender, preoperative diagnosis, type of procedure (primary versus revision), and surgical approach. Preoperative diagnoses included: inflammatory arthritis (11), osteoarthritis (two), avascular necrosis (one), developmental dysplasia of the hip (one), and posttraumatic arthritis (one). Fourteen of 16 patients (88%) had complete recovery. Two patients (12%) had persistent symptoms despite operative intervention. The only significant predisposing factor to developing an upper extremity neurologic injury after total hip arthroplasty was the preoperative diagnosis of an inflammatory arthropathy. Upper extremity neurologic injuries after total hip arthroplasty are rare. Patients with the preoperative diagnosis of an inflammatory arthropathy are at greater risk for experiencing upper extremity neurologic injury. The prognosis is favorable, with 88% of patients having complete recovery. Cautious induction of anesthesia and careful attention to patient positioning in the perioperative, intraoperative, and postoperative period are essential to help minimize the incidence of neurologic injuries in the upper extremity after total hip arthroplasty.