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Treatment strategies for iatrogenic nerve injuries after joint replacement
Andrew L O'Brien MD, MPH, Julie M West MS, PA-C, Amy M Moore MD
The Ohio State University Wexner Medical Center
2022-01-15
Presenter: Gunel Guliyeva
Affidavit:
Gregory Pearson
Director Name: Gregory Pearson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Peripheral nerve injuries are rare but potentially devastating complications of joint replacement surgery that can result in loss of motor function, sensory disturbances, and/or chronic pain. Depending on the type of injury and the timing of the referral to a peripheral nerve surgeon, treatment options such as nerve transfers and/or nerve decompressions can be offered to improve function and reduce pain.
Retrospective review identified patients who presented with nerve injury after joint replacement. Patient characteristics were gathered and the visual analog scale was used to quantify patient-reported outcomes. Motor function was assessed in patients who underwent nerve transfers.
Seven patients presented with nerve injuries - five after total hip arthroplasty, and two after total shoulder arthroplasty. Average time from nerve injury to presentation was 568.11 days. Average time to presentation for those who underwent nerve transfer was 136 days, compared to 893 days for those who underwent decompression. Four patients underwent nerve transfers and nerve decompression, and three patients underwent nerve decompression only. All patients reported postoperative improvements in pain, quality of life, and depression. MRC grades which improved in the patients who had nerve transfers. All surgeries were outpatient and no 30-day post-operative complications occurred.
Nerve injury after joint replacement is uncommon, but when it occurs it is devastating. Nerve decompressions can provide pain control benefits no matter the time from injury, and if a timely referral is made, nerve transfers may offer the ability to restore function. Collaboration with orthopedic surgeons about nerve reconstruction options is essential.
