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The Journal of Bone and Joint Surgery, Vol 64, Issue 3 347-351, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
Peroneal-nerve palsy following total knee arthroplasty. A review of The Hospital for Special Surgery experience
HA Rose, RW Hood, JC Otis, CS Ranawat and JN Insall
Twenty-three postoperative peroneal-nerve palsies in twenty-two patients
were documented in the records of 2626 consecutive knee arthroplasties that
were performed at The Hospital for Special Surgery from 1974 through 1980.
This is an incidence of 0.87 per cent. The preoperative knee deformities
included fourteen flexion contractures, eleven valgus deformities, and five
biplane deformities. In five patients a peroneal palsy developed despite a
peroneal-nerve release at the time of arthroplasty. Only two patients, who
initially had only a motor loss, had a complete clinical recovery.
Follow-up ranged from six months to seven years (average 3.1 years).
Sensory deficits, initially noted in eighteen patients, had not fully
resolved in any patient at the time of writing. Although motor deficits
were initially noted in all patients, only 28.6 per cent of them fully
resolved. The possible causes of the nerve palsy appeared to be direct
traction on the nerve, traction on the surrounding tissues resulting in
vascular compromise to the nerve, direct pressure on the nerve from the
postoperative dressing, or a combination of these factors. When the palsy
is discovered, the suggested treatment is a change to a looser dressing and
flexion of the knee. The value of surgical exploration of the nerve in the
immediate postoperative period is not known.
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