Prognosis for Peripheral Nerve Injuries after Hip Joint Arthroplasty.

BACKGROUND: Peripheral nerve damage is a rare complication of hip replacement surgery that severely impairs the therapeutic outcome. The aim of the present study was to determine the time needed for nerve recovery and re-storation of activity following iatrogenic damage during a primary or revision hip arthroplasty from an anterolateral approach and its relationship with the severity of damage. MATERIALS AND METHODS: A prospectively collected database of 1107 patients treated with primary arthroplasty and 303 patients following revision arthroplasty (mean age 63 years, range 53 to 72 years) was analysed. This included 15 cases of palsy of the peroneal branch of the sciatic nerve and 7 of the femoral nerve. The mean follow-up was 3.6 years (minimum two years). RESULTS: The following risk factors were identified: dysplastic osteoarthritis, limb elongation, revision arthroplasty, female sex and post-traumatic osteoarthritis. All five patients demonstrating light palsy (Lovett score 3-5), and 9 out of the 17 with severe palsy (Lovett score 0-2) achieved full recovery. Of all patients, 63.6% regained nerve function after 4 weeks to 24 months (mean 17 months), with nine demonstrating complete recovery and five partial. Also, 66.6% patients regained femoral nerve function and 61.5%, sciatic nerve function. CONCLUSION: 1. The femoral nerve and the peroneal branch of the sciatic nerve demonstrate a similar pattern of functional recovery following damage. 2. All patients recovered from light palsy, and almost 2/3 of cases of severe palsy demonstrated partial or complete recovery. 3. Female sex is a significant risk factor.

Feet Deformity and Gait Disturbance in a Patient with Pachydermoperiostosis (PDP). Case Study.

Pachydermoperiostosis is a rare condition representing a primary form of hypertrophic osteoarthropathy. It presents in different stages. Patients often overlook early symptoms, because they are benign. The most common manifestations are clubbing of the fingers and toes, skin thickening with characteristic folds on the face and head and widening of joints accompanied by radiological changes. Surgical treatment is not often needed, and, consequently, there are no strict guidelines on surgical management, which is mainly based on case report ana-lysis. This paper presents a case of surgical management of pachydermoperiostosis.