Nerve Decompression Surgery After Total Hip Arthroplasty: What Are The Outcomes?

• Published in: The Journal of arthroplasty 2017-04, Vol.32 (4), p.1335-1339
• Main Authors: Chughtai, Morad, M.D, Khlopas, Anton, M.D, Gwam, Chukwuwieke U., M.D, Elmallah, Randa K., M.D, Thomas, Melbin, M.D, Nace, James, D.O, Mont, Michael A., M.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Cohort Studies; Decompression, Surgical - methods; Female; Humans; Male; Middle Aged; Muscle Strength; nerve; nerve decompression; nerve release; Orthopedics; Pain Measurement; sciatic nerve palsy; Sciatic Neuropathy - etiology; Sciatic Neuropathy - surgery; Sensation; THA; total hip arthroplasty; Treatment Outcome
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.10.032

Introduction The purpose of our study was to compare: 1) muscle strength; 2) pain; 3) sensation; and 4) various outcomes measurement scales between post-THA patients who had a sciatic nerve injury and did or did not receive decompression surgery for this condition; and 5) to compare these findings to current literature. Methods Nineteen patients who had nerve injury after THA were reviewed. Patients were stratified into those who had a nerve decompression(n=12), and those who did not(n=7). Motor strength was evaluated using the Muscle Strength Testing Scale. Pain was evaluated by using the Visual Analogue Scale. Systematic literature search was performed to compare the findings of this study to others currently published. Results The decompression group had a significant improvement in motor strength and VAS scores as compared to non-operative group. Patients in decompression group had a significantly larger increases in mean HHS and UCLA scores. There was no significant difference in the increase of SF-36 physical and mental scores between the two groups. Literature review for non-operative management yielded 5 studies (93 patients), with 33% improvement. There were seven studies (81 patients) on nerve decompression surgery, with 75% improvement. Conclusions This study demonstrates the benefits of nerve decompression surgery in patients who had sciatic nerve injury following THA as evidenced by results of standardized outcome measurement scales. It is possible to achieve improvements in terms of strength, pain, and clinical outcomes. Comparative studies with larger cohorts are needed to fully assess the best candidates for this procedure.