Ob. Idusuyi et Bf. Morrey, PERONEAL NERVE PALSY AFTER TOTAL KNEE ARTHROPLASTY - ASSESSMENT OF PREDISPOSING AND PROGNOSTIC FACTORS, Journal of bone and joint surgery. American volume, 78A(2), 1996, pp. 177-184
Thirty-two postoperative peroneal-nerve palsies in thirty patients wer
e documented in a retrospective review of 10,361. consecutive total kn
ee arthroplasties performed at one institution from 1979 through 1992,
The mean age of the thirty patients was sixty-five Sears (range, twen
ty-eight to seventy-eight years), Four of these patients had had a pre
vious proximal tibial osteotomy and five had had a previous lumbar lam
inectomy. Ten knees (ten patients) had preoperative valgus alignment o
f 12 degrees or more, A control group of 100 patients who had had tota
l knee arthroplasty during the same period was computer-matched to the
patients by age, sex, and operating surgeon, Comparison of this contr
ol group with the thirty patients showed that epidural anesthesia for
postoperative control of pain (p < 0.03), previous laminectomy (p < 0.
04), and preoperative valgus deformity (p < 0.0001) were significantly
associated with peroneal nerve palsy The relative risk for patients w
ho had had a previous proximal tibial osteotomy was doubled, but this
was not significant (p < 0.4), To determine risk factors associated wi
th anesthesia better, a subgroup of 4388 total knee arthroplasties per
formed during a five-year period (1988 through 1992) was also studied,
In this sample, twenty-five peroneal-nerve palsies were documented, E
ighteen occurred after epidural anesthesia (p < 0.03); five, after gen
eral anesthesia; and two, after spinal anesthesia. An important findin
g of this study is the high frequency of delayed presentation of peron
eal nerve palsy We believe that epidural anesthesia for postoperative
control of pain leads to decreased proprioception and sensation postop
eratively, It is postulated that positioning of the limb in this unpro
tected state may be a factor in the late development of palsy The conc
ept of the so-called double-crush phenomenon may partially explain the
palsy seen in the patients who had had a lumbar laminectomy and asymp
tomatic peripheral neuropathy.