Iatrogene Nervenläsionen in der Hüft- und Knieendoprothetik

Zusammenfassung

Iatrogene Verletzungen motorischer Nerven gehören zu den Majorkomplikationen der Hüft- und Knieendoprothetik. Entsprechende Risikofaktoren und das Vorgehen bei solchen Schädigungen sollten den behandelnden Ärzten vertraut sein.

Abstract

Iatrogenic nerve injuries are rare complications of total hip and knee arthroplasty, which may cause chronic pain and loss of function, severely affecting the patientʼs daily activities and quality of life. Nerves “at risk” include the sciatic nerve, the femoral nerve, the lateral femoral cutaneous nerve and the superior gluteal nerve during total hip arthroplasty, and the infrapatellar branch of the saphenous nerve as well as the peroneal nerve during total knee arthroplasty. Multiple procedure-related and patient-related factors have been identified to modify the risk of nerve injury in the course of lower limb joint replacement surgery. These include the surgeonʼs skills, the surgical approach, the type of implant fixation, the intraoperative positioning of the patient, as well as pre-existing scars, the patientʼs sex, age and comorbidities. Diagnostic and therapeutic approaches should be based on the aetiology of the lesion: iatrogenic nerve lesions can result from direct (compression or transection) and/or indirect (traction, ischemia) trauma. The majority of nerve injuries encountered in hip or knee arthroplasty has been referred to as “minor” nerve lesions, which generally respond very well to non-operative treatment. “Major” nerve lesions, such as complete motor nerve transection, may result in lifelong impairment. Any perioperatively encountered neurological deficit requires a meticulous diagnostic work-up and an individually tailored treatment strategy, respecting aetiology and anatomic site of the nerve lesion as well as the individual patientʼs needs and comorbidities.

Schlüsselwörter

Nervenläsion - Endoprothetik - Hüftgelenk - Kniegelenk - postoperative Komplikationen

Key words

postoperative neurological deficit - arthroplasty - hip joint - knee joint - perioperative complications

• Literatur

• 1 Pabinger C, Lothaller H, Portner N. et al. Projections of hip arthroplasty in OECD countries up to 2050. Hip Int 2018; 28: 498-506
• 2 EPRD. eutsches Endoprothesenregister Deutschland. Jahresbericht 2017. https://www.eprd.de/fileadmin/user_upload/Dateien/Publikationen/Berichte/EPRD-Jahresbericht_2017_Einzelseiten_Online-Version.pdf Stand: 03.12.2019
• 3 Hasija R, Kelly JJ, Shah NV. et al. Nerve injuries associated with total hip arthroplasty. J Clin Orthop Trauma 2018; 9: 81-86
• 4 Jacob AK, Mantilla CB, Sviggum HP. et al. Perioperative nerve injury after total hip arthroplasty: regional anesthesia risk during a 20-year cohort study. Anesthesiology 2011; 115: 1172-1178
• 5 Farrell CM, Springer BD, Haidukewych GJ. et al. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87: 2619-2625
• 6 Shetty T, Nguyen JT, Wu A. et al. Risk Factors for Nerve Injury After Total Hip Arthroplasty: A Case-Control Study. J Arthroplasty 2019; 34: 151-156
• 7 Christ AB, Chiu YF, Joseph A. et al. Risk factors for peripheral nerve injury after 207,000 total hip arthroplasties using a New York State database (Statewide Planning and Research Cooperative System). J Arthroplasty 2019; 34: 1787-1792
• 8 Idusuyi OB, Morrey BF. Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg Am 1996; 78: 177-184
• 9 Shetty T, Nguyen JT, Sasaki M. et al. Bogner E et al. Risk factors for acute nerve injury after total knee arthroplasty. Muscle Nerve 2018; 57: 946-950
• 10 Christ AB, Chiu YF, Joseph A. et al. Incidence and risk factors for peripheral nerve injury after 383,000 total knee arthroplasties Using a New York State database (SPARCS). J Arthroplasty 2019; 34: 2473-2478
• 11 Schmalzried TP, Noordin S, Amstutz HC. Update on nerve palsy associated with total hip replacement. Clin Orthop Relat Res 1997; (344) 188-206
• 12 Barrack RL, Butler RA. Avoidance and management of neurovascular injuries in total hip arthroplasty. Instr Course Lect 2003; 52: 267-274
• 13 Ackmann T. Anatomie des Ramus infrapatellaris in Relation zu drei Hautinzisionen der Knieendoprothetik und als anatomische Grundlage zur Behandlung neuropathischer Schmerzen durch Kryodenervierung [Inauguraldissertation]. Münster:: Univ. Münster; 2015
• 14 Nercessian OA, Ugwonali OFC, Park S. Peroneal nerve palsy after total knee arthroplasty. J Arthroplasty 2005; 20: 1068-1073
• 15 Rommel O, Finger L, Bös E. et al. Neuropathische Schmerzen nach Läsion des R. infrapatellaris des N. femoralis. Schmerz 2009; 23: 355-359
• 16 Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy association with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am 1991; 73: 1074-1080
• 17 Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 1987; (218) 136-141
• 18 Park JH, Hozack B, Kim P. et al. Common peroneal nerve palsy following total hip arthroplasty: prognostic factors for recovery. J Bone Joint Surg Am 2013; 95: e55
• 19 Brown GD, Swanson EA, Nercessian OA. Neurologic injuries after total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2008; 37: 191-197
• 20 Lundborg G. Structure and function of the intraneural microvessels as related to trauma, edema formation, and nerve function. J Bone Joint Surg Am 1975; 57: 938-948
• 21 DeHart MM, Riley LH. Nerve injuries in total hip arthroplasty. J Am Acad Orthop Surg 1999; 7: 101-111
• 22 Navarro X, Udina E. Chapter 6: Methods and protocols in peripheral nerve regeneration experimental research: part III – electrophysiological evaluation. Int Rev Neurobiol 2009; 87: 105-126
• 23 Pöschl P, Schulte-Mattler WJ. Neurophysiologische Diagnostik bei traumatischen Nervenläsionen. Klin Neurophysiol 2012; 43 (01) 1-9
• 24 Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften – AWMF. S3-Leitlinie: Versorgung peripherer Nervenverletzungen. AWMF-Register Nr. 005/010. Stand 06/2013. Im Internet (Stand: 03.12.2019): https://www.awmf.org/leitlinien/detail/ll/005-010.html
• 25 Kawano S, Sonohata M, Kitajima M. et al. Risk factors for the development of nerve palsy following primary total hip arthroplasty. Open Orthop J 2018; 12: 164-172
• 26 Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. Surg Neurology 2005; 63: 5-25
• 27 Fleischmann AN, Rothmann RH, Parvizi J. Femoral nerve palsy following total hip arthroplasty: incidence and course of revolvers. J Arthroplasty 2018; 33: 1194-1199
• 28 Slater N, Singh R, Senasinghe N. et al. Pressure monitoring of the femoral nerve during total hip replacement: an explanation for iatropathic palsy. J R Coll Surg Edinb 2000; 45: 231-233
• 29 Nercessian OA, Piccouluga F, Eftekhar NS. Postoperatives sciatic and femoral nerve palsy with reference to leg lengthening and medialization/lateralization of the hip joint following total hip arthroplasty. Clin Orthop Relat Res 1994; 304: 165-171
• 30 DeFine M, Romagnoli M, Zaffagnini S. et al. Sciatic nerve palsy following total hip replacement: are patients personal characteristics more important than limb lengthening? A Systematic Review. Biomed Res Int 2017; 2017: 8361071
• 31 Fajardo LF. Pathological effects of hyperthermia in normal tissues. Cancer Res 1984; 44 (10 Suppl): 4826s-4835s
• 32 De Vrind HH, Wondergem J, Haveman J. Hyperthermia-induced damage to rat sciatic nerve assessed in vivo with functional methods and with electrophysiology. J Neurosci Methods 1992; 45: 165-174
• 33 Jerosch J. Femoral nerve palsy in hip replacement due to pelvic cement extrusion. Arch Orthop Trauma Surg 2000; 120: 499-501
• 34 Xu LW, Veeravagu A, Azad TD. et al. Delayed presentation of sciatic nerve injury after total hip arthroplasty: neurosurgical considerations, diagnosis, and management. J Neurol Surg Rep 2016; 77: e134-e138
• 35 Enneking F, Chan V, Greger J. et al. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med 2005; 30: 4-35
• 36 Basques B, Toy J, Bohl D. et al. General compared with spinal Anesthesia for total Hip arthroplasty. J Bone Joint Surg Am 2015; 97: 455-461
• 37 Njathi CW, Johnson RL, Laughlin RS. et al. Complications after continuous posterior lumbar plexus blockade for total hip arthroplasty. Reg Anesth Pain Med 2017; 42: 446-450
• 38 Wright ME, Rizzolo D. An update on the pharmacologic management and treatment of neuropathic pain. JAAPA 2017; 30: 13-17
• 39 Lindsay L, Farrell C. Pharmacological management of neuropathic pain. Prescriber 2015; 26: 13-18
• 40 Piza-Katzer H, Schöller T, Stichelberger M. Iatrogene N. femoralis-Läsionen. HaMiPla – Handchir Mikrochir Plast Chir 2009; 41: 230-237
• 41 Chugtai M, Kholaps A, Gram CU. et al. Nerve decompression surgery after total hip arthroplasty: what are the outcomes?. J Arthroplasty 2017; 32: 1335-1339
• 42 Zappe B, Glauser PM, Majewski M. et al. Long-term prognosis of nerve palsy after total hip arthroplasty: results of two-year-follow-ups and long-term results after a mean time of 8 years. Arch Orthop Trauma Surg 2014; 134: 1477-1482
• 43 Rudin D, Manestar M, Ullrich O. et al. The anatomical course of the lateral femoral cutaneous nerve with special attention to the anterior approach to the hip joint. J Bone Joint Sure Am 2016; 98: 561-567
• 44 Chomiak J, Huracek J, Dvorak J. et al. Lesion of gluteal nerves and muscles in total hip arthroplasty through 3 surgical approaches. An electromyographically controlled study. Hip Int 2015; 25: 176-183
• 45 Hoshino C, Koga D, Koyano G. et al. Femoral nerve palsy following primary total hip arthroplasty with the direct anterior approach. PLoS One 2019; 14: e0217068
• 46 Fox AJ, Bedi A, Wanivenhaus F. et al. Femoral neuropathy following total hip arthroplasty: review and management guidelines. Acta Orthop Belg 2012; 78: 145-151
• 47 Macheras GA, Christofilopoulos P, Lepetsos P. et al. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach. Hip Int 2016; 26: 338-343
• 48 Goulding K, Beaulé PE, Kim PR. et al. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res 2010; 468: 2397-2404