THA Complications

Question 1

What branch of the sciatic nerve is most commonly a/w palsy after THA?

Answer 1

Peroneal branch (80%); place hip in extension and knee in flexion post-operatively to decrease tension

Question 2

What are risk factors for nerve palsies following THA or revision THA?

Answer 2

1) developmental dysplasia of the hip
2) revision surgery
3) female gender
4) limb lengthening
5) posttraumatic arthritis
6) surgeon self-rated procedure as difficult

only 35% to 40% recover full strength after complete palsy

Question 3

What percentage of patients with complete peroneal nerve palsy after total hip arthroplasty will never recover full strength?

Answer 3

60-65%

Question 4

What is the most common reason for litigation following total hip arthroplasty?

Answer 4

Limb length discrepancy; operative lengthening is most common

weak abductors may provide the sensation of a long leg in the absence of true LLD; resolves in 3-6 months if not treat with shoe lift

Question 5

What is the diagnosis and treatment of iliopsoas impingement following THA?

Answer 5

1) Diagnose with steroid injection in tendon sheath under fluoro
2) treat with cup revision if cup is proud anteriorly
3) tenotomy or resection via open or arthroscopic techniques if radiographs normal

Question 6

What are indications for surgery of periprosthetic osteolysis?

Answer 6

1) pathological fracture
2) impending pathological fracture
3) symptomatic THA with evidence of osteolysis
4) extensive osteolysis that would compromise revision 5) surgery in the future

Question 7

Placement of an inferior retractor under the transverse acetabular ligament, places what structure at risk?

Answer 7

Obturator artery; screw placement in the anterior-inferior quadrant also places obturator at risk