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Updated: Jun 11 2021

TKA Peroneal Nerve Palsy

  • summary
    • TKA Peroneal Nerve Palsy is a rare, potentially devastating, complication of TKA that is most commonly seen following correction of a knee with a valgus and/or flexion deformity. 
    • Diagnosis is made clinically post-op with decreased sensation in peroneal nerve distribution with weakness if dorsiflexion of the ankle. 
    • Treatment is placing the knee in flexion immediately post-operatively. Observation and AFO in the presence of foot drop are recommended to monitor for recovery of the nerve.
  • Neurologic Injury (Peroneal nerve)
    • Introduction
      • incidence
        • 0.3%-2%
      • risk factors
        • preoperative valgus and/or flexion deformity
        • tourniquet time > 120 min
        • postoperative use of epidural analgesia
        • aberrant retractor placement
        • preoperative diagnosis of neuropathy (centrally or peripherally)
      • prognosis
        • 50% or more improve in time with no additional treatment
    • Anatomy
      • common peroneal nerve lying on lateral head of gastrocnemius at the level of the joint line
      • distance from posterolateral corner of tibia to peroneal nerve is 9mm-15mm at this level
    • Evaluation
      • EMG
        • obtain after 3 months if no improvement
    • Treatment
      • remove dressing and place knee in flexed position
        • indications
          • initial postoperative management in all cases noted in the immediate postoperative period
      • ankle-foot orthosis
        • indications
          • complete foot drop
      • late nerve decompression or muscle transfer
        • indications
          • no recovery after 3 months
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