Updated: 11/11/2016

TKA Peroneal Nerve Palsy

Topic
Review Topic
0
0
Questions
8
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0
Evidence
1
0
0
Techniques
3
Neurologic Injury (peroneal nerve)
  • Introduction
    • incidence
      • .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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Technique Guides (3)
Questions (8)

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(OBQ12.207) A 56-year-old male undergoes an uncomplicated revision total knee arthroplasty. Post-operatively, he is noted to have a foot drop that has persisted despite conservative management including bracing and physical therapy. At two months, the patient undergoes external neurolysis with no improvement in function. At 18 months follow-up, he demonstrates passive ankle dorsiflexion 10 degrees past neutral, complete absence of active dorsiflexion, and 5/5 inversion strength. Which of the following is the most appropriate treatment at this time? Review Topic

QID: 4567
1

Continue Ankle-foot orthosis (AFO) and physical therapy

8%

(332/3951)

2

Repeat neurolysis with possible nerve repair

1%

(27/3951)

3

Peroneus tertius transfer

4%

(149/3951)

4

Peroneus tertius transfer with achilles tendon lengthening

7%

(260/3951)

5

Posterior tibial tendon transfer to dorsum of foot

80%

(3167/3951)

L 2

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(OBQ10.62) A 65-year-old male undergoes a primary total knee arthroplasty. His preoperative radiographs are seen in figures A and B. Postoperative examination reveals an inability to dorsiflex his ankle or extend his toes. Sensation is decreased along the dorsum of his foot as well as between the 1st and 2nd toes. All of the following are risk factors for this complication following total knee arthroplasty EXCEPT? Review Topic

QID: 3150
FIGURES:
1

Aberrant retractor placement

0%

(11/2645)

2

Postoperative epidural analgesia

9%

(244/2645)

3

Correction of a 20 degree preoperative valgus deformity

2%

(55/2645)

4

Excessive medial release

84%

(2228/2645)

5

Preoperative diagnosis of neuropathy

4%

(96/2645)

L 1

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(OBQ07.222) A 65-year-old female has severe knee arthritis with a significant flexion contracture and valgus deformity. In the recovery room following her total knee replacement, she is unable to dorsiflex her ankle. Management should include? Review Topic

QID: 883
1

Application of an AFO to prevent an equinus contracture

3%

(58/1812)

2

Unwrap any compressive dressings and flex the knee

93%

(1692/1812)

3

Immediate EMG

0%

(5/1812)

4

Open exploration of the peroneal nerve

1%

(12/1812)

5

Reassurance

2%

(37/1812)

L 1

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(OBQ04.82) What preoperative knee deformity puts a patient at most risk for a postoperative peroneal nerve palsy after total knee arthroplasty? Review Topic

QID: 1187
1

Valgus deformity only

2%

(23/1031)

2

Valgus and flexion contracture

91%

(943/1031)

3

Varus and flexion contracture

3%

(35/1031)

4

Varus deformity only

2%

(18/1031)

5

Flexion contracture only

0%

(5/1031)

L 1

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