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
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - High Tibial Osteotomy Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Parapatellar Approach Derek Bernstein Stephen Incavo Recon - High Tibial Osteotomy Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique Derek Bernstein Stephen Incavo Recon - TKA Axial Alignment
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next (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? QID: 4567 Type & Select Correct Answer 1 Continue Ankle-foot orthosis (AFO) and physical therapy 8% (360/4400) 2 Repeat neurolysis with possible nerve repair 1% (29/4400) 3 Peroneus tertius transfer 4% (177/4400) 4 Peroneus tertius transfer with achilles tendon lengthening 7% (297/4400) 5 Posterior tibial tendon transfer to dorsum of foot 80% (3520/4400) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? QID: 3150 FIGURES: A B Type & Select Correct Answer 1 Aberrant retractor placement 0% (13/3294) 2 Postoperative epidural analgesia 9% (295/3294) 3 Correction of a 20 degree preoperative valgus deformity 2% (77/3294) 4 Excessive medial release 84% (2777/3294) 5 Preoperative diagnosis of neuropathy 4% (119/3294) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? QID: 883 Type & Select Correct Answer 1 Application of an AFO to prevent an equinus contracture 4% (94/2643) 2 Unwrap any compressive dressings and flex the knee 92% (2438/2643) 3 Immediate EMG 0% (10/2643) 4 Open exploration of the peroneal nerve 1% (23/2643) 5 Reassurance 2% (65/2643) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ04.82) What preoperative knee deformity puts a patient at most risk for a postoperative peroneal nerve palsy after total knee arthroplasty? QID: 1187 Type & Select Correct Answer 1 Valgus deformity only 2% (33/1384) 2 Valgus and flexion contracture 91% (1261/1384) 3 Varus and flexion contracture 4% (53/1384) 4 Varus deformity only 2% (22/1384) 5 Flexion contracture only 0% (6/1384) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (0) Podcasts (1) Recon⎜TKA Peroneal Nerve Palsy Team Orthobullets 4 Recon - TKA Peroneal Nerve Palsy Listen Now 16:12 min 10/21/2019 109 plays 5.0 (1)