Villa Morgan, Farrar Jacob, Larkin Kevin, Satpathy Jibanananda, Isaacs Jonathan, Patel Nirav
Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA.
Arthroplast Today. 2023 Aug 23;23:101205. doi: 10.1016/j.artd.2023.101205. eCollection 2023 Oct.
Common peroneal nerve (CPN) palsy after primary total knee arthroplasty represents a relatively rare but serious complication. Recently, there has been a growing interest in prophylactic CPN decompression in high-risk patients with significant combined valgus and flexion deformity. This study aimed to examine outcomes at our institution in those undergoing prophylactic CPN decompression at the time of total knee arthroplasty.
A retrospective evaluation of a single-institution experience with selected patients at high risk for CPN palsy who underwent prophylactic nerve decompression through a separate incision at the time total knee arthroplasty was performed between July 1, 2018 and December 31, 2022. Patient demographics as well as perioperative and intraoperative clinical and radiographic measurements were collected and analyzed.
A total of 14 patients (15 knees) met our inclusion criteria. The mean preoperative femorotibial angle was 18.6° of valgus (range 13°-22°). The mean preoperative flexion contracture was 4.3° (range 0°-25°). The patients with flexion contractures preoperatively had a mean combined valgus/flexion contracture deformity of 28.8° (range 23°-38°) . There was preservation of nerve function in all knees. No knees required subsequent operative intervention within 90 days of surgery.
Early experience with prophylactic CPN release in our high-risk population demonstrates preservation of nerve function in all patients and is reasonable to consider in patients with a large preoperative combined valgus/flexion deformity. Further studies with larger sample sizes would be beneficial in verification of the results with this technique, as well as determining an angular deformity threshold for which CPN release should be considered.
初次全膝关节置换术后腓总神经（CPN）麻痹是一种相对罕见但严重的并发症。近来，对于合并严重外翻和屈曲畸形的高危患者进行预防性CPN减压的关注度日益增加。本研究旨在探讨在我院接受全膝关节置换术时进行预防性CPN减压患者的治疗效果。
对2018年7月1日至2022年12月31日期间在我院接受全膝关节置换术时通过单独切口进行预防性神经减压的CPN麻痹高危患者进行单中心回顾性评估。收集并分析患者的人口统计学资料以及围手术期和术中的临床及影像学测量数据。
共有14例患者（15膝）符合纳入标准。术前平均股胫角为外翻18.6°（范围13° - 22°）。术前平均屈曲挛缩为4.3°（范围0° - 25°）。术前有屈曲挛缩的患者平均外翻/屈曲挛缩合并畸形为28.8°（范围23° - 38°）。所有膝关节的神经功能均得以保留。术后90天内无膝关节需要后续手术干预。
在我们的高危人群中进行预防性CPN松解的早期经验表明，所有患者的神经功能均得以保留，对于术前合并严重外翻/屈曲畸形的患者而言，考虑进行预防性CPN松解是合理的。更大样本量的进一步研究将有助于验证该技术的结果，以及确定应考虑进行CPN松解的角度畸形阈值。
