Rajani Amyn M, Mittal Anmol R S, Kulkarni Vishal U, Rajani Khushi A, Rajani Kashish A
Department of Orthopaedics, OAKS Clinic, Gamdevi, Mumbai, Maharashtra, India.
Clinical Research, OAKS Clinic, Gamdevi, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2023 Aug;13(8):93-96. doi: 10.13107/jocr.2023.v13.i08.3830..
Common peroneal nerve palsy (CPNP) is a rare complication post total knee arthroplasty (TKA). Even though it is diagnosed acutely, the recovery potential is just over 50%. The average period for complete recovery in such cases is 5 months; however, the management remains controversial. Even though the recovery was delayed, the patient made full recovery.
A 70-year-old female patient was diagnosed to have bilateral tricompartmental knee osteoarthritis with varus deformity, both clinically and radiologically (Kellgren-Lawrence grade 4). She underwent bilateral TKA in a single sitting as per the standard protocols practiced by the primary author. On post-operative day 1, she had left-sided foot drop with a complete sensory deficit. The patient underwent routine rehabilitation with an ankle foot orthosis splint in the immediate post-operative period, with simultaneous faradic current stimulation for the left lower limb. Periodic electromyography and nerve conduction study was done at the end of 4-week and 3-month post-TKA. At 6.5-month post-surgery, she made a full clinical recovery.
The surgical maneuvers and full neurovascular examination before and after every TKA surgery should be carefully performed. Despite this, if a patient presents with CPNP, the surgeon need not take an aggressive approach, unlike fracture fixation cases. These patients can be managed conservatively using appropriate orthosis, physical therapy, and faradic current stimulation. Through this case, we attempt to report that CPNP patient can recover even after 6 months of surgery when there is no tangible cause for the palsy.
腓总神经麻痹（CPNP）是全膝关节置换术（TKA）后一种罕见的并发症。尽管其急性发作时即可确诊，但其恢复几率仅略高于50%。此类病例完全恢复的平均时间为5个月；然而，其治疗方法仍存在争议。尽管恢复过程有所延迟，但该患者最终完全康复。
一名70岁女性患者，经临床和影像学检查（Kellgren-Lawrence分级4级）确诊为双侧三间室膝关节骨关节炎伴内翻畸形。按照第一作者所采用的标准方案，她在一次手术中接受了双侧TKA。术后第1天，她出现左侧足下垂及完全性感觉缺失。术后早期，患者接受了常规康复治疗，使用踝足矫形器夹板，并同时对左下肢进行感应电刺激。TKA术后4周和3个月时分别进行了定期肌电图和神经传导研究。术后6.5个月时，她实现了完全临床康复。
每次TKA手术前后均应仔细进行手术操作及全面的神经血管检查。尽管如此，如果患者出现CPNP，与骨折固定病例不同，外科医生无需采取激进的治疗方法。这些患者可通过使用合适的矫形器、物理治疗和感应电刺激进行保守治疗。通过本病例，我们试图报告，当麻痹无明确病因时，CPNP患者即使在术后6个月也可康复。
