During a presentation at the Current Concepts in Joint Replacement Winter Meeting, Edwin P. Su, MD, highlighted patient and surgeon factors associated with the development of motor nerve palsy after primary total hip arthroplasty.
Dr. Su and his colleagues studied 39,056 primary total hip arthroplasties performed at the Hospital for Special Surgery during a 15-year-period. The investigators matched each case with two control patients who underwent THA during the same week, but did not develop the condition.
In addition to examining patient characteristics that could be linked with the risk of nerve palsy, researchers studied surgeon factors such as fellowship training, years in practice and volume. They also studied radiographic findings, such as the grade of arthritis, center of rotation and off-set.
Here are three key facts:
1. A multivariate analysis revealed patients younger than 50 years of age who had a history of smoking were among the factors significantly associated with an increased risk for nerve palsy.
2. Dr. Su said the time of day also had an effect. Procedures that took place around 4:00 pm or later had a significantly higher odds ratio 4.7 times higher, and a history of spinal stenosis and lumbar spine disease were the strongest associated factors with an odds ratio of almost 80 times greater risk of nerve palsy.
3. He added these factors can help physicians consult their patients, stratify their patients, and change their schedule to perform these procedures on patients who are higher risk earlier in the day.