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VOLUME 17 , ISSUE 1 ( January-April, 2022 ) > List of Articles

Original Article

The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty

Asim Makhdom, Amber A Hamilton

Keywords : Foot drop, Knee arthroplasty, Knee replacement, Peroneal palsy, Valgus knee

Citation Information : Makhdom A, Hamilton AA. The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty. 2022; 17 (1):38-43.

DOI: 10.5005/jp-journals-10080-1545

License: CC BY-NC-SA 4.0

Published Online: 24-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Common peroneal nerve (PN) palsy after total knee arthroplasty (TKA) is a serious complication. Although many authors suggest delayed or immediate PN decompression after TKA in these patients, little is known about the role of prophylactic peroneal nerve decompression (PPND) at the time of TKA. The aim is to report the results of PPND in high-risk patients at the time of TKA. Materials and methods: A multi-institutional retrospective study review of nine patients (10 knees) who underwent PPND at the time of TKA was conducted. Patients who had severe valgus deformities (≥15° of femorotibial angle and not fully correctable by examination under anaesthesia) with or without flexion contractures were included. PPND was performed through a separate 3–4-cm incision at the time of TKA. The demographics, preoperative and postoperative anatomical and mechanical alignments, range of motion, operation time, postoperative neurological function and complications were recorded. Results: All patients had a completely normal motor and sensory neurological function postoperatively and no complications related to PPND were reported. All patients followed the standard physical therapy protocol after TKA without modifications. The mean preoperative femorotibial angle was 20° (range 15–33°) and the mean postoperative femorotibial angle was 6.3° (range 5–9°) (p = 0.005). The mean preoperative flexion contracture was 9 (range 0–20) and the mean residual contracture was 1.2° (range 2–5°) (p = 0.006). Conclusion: PPND at the time of TKA is an option to minimise the risk of PN palsy in high-risk patients. This approach can be considered for patients undergoing TKA in selected high-risk patients with a severe valgus deformity.

  1. Zywiel MG, Mont MA, McGrath MS, et al. Peroneal nerve dysfunction after total knee arthroplasty: characterization and treatment. J Arthroplasty 2011;26(3):379–385. DOI: 10.1016/j.arth.2010.03.020.
  2. Park JH, Restrepo C, Norton R, et al. Common peroneal nerve palsy following total knee arthroplasty: prognostic factors and course of recovery. J Arthroplasty 2013;28(9):1538–1542. DOI: 10.1016/j.arth.2013.02.025.
  3. Mont MA, Dellon AL, Chen F, et al. The operative treatment of peroneal nerve palsy. J Bone Joint Surg Am 1996;78(6):863–869. PMID: 8666604.
  4. Schinsky MF, Macaulay W, Parks ML, et al. Nerve injury after primary total knee arthroplasty. J Arthroplasty 2001;16(8):1048–1054. DOI: 10.1054/arth.2001.26591.
  5. Nercessian OA, Ugwonali OF, Park S. Peroneal nerve palsy after total knee arthroplasty. J Arthroplasty 2005;20(8):1068–1073. DOI: 10.1016/j.arth.2005.02.010.
  6. Christ AB, Chiu YF, Joseph A, et al. Incidence and risk factors for peripheral nerve injury after 383,000 total knee arthroplasties using a New York state database (SPARCS). Arthroplasty 2019;34(10): 2473–2478. DOI: 10.1016/j.arth.2019.05.008.
  7. Nielsen S, Hvid I, Sneppen O. Total condylar knee arthroplasty. A report of 2-year follow-up on 247 cases. Arch Orthop Trauma Surg 1985;104(4):227–232. DOI: 10.1007/BF00450215.
  8. Erickson BJ, Brown N, Fernandez J, et al. Acute decompression for peroneal nerve palsy following primary total knee arthroplasty: a report of two cases. JBJS Case Connect 2015;5(1):e16–e24. DOI: 10.2106/JBJS.CC.N.00134.
  9. Krackow KA, Maar DC, Mont MA, et al. Surgical decompression for peroneal nerve palsy after total knee arthroplasty. Clin Orthop Relat Res 1993;292:223–228. PMID: 8390926.
  10. Ward JP, Yang LJ, Urquhart AG. Surgical decompression improves symptoms of late peroneal nerve dysfunction after TKA. Orthopedics 2013;36(4):e515–e519. DOI: 10.3928/01477447-20130327-33.
  11. Nogueira M, Paley D. Prophylactic and therapeutic peroneal nerve decompression for deformity correction and lengthening. Oper Tech Orthop 2011;21(2):180–183. DOI: 10.1053/j.oto.2011.01.001.
  12. Gruskay JA, Fragomen AT, Rozbruch SR. Idiopathic rotational abnormalities of the lower extremities in children and adults. JBJS Rev 2019;7(1):e3. DOI: 10.2106/JBJS.RVW.18.00016.
  13. Tanzer M, Makhdom AM. Preoperative planning in primary total knee arthroplasty. J Am Acad Orthop Surg 2016;24(4):220–230. DOI: 10.5435/JAAOS-D-14-00332.
  14. Clarke HD, Fuchs R, Scuderi GR, et al. Clinical results in valgus total knee arthroplasty with the “pie crust” technique of lateral soft tissue releases. J Arthroplasty 2005;34(10):2473–2478. DOI: 10.1016/j.arth.2005.03.036.
  15. Idusuyi OB, Morrey BF. Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg Am 1996;78(2):177–184. DOI: 10.2106/00004623-199602000-00003.
  16. Lamm BM, Paley D, Testani M, et al. Tarsal tunnel decompression in leg lengthening and deformity correction of the foot and ankle. J Foot Ankle Surg 2007;46(3):201. DOI: 10.1053/j.jfas.2007.01.007.
  17. Blonna D, O'Driscoll SW. Delayed-onset ulnar neuritis after release of elbow contracture: preventive strategies derived from a study of 563 case. Arthroscopy 2014;30(8):947–956. DOI: 10.1016/j.arthro.2014.03.022.
  18. Insall J, Scott WN, Ranawat CS. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 1979;61(2):173. PMID: 422602.
  19. Cree AK, Coolican MRJ, Tonkin MA. Prevention of common peroneal nerve palsy after surgery for valgus deformity about the knee. Knee 1998;5(4):261–265. DOI: 10.1016/S0968-0160(98)00017-9.
  20. Rose HA, Hood RW, Otis JC, et al. Peroneal nerve palsy following total knee arthroplasty. J Bone Jt Surg 1982;64(A):347–351. PMID: 7061551.
  21. Xu J, Liu H, Luo F, et al. Common peroneal nerve ‘pre-release’ in total knee arthroplasty for severe valgus deformities. Knee 2020;27(3): 980–986. DOI: 10.1016/j.knee.2020.02.012.
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