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A possible complication of total hip replacement surgery is nerve palsy, the temporary or permanent loss of sensation or loss the ability to move. This complication occurs in from 0.6 to 3.7 percent of patients who have total hip replacement procedures. Peripheral nerve injuries can occur as a result of nerve laceration, ischemia (decreased blood supply), mechanical injury such as compression or separation, or a combination of these circumstances. A review was undertaken of all patients who developed nerve palsy following total hip replacement during a 17-year period to determine long-term follow-up and prognosis and to identify patients at risk. There were 3,126 operations performed; the overall incidence of nerve palsy was 1.7 percent. The incidence of nerve palsy was significantly higher for patients with congenital dislocation of the hip (5.2 percent) and for patients who underwent revision procedures (3.2 percent) than for patients who had joint replacement for osteoarthritis (1.0 percent). The sciatic nerve (the body's largest nerve which passes from the lower spine down the back of the thigh) was involved in 80 percent of the neuropathies. Fifty-three extremities were reevaluated at follow-ups ranging from 1 to 16.5 years after surgery. Only 7 limbs recovered complete neurologic function; 18 limbs had mild weakness, sensory loss and/or mild dysesthesia (abnormal sensations such as numbness or tingling on the skin); and 15 limbs had more severe weakness. Six additional patients had limited walking ability, and seven patients had severely impaired motor function. All patients who had a nerve palsy had decreased walking ability. Patients younger than 48 years who had undergone primary hip replacement had the greatest disability. The degree of nerve injury influenced the prognosis of neurological recovery. All patients who maintained motor function or recovered some motor function during hospitalization made a good recovery. Patients with severe dysesthesia did not recover neurological function. (Consumer Summary produced by Reliance Medical Information, Inc.)

People who have had congenital dislocation of the hip frequently develop subsequent osteoarthrosis with dysplasia (abnormal tissue development) in the same area. Surgical correction using partial or total hip replacement is much more difficult in these patients than in patients whose only problem is osteoarthritis. Often the socket part of the hip is shallow, and this or other changes in the bony structure necessitate particular compensations in surgical hardware and techniques. The outcomes of 74 cemented total hip replacements, in which both ball and socket were replaced, in 55 patients (C group), and of 37 cemented surface replacements of the socket portion only in 32 patients (S group) were evaluated. Patients treated with surface rather than conventional replacements tended to have less severe dysplasia and require less extensive surgical reconstruction. Short-term outcomes in both groups were favorable, and patients reported pain relief and improved hip function. However, group C had more postsurgical complications such as infection, dislocation, and partial nerve paralysis. Infection may have been related to the greater degree of surgical intervention, while nerve dysfunction was related to surgically-induced leg lengthening. All older patients in the C group did well in the long-term, while durable long-term results were not achieved in younger patients in either group. Early surgical techniques and anatomic factors contributed to difficulties with the surface replacement surgery. The major failure necessitating additional surgery or treatment was aseptic (noninfected) loosening of the socket prosthesis. The results suggest that younger patients (under age 60) with osteoarthrosis following congenital hip dislocation should receive treatment other than total or surface hip replacement surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Resection arthroplasty is often used as a salvage procedure when deep infection occurs following the insertion of a prosthesis during hip replacement surgery. This procedure is rarely indicated as a first or primary procedure. The results of 48 resected arthroplasties, performed on 43 patients, were analyzed. The indications for the procedure were: serious infection following total hip replacement, loosening of the hip prosthesis without sepsis or decay, and primary septic arthritis (bacterial infection of the joint). Sepsis was eliminated in 40 of the 43 patients using this procedure. The level of pain was markedly reduced for most patients; 35 percent of the patients achieved good pain relief. Following resection arthroplasty, the patients were generally inactive, but were able to be independent and walk a limited distance with support. In this study, women generally had less favorable outcomes than men. Patients who had resection arthroplasty due to sepsis following hip replacement also had poorer outcomes than the remainder of the study group. Regarding surgical technique, the authors suggest that as much of the femoral head as possible be left intact; better outcome and function were correlated with the amount of intact femoral bone. (Consumer Summary produced by Reliance Medical Information, Inc.)