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Management of Peripheral Nerve and Vascular Injuries Associated With Total Hip Arthroplasty
Nerve injuries are uncommon in total hip arthroplasty (THA), and the mechanism of injury is generally unknown. Research shows that the risk of nerve injury in revision THA is nearly three times that in primary THA. The most commonly injured nerve is the sciatic nerve, specifically its peroneal division, accounting for 79% of all nerve palsies in one study, with isolated femoral palsies accounting for 13%, and obturator palsies accounting for 1.6%. Sensory nerves known to be at risk of injury include the lateral femoral cutaneous nerve, which is at risk in the direct anterior approach. Vascular injury is also an uncommon complication
of THA, with a reported incidence of 0.2% to 0.3%. Vascular injury most commonly affects the external iliac artery or the femoral artery (48% and 23%, respectively). This chapters reviews the prevalence, common etiologies, diagnostic studies, and strategies for managing neurovascular injuries that occur in THA.