A systematic review of upper extremity neuropathy following total hip arthroplasty

There is a paucity of literature describing upper extremity neuropathy following the procedure. We performed a systematic review of upper extremity neuropathy following total hip arthroplasty (THA) to provide characteristics regarding the incidence, suspected aetiology, and outcomes of such complications.

A systematic review of the literature was performed which investigated the COCHRANE and Medline databases regarding “peripheral neuropathy total hip arthroplasty” and “nerve palsy associated total hip arthroplasty.” Studies were excluded if they were not Level I, II, or III of evidence or had incomplete reported data. Studies were evaluated and data was extracted for the analysis if they met all inclusion criteria. Data extracted was compiled to assess nerve injury, aetiology, and resolution of symptoms.

The search included 77 articles and 4 were selected for inclusion. A total of 21,346 patients underwent a THA with 40 of those cases resulting in an upper extremity nerve injury yielding a complication rate of 0.20%. The most likely aetiology of the upper extremity neuropathy was a compression neuropathy related to improper patient positioning of the contralateral/ipsilateral arm. Full resolution was reported in 74.42% of these cases (32 of 43 cases).

Upper extremity neuropathy following THA is a rare complication that presents with variations of sensory and motor deficits. A thorough attention to proper positioning of the upper extremity is necessary to mitigate this risk.