Study Finds Nerve Damage After Hip Surgery May Be Due to Inflammation
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A recent Mayo Clinic Proceedings article links some nerve damage after hip surgery to inflammatory neuropathy. Historically, nerve damage from hip surgery has been attributed to mechanical factors caused by anesthesiologists or surgeons, such as positioning of the patient during surgery or direct surgical injury of the nerves.
In this study, researchers examined patients who developed inflammatory neuropathies, where the immune system attacks the nerves, leading to weakness and pain. Inflammatory neuropathies may be treated with immunotherapy.
"Neuropathy after surgery can significantly affect postsurgical outcomes," says Nathan Staff, M.D., Ph.D., Mayo Clinic neurologist. "The good news is that if we're able to identify patients experiencing postsurgical inflammatory neuropathy, rather than damage caused by a mechanical process, we may be able to provide treatment immediately to mitigate pain and improve overall outcomes."
The study was a retrospective case series, including patients who developed pain and weakness in a limb after undergoing hip surgery where there was no documented direct or traction injury during surgery. Nerve biopsy demonstrated an inflammatory neuropathy in all patients.
Neuropathy refers to damage to the peripheral nerves in the limbs. Patients with neuropathy often experience numbness, tingling, pain and weakness that starts in their feet and moves upward. Neuropathy described in this study is isolated to the limb where the hip surgery occurred -- often affecting the sciatic nerve that runs down the leg and controls strength and sensation.
Dr. Staff says it is important that physicians understand that nerve damage may be related to an inflammatory issue, and there are some telltale signs for physicians to look for:
- Patient's neuropathy isn't immediate, but rather it develops over time
- Severe pain
- Neuropathy progresses
- Different anatomical distribution than expected
"We know new or worsened weakness after hip surgery can be attributed to surgical factors, such as stretching, compression, contusion, hematoma or even transection of the nerve. But now we know that this weakness may be attributed to an inflammatory issue, and it's important that physicians look for this cause, too," says Dr. Staff.
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Ruple S. Laughlin, P. James B. Dyck, James C. Watson, Robert J. Spinner, Kimberly K. Amrami, Rafael J. Sierra, Robert T. Trousdale, Nathan P. Staff. Ipsilateral Inflammatory Neuropathy After Hip Surgery. Mayo Clinic Proceedings, Published Online January 6 2014. doi: 10.1016/j.mayocp.2013.10.027