Femoral Nerve Palsy Following Direct Anterior Total Hip Arthroplasty in a Patient With Iliac Venous Stents: A Case Report

TL;DR

A patient with iliac venous stents developed severe femoral nerve palsy after hip surgery, possibly due to increased nerve vulnerability from the stents.

Contribution

Highlights a rare complication in patients with venous stents undergoing hip surgery and suggests a novel contributing factor.

Findings

Severe femoral nerve palsy occurred post-surgery in a patient with iliac venous stents.

Venous stents may increase femoral nerve vulnerability during surgical retraction.

Care is needed to prevent nerve compression in patients with prior stenting.

Abstract

A male in his 50s with chronic venous insufficiency and bilateral iliac venous stents who had undergone right direct anterior approach total hip arthroplasty presented on postoperative day one with sensory deficiencies and motor weakness in the distribution of the right femoral nerve. The patient was diagnosed with severe femoral nerve palsy, based on absent quadriceps activation and electromyography-confirmed denervation. Though a known complication of this approach, severe femoral nerve palsy is a rare occurrence. The authors hypothesize that venous stents may have contributed to the increased vulnerability of the femoral nerve during retraction. Great care should be taken in patients with prior stenting to avoid further compression perioperatively and subsequent development of femoral nerve palsy.

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