Which type of foot drop a complication of orthopedic surgery?

Updated: Mar 23, 2020
  • Author: James W Pritchett, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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A foot drop of particular concern to orthopedic surgeons is the peroneal nerve palsy seen after total knee arthroplasty (TKA; 0.3-4% of cases) or proximal tibial osteotomy (3-13% of cases). Ischemia, mechanical irritation, traction, crush injury, and laceration can cause intraoperative injury to the peroneal nerve. It has also been suggested that correction of a severe valgus or flexion deformity can stretch the peroneal nerve and lead to palsy. Postoperative causes of peroneal nerve palsy include hematomas and constrictive dressings.

In a study by Cohen et al, the relative risk of palsy was 2.8 times higher with epidural anesthesia for TKA than with general or spinal anesthesia. [2] Epidural anesthesia probably decreased proprioception and sensation (intraoperatively and, to some extent, postoperatively), allowing the limb to rest in an unprotected state susceptible to local compression. In addition, intraoperative neurologic damage may not have been readily apparent in the immediate postoperative period, because of ongoing effects of epidural anesthesia.

In the same study, the relative risk of palsy was 6.5 times greater in patients who had a prior lumbar laminectomy. [2]

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