Nerve injury after total hip arthroplasty: etiology, preventive strategies and medico-legal considerations.

BACKGROUND

Nerve injuries in total hip arthroplasty (THA) are rare but clinically and medico-legally significant adverse events, sometimes severely affecting patients' wellbeing through motor dysfunction and often permanent sensory alterations. Nerve injuries can result from complex interactions between a patient's pathophysiology, the technical aspects of surgery and individual response to surgical trauma - often rendering them not entirely avoidable. Professional liability should be assessed within a comprehensive framework, considering biological and procedural variables, adherence to clinical preventive measures, and proper documentation.

OBJECTIVE

This study provides a narrative review of the etiology of nerve injuries and identifies the nerves most frequently affected, with a focus on perioperative actions associated with specific nerve involvement. It also explores the medico-legal implications of post-THA nerve injuries, for an integrated approach to surgical risk management.

RESULTS

Nerves more frequently involved during the four phases of the surgical management (preoperative, intraoperative, immediate postoperative and long-term postoperative) are, in order, the sciatic, the femoral, the obturator, the superior gluteal and the lateral femoral cutaneous nerves. Main activities and/or situations associated with the risk of nerve injury, to be prevented or managed properly, are the type of approach, specific intraoperative positioning and timing, surgical technique with ligations, dissections and retractors roles, limb length, local retraction or expansion due to infection, hematoma or cement loss. Therefore, the adverse outcomes should not be automatically interpreted as surgical negligence, especially when standard care and clinical risk management protocols have been followed and documented in clinical records. Thus, distinguishing between unfaulty adverse event and negligence.

CONCLUSIONS

The definition of a risk prevention and management strategy for nerve injury represents the first step in patient safety and, consequently, in reducing the likelihood of professional liability claim following THA.