Femoral nerve damage & quad muscle deficit post op total knee

Right knee arthroplasty post-op quad musclesdeficit
by Katy890, 19 minutes ago
I have just had 2 total knee replacements 2 months apart.  First knee recovery went fine.  With second knee, I have 118 degrees of flexion and 12 degrees of extension.   My problem is that I am having serious femoral nerve pain ever since my 2nd operation 3 weeks ago today.  It radiates into greater trochanter area of right hip and down my leg -- sometimes going down into the mid-calf area.  Quadriceps muscles are not responding to straight leg lifts or lower leg curls ever since.  Can't lift my leg up from either a sitting or lying down position yet.  I have to lasso my leg with a bathrobe sash and straight leg lift it to get into and out of bed.  
Am enrolled in PT in an aquatic setting starting next week.  Have seen my PCP and requested an EMG study ASAP.    
I had a fairly large hematoma in my right groin area immediately post-op that produces pain. Pain hasn't stopped since then.  The pain is a continuous ache, chronic thus far, and has not responded to ice packs or heat.  It gets more pronounced after exercise such as walking or after PT.  My PT evaluation today included palpation and probing of the groin area.  This produced level 8 to 9 pain at the time.  Surgeon says quad area right above knee is twitching, but no muscle control at all.
I am not diabetic, but have had 3 previous back surgeries at L4-L5 in 1999, L3-L4 in 2005 and L2-L3 in 2006. I am 66.
Any thoughts as to causes or prognosis would be greatly appreciated.  


This discussion is related to Re: Femoral nerve damage following surgery.

[Dr. A. Srivastava]

Thank you for your question. These symptoms you are having can occur due to impingement, irritation or compression of nerve of thigh. Most frequently involved nerve is lateral cutaneous nerve of thigh (which is branch of femoral nerve). This condition is called meralgia paraesthetica which manifests itself as pain, tingling or burning sensation of outer thigh. It may occur due to injury to nerve either due to spinal deformity or along its path to thigh by any ligament or tendon stretch, excessive tight clothing (therefore it is also called "jeans disease"), diabetic neuropathy or damage to nerve after laparoscopic hernia repair etc. Another nerve which may cause pain in legs is sciatic nerve compression. I would advice a CT scan of spine and thigh, blood sugar levels, and EMG to check out abnormal muscle responses.  Once the diagnosis is reached then treatment modalities available are strict rest, loose clothing, painkillers (NSAIDS and opioid), pain modifier medicines like carbamazepine may also be prescribed by the doctor. Therefore a neurologist’s consultation may help you in this regard.  Hope this information proves helpful to you. Take care.

[Kristyd]

I am a 42 year old female who underwent THR 3 weeks ago. The surgery went great except for I now have nerve damage. I am taking neuratin and pain meds. The prognosis doesn't look all that promising. The numbness is from my groin down to my ankle. I also have pain and sensory in my thigh. Any adivise? Thanks, Kristy D