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- Dr. Bal in the News...
TestimonialsDr. Bal's Patients Tell Their Stories
"I am very satisfied with the outcome of my surgery and the improved quality of life I am now enjoying..."
Shamsy Kazemi-Bardool, Iran
"I am looking forward to being able to boat and golf this summer, without having to endure the pain and limitations of prior years..."
Greg Voreis, Mo.
"Just 9 ½ weeks following my surgery knee replacements, I traveled to Hawaii and went scuba diving..."
David Booker, Mo.
"Dr. Bal did great a job explaining the procedure through conversation and with his hip surgery book. He changed my life..."
Dennis Disselhoff, Mo.
"It is so important to have a physician who you trust, and who will listen to you. That's critical. I have never seen a doctor who cares so much for each and every patient..."
Faye Bleigh, Mo.
"I am glad to have come to Dr. Bal; his office staff was great to work with; the hospital experience was very good, and the outcome of surgery was all I had hoped for..."
Craig Jacobson, Ne.
"I feel so free now. Last weekend I rode my bike to Cooper's Landing and enjoyed a great meal as I watched the Missouri River roll by and listened to the bluegrass music..."
Marilyn McCreary, Mo.
"The staff at Capitol Region were very gracious, attentive and thorough. I would go back there anytime. They made sure I was comfortable..."
Bob Smith, Mo.
"It has been a real pleasure to meet and get to know Dr. Bal. He is caring, thorough in his explanations, and a great friend...."
Richard Wallace, Mo.
Review of possible complications
This is a very distressing complication that can occur after any hip or knee replacement. The thing that makes this rare complication even more distressing is that often no obvious cause for the nerve injury can be found. Fortunately, almost all nerve injuries after hip or knee replacement surgery are temporary, and the function returns over time.
Two major nerves enter the leg from the back. One is the sciatic nerve that lies close to the buttock, and the other is the femoral nerve that is close to the front, in the groin area. Either or both are at risk when the hip is replaced. There is a third nerve, called the obturator nerve, that runs by the inside of thigh. It is rarely affected by hip replacement. The sciatic nerve splits into two branches, called the peroneal and tibial nerves, that run by the knee. The femoral nerve ends by the time it reaches the knee joint. During knee replacement, the peroneal and tibial nerves are at risk.
Weakness of the foot and leg muscles, painful tingling and a pins-and-needles sensation, burning, and partial paralysis of the foot are the common symptoms of a nerve injury. In most cases, the injury occurs because the joint must be manipulated during the surgery. In other cases, pressure on the nerve from swelling after surgery, or from tissue retraction during surgery, can cause the nerve problem. Bleeding into the hip joint space after surgery is a risk, especially since you will be on a blood thinner, and sometimes the blood will irritate and compress the nerves located nearby. Stretching of the leg in order to gain leg length introduces the risk of a nerve injury by direct stretching, which is why leg lengthening during hip replacement is best avoided, even if you start with a short leg on that side and would love to have the surgeon gain some length while the hip is being replaced. In the vast majority of cases of nerve injury however, no obvious cause for the injury (also called “palsy”) can be identified, and the injury can occur without warning.
Fortunately, the majority of nerve injuries also resolve, although this can take anywhere from a few weeks to a couple of years to happen. In extremely rare cases, a second operation may be necessary to explore the nerve and make sure that it is not caught up in scar. Exploration and release of a nerve is seldom undertaken, and only when there is no sign of nerve recovery several months after the joint replacement. Even then, it is undertaken only after consultation with a neurologist, and after special studies (called EMG and NCV, for electromyogram, and nerve conduction velocity respectively) are done to establish the electric signals in the nerves.
Many precautions are taken during surgery to minimize the possibility of an injury to the nerve. You will be positioned carefully during surgery, and we take a lot of time to ensure proper and safe positioning of your body and the extremities before surgery. This is what takes us time in the operating room, before we can start the actual operation. During surgery, the handling of tissues, the retraction of anatomic structures and meticulous attention to detail will minimize the risk of injury to a nerve.
Keep in mind thought that there are factors beyond the control of anyone that can lead to a nerve problem, and compromise the immediate result of a joint replacement procedure. As mentioned, since you will be on a blood thinner to prevent blood clots after the operation, it is possible that bleeding may occur into the joint. The accumulated blood can squeeze and irritate the adjacent nerves, making it necessary for us to go back to the operating room to remove the blood from the joint. Anatomic variations in certain patients may increase the risk of nerve injury as well. Pre-exisiting nerve damage may accompany some diseases such as multiple sclerosis, diabetes, heavy alcohol use, and smoking, making such individuals more susceptible to nerve palsy. Fortunately, these things happen very infrequently. Nonetheless, it is wise to know about this subject.
One known cause of nerve injury is lengthening of the leg during hip replacement surgery. For this reason, it is usually not possible to lengthen the leg by more than half an inch at most. With some special types of hip problems, especially those that originated in childhood, it is very risky to attempt any lengthening of the leg.
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Replacement Surgery Guides
|Guide to Hip Replacement||Guide to Knee Replacement|