L4 Radiculopathy Presenting as Postoperative Femoral Nerve Neuropraxia Following Total Hip Arthroplasty (THA) in the Setting of Hip-Spine Syndrome

Hip-spine syndrome (HSS) is the symptomatic degenerative pathology of both the lumbar spine and hip that can lead to diagnostic and therapeutic challenges, as these pathologies can present with overlapping clinical symptoms. There are no definitive best practices for managing HSS, but there is some evidence that the management of hip pathologies prior to spinal pathologies results in better outcomes. This report details a unique patient who had total hip arthroplasty (THA) for osteoarthritis and experienced postoperative femoral nerve-like neuropraxia. Through prudent clinical reasoning and diagnostic evaluation, the patient's neuropraxia was determined to be of radicular origin rather than an intraoperative injury of the femoral nerve. This challenging diagnosis exemplifies the importance of recognizing concomitant pathology in the hip and spine, as well as performing appropriate diagnostic testing in a patient who underwent THA and presented with postoperative femoral nerve-like neuropraxia.