Foot Drop After Hip Replacement: Case Illustration of Iatrogenic Peroneal Nerve Injury and Review of Literature

Introduction: Iatrogenic peroneal nerve injuries are rare, serious complications of orthopedic procedures, especially hip arthroplasty, hip fracture fixation, or prosthetic implantation. These injuries cause disabling functional deficits if not promptly recognized and treated. Early neurophysiological assessment and referral to a neurosurgeon are critical for recovery. [1-3] Case Illustration: We report the case of a 60-year-old female patient who sustained a right femoral neck fracture after a fall. She underwent hip arthroplasty with a titanium prosthesis five days post-injury. Postoperatively, she developed complete ipsilateral foot drop and neuropathic pain with electric-shock sensations radiating from the knee to the lateral toes. Immobilization lasted over six weeks. Initial physiotherapy and daily TENS were ineffective. At two months, electromyography showed absent motor activity in the common peroneal nerve. Repeat ENMG studies confirmed a persistent deficit. MRI excluded spinal pathology. Nutritional neurotrophic supplementation (alpha-lipoic acid and gamma-linolenic acid) administered by a neurologist was ineffective. Given the plateau neurological state, neurosurgeon consultation was recommended, and within a month, the patient underwent peroneal nerve decompression. Discussion: Iatrogenic peroneal nerve injuries after hip procedures may result from direct trauma, limb positioning, or traction during surgery. [4, 5] Prompt exploration and neurolysis, combined with structured physiotherapy, can enhance functional outcomes.[6] Delayed recognition and mislabeling as neurapraxia remain frequent, leading to disabling deficits. [7, 8, 9] Conclusion: This case highlights the impact of delayed recognition of iatrogenic peroneal nerve injury after hip arthroplasty. Early suspicion, neurophysiological confirmation, and timely referral to peripheral nerve specialists are essential for optimizing neurological and functional outcomes.