Carolina Mallar, BS
Medical Student
University of Miami
Miami, Florida, United States
Haleh Amirian, MD, MS
Psotdoctoral Fellow
University of Miami
Miami, Florida, United States
Diana M. Molinares Mejia, MD
Attending Physician
Jackson Memorial Hospital/University of Miami
Miami, FL, Florida, United States
ALWIN DAVID, MD
Resident Physician
University of Miami/Jackson Health System
Miami, Florida, United States
Femoral Neuropathy
Case Description: 73-year-old female with a history of right femoral head and neck pigmented villonodular synovitis (PVNS) underwent a right total hip arthroplasty (THA). Postoperatively, she developed right femoral neuropathy, presenting with significant weakness in the right quadriceps, hip flexors, and knee extensors, along with pain in the right femoral nerve distribution. Ultrasound revealed extensive scar tissue completely encasing the femoral nerve just distal to the inguinal ligament with scar tissue compression on the femoral nerve. The patient underwent right femoral nerve neurolysis followed by a nerve wrap, resulting in notable improvement in both motor function and sensation.
Discussions:
PVNS is a rare, locally aggressive proliferative disorder of the synovium characterized by hyperplasia and hemosiderin deposition. Femoral neuropathy, while uncommon, is a serious complication that can occur due to the mass effect of PVNS or surgical intervention (reported incidence rates ranging from 0.08% to 7.6%)1. The use of a nerve wrap in this context can help prevent fibrosis and facilitate nerve recovery. From a rehabilitation perspective, this case highlights the importance of early intervention and targeted rehab for significant motor and sensory deficits caused by femoral neuropathy. The use of adjunctive techniques like nerve wrapping improves recovery and demonstrates the need for integrating such measures into the treatment plan. Prompt recognition and tailored rehabilitation efforts including physical and occupational therapy are essential for optimizing functional outcomes and enhancing the patient's quality of life.
Conclusions:
This case highlights the potential for femoral neuropathy as a complication of both PVNS and its surgical management, especially following THA. The successful application of nerve wrap alongside neurolysis underscores the importance of considering adjunctive measures to facilitate nerve recovery. Early intervention and appropriate surgical management are crucial to optimizing patient outcomes in cases of postoperative femoral neuropathy.
