A case of axial nerve paralysis in the BHA through the direct anterior approach

Abstract

 We encountered a case that presented with axillary nerve palsy after bipolar hip arthroplasty (BHA) performed through the direct anterior approach.

 During the surgery, the patient was placed in the supine position, with the abduction angle of the affected shoulder joint fixed at 100°. On the day after the surgery, the patient was unable to elevate the affected shoulder joint and complained of paresthesia along the proximal lateral aspect of the upper arm. We hypothesized that intraoperative manipulation of the lower limb caused the trunk to be pulled distally and the shoulder joint abduction angle to increase, resulting in compression of the quadrilateral space (QLS) and axillary nerve palsy. During surgery involving manipulation of the lower limbs, the immobilization position of the patient should also take into account the impact on the upper limbs.