Common Peroneal Nerve Palsy Due to Giant Fabella After Total Knee Arthroplasty

Abstract

Background: Common peroneal nerve palsy (CPNP) is a rare but serious complication following primary total knee arthroplasty (TKA). The common peroneal nerve is one of the main molecules of the sciatic nerve. CPNP is a series of symptoms caused by common peroneal nerve injury due to paralysis and atrophy of the fibula and tibia muscles. The main clinical symptoms are: ankle joint unable to extend back, toe unable to extend back, foot droop, walking in a steppage gait, and foot dorsal skin sensation having decreased or disappeared. If treatment is not timely, severe cases may result in atrophy of the anterior tibia and lateral calf muscles. The risk factors for CPNP include mechanical stretching of the nerve, disruption of the blood supply to the nerve, and compression of the nerve. The CPNP should be treated in a timely manner and according to the cause. Its function should be restored as soon as possible to avoid serious adverse consequences. It has negative effects on patients' life and physical and mental health. To our knowledge, this is the first study to describe CPNP due to a giant fabella after TKA.

Case presentation: The present study reported on a 70-year-old female patient. The patient underwent a primary TKA of the right knee for osteoarthritis. Relevant examinations were conducted and the operation went smoothly. Three hours postoperation, a right partial CPNP was observed, with progressive aggravation over time. On palpation, there was a 2 × 2-cm fixed hard mass in the posterolateral aspect of the right knee, with mild tenderness to deep palpation. Radiographs demonstrated that a giant fabella was located at the posterolateral condyle of the right femur. Fabellectomy and neurolysis of the common peroneal nerve were performed. The peroneal nerve palsy resolved gradually after the operation. At 8-month follow up after fabellectomy and neurolysis, the function of the common peroneal nerve had fully recovered.

Conclusions: The presence of giant feballa pressing on the common peroneal nerve should be considered when common peroneal nerve palsy occurs after TKA. Surgical exploration and release compression should be performed in a timely manner.

Keywords: Common peroneal nerve; Fabella; Palsy; Total knee arthroplasty.

Fig. 1

(A) Intraoperative (B) Schematic digram. The red arrow idcicates fabella and the blue arrow indicates common peroneal never.

Fig. 2

(A) The size of its articular surface of the fabella was approximately 20 × 23mm, and it was 17 mm high. (B) Schematic digram.The removed fabella by surgery.

Fig. 3

Release of the epineurium of the swollen common peroneal nerve.