femoral nerve damage

[hipdiver]

I am almost 3 weeks post op from a BHR performed here in the Atlanta area. On the one hand, the recovery is going well as the incision is about healed, I'm almost pain free, and can walk with one crutch (I'm a big guy at 225 lbs.) One major problem though - due to damage during surgery to the femoral nerve, I have no use of my quadraceps muscles. In a seated position I cannot lift or straighten my operated leg at all. I can only walk on flat ground as any incline up or down would require use of the quads to remain upright. All I can get from my surgeon and neurologist are that this is very unusual and I "should" recover after "some period of time". Its the uncertainty that is very depressing and scary. Before surgery I could play golf (very well), mow the yard with frequent rest breaks, etc. I was just tired of the pain in my hip which prevented me from walking more than 5 minutes w/o taking a break or standing for any period of time. In addition, prior to surgery, besides my my regular weight lifting regimen, I added a hip & thigh weight routine to put my upper legs in excellent condition in order to make the recovery as easy as possible. To find out the day after surgery that I had no use of my quads on the op leg was quite a blow. Though every patient is different - if anyone has had a similar experience and recovered I would like to know the details. Is there anything I can do? The surgeon is no help - the PT doesn't know what to do. Any feedback appreciated. 

[dw]

I haven't had that issue, but found this info after a quick google search (the "I" in the following is a doc responding to a quesion):
Injury to the femoral nerve is a recognized complication during abdominal, pelvic, inguinal and hip operations. The most common surgical cause associated with femoral nerve injury has been abdominal hysterectomy, (7.5-10% incidence quoted). The nerve usually is inadvertently damaged (either cut, snared by suture, stretch or pressure from retractors) during the procedure. Post op complication such as a large blood clot (iliacus hematoma) can also injure the nerve. Infection (abscess) my develop post op and cause injury.
Other causes of femoral nerve injury/problem include:lithotomy position,
trauma(bullet and stab wound, hip and pelvic fractures), tumors, diabetes.
In your case it is important to know when the weakness occur, right away, soon after surgery or delayed (such as hematoma or abscess formation)
The most useful test is an EMG of not only your quadriceps muscles but also other muscles in the area in search of involvement outside the femoral nerve territory. A nerve conduction study may be helpful too.
If you have not been evaluated by a neurologist and EMG/NCS, then you should talk to your doctor. The prognosis is dependent on the cause and the extent of the injury.
If a complete laceration of the nerve is suspected, exploration and suturing of the nerve are indicated. In lesser injuries, it is best to await spontaneous recovery for a few weeks.
The EMG should be done after at least 3 weeks after the surgery/onset of the weakness.

[hipdiver]

thanks for your response - the problem was first noted the day after surgery when visited by the hospital PT - that's when we noticed the lack of movement and numbness in the quads - I had the nerve response test two weeks post op - the neurologist says he thinks the nerve was "stretched" and not totally severed. The question he or the surgeon can't answer is how bad and how long to the possible recovery. I've heard from 2 months to a year (or never). Its quite a big difference. I guess I would like to hear from someone who had about the same experience with a positive outcome to help me sleep better at night knowing recovery is sometime in the future. 

[Pat Walter]

Hip Hip Diver

I am sorry to hear about your nerve problem.  I have read about similar problems in the past. They are not very common but have happened.  Normally, most of the people recover from them.  There has been no normal recovery time that I remember.  It really depends on your own body. There have been people with probelms after surgery that have taken up to a year to heal - but again, they are very few and far between.  Of course that does not help you, but I like to remind people that nerve damage does not happen often.

I hope that you can find an answer and will heal quickly.  I wish I could tell your more, but I am not medically trained.  I encourage you to send us an update now and then.  We are all good listeners and will keep you in our thoughts.

Pat

[Bob E]

Hi Hipdiver
I'm in this site researching a resurfacing. August of 09 I was in an accident that severely fractured my acetabulum. Two major surgeries put me back together. After the surgeries there were a lot of nerve damage issues down the outside of hip to knee and hip flexor to top of knee. The doctors told me the same thing, healing could be one to two months to maybe a year or maybe never! Almost one year out and it has greatly improved. There's still some numbness down the outside but the top of my leg is fine and the quads are responding fine.
How are you doing? Who was your surgeon? I live south of Atlanta in LaGrange and "shopping".
Bob