Nerve Injuries After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Background: Nerve injury is an uncommon but consequential complication following total hip arthroplasty (THA), with outcomes that range from full recovery to persistent long-term deficits. Despite decades of research, uncertainty remains regarding its true incidence, risk factors, and prognosis. Methods: This systematic review and meta-analysis synthesized data from 17 studies encompassing diverse designs, including large database analyses and focused case series. Clinical characteristics, surgical factors, nerve-injury patterns, management strategies, and recovery outcomes were extracted. Pooled proportions were calculated using a random-effects model, and predictors were assessed through meta-regression. Results: Across 17 studies, the most frequently affected nerves were the sciatic, peroneal, and femoral branches, with the peroneal division consistently identified as most vulnerable. Immediate postoperative presentation was common, particularly in injuries related to traction, limb lengthening, or retractor compression, while delayed-onset injuries were often linked to hematoma, screw prominence, or pseudotumor formation. Pooled incidence of nerve injury after THA was 0.36% (95% CI 0.35-0.37%). Complete recovery occurred in 48.6% (95% CI 33.9-63.3%), whereas 50.5% (95% CI 36.0-65.0%) experienced residual deficits. Reoperation was required in 33.1% (95% CI 4.2-62.0%), and 39.8% (95% CI 25.1-54.4%) had permanent neurological impairment. Orthotic use was common due to persistent dorsiflexion weakness. Meta-regression identified comorbidity burden as the only significant predictor of nerve injury. Conclusion: Nerve injuries after THA remain clinically significant, with substantial variability in presentation, recovery, and long-term disability. Early detection, careful surgical technique, and risk stratification especially in patients with the multiple comorbidities are very important for prevention and improved outcomes.