Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

Musculoskeletal and Sports Medicine

Unable to Walk After a Hip Replacement: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 3

    Poster Presenter(s)

  • Andrew Hua, MD, PhD

    Resident
    Medical College of Wisconsin Affiliated Hospitals PM&R Program
    Milwaukee, Wisconsin

    • Co-Author(s)

  • AG

    Austin Gerdes, MD, MPH

    Resident Physician
    Medical College of Wisconsin Affiliated Hospitals
    Milwaukee, Wisconsin

  • PC

    Peter Connelly, MD

    Associate Professor
    Medical College of Wisconsin
    Elm Grove, Wisconsin

Disclosure(s):
Andrew Hua, MD, PhD: No financial relationships to disclose
Case Diagnosis: Intra-operative traction of the femoral nerve during anterior total hip arthroplasty can result in femoral nerve neuropraxia leading to hip and knee weakness.

Case Description or Program Description: A 78-year-old patient presented to clinic for electrodiagnostic evaluation of persistent right leg weakness after undergoing a right anterior total hip arthroplasty without intra-operative complications. Immediately after surgery, the patient endorsed quadriceps weakness and decreased sensation over his anterior thigh. He endorsed chronic low back pain that was unchanged after surgery. He was given a knee immobilizer and started physical therapy (PT) but had minimal improvement after two months. Magnetic resonance imaging of his femur showed severe edema within the anterior muscle compartment with moderate circumferential subcutaneous edema.

Setting: Physical medicine and rehabilitation clinic

Assessment/Results: Electrodiagnostic evaluation revealed severe, acute, and ongoing neurogenic changes in the distribution of the right femoral nerve including the iliopsoas and vastus medialis, consistent with a right femoral neuropathy. There was evidence of axon continuity with multiple motor units present in the distal femoral innervated muscles. Concurrently, there was electrodiagnostic evidence of chronic/ongoing neurogenic changes in the right S1 myotome consistent with a chronic right S1 radiculopathy. The patient continued to participate in physical therapy over 8 months with good improvement in his hip flexion and knee extension strength and regained the ability to walk with a 4-wheeled walker without a brace.

Discussion (relevance): This is a complicated case in which the patient had evidence of both a femoral neuropathy and a lumbar radiculopathy. He was presumed to have femoral nerve neuropraxia secondary to transient intra-operative traction of the femoral nerve to facilitate anterior total hip arthroplasty. EMG results also provided positive prognostic factors with intact motor units in distal femoral innervated muscles.

Conclusions: Femoral neuropathy is a rare complication of total hip arthroplasties, and EMG can be used to diagnose and prognosticate nerve recovery.