Post-Hip Replacement Surgery: Left Calf Numbness and Nerve Damage

Loss of sensation in the left calf following hip replacement surgery?

I underwent left hip joint replacement surgery on November 14th of last year.
After the surgery, I noticed that the back of my left calf, from below the knee to the ankle, had no sensation.
Touching it feels like there is a thick layer in between, and due to the lack of sensation, it feels numb.
The muscles in the back of my calf are very tight and stiff, and I cannot dorsiflex my foot, although I can plantarflex it.
My ankle is swollen.
On February 22nd of this year, my doctor arranged for nerve conduction studies and electromyography (EMG).
The doctor only mentioned that there is a partial strain of the sciatic nerve and that it will recover.
However, due to my lack of medical expertise, I do not understand the examination report, so I have listed it below and would appreciate your advice.
Thank you.
The nerve conduction studies showed:
(1) reduced compound muscle action potential (CMAP) amplitude in the left peroneal and tibial nerves,
(2) slowing of motor conduction velocities in the bilateral tibial nerves,
(3) absent sensory nerve action potential (SNAP) in the left sural and superficial peroneal nerves,
(4) reduced SNAP amplitude and slowing of sensory conduction velocity in the right superficial peroneal nerve.
The electromyography study showed:
(1) active denervation changes, mild neurogenic polyphasic waves, and reduced recruitment in the left tibialis anterior muscle,
(2) active denervation changes, mild neurogenic polyphasic waves with giant motor unit action potentials (MUAPs) up to 4K and reduced recruitment in the left gastrocnemius muscle (medial head),
(3) active denervation changes, mild to moderate neurogenic polyphasic waves, and reduced recruitment in the left biceps femoris muscle,
(4) moderate neurogenic polyphasic waves in the left L5 lumbar paraspinal muscle.
The above findings suggest:
(1) left sciatic neuropathy,
(2) coexisting relatively chronic lumbosacral radiculopathy,
(3) an underlying sensorimotor polyneuropathy may also be considered.
Clinical correlation is advised.

Du Du, 60~69 year old female. Ask Date: 2024/04/17

Dr. Chen Yongxue reply Orthopedics

Hello, according to the letter, the electromyography findings indicate: (1) left sciatic neuropathy, (2) coexisting chronic lumbosacral radiculopathy, and (3) an underlying sensorimotor polyneuropathy may also be considered.
Thank you.

Reply Date: 2024/04/17

More Info

Post-hip replacement surgery complications can be concerning, especially when they involve neurological symptoms such as numbness and weakness in the lower extremities. Based on your description and the results of your nerve conduction studies and electromyography, it appears that you are experiencing significant nerve-related issues following your left hip replacement surgery.

The numbness in your left calf, which extends from below the knee to the ankle, along with the feeling of heaviness and the inability to dorsiflex (lift the foot upwards), suggests that there may be damage or irritation to the nerves that innervate that area. The findings from your nerve conduction studies indicate reduced compound muscle action potential (CMAP) amplitudes in the left peroneal and tibial nerves, which are crucial for motor function in the lower leg. The absence of sensory nerve action potentials (SNAP) in the left sural and superficial peroneal nerves further supports the idea of nerve damage, as these nerves are responsible for sensation in the calf and foot.

The electromyography results show active denervation changes in several muscles, indicating that the nerves supplying these muscles are not functioning properly. The presence of neurogenic polyphasic waves suggests that there is ongoing nerve injury or irritation, which could be contributing to your symptoms of weakness and numbness.

The diagnosis of left sciatic neuropathy indicates that the sciatic nerve, which runs from the lower back down the leg, may be compromised. This could be due to direct trauma during surgery, compression from swelling, or even positioning during the procedure. The coexisting chronic lumbosacral radiculopathy suggests that there may also be issues originating from the lumbar spine, which could be affecting the nerves that travel down to your leg. Additionally, the mention of a potential underlying sensorimotor polyneuropathy indicates that there could be a broader issue affecting multiple nerves, possibly related to systemic conditions such as diabetes or vitamin deficiencies.

Recovery from nerve injuries can vary widely depending on the severity of the damage and the underlying cause. In many cases, nerves can regenerate and heal over time, but this process can take weeks to months. Physical therapy is often recommended to help improve strength and mobility, and to facilitate nerve recovery. It is crucial to follow up with your healthcare provider to monitor your progress and to discuss potential treatment options, which may include physical therapy, pain management strategies, or further diagnostic imaging if necessary.

In summary, your symptoms and the findings from your nerve studies suggest that you are dealing with significant nerve-related issues following your hip replacement surgery. It is essential to maintain open communication with your healthcare team, as they can provide you with the best guidance tailored to your specific situation. They may recommend a multidisciplinary approach involving neurologists, orthopedic surgeons, and physical therapists to optimize your recovery and address the numbness and weakness in your left leg.

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