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[Nerve injuries in total hip arthroplasty--prophylactic strategies--quality assurance and risk management in orthopaedic and trauma surgery].

AIM
Nerve lesions are a serious complication of total hip arthroplasty. The incidence of lesions of large nerves exceeds those of luxation and septic loosening. An analysis of damage causes should lead to prophylactic strategies and improvement of operative technique. Patients are more aware of this complication and malpractice cases are increasing. Between 1977 and 2001 the medical association of North Rhine dealt with 126 cases of nerve lesions.


METHOD
All potential intraoperative causes for nerve damage are investigated.


RESULTS
Incorrectly placed Hohmann retractors offer the largest damage potential. Electro surgery and self-cutting screws have a hazardous potential. Sharp injuries, retractor damage and leg lengthening are infrequent causes for nerve lesions. Positioning devices such as leg holders used for robotic hip surgery might damage the peroneal nerve.


CONCLUSION
Risk management is necessary for medico-legal quality control and gives protection for patient and surgeon. Risk management may prevent damage in advance. The head of the department is in charge of internal quality control. Systematic evaluations of operative techniques and damage possibilities are necessary to avoid future malpractice. Guidelines give a good support, but cannot replace teaching on the patient. Operation reports offer the surgeon the chance to document cautious and nerve protecting techniques.