• J Beller, U Trockel, and M Lukoschek.
• Orthopädische Klinik, Vincentius-Krankenhaus AG, Konstanz. juergen.beller@uni-wh.de
• Orthopade. 2008 May 1;37(5):475-80.

BackgroundPeroneal nerve palsy is a rare but distressing complication of total knee arthroplasty (TKA). After introducing a standardised intraoperative and postoperative epidural anaesthesia protocol under otherwise unchanged perioperative management, we noted a sudden cumulation of peroneal nerve palsies after TKA.Patients And MethodsIn this retrospective study we checked the patients' histories for well-known risk factors for nerve lesions after TKA as well as for those risk factors controversially discussed in the literature.ResultsWe found an additive harmful impact of epidural anaesthesia leading to unrecognised pressure on the peroneal nerve, which caused, in combination with a pressure lesion of the pneumatic tourniquet, an axonal lesion in terms of a double-crush syndrome. By lowering the pneumatic tourniquet pressure and carefully positioning the operated leg, we found a clearly reduced risk of nerve lesion while preserving the advantages of epidural anaesthesia for the patient.ConclusionTo prevent a peroneal lesion after TKA while using continuous epidural anaesthesia, we strongly recommend limiting the pneumatic tourniquet pressure to 320 mmHg while ensuring pressure-free positioning of the operated leg.

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