{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:36:00Z","timestamp":1791833760809,"version":"4.3.4"},"reference-count":32,"publisher":"Open Medical Publishing","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n Nerve injury is an uncommon but clinically meaningful complication following total knee arthroplasty (TKA). Reported incidences vary widely across the literature, and the specific patterns, predictors, and recovery trajectories remain unclear. This systematic review and meta-analysis aimed to determine the prevalence, types, risk factors, management approaches, and recovery outcomes of nerve injuries after TKA.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A comprehensive search identified eight eligible studies reporting postoperative nerve injuries following primary or revision TKA. Data extracted included patient demographics, surgical and perioperative characteristics, nerve injury types, management strategies, and recovery outcomes. Random-effects models were used to pool incidence and recovery proportions. Meta-regression evaluated demographic and procedural predictors, while sensitivity analyses assessed robustness. Publication bias was examined using funnel-plot visualization.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Across 1,599,948 TKAs, 4,746 nerve injury events were identified. The pooled incidence was highly variable, with a random-effects estimate of 12.86% and substantial heterogeneity (I\u00b2 = 99.6%). The common peroneal nerve accounted for the majority of injuries, while tibial, femoral, sciatic, and saphenous nerve injuries were less frequent. Demographic factors such as age, sex, BMI, comorbidities, and preoperative deformity were not significant predictors (p > 0.05). Among procedural factors, only tourniquet use was significantly associated with increased nerve injury risk (p = 0.0136). Overall recovery was favorable, with a pooled recovery rate of 73% (I\u00b2 = 86.4%). Time to full recovery ranged from approximately 10 to 22 months. Conservative management was the mainstay, with selective surgical intervention for compressive etiologies. Funnel-plot asymmetry suggested potential publication bias.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Nerve injury after TKA remains uncommon but clinically significant, with the common peroneal nerve most frequently affected. Tourniquet use appears to be the key modifiable risk factor. Most patients recover function, though recovery may be prolonged. Further standardized prospective research is needed to refine prevention and management strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.52965\/001c.160847","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:01:06Z","timestamp":1777590066000},"source":"Crossref","is-referenced-by-count":1,"title":["Nerve Injuries After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis"],"prefix":"10.52965","volume":"18","author":[{"given":"Abdullah A.","family":"Alturki","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Ministry of the National Guard \u2013 Health Affairs, Riyadh, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"},{"name":"King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turki S.","family":"Almugren","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ministry of the National Guard \u2013 Health Affairs, Riyadh, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali A.","family":"Alhandi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ministry of the National Guard \u2013 Health Affairs, Riyadh, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmalik A.","family":"Alsaeed","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ministry of the National Guard \u2013 Health Affairs, Riyadh, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim A.","family":"Alrumaih","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ministry of the National Guard \u2013 Health Affairs, Riyadh, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmajed A.","family":"Alwarafi","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"},{"name":"King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah S.","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ministry of the National Guard \u2013 Health Affairs, Riyadh, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad A.","family":"Aljaafri","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ministry of the National Guard \u2013 Health Affairs, Riyadh, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"},{"name":"King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"30777","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s42836-025-00315-0","article-title":"Surgical management of peripheral nerve symptoms following knee arthroplasty","volume":"7","author":"O. C., et al. van Varsseveld","year":"2025","journal-title":"Arthroplasty"},{"issue":"6","key":"ref2","doi-asserted-by":"publisher","first-page":"e0324527","DOI":"10.1371\/journal.pone.0324527","article-title":"Risk factors for perioperative nerve injury associated with total knee arthroplasty: Analysis of a national administrative database","volume":"20","author":"R. H., et al. Jayaram","year":"2025","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"101331","DOI":"10.1016\/j.artd.2024.101331","article-title":"Peroneal nerve palsy after total knee arthroplasty","volume":"26","author":"\u00d8., et al. H\u00f8vik","year":"2024","journal-title":"Arthroplasty Today"},{"issue":"6","key":"ref4","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1002\/mus.26473","article-title":"Clinical spectrum of neuropathy after primary total knee arthroplasty: a series of 54 cases","volume":"59","author":"S. J. A., et al. Speelziek","year":"2019","journal-title":"Muscle & nerve"},{"issue":"6","key":"ref5","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1002\/mus.26045","article-title":"Risk factors for acute nerve injury after total knee arthroplasty","volume":"57","author":"T., et al. Shetty","year":"2018","journal-title":"Muscle & nerve"},{"issue":"9","key":"ref6","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1016\/j.arth.2013.02.025","article-title":"Common peroneal nerve palsy following total knee arthroplasty: prognostic factors and course of recovery","volume":"28","author":"J. H., et al. Park","year":"2013","journal-title":"The Journal of Arthroplasty"},{"issue":"8","key":"ref7","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1054\/arth.2001.26591","article-title":"Nerve injury after primary total knee arthroplasty","volume":"16","author":"M. F., et al. Schinsky","year":"2001","journal-title":"The Journal of arthroplasty"},{"issue":"2","key":"ref8","doi-asserted-by":"publisher","first-page":"177","DOI":"10.2106\/00004623-199602000-00003","article-title":"Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors","volume":"78","author":"O. B. Idusuyi","year":"1996","journal-title":"JBJS"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14155375","article-title":"Advancements in Total Knee Arthroplasty over the Last Two Decades","volume":"14","author":"J. Zimnoch","year":"2025","journal-title":"Journal of Clinical Medicine"},{"issue":"2","key":"ref10","doi-asserted-by":"publisher","first-page":"159","DOI":"10.3109\/17453674.2013.782525","article-title":"Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field: a neurophysiological study","volume":"84","author":"C., et al. Olivecrona","year":"2013","journal-title":"Acta Orthopaedica"},{"issue":"5","key":"ref11","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000001912","article-title":"Knowledge and attitude toward total knee arthroplasty among senior medical students in comparison to public population in Saudi Arabia: cross-sectional study","volume":"86","author":"A. M. Makhdom","year":"2024","journal-title":"Annals of Medicine and Surgery"},{"key":"ref12","article-title":"Complications after total knee arthroplasty","author":"M. S., et al. Ayas","year":"2019","journal-title":"Knee Surgery-Reconstruction and Replacement"},{"issue":"10","key":"ref13","doi-asserted-by":"publisher","first-page":"2473","DOI":"10.1016\/j.arth.2019.05.008","article-title":"Incidence and Risk Factors for Peripheral Nerve Injury After 383,000 Total Knee Arthroplasties Using a New York State Database (SPARCS)","volume":"34","author":"A. B., et al. Christ","year":"2019","journal-title":"The Journal of Arthroplasty"},{"issue":"8","key":"ref14","doi-asserted-by":"publisher","first-page":"e90216","DOI":"10.7759\/cureus.90216","article-title":"Prophylactic Common Peroneal Nerve Release in Complex Total Knee Replacement: A Narrative Review of Rationale, Surgical Techniques, Outcomes, and Future Directions","volume":"17","author":"Z. Younis","year":"2025","journal-title":"Cureus"},{"issue":"3","key":"ref15","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1007\/s00402-020-03708-9","article-title":"The anatomical relationship of the common peroneal nerve to the proximal fibula and its clinical significance when performing fibular-based posterolateral reconstructions","volume":"141","author":"E., et al. Hohmann","year":"2021","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"ref16","doi-asserted-by":"publisher","DOI":"10.4103\/jajs.jajs_142_24","article-title":"Incidence of Common Peroneal Nerve Palsy among Patients with Varus Deformity Undergoing Bilateral Simultaneous Total Knee Replacement \u2013 A Retrospective Observation","volume":"12","author":"S. K., et al. Bhattacharjee","year":"2025","journal-title":"Journal of Arthroscopy and Joint Surgery"},{"issue":"1","key":"ref17","doi-asserted-by":"publisher","first-page":"105","DOI":"10.6315\/TJPMR.202106_49(1).0009","article-title":"Tibial Neuropathy after Revision Total Knee Prosthesis: A casereport","volume":"49","author":"C.-P. Wang","year":"2021","journal-title":"Rehabilitation Practice and Science"},{"issue":"4","key":"ref18","doi-asserted-by":"publisher","first-page":"e515","DOI":"10.3928\/01477447-20130327-33","article-title":"Surgical decompression improves symptoms of late peroneal nerve dysfunction after TKA","volume":"36","author":"J. P. Ward","year":"2013","journal-title":"Orthopedics"},{"issue":"1","key":"ref19","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s43166-020-00017-2","article-title":"Frequency of infrapatellar neuropathy post-total knee replacement and arthroscopic surgery in Egyptian patients","volume":"47","author":"D. S. Saif","year":"2020","journal-title":"Egyptian Rheumatology and Rehabilitation"},{"issue":"6","key":"ref20","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1002\/mus.26045","article-title":"Risk factors for acute nerve injury after total knee arthroplasty","volume":"57","author":"T., et al. Shetty","year":"2018","journal-title":"Muscle & Nerve"},{"issue":"1","key":"ref21","doi-asserted-by":"publisher","first-page":"368290","DOI":"10.1155\/2013\/368290","article-title":"Tourniquet-Related Iatrogenic Femoral Nerve Palsy after Knee Surgery: Case Report and Review of the Literature","volume":"2013","author":"J., et al. Mingo-Robinet","year":"2013","journal-title":"Case Reports in Orthopedics"},{"issue":"12","key":"ref22","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1007\/s00264-011-1235-5","article-title":"International survey of primary and revision total knee replacement","volume":"35","author":"S. M., et al. Kurtz","year":"2011","journal-title":"Int Orthop"},{"issue":"3","key":"ref23","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1007\/s40122-025-00726-6","article-title":"Neurological Deficits Following Regional Anesthesia and Pain Interventions: Reviewing Current Standards of Care","volume":"14","author":"S. N., et al. El-Tallawy","year":"2025","journal-title":"Pain Ther"},{"issue":"1","key":"ref24","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.arth.2018.09.008","article-title":"Risk Factors for Nerve Injury After Total Hip Arthroplasty: A Case-Control Study","volume":"34","author":"T., et al. Shetty","year":"2019","journal-title":"The Journal of Arthroplasty"},{"issue":"5","key":"ref25","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1016\/j.jcot.2019.08.003","article-title":"Management of peripheral nerve injury","volume":"10","author":"P. S. Bhandari","year":"2019","journal-title":"J Clin Orthop Trauma"},{"issue":"2","key":"ref26","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.ocl.2021.11.002","article-title":"Nerve injuries in total knee arthroplasty","volume":"53","author":"D. Cohen","year":"2022","journal-title":"Orthop Clin North Am"},{"issue":"4","key":"ref27","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.artd.2020.07.017","article-title":"Common Peroneal Nerve Injury and Recovery after Total Knee Arthroplasty: A Systematic Review","volume":"6","author":"C. N., et al. Carender","year":"2020","journal-title":"Arthroplast Today"},{"issue":"9","key":"ref28","doi-asserted-by":"publisher","first-page":"e08032","DOI":"10.1016\/j.heliyon.2021.e08032","article-title":"Diagnosis and treatment of the most common neuropathies following knee injuries and reconstructive surgery \u2013 A narrative review","volume":"7","author":"D., et al. Szwedowski","year":"2021","journal-title":"Heliyon"},{"issue":"6","key":"ref29","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1002\/mus.26045","article-title":"Risk factors for acute nerve injury after total knee arthroplasty","volume":"57","author":"T., et al. Shetty","year":"2018","journal-title":"Muscle Nerve"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"101331","DOI":"10.1016\/j.artd.2024.101331","article-title":"Peroneal Nerve Palsy After Total Knee Arthroplasty","volume":"26","author":"\u00d8., et al. H\u00f8vik","year":"2024","journal-title":"Arthroplast Today"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2147\/LRA.S101373","article-title":"Anesthesia for the patient undergoing total knee replacement: current status and future prospects","volume":"10","author":"Z. A., et al. Turnbull","year":"2017","journal-title":"Local Reg Anesth"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"M. J., et al. Page","year":"2021","journal-title":"BMJ"}],"container-title":["Orthopedic Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/160847-nerve-injuries-after-total-knee-arthroplasty-a-systematic-review-and-meta-analysis","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:02:18Z","timestamp":1777590138000},"score":1,"resource":{"primary":{"URL":"https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/160847-nerve-injuries-after-total-knee-arthroplasty-a-systematic-review-and-meta-analysis"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":32,"URL":"https:\/\/doi.org\/10.52965\/001c.160847","relation":{},"ISSN":["2035-8164"],"issn-type":[{"value":"2035-8164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}