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Guillain–Barré Syndrome Mimicking Nerve Injury After Total Hip Arthroplasty

Image - Photo of Eduardo A. Salvati, MD
Eduardo A. Salvati, MD
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Clinical Professor of Surgery (Orthopaedics), Hospital for Special Surgery

Benton R. Heyworth, MD
Pediatric Orthopaedic Surgery, Children's Hospital Boston

Peter D. Fabricant, MD
Orthopaedic Surgery, Hospital for Special

Mark M. Pizzurro, MD
Orthopaedic Surgery, St. Joesph's Regional Medical Center, Seton Hall University

Burak Besac, MD
Orthopaedic Surgery, Hospital for Special Surgery

Abstract

Background 
Guillain–Barré syndrome (GBS) is a rare, acute, inflammatory demyelinating polyneuropathy with a presentation of progressive ascending motor weakness of the extremities, which may extend to the respiratory muscles and require mechanical support.

Case Description 
This case describes a healthy male who developed GBS 1 week following otherwise an uncomplicated bilateral total hip arthroplasty surgery. The diagnosis was made based on physical exam significant for bilateral lower extremity weakness and diffuse arreflexia, and confirmed by nerve conduction studies. There were no effects on respiratory function, and the patient underwent a gradual recovery, with near complete return of motor function by 10 weeks following surgery and no functional deficits at 1 year following surgery. Functional activity levels are maintained 4 years postoperatively.

Literature Review 
A literature review is presented. While GBS has been described in the literature following several different forms of surgery and anesthesia, cases after orthopedic surgery are exceedingly rare.

Purposes and Clinical Relevance 
This case demonstrates that GBS may occur following orthopedic, including total joint arthroplasty, surgery. The presentation of GBS can be variable, but the hallmarks are areflexia and diffuse ascending weakness, with or without sensory symptoms. Rapid diagnosis and treatment are critical for preventing disability and life-threatening sequelae.

This article appears in HSS Journal: Volume 7, Number 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

 

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