Here's a valid, we'll documented, peer-reviewed explanation on this subject:

That sounds like an extremely difficult recovery, and everything you describe fits with a very rare but documented complication: femoral nerve neuropraxia (or higher-grade nerve injury) after laparoscopic inguinal hernia repair, usually due to a postoperative hematoma or traction/compression around the femoral canal.

A few key points may help clarify what’s going on and what to expect:

Rarity & Surgeon’s Statement:

Your surgeon is correct that this complication is very rare—but when it does occur, it’s usually related to a hematoma compressing the femoral nerve. That part is well-documented. The “38 cases worldwide” figure is probably an understatement—there are more case reports than that—but it still remains rare enough that recovery timelines are not well-studied.

Understanding the Nerve Injury:

“Neuropraxia” is typically the mildest nerve injury (temporary conduction block).
But your nerve conduction study showing no signal to the quadriceps raises the possibility of:

Axonotmesis (axonal damage, but nerve sheath intact), or

A mixed injury (part neuropraxic, part axonotmetic).

If it were pure neuropraxia, some return of signal is usually seen within 6–12 weeks.

At 22 weeks, ongoing paralysis suggests damage more severe than just neuropraxia — but still often recoverable.

Expected Recovery Timeline>

For axonal injuries:

Nerve regrowth occurs at ~1 mm/day (about 1 inch per month).

For the femoral nerve (a long, proximal nerve), meaningful recovery may take 6–18 months, sometimes even 24 months.

The first signs of recovery are usually:

Twitching in the quadriceps.

Slight ability to lift the knee.

Reduction in numbness above the knee.

The fact that the hematoma resolved does not automatically mean the nerve instantly resumes function — the damage can take months to heal.

What is Concerning / Needs Attention>

At this point (5+ months):

Persistent quadriceps paralysis.

No measurable nerve conduction.

Ongoing severe pain.

These are not unusual in nerve injuries but indicate that:

You need ongoing neurology follow-up.

Repeat EMG/NCS every 3–4 months to look for early reinnervation.

Early involvement of a specialist peripheral nerve surgeon should be considered.

Proven Helpful Steps:

a. Physiotherapy is essential even without nerve signals
To prevent:

Knee contracture.

Muscle shortening.

Joint instability.

b. Electrical stimulation (NMES)
Helps preserve muscle bulk while you wait for nerve regrowth.

c. Pain management:

Burning/throbbing nerve pain often responds best to:

Pregabalin or gabapentin.

Duloxetine.

Amitriptyline (low dose at night).

d. Bracing:

A locked knee brace and crutches are exactly what patients typically need during early recovery.

Surgical Exploration?

Most femoral nerve injuries are treated conservatively, but surgical exploration is considered when:

There is no improvement at 6–9 months,

EMG shows no evidence of reinnervation.

There is suspicion of scar entrapment or ongoing compression.

A peripheral nerve specialist (not a general surgeon) is the one to assess this.

The Bottom Line:

At 22 weeks, lack of recovery is absolutely distressing—but not outside the recovery window for femoral nerve injuries.

Many cases show first signs of improvement between 6–12 months.

Full recovery can take 1–2 years, and some patients have partial but meaningful improvement even later.

Your next steps should include repeat EMG, aggressive PT, nerve-focused pain management, and possibly referral to a peripheral nerve specialist.