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Neuropraxia following inguinal hernia surgery
Hello. I had keyhole surgery for an inguinal hernia on 11th July 2025. Immediately after surgery I was aware that I had no feeling in my left leg. 6 hours post op, and the surgeon assured me that it would be OK in a further hour or so. 2 weeks later and I left hospital using a wheelchair to get to the car, and from the car to the house wearing a leg brace and using 2 elbow crutches. Before being discharged from hospital, I was diagnosed with neuropraxia caused by a haematoma which had strangled the femoral nerve. The haematoma has since dispersed, however, nerve conduction studies concluded that there was no signal from the femoral nerve to the quad muscles. My surgeon told me that there has only ever been 38 cases worldwide from millions of similar operations, so therefore, not a lot of information available. Today is the 12th December 2025. 22 weeks post op and my leg is still numb, I am unable to flex my knee joint, and I am in constant pain and discomfort. Any help or advice would be greatly appreciated. Thanks for taking the time to read, and thanks to anyone who responds.
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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.
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2 ReactionsThank you for your kind words of encouragement. Unfortunately the NHS in the UK is on its knees for many reasons. I am awaiting an appointment with a peripheral nerve specialist/plastic surgeon, but unfortunately it will be their decision whether or not they will see me. I am also awaiting an appointment with a neurology physiotherapist. I should have had my nerve conduction studies at 8 weeks post op, or 12 weeks maximum. However it was week 18 before I was seen.
@tommy901 Thank you. Could you please provide the reference for your source?
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2 Reactions@naturegirl5 Medical & Scientific Articles:
1. Postoperative femoral neuropathy — PubMed review
A classic surgical review explaining that postoperative femoral nerve injury can occur from compression or retraction during surgery, and recovery often takes weeks to months with physiotherapy.
👉 https://pubmed.ncbi.nlm.nih.gov/1311869/
2. Femoral nerve involvement in hernia repair — case report review
Discusses documented cases of transient femoral nerve injury after inguinal hernia surgery and the role of EMG in diagnosis and monitoring recovery.
👉 https://pubmed.ncbi.nlm.nih.gov/15999220/
3. Iatrogenic femoral nerve injury (literature scoping review)
Systematic review showing that most cases recover motor and sensory function within several months but ischemic or axonal injuries take longer — and outlining the role of electrodiagnostic monitoring.
👉 https://pmc.ncbi.nlm.nih.gov/articles/PMC8593564/
4. Femoral nerve and lumbar plexus injury after surgery — electrodiagnostic study
Study of femoral neuropathy after lumbar surgical approaches — shows that many serious injuries still show significant improvement within 12 months and that serial EMG/NCS is helpful for prognosis.
👉 https://pubmed.ncbi.nlm.nih.gov/28560607/