J Neurol Surg Rep 2016; 77(03): e134-e138
DOI: 10.1055/s-0035-1568134
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Delayed Presentation of Sciatic Nerve Injury after Total Hip Arthroplasty: Neurosurgical Considerations, Diagnosis, and Management

Linda W. Xu
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
Anand Veeravagu
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
Tej D. Azad
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
Ciara Harraher
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
John K. Ratliff
1   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
› Author Affiliations
Further Information

Publication History

23 December 2015

11 October 2015

Publication Date:
05 September 2016 (online)

Abstract

Background Total hip arthroplasty (THA) is an established treatment for end-stage arthritis, congenital deformity, and trauma with good long-term clinical and functional outcomes. Delayed sciatic nerve injury is a rare complication after THA that requires prompt diagnosis and management.

Methods We present a case of sciatic nerve motor and sensory deficit in a 52-year-old patient 2 years after index left THA. Electromyography (EMG) results and imaging with radiographs and CT of the affected hip demonstrated an aberrant acetabular cup screw in the posterior-inferior quadrant adjacent to the sciatic nerve.

Case Description The patient underwent surgical exploration that revealed injury to the peroneal division of the sciatic nerve due to direct injury from screw impingement. A literature review identified 11 patients with late-onset neuropathy after THA. Ten patients underwent surgical exploration and pain often resolved after surgery with 56% of patients recovering sensory function and 25% experiencing full recovery of motor function.

Conclusions Delayed neuropathy of the sciatic nerve is a rare complication after THA that is most often due to hardware irritation, component failure, or wear-related pseudotumor formation. Operative intervention is often pursued to explore and directly visualize the nerve with limited results in the literature showing modest relief of pain and sensory symptoms and poor restoration of motor function.

Note

Linda W. Xu and Anand Veeravagu authors contributed equally to this manuscript.


 
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