Entwinement of sciatic nerve around a total hip prosthesis following closed reduction of dislocated total hip...

The usual causes of injury to sciatic nerve during total hip replacement are intraoperative direct nerve injury, significant leg lengthening, improper retractor placement, cement extravasation, cement-related thermal damage, patient positioning, manipulation and postoperative hematoma. We present a case of early sciatic nerve injury with entrapment of sciatic nerve around the prosthetic femoral neck following repeated manipulation of dislocated total hip replacement. This case emphasises the importance of soft tissue in dealing with orthopedic problem. Limited number of attempts at closed reduction should be made as prolonged manipulation may place surrounding soft-tissue structures particularly nerve at risk of injury. If a closed reduction with the patient under general anesthesia is difficult, there should be a low threshold for open exploration and reduction. Documentation of neurovascular status before and after manipulation is essential.