Prevention of sciatic nerve entrapment in trochanteric wiring following total hip arthroplasty

Sciatic nerve entrapment secondary to trochanteric wiring is a rare but serious complication following total hip arthroplasty (THA) in which the transtrochanteric approach has been used. To eliminate this risk, the authors modified the Charnley drill-and-wire-guide forceps for the femur, an instrument that facilitates both the drilling of an anteroposterior hole through the femur in the intertrochanteric region and the insertion of the horizontal wire. Transformation of the slot on the lower branch of the forceps into a loop that engages the posterior end of the wire, thereby advancing it automatically when the instrument is retracted, effectively prevents entrapment of both the sciatic nerve and the soft tissues. The modified instrument also saves time, and in more than 3000 THAs in which it has been used, no case of sciatic nerve entrapment has been observed.