Irreducible Periprosthetic Hip Dislocation Due to Muscular Entrapment with Concomitant Sciatic Nerve Involvement

Periprosthetic dislocations remain a prevalent complication following total hip arthroplasty, with heightened risks in elderly patients and those with cognitive impairments. While most cases can be managed with closed reduction, irreducible dislocations are rare and may be due to unusual mechanical or soft-tissue impediments.

This case report describes an 87-year-old woman with an irreducible prosthetic hip dislocation due to penetration of the femoral head through the gluteus medius musculature after a ground-level fall. After multiple failed closed reduction attempts, the patient developed a foot drop with sensory changes indicating a sciatic nerve palsy. Open reduction was then indicated, along with neurolysis of the sciatic nerve.

The case underscores the challenges of managing complex hip dislocations in older adults and highlights the importance of addressing mechanical and neurological factors during treatment.