Delayed Sciatic Neuropathy Due to Late Migration of Cerclage Wire Following Total Hip Arthroplasty

Femoral cerclage wiring is commonly used during total hip arthroplasty (THA) to prevent propagation of intraoperative femoral cracks. Neurologic complications related to cerclage wiring are extremely rare, particularly as delayed presentations. We report a 62-year-old woman who developed acute, severe sciatic pain 7 years after uncemented THA in which a prophylactic 18-gauge cerclage wire had been applied for a nondisplaced femoral crack. Lumbar imaging was normal, but pelvic radiographs showed wire breakage. Magnetic resonance imaging demonstrated migration of a wire fragment adjacent to the sciatic nerve distal to the lesser trochanter. Surgical exploration revealed a hook-shaped wire fragment encircling the nerve. Wire removal and neurolysis led to complete symptom resolution. Late wire breakage and migration may cause severe neurologic complications after THA.