Sciatic nerve entrapment secondary to trochanteric wiring following total hip arthroplasty. A case report

In an 81-year-old woman the sciatic nerve was inadvertently penetrated with the trochanteric wire and incorporated into the trochanteric wiring during trochanteric attachment in total hip arthroplasty through a transtrochanteric approach. Immediately after operation, the patient had a sciatic palsy. Exploration of the wound revealed that the nerve had been entrapped in the trochanteric wiring mechanism. Despite release of the nerve and neurolysis, symptoms persisted, and the patient had a complete sciatic palsy that has not recovered. The technical aspects of total hip arthroplasty utilizing trochanteric osteotomy should include internal rotation of the femur during insertion of trochanteric wire so that the posterior aspects of the hip joint and the femoral shaft can be fully observed. Similarly, all wire should be free of any soft tissue prior to twisting and tightening. Patients awakening with profound and immediate sciatic involvement should be explored early to determine the cause as well as to alleviate any possible impingement that might interfere with the prognosis of this very serious injury.