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Delayed sciatic palsy after total hip replacement: case report

M S Edwards, N M Barbaro, S W Asher

    Neurosurgery
    |July 1, 1981
    PubMed
    Summary
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    Sciatica after total hip replacement can occur due to cement spurs eroding the sciatic nerve. Surgical removal of the spur and neurolysis relieved symptoms in this patient.

    Area of Science:

    • Orthopedic Surgery
    • Neurology
    • Rheumatology

    Background:

    • Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory condition.
    • Total hip arthroplasty (THA) is a common surgical procedure for hip joint issues.
    • Sciatica, or sciatic nerve pain, can manifest with various etiologies.

    Observation:

    • A 33-year-old woman with a 22-year history of JRA presented with right lower extremity sciatica.
    • Symptoms developed 32 months post-THA, localized to the sciatic nerve.
    • Physical examination and electromyography indicated sciatic nerve involvement near the midthigh.

    Findings:

    • Surgical exploration revealed a methyl methacrylate spur from the acetabular prosthesis eroding the sciatic nerve.
    • The spur impinged on the branch to the short head of the biceps femoris muscle.

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  • Sciatica was successfully treated with neurolysis.

    • Implications:

    • This case highlights a rare complication of THA: sciatic neuropathy caused by cement extravasation.
    • Early diagnosis and surgical intervention are crucial for managing nerve compression after THA.
    • Understanding this etiology is important for orthopedic surgeons and neurologists managing patients with hip replacements.