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La compresión del nervio ciático como causa de dolor crónico severo después de un reemplazo total de rodilla: un
Tim Philips1, Willem Goethals2, Francis De Neve3
1Department of Orthopaedic Surgery and Traumatology, AZ Middelares, Gent, Belgium; Department of Orthopaedic Surgery and Traumatology, University Hospital Gent, Ghent, Belgium.
The Knee
|February 10, 2026
Resumen
Una rara complicación del reemplazo total de rodilla (TKR) es la ruptura del tendón isquiotibial proximal que causa compresión del nervio ciático. El diagnóstico rápido con resonancia magnética y neurólisis quirúrgica ofrece un excelente alivio del dolor y recuperación funcional.
Área de la Ciencia:
- Cirugía Ortopédica en Cirugía Ortopédica.
- Neurología Neurología.
- Manejo del dolor Manejo del dolor.
Sus antecedentes:
- El dolor persistente después del reemplazo total de rodilla (TKR) es un problema complejo con varias causas.
- Las etiologías menos comunes del dolor TKR, como la ruptura del tendón de la corva, a menudo se pasan por alto.
- Este caso presenta un caso único de dolor posterior del muslo después de la TKR debido a la ruptura del tendón isquiotibial proximal y la compresión del nervio ciático.
Objetivo del estudio:
- Para informar de un raro caso de compresión del nervio ciático causada por la ruptura del tendón isquiotibial proximal después de la TKR.
- Para resaltar los desafíos de diagnóstico y el manejo exitoso de esta complicación postoperatoria específica.
- Para aumentar la conciencia de esta causa inusual de dolor TKR persistente.
Principales métodos:
- Se evaluó a una paciente de 66 años con dolor severo posterior del muslo después de la TKR.
- El examen clínico y la imagen (IRM) confirmaron una ruptura completa del tendón isquiotibial proximal con atrapamiento del nervio ciático.
- El paciente se sometió a exploración quirúrgica, neurólisis y descompresión del nervio ciático.
Principales resultados:
- El paciente experimentó una reducción inmediata y significativa del dolor (80/100 a 10/100) después de la cirugía.
- La recuperación funcional completa se logró en dos meses sin déficits neurológicos.
- El resultado quirúrgico fue altamente satisfactorio, resolviendo el dolor crónico atribuido a la compresión del nervio ciático.
Conclusiones:
- La ruptura del tendón isquiotibial proximal que causa compresión del nervio ciático es una causa excepcionalmente rara de dolor crónico posterior a la TKR.
- La sospecha clínica es crucial para los pacientes con dolor desproporcionado en la parte posterior del muslo que no responden a los tratamientos estándar.
- La resonancia magnética temprana y la neurólisis quirúrgica oportuna son clave para un diagnóstico preciso y un manejo exitoso, mejorando los resultados del paciente.
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