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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 5, 674-676.
doi: 10.1302/0301-620X.90B5.19536  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Delayed, transient sciatic nerve palsy after primary cementless hip arthroplasty

A REPORT OF TWO CASES

O. May, MD, MSc, Orthopaedic Surgeon1; J. Girard, MD, Orthopaedic Surgeon1; J. F. Hurtevent, MD, Radiologist1; and H. Migaud, MD, Professor Division of Orthopaedic Surgery1

1 Radiology Department Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, Avenue Oscar Lambret, 59037 Lille, France.

Correspondence should be sent to Dr J. Girard; e-mail: j_girard_lille{at}yahoo.fr

Delayed sciatic nerve palsy is uncommon after primary hip replacement. Two kinds of sciatic palsy have been reported with regard to the time of onset: early palsy related to wound haematoma or lumbosacral nerve elongation which occurs between surgery and 18 days, is more frequent than delayed palsy, occurring between 10 and 32 months, which is usually caused by cement extrusion or heat produced by cement polymerisation.

We present two cases of delayed, transient sciatic nerve palsy arising at three weeks and four months after primary cementless arthroplasty, respectively, without haematoma and with a normal lumbar spine. These palsies were possibly caused by excessive tension from minor limb lengthening of 2 cm to 4 cm required to achieve leg-length equality. As the initial symptoms were limited to calf pain and mild numbness in the foot, surgeons should be aware of this mode of onset, particularly when it is delayed after hip replacement. Both patients recovered fully by 12 months after surgery so we did not undertake surgical exploration of the nerve in either patient.




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N. Manidakis, N. K. Kanakaris, V. S. Nikolaou, and P. V. Giannoudis
Early palsy of the sciatic nerve due to heterotopic ossification after surgery for fracture of the posterior wall of the acetabulum
J Bone Joint Surg Br, February 1, 2009; 91-B(2): 253 - 257.
[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General