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Hip: A. J. Butt, T. McCarthy, I. P. Kelly, T. Glynn, and G. McCoy Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement J Bone Joint Surg Br 2005; 87-B: 1465-1467 [Abstract] [Full text] [PDF]

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Queries on sciatic nerve palsy following THR

Vinayagam Leninbabu, Sanath Shah, Richard Samarji   (2 December 2005)

Sciatic nerve palsy after THR

Harish V Kurup, Venkat Neelapala   (24 November 2005)

Queries on sciatic nerve palsy following THR 2 December 2005
Vinayagam Leninbabu, Registrar Manchester Royal Infirmary, Sanath Shah, Richard Samarji Send letter to journal: Re: Queries on sciatic nerve palsy following THR leninkavitha{at}hotmail.com Vinayagam Leninbabu, et al.	Sir, We read this article with interest and discussed it in our monthly journal club. The authors do not discuss the reason for the increase in the incidence of sciatic nerve palsy from 0.2% in the previous 10 years to 1.69% in the year when the study was conducted. We are interested to know whether this may be due to a change in surgical approach or to a change in the protocol for thromboembolic prophylaxis. We feel that giving tinzaparin at a dose of 50 IU/kg body weight1 once a day is more appropriate than giving 4500 IU for all patients irrespective of their body weight. There are no details of how the diagnosis was made in the first 3 patients who were treated expectantly. Were ultrasound or MRI scans performed to show the haematoma? The palsy could have been caused by many factors.2-6 We are interested to know how the blood loss was calculated in patients in whom no drain was used. Also doing an INR and APTT in every patient seems unreasonable. Finally, the idea of exploring freshly operated hips within 48 hours of surgery based on clinical findings alone, appears to be misleading. Identification of the haematoma by an ultrasound, MRI or Nerve Conduction Studies is appropriate, as in most cases the irritation is due to handling of sciatic nerve during surgery. Schmalzried et al7 have shown that more than 85% of cases have excellent to good recovery. They also show that the presence of some motor function in the immediate post-operative period, or signs of recovery in the first two weeks following nerve palsy, indicate that a good outcome might be expected. We have come across 2 cases of sciatic nerve palsy in the last 5 years where the MRI scan showed evidence of haematoma but both had complete recovery within 6 weeks following expectant treatment. V. LENINBABU, Registrar S. SHAH R. SAMARJI Manchester Royal Infirmary, Manchester, UK. 1.British National Formulary. 2004;47:114-5. 2.Crawford JR, Van Rensburg L, Marx C. Compression of the sciatic nerve by wear debris following total hip replacement: a report of three cases. J Bone Joint Surg [Br] 2003;85-B:1178-80. 3. Floman Y, Bernini PM, Marvel JP Jr, Rothman RH. Low-back pain and sciatica following total hip replacement: a report of two cases. Spine 1980;5(3):292-4. 4. Sakai T, Sugano N, Fujii M, et al. Sciatic nerve palsy after cementless total hip arthroplasty. Treatment by modular neck and calcar shortening: a case report. J Orthop Sci. 2002;7(3):400-2. 5. Katsimihas M, Hutchinson J, Heath P, et al. Delayed transient sciatic nerve palsy after total hip arthroplasty. J Arthroplasty. 2002;17(3):379-81. 6. Austin MS, Klein GR, Sharkey PF, et al. Late sciatic nerve palsy caused by haematoma after primary total hip arthroplasty. J Arthroplasty 2004;19(6):790-2. 7. Schmalzried TP, Noordin S, Amstutz HC. Update on nerve palsy associated with total hip replacement. Clin Orthop Relat Res. 1997;(344):188-206.
Sciatic nerve palsy after THR 24 November 2005
Harish V Kurup, Specialist Registrar in Orthopaedics Ysbyty Gwynedd, Bangor, North wales, Venkat Neelapala Send letter to journal: Re: Sciatic nerve palsy after THR harishvk{at}yahoo.com Harish V Kurup, et al.	Sir, We read this article with interest and have some queries for the authors. 1. Where was the suction drain placed in these patients? In the subcutaneous or sub-fascial plane? 2. Did all these patients have a diagnosis of haematoma made entirely on clinical grounds, or did any have an ultrasound scan to confirm this before exploration? 3. In table III you state that total blood loss was 946 and 1174ml; how did you get these exact measurements? All suction drainage systems in common use measure this only in multiples of 5 or 10 ml. 4. Did these patients get any further anticoagulation after exploration and haematoma evacuation? H. KURUP, Specialist Registrar in Orthopaedics V. NEELAPALA Department of Orthopaedics, Ysbyty Gwynedd, Bangor, UK.