Electronic Letters to:

Case Report: A. Sosna, D. Pokorny, and D. Jahoda Sciatic nerve palsy after total hip replacement J Bone Joint Surg Br 2005; 87-B: 1140-1141 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Letter from Drs Alemdaroğlu and Alemdaroğlu

Bahadır Alemdaroğlu, Ebru Alemdaroğlu   (14 October 2005)

Letter from Mr McCullough

Christopher John McCullough   (24 August 2005)

Letter from Drs Alemdaroğlu and Alemdaroğlu 14 October 2005
Bahadır Alemdaroğlu, MD Ankara Education and Research Hospital, Ankara, Turkey, Ebru Alemdaroğlu Send letter to journal: Re: Letter from Drs Alemdaroğlu and Alemdaroğlu balemdaroglu{at}yahoo.com.tr Bahadır Alemdaroğlu, et al.	Sir, We read this article with interest. It highlights a common complication, sciatic palsy as a complication of total hip arthroplasty. The lengthening of the lower limb is a well-known cause of sciatic palsy after total hip replacement.1,2,3,4 The peroneal branch of the nerve is much more vulnerable than the tibial branch to traction injury as reported by Edwards, Tullos and Noble.4 We would like to draw attention to the inappropriate use of a long necked stem with marked lengthening of the limb which should be addressed by the authors. The tip of the greater trochanter is positioned at least four centimetres inferiorly to the centre of the femoral head in the vertical axis and Shenton’s line is disturbed. We think that medial traction of the nerve within the piriformis in this anatomical variant is important only in association with elongation of the lower limb. B. ALEMDAROğLU, MD E. ALEMDAROğLU, MD Ankara Education and Research Hospital, Ankara, Turkey. 1. Silbey MB, Callaghan JJ. Sciatic nerve palsy after total hip arthroplasty: treatment by modular neck shortening. Orthopedics 1991;14:351-2. 2. Nercessian OA, Piccoluga F, Eftekhar NS. Postoperative sciatic and femoral nerve palsy with reference to leg lenghtening and medialization/lateralization of the hip joint following total hip arthroplasty. Clin Orthop Relat Res 1994;304:165-71. 3. 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;7:400-2. 4. Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 1987;218:136-41.
Letter from Mr McCullough 24 August 2005
Christopher John McCullough, Consultant Orthopaedic Surgeon NWLHT Send letter to journal: Re: Letter from Mr McCullough dinad{at}btopenworld.com Christopher John McCullough	Sir, Sciatic nerve palsy leading to a persistent neurological deficit is often the subject of litigation, and defending a claim can be exremely difficult. Even if the nerve has not been lacerated, thermally burnt or compressed by an intra- or extra-neural haematoma, it is assumed that the injury has been caused by an excessive traction force or the injudicious use of retraction. However, 40% of sciatic nerve palsies following hip replacement have no known cause.1 Sosna, Pokorny and Jahoda2 have demonstrated that an anatomical anomaly has led to a sciatic nerve palsy following a hip replacement via a posterior approach in which the piriformis tendon was divided. Only by exploring the damaged nerve was the diagnosis established and treatment successfully accomplished. Clearly this case could be robustly defended in Court. Sciatic nerve palsy is equally common in hip replacements whether undertaken via an anterior or posterior approach. Schmalzried, Noordin and Amstutz3 have postulated that the aggregate data and experience suggests an interplay between individual patient anatomy and the specifics of that reconstructive procedure. Anatomical studies have shown a variability in the manner in which the sciatic nerve, specifically the peroneal division, enters and traverses the gluteal region. The fact that females are more prone to suffer nerve damage than males and that patients with developmental dysplasia of the hip are also at increased risk of nerve palsy suggests that individual anatomy is relevant to the risk of nerve palsy, although it is difficult to specify a particular anatomical abnormality. If specific anatomical anomalies of the sciatic nerve could be identified in in vitro studies concentrating on the course of the nerve and the details of its blood supply, a body of information could be collated which would be useful in the defence of sciatic nerve palsies following hip replacement when no identifiable injury could be established. C. J. McCULLOUGH, MA, FRCS Clementine Churchill Hospital, Harrow, UK. 1. Wasielekski RC, Crossett LS, Rubash HE. Neural and vascular injury in total hip arthroplasty. Clin Orthop 1992;23:219-35. 2. Sosna A, Pokorny D, Jahoda D. Sciatic nerve palsy after total hip replacement. J Bone Joint Surg [Br] 2005;87-B:1140-1. 3. Schmalzried TP, Noordin S, Amstutz H C. Update on nerve palsy associated with total hip replacement. Clin Orthop 1997;344:188-206.