Compression of the Sciatic Nerve by Wear Debris Following Total Hip Replacement: A Report of Three Cases

Crawford, John R.; Rensburg, Lee Van; Marx, Clare

doi:10.1302/0301-620x.85b8.13638

Cited by 26 publications

(15 citation statements)

References 9 publications

(4 reference statements)

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“…Sciatic nerve release has also been performed for complications related to wear debris, hardware loosening, or migration [21][22][23][24]. Crawford reported on three patients with long-standing total hip replacements who developed progressive sciatic neuropathy with radicular pain following compression of the nerve by wear debris.…”

Section: Surgical Decompression and Resultsmentioning

confidence: 99%

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Sciatic Nerve Injury Associated with Acetabular Fractures

Issack

Helfet

2009

HSS Journal®

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Sciatic nerve injuries associated with acetabular fractures may be a result of the initial trauma or injury at the time of surgical reconstruction. Patients may present with a broad range of symptoms ranging from radiculopathy to foot drop. There are several posttraumatic, perioperative, and postoperative causes for sciatic nerve palsy including fracture-dislocation of the hip joint, excessive tension or inappropriate placement of retractors, instrument- or implant-related complications, heterotopic ossification, hematoma, and scarring. Natural history studies suggest that nerve recovery depends on several factors. Prevention requires attention to intraoperative limb positioning, retractor placement, and instrumentation. Somatosensory evoked potentials and spontaneous electromyography may help minimize iatrogenic nerve injury. Heterotopic ossification prophylaxis can help reduce delayed sciatic nerve entrapment. Reports on sciatic nerve decompression are not uniformly consistent but appear to have better outcomes for sensory than motor neuropathy.

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Section: Surgical Decompression and Resultsmentioning

confidence: 99%

“…A hematoma may develop which may progressively compress the nerve resulting in sciatic neuropathy in the early postoperative period [17,18]. Capsular and muscular scarring, hardware debris, or implant migration can irritate the sciatic nerve and present as a delayed neuropathy months to years after surgery [4,[19][20][21][22][23][24].…”

Section: Etiologymentioning

confidence: 99%

Sciatic Nerve Injury Associated with Acetabular Fractures

Issack

Helfet

2009

HSS Journal®

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“…In our patient, allergy testing confirmed the presence of both nickel and chromium sensitisation, despite no history of allergic reactions or intolerance to metals. Elves et al showed that in patients with metal-on-metal hip replacements, up to 38% of patients were sensitive to one or more of the metals and in those with non-traumatic loosening, up to 65% were sensitive to the metal ions 11. It is unclear as to whether sensitisation to the metal ions causes soft tissue destruction or vice versa.…”

Section: Discussionmentioning

confidence: 99%

“…Localised reversible sciatic nerve injury following total hip replacement has been reported in cases related to nerve compression from wear debris,11 subfascial haematoma12 and iatrogenic intraoperative pressure on an anatomical variant of the nerve through piriformis muscle 13. In this article, we present an unusual case of irreversible sciatic nerve palsy secondary to metal debris accumulation following hip resurfacing arthroplasty.…”

Section: Introductionmentioning

confidence: 93%

Delayed sciatic nerve palsy following resurfacing hip arthroplasty caused by metal debris

et al. 2012

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SummaryThe rapid rise in the incidence of failed metal-on-metal hip articulations in recent years has led to many patients requiring complex revision surgery. These failed metal prostheses may produce local metallic debris, which promotes both local and systemic adverse effects. We report an unusual case of failed metal-on-metal resurfacing hip arthroplasty presenting with ipsilateral buttock pain and foot drop 6 months after surgery. After thorough investigations, the metal-on-metal bearing was revised to a metal-on-polyethylene total hip replacement. This resulted in marked improvement in the systemic symptoms, inflammatory marke and metal ion levels postoperatively. However, neither clinical nor neurophysiological sciatic nerve recovery followed. The patient eventually required tendon transfer surgery for her persistent foot drop. BACKGROUND

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“…These include direct nerve injury, injury from retractors, and postoperative hematoma [14,15,21,29,57]. Delayed-onset sciatic injury from methylmethacrylate [49], trochanteric wire [48], prosthetic dislocation [57], acetabular reinforcement rings [21,47], and wear debris causing an inflammatory reaction and cystic masses compressing the sciatic nerve [18] have also been reported. A recent report suggests that intraoperative retraction of a piriformis muscle through which sciatic nerve fibers penetrate as an anatomic variant could cause what has before been viewed as idiopathic cases of postoperative sciatic neuropathy [22].…”

Section: Nerve Palsy and Hip Arthroplastymentioning

confidence: 99%

Sciatic Neuropathy: Case Report and Discussion of the Literature on Postoperative Sciatic Neuropathy and Sciatic Nerve Tumors

Feinberg

Sethi

2006

HSS Journal®

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Sciatic nerve injury and dysfunction is not an uncommon cause of lower extremity symptoms in a musculoskeletal practice. We present the case of a man who presented with lower extremity weakness, pain, and cramps, and was initially diagnosed at an outside institution with bilateral S1 radiculopathies and recommended for spine surgery. He came to us for a second opinion. Electrodiagnostic testing revealed an isolated sciatic neuropathy and the patient was referred for imaging, which showed a sciatic nerve sheath tumor. Review of the literature on sciatic neuropathies shows that there can be many possible etiologies of sciatic nerve dysfunction, but that hip arthroplasty continues to be the leading risk factor. Sciatic nerve tumors are not commonly described in the literature and their definitive management remains unclear.Key words Sciatic nerve . Lumbar radiculopathy . Electrodiagnostics . Electromyography . Nerve tumors Case discussionThe subject is a 52-year-old man with a 16-year history of mild, intermittent low back pain who presented with a chief complaint of pain, cramps, and weakness in the left lower extremity. He complained of a 2-month history of persistent pain in the upper thigh-lower buttock region with pain radiating to the left leg, calf, and toes. His pain ranged from 6 to 9 on a 10-point scale, with worse pain when lying down, flexing, walking uphill, and bending. Pain lessened with rest and short periods of stretching. He denied any specific complaint of back pain, numbness, and changes in bowel or bladder function. He denied any constitutional symptoms.The patient had his first episode of back pain 16 years earlier, at which time he responded to a treatment of acupuncture and stretching. He had occasional recurrent symptoms but did well until 4 years ago, when he began to experience pain predominantly down the right lower limb and sciatica. He underwent a course of physical therapy and trigger point injections and his symptoms resolved. He was then relatively well until the current episode.The patient underwent electrodiagnostic testing several weeks after the onset of his presenting symptoms. As per written reports presented by the patient, abnormal spontaneous activity was detected in isolation in the right and left gastrocnemius muscles. There was no involvement of any of the proximal muscles including the paraspinal muscles. The patient was diagnosed with bilateral S1 radiculopathies. A recent magnetic resonance imaging (MRI) showed mild disk bulges and disk degeneration most pronounced at the L4/5 level, without significant foraminal or canal compromise. This study, in comparison to a study performed 4 years earlier during the patient's prior episode of right-sided sciatic complaints, showed no significant changes.Except for this main complaint, the patient's medical history was significant only for hypertension and partial amputation of the left thumb secondary to trauma. The patient had no medication allergies and was taking p.r.n. narcotic pain medications, antihypertensive pa...

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Compression of the Sciatic Nerve by Wear Debris Following Total Hip Replacement: A Report of Three Cases

Cited by 26 publications

References 9 publications

Sciatic Nerve Injury Associated with Acetabular Fractures

Sciatic Nerve Injury Associated with Acetabular Fractures

Delayed sciatic nerve palsy following resurfacing hip arthroplasty caused by metal debris

Sciatic Neuropathy: Case Report and Discussion of the Literature on Postoperative Sciatic Neuropathy and Sciatic Nerve Tumors

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