- See:
Total Hip Replacement Menu:
-
arterial injuries: in THR:
-
nerve injury;
- Discussion:
- incidence of
sciatic &/or
femoral palsies after THR ranges from 1-3%;
- incidence of nerve palsy is 1-2% of primary total hip replacement, 3-4% after revision, and 5-6% in THR for congenitally dislocated hips;
- majority of these nerve deficits are partial, & many will resolve;
- females seem to be at significantly higher risk;
-
sciatic and
superior gluteal nerve and vessels course opposite the posterior superior quadrant, and the
inferior gluteal and
pudendal structures are opposite the postero-inferior quadrant;
- w/ EMG evaluation, there is > 75% incidence of subclinical injury to the superior and
inferior gluteal innervated muscles with use of
posterior and lateral approaches;
-
diff dx:
- revision total hip replacement;
- limb lengthening;
- female gender;
- anticoagulation;
- broken trochanteric osteotomy wires;
- vascular insufficiency;
-
prognosis:
- recovery from mild injury that consists of transient conduction block may occur in days to wks;
- if the injury has been severe enough to cause axonal damage, recovery may not occur at all or may be incomplete after 1 to 2 yrs;
- consider
electromyography;
- Management:
- if limb has been lengthened, & there is no other cause of injury, knee may be flexed to relieve stretch of sciatic nerve;
-
prevention of decubiti
-
EMG studies
Nerve palsy associated with total hip replacement. Risk factors and prognosis.
Sciatic nerve palsy after total hip arthroplasty: treatment by modular neck shortening.
Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty.
Somatosensory-evoked potential monitored during total hip arthroplasty.
Sciatic neuropathy secondary to intrapelvic migration of an acetabular cup. ZU Isiklar MD et al. JBJS. Vol 79-A. No 9. Sep 1997. p 1395.
Neural and vascular injury in total hip arthroplasty. RC Wasielewski et al. Orthop Clinics of North America. Vol 23. 1992. p 219-235.
Peripheral neuropathies associated with total hip arthroplasty. ER Weber. JBJS. Vol 58-A. 1976. p 66-69.
Motor Nerve Palsy Following Primary Total Hip Arthroplasty.
Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement.
Sciatic Nerve Palsy After Primary Total Hip Arthroplasty. A New Perspective.
Neurovascular Injuries in Acetabular Reconstruction Cage Surgery. An Anatomical Study.
Delayed, transient sciatic nerve palsy after primary cementless hip arthroplasty
