The prevalence of sciatic nerve injury associated with dislocation of a hip prosthesis is <0.1%1-4. The severity of the nerve injury has been found to be related to the chronicity of the dislocation prior to joint reduction and to the location of the injury on the basis of intraneural topography2,4-6. To our knowledge, no previous patients with entwinement of the sciatic nerve around a total hip prosthesis following closed reduction of a dislocation have been reported. We describe the case of a patient in whom sciatic nerve injury occurred after repeated closed reduction of a dislocated hip prosthesis.
A sixty-six-year-old woman was referred to our clinic with a fourteen-month history of complete sciatic nerve palsy associated with unrelenting pain in the left lower extremity following closed reduction of a dislocated total hip prosthesis. Previously, the patient underwent a total hip arthroplasty through a posterior approach because of degenerative arthritis of the left hip. One month postoperatively, the hip prosthesis dislocated posteriorly after the patient reached across her body while sitting with the involved foot elevated in front of her. A difficult reduction had been accomplished with the patient under conscious sedation, after which she had total paralysis of all of the muscles below the knee and burning pain and paresthesias radiating from the mid-thigh to the foot. The neurological examination before the closed manipulation was normal. At the time of our evaluation, the patient noted persistent symptoms. She was dependent on narcotic analgesics and gabapentin to control the pain and often had to pack the lower extremity in ice to obtain relief at night. She was able to walk with toe-touch weight-bearing on the involved limb with use of an ankle-foot orthosis.
Physical examination revealed a complete motor deficit of …
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