title: Delayed sciatic nerve palsy following resurfacing hip arthroplasty caused by metal debris.
abstract: The 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.
authors.affiliation: Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK. babar.kayani@gmail.com
authors.forename: Babar
authors.initials: B
authors.lastname: Kayani
authors.forename: Jeeshan
authors.initials: J
authors.lastname: Rahman
authors.forename: Sammy A
authors.initials: SA
authors.lastname: Hanna
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cannon
authors.forename: William J
authors.initials: WJ
authors.lastname: Aston
authors.forename: Jonathan
authors.initials: J
authors.lastname: Miles
mesh_terms: D005260:Female; D005547:Foreign Bodies / Q000150:complications* / Q000601:surgery*; D005549:Foreign-Body Reaction / Q000209:etiology / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D061825:Metal-on-Metal Joint Prostheses; D008670:Metals; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D020426:Sciatic Neuropathy / Q000209:etiology* / Q000601:surgery*
chemical_list: D008670:Metals