Delayed Presentation of Sciatic Nerve Injury after Total Hip Arthroplasty: Neurosurgical Considerations, Diagnosis, and Management.
BACKGROUND
Total hip arthroplasty (THA) is an established treatment for end-stage arthritis, congenital deformity, and trauma with good long-term clinical and functional outcomes. Delayed sciatic nerve injury is a rare complication after THA that requires prompt diagnosis and management.


METHODS
We present a case of sciatic nerve motor and sensory deficit in a 52-year-old patient 2 years after index left THA. Electromyography (EMG) results and imaging with radiographs and CT of the affected hip demonstrated an aberrant acetabular cup screw in the posterior-inferior quadrant adjacent to the sciatic nerve.


METHODS
The patient underwent surgical exploration that revealed injury to the peroneal division of the sciatic nerve due to direct injury from screw impingement. A literature review identified 11 patients with late-onset neuropathy after THA. Ten patients underwent surgical exploration and pain often resolved after surgery with 56% of patients recovering sensory function and 25% experiencing full recovery of motor function.


CONCLUSIONS
Delayed neuropathy of the sciatic nerve is a rare complication after THA that is most often due to hardware irritation, component failure, or wear-related pseudotumor formation. Operative intervention is often pursued to explore and directly visualize the nerve with limited results in the literature showing modest relief of pain and sensory symptoms and poor restoration of motor function.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
Linda W
LW
Xu
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
Anand
A
Veeravagu
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
Tej D
TD
Azad
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
Ciara
C
Harraher
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States.
John K
JK
Ratliff
delayed neuropathy; operative outcome; sciatic nerve; total hip arthroplasty