Management of sciatic nerve palsy after a total hip arthroplasty

Sciatic nerve injury, though uncommon with the index procedure, is a disabling complication of Total Hip Arthroplasty causing distress to not only the patient but also the surgeon and may become a source of anxiety, concern, and potential litigation. It can present frequently with foot drop and pain and result from either ischemia, compression, traction, transection, or a variable combination of these during the manipulation of leg at the time of surgery. Immediately and regularly examining the patient in the post-operative period for foot drop, dysesthesias, and/or sensory loss in the nerve distribution is imperative. Early recognition and accurate assessment of a possible nerve transection or compression using radiology may require an immediate corrective surgery or a neurolysis or even nerve grafting. Neurophysiology studies such as nerve conduction studies or electromyography should be optimally timed to gauge the extent of nerve injury and thus predicting its regeneration and recovery. Full nerve function is restored in approximately two-thirds of the cases; however, the degree of nerve injury, age and body mass index of the patient, and clinical presentation usually determine the prognosis of final functional outcome.