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Management of Sciatic Nerve Injuries Following Total Hip Arthroplasty
Jagwant Singh, MRCS; L Jeyaseelan; M Sicuri; M Fox; M Sinisi
Royal National Orthopaedic Hospital, London, United Kingdom
Introduction: Sciatic nerve injury remains a significant and devastating complication of total hip arthroplasty. While as urgent exploration is recommended for nerve palsies associated with pain, management of sciatic nerve palsy with little or no pain is still controversial. In light of this, many patients with persistent palsies are often not referred to our specialist centre until after 6 months post-injury.
The aim of this study was to review the outcomes of surgical intervention in patients presenting with sciatic nerve palsy more than 6 months after total hip arthroplasty.
Methods: This retrospective cohort study identified 35 patients who underwent exploration and neurolysis of the affected sciatic nerve. All patients had documented follow-up at 1, 3,6,12 and 18 months to assess sensory and motor recovery.
The primary outcome measure was improvement in nerve grades/nerve recovery over time following delayed exploration and neurolysis. A secondary measure of outcome was to note the impact of delay in exploration and neurolysis on nerve recovery.
Results: All the patients were operated at a median time of eight months (6-36 months) after their original injury. Traction injury was the most common cause of injury i.e. 28 patients.
We found a statistically significant functional recovery following neurolysis of the sciatic nerve (p<0.01). A statistically significant relationship was also found between time to neurolysis and recovery of tibial nerve function (p = 0.02), such that greater delay to neurolysis was associated with poorer recovery. There was no significant relationship between time to neurolysis and recovery of common peroneal nerve function (p = 0.28).
Conclusion: We found that neurolysis of the sciatic nerve, six months or more post injury is associated with functional recovery. We feel that without surgical exploration this clinical improvement would not have occurred. It also emphasises the fact that at six months even if there is no conduction there is still a case for neurolysis.
Therefore, we believe that neurolysis plays a vital role at any stage of sciatic nerve injury. However, early presentation to a specialist unit is associated with better outcomes.
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