Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

Abstract

IntroductionInfectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction.Case presentationWe report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year after total hip replacement. She was diagnosed with an ileopectineal bursitis after total hip replacement, leading to femoral nerve palsy. The diagnosis was obtained by thorough clinical examination, the results of focused computed tomography and magnetic resonance imaging.ConclusionTo the best of our knowledge, this is the first report of non-infectious ileopectineal bursitis in a patient without rheumatoid arthritis as a complication of total hip replacement. This rare case underlines the importance of proper neurologic examination of persistent conditions after orthopedic intervention in otherwise healthy individuals. We believe this case should be useful for a broad spectrum of medical specialties, including orthopedics, neurology, radiology, and general practice.

Rapidly Progressive Osteolysis and a Large Cystic Lesion that Destroyed the Inner Table of the Iliac Bone Following Cementless Total Hip Arthroplasty: A Case Report

“…Osteolysis surrounding prosthesis has been defined as a complication that is caused by wear debris, and affects the clinical outcome of THA [1]. There are many reports of osteolysis and accompanying enlargement of the cyst [2][3][4][5][6][7], but few reports present pathological findings [2,3]. The pathological findings of our case indicated that there were polyethylene particle-like substances in abundant macrophages, and hemosiderin was present in the interstitium of the tissue.…”

“…In general, polyethylene wear debris causes the formation of a soft tissue mass as a result of an inflammatory reaction. Some cases with cystic or tumorous lesions have also been reported [2][3][4][5][6], and it has been suggested that cystic lesions after THA may be an early sign of wear debris [7]. We report an unusual case of a rapidly progressive osteolysis and a cystic lesion that destroyed the inner table of the iliac bone and occurred secondary to a cementless total hip arthroplasty (THA) 12 years after surgery.…”

A Rare Case of Femoral Neuropathy Associated with Ilio-Psoas Bursitis After 10 Years of Total Hip Arthroplasty

“…The femoral nerve can also be compressed by extruded cement if acetabular cement pressurization is used. One case of enlarged non-infective iliopsoas bursitis as a cause of femoral nerve palsy one year after THA has been reported [14]. Another case reported illiopsoas bursitis three years after ceramic-on-ceramic THA caused by an inflammatory response to hemorrhage within the bursa [15].…”

Nerve Palsy following Total Hip Arthroplasty: A Review of the Current Literature

“…EMG may show some acute denervation. 25 Femoral nerve palsies are more predictable and have a better prognosis than sciatic nerve injuries in general. 2,5 Treatment is dependent on cause.…”

“…For instance, if the etiology is due to an inflamed iliopectineal bursa, it may simply be drained. 25 If the cause is an acute iliacus hematoma, prompt decompression should be performed. 16 The prognosis for neurological recovery is related to the degree of nerve damage.…”