Sciatic neuropathy secondary to total hip arthroplasty wear debris

Fischer, Steven Roger; Christ, David J.; Roehr, Bernard

doi:10.1016/s0883-5403(99)90237-1

Cited by 43 publications

(23 citation statements)

References 19 publications

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“…Although there are few reports of extra-articular granulomatous masses associated with hip prostheses, cases of thigh masses are less common than intra-pelvic or gluteal masses. This might be related to the pressure gradients in the effective joint space, that is, a pseudocapsule generated after THA has some weak areas where herniation or extrusion into this joint space, such as that around the iliopsoas tendon or external rotators, is more likely to occur [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Pseudotumor associated with cemented bipolar hemiarthroplasty: an unusual presentation as a granulomatous thigh mass

et al. 2015

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Although polyethylene wear-induced osteolysis is a common complication of hip arthroplasty, extensile osteolysis developing into a large granulomatous thigh mass at a site distant from the joint is rare. We report a case of a thigh pseudotumor 25 years after cemented bipolar hemiarthroplasty, in which x-rays revealed a radiolucent line around the stem at the proximal site only, not at the diaphysis of the femur. We initially suspected a real tumor because it had a unique appearance, as if the mass resorbed the posterior cortex of the femur, and it was located at a site distant from the proximal osteolytic lesions. We clearly showed the existence of a connection between the thigh mass and the joint space by performing intra-articular injection of contrast medium with continuous pressure. It seemed that polyethylene wear particles were transported distally along the stem-cement interface by fluid pressure, and an osteolytic reaction against polyethylene wear particles had occurred at the posterior middle third of the stem where the cement mantle was nonuniform and polyethylene particles first came into contact with the bone. Our findings suggest that nonuniform cemented prosthesis with osteolysis, even if it is low grade in a limited area, carries the risk of extensile osteolysis with asymptomatic development of an extra-articular granulomatous mass.

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Section: Discussionmentioning

confidence: 99%

Pseudotumor associated with cemented bipolar hemiarthroplasty: an unusual presentation as a granulomatous thigh mass

et al. 2015

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“…Documented cases for late sciatic nerve palsy also have included entrapment of methylmethacrylate fragments, migrating trochanteric wires, dislocation of the hip, hemorrhage, migration of the acetabular cup, and wear debris containing a mass [1,3,5]. Among 50 cases in a meta-analysis of the English literature regarding intrapelvic complications after THA failure, Bach et al [2] identified only three cases of sciatic nerve injury [5,18] and two cases involving intrapelvic mass formation [10,13].…”

Section: Discussionmentioning

confidence: 99%

“…The literature contains a few reports of wear debris from THA producing a clinically detectable mass effect that can provoke delayed nerve palsy [5,10,11,13,17]. Harvie et al recently reported two cases of femoral neuropathy attributable to pseudotumor masses caused by metal-on-metal resurfacing arthroplasty [7].…”

Section: Introductionmentioning

confidence: 99%

Case Report: Femoral Neuropathy Secondary to Total Hip Arthroplasty Wear Debris

Fokter

Repše-Fokter²,

Takač

2009

Clinical Orthopaedics &Amp; Related Research

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Femoral nerve palsy after THA is well known, but delayed palsy is rare. We describe a 58-year-old man who had progressive thigh pain, weakness, and numbness develop 13 years after cementless arthroplasty of his left hip. Plain radiographs showed substantial liner wear. MRI of the lumbar spine was unrevealing and EMG showed a peripheral neurogenic process involving the left femoral nerve. The large intrapelvic cystic mass was confirmed by an abdominopelvic CT scan. Percutaneous aspiration of the cyst was performed. Cultures of the fluid were negative and cytopathologic examination showed necrotic debris without malignant cells. Biopsy revealed necrosis and abundant foreign body granulation tissue with polarizable debris. During surgical removal of the cyst, a defect of the inner acetabular wall was noted. After subsequent revision arthroplasty with allograft bone, the patient's clinical symptoms improved and his EMG returned to normal.

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“…Few articles describe late neuropathies, especially those induced by hardware. Masses from particulate debris related to acetabular loosening [5] and migration of a trochanteric wire after THA [1] can cause late sciatic neuropathy. An acetabular reinforcement ring has been reported to cause impingement of the sciatic nerve between the dorsal aspect of the acetabular reinforcement ring and scar tissue [13].…”

Section: Discussionmentioning

confidence: 99%

“…Most of them are surgery-related and occur during the procedure or are delayed by a few days [9], especially when caused by a hematoma [2,6]. Late nerve lesions are uncommon and are reported only sporadically [3,5]. Late hardware-induced sciatic nerve complications are rarely reported [1,8,14].…”

Section: Introductionmentioning

confidence: 99%

Late Hardware-induced Sciatic Nerve Lesions After Acetabular Revision

Vastamäki

Ylinen

Puusa

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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We encountered late hardware-induced sciatic nerve lesions after acetabular revision in six patients. There were five female patients and one male patient. The mean age of the patients at the time of index acetabular revision was 59.3 years (range, 42-76 years). The interval from the index acetabular revision to the onset of sciatic nerve symptoms averaged 9.4 months (range, 4-16 months) and that from the onset of symptoms to nerve release was 11.3 months (range, 8-13 months), except in two patients with intermittent symptoms in which it was 9 and 10.5 years, respectively. Sciatic nerve release was successful in two patients, but in four patients, the nerve had been partly or entirely cut by the metallic hardware resulting in a permanent deficit. The minimum followup was 2 years (mean, 4 years; range, 2-7 years). Mechanical irritation should be suspected in the case of any late sign of peroneal neuropathy after acetabular revision with a macrocup or antiprotrusion device, and plate fixation of the posterior column. We recommend exploration and nerve release before a permanent lesion of the nerve has developed.

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Sciatic neuropathy secondary to total hip arthroplasty wear debris

Cited by 43 publications

References 19 publications

Pseudotumor associated with cemented bipolar hemiarthroplasty: an unusual presentation as a granulomatous thigh mass

Pseudotumor associated with cemented bipolar hemiarthroplasty: an unusual presentation as a granulomatous thigh mass

Case Report: Femoral Neuropathy Secondary to Total Hip Arthroplasty Wear Debris

Late Hardware-induced Sciatic Nerve Lesions After Acetabular Revision

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