Updated: 3/3/2019

THA Sciatic Nerve Palsy

Topic
Review Topic
0
0
Questions
11
0
0
Evidence
3
0
0
Introduction
  • illustrationIntroduction
    • epidemiology
      • uncommon (0-3%), but potentially devastating complication following THA
      • peroneal division of sciatic nerve most commonly affected (80%)
        • sciatic nerve travels closest to acetabulum at level of ischium 
        • exercise care with posterior acetabular retraction when hip in flexed position 
      • less commonly affected nerves 
        include
        • femoral
        • obturator
        • superior gluteal
    • causes
      • direct trauma
      • stretch
      • compression due to hematoma
      • heat from polymethylmethacralate polymerization
      • unknown (40%)
    • risk factors
      • for motor nerve palsies include  
        • developmental dysplasia of the hip
        • revision surgery
        • female gender
        • limb lengthening 
        • posttraumatic arthritis 
        • surgeon self-rated procedure as difficult
    • prognosis
      • only 35% to 40% recover full strength after complete palsy
 Presentation
  • Post-operative complaints of numbness, paresthesias, or weakness
Imaging
  • Post-operative CT
    • may be helpful if hematoma suspected
  • Ultrasound
    • may be helpful if hematoma suspected
Studies
  • EMGs
    • may be used post-operatively to confirm level of injury and guide discussion with patient regarding prognosis
Treatment
  • Intraoperative
    • adult hip dysplasia undergoing THA
      • subtrochanteric osteotomy 
      • downsizing components
  • Immediate postoperative
    • place hip in extension and knee in flexion
      • indications
        • immediate post-operative palsy
      • technique
        • decreases tension along sciatic nerve 
    • immediate excavation in operating room    
      • indications
        • post-operative hematoma
  • Persistent foot drop
    • AFO orthosis  
      • indications
        • first line of treatment for persistent foot drop
 

Please rate topic.

Average 4.7 of 10 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (11)

You have 100% on this question.
Just skip this one for now.

(OBQ13.231) Immediately following a total hip arthroplasty (THA), a healthy 55-year-old patient is unable to dorsiflex her ankle or extend her great toe. After 4 weeks she continues to ambulate with a "slapping gait." Examination reveals passive ankle joint dorsiflexion to 10 degrees. What is the most appropriate next treatment option? Review Topic

QID: 4866
FIGURES:
Type in at least one full word to see suggestions list
1

MRI of her spine and pelvis

2%

(86/3465)

2

Revision total hip arthroplasty

4%

(132/3465)

3

Ankle-foot orthosis

90%

(3102/3465)

4

Posterior tibial tendon transfer to navicular bone

2%

(60/3465)

5

Neurology consult

2%

(67/3465)

L 1

Select Answer to see Preferred Response

SUBMIT RESPONSE 3

You have 100% on this question.
Just skip this one for now.

(OBQ13.30) After total hip arthroplasty (THA) for osteoarthritis a patient is unable to dorsiflex her ankle or extend her great toe. She is treated conservatively with an orthosis and after 3 months on physical therapy she ambulates with a "slapping gait." What is the most appropriate next treatment option? Review Topic

QID: 4665
Type in at least one full word to see suggestions list
1

MRI of her spine

6%

(267/4752)

2

Ankle Fusion

1%

(47/4752)

3

Continue Ankle-Foot Orthosis

89%

(4210/4752)

4

Revision total hip arthroplasty

1%

(45/4752)

5

Sural nerve grafting

3%

(161/4752)

L 1

Select Answer to see Preferred Response

SUBMIT RESPONSE 3

You have 100% on this question.
Just skip this one for now.

(OBQ11.208) A 65-year-old female with a history of developmental dysplasia of the hip (DDH) undergoes a total hip arthroplasty (THA) utlizing a posterior approach. Following THA, she notices an inability to dorsiflex the ankle of her operative extremity. Her pre-operative and post-operative radiographs are seen in figues A and B. Which of the following intra-operative techniques could have avoided this complication in this patient?

Review Topic

QID: 3631
FIGURES:
Type in at least one full word to see suggestions list
1

Utilization of an anterior approach

4%

(127/3619)

2

Modular components

1%

(41/3619)

3

Use of a larger femoral head

1%

(19/3619)

4

Femoral shortening osteotomy

94%

(3384/3619)

5

Acetabular osteotomy

1%

(43/3619)

L 1

Select Answer to see Preferred Response

SUBMIT RESPONSE 4
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

You have 100% on this question.
Just skip this one for now.

(OBQ09.155) A 67-year-old woman undergoes a total hip arthroplasty. Postoperatively, she develops a complete peroneal palsy that does not improve with flexion of the knee and removal of compressive dressings. All of the following are associated with a post-operative nerve palsy EXCEPT: Review Topic

QID: 2968
Type in at least one full word to see suggestions list
1

Developmental dysplasia of the hip

1%

(22/1932)

2

Lengthening of the extremity

0%

(4/1932)

3

Surgeon self-rating the procedure as being a difficult intervention

9%

(172/1932)

4

Avascular necrosis of the femoral head

66%

(1275/1932)

5

Posttraumatic arthritis

23%

(451/1932)

L 3

Select Answer to see Preferred Response

SUBMIT RESPONSE 4

You have 100% on this question.
Just skip this one for now.

(OBQ08.267) Risk factors for a motor nerve palsy following primary total hip arthroplasty include all of the following EXCEPT? Review Topic

QID: 653
Type in at least one full word to see suggestions list
1

Developmental dysplasia of the hip

3%

(30/968)

2

Limb lengthening

1%

(8/968)

3

Posttraumatic arthritis

26%

(256/968)

4

Obesity

45%

(433/968)

5

Posterior approach

25%

(238/968)

L 4

Select Answer to see Preferred Response

SUBMIT RESPONSE 4

You have 100% on this question.
Just skip this one for now.

(OBQ08.224) What percentage of patients with complete peroneal nerve palsy after total hip arthroplasty will never recover full strength? Review Topic

QID: 610
Type in at least one full word to see suggestions list
1

90% to 95%

7%

(101/1407)

2

60% to 65%

44%

(623/1407)

3

40% to 45%

18%

(247/1407)

4

20% to 25%

23%

(326/1407)

5

0% to 5%

7%

(103/1407)

L 4

Select Answer to see Preferred Response

SUBMIT RESPONSE 2

You have 100% on this question.
Just skip this one for now.

(SAE07HK.89) Which of the following factors increases the risk of sciatic nerve injury in primary total hip arthroplasty (THA)? Review Topic

QID: 6049
Type in at least one full word to see suggestions list
1

Male gender

0%

(0/56)

2

Anterolateral approach

0%

(0/56)

3

Posterior superior quadrant acetabular screw placement

14%

(8/56)

4

Osteonecrosis

0%

(0/56)

5

Developmental dysplasia of the hip

84%

(47/56)

L 1

Select Answer to see Preferred Response

SUBMIT RESPONSE 5

You have 100% on this question.
Just skip this one for now.

(OBQ07.110) All of the following are risk factors for developing a sciatic nerve palsy following total hip arthroplasty EXCEPT: Review Topic

QID: 771
Type in at least one full word to see suggestions list
1

Female gender

39%

(767/1972)

2

Developmental dysplasia of the hip

2%

(31/1972)

3

Revision surgery

1%

(18/1972)

4

Rheumatoid arthritis

58%

(1147/1972)

5

Lengthening of the extremity

0%

(5/1972)

L 3

Select Answer to see Preferred Response

SUBMIT RESPONSE 4

You have 100% on this question.
Just skip this one for now.

(OBQ04.142) Figures A and B are pre-operative and intra-operative radiographs of a 67-year-old male that has undergone a left total hip arthroplasty under general anesthesia. The patient had no motor deficits pre-operatively. During the operation, the trial acetabular and femoral components were positioned and reduced with no complication. Intra-operative leg lengths were equal. Before implanting the real components, the surgeon and anaesthesiologist performed a wake up test, which revealed that the patient was unable to dorsiflex the left foot. What would be the most appropriate next step in the management of this patient? Review Topic

QID: 1247
FIGURES:
Type in at least one full word to see suggestions list
1

Urgent electromyogram and nerve conduction study

3%

(67/1995)

2

Continue with sized trial components and observe the motor function in surgical recovery area

21%

(419/1995)

3

Remove all implants and insertion of cement spacer

5%

(94/1995)

4

Perform a shortening subtrochanteric osteotomy

70%

(1397/1995)

5

Urgent neurology consult

0%

(3/1995)

L 3

Select Answer to see Preferred Response

SUBMIT RESPONSE 4

You have 100% on this question.
Just skip this one for now.

(OBQ04.249) During revision total hip arthroplasty (THA), adjunctive motor-evoked potentials (MEPs) and electromyography (EMG) are utilized to monitor the sciatic and peroneal nerves. During the procedure, a conduction abnormality arises in the sciatic nerve. Which of the following actions would decrease tension on the sciatic nerve? Review Topic

QID: 1354
Type in at least one full word to see suggestions list
1

Provide traction to the leg

0%

(4/2308)

2

Pulsatile irrigation in the wound to remove blood clots

0%

(2/2308)

3

Flex the hip

5%

(119/2308)

4

Extend the hip

94%

(2170/2308)

5

Extend the knee

0%

(5/2308)

L 1

Select Answer to see Preferred Response

SUBMIT RESPONSE 4
ARTICLES (3)
Topic COMMENTS (0)
Private Note