Painful total hip replacement due to sciatic nerve entrapment in scar tissue and lipoma.

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Serval ID
serval:BIB_4E754A713425
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Painful total hip replacement due to sciatic nerve entrapment in scar tissue and lipoma.
Journal
Musculoskeletal Surgery
Author(s)
Wettstein M., Garofalo R., Mouhsine E.
ISSN
2035-5114[electronic], 2035-5114[linking]
Publication state
Published
Issued date
2010
Volume
94
Number
2
Pages
77-80
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Painful total hip replacement remains a challenging problem because of the large amount of possible diagnoses. We report about a 64-year-old female patient who was misdiagnosed during 4 years as psychiatric. She suffered of excruciating left retrotrochanteric pain after the implantation of a cementless total hip replacement and revision because of recurrent hip dislocations. Walking was limited to short distances using two crutches. The work-up at this time included the usual diagnoses and remained unsuccessful. No loosening, infection or malposition of the prosthesis could be found, and she had no neurologic deficits in her operated leg. An MRI was obtained to visualize the retrotrochanteric soft tissues and showed a tight scar surrounding the sciatic nerve, which was also compressed by an adjacent lipoma. Therefore, she was reoperated on to remove the lipoma and the scar tissue around the sciatic nerve. To decrease the risk of recurrent scarring around the sciatic nerve, an adhesion barrier was applied before closure. One year after the operation, the patient has no neurologic deficit, no more pain and is able to walk unlimited distances without crutches. Scar tissue around the sciatic nerve is frequently observed during revision surgery. However, we feel that sciatic nerve entrapment by scar tissue should be a part of the differential diagnosis of painful THR. MRI may be a useful tool to achieve this diagnosis.
Pubmed
Open Access
Yes
Create date
02/02/2011 13:12
Last modification date
01/10/2019 6:17
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