Neurolysis for the Treatment of Sciatic Nerve Palsy Associated with Total Hip Replacement

Michael Drexler Gilad Regev Ronen Sever Morsi Khashan Zvi Lidar Shlomo Rochkind
The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel

Sciatic nerve (SN) palsy following total hip arthroplasty (THA) is a relatively rare yet potentially devastating complication. The purpose of this case series was to report on the results of patients with SN palsy following primary and revision THA treated with SN neurolysis. A retrospective review was made of 12 patients undergoing interfascicular neurolysis for SN palsy at our institution, who had failed a trial of nonoperative treatment for a minimum of 6 months. Following surgery, a statistically and clinically significant improvement in motor and sensory function was seen in all patients. The average peroneal nerve score function improved from 0.42 (0-3) to 3 (1-5) (p<0.0001). The average tibial nerve motor function score improved from 1.75 (1-4) to 3.92 (3-5). Improvement in sensory function was clinically negligible, ranging from 0 to 1 in most patients. Eleven patients reported improvement in their pain following surgery. We conclude that neurolysis of the SN results in a favorable prognosis for patient suffering from SN palsy following THA. Our findings suggest that surgery should not be delayed for greater than 12 months following injury.