Letter to the Editor
Wound Hematoma Induced Sciatic Nerve Palsy After Total Hip Arthroplasty
and was unable to move the foot. Evacuation of a subfascial hematoma of 600 ml was performed 6 hours after the initial observation of sciatic nerve malfunction. Bleeding came from small vessels in the external rotator muscles and hemostasis was obtained by cauterizing tile arteria circum flexure medialis. The symptoms of sciatic nerve malfunction gradually disappeared during the first week. When d|scharged 8 days after surgery, the patient had no symptoms of sciatic nerve lesion. Discussion. The increased pressure in the compartment beneath the closed fascia seems to be responsible for tlle loss of nerve function. Our two cases suggest that the recovery of sciatic nerve function is dependent on the time interval between onset of symptoms and evacuation of the wound hematoma. Similar observations have been reported by others. 1.2 We therefore recommend frequent postoperative clinical examination and registration of sciatic nerve function after hip surgery. If postoperative development of sciatic nerve palsy does occur, the w o u n d must be examined. Occurrence of a w o u n d hematoma should lead to immediate hematoma evacuation before the onset of irreversible nerve damage.
To the Editor: We report two cases of sciatic nerve palsy after total hip arthroplastu due to the development of subfascial hematomas. C a s e 1. A 70-year-old w o m a n with arthrosis in the fight hip joint underwent cemented total hip arthroplasty (THA) in tile right hip. She was injected ,,vitil a low-molecular-weight heparin for thromboprophylaxis once daily starting 12 hours before surgery. The operation was performed through the posterolateral approach, and the socket and femoral component was inserted without complication. Twenty-four hours after the operation, clinical examination revealed a normal sciatic nerve function. On the second postoperative day, the patient complained of pain in the fight buttock region, loss of sensation in the fight lower limb, and was unable to move the right foot. Twelve hours after the initial observation of sciatic nerve malfunction, the patient underwent reoperation and a subfascial w o u n d hematoma of 400 ml was evacuated. Bleeding from a eircumflexum arteria in the trochanteric region stopped after compression. A year and a half after the operation, she suffered from pain on the lateral foot and leg region and was unable to move the foot. Electromyographic examination revealed a severe malfunction of the right sciatic nerve. C a s e 2. A 73-year-old m a n had a cemented THA on the right hip for severe arthrosis. The operative procedure was as described in case 1. tle was injected with a lowmolecular-weight heparin for thromboprophylaxis once daily starting 12 hours before surgery. Sciatic nerve function was normal 12 hours after the operation. However, 12 hours later he complained of severe pain in the fight buttock region and sensory changes in the right lower limb,
Jens V. Sorensen, MD Knud S. Christensen, MD
Departmott of Orthopaedics Aalborg Hospital Aalborg, Denmark References I. Flemming RE, Michelsen CB, Stinchfield FE: Sdatic paralysis: a complication of bleeding following hip surgery. J Bone Joint Surg 61A: 37, 1979 2. Roblin L, Tea S, Le Saout Jet al: Les complications paral~Jques de la chimrgie de la hance: apropos de 48 observations. Rev Chir Orthop 75:104, 1989
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Wound Hematoma Induced Sciatic Nerve Palsy After Total Hip Arthroplasty
and was unable to move the foot. Evacuation of a subfascial hematoma of 600 ml was performed 6 hours after the initial observation of sciatic nerve malfunction. Bleeding came from small vessels in the external rotator muscles and hemostasis was obtained by cauterizing tile arteria circum flexure medialis. The symptoms of sciatic nerve malfunction gradually disappeared during the first week. When d|scharged 8 days after surgery, the patient had no symptoms of sciatic nerve lesion. Discussion. The increased pressure in the compartment beneath the closed fascia seems to be responsible for tlle loss of nerve function. Our two cases suggest that the recovery of sciatic nerve function is dependent on the time interval between onset of symptoms and evacuation of the wound hematoma. Similar observations have been reported by others. 1.2 We therefore recommend frequent postoperative clinical examination and registration of sciatic nerve function after hip surgery. If postoperative development of sciatic nerve palsy does occur, the w o u n d must be examined. Occurrence of a w o u n d hematoma should lead to immediate hematoma evacuation before the onset of irreversible nerve damage.
To the Editor: We report two cases of sciatic nerve palsy after total hip arthroplastu due to the development of subfascial hematomas. C a s e 1. A 70-year-old w o m a n with arthrosis in the fight hip joint underwent cemented total hip arthroplasty (THA) in tile right hip. She was injected ,,vitil a low-molecular-weight heparin for thromboprophylaxis once daily starting 12 hours before surgery. The operation was performed through the posterolateral approach, and the socket and femoral component was inserted without complication. Twenty-four hours after the operation, clinical examination revealed a normal sciatic nerve function. On the second postoperative day, the patient complained of pain in the fight buttock region, loss of sensation in the fight lower limb, and was unable to move the right foot. Twelve hours after the initial observation of sciatic nerve malfunction, the patient underwent reoperation and a subfascial w o u n d hematoma of 400 ml was evacuated. Bleeding from a eircumflexum arteria in the trochanteric region stopped after compression. A year and a half after the operation, she suffered from pain on the lateral foot and leg region and was unable to move the foot. Electromyographic examination revealed a severe malfunction of the right sciatic nerve. C a s e 2. A 73-year-old m a n had a cemented THA on the right hip for severe arthrosis. The operative procedure was as described in case 1. tle was injected with a lowmolecular-weight heparin for thromboprophylaxis once daily starting 12 hours before surgery. Sciatic nerve function was normal 12 hours after the operation. However, 12 hours later he complained of severe pain in the fight buttock region and sensory changes in the right lower limb,
Jens V. Sorensen, MD Knud S. Christensen, MD
Departmott of Orthopaedics Aalborg Hospital Aalborg, Denmark References I. Flemming RE, Michelsen CB, Stinchfield FE: Sdatic paralysis: a complication of bleeding following hip surgery. J Bone Joint Surg 61A: 37, 1979 2. Roblin L, Tea S, Le Saout Jet al: Les complications paral~Jques de la chimrgie de la hance: apropos de 48 observations. Rev Chir Orthop 75:104, 1989
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