Compressive Iliac Aneurysm A Rare Case of Sciatic Nerve Palsy after Total Hip Replacement

Pedro Neves, Rafaela Coelho, RuiLemos A, Pedro Serrano, Joaquim Ramos, Pedro Barreira


Introduction Sciatic nerve injury is an aknowledged iatrogenic complication of total hip arthroplasty THA usually associated with posterior surgical approaches Its temporal proximity with arthroplasty produce a positive causal relation between the two entities but it is worth recalling that there may be other causes unrelated to arthroplastic procedure for neurological injury Case presentation We present a case of a male patient currently with yearsold with left hip total replacement history In the patient underwent right femoral popliteal bypass because of a popliteal thrombosed aneurysm Right hip arthroplasty was repeatedly delayed until when he was successfully operated Six weeks after surgery the patient had an episode of strong leg pain followed by paresthesia and reduction of ankle dorsiflexion strength Electromyography was performed and showed highsciatic nerve injury CT scan showed a mass exerting compressive effect on the sciatic notch Later was performed angio CT scan which revealed aneurysm of the right internal iliac artery being treated by endovascular approach In later angiographic control was confirmed regression of the aneurysm Currently the patient has no pain but has not regained dorsiflexion capacity of the foot Discussion This case alerts us to the need for complete clinical evaluation of the patient and the attention to differential diagnosis before a situation of the sciatic nerve palsy

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