Late Hardware-induced Sciatic Nerve Lesions After Acetabular Revision

We encountered late hardware-induced sciatic nerve lesions after acetabular revision in six patients. There were five female patients and one male patient. The mean age of the patients at the time of index acetabular revision was 59.3 years (range, 42-76 years). The interval from the index acetabular revision to the onset of sciatic nerve symptoms averaged 9.4 months (range, 4-16 months) and that from the onset of symptoms to nerve release was 11.3 months (range, 8-13 months), except in two patients with intermittent symptoms in which it was 9 and 10.5 years, respectively. Sciatic nerve release was successful in two patients, but in four patients, the nerve had been partly or entirely cut by the metallic hardware resulting in a permanent deficit. The minimum followup was 2 years (mean, 4 years; range, 2-7 years). Mechanical irritation should be suspected in the case of any late sign of peroneal neuropathy after acetabular revision with a macrocup or antiprotrusion device, and plate fixation of the posterior column. We recommend exploration and nerve release before a permanent lesion of the nerve has developed.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.