Diagnosis of sciatic nerve neuropathy in patients after total hip replacement

The incidence of sciatic nerve (SN) damage after a total hip replacement (THR) is as high as 10 percent. The diagnosis of SN post-surgery neuropathy in patients after THR is a challenging issue as the damage to this nerve can lead to the significant impairment of the extremity function and persistent disability even if the repair and recovery of the osseous structure surgeries were successful. This research had the evaluation of dynamics in clinical indicants and electrophysiological patterns in patients with primary idiopathic coxarthrosis aimed at early detection of post-surgery SN neuropathy after THR as its objective.

 MATERIAL  AND  METHODS .  The  research  involved  71  patients  aged  45  to  68  y. o.  with  primary  idiopathic coxarthrosis who had undergone THR in the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery in 2019–2020. We examined all patients (n=71) with clinical methods, studied their neurologic status (VAS, muscle strength and sensitivity), and performed ENMG before their surgeries and 14 days after them to diagnose the syndrome of SN post-surgery damage as early as possible.

RESULTS . Post-surgery SN neuropathy was found in all patients (n=71). 55 individuals had sensitivity disorders only and ENMG findings revealed a slight decrease in the amplitude of peroneal and tibial nerves m-responses as compared to their pre-surgery indicants. In 16 individuals who underwent their extremities’ lengthening in more than 3 cm, we observed movement and sensitivity disorders. EN mG findings featured a significant decrease in the amplitude of peroneal and tibial nerves m-responses as compared to their pre-surgery indicants.

CONCLUSION. THR surgery involves a high risk of traction and entrapment changes in SN leading to the progressing of post-surgery neuropathy most evident in patients who underwent their lower extremities’ lengthening in more than 3 cm.

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