Transient Sciatic Nerve Palsy Research Articles

Ceramic-on-Ceramic Bearing Total Hip Arthroplasty in Young Patients with Osteonecrosis of Femoral Head

Purpose: To evaluate the short-term clinical and radiographic results associated with use of the ceramicon-ceramic articulation uncemented total hip arthroplasty (THA) in patients less than fifty years old with osteonecrosis of femoral head. Materials and Methods: Sixty-eight THAs with use of the ceramic-on-ceramic articulation were performed in fifty-nine patients who were younger than fifty years old with the implantation of an uncemented plasma coated Plasma cup and Bicontact stem. All patients were available for complete clinical and radiographic analysis after a mean duration of a follow-up of 31.6 months (range; 24-50 months). The average age of the patients at the index operation was 39.4 years (range; 16-49 years). Preoperative diagnosis was osteonecrosis of femoral head in all hips. The causative factors were idiopathic in twenty-one hips; alcohol abuse in twenty-eight hips, steroid in eleven hips, and posttraumatic in eight hips. Clinical evaluation was done by Harris Hip score (HHS). Radiographic evaluation was done in terms of stability of components and prevalence of osteolysis. Results: The mean preoperative HHS of 61 points improved to 95 points at the time of the final follow-up. Excellent results were found in 57 hips (84%), good results were 11 hips (16%). No acetabular or femoral components were loosened radiographically. There was no evidence of osteolysis. There were two postoperative dislocation, one intraoperative femoral fissuring, and one transient sciatic nerve palsy. Conclusion: Short-term clinical and radiographic results associated with use of the ceramic-on-ceramic articulation uncemented THA in patients less than fifty years old with osteonecrosis of femoral head were excellent. However, longer-term follow up is needed.

Delayed transient sciatic nerve palsy after total hip arthroplasty

Sciatic nerve palsy after total hip arthroplasty is a well-known complication, but delayed sciatic nerve palsy is rare. We report such a case with profound clinical manifestations and well-documented electrophysiologic changes. We found no helpful guidance to managing delayed palsy in the literature. We also are unaware of any previous cases reported in which nearly full recovery has occurred.

Posterior iliac osteotomy for fixed pelvic obliquity.

In nine children with a myelomeningocele and fixed pelvic obliquity due to uncorrectable lumbosacral scoliosis, a bilateral posterior iliac osteotomy was done and a wedge of bone was transferred form the low side to the high side of the pelvis. This produced a mean correction of 14 degrees (41 per cent) of the pelvic obliquity and a mean correction of the trunk list from the midline of seven centimeters (69 per cent). Two to seven-year follow-ups showed that the correction was permanent, without tendency for the obliquity to return as long as the scoliosis did not progress. The procedure resulted in several complications, including fracture of the pelvis and transient sciatic-nerve palsy; however, it provided a means of correcting pelvic obliquity that could not be corrected by standard procedures.