Sciatic nerve injury remains a significant and devastating complication of total hip arthroplasty. Incidence as quoted in the literature ranges from 0.08% in primary joint replacement to 7.5% in revision arthroplasty. While as urgent exploration is recommended for nerve palsies associated with pain, management of sciatic nerve palsy with little or no pain is still controversial. In light of this, many patients with persistent palsies are often not referred to our specialist centre until after 6 months post-injury. The aim of this study was to review the outcomes of surgical intervention in patients presenting with sciatic nerve palsy more than 6 months after total hip arthroplasty. This retrospective cohort study identified 35 patients who underwent exploration and neurolysis of the affected sciatic nerve. All patients had documented follow-up at 1, 3, 6, 12 and 18 months to assess sensory and motor recovery. Patients were scored for sensory and motor function in the tibia and common personal nerve divisions, pre and post-operatively. The scoring system devised by Kline et al (1995) was used. Pre-operative electrophysiology was also reviewed. We found a statistically significant functional recovery following neurolysis of the sciatic nerve (p<0.01). A statistically significant relationship was also found between time to neurolysis and recovery of tibial nerve function (p = 0.02), such that greater delay to neurolysis was associated with poorer recovery. There was no significant relationship between time to neurolysis and recovery of common peroneal nerve function (p = 0.28). Our results indicate that the neurolysis of the sciatic nerve, six months or more post injury is associated with functional recovery. We feel that without surgical exploration this clinical improvement would not have occurred. Therefore, we believe that neurolysis plays a vital role at any stage of sciatic nerve injury. However, early presentation to a specialist unit is associated with better outcomes

Introduction: Reconstruction of ruptured anterior cruciate ligament is a commonly performed orthopaedic procedure. There are many ways of reconstructing this ligament. One method of doing so is to harvest a tendon graft from the hamstring muscles and use it as part of the reconstruction. The tendon is usually harvested by passing a tendon stripper along the length of the tendon from an anterior knee incision. The semitendinosus and the gracilis are the hamstring muscles whose tendons are used for this. A recent case study reported injury to the sciatic nerve during the harvest of semitendinosus graft. Although morbidity arising from iatrogenic injury to nerves at the anterior aspect of the knee has been well documented, little has been written about the relationship of the sciatic nerve to the semitendinosus and gracilis in the posterior thigh. This study proposes to look at this anatomical relationship. Method: 20 legs on ten cadavers underwent the same dissection to expose the semitendinosus tendon, gracilis tendon and the sciatic nerve while maintaining their anatomical relationships. In all cases the gracilis lay further away from the sciatic nerve than the semiten-dinosus tendon. As the semitendinosus tendon was in between the semitendinosus and the sciatic nerve in all instances it was decided not to measure the distance between gracilis and the sciatic nerve. The distance between the closest point of the sciatic nerve to the tendon of semitendinosus was measured at the joint line and at intervals of 20 mm from the joint line. Results: In 45 % of the subjects the sciatic nerve and the semitendinosus tendon gradually moved further apart as the measurements were taken more proximally in the leg. In 10 % they consistently moved apart from 6 cm from the joint line onwards. In another 10% they moved consistently apart from the 8cm from the joint line measurement and in 15 % they moved apart consistently from 12 cm from the joint line. In the remaining 20 % the sciatic nerve and the semitendinosus tendon did not consistently move apart from each other until after 14 cm from the joint line. In one subject (a female of small stature) it was noted that the semitendinosus muscle lay almost directly upon the sciatic nerve. In 6 subjects the minimum distance between the sciatic nerve and the semitendinosus tendon was less than 18mm. In one subject the distance between the sciatic nerve and the semitendinosus tendon was found to be 10 mm at the closest point and remained in close proximity for a further 4 cm. Conclusion: In 55 % of our patients the sciatic nerve did not consistently move further away from the semi-tendinosus tendon as it was measured more proximally. In some subjects the minimum distance between the nerve and the tendon was less than 2 cm. Both these facts would put the sciatic nerve at risk during tendon harvesting if the tendon stripper were to move outside of the tendon during the procedure

Purpose: To quantify the functional outcome of patients who were known to have sciatic nerve involvement pre-operatively and went on to have nerve preserving surgery utilising a planned marginal excision with epineurectomy. Materials and Methods: Ten patients with large volume posterior thigh soft tissue sarcoma with known sciatic nerve involvement were reviewed between 1997 and 2004. Nine underwent surgery with extended epineurectomy of the sciatic nerve and planned marginal excision. All patients underwent staging and follow up at Sarcoma Clinic with functional assessment and TESS evaluation. Results: There were seven low and two high grade posterior thigh tumours of which nine were liposarcoma and 1 haemangiopericytoma. Two were recurrent and eight primary. There were five men and five women with a mean age of 77. Nine patients underwent planned marginal excision. Sciatic nerve involvement was 13–30cm in eight cases and in one case the sciatic nerve was abutting the tumour throughout its length. There was soft tissue reconstruction in three cases using fascial adductor or gracilis graft for sciatic nerve cover and one with superficial femoral nerve and vein resection requiring ipsilateral saphenous reconstruction. The remainder underwent direct primary reconstruction. Four patients underwent radiotherapy 46–60 Gy. There was no local recurrence of disease within 14 – 96m follow-up. There was one patient with post radiation wound breakdown that resolved. Three patients have died of unrelated causes. To date there has been no evidence of local recurrence of disease at FU. Conclusion: Planned marginal excision of low grade large volume posterior thigh sarcomas with extensive sciatic nerve involvement can be successfully treated with preservation of the sciatic nerve without significant morbidity and resultant good limb function

Intro. Sciatic nerve injury (SNI) is a rare and potentially devastating complication after total hip arthroplasty (THA). Neural monitoring has been found in several studies to be useful in preventing SNI, but can be difficult to practically implement during surgery. In this study, we examine the results of using a handheld nerve stimulator for intraoperative sciatic nerve monitoring during complex THA requiring limb lengthening and/or significant manipulation of the sciatic nerve. Methods. We retrospectively reviewed a consecutive series of 11 cases (9 patients, 11 hips) with either severe developmental dysplasia of the hip (Crowe 3–4) or other underlying conditions requiring complex hip reconstruction involving significant leg lengthening and/or nerve manipulation. Sciatic nerve function was monitored intra-operatively with a handheld nerve stimulator by obtaining pre- and post-reduction conduction thresholds during component trialling. The results of nerve stimulation were then used to influence intraoperative decision- making (downsizing components, shortening osteotomy). Results. No permanent postoperative sciatic nerve complication occurred, with an average increase of 28.5mm in limb length, ranging from 6 to 51mm. In 2 out of 11 cases, a change in nerve response was identified after trial reduction, which resulted in an alternate surgical plan (femoral shortening osteotomy and downsizing femoral head). In the remainder cases, the stimulator demonstrated a response consistent with the baseline assessment, assuring that the appropriate lengthening was achieved without SNI. One patient had a transient motor and sensory peroneal nerve palsy, which resolved within two weeks. Conclusions. The intraoperative use of a handheld nerve stimulator facilitates surgical decision-making and can potentially prevent SNI. The real-time assessment of nerve function allows immediate corrective action to be taken before nerve injury occurs

Purpose: To investigate sciatic nerve conduction during hamstring lengthening. Conclusion: Sciatic nerve traction is caused during hamstring lengthening. Summary of method, results, and discussion: Ten children with spastic cerebral palsy underwent distal hamstring lengthening, average popliteal angel before surgery was 80 degrees. Methods: The tendon of the semitendinosus was elongated by sliding lengthening. The gracilis tendon was cut and the tendons of the biceps and semimembranosus were elongated by dividing the aponeurosis. Thereafter to elongate the hamstring the hip and knee were flexed to 90 degrees and the knee slowly extended with continuous evoked EMG monitoring. Bipolar nerve stimulation placed near the sciatic nerve consisted of the delivering of rectangular impulses of amplitude 0.8-1.2 ma for 100 US duration. The EMG recordings were performed from the tibialis anterior muscle. Results: In all patients motor potential amplitude gradually decreased during extension of knee (hamstring lengthening). The average decrease of the amplitude at popliteal angle of 60 degrees was 37 percent (16-75) and at 30 degrees 83 percent (36-98). The elongation was stopped at 30° of popliteal angle. On extending the hip and knee motor potential amplitude returned to normal. Discussion: Elongation of hamstring muscle is associated with traction on the f sciatic nerve as appears by decrease in sciatic nerve motor potential amplitude. To avoid nerve injury no excessive hamstring lengthening should be done and no nerve traction should be allowed at postoperative immobilization

Introduction. Our Unit has been treating large volume soft tissue sarcomas involving the sciatic nerve with epineurectomy for over a decade. The aim of this study was to quantify the functional outcome of patients who were known to have sciatic nerve involvement pre-operatively and went on to have nerve preserving surgery utilising a planned marginal excision with epineurectomy. Methods. 20 patients with soft tissue sarcomas involving the sciatic nerve were studied treated between 1997 and 2010. Nineteen underwent surgery with extended epineurectomy of the sciatic nerve and planned marginal excision. All patients underwent staging and follow up at our Sarcoma Clinic with functional assessment and TESS evaluation. Results. There were sixteen low and four high-grade posterior thigh tumours of which nineteen were liposarcomas and one haemangiopericytoma. Two were recurrent and eighteen were primary. There were seven men and thirteen women with a mean age of 77 years. Nineteen patients underwent planned marginal excision. There was soft tissue reconstruction in three cases using fascial adductor or gracilis graft for sciatic nerve cover and one with superficial femoral nerve and vein resection requiring ipsilateral saphenous reconstruction. The remainder underwent direct primary reconstruction. Eight patients underwent post operative radiotherapy. There was no local recurrence of disease. There was one patient with post radiation wound necrosis that resolved. Four patients have died of unrelated causes. Discussion. Planned marginal excision (PME) of low grade large volume posterior thigh sarcomas with extensive sciatic nerve involvement can be successfully treated with preservation of the sciatic nerve without significant morbidity and excellent resultant limb function. Even with PME of high grade disease with adjuvant radiotherapy, there was no local recurrence. Whilst the procedure is technically demanding, providing strict surgical technique is employed, damage to the sciatic nerve is rare and leaves patients with an unimpaired future lifestyle

During revision hip surgery, damage to the sciatic nerve is due most commonly to excessive tension. While the nerve is strong in tension and is able to tolerate this remarkably, it is sensitive to lateral compression against angled structures and it is likely that tension causes injury by such pressure. In a personal series of 441 revision hip procedures, sciatic nerve injury occurred in 9 recognised cases:. 2 were complete with no useful recovery. 2 were severe with some incomplete recovery. 3 were predominantly lateral popliteal with incomplete recovery. 2 were transient and clinically fully recovered. In only two of these were the cause and the time of injury identifiable. In these cases, pain was not a serious feature but in eight separate medico-legal cases, burning pain of variable distribution has been the most serious complaint. Medical negligence has been successfully sustained on the grounds of res ipsa locitur. Regrettably, patients must be given informed consent with yet another potential hazard being listed. We have found that in normal individuals the range of straight leg raising varies between 30 and 90 degrees. Towards the limit of this range the nerve is tight and a crude cadaveric test indicated a tension force of 40 newtons! In an athlete this may be extreme and yet the nerve does not complain. Excluding direct compression (e.g. by a retractor) and thermal injury, we suggest that the tension developed during unguarded straight leg raising while the patient is still anaesthetised is a serious risk factor. After even conservative lengthening, the tension rises alarmingly during such action. It is possible that pre-existing lumbar degenerative disk disease can contribute to the hazard and be source of pain

An observation was made in our unit that sciatic nerve injury following total hip arthroplasty seemed to be more common in women. This observation has been mentioned in the literature, but no anatomical explanation has been postulated. We aimed to confirm this and suggest an anatomical explanation. Members of the British Hip Society were approached by means of a postal questionnaire regarding the sex incidence of sciatic nerve injury following both primary and revision hip surgery in their practice. In this cohort of surgeons, of 179 reported sciatic nerve injuries, 77% were in women (80% in primary hip replacement and 69% in revision surgery), which is statistically significant. We suggest that the wider outlet of the female pelvis causes the path of the sciatic nerve to pass more closely to the posterior wall of the acetabulum so making it more vulnerable to surgical injury. This hypothesis has been explored by measurements taken from CT scans of the pelvis and hips. Results do confirm the closer proximity of the nerve to the hip joint in women. We therefore advise increased care when performing hip replacement in women and suggest that this be mentioned as a gender linked risk when consenting patients prior to surgery

Purpose: To assess the functional outcome of patients who pre-operatively, were known to have sciatic nerve tumour involvement and proceeded to have nerve-preserving planned marginal excision with epineurectomy. Methods: We identified patients who had surgery between 1997 and 2004, for soft tissue sarcomas in the posterior thigh with known sciatic nerve involvement. During this period it was the practice of the senior authors (MG & HG) to apply a nerve-preserving epineurectomy approach as part of their planned marginal excision of these tumours. The identified patients had their notes reviewed, and were contacted by post to complete a Toronto Extremity Severity Score (TESS) questionnaire to assess lower limb function in day-to-day life. Details of their presenting features, oncological work-up, surgical intervention and adjuvant therapy was established and correlated to the TESS score. Conclusion: This study demonstrates that a careful epineurectomy can preserve sciatic nerve function and allow tumour excision with no increase in local recurrence rate. With good soft tissue cover it appears nerve function can be maintained, even in cases where adjuvant radiotherapy is indicated

Purpose of the study: Balistic nerve injury is not common in civil medicine. We analyzed a series of 30 patients who underwent surgery for this type of injury suffered in the Gaza strip between 2002 and 2004. All patients presented paralysis of the sciatic nerve or one of its major branches. All injuries were caused by war weapons. Material and methods: The series included 28 men and two women, mean age 22 years (range 2.5–65). The injury had occurred more than one year earlier for 33% of patients. The injury was situated at the knee level in twelve patients and in the thigh in ten. Complete nerve section was observed in 12 patients and partial section in two. Loss of nervous tissue was significantly greater for lesions around the knee. Nineteen patients underwent surgery for: neurolysis (n=3), direct nerve suture (n=8) and nerve grafts (n=8). Eleven patients were reviewed at mean 13.7 months (range 3–30 months). There were no failures. Results of reinnervation of the tibial nerve territory were better than for the fibular nerve. Sixteen patients underwent palliative transfer for a hanging foot for more than six months: 15 transfers of the posterior tibial muscle through the interosseous membrane and hemitransfer of the Achilles tendon. Seven patients underwent Achilles tendon lengthening at the same time and five had a reinnervation procedure on the common fibular nerve. Results: Seven patients were reviewed with a mean follow-up of 1.8 years (range 4–30 months. None of the patients used an anti-equin orthesis. There were three cases of forefoot malposition. The overall Stanmore score was good at 75.4/100 (range 59–100). Discussion: High-energy ballistic trauma creates a specific type of injury. Nervous surgery can be indication early to favor spontaneous recovery. Palliative surgery for fibular lesions provides regularly good results. Conclusion: Nerve injuries due to ballistic trauma should be explored surgically because of the possibility of direct nerve repair. In addition, depending on the type of paralysis, reliable palliative surgery can be proposed

Sciatic nerve palsy is a troublesome complication of total hip arthroplasty, and may be caused by direct injury or over-traction at the time of the operation. We investigated the effects of over-traction on the blood flow of the sciatic nerve by placing the hip and knee joints in various positions. Twenty hip joints of 10 adult dogs were examined. Using a posterior surgical approach, the sciatic nerve was exposed and a site 1 cm distal to the greater trochanter was selected for blood-flow measurement. The blood-flow was measured using a Laser Doppler Flowmetry, with the hip and knee joints at various positions. Blood flow decreased as flexion angle increased and internal rotation angle of the hip joint increased, and decreased with as flexion angle of the knee joint decreased. When we positioned the hip joint at 160 degrees of flexion and 30 degrees of internal rotation and the knee joint at 0 degrees of flexion, we found that the mean blood-flow decreased by 69% from the value measured when the hip joint was at 90 degrees of flexion and the knee joint was 90 degrees of flexion. When knee flexion was 90 degrees there was no significant difference in average blood flow between 30 degrees of internal rotation of the hip and 0 degrees internal rotation. When knee flexion was 0 degrees there was a significant difference in average blood flow between 30 degrees of internal rotation of the hip and 0 degrees of internal rotation. Our results suggest that surgeons should pay attention to extension of the knee and the flexion and internal rotation positions of the hip to prevent sciatic nerve palsy as a complication of total hip arthroplasty

Purpose. Ankle and hindfoot surgery is associated with severe post-operative pain, leading to a reliance on opiate analgesia and its side effects, longer hospital stays, and patient dissatisfaction. Popliteal sciatic nerve blockade has the potential to resolve these issues. We present our experience with using a continuous local anaesthetic nerve block delivered by an elastomeric pump in patients undergoing major foot and ankle surgery. Methods. All patients undergoing major ankle or hindfoot surgery during a one-year period under a single surgeon were eligible for a continuous popliteal block. An ultrasound-guided popliteal nerve catheter was inserted immediately before surgery and a bolus of bupivacaine infiltrated. Using a 250ml elastomeric pump, a continuous infusion was started immediately post operatively and terminated 48 hours later. Prospective data including post-operative analgesia, nausea and vomiting (PONV), length of stay (LOS), pain scores, and patient satisfaction were recorded daily for 48 hours post operatively. Results. Eighty-one patients (53 male, 28 female) with a mean age 60 years (24–84 years) were included. 66 patients received spinal anaesthesia with 15 having general anaesthetics. There were no complications associated with the nerve catheters. At day 1 post op, 49 (60%) patients reported having no or mild pain. 68 (84%) patients had no PONV. 27 (33%) patients did not require any opiate analgesia during their post op period. Average LOS for all patients was 54 hours, with 41 (51%) discharged within 48 hours. 74 (91%) reported good or excellent pain management in the post operative period. Conclusions. Continuous popliteal sciatic nerve blockade is a safe and effective method for controlling post-operative pain, reducing opiate-induced side effects, and optimising length of stay. Patient-reported outcomes support its use in major ankle and hindfoot surgery. Furthermore, reduced costs from early discharge in combination with a daycase tariff uplift can bring significant financial savings

Introduction: Sciatic nerve blocks have been used to reduce post-operative analgesia and allow early discharge for patients undergoing foot and ankle surgery. This study aims to identify utilisation of this procedure and to ascertain if there is a consensus amongst surgeons as to best practise with regards to who performs the block and how it is performed. Method: We surveyed current committee members of the American and members of the British orthopaedic foot and ankle surgery societies (AOFAS and BOFAS). Results: More than half of those who responded perform over 90% foot and ankle surgery. 77% performed sciatic nerve blockade through the popliteal approach (26% used the subgluteal approach). The most common position was supine with 80% being performed by the anaesthetist. 45% never used ultrasonography to detect the position of the nerve and variable levels of nerve stimulation were used. 30% used an infusion catheter with 20% allowing discharge to home with the catheter. 42% of surgeons where happy to have the block performed under full anaesthesia. The commonest complication cited was prolonged anaesthesia, the majority of which resolved. Performing the block awake or sedated did not seem to alter the number of complications seen. Discussion: This study represents a current practice review of sciatic nerve blocks performed in foot and ankle surgery and shows a variety of techniques used. Although this is now a widely used block, no consensus has been reached as to the use of ultrasound, level of nerve stimulation or whether the patient needs to be awake for the procedure. The use of infusion catheters (especially after discharge) has not been widely utilised, especially amongst UK surgeons

Purpose: Nerve re-generation and functional recovery are often incomplete after a peripheral nerve lesion. The aim of this study was to determine if the injection of chondrotinase ABC at the lesion site, one hour of electrical stimulation, and the combination of these treatments at the time of repair are effective in promoting nerve regeneration and muscle re-innervation. Method: A complete right sciatic nerve section was done on 32 female Sprague-Dawley rats. End-to-end microsuture repair was performed and fibrin glue was added. Five groups were studied:. Sutures and Fibrine glue (S+F),. S+F and chondrotinase ABC,. S+F and electrical stimulation,. S+F and chondrotinase and electrical stimulation,. uninjured nerve. Video kynematic, EMG, muscle strengh and axonal count were used to asses nerve recovery at 150 days post-repair. Results: Side video kinematics was performed and a larger excursion of the hip-ankle-toe angle during walking was showed in groups 2, 3, and 4. (p< 0.05) At 150 days, in-vivo EMg activity and maximal muscle force were similar in group 2, 3, 4, 5 and all of them were higher compared to group 1 (p< 0.05). Histological study revealed equivalent number of axone in all group and pore correlation with nerve function. Conclusion: In conclusion, five months after nerve transection, the recovery is incomplete when using suture and fibrine glue only. Moreover, an injection of chondrotinase ABC at the lesion site and/or one hour of electrical stimulation of the proximal nerve stump is beneficial in promoting nerve regeneration and functional muscle re-innervation

Aims. Avulsion of the proximal hamstring tendon origin can result in significant functional impairment, with surgical re-attachment of the tendons becoming an increasingly recognized treatment. The aim of this study was to assess the outcomes of surgical management of proximal hamstring tendon avulsions, and to compare the results between acute and chronic repairs, as well as between partial and complete injuries. Methods. PubMed, CINAHL, SPORTdiscuss, Cochrane Library, EMBASE, and Web of Science were searched. Studies were screened and quality assessed. Results. In all, 35 studies (1,530 surgically-repaired hamstrings) were included. Mean age at time of repair was 44.7 years (12 to 78). A total of 846 tears were acute, and 684 were chronic, with 520 tears being defined as partial, and 916 as complete. Overall, 92.6% of patients were satisfied with the outcome of their surgery. Mean Lower Extremity Functional Score was 74.7, and was significantly higher in the partial injury group. Mean postoperative hamstring strength was 87.0% of the uninjured limb, and was higher in the partial group. The return to sport (RTS) rate was 84.5%, averaging at a return of 6.5 months. RTS was quicker in the acute group. Re-rupture rate was 1.2% overall, and was lower in the acute group. Sciatic nerve dysfunction rate was 3.5% overall, and lower in the acute group (p < 0.05 in all cases). Conclusion. Surgical treatment results in high satisfaction rates, with good functional outcomes, restoration of muscle strength, and RTS. Partial injuries could expect a higher functional outcome and muscle strength return. Acute repairs result in a quicker RTS with a reduced rate of re-rupture and sciatic nerve dysfunction. Cite this article: Bone Jt Open 2022;3(5):415–422

Total hip arthroplasty (THA) for congenital hip dysplasia (CDH) presents a challenge. In high-grade CDH, key surgical targets include cup placement in the anatomical position and leg length equality. Lengthening of more than 4 cm is associated with sciatic nerve injury, therefore shortening osteotomies are necessary. We present our experience of different shortening osteotomies including advantages and disadvantages of each technique. 89 hips, in 61 pts (28 bilateral cases), for high CDH were performed by a single surgeon from 1997 to 2022. 67 patients were female and 22 were male. Age ranged from 38 to 68 yrs. In all patients 5–8cm of leg length discrepancy (LLD) was present, requiring shortening femoral osteotomy. 12 patients underwent sequential proximal femoral resection with trochanteric osteotomy, 46 subtrochanteric, 6 midshaft, and 25 distal femoral osteotomies with simultaneous valgus correction were performed. All acetabular prostheses were placed in the true anatomical position. We used uncemented high porosity cups. Patients were followed up for a minimum of 12 months. All osteotomies healed uneventfully except 3 non-unions of the greater trochanter in the proximal femur resection group. No femoral shaft fractures in proximally based osteotomies. No significant LLD compared to the unaffected or reconstructed side. 2 patients suffered 3 and 5 degrees malrotation of the femur in the oblique sub-trochanteric group. 3 patients suffered transient sciatic nerve palsies. Shortening femoral osteotomies in the treatment of DDH are necessary to avoid injury to the sciatic nerve. In our series, we found transverse subtrochanteric osteotomies to be the most technically efficient, versatile and predictable in their clinical outcome, due to the ability to correct rotation and preserve the metaphyseal bone integrity, allowing for better initial stem stability. Distal femoral osteotomies allowed for controllable correction of valgus knee deformity

The effects of Hypericum perforatum on nerve regeneration after sciatic nerve injury have not yet been evaluated in all its aspects yet. In this experimental study, the effect of Hypericum perforatum on injured nerve tissue was histologically and biochemically investigated. Motor functional healing was surveyed by gait analysis. Rats were divided into 3 groups: Group I (n=8) was intact control group and no intervention and treatment was applied to this group. Group II (n=16) was surgical control group and Group III (n=16) was Hypericum perforatum group. After the operation, while any treatment was performed on Group II, 30 mg/kg dose Hypericum perforatum extract was intraperitoneally administered to the Group III per day for 8 weeks from the 1. st. day of post-op. Gait analysis was made to all rats for functional evaluation at 2. nd. , 3. rd. , 4. th. , 6. th. and 8. th. weeks, and sciatic functional index (SFI) was evaluated. At the end of the eighth week, sciatic nerve tissue samples were taken from the sacrificed rats. Tissues were examined biochemically, histologically and immnohistochemically. Malondialdehyde (MDA) as an indicator of oxidative stress and main antioxidant enzyme [superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT)] levels were biochemically measured. The nerve degeneration and regeneration were histologically viewed, and also cell count was immnohistochemically done by having done anti-S100 staining. It was seen that measurement results of SFI were statistically significantly difference between groups (p<0,001). In the sciatic nerve tissue samples taken from the rats, it was not determined a statistically significant difference between MDA, SOD, GPx and CAT levels detected by ELISA method (p>0,05). In the histological evaluation, it was seen that Hypericum perforatum affected positively the regeneration and immunohistochemically, it was found a statistically significant difference between the anti-S-100 positive cell numbers. The obtained results in this study show that; Hypericum perforatum, which was intraperitoneally administered on rats subjected to nerve injury, has affected positively the nerve regeneration and it can also provide an insight to future studies

Aims. The aim of this study was to assess the clinical and radiological results of patients who were revised using a custom-made triflange acetabular component (CTAC) for component loosening and pelvic discontinuity (PD) after previous total hip arthroplasty (THA). Methods. Data were extracted from a single centre prospective database of patients with PD who were treated with a CTAC. Patients were included if they had a follow-up of two years. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance and clinical relevance. Results. A total of 18 females with 22 CTACs who had a mean age of 73.5 years (SD 7.7) were included. A significant improvement was found in HOOS (p < 0.0001), mOHS (p < 0.0001), EQ-5D-3L utility (p = 0.003), EQ-5D-3L NRS (p = 0.013), VAS pain rest (p = 0.008), and VAS pain activity (p < 0.0001) between baseline and final follow-up. Minimal clinically important improvement in mOHS and the HOOS Physical Function Short Form (HOOS-PS) was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. Conclusion. CTAC in patients with THA acetabular loosening and PD can result in stable constructs and significant improvement in functioning and health-related quality of life at two years' follow-up. Further follow-up is necessary to determine the mid- to long-term outcome. Cite this article: Bone Jt Open 2023;4(2):53–61

Sciatic Nerve Palsy (SNP) is a recognised complication in Primary Total Hip Replacement after a transtrochanteric or a posterior approach (5). It is considered to be caused by direct trauma to the nerve during surgery. In our unit this complication was rare with an incidence of < 0.2% over the past ten years. However we know describe six cases of sciatic nerve palsy occurring in 355 consecutive primary THRs (incidence 1.60%) performed in our unit from June 2000 to June 2001. Each of these sciatic nerve palsies we believe was due to postoperative haematoma in the region of the sciatic nerve. To our knowledge there are only five reported cases in the literature of sciatic nerve palsy secondary to postoperative haematoma (1). (Each of the six patients who developed SNP was receiving prophylactic anticoagulation). Cases recognized early and drained promptly showed earlier and more complete recovery. Those in whom diagnosis was delayed and were therefore managed expectantly showed no or poor recovery. More than usual pain the buttock, significant swelling in the buttock region and sciatic nerve tenderness associated with signs of sciatic nerve irritation may suggest the presence of haematoma in the region of the sciatic nerve. It is therefore of prime importance to be vigilant for the signs and symptoms of sciatic nerve palsy in the early post operative period because if recognized and treated early the potential injury to the sciatic nerve may be reversible

Nerve transfer is an emerging treatment to restore upper limb function in people with tetraplegia. The objective of this study is to examine if a flexible collage sheet (FCS) can act as epineurial-like substitute to promote nerve repair in nerve transfer. A preclinical study using FCS was conducted in a rat model of sciatic nerve transection. A prospective case series study of nerve transfer was conducted in patients with C5-C8 tetraplegia who received nerve transfer to restore upper limb function. Motor function in the upper limb was assessed pre-treatment, and at 6-,12-, and 24-months post-treatment. Macroscopic assessment in preclinical model showed nerve healing by FCS without encapsulation or adhesions. Microscopic examination revealed that a new, vascularised epineurium-like layer was observed at the FCS treatment sites, with no evidence of inflammatory reaction or nerve compression. Treatment with FCS resulted in well-organised nerve fibres with dense neurofilaments distal to the coaptation site. Axon counts performed proximal and distal to the coaptation site showed that 97% of proximal axon count of myelinated axons regenerated across the coaptation site after treatment with CND. In the proof of concept clinical study 17 nerve transfers were performed in five patients. Nerve transfers included procedures to restore triceps function (N=4), wrist/finger/thumb extension (N=6) and finger flexion (N=7). Functional motor recovery (MRC ≥3) was achieved in 76% and 88% of transfers at 12 and 24 months, respectively. The preclinical study showed that FCS mimics epineurium and enable to repair nerve resembled to normal nerve tissue. Clinical study showed that patients received nerve transfer with FCS experienced consistent and early return of motor function in target muscles. These results provide proof of concept evidence that CND functions as an epineurial substitute and is promising for use in nerve transfer surgery