1. The results of repair of the
We report a case of iatrogenic
Injuries to the
Traction injury to the
Injury to the
1. We have described what happens to patients a number of years after injury of the
We present the case of a 63-year-old woman who sustained an acrylic cement burn of the
Pain in the distribution of the
Experiments have shown that the tension of the
We describe a patient in whom an initially intact
Severe leg pain in a patient after total hip replacement was found to be caused by compression of the
An orientated substratum has been implicated in the development and regeneration of axons and synapses. We prepared a basement membrane matrix from autogenous striated muscle, used it to repair the
1. The risk of injury to the
The aim of this cadaver study was to identify
the change in position of the
1. A case of complete sciatic palsy complicating anticoagulant therapy is presented. 2. A brief review of the possible pathogenesis is made and the importance of early recognition and treatment of the syndrome is emphasised.
Peripheral nerve injury is an uncommon but serious
complication of hip surgery that can adversely affect the outcome.
Several studies have described the use of electromyography and intra-operative
sensory evoked potentials for early warning of nerve injury. We
assessed the results of multimodal intra-operative monitoring during
complex hip surgery. We retrospectively analysed data collected
between 2001 and 2010 from 69 patients who underwent complex hip
surgery by a single surgeon using multimodal intra-operative monitoring
from a total pool of 7894 patients who underwent hip surgery during
this period. In 24 (35%) procedures the surgeon was alerted to a
possible lesion to the sciatic and/or femoral nerve. Alerts were
observed most frequently during peri-acetabular osteotomy. The surgeon
adapted his approach based on interpretation of the neurophysiological changes.
From 69 monitored surgical procedures, there was only one true positive
case of post-operative nerve injury. There were no false positives
or false negatives, and the remaining 68 cases were all true negative.
The sensitivity for predicting post-operative nerve injury was 100%
and the specificity 100%. We conclude that it is possible and appropriate
to use this method during complex hip surgery and it is effective
for alerting the surgeon to the possibility of nerve injury.
Sciatic nerve palsy is a recognised complication of primary total hip replacement. In our unit this complication was rare with an incidence of <
0.2% in the past ten years. We describe six cases of sciatic nerve palsy occurring in 355 consecutive primary total hip replacements (incidence 1.69%). Each of these palsies was caused by post-operative haematoma in the region of the
Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the