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Tuesday, November 27, 2012
Delayed sciatic nerve palsy following resurfacing hip arthroplasty caused by metal debris.
BMJ Case Rep. 2012 Nov 14;2012. pii: bcr2012006856. doi: 10.1136/bcr-2012-006856.
Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK.
The rapid rise in the incidence of failed metal-on-metalhip articulations in recent years has led to many patients requiring complex revision surgery. These failed metal prostheses may produce local metallic debris, which promotes both local and systemic adverse effects. We report an unusual case of failed metal-on-metal resurfacing hiparthroplasty presenting with ipsilateral buttock pain and foot drop 6 months after surgery. After thorough investigations, the metal-on-metal bearing was revised to a metal-on-polyethylene total hip replacement. This resulted in marked improvement in the systemic symptoms, inflammatory marke and metal ion levels postoperatively. However, neither clinical nor neurophysiological sciatic nerve recovery followed. The patient eventually required tendon transfer surgery for her persistent foot drop.