Total Hip Replacement Results in Sciatic Nerve Injury and Foot Drop

This case involves a patient who was admitted to the hospital for an elective total left hip replacement. After surgery, the patient complained of an inability to flex or extend their left ankle. The impression in the medical note was that there was a postoperative foot drop associated with numbness on the dorsal aspect of the foot. A neurology consult and further imaging studies were ordered to evaluate the possibility of any nerve damage from the surgery. An electromyography (EMG) showed a left sciatic mononeuropathy with the lesion predominantly affecting the peroneal fibers. Additionally, an MRI showed that there was a large neuroma formation of the sciatic nerve at the level of the femoral neck with surrounding scar encasement. The plaintiff claims that the surgeon lacerated this nerve, after the plaintiff consulted other surgeons who attribute the neuroma formation to a damaged nerve.

Question(s) For Expert Witness

Is this a recognized complication given the anterior approach, and does the presence of a neuroma formation suggest that a laceration to the nerve occurred during this procedure?

Expert Witness Response E-000626

I teach the anterior approach as one of several approaches to the hip joint for THR. Injury to the sciatic nerve can be a result of excessive traction and/or pressure in attempting to gain sufficient exposure of the joint during a THR. It should not happen and usually is avoided with meticulous dissection. A nueroma takes time to develop after a laceration of a nerve. Overzealous release of posterior structures from an anterior approach could conceivably have occurred, and if this was the case, the surgery was poorly performed.