A Little too Close to the Bone? Risk of Sciatic Nerve Injury during Hip Arthroplasty

Sciatic nerve palsy is an uncommon but potentially disabling complication of total hip arthroplasty and may be a cause for litigation. At operation, the location of the nerve appears to be extremely variable. In this study, the position of the sciatic nerve in relation to the femoral head, the greater trochanter and the ischial tuberosity was measured in thirty-nine cadavers. The distance between the nerve and the femoral head varied from 15 to 32 mm (mean 23 mm). This distance was unrelated to patient size or sex. Its position between the ischial tuberosity and the greater trochanter was also variable. In view of its variable and unpredictable position, it is recommended that the sciatic nerve is identified in all hip arthroplasties when a posterior approach is used.