Distal femoral shortening osteotomy for treatment of sciatic nerve palsy after total hip arthroplasty — a report of 3 cases

Total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with associated femoral head dislocation is a challenging procedure, with a high complication rate. These include dislocation, nonunion or malunion of osteotomies, infection, implant loosening, and sciatic nerve injury (Rogers et al. 2012, Sonohata et al. 2016). In severe DDH cases, overlengthening of the lower limb may cause sciatic nerve injury, a devastating complication (De Fine et al. 2017). Secondary neurologic pain and associated muscle weakness may overshadow otherwise excellent arthroplasty reconstruction and lead to patient dissatisfaction. In order to avoid this complication, it has been suggested that a proximal or subtrochanteric femoral osteotomy be performed when lengthening exceeds 4 cm (Cameron et al. 1998). Other authors have suggested intraoperative monitoring to assess nerve function as a decision tool to determine the maximal or appropriate limb lengthening (Paavilainen 1997). When a sciatic nerve injury is identified postoperatively, there is debate over what is the optimal treatment.

In 3 THA cases for DDH (2 patients), we describe an effective surgical technique for treating associated sciatic nerve injuries secondary to excessive nerve tension. A late shortening distal femoral osteotomy was performed as treatment for 2 hips and as a prophylactic procedure for the third case.