Sciatic Nerve Entanglement Around a Femoral Prosthesis During Closed Reduction of a Dislocated Total Hip Prosthesis: The Role of Metal-Suppression MRI

Case: A 68-year-old woman who had undergone a right total hip arthroplasty presented with a right posterior hip dislocation, and subsequently developed an ipsilateral sciatic nerve palsy after closed reduction. Magnetic resonance imaging (MRI) with metal suppression demonstrated sciatic nerve entanglement around the prosthetic femoral neck. A sciatic nerve release was performed, resulting in poor early neurologic recovery. Conclusion: Sciatic nerve entanglement following closed reduction of a dislocated total hip prosthesis is a rare injury. Assessment of neurovascular status before and after reduction is imperative. We recommend prompt MRI with metal suppression in patients with acute neurologic symptoms following reduction of a dislocated hip prosthesis to evaluate for acute nerve pathology and assess the need for emergency surgery.