Article

Painful total hip replacement remains a challenging problem because of the large
amount of possible diagnoses. We report about a 64-year-old female patient who
was misdiagnosed during 4 years as psychiatric. She suffered of excruciating left
retrotrochanteric pain after the implantation of a cementless total hip replacement and revision because of recurrent hip dislocations. Walking was
limited to short distances using two crutches. The work-up at this time included
the usual diagnoses and remained unsuccessful. No loosening, infection or
malposition of the prosthesis could be found, and she had no neurologic deficits
in her operated leg. An MRI was obtained to visualize the retrotrochanteric soft
tissues and showed a tight scar surrounding the sciatic nerve, which was also
compressed by an adjacent lipoma. Therefore, she was reoperated on to remove the
lipoma and the scar tissue around the sciatic nerve. To decrease the risk of
recurrent scarring around the sciatic nerve, an adhesion barrier was applied
before closure. One year after the operation, the patient has no neurologic
deficit, no more pain and is able to walk unlimited distances without crutches.
Scar tissue around the sciatic nerve is frequently observed during revision
surgery. However, we feel that sciatic nerve entrapment by scar tissue should be
a part of the differential diagnosis of painful THR. MRI may be a useful tool to
achieve this diagnosis.

Langue : ANGLAIS