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Tomakulöse Neuropathie (HNPP) als Ursache einer verzögerten Parese des N. femoralis nach Hüfttotalendoprothesenimplantation

Delayed paresis of the femoral nerve after total hip arthroplasty associated with hereditary neuropathy with liability to pressure palsies (HNPP)

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Zusammenfassung

Verzögerte Läsionen des N. femoralis oder N. ischiadicus im Zusammenhang mit Totalendoprothesenimplantationen des Hüftgelenks stellen eine Rarität dar. Derartige Läsionen wurden in Zusammenhang mit Zementkanten, Narbenbildungen, Wanderung gebrochener Drahtzerklagen, subfaszialen Hämatomen oder Stützringosteosynthese beschrieben.

Wir berichten über eine verzögerte Parse des N. femoralis 2 Wochen nach Totalendoprothesenimplantation des Hüftgelenks bei einer 62-jährigen Patientin.

Die Patientin bot das Bild einer kompletten Parese des N. femoralis, ohne sensorische Defizite. Nach elektrophysiologischer Untersuchung erfolgte die Revision des N.  femoralis. Intraoperativ stellte sich der N. femoralis im gesamten Verlauf unauffällig dar. Eine weitere Woche später bot die Patientin, nachdem sie Achselkrücken benutzt hatte, eine Parese der Hand und Fingerstrecker links. Eine erneut durchgeführte fachneurologische Abklärung führte zur Diagnose einer „tomakulösen Neuropathie“.

Die tomakulöse Neuropathie („hereditary neuropathy with liability to pressure palsies“, HNPP) ist eine genetisch bedingte Myelinisierungsstörung des peripheren Nervensystems mit erhöhter Vulnerabilität auf Druck und in physiologischen Engpässen. Klinisch finden sich reversible sensomotorische Ausfälle typischer Lokalisation. Dieses Krankheitsbild sollte bei den differenzialdiagnostischen Überlegungen, insbesondere beim zeitlich versetzten Auftreten mehrer Engpasssyndrome in Betracht gezogen werden. Selten kann diese Erkrankung auch zu postoperativen Paresen, z. B. nach Hüfttotalendoprothesenimplantationen führen.

Abstract

Delayed lesions of the femoral or sciatic nerve are a rare complication after total hip arthroplasty. Several cases in association with cement edges, scar tissue, broken cerclages, deep hematoma, or reinforcement rings have been published.

We report about a 62-year-old female who developed a pure motor paresis of the quadriceps muscle 2 weeks after total hip arthroplasty. After electrophysiological evaluation had revealed an isolated femoral nerve lesion, revision of the femoral nerve was performed. During operative revision no pathologic findings could be seen. One week later the patient developed paralysis of the left wrist and finger extensors after using crutches. Electrophysiological evaluation revealed several nerve conduction blocks in physiological entrapments and the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) was established.

Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare disease with increased vulnerability of the peripheral nerve system with mostly reversible sensorimotor deficits. It should be taken into consideration in cases of atypical findings of compression syndromes of peripheral nerves or delayed neuropathy, e. g., after total hip arthroplasty.

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Literatur

  1. Amato AA, Gronseth GS, Callerame KJ et al. (1996 ) Tomaculous neuropathy: a clinical and electrophysiological study in patients with and without 1.5-Mb deletions in chromosome 17p11.2. Muscle Nerve 19: 16–22

    Article  CAS  PubMed  Google Scholar 

  2. Asnis SE, Hanley S, Shelton PD (1985) Sciatic neuropathy secondary to migration of trochanteric wire following total hip arthroplasty. Clin Orthop 196: 226–228

    PubMed  Google Scholar 

  3. Bell KM, Chalmers J (1991) Recurrent common peroneal palsy in association with the Ehlers-Danlos syndrome. A case report. Acta Orthop Scand 62: 612–613

    CAS  PubMed  Google Scholar 

  4. Casagrande PA, Danahy PR (1971) Delayed sciatic-nerve entrapment following the use of self-curing acrylic. A case report. J Bone Joint Surg Am 53: 167–169

    CAS  PubMed  Google Scholar 

  5. Chance PF (1999) Overview of hereditary neuropathy with liability to pressure palsies. Ann N Y Acad Sci 883: 14–21

    CAS  PubMed  Google Scholar 

  6. Chattopadhyay AK, Kandler RH, Sharrack B (1995) The association of hereditary neuropathies and heritable skeletal disorders. Postgrad Med J 834: 245–246

    Google Scholar 

  7. Cohen B, Bhamra M, Ferris BD (1991) Delayed sciatic nerve palsy following total hip arthroplasty. Br J Clin Pract 45: 292–293

    CAS  PubMed  Google Scholar 

  8. De Hart MM, Riley LH Jr (1999) Nerve injuries in total hip arthroplasty. J Am Acad Orthop Surg 7: 101–111

    PubMed  Google Scholar 

  9. Del Colle R, Fabrizi GM, Turazzini M et al. (2003) Hereditary neuropathy with liability to pressure palsies: electrophysiological and genetic study of a family with carpal tunnel syndrome as only clinical manifestation. Neurol Sci 24: 57–60

    PubMed  Google Scholar 

  10. Edwards MS, Barbaro NM, Asher SW, Murray WR (1981) Delayed sciatic palsy after total hip replacement: case report. Neurosurgery 9: 61–63

    CAS  PubMed  Google Scholar 

  11. Fischer SR, Christ DJ, Roehr BA (1999) Sciatic neuropathy secondary to total hip arthroplasty wear debris. J Arthroplasty 14: 771–774

    CAS  PubMed  Google Scholar 

  12. Infante J, Garcia A, Combarros O et al. (2001) Diagnostic strategy for familial and sporadic cases of neuropathy associated with 17p11.2 deletion. Muscle Nerve. 24: 1149–1155

  13. Katsimihas M, Hutchinson J, Heath P, Smith E, Travlos J (2002) Delayed transient sciatic nerve palsy after total hip arthroplasty. J Arthroplasty 17: 379–381

    Article  CAS  PubMed  Google Scholar 

  14. Lane JE, Foulkes GD, Hope TD, Mayorov VI, Adkison L (2001) Hereditary neuropathy with liability to pressure palsies mimicking multifocal compression neuropathy. J Hand Surg Am 26: 670–974

    CAS  PubMed  Google Scholar 

  15. Liehr T, Grehl H, Rautenstrauss B (1997) Molecular diagnosis of PMP22-associated neuropathies using fluorescence in situ hybridization (FISH) on archival peripheral nerve tissue preparations. Acta Neuropathol (Berl) 94: 266–271

    Google Scholar 

  16. Mariman EC, Gabreels-Festen AA, van Beersum SE et al. (1994) Prevalence of the 1,5-Mb 17p deletion in families with hereditary neuropathy with liability to pressure palsies. Ann Neurol 36: 650–655

    CAS  PubMed  Google Scholar 

  17. Nelis E, Van Broeckhoven C, De Jonghe P et al. (1996) Estimation of the mutation frequencies in Charcot-Marie-Tooth disease type 1 and hereditary neuropathy with pressure palsies: a European collaborative study. Eur J Hum Genet 4: 25–33

    Google Scholar 

  18. Oleksak M, Edge AJ (1992) Compression of the sciatic nerve by methylmethacrylate cement after total hip replacement. J Bone Joint Surg Br 74: 729–730

    CAS  PubMed  Google Scholar 

  19. Schmalzried TP, Noordin S, Amstutz HC (1997) Update on nerve palsy associated with total hip replacement. Clin Orthop 344: 188–206

    Article  PubMed  Google Scholar 

  20. Schuh A, Riedel F, Craiovan B, Zeiler G (2003) Verzögerte Läsion des N. ischiadicus nach Totalendoprothesenimplantation des Hüftgelenks mit Stützringosteosynthese. Zentralbl Chir 128: 871–873

    Article  CAS  PubMed  Google Scholar 

  21. Sorensen JV, Christensen KS (1992) Wound hematoma induced sciatic nerve palsy after total hip arthroplasty. J Arthroplasty 7: 551

    CAS  PubMed  Google Scholar 

  22. Taggart TF, Allen TR (2001) Surgical treatment of a tomaculous neuropathy. J R Coll Surg Edinb 46: 240–241

    Google Scholar 

  23. Tinant F, Zeevaert B, Benkirane H, Laurent L, Wang F (2002) Hereditary neuropathy with pressure hypersensitivity or tomaculous neuropathy. Rev Med Liege 57: 651–654

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopädische Klinik Rummelsberg, Schwarzenbruck.

    A. Schuh, V. Dürr & G. Zeiler

  2. Neurologische Klinik Rummelsberg, Schwarzenbruck

    H. Weier & M. Winterholler

  3. Orthopädische Klinik Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck

    A. Schuh

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  1. A. Schuh
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  2. V. Dürr
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  3. H. Weier
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  4. G. Zeiler
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  5. M. Winterholler
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Correspondence to A. Schuh.

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Schuh, A., Dürr, V., Weier, H. et al. Tomakulöse Neuropathie (HNPP) als Ursache einer verzögerten Parese des N. femoralis nach Hüfttotalendoprothesenimplantation. Orthopäde 33, 836–840 (2004). https://doi.org/10.1007/s00132-004-0652-1

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