Skip to main content
SpringerLink
Log in

Beinparese nach Hüftendoprothesenimplantation

Eine seltene Differenzialdiagnose

Lower limb paresis after total hip arthroplasty

A rare differential diagnosis

  • Originalien
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Wir berichten über eine komplexe Nervenschädigung im Rahmen einer Revisionshüftendoprothetik. Klinisch imponierte eine proximale Beinparese mit diffusen Sensibilitätsstörungen. Kausal fand sich ein ausgeprägtes M.-iliopsoas-Hämatom, das sich während der postoperativen Rehabilitation unter therapeutischer Antikoagulation bei Vorhofflimmern entwickelte. Iliopsoashämatome mit konsekutiven neurologischen Defiziten im Umfeld der Hüftendoprothetik sind rare Ereignisse, eine Literaturübersicht wird angeboten. Die Therapie der retroperitonealen Einblutung wird kontrovers diskutiert, überwiegend wird ein konservatives Vorgehen favorisiert. Die Prognose der neurologischen Schäden ist ernüchternd, bei lediglich 20 % der Geschädigten ist eine vollständige Restitution zu erwarten.

Abstract

We report on a case of complex nerve damage during total hip arthroplasty. The most severe clinical symptom was proximal leg paresis with diffuse sensory loss. There was an extensive causal Iliopsoas hematoma which developed during the postoperative rehabilitation under therapeutic anticoagulation for atrial fibrillation. An iliopsoas hematoma with subsequent neurological deficits are rare events in the field of hip arthroplasty and a literature review is provided. The treatment of retroperitoneal hemorrhage is controversial but in most instances a conservative approach is favored. The prognosis of neurological damage is sobering as only 20 % of victims are expected to achieve complete restitution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Goetz M, Seybold D, Gossé F et al (2010) Das Risiko der Nervenläsion in der Hüftendoprothetik. Z Orthop Unfall 148(2):163–167

    Article  PubMed  Google Scholar 

  2. Kirschner S, Goronzy J, Storch A et al (2011) Vermeidung, Diagnostik und Therapie von Nervenläsionen nach Hüftendoprothesenimplantation. Orthopade 40(6):491–499

    Article  PubMed  CAS  Google Scholar 

  3. Barrack RL (2004) Neurovascular injury: avoiding catastrophe. J Arthroplasty 19(4 Suppl 1):104–107

    Article  PubMed  Google Scholar 

  4. Lee MC, Nickisch F, Limbird RS (2006) Massive retroperitoneal hematoma during enoxaparin treatment of pulmonary embolism after primary total hip arthroplasty: case reports and review of the literature. J Arthroplasty 21(8):1209–1214

    Article  PubMed  Google Scholar 

  5. Witt DM (2012) Rivaroxaban and usual care had similar rates of recurrent VTE and bleeding in symptomatic PE. Ann Intern Med 157(4):JC2–JC6

    Article  PubMed  Google Scholar 

  6. Gómez-Outes A, Terleira-Fernández AI, Suárez-Gea ML, Vargas-Castrillón E (2012) Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment comparisons. BMJ 344:e3675

    Article  PubMed  Google Scholar 

  7. Fortina M, Carta S, Del Vecchio EO et al (2007) Retroperitoneal hematoma due to spontaneous lumbar artery rupture during fondaparinux treatment. Case report and review of the literature. Acta Biomed 78(1):46–50

    PubMed  CAS  Google Scholar 

  8. Vayá A, Mira Y, Aznar J et al (2003) Enoxaparin-related fatal spontaneous retroperitoneal hematoma in the elderly. Thromb Res 110(1):69–71

    Article  PubMed  Google Scholar 

  9. Sunga KL, Bellolio MF, Gilmore RM, Cabrera D (2012) Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med 43(2):e157–e161

    Article  PubMed  Google Scholar 

  10. Daliakopoulos SI, Bairaktaris A, Papadimitriou D, Pappas P (2008) Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report. J Med Case Rep 2:162

    Article  PubMed  Google Scholar 

  11. Andres RH (o J) Infiziertes retroperitoneales Hämatom als ungewöhnliche Ursache eines Fallfusses. Schweiz Arch Neurol Psychiatr 155:60

  12. Besir FH, Gul M, Ornek T et al (2011) Enoxaparin-associated giant retroperitoneal hematoma in pulmonary embolism treatment. N Am J Med Sci 3(11):524–526

    Article  PubMed  Google Scholar 

  13. Aveline C, Bonnet F (2004) Delayed retroperitoneal haematoma after failed lumbar plexus block. Br J Anaesth 93(4):589–591

    Article  PubMed  CAS  Google Scholar 

  14. Brien WW, Sarmiento A (1992) Vascular injury during cementless total hip arthroplasty. Orthopedics 15(1):54–56

    PubMed  CAS  Google Scholar 

  15. Hwang SK (1994) Vascular injury during total hip arthroplasty: the anatomy of the acetabulum. Int Orthop 18(1):29–31

    Article  PubMed  CAS  Google Scholar 

  16. Parvizi J, Tarity TD, Herz A et al (2006) Ninety-day mortality after bilateral hip arthroplasty. J Arthroplasty 21(7):931–934

    Article  PubMed  Google Scholar 

  17. Pouliot MA, Lee KB, Goodman SB (2009) Retroperitoneal hematoma: an unusual cause of pain after total hip arthroplasty. J Arthroplasty 24(7):1144.e9–1144.e12

    Article  PubMed  Google Scholar 

  18. Braun KF, Siebenlist S, Sandmann G et al (2012) Rezidivierende Iliopsoaseinblutungen als Differenzialdiagnose bei chronischen Leistenschmerzen nach Hüfttotalendoprothesenimplantation: Eine Fallserie. Orthopade 41(3):212–216

    Article  PubMed  CAS  Google Scholar 

  19. Bartelt RB, Sierra RJ (2011) Recurrent hematomas within the iliopsoas muscle caused by impingement after total hip arthroplasty. J Arthroplasty 26(4):665.e1–665.e5

    Article  PubMed  Google Scholar 

  20. Nakamura Y, Mitsui H, Toh S, Hayashi Y (2008) Femoral nerve palsy associated with iliacus hematoma following pseudoaneurysm after revision hip arthroplasty. J Arthroplasty 23(8):1240.e1–1240.e4

    Article  PubMed  Google Scholar 

  21. Sáenz-Martínez J, Ibáñez R, Unceta-Barrenechea B, Aizpurua MJ (1992) Shock hemorrágico por rotura de vena ilíaca. Una complicación muy rara en las artroplastias de cadera. Rev Esp Anestesiol Reanim 39(1):49–51

    PubMed  Google Scholar 

  22. Gogus A, Ozturk C, Sirvanci M et al (2008) Femoral nerve palsy due to iliacus hematoma occurred after primary total hip arthroplasty. Arch Orthop Trauma Surg 128(7):657–660

    Article  PubMed  Google Scholar 

  23. Ha YC, Ahn IO, Jeong ST et al (2001) Iliacus hematoma and femoral nerve palsy after revision hip arthroplasty: a case report. Clin Orthop Relat Res 385:100–103

    Article  PubMed  Google Scholar 

  24. Wooten SL, McLaughlin RE (1984) Iliacus hematoma and subsequent femoral nerve palsy after penetration of the medical acetabular wall during total hip arthroplasty. Report of a case. Clin Orthop Relat Res 191:221–223

    PubMed  Google Scholar 

  25. Won D, Kim S, Park S et al (2011) Abdominal compartment syndrome due to spontaneous retroperitoneal hemorrhage in a patient undergoing anticoagulation. Yonsei Med J 52(2):358–361

    Article  PubMed  Google Scholar 

  26. Parmer SS, Carpenter JP, Fairman RM et al (2006) Femoral neuropathy following retroperitoneal hemorrhage: case series and review of the literature. Ann Vasc Surg 20(4):536–540

    Article  PubMed  Google Scholar 

  27. Holzapfel BM, Heinen F, Holzapfel DE et al (2012) Nervenläsionen nach minimal-invasiver Hüftendoprothetik. Orthopade 41(5):354–364

    Article  PubMed  CAS  Google Scholar 

  28. Fox AJS, Bedi A, Wanivenhaus F et al (2012) Femoral neuropathy following total hip arthroplasty: review and management guidelines. Acta Orthop Belg 78(2):145–151

    PubMed  Google Scholar 

  29. Uskova AA, Plakseychuk A, Chelly JE (2010) The role of surgery in postoperative nerve injuries following total hip replacement. J Clin Anesth 22(4):285–293

    Article  PubMed  Google Scholar 

Download references

Danksagung

Der Dank gilt allen Kollegen der Orthopädischen Klinik Schwerin, die bei der Behandlung der Patienten mitgewirkt haben, sowie der neurologischen Kollegin Frau Steffi Reimann für die neurologische Diagnostik.

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Lachmann gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Orthopädische Klinik, HELIOS-Kliniken Schwerin, Wismarsche Str. 393–397, 19049, Schwerin, Deutschland

    M. Lachmann

Authors
  1. M. Lachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Lachmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lachmann, M. Beinparese nach Hüftendoprothesenimplantation. Orthopäde 42, 874–878 (2013). https://doi.org/10.1007/s00132-013-2172-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-013-2172-3

Schlüsselwörter

Keywords

Search

Navigation