Comparative analysis of surgical techniques used to repair a closed sciatic nerve injury in patients undergoing total hip replacement

Abstract

Introduction A variety of surgical techniques used to treat a closed sciatic nerve injury after total hip replacement (THR) require careful evaluation and comparison of short- and long-term outcomes of the complex management emphasizing a paucity of publications on the subject and a high social and economic role of the issue. The aim of the study was to compare outcomes of various surgical techniques used to treat closed sciatic nerve injuries after THR. Material and methods A total of 94 patients with closed sciatic nerves injuries associated with THR were divided into three groups. Microsurgical neurolysis of the sciatic nerve was produced for patients of Group I; patients of group II underwent microsurgical neurolysis of the sciatic nerve and electrical nerve stimulation; patients of group III had microsurgical neurolysis and electrical stimulation of the sciatic nerve with multichannel electrodes and segmental apparatus of the spinal cord at the conus and epiconus level. Clinical and neurological tests, dynamic electrophysiological monitoring were employed for clinical and functional evaluation. Results In In the postoperative period, positive dynamics in clinical and electrophysiological parameters with improved pain, lower limb functionality, increased amplitudes and decreased latency of M‑response with most positive changes observed in Group III compared to Group I and Group II (p < 0.05). Discussion The function of the sciatic nerve restored in all patients with the most pronounced effect recorded in group III. The effect from the technique was associated with a simultaneous electrical stimulation of the trunk of the peripheral nerve and the segmental apparatus of the spinal cord causing synergetic effect on the structures. Conclusion The most effective method of surgical treatment was the use of Microsurgical neurolysis combined with two-level electrical stimulation was shown to be most effective and characterized by faster pain regression and positive dynamics in clinical and electrophysiological parameters in the affected lower limb of patients Group III.

Keywords

• sciatic nerve
• trauma
• total hip replacement
• electric stimulation
• surgical management