The Journal of Bone and Joint Surgery, Vol 67, Issue 8 1225-1228, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Obturator-nerve palsy resulting from intrapelvic extrusion of cement during total hip replacement. Report of four cases
JM Siliski and RD Scott
Obturator neuropathy is an infrequently identified complication of total
hip replacement that may cause debilitating pain. There have been isolated
reports of this complication in the literature, but only one case has been
published in which intrapelvic cement was the causative agent. We are
describing the cases of four patients with obturator neuropathy after total
hip replacement, documented by electromyography and attributed to
intrapelvic extension of cement. In each patient the source of the symptoms
was not initially apparent. In three of the patients the extruded cement
and obturator nerve were explored surgically. One of the three patients was
improved by obturator neurectomy. Of the other two patients, both treated
by excision of cement, only one was improved. The fourth patient was not
treated. Persistent pain in the groin and thigh, intrapelvic cement visible
on plain roentgenograms, and adductor weakness after total hip replacement
suggest that this complication has occurred. Electromyography can confirm
the presence of obturator neuropathy. Based on this limited series,
excision of the extruded cement and preservation of the nerve should be
attempted only when the nerve is grossly normal and functional as
determined by electrical stimulation at the time of surgical exploration;
otherwise, obturator neurectomy should be considered.
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