Delayed Acute Sciatic Nerve Palsy as a Complication of Bridging Chemothromboprophylaxis Following Hip Hemiarthroplasty: A Case Report

Sciatic nerve palsy is a recognized complication of hip arthroplasty1,2. The prevalence is low, ranging from 0% to 3.7%1. Delayed-onset acute sciatic nerve palsy due to hematoma formation is rarely seen. Recently, with the increased use of strong anticoagulants for thromboprophylaxis, an increase in the prevalence of sciatic nerve palsy secondary to local hematoma formation has been reported3. We report the case of a patient who developed complete sciatic nerve palsy over the course of a few hours on the fifth day after hip arthroplasty as a result of local bleeding secondary to bridging chemoprophylaxis with use of low-molecular-weight heparin. The patient discussed in this report was informed that data concerning her case were to be submitted for publication, and she provided consent. A seventy-year-old woman presented to our emergency department with a right intertrochanteric hip fracture. The orthopaedic examination revealed external rotation posture of the lower extremity, painful and limited range of motion of the right hip, and weakness on the right side of the body. The patient had a height of 1.65 m (65 in) and a weight of 70 kg (154 lb). Medical conditions included atrial fibrillation, mild hypertension, and cerebrovascular embolism. The patient had been followed by a cardiologist for three years because of a history of thromboembolism and was taking Coumadin (warfarin), amlodipine besylate, and metoprolol succinate. She was not taking any other antithrombotic medications, such as aspirin or clopidogrel, for the treatment of vascular disease. The preoperative neurological examination revealed weakness of the right upper and lower extremities. The international normalized ratio was 2.23. The Coumadin was stopped, and low-molecular-weight heparin (enoxaparin sodium, 60 mg; two times per day) was started, as recommended by the consulting cardiologist. When the international normalized ratio was decreased to 1.55 …