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| Acute Neuropathy Following Total Hip Arthroplasty1 | ||
| A sixty-nine-year-old man who had undergone a left total hip arthroplasty for osteoarthritis at another institution presented three weeks postoperatively with severe pain and muscle spasms in the left limb, which had been present from the time of the operation. | ||
| The patient described the pain as radiating down the anterior aspect of the thigh to the lateral part of the knee and over the top of the foot. He was not able to sleep for more than ten minutes at a time. A few days earlier, a contrast venogram was interpreted as negative for deep-vein thrombosis. Oxycodone-acetaminophen (two tablets every four hours) had not relieved the pain. | ||
| Clinical examination revealed a limb-length discrepancy, with the side that had been operated on being 25 mm longer. The patient had a strong dorsalis pedis pulse and no increase in symptoms on the straight-leg-raising test. The findings on motor and sensory examinations were normal. | ||
| Radiographic examination revealed a well-positioned cementless acetabular component and a cementless porous-coated femoral component (Fig. 1). The distance from a horizontal line drawn between the inferior aspect of the left and right ischia to the tip of the lesser trochanter showed an increase of 28 mm on the involved side. The patient believed that the limb lengths had been equal prior to the hip replacement. | ||
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Fig. 1 Anteroposterior radiograph of the pelvis, made three weeks after the initial operation, showing limb-length discrepancy. For larger view, click on image |
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| What is the diagnosis? | ||
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