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DOI: 10.1055/s-2004-820360
© Georg Thieme Verlag Stuttgart · New York
Femoralisparese wegen ausgeprägter Granulombildung bei aseptischer Pfannenlockerung einer zementfreien Hüftendoprothese
Femoral Nerve Palsy Due to Excessive Granuloma in Aseptic Cup Loosening in Cementless Total Hip ArthroplastyPublikationsverlauf
Publikationsdatum:
15. Oktober 2004 (online)
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Zusammenfassung
Einleitung: Femoralisparesen nach Totalendoprothesenimplantationen des Hüftgelenkes können die unterschiedlichsten Ursachen haben. Verzögerte Läsionen des Nervus femoralis aufgrund einer ausgeprägten Granulombildung bei Implantatlockerungen stellen eine ausgesprochene Rarität dar.Falldarstellung: Wir berichten über den Fall einer verzögerten Parese des Nervus femoralis wegen aseptischer Pfannenlockerung einer zementfreien Hüfttotalendoprothese. Die elektrophysiologische Untersuchung zeigte eine fortgeschrittene Läsion des Nervus femoralis mit sensomotorischen Defiziten. Ein Abdomen-Becken-CT stellte ein exzessives Granulom mit großer intrapelviner Raumforderung dar. Nach Pfannenwechsel, Revision des Nervus femoralis und Resektion des Granuloms besserten sich die neurologischen Defizite.Schlussfolgerung: Dieser Fall demonstriert die Notwendigkeit regelmäßiger klinisch-radiologischer Verlaufkontrollen in 1-2-jährlichen Abständen nach totalendoprothetischem Ersatz des Hüftgelenkes, um schwerwiegende Lockerungen, Granulombildung und damit verbunden beispielsweise Nervenläsionen zu vermeiden.
Abstract
Aim: Femoral nerve palsy after total hip arthroplasty can result from several causes. Delayed neuropathies of the femoral nerve because of excessive granuloma in loosened implants are a rare condition.Case report: We report the case of delayed neuropathy of the femoral nerve after cementless total hip arthroplasty because of aseptic loosening of the cup. Electrophysiologic evaluation revealed a severe lesion of the femoral nerve with sensomotoric deficits. An abdominopelvic computed tomography (CT) scan revealed an excessive granuloma with a large intrapelvic portion. After revision of the loosened acetabular component and the femoral nerve and removal of the granuloma the neurologic symptoms improved.Conclusion: Regular (1-2 years) clinical and radiological follow-ups are requested after total hip arthroplasty to prevent excessive loosening of implants, excessive granuloma and severe sequelae like nerve damage.
Schlüsselwörter
Hüftendoprothese - Lockerung - Parese - Femoralisnerv - Granulom
Key words
Total hip replacement - loosening - palsy - femoral nerve - granuloma
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