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This case report describes a 28-year-old male with DDH who developed sciatic nerve irritation from a protruding transacetabular screw following THA. The patient underwent successful extra-acetabular screw trimming, avoiding component revision, and achieved pain relief with improved function at 3-year follow-up, though some residual weakness persisted. This highlights a surgical technique for managing this complication.
Extra-acetabular screw trimming is a viable option for managing symptomatic protruding transacetabular screws after THA in DDH, potentially avoiding more extensive revision surgery.
BACKGROUND Total hip arthroplasty (THA) in young patients with developmental dysplasia of the hip (DDH) is a technically demanding procedure that is associated with a higher incidence of implant-related complications. Transacetabular screw fixation may be required to achieve acetabular stability in these complex reconstructions, but improper screw placement can result in neurovascular injury. Although symptomatic screw prominence is quite uncommon, when present, it may lead to severe neurovascular complications requiring prompt attention and management. This case highlights a rare yet significant complication of symptomatic sciatic nerve irritation caused by a protruding transacetabular screw after THA and demonstrates a safe extra-acetabular surgical strategy that avoids component revision. CASE SUMMARY We report the case of a 28-year-old male who underwent staged bilateral THA via a superior approach for DDH. Following right-sided arthroplasty, the patient developed sciatic-type right leg pain and weakness of foot and ankle dorsiflexion due to a protruding transacetabular screw. Revision surgery included retention of all the well-fixed arthroplasty components, exploration and dissection of the sciatic nerve and trimming of the prominent screw edge. At 3 years postoperatively, the patient was pain-free and had minimal restrictions during daily activities. However, some residual weakness of ankle dorsiflexion remained and an ankle-foot orthosis was used during long-distance walking. CONCLUSION This case underscores the need for careful attention to transacetabular screw placement during THA in DDH and demonstrates a safe and effective extra-acetabular surgical strategy for managing symptomatic screw protrusion avoiding joint dislocation, liner exchange and component revision.
