52 y.o. female underwent left total hip arthroplasty via direct anterior approach and sustained a nerve injury/foot drop. surgery was performed december 1 2025. post op, she developed complete motor and sensory loss of the left lower extremity (LLE) with 0/5 strength. she reported pain and paresthesias but was otherwise unable to perceive light touch throughout the LLE. she was unable to stand 2/2 absent motor function and sensation. she also reported loss of bladder sensation, requiring physical pressure to initiate urination, as well as constipation. post op MRI reportedly revealed mild peri-facet enhancement at L3-L4 with subtle enhancement within the posterior epidural space, w/out compressive mass effect on the thecal sac. there was post surgical edema surrounding the left sciatic nerve; however no significant abnormal enhancement of the sciatic nerve was identified. the procedure was initially performed under spinal/epidural anesthesia with MAC. it was reported that the patient moved during the operation, prompting conversion to general anesthesia. ID was consulted due to concern for infection vs inflammation in the setting of nonspecific peri-facet enhancement at L3-L4 and subtle posterior epidural enhancement w/out thecal sac compression. post op. Neuro was consulted and she was started on IV steroids. EMG was eventually performed February 2026 and reported severe but partial left sciatic neuropathy and mild left femoral neuropathy, with no evidence of reinnervation.
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Do you believe there might have been medical error?
There is no evidence of medical error. Sciatic nerve injury is a known complication of total hip arthroplasty. Peri facet enhancement at L3-4 would not explain the neurologic deficit. Spinal and epidural anesthesia would not explain the EMG finding of severe left sciatic neuropathy and mild femoral nerve neuropathy.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Foot drop is a common complication of total hip arthroplasty. There is evidence that a medical error occurred in this case.
What makes you a good expert for this case?
I am a board certified orthopedic spine surgeon. I have been in practice for over 15 years.
How often do you encounter cases similar to this one in your practice?
I perform both hip replacement surgery and spine surgery on a regular basis.
Do you believe there might have been medical error?
Based on the available evidence, this appears to be a severe but recognized complication of total hip arthroplasty without clear evidence of medical error. Sciatic and even combined sciatic–femoral neuropathies can occur from traction, positioning, retractor pressure, or limb lengthening during hip replacement, and an immediate postoperative 0/5 deficit, while devastating, does not by itself establish negligence or medical error. However, the bladder sensory findings are atypical for an isolated peripheral nerve injury and appropriately raise concern for a more proximal neuraxial issue. Nevertheless, the absence of compressive pathology on MRI and the involvement of neurology suggest that the deficit was investigated in a timely and standard manner. Whether there was indeed error would depend on specific operative details — excessive lengthening, improper positioning, delayed imaging, or documentation gaps — none of which are evident from the facts provided. However given the presence of bladder involvement there is a high chance of an exposure/medical error.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The surgery almost certainly caused the nerve injury in a medical sense, but that alone does not establish malpractice. Causation in the legal sense would require evidence of a specific deviation from standard care that directly led to the deficit, and based on the facts provided, that has not been clearly demonstrated.
What makes you a good expert for this case?
I am a board-certified orthopedic surgeon with years of experience reviewing medicolegal cases.
How often do you encounter cases similar to this one in your practice?
I see patients with peripheral nerve injuries as a consequence of surgery somewhere on the order of once per month.
Do you believe there might have been medical error?
Would need more information to be able to say for sure. However, it is extremely rare to have a sciatic nerve injury from an anterior approach hip replacement as the sciatic nerve is in a posterior location and not at risk with this approach. Also complete motor and sensory loss of the entire lower extremity (hip to the foot) would not be consistent with an injury to the sciatic nerve at the level of the hip joint.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
As above. Would need more information. However, the symptoms described involving the entire lower extremity are not consistent with injury to the sciatic nerve at the level of the hip joint. This is also already extremely rare from an anterior approach hip replacement.
What makes you a good expert for this case?
I am a fellowship trained hip and knee replacement surgeon with over 10 years of experience, and routinely perform hip replacement surgeries through the anterior and posterior approaches.
How often do you encounter cases similar to this one in your practice?
I have never encountered a case of sciatic nerve palsy from the anterior approach.
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