Iliacus hematoma and subsequent femoral nerve palsy after penetration of the medical acetabular wall during total hip arthroplasty. Report of a case.

Intrapelvic perforation of the medial acetabular wall during total hip arthroplasty is not uncommon but has been associated only rarely with adverse effects. A postoperative iliacus hematoma with secondary femoral nerve palsy occurred in a 61-year-old woman. The patient had been on Coumadin prophylaxis against deep venous thrombosis, but bleeding times were never excessively prolonged. Diagnosis was made by computerized tomographic (CT) scan. Conservative therapy produced resolution of the nerve deficit within eight months. Careful attention to the placement of anchoring drill holes in the acetabulum could have prevented this complication. Iliacus hematoma should be considered in the differential diagnosis of a femoral nerve palsy in the postoperative total hip patient, particularly if anticoagulation is employed.