Use of multimodal intra-operative monitoring in averting nerve injury during complex hip surgery

• Published in: Journal of bone and joint surgery. British volume Vol. 94; no. 2; pp. 179 - 184
• Main Authors: SUTTER, M, HERSCHE, O, LEUNIG, M, GUGGI, T, DVORAK, J, EGGSPUEHLER, A
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01-02-2012
• Subjects: Acetabulum - surgery; Adolescent; Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Biological and medical sciences; Diseases of the osteoarticular system; Electromyography - methods; Evoked Potentials, Motor; Female; Femoral Nerve - injuries; Femur - surgery; Humans; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative - methods; Osteotomy - adverse effects; Peripheral Nerve Injuries - diagnosis; Peripheral Nerve Injuries - etiology; Peripheral Nerve Injuries - prevention & control; Retrospective Studies; Sciatic Nerve - injuries; Sensitivity and Specificity; Treatment; Surgery; Orthopedics; Hip
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.94B2.28019

Peripheral nerve injury is an uncommon but serious complication of hip surgery that can adversely affect the outcome. Several studies have described the use of electromyography and intra-operative sensory evoked potentials for early warning of nerve injury. We assessed the results of multimodal intra-operative monitoring during complex hip surgery. We retrospectively analysed data collected between 2001 and 2010 from 69 patients who underwent complex hip surgery by a single surgeon using multimodal intra-operative monitoring from a total pool of 7894 patients who underwent hip surgery during this period. In 24 (35%) procedures the surgeon was alerted to a possible lesion to the sciatic and/or femoral nerve. Alerts were observed most frequently during peri-acetabular osteotomy. The surgeon adapted his approach based on interpretation of the neurophysiological changes. From 69 monitored surgical procedures, there was only one true positive case of post-operative nerve injury. There were no false positives or false negatives, and the remaining 68 cases were all true negative. The sensitivity for predicting post-operative nerve injury was 100% and the specificity 100%. We conclude that it is possible and appropriate to use this method during complex hip surgery and it is effective for alerting the surgeon to the possibility of nerve injury.