gms | German Medical Science

Results of intraoperative multimodal electrophysiological monitoring in reconstructive surgery of hip dysplasia with inherent risk of nerve palsy is therefore recommended

Reconstruction of dysplastic hips with THA and concurrent elongation of the leg inherits a risk of 2.5-3% of sciatic nerve palsy. To reduce the rate of nerve injuries or ischemic events Sensory Evoked Potentials or Electromyography have been used without influence on the outcome. At the Schulthess Clinic Zurich, multimodal electrophysiological monitoring (MEP, SEP, EMG) in hip surgery has been routinely established. Critical nerve segments are monitored through cortical and/or cauda equina evoked motor and sensory responses

To date, in 22 patients with hip dysplasia and previous surgery multimodal intraoperative montitoring has been applied, of whom 13 had total hip arthoplasty with a mean elongation of the leg of 3 cm and 9 patients additional periacetabular correction osteotomy. In 1 patient with transient intraoperative signal alteration, the postoperative neurological state remained unchanged. 1 patient with probably traction induced disturbance of the sciatic function showed a delayed sciatic palsy. 6 patients showing significant functional disruptions in the sciatic nerve and therefore requiring a change in operational strategy, completely recuperated by the end of the operation and showed no neurological deficit

The use of intraoperative multimodal electrophysiological monitoring in reconstructive surgery of hip dysplasia with inherent risk of nerve palsy is therefore recommended.