Is intraoperative neuromonitoring effective in hip and pelvis orthopedic and trauma surgery? A systematic review

Intraoperative Neurophysiological Monitoring in Total Hip Arthroplasty for Crowe Types 3 and 4 Hips

Background

Crowe types 3 and 4 dysplastic hips usually need total hip arthroplasty (THA) with femoral shortening osteotomy (FSO) to facilitate reduction, equalize limb length, and decrease the traction stress in nerves. The frequency of peripheral nerve palsy after primary THA has been reported to range from 0.08% to 3.7%. Apart from direct trauma to the nerve, the excessive extension of the extremity is also reported as a common cause of nerve damage. The current study aimed to evaluate the outcomes of intraoperative neurophysiological monitoring (IONM) in THA for Crowe types 3 and 4 hips.

Methods

The data of patients who underwent primary THA with IONM were retrospectively reviewed using our medical records. Patients with Crowe types 3 and 4 dysplastic hips were included in the study. Motor-evoked potentials and somatosensory-evoked potentials were assessed intraoperatively. Preoperative dislocation height and postoperative trochanter minor differences were measured using preoperative and postoperative radiographs.

Results

Twenty-three hips of 19 patients (4 bilateral THAs) with a mean age of 45 years participated in the study. Ten hips (43%) were classified as Crowe type 4, whereas 13 hips (57%) were Crowe type 3. The mean preoperative dislocation height was 41.6 mm (range, 15-100 mm). Postoperatively, only 6 patients had a difference between trochanter minor levels with a mean of 8.5 mm (range, 3-17 mm). Three patients underwent a subtrochanteric FSO to achieve reduction. Postoperatively, no patient had any motor and sensory nerve dysfunction.

Conclusions

According to the results acquired from this study, no nerve palsy was observed after THA for Crowe types 3 and 4 hips, and subtrochanteric FSO was not performed in all Crowe type 3 hips and 70% of Crowe type 4 hips with the aid of IONM.

Common peroneal nerve palsy after primary total hip arthroplasty

PURPOSE

The study wants to evaluate the incidence, the clinical evolution, and treatment of common peroneal nerve (CPN) palsy after primary total hip arthroplasty.

METHODS

Our clinical prospective study was made between January 2016 and December 2020. The study group comprised 1240 total hip replacements over a period of five years. Six cases were diagnosed with CPN palsy (0.48%). Five were women and one man, aged from 52 to 71 years old. The common peroneal nerve lesion was diagnosed clinically and by electromyography.

RESULTS

The follow-up period was at least 24 months post-operatively. In all six cases, there was a complete common peroneal nerve palsy, documented by electromyography. The poorest results were obtained in the older patients and those who had the highest body mass index, which at two years post-operatively achieved only a partial sensory rehabilitation, with complete motor deficit. All patients can walk unassisted, without support, with one case having complete rehabilitation achieved 18 months postoperatively and three with partial rehabilitation.

CONCLUSION

CPN palsy after primary THA is a very serious complication with poor functional outcome. There is no consensus regarding the treatment. The age and the intensity of the rehabilitation program are the only significant factors for the medical rehabilitation after this debilitating post-operative complication.