Neuromonitoring in pre-post and intraoperative total hip replacement surgery in type 4 high-riding developmental dysplasia of the hip

A. Taheriazam, S. Baghbani, M. Malakooti, F. Jahanshahi, M. Allahyari, A. Dindar Mehrabani, S. Amiri

Department of Orthopedics, School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran. amiri.shay@iums.ac.ir

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• Orthopedics
• Surgery

OBJECTIVE: The choice approach to treating congenital dislocation of the hip joint is total hip replacement (THR). One of the severe but uncommon complications of THR is nerve damage. The most common nerve injury associated with total hip arthroplasty (THA) is sciatic nerve palsy, and the second typical nerve damage with THA is femoral nerve paralysis.

PATIENTS AND METHODS: In this prospective cohort study, 35 patients with type 4 high riding developmental dysplasia of the hip (DDH) who were candidates for THA were enrolled. The somatosensory evoked potential (SSEP), motor evoked potential (MEP), and electromyography (EMG) were measured pre-post and intraoperatively to check the status of the sciatic and femoral nerves. After collecting the mentioned information, the data was analyzed by SPSS V. 26 software.

RESULTS: Out of 35 patients with DDH type 4 who were candidates for THR, nine patients showed a 50 percent decrease in SSEP amplitude, and six patients showed a 10 percent decrease in SSEP latency. One patient during and two patients after the surgery showed more than an 80 percent decrease in MEP amplitude. Meanwhile, 14 patients showed abnormal spikes during and two patients after surgery regarding EMG. All patients with disturbed neurophysiological findings reverted to normal in the further investigation during follow-up. No correlation was found between increasing limb shortness and these modalities.

CONCLUSIONS: Using neuromonitoring techniques during Total Hip Arthroplasty (THA) can help identify potential early nerve damage, prevent post-surgical complications, and improve high-riding DDH patient outcomes.

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