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J Bone Joint Surg Br. 2012 Feb;94(2):179-84. doi: 10.1302/0301-620X.94B2.28019.

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

Author information

1
Schulthess Clinic, Lengghalde 2, Zurich 8008, Switzerland. martin.sutter@kws.ch

Abstract

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.

PMID:
22323682
DOI:
10.1302/0301-620X.94B2.28019
[Indexed for MEDLINE]

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