Intraoperative monitoring of the femoral and sciatic nerves in total hip arthroplasty with high-riding developmental dysplasia

Bone Joint J. 2019 Nov;101-B(11):1438-1446. doi: 10.1302/0301-620X.101B11.BJJ-2019-0341.R2.


Aims: This study aimed to explore whether intraoperative nerve monitoring can identify risk factors and reduce the incidence of nerve injury in patients with high-riding developmental dysplasia.

Patients and methods: We conducted a historical controlled study of patients with unilateral Crowe IV developmental dysplasia of the hip (DDH). Between October 2016 and October 2017, intraoperative nerve monitoring of the femoral and sciatic nerves was applied in total hip arthroplasty (THA). A neuromonitoring technician was employed to monitor nerve function and inform the surgeon of ongoing changes in a timely manner. Patients who did not have intraoperative nerve monitoring between September 2015 and October 2016 were selected as the control group. All the surgeries were performed by one surgeon. Demographics and clinical data were analyzed. A total of 35 patients in the monitoring group (ten male, 25 female; mean age 37.1 years (20 to 46)) and 56 patients in the control group (13 male, 43 female; mean age 37.9 years (23 to 52)) were enrolled. The mean follow-up of all patients was 13.1 months (10 to 15).

Results: The two groups had no significant differences in preoperative data. In the monitoring group, ten nerve alerts occurred intraoperatively, and no neural complications were detected postoperatively. In the control group, six patients had neural complications. The rate of nerve injury was lower in the monitoring group than in the control group, but this did not achieve statistical significance. The degree of leg lengthening was significantly greater in the monitoring group than in the control group. In further analyses, patients who had previous hip surgery were more likely to have intraoperative nerve alerts and postoperative nerve injury.

Conclusion: Nerve injury usually occurred during the processes of exposure and reduction. The use of intraoperative nerve monitoring showed a trend towards reduced nerve injury in THA for Crowe IV DDH patients. Hence, we recommend its routine use in patients undergoing leg lengthening, especially in those with previous hip surgery. Cite this article: Bone Joint J 2019;101-B:1438-1446.

Keywords: Arthroplasty; Electromyography; Hip dysplasia; Intraoperative; Monitoring; Nerve injury.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Arthroplasty, Replacement, Hip / methods*
  • Female
  • Femoral Nerve / injuries
  • Femoral Nerve / physiology*
  • Hip Dislocation, Congenital / surgery*
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / methods
  • Organ Sparing Treatments / methods*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Sciatic Nerve / injuries
  • Sciatic Nerve / physiology*
  • Trauma, Nervous System / prevention & control
  • Young Adult