The use of motor-evoked potentials to monitor sciatic nerve status during revision total hip arthroplasty.
Sciatic nerve palsy is an uncommon complication after total hip arthroplasty (THA) but can cause permanent functional impairment in the extremity. The goal of this study was to identify specific intraoperative maneuvers that may increase the risk of sciatic nerve injury during revision THA. Motor-evoked potentials (MEPs) were used in combination with electromyography (EMG) monitoring during revision THA in 27 consecutive patients to identify intraoperative events that cause conduction abnormalities through the sciatic and peroneal nerves. MEP monitoring required general anesthesia and a neurophysiologist in the operating room throughout the procedure. Significant electrical events occurred, most commonly during acetabular reconstruction. Hip flexion should be avoided during posterior acetabular retraction when using the posterior approach with posterior dislocation. The position of the sciatic nerve should be clearly identified when complex structural acetabular augmentation with allograft is performed during revision THA. MEP monitoring was used as a research tool for this study. However, we do not use MEP monitoring in our revision THA clinical practice.
Satcher
Robert L
RL
Division of Orthopaedic Oncology, Department of Orthopaedics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Noss
R S
RS
Yingling
C D
CD
Ressler
James
J
Ries
Michael
M
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012086:Reoperation; D012584:Sciatic Nerve / Q000293:injuries / Q000502:physiology*; D020426:Sciatic Neuropathy / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control