Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty
Background: Total hip arthroplasty (THA) stands as the standard treatment in neglected developmental dysplasia of the hip (DDH), and its application in severe cases may be linked to debilitating outcomes, including nerve damage. Here, we aimed to report the results of intraoperative nerve monitoring...
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Elsevier
2025-02-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344124002978 |
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| author | Alireza Manafi Rasi, MD Sina Afzal, Dr., MD Mojtaba Baroutkoub, MD Hasan Shakiba, MD Pooya Kalani, MD Mehdi Tavassoli, MD Reza Zarei, MD |
| author_facet | Alireza Manafi Rasi, MD Sina Afzal, Dr., MD Mojtaba Baroutkoub, MD Hasan Shakiba, MD Pooya Kalani, MD Mehdi Tavassoli, MD Reza Zarei, MD |
| author_sort | Alireza Manafi Rasi, MD |
| collection | DOAJ |
| description | Background: Total hip arthroplasty (THA) stands as the standard treatment in neglected developmental dysplasia of the hip (DDH), and its application in severe cases may be linked to debilitating outcomes, including nerve damage. Here, we aimed to report the results of intraoperative nerve monitoring (IONM) via an active method. Methods: In this retrospective cohort study, we recruited patients with Crowe types III and IV DDH, who underwent THA. The study comprised 2 cohorts: one without nerve monitoring and the other with active IONM under epidural anesthesia. The primary study outcomes included the incidence of neural complications, the extent of achieved leg lengthening, and the necessity for femoral osteotomy. Results: A total of 183 patients were included in this study as the cases underwent THA under epidural anesthesia and IONM, along with 156 historical cohorts of controls. In the group with IONM, no clinically postoperative nerve injury was detected, while in the control group, 6 (3.8%) patients experienced neural complications (P = .08). The mean achieved limb lengthening was significantly greater in the monitoring group as 4.2 cm (range = 2.4-5.6) than in the control group as 3.56 cm (range = 2.2-5.6) (P = .04). The rate of femoral osteotomy was significantly lower in the monitoring group (13.6%, 25/183) compared to the control group (27.5%, 43/156) (P < .005). Conclusions: The utilization of active IONM in patients under epidural anesthesia during THA for severe DDH proves to be an effective approach. This method allows for real-time assessment of nerve function throughout the surgical procedure, demonstrating its potential to minimize postoperative complications. |
| format | Article |
| id | doaj-art-b6c71f7d4c8d4d789ede5deaa2aa1b56 |
| institution | Kabale University |
| issn | 2352-3441 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj-art-b6c71f7d4c8d4d789ede5deaa2aa1b562025-02-10T04:34:33ZengElsevierArthroplasty Today2352-34412025-02-0131101612Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip ArthroplastyAlireza Manafi Rasi, MD0Sina Afzal, Dr., MD1Mojtaba Baroutkoub, MD2Hasan Shakiba, MD3Pooya Kalani, MD4Mehdi Tavassoli, MD5Reza Zarei, MD6Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranPain Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IranDepartment of Orthopedic Surgery, School of Medicine, Babol University of Medical Sciences, Babol, IranDepartment of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Corresponding author. Department of Orthopedic Surgery, 7th Floor, Bldg No.2 Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, Iran 19839-63113.Background: Total hip arthroplasty (THA) stands as the standard treatment in neglected developmental dysplasia of the hip (DDH), and its application in severe cases may be linked to debilitating outcomes, including nerve damage. Here, we aimed to report the results of intraoperative nerve monitoring (IONM) via an active method. Methods: In this retrospective cohort study, we recruited patients with Crowe types III and IV DDH, who underwent THA. The study comprised 2 cohorts: one without nerve monitoring and the other with active IONM under epidural anesthesia. The primary study outcomes included the incidence of neural complications, the extent of achieved leg lengthening, and the necessity for femoral osteotomy. Results: A total of 183 patients were included in this study as the cases underwent THA under epidural anesthesia and IONM, along with 156 historical cohorts of controls. In the group with IONM, no clinically postoperative nerve injury was detected, while in the control group, 6 (3.8%) patients experienced neural complications (P = .08). The mean achieved limb lengthening was significantly greater in the monitoring group as 4.2 cm (range = 2.4-5.6) than in the control group as 3.56 cm (range = 2.2-5.6) (P = .04). The rate of femoral osteotomy was significantly lower in the monitoring group (13.6%, 25/183) compared to the control group (27.5%, 43/156) (P < .005). Conclusions: The utilization of active IONM in patients under epidural anesthesia during THA for severe DDH proves to be an effective approach. This method allows for real-time assessment of nerve function throughout the surgical procedure, demonstrating its potential to minimize postoperative complications.http://www.sciencedirect.com/science/article/pii/S2352344124002978Congenital hip dysplasiaTotal hip arthroplastyEpidural anesthesiaSciatic nerve injuryNerve monitoring |
| spellingShingle | Alireza Manafi Rasi, MD Sina Afzal, Dr., MD Mojtaba Baroutkoub, MD Hasan Shakiba, MD Pooya Kalani, MD Mehdi Tavassoli, MD Reza Zarei, MD Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty Arthroplasty Today Congenital hip dysplasia Total hip arthroplasty Epidural anesthesia Sciatic nerve injury Nerve monitoring |
| title | Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty |
| title_full | Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty |
| title_fullStr | Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty |
| title_full_unstemmed | Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty |
| title_short | Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty |
| title_sort | evaluation of active intraoperative nerve monitoring in severe developmental dysplasia of the hip patients undergoing total hip arthroplasty |
| topic | Congenital hip dysplasia Total hip arthroplasty Epidural anesthesia Sciatic nerve injury Nerve monitoring |
| url | http://www.sciencedirect.com/science/article/pii/S2352344124002978 |
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