Novel technique for intraoperative sciatic nerve assessment in complex primary total hip arthroplasty: a pilot study

Area of Science:

• Orthopedic Surgery
• Neurophysiology
• Medical Devices

Background:

• Sciatic nerve injury (SNI) is a significant risk during total hip arthroplasty (THA), especially in complex cases.
• Intraoperative neural monitoring can prevent SNI but is often challenging to implement.
• This study evaluates a handheld nerve stimulator for SN monitoring in complex THA.

Purpose of the Study:

• To assess the efficacy of a handheld nerve stimulator for intraoperative sciatic nerve (SN) monitoring during complex total hip arthroplasty (THA).
• To determine if this monitoring technique can prevent sciatic nerve injury (SNI) in cases requiring significant limb lengthening or nerve manipulation.

Main Methods:

• A series of 11 complex THA cases (Crowe 3-4 hip dysplasia or similar) were analyzed.
• Sciatic nerve (SN) function was monitored using a handheld nerve stimulator, measuring pre- and post-reduction thresholds.
• Nerve stimulation results guided intraoperative decision-making.

Main Results:

• No permanent sciatic nerve injury (SNI) occurred in any of the 11 cases.
• A handheld nerve stimulator identified two instances where surgical plans were altered (femoral shortening, smaller femoral head) to prevent potential nerve damage.
• One patient experienced a transient peroneal nerve palsy that resolved within two weeks.

Conclusions:

• Intraoperative use of a handheld nerve stimulator is effective in guiding surgical decisions during complex THA.
• This technique can potentially prevent sciatic nerve injury (SNI) by allowing real-time assessment and corrective action.
• The nerve stimulator provides valuable feedback to ensure safe limb lengthening and nerve manipulation.