Technique for Intraoperative Neuromonitoring During Periacetabular Osteotomy After Concomitant Hip Arthroscopy

Intraoperative neurologic injury during periacetabular osteotomy (PAO) for the treatment of symptomatic acetabular dysplasia is a major complication that can lead to permanent disability and limit the benefit of correcting the acetabular dysplasia. Current literature reflects the evolution of hip-preservation surgery for symptomatic acetabular dysplasia to include hip arthroscopy to address the intra-articular abnormalities, including labral tears, chondral lesions, and femoral cam morphology. A growing number of young hip surgeons and surgeon teams are subscribing to this approach and now performing concomitant hip arthroscopy and PAO. The value of intraoperative neuromonitoring cannot be understated, both in terms of surgeon confidence as well as patient safety, particularly during the learning curve of PAO, with or without hip arthroscopy. We present our current technique for the application of neuromonitoring to allow free mobility of the operative leg and continuous monitoring during PAO. This reproducible technique allows the use of nonsterile neuromonitoring to be used through a sterile conduit, positioned to allow free mobility of the operative extremity and performance of the PAO. We believe this technique provides additional safety benefit and increases awareness regarding neurologic compromise, particularly for the low-volume PAO surgeon or during the procedural learning curve.