Intraoperative Neuromonitoring During Periacetabular Osteotomy Provides Actionable Alerts.

Area of Science:

• Orthopedic surgery
• Neuromonitoring
• Hip preservation surgery

Background:

• Bernese periacetabular osteotomy (PAO) is increasingly used for hip dysplasia and impingement.
• Major neurological injury occurs in ~2% of PAO procedures.
• Intraoperative neuromonitoring (IONM) is recommended but not universally adopted for PAO.

Purpose of the Study:

• To report the incidence and clinical significance of IONM alerts during Bernese PAO.
• To evaluate the impact of IONM on patient safety in PAO.

Main Methods:

• Retrospective review of 94 consecutive Bernese PAOs with IONM (2017-2023).
• Monitoring included motor evoked potentials and somatosensory evoked potentials.
• Analysis of IONM alerts, surgical responses, and postoperative neurological status.

Main Results:

• IONM alerts occurred in 10 of 94 PAOs (11%).
• Six alerts prompted surgical team actions (e.g., repositioning, fragment adjustment).
• No postoperative neurological deficits were detected in any patient.

Conclusions:

• IONM alerts in approximately 11% of PAOs are actionable.
• IONM may enhance patient safety and reduce the risk of nerve injury during PAO.
• This study supports the utility of IONM in Bernese PAO procedures.