The Advantages of Using Intraoperative Neurophysiological Monitoring in Hip Surgeries: A Meta-Analysis
DOI:
https://doi.org/10.5281/zenodo.11152081Keywords:
Sciatic nerve, palsy, hip, neuromonitoring, neurophysiology, pelvis, IONM, femoral nerve, saphenous nerve, tibial nerve, EMG, MEP, TOFAbstract
Various hip surgeries place peripheral nerves at risk of injury, such as those occurring during total hip arthroplasty, arthroscopic hip repair, and periacetabular osteotomy. In total hip arthroplasty, intraoperative neurophysiological monitoring (IONM) is focused on the sciatic nerve, which is particularly vulnerable due to its proximity to the surgical site. During arthroscopic hip repair, careful attention is paid to monitoring the femoral and lateral femoral cutaneous nerves to prevent traction and compression injuries. In periacetabular osteotomy, which involves cutting and realigning the hip socket, the primary focus of monitoring is on the sciatic and obturator nerves to minimize the risk of bone repositioning and fixation damage.
The use of IONM in hip surgeries is becoming increasingly popular to prevent neurological deficits associated with procedures such as total hip replacements and hip dysplasia corrections. This meta-analysis draws on data from 18 studies involving 522 patients, adhering to PRISMA guidelines, and utilizing techniques such as somatosensory evoked potentials (SEP), motor evoked potentials (MEP), electromyography (EMG), and train of four stimulation (TOF). The findings suggest that using multiple IONM techniques resulted in an alert rate of 61%, compared to 54% in single-modality IONM treatments. The results demonstrate that multimodal IONM improves the detection and prevention of nerve injuries, with combined modalities providing higher sensitivity and specificity than single-modality monitoring.
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