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 (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. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/ 4.0/).