Multimodal Neuromonitoring During Safe Surgical Dislocation of the Hip for Joint Preservation: Feasibility, Safety, and Intraoperative Observations

INTRODUCTION: Nerve injuries can occur from major hip surgeries, and some may be significant. Our goal was to assess the feasibility and safety of neuromonitoring during hip preservation surgery and the incidence of alerting events during such monitoring. METHODS: Twenty-five adult patients underwent surgical hip dislocation for femoroacetabular impingement. Upper and lower extremity somatosensory evoked potentials, lower extremity transcranial motor evoked potentials, and lower extremity electromyography were recorded. RESULTS: We observed a temporary reduction of the monitored parameters in twelve patients (48%) during surgery. There were no clinically significant neurological deficits postoperatively in any cases. DISCUSSION: Neuromonitoring did demonstrate events during hip surgery in our case series. Although it may not be practical to use neuromonitoring in all major hip surgeries, it may be prudent from the perspective of patient safety to use it in high-risk cases, including those requiring prolonged surgical time; in patients with high body mass index, excessive deformity correction, and preexisting neuropathy; and in revision cases, among others.