Incidence of sciatic and femoral nerve injury in first-time anterior hip arthro-plasty is between 0.28% and 3%, however, revision and complex procedures increase the risk to 7.6%. This case study demonstrates femoral nerve degradation that was detected and quickly reversed with a team approach. At 40 mm of traction (10-12 turns on the crank) the signals remained stable. With two additional turns, a decrease and subsequent loss of the right distal saphenous SSEP was noted. The surgeon released the extra two turns of traction and the signals quickly returned. The patient was evaluated post-operatively and was doing well with no deficits noted. It is common practice in hip arthroplasty surgery to add-traction to open the hip joint. Unfortunately, this can result in adverse neurological complications when performed too aggressively for an extended period of time. Each individual patient may vary in the level of traction that is tolerable. We have found that monitoring via multiple nerves and muscles provides.the best monitoring for provocative testing of this kind. SSEPs and MEPs may serve as a barometer of nerve conduction and blood perfusion to individual extremities as well as nerves with a team approach in place.
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