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Review Question - QID 1354

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QID 1354 (Type "1354" in App Search)
During revision total hip arthroplasty (THA), adjunctive motor-evoked potentials (MEPs) and electromyography (EMG) are utilized to monitor the sciatic and peroneal nerves. During the procedure, a conduction abnormality arises in the sciatic nerve. Which of the following actions would decrease tension on the sciatic nerve?

Provide traction to the leg

0%

11/3237

Pulsatile irrigation in the wound to remove blood clots

0%

5/3237

Flex the hip

6%

180/3237

Extend the hip

93%

3016/3237

Extend the knee

0%

8/3237

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The only answer choice that would decrease tension on the sciatic nerve is hip extension.

Satcher et al used motor-evoked potentials (MEPs) and electromyography (EMG) monitoring during 27 consecutive total hip revision cases to identify intraoperative events that caused conduction abnormalities of the sciatic and peroneal nerves. Leg positioning was the most commonly associated factor that increased sciatic nerve pressure, causing changes in monitored parameters in 4 patients. The position that caused the most conduction abnormality was hip flexion during posterior acetabular retraction in these patients.

Incorrect Answers:
1,2,3,5: During hip flexion, the nerve can impinge on the acetabular retractor. Providing traction to the leg, pulsatile irrigation, hip flexion, and knee extension would all increase sciatic nerve pressure.

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