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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_16 | Pages 96 - 96
19 Aug 2024
Gauthier P Garceau S Parisien A Beaulé PE
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The purpose of our study is to examine the outcome of patients undergoing outpatient total hip arthroplasty with a BMI >35.

Case-control matching on age, gender (46% female;54%male), and ASA (mean 2.8) with 51 outpatients BMI≥35 kg/m2 (mean of 40 (35–55)), mean age of 61 (38–78) matched to 51 outpatients BMI<35 kg/m2 (mean of 27 (17–34)) mean age 61 (33–78). Subsequently 47 inpatients BMI≥35 kg/m2 (mean of 40 (35–55)) mean age 62 (34–77) were matched outpatients BMI≥35 kg/m2. For each cohort, adverse events, readmission in 90 days, reoperations were recorded.

Rate of adverse events was significantly higher in BMI ≥35: 15.69% verus 1.96% (p=0.039) with 5 reoperations in the BMI≥35 cohort vs 0 in the BMI<35 kg/m2 (p= 0.063). Readmissions did not differ between groups (p=0.125). No significant difference for all studied outcomes between the outpatient and inpatients cohorts with BMI≥35 kg/m2. The most complications requiring surgery/medical intervention (3B) were in the inpatient cohort of patients >35. The prevalence of Diabetes and Obstructive Sleep apnea was 21.6% and 29.4% for BMI>35 compared to 9.8% and 11.8%, for BMI <35, respectively.

Severely obese patients have an overall higher rate of adverse events and reoperations however it should not be used a sole variable for deciding if the patient should be admitted or not.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_12 | Pages 25 - 25
23 Jun 2023
Ricard M Pacheco L Koorosh K Poitras S Carsen S Grammatopoulos G Wilkin G Beaulé PE
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Our understanding of pre-arthritic hip disease has evolved tremendously but challenges remain in categorizing diagnosis, which ultimately impacts choice of treatments and clinical outcomes. This study aims to report patient reported outcome measures (PROMs) comparing four different condition groups within hip preservation surgery by a group of fellowship-trained surgeons.

From 2018 to 2021, 380 patients underwent hip preservation surgery at our center and were classified into five condition groups: dysplasia: 82 (21.6%), femoro-acetabular impingement (FAI): 173 (45.4%), isolated labral tear: 103 (27.1%), failed hip preservation: 20 (5.3%) and history of childhood disease/other: 2 (0.5%). International hip outcomes Tool 12 (IHOT-12), numeric pain score and patient-reported outcomes measurement information system (PROMIS) were collected pre-operatively and at 3 months and 1 year post-operatively, with 94% and 82% follow-up rate respectively.

Arthroscopy (75.5%) was the most common procedure followed by peri-acetabular osteotomy (PAO) (22.4%) and surgical dislocation (2.1%). Re-operation rate were respectively 18.3% (15), 5.8% (10), 4.9% (5), 30% (6) and 0%. There were 36 re-operations in the cohort, 14 (39%) for unintended consequences of initial surgery, 10 (28%) for mal-correction leading to a repeat operation, 8 (22%) progression of arthritis, and 4 (11%) for incorrect initial diagnosis/intervention. Most common re-operations were hardware removal 31% (7 PAO, 3 surgical hip dislocation and 1 femoral de-rotational osteotomy), arthroscopy 31% (11) and arthroplasty 28% (10). All groups had significant improvements in their IHOT-12 as well as PROMIS physical and numerical pain scales, except those with failed hip preservation. Dysplasia group showed a slower recovery.

Overall, this study demonstrated a clear relation between the condition groups, their respective intervention and the significant improvements in PROMs with isolated labral pathology being a valid diagnosis. Establishing tertiary referral centers for hip preservation and longer follow-up is needed to monitor the overall survivorship of these various procedures.


Bone & Joint Open
Vol. 3, Issue 10 | Pages 804 - 814
13 Oct 2022
Grammatopoulos G Laboudie P Fischman D Ojaghi R Finless A Beaulé PE

Aims

The primary aim of this study was to determine the ten-year outcome following surgical treatment for femoroacetabular impingement (FAI). We assessed whether the evolution of practice from open to arthroscopic techniques influenced outcomes and tested whether any patient, radiological, or surgical factors were associated with outcome.

Methods

Prospectively collected data of a consecutive single-surgeon cohort, operated for FAI between January 2005 and January 2015, were retrospectively studied. The cohort comprised 393 hips (365 patients; 71% male (n = 278)), with a mean age of 34.5 years (SD 10.0). Over the study period, techniques evolved from open surgical dislocation (n = 94) to a combined arthroscopy-Hueter technique (HA + Hueter; n = 61) to a pure arthroscopic technique (HA; n = 238). Outcome measures of interest included modes of failures, complications, reoperation, and patient-reported outcome measures (PROMs). Demographic, radiological, and surgical factors were tested for possible association with outcome.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_4 | Pages 11 - 11
1 Apr 2022
McGoldrick NP Cochran M Biniam B Bhullar R Beaulé PE Kim PR Gofton W Grammatopoulos G
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Short cementless femoral stems are increasingly popular as they allow for less dissection for insertion. Use of such stems with the anterior approach (AA) may be associated with considerable per-operative fracture risk. This study's primary aim was to evaluate whether patient-specific femoral- and pelvic- morphology and surgical technique, influence per-operative fracture risk. In doing so, we aimed to describe important anatomical thresholds alerting surgeons.

This is a single-centre, multi-surgeon retrospective, case-control matched study. Of 1145 primary THAs with a short, cementless stem inserted via the AA, 39 periprosthetic fractures (3.4%) were identified. These were matched for factors known to increase fracture risk (age, gender, BMI, side, Dorr classification, stem offset and indication for surgery) with 78 THAs that did not sustain a fracture. Radiographic analysis was performed using validated software to measure femoral- (canal flare index [CFI], morphological cortical index [MCI], calcar-calcar ratio [CCR]) and pelvic- (Ilium-ischial ratio [IIR], ilium overhang, and ASIS to greater trochanter distance) morphologies and surgical technique (% canal fill). Multivariate and Receiver-Operator Curve (ROC) analysis was performed to identify predictors of fracture.

Femoral factors that differed included CFI (3.7±0.6 vs 2.9±0.4, p<0.001) and CCR (0.5±0.1 vs 0.4±0.1, p=0.006). The mean IIR was higher in fracture cases (3.3±0.6 vs 3.0±0.5, p<0.001). % Canal fill was reduced in fracture cases (82.8±7.6 vs 86.7±6.8, p=0.007). Multivariate analysis and ROC analyses revealed a threshold CFI of 3.17 was predictive of fracture (sensitivity:84.6% / specificity:75.6%). Fracture risk was 29 times higher when patients had CFI>3.17 and II ratio>3 (OR:29.2 95%CI: 9.5–89.9, p<0.001).

Patient-specific anatomical parameters are important predictors of fracture-risk. When considering the use of short stems via the AA, careful radiographic analysis would help identify those at risk in order to consider alternative stem options.


Bone & Joint Research
Vol. 10, Issue 12 | Pages 780 - 789
1 Dec 2021
Eslam Pour A Lazennec JY Patel KP Anjaria MP Beaulé PE Schwarzkopf R

Aims

In computer simulations, the shape of the range of motion (ROM) of a stem with a cylindrical neck design will be a perfect cone. However, many modern stems have rectangular/oval-shaped necks. We hypothesized that the rectangular/oval stem neck will affect the shape of the ROM and the prosthetic impingement.

Methods

Total hip arthroplasty (THA) motion while standing and sitting was simulated using a MATLAB model (one stem with a cylindrical neck and one stem with a rectangular neck). The primary predictor was the geometry of the neck (cylindrical vs rectangular) and the main outcome was the shape of ROM based on the prosthetic impingement between the neck and the liner. The secondary outcome was the difference in the ROM provided by each neck geometry and the effect of the pelvic tilt on this ROM. Multiple regression was used to analyze the data.


Bone & Joint Research
Vol. 9, Issue 5 | Pages 242 - 249
1 May 2020
Bali K Smit K Ibrahim M Poitras S Wilkin G Galmiche R Belzile E Beaulé PE

Aims

The aim of the current study was to assess the reliability of the Ottawa classification for symptomatic acetabular dysplasia.

Methods

In all, 134 consecutive hips that underwent periacetabular osteotomy were categorized using a validated software (Hip2Norm) into four categories of normal, lateral/global, anterior, or posterior. A total of 74 cases were selected for reliability analysis, and these included 44 dysplastic and 30 normal hips. A group of six blinded fellowship-trained raters, provided with the classification system, looked at these radiographs at two separate timepoints to classify the hips using standard radiological measurements. Thereafter, a consensus meeting was held where a modified flow diagram was devised, before a third reading by four raters using a separate set of 74 radiographs took place.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 54 - 54
1 Oct 2019
Lamontagne M Catelli DS Beaulé PE
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Osteochondroplasty procedure for cam deformity provides excellent outcomes on alleviating pain, improving quality of life and clinical function in femoroacetabular impingement syndrome (FAIS) patients. Although medium-term outcomes on gait biomechanics have been reported, it is unclear how it would translate to better hip muscle forces and joint loading in high range of motion tasks. The purpose of this study was to compare the muscle forces and hip joint contact forces (HCF) during a squat task in individuals before and after cam-FAIS surgical correction. Ten cam-FAIS patients prior and 2-years after osteochondroplasty, and 10 BMI- age- and sex-matched healthy control participants (CTRL) underwent 3D motion and ground reaction forces capture while performing a deep squatting task. Muscle and HCF were estimated using musculoskeletal modeling and comparisons were done using statistical parametric mapping (SPM).

Postoperatives squatted down with a higher anterior pelvic tilt and higher hip flexion compared with the preoperatives. Preoperative semimembranosus generated lower forces than the two other groups on the squat ascending, with no differences detected between post-ops and CTRLs. Preoperatives also showed reduced forces for the distal, ischial and medial portions of the adductor magnus relative to the CTRLs, which although reduced, still presented differences postoperatively. Preoperative anterior and medial contact forces were significantly lower than the CTRL group during both phases of the squat. Postoperative vertical and medial forces were also lower compared to the CTRLs. However, with higher vertical forces during the ascent phase of the squat compared to the preoperative, the postoperative group, significantly increased its HCF magnitude. A higher anterior pelvic tilt was associated with an innate restoration of the pelvis position, once the cam deformity no longer existed. The increased force of the semimembranosus muscle while ascending the squat generated higher vertical HCF, which also influenced the increased HCF total magnitude.

For any tables or figures, please contact the authors directly.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 65 - 65
1 Oct 2019
Beaulé PE Slullitel PA Dobransky J Kreviazuk C Kim JK Grammatopoulos G
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Introduction

Porous coated cups have a low modulus of elasticity that enhances press-fit and a surface that promotes osseointegration as well as permitting modularity. Monoblock ceramic acetabular cups represent a subtype of uncemented cup permitting the use of large femoral heads. The aim of this study was to compare the short-term clinical and radiographic performances of both cups.

Methods

This was a prospective RCT of 86 unilateral THA patients (M: 40, F: 48; mean age: 59.5 ± 10.6) randomized to either a porous-coated, modular metal-on-polyethylene (MoP) acetabular component (pore size 250µm, 45% mean volume porosity)(n=46) or a hydroxyapatite (HA) and titanium-coated monoblock shell with ceramic-on-ceramic(CoC) bearing (pore size 300µm, 48% mean volume porosity & 80nm HA coating thickness)(n=42). All sockets were under-reamed by 1 mm. Two-year radiographs and patient-reported outcomes (PROMs) were available.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 1 - 1
1 Oct 2018
Bali K Ibrahim MM Smit K Poitras S Wilkin GP Beaulé PE
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Background

Hip dysplasia has traditionally been classified based on the lateral center edge angle (LCEA). A recent meta-analysis demonstrated no definite consensus and a significant heterogeneity in LCEA values used in various studies to define hip dysplasia and borderline dysplasia. To overcome the shortcomings of classifying hip dysplasia based on just LCEA, a comprehensive classification for adult acetabular dysplasia (CCAD) was proposed to classify symptomatic hips into three discrete prototypical patterns of hip instability; lateral/global, anterior, or posterior. The purpose of this study was to assess the reliability of this recently published CCAD.

Methods

One hundred thirty-four consecutive hips that underwent a PAO were categorized using a validated software (Hip2Norm) into four categories of normal, lateral/global, anterior or posterior. Based on the prevalence of individual dysplasia and using KappaSize R package version 1.1, seventy-four cases were necessary for reliability analysis: 44 dysplastic and 30 normal hips were randomly selected. Five surgeons (3 fellowship trained in hip preservation) did a first reading (Time 1) to classify the hips, followed by four raters for a second reading (Time 2) minimum two weeks apart. Thereafter, a consensus meeting was held where a simplified flow diagram was devised before a third reading by four raters using a separate set of 74 radiographs took place.


Bone & Joint Research
Vol. 2, Issue 8 | Pages 140 - 148
1 Aug 2013
Gauthier L Dinh L Beaulé PE

Objectives

To quantify and compare peri-acetabular bone mineral density (BMD) between a monoblock acetabular component using a metal-on-metal (MoM) bearing and a modular titanium shell with a polyethylene (PE) insert. The secondary outcome was to measure patient-reported clinical function.

Methods

A total of 50 patients (25 per group) were randomised to MoM or metal-on-polyethlene (MoP). There were 27 women (11 MoM) and 23 men (14 MoM) with a mean age of 61.6 years (47.7 to 73.2). Measurements of peri-prosthetic acetabular and contralateral hip (covariate) BMD were performed at baseline and at one and two years’ follow-up. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC), University of California, Los Angeles (UCLA) activity score, Harris hip score, and RAND-36 were also completed at these intervals.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 177 - 177
1 Sep 2012
Carsen S Beaulé PE Willis B Ward L Rakhra K Dunlap H Moroz P
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Purpose

The importance of femoral head-neck morphology in the development of early hip osteoarthritis is recognized in femeroacetabular impingement (FAI), however no studies have examined FAI morphology in the developing hip, i.e. pre-closure of the proximal femoral physis. We developed a pilot project to study prevalence of CAM-type FAI hip morphology in both the pre- and post-closure proximal femoral physes of asymptomatic children using MR-imaging. We also examined biologic markers possibly related to FAI etiology, including Vitamin D metabolites, BMI, family history, and activity levels.

Method

Recruitment included volunteers with asymptomatic lower extremities, and either pre- or post-closure of the proximal femoral physis. Males were 10–12 years (pre-closure) or 15–18 years (post-closure); females were 8–10 years or 14 18 years. Phlebotomy and urine sampling were used to assess metabolic markers. MRI of bilateral hips and a clinical exam including hip impingement tests were conducted. MR imaging assessment was independent and blinded and recorded using established parameters including alpha angles measured at both the 3:00 (anterior head-neck junction) and 1:30 (antero-superior head-neck junction) radial image positions.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 165 - 165
1 Sep 2012
Powell JN Beaulé PE Antoniou J Bourne RB Schemitsch EH Vendittoli P Smith F Werle J Lavoie G Burnell C Belzile É Kim P Lavigne M Huk OL O'Connor G Smit A
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Purpose

The purpose of the study was to determine the rate of conversion from RSA to THR in a number of Canadian centers performing resurfacings

Method

Retrospective review was undertaken in 12 Canadian Centers to determine the rate of revision and reason for conversion from RSA to THR. Averages and cross-tabulation with Chi-Squared analysis was performed. kaplan Meier survivorship was calculated.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 41 - 41
1 Sep 2012
Beaulé PE Speirs AD Sylvester SE Nishiwaki T Hamdi A
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Purpose

Primary uncemented total hip arthroplasty is the fixation of choice for most patients undergoing hip replacement in North America. Initial stem stability will be detected by the fit and fill of the implant to the bone as well as the overall stem geometry as it relates to its mechanical stability. This study aims to determine the geometric and structural parameters of common cementless tapered femoral stems to better understand their early clinical performance with respect to bony fixation.

Method

Templates for six proximally coated tapered uncemented femoral stems: Accolade (Stryker), Profemur (Wright), Taperloc (Biomet), M/L Taper (Zimmer), Anthology (Smith-Nephew) and Trilock (Depuy) were scanned and saved as images on a PC. Stem sizes were assigned according to AP plane width measurements taken at the most lateral implant shoulder, and images analyzed using ImageJ (US National Institutes of Health). Measurements were made of stem length, and at various locations, the width and thickness of the stem. Coronal plane stiffness was calculated according to beam theory, assuming an elastic modulus of 114 GPa for the Profemur, Taperloc M/L Taper, Anthology and Trilock stems. The Accolade stem has a modulus of 85.5 GPa. due to TMZF alloy which is 25% more flexible. Stem thickness and taper ratios were calculated as a measure of lateral vs. AP fill of the femur. All measurements were plotted as manufacturer-specific curves relative to stem width.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 159 - 159
1 Sep 2012
Beaulé PE Dinh L Gauthier L Kim PR Feibel RJ Thurston PR Giachino AA
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Purpose

Use of a large femoral head metal-on-metal bearing in total hip arthroplasty may offer an advantage in terms of dislocation rates and more natural joint kinematics. The acetabular component is more rigid however in these prostheses and if not placed accurately can lead to increased levels of metal ion release. A prospective randomized controlled trial was conducted to quantify bone mineral density on the acetabular side, as well as compare metal ion levels from a standard metal-on-polyethylene bearing to a large head metal-on-metal bearing in primary total hip arthroplasty.

Method

Fifty patients were randomized to receive total hip arthroplasty with either the CONSERVE A-Class Total Hip with BFH femoral head or the Lineage acetabular component with polyethylene insert and cobalt chrome femoral head. There were 27 females (11 BFH) and 23 males (14 BFH), with a mean overall age of 61.6 (range 47.7–73.2). Serum levels of cobalt, chromium, and titanium were measured at regular intervals up to two years. Harris Hip Score, WOMAC, UCLA, and RAND-36 were completed at these same intervals. Standard radiographs as well as periprosthetic BMD were performed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 108 - 108
1 Sep 2012
March GM Elfatori S Beaulé PE
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Purpose

Transfusion rates after primary total hip has been reported up to 39.2%. The purpose of our study was to evaluate the efficacy of TXA in minimizing risk of allogeneic blood transfusion after primary total hip and hip resurfacing arthroplasty.

Method

Retrospective data on a cohort of 88 patients undergoing total hip arthroplasty and 44 who undergoing hip resurfacing arthroplasty who received a single pre-operative bolus of 1g TXA was compared with a control group matched for starting haemoglobin (Hg), body mass index (BMI), age, gender, blood loss, surgical time, and surgeon. All procedures were completed at a single institution with standardized post-operative care. Endpoints included allogeneic blood transfusion rate, post operative day one Hg, and overall Hg decrease.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VIII | Pages 48 - 48
1 Mar 2012
Beaulé PE
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The renewed interest in the clinically proven low wear of the metal-on-metal bearing combined with the capacity of inserting a thin walled cementless acetabular component has fostered the reintroduction of hip resurfacing. As in other forms of conservative hip surgery, i.e. pelvic osteotomies and impingement surgery, patient selection will help minimize complications and the need for early reoperation.

Patient Selection and Hip Resurfacing

Although hip resurfacing was initially plagued with high failure rates, the introduction of metal on metal bearings as well as hybrid fixation has shown excellent survivorships of 97 to 99% at 4 to 5 years follow-up. However, it is important to critically look at the initial published results. In all of these series there was some form of patient selection. For example, in the Daniel and associates publications, only patients with osteoarthritis with an age less than 55 were included with 79% of patients being male. Treacy and associates stated that: “the operation was offered to men under the age of 65 years and women under the age of 60 years, with normal bone stock judged by plain radiographs and an expectation that they would return to an active lifestyle, including some sports”. However in the materials and methods, although the mean age is 52 years, the range is from 17 to 76 years including some patients with rheumatoid arthritis as well as osteonecrosis. Obviously, some form of patient selection is needed; but how one integrates them is where the Surface Arthroplasty Risk Index (SARI) is useful. With a maximum score of 6, points are assigned accordingly: femoral head cyst >1cm: 2 points; patient weight <82kg: 2 points; previous hip surgery: 1 point; UCLA Activity level >6: 1 point.

A SARI score >3 represented a 4 fold increase risk in early failure or adverse radiological changes and with a survivorship of 89% at four years. The SARI index also proved to be relevant in assessing the outcome of the all cemented McMinn resurfacing implant (Corin¯, Circentester, England) at a mean follow-up of 8.7 years. Hips which had failed or with evidence of radiographic failure on the femoral side had a significantly higher SARI score than the remaining hips, 3.9 versus 1.9. Finally, one must consider the underlying diagnosis when evaluating a patient for hip resurfacing. In cases of dysplasia, acetabular deficiencies combined with the inability of inserting screws through the acetabular component may make initial implant stability unpredictable. This deformity in combination with a significant leg length discrepancy or valgus femoral neck could compromise the functional results of surface arthroplasty, and in those situations a stem type total hip replacement may provide a superior functional outcome. In respect to other diagnoses (osteonecrosis, inflammatory arthritis), initial analyses have not demonstrated any particular diagnostic group at greater risk of earlier failure. The only reservation we have is in patients with compromised renal function since metal ions generated from the metal-on-metal bearing are excreted through the urine and the lack of clearance of these ions may lead to excessive levels in the blood.

Surgical Technique

Because resurfacing has not been within the training curriculum of orthopaedic surgeons for the last 2 decades, there will most likely be a learning curve in the integration of this implant within clinical practice. This data was confirmed for hip resurfacing when looking at the Canadian Academic Experience where in the first 50 cases of five arthroplasty surgeons only a 3.2% failure rate was noted of which 1.6% were due to neck fracture. Femoral neck fracture can occur because of significant varus positioning as well as osteonecrosis of the femoral head due to either disruption of the blood supply or over cement penetration. Finally, abnormal wear patterns leading to severe soft tissue reactions are being increasingly recognized and are related to either impingement or vertically placed acetabular components. Although impingement has long been recognized after total hip arthroplasty to limit range of motion and in extreme cases to hip instability, the risk after hip resurfacing may be greater since the femoral head-neck unit is preserved. Beaulé and associates have reported that 56% of hips treated by hip resurfacing have an abnormal offset ratio pre-operatively, with the two main diagnostic groups presenting deficient head-neck offset being osteonecrosis and osteoarthritis both of which have been associated with femoroacetabular impingement in the pre arthritic state.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VIII | Pages 41 - 41
1 Mar 2012
Beaulé PE
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Femoral neck fractures remain the leading cause of early failure after metal-on-metal hip resurfacing. Although its' exact pathomechanism has yet to be fully elucidated, current retrieval analysis has shown that either an osteonecrotic event and/or significant surgical trauma to the femoral head neck junction are the leading causes. It is most likely that no single factor like patient selection and/or femoral component orientation can fully avoid their occurrence. As in osteonecrosis of the native hip joint, a certain cell injury threshold may have to be reached in order for femoral neck fracture to occur. These insults are not limited to the surgical approach, but also include femoral head preparation, neck notching, and cement penetration.

Although some have argued that the posterior approach does not represent an increased risk fracture for ON after hip resurfacing because of the so-called intraosseous blood supply to the femoral head, to date, the current body of literature on femoral head blood flow in the presence of arthritis has confirmed the critical role of the extraosseous blood supply from the ascending branch of the medial circumflex, as well as the lack of any substantial intraosseous blood supply. Conversely, anterior hip dislocation of both the native hip joint as well as the arthritic hip preserves femoral head vascularity. The blood supply can be compromised by either sacrificing the main branch of the ascending medial femoral circumflex artery or damaging the retinacular vessels at the femoral head-neck junction. Thus an approach which preserves head vascularity, while minimizing soft tissue disruption would certainly be favorable for hip resurfacing. This presentation will review the current state of knowledge on vascularity of the femoral head as well as surgical techniques enhancing its preservation.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 567 - 567
1 Nov 2011
Beaulé PE Smith F Powell JN Antoniou J Bourne RB Lavigne M Belzile E Schemitsch EH Garbuz D
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Purpose: Recently, there has been concern raised on the occurrence of pseudotumors after metal on metal hip resurfacing. A pseudotumor is defined as a local soft tissue mass associated with localized bony and/or tissue (muscle) destruction. The primary purpose of this study is to determine the incidence of this complication in several high volume Canadian academic centres.

Method: Nine of the 11 Canadian academic centres who perform metal on metal hip resurfacings were surveyed. The number of metal on metal hip resurfacing arthroplasties performed at each centre was first determined, as were the number of those who have presented with a pseudotumour, and subsequently gone on to revision surgery. The basic demographics of the group were recorded, as were the radiographic and implant design variables for those cases presenting with a pseudotumour.

Results: A sample of 3,400 hip resurfacing arthroplasties performed between 2002 and December 2008 were surveyed. Demographics were tabulated for a sub-sample of these patients. 76% were male, the mean length of follow-up was 3.02 years, mean BMI was 28.65, and mean age was 52.10 years. Three of 3,400 cases presented with a pseudotumour, an incidence of .09%.

Conclusion: Although pseudotumors remain a concern after metal on metal hip resurfacing, the incidence at short to mid term follow-up is very low in this multi-centre academic survey. This information is significantly lower than what other groups have recently reported. Continued close monitoring is required in order to determine what clinical factors are at play.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 561 - 561
1 Nov 2011
Beaulé PE Poitras S Dervin GF
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Purpose: The Quality of Recovery-40 questionnaire (QoR-40) has been developed, validated and extensively used to assess the quality of life of patients following major surgery. It is composed of 40 questions answered by the patient and organized into six dimensions: emotional state, physical comfort, psychological support, physical independence, pain, and global score. However, this questionnaire has not been validated in an orthopaedic population. The objective of the study was to assess the psychometric properties of the QoR-40 in a population of patients undergoing total knee or hip arthroplasty.

Method: Sixty seven patients undergoing total knee arthroplasty and 65 patients undergoing total hip arthroplasty were recruited. Patients were assessed with the QoR-40 and the SF-12, a validated generic quality of life questionnaire, at the following seven times: three and one week pre-operative; one, two and three days post-operative (short-term); one and three months post-operative (long-term). The following psychometric properties of the QoR-40 were assessed: reliability between three and one week pre-operative using intra-class correlation coefficients (ICC), construct validity with the SF-12 using Pearson product moment correlations, responsiveness to change using effect sizes, floor and ceiling effects, and predictive validity of short-term QoR-40 scores of long-term SF-12 scores.

Results: All dimensions and global scores of the QoR-40 appeared reliable, with ICCs’ ranging from 0.75 to 0.84. For construct validity, physical dimension scores of the QoR-40 (physical comfort, physical independence, pain) were weakly or not significantly related to the physical component scale of the SF-12 (−0.09 to 0.34), except for long-term where the correlations were moderate (0.35 to 0.62). The emotional state score of the QoR-40 was moderately to substantially related to the mental component scale of the SF-12 for all periods (0.40 to 0.78). Effect sizes were higher for the QoR-40 when compared to the SF-12 in the intervals of the first month, while they were higher for the SF-12 in the intervals above one month. The QoR-40 demonstrated ceiling effects for the physical independence dimension pre-operatively and three months post-operatively, and for all periods for the psychological support dimension. As for predictive validity, short-term post-operative QoR-40 scores were weakly or not significantly predictive of long-term postoperative SF-12 scores (0.01 to 0.41).

Conclusion: The QoR-40 appears to be a reliable tool assessing a quality of life construct different from the SF-12 and more responsive to change during the short-term follow-up to surgery. The QoR-40 could be used to assess short-term quality of life following surgery. The QoR-40 should not be used to predict long-term quality of life. To further improve the tool, the psychological support dimension of the QoR-40 should be reconceptualized because of ceiling effects.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 555 - 555
1 Nov 2011
White C Castellaro JL Beaulé PE Kim P
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Purpose: Although femoral neck fractures remain a concern in terms of short term failures for hip resurfacing, acetabular component position and fixation are increasingly being recognized as causes of mid term failures for hip resurfacing. The purpose of our study was to evaluate the migration pattern of a cementless acetabular component for a metal on metal hip resurfacing.

Method: Between January 2006 and June 2007, 130 patients underwent metal on metal hip resurfacing; 66 hips in 60 patients were included in this analysis. Forty-eight patients were male and 12 were female, with a mean age of 50 (range, 32–66). Ninety-five percent of the surgeries were performed for osteoarthritis. All surgeries were performed by two surgeons using the Conserve Plus (Wright Medical Technology, Memphis, TN) hip resurfacing system. The acetabular component is a monoblock cobalt chrome with a porous beaded surface for osteointegration. In all cases acetabular migration was measured both vertically and horizontally, on serial radiographs using the computer-assisted Ein Bild Röntgen Analyse (EBRA) method. A minimum of three comparable radiographs is necessary for calculating the migration curves. We scored medial migration as negative horizontal movement.

Results: At a mean follow up 25.3 months (range, 24–36 months), each hip had an average of 5.1 radiographs for analysis. The software excluded two cases for poor comparability ending finally with 64 cases for the analysis. Eighty-seven point five per cent of the cups showed less than 1 mm migration in the medium-lateral axis and 54.7% less than 1 mm in the vertical axis. Seventy-seven percent of the cups showed a combined migration of less than 2 mm in the observation period, without radiolucencies, leaving 23% of the acetabular components with 2 mm or greater of component migration. One of these cases required revision for aseptic loosening at 34 months.

Conclusion: In our study the majority of the acetabular components were stable with some of the migration observed secondary to lack of complete initial seating due to the rigidity of the shell. Krismer et al did report on the migration of the PCA shell (also a porous beaded cobalt-chrome shell) using EBRA, with 27.5% of the shells demonstrating > 1 mm of migration. Although hip resurfacing has only mid term followup, results have been good to excellent. Caution should still be maintained since the higher frictional torque generated by the larger femoral head size as well as the nanometer size particles could negatively affect long term fixation of the acetabular component.