A staging system has been developed to revise the 1994 ARCO classification for ONFH. The final consensus resulted in the following 4-staged system: stage I—X-ray is normal, but either magnetic resonance imaging or bone scan is positive; stage II—X-ray is abnormal (subtle signs of osteosclerosis, focal osteoporosis, or cystic change in the femoral head) but without any evidence of subchondral fracture, fracture in the necrotic portion, or flattening of the femoral head; stage III—fracture in the subchondral or necrotic zone as seen on X-ray or computed tomography scans. This stage is further divided into stage IIIA (early, femoral head depression ≤2 mm) and stage IIIB (late, femoral head depression >2 mm); and stage IV—X-ray evidence of osteoarthritis with accompanying joint space narrowing, acetabular changes, and/or joint destruction. Radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) scans may all be involved in diagnosing ONFH; however, the optimal diagnostic modality remains unclear. The purpose of this study was to identify: 1) how ONFH is diagnosed at a single academic medical center, and 2) if CT is a necessary modality for diagnosing/staging OFNH. The EMR was queried for the diagnosis of ONFH between 1/1/2008–12/31/2018 at a single academic medical center. CT and MRI scans were reviewed by the senior author and other contributors. The timing and staging quality of the diagnosis of ONFH were compared between MRI and CT to determine if CT was a necessary component of the ONFH work-up.Introduction
Methods
Meaningful clinical improvement as demonstrated through patient-reported outcome measures (PROMs) are increasingly used to evaluate success of total hip arthroplasty (THA) procedures. This patient perspective can provide a full picture when used with clinical data to best evaluate surgical outcomes. All primary THA procedures reported to the American Joint Replacement Registry from 2012–2018 with linked pre-operative and 1-year post-operative functional or anatomical PROMs were included. The achievement of minimal clinically-important difference (MCID) was calculated using the distribution method. Logistic regression models with covariate adjustment for patient demographics, American Society of Anesthesiologists (ASA) score, and body mass index (BMI) were constructed to identify associations with PROMs. Results were analyzed based on hospital size (small, medium and large) and teaching type (non-teaching, minor and major) based on the American Hospital Association Survey (2015).Introduction
Methods
Orthopedic surgeons have relied heavily on opiates after total hip replacement (THR) despite no clear evidence of benefit and a rapidly growing abuse epidemic. Multimodal analgesia may reduce or even obviate the need for opiates after elective surgery. In a cluster-randomized, crossover trial, 235 patients undergoing THR were assigned to receive multimodal analgesia with minimal opiates (Group A-10 tablets), multimodal analgesia with a full opiate supply (Group B-60 tablets), or a traditional opiate regimen without multimodal analgesia (Group C-60 tablets). The multimodal regimen comprised scheduled-dose acetaminophen, meloxicam, and gabapentin. Primary outcomes were daily pain and opiate utilization for the first 30-days. Secondary outcomes included assessments of satisfaction, sleep-quality, opiate-related symptoms, hip function, and adverse events.Background
Methods
