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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_3 | Pages 44 - 44
1 Mar 2021
Vogel D Finless A Grammatopoulos G Dobransky J Beaulé P Ojaghi R
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Surgical treatment options for Femoroacetabular impingement (FAI) includes both surgical dislocation and hip arthroscopy techniques. The primary aim of this study was to evaluate and compare the survivorship of arthroscopies (scope) and surgical dislocations (SD) at minimum 5-year follow-up. The secondary aim was to describe differences in functional outcomes between the 2 groups.

This was a retrospective, single surgeon, consecutive, case-series from a large tertiary care centre. We evaluated all surgeries that were performed between 2005 and 2011. Our institutional database was queried for any patient undergoing surgery for FAI (pincer (n=23), cam (n=306), or mixed (n=103) types). Patients with childhood pathologies i.e. Legg Calve Perthes and slipped capital femoral epiphysis were excluded. This resulted in 221 hips (169 males, 52 females) who underwent either SD (94, 42.5%) or scope (127, 57.5%). A manual chart review was completed to identify patients who sustained a complication, underwent revision surgery or progressed to a total hip arthroplasty (THA). In addition, we reviewed prospectively collected patient reported outcome measure (PROMs) using (SF12, HOOS, and UCLA). Survivorship outcome was described for the whole cohort and compared between the 2 surgical groups. PROMs between groups were compared using The Mann-Whitney U test and the survival between groups was assessed using the Kaplan-Meier Analysis and the Log-Rank Mantel Cox test. All analyses were performed in SPSS (IBM, v. 26.0).

The cohort included 110 SDs and 320 arthroscopies. The mean age of the whole cohort was 34±10; patients in the SD group (32±9) were younger compared to the arthroscopy group (39±10) (p<0.0001). There were 16 post-operative complications (similar between groups) and 77 re-operations (more common in the SD group (n=49) due to symptomatic metal work (n=34)). The overall 10-year survival was 91±3%. Survivorship was superior in the arthroscopy group at both 5- (96% (95%CI: 93 – 100)) and 8- years 94% (95%CI: 90 – 99%) compared to the SD Group (5-yr: 90% (95%CI: 83 – 98); 8-yr: 84% (95%CI:75 – 93)) (p=0.003) (Figure 1). On average HOOS improved from 54±19 to 68±22 and WOMAC from 65±22 to 75±22. The improvement in PROMs were similar between the 2 groups.

We report very good long-term joint preservation for the treatment of FAI, which is similar to those reported in hip dysplasia. In addition, we report satisfactory improvement in function following such treatment. The differences reported in joint survival likely reflect selection biases from the treating surgeon; more complex cases and those associated with more complex anatomy were more likely to have been offered a SD in order to address the pathology with greater ease and hence the inferior joint preservation identified in this group.

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


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_3 | Pages 57 - 57
1 Mar 2021
Sanders E Dobransky J Finless A Adamczyk A Wilkin G Liew A Gofton W Papp S Beaulé P Grammatopoulos G
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Management of acetabular fractures in the elderly population remains somewhat controversial in regards to when to consider is open reduction internal fixation (ORIF) versus acute primary total hip. study aims to (1) describe outcome of this complex problem and investigate predictors of successful outcome.

This retrospective study analyzes all acetabular fractures in patients over the age of 60, managed by ORIF at a tertiary trauma care centre between 2007 and 2018 with a minimum follow up of one year. Of the 117 patients reviewed, 85 patients undergoing ORIF for treatment of their acetabular fracture were included in the analysis. The remainder were excluded based management option including acute ORIF with THA (n=10), two-stage ORIF (n=2), external fixator only (n=1), acute THA (n=1), and conservative management (n=1). The remainder were excluded based on inaccessible medical records (n=6), mislabelled diagnosis (n=6), associated femoral injuries (n=4), acetabular fracture following hemiarthroplasty (n=1). The mean age of the cohort is 70±7 years old with 74% (n=62) of patients being male. Data collected included: demographics, mechanism of injury, Charlson Comorbidity Index (CCI), ASA Grade, smoking status and reoperations. Pre-Operative Radiographs were analyzed to determine the Judet and Letournel fracture pattern, presence of comminution and posterior wall marginal impaction. Postoperative radiographs were used to determine Matta Grade of Reduction. Outcome measures included morbidity-, mortality- rates, joint survival, radiographic evidence of osteoarthritis and patient reported outcome measures (PROMs) using the Oxford Hip Score (OHS) at follow-up. A poor outcome in ORIF was defined as one of the following: 1) conversion to THA or 2) the presence of radiographic OA, combined with an OHS less than 34 (findings consistent with a hip that would benefit from a hip replacement). The data was analyzed step-wise to create a regression model predictive of outcome following ORIF.

Following ORIF, 31% (n=26) of the cohort had anatomic reduction, while 64% (n=54) had imperfect or poor reduction. 4 patients did not have adequate postoperative radiographs to assess the reduction. 31 of 84 patients undergoing ORIF had a complication of which 22.6% (n=19) required reoperation. The most common reason being conversion to THA (n=14), which occurred an average of 1.6±1.9 years post-ORIF. The remainder required reoperation for infection (n=5). Including those converted to THA, 43% (n=36) developed radiographic OA following acetabular fracture management. The mean OHS in patients undergoing ORIF was 36 ± 10; 13(16%) had an OHS less than 34. The results of the logistic regression demonstrate that Matta grade of reduction (p=0.017), to be predictive of a poor outcome in acetabular fracture management. With non-anatomic alignment following fixation, patients had a 3 times greater risk of a poor outcome. No other variables were found to be predictive of ORIF outcome.

The ability to achieve anatomic reduction of fracture fragments as determined by the Matta grade, is predictive of the ability to retain the native hip with acceptable outcome following acetabular fracture in the elderly. Further research must be conducted to determine predictors of adequate reduction in order to identify candidates for ORIF.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_5 | Pages 36 - 36
1 Jul 2020
DaVries Z Salih S Speirs A Dobransky J Beaule P Grammatopoulos G Witt J
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Purpose

Spinopelvic parameters are associated with the development of symptomatic femoroacetabular impingement and subsequent osteoarthritis. Pelvic incidence (PI) characterizes the sagittal profile of the pelvis and is important in the regulation of both lumbar lordosis and pelvic orientation (i.e. tilt). The purpose of this imaging-based study was to test the association between PI and acetabular morphology.

Methods

Measurements of the pelvis and acetabulum were performed for 96 control patients and 29 hip dysplasia patients using 3D-computed topography (3D-CT) scans. Using previously validated measurements the articular cartilage and cotyloid fossa area of the acetabulum, functional acetabular version/inclination, acetabular depth, pelvic tilt, sacral slope, and PI were calculated. Non-parametric statistical tests were used; significance was set at p<0.05.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_1 | Pages 102 - 102
1 Feb 2020
Beaule P Galmiche R Lafleche J Gofton W Dobransky J Moreau G
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Background

Over 35% of surgeons in the United States, and 10% in Canada use the direct anterior approach for primary total hip arthroplasty (THA). Some of the key barriers in its wider adoption are the learning curve and associated increased risk of adverse events. The purpose of this study was to determine the adoption rate as well as 90-day re-admission and adverse event of the anterior approach in a community-based hospital.

Methods

From December 2015 to August 2018, two laterally based approach senior orthopaedic surgeons with over 20 years of practice performed 319 primary total hip replacements, with 164 being done through the anterior approach and 155 through the lateral approach. All but 8 of the anterior approaches were done on a regular operating table.


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_9 | Pages 20 - 20
1 May 2018
Grammatopoulos G Gofton W Cochran M Dobransky J Carli A Abdelbary H Gill H Beaulé P
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Introduction

The resultant cup orientation depends upon the orientation of the pelvis at impaction. No studies to date have assessed whether patient-position during total hip arthroplasty (THA) has an effect on cup orientation. This study aims to 1) Determine the difference in pelvic position that occurs between surgery and radiographic, supine, post-operative assessment; 2) Examine how the difference in pelvic position influences subsequent cup orientation and 3) Establish whether pelvic orientation, and thereafter cup orientation, differences exist between THAs performed in the supine versus the lateral decubitus positions.

Patients/Materials & Methods

This is a retrospective, multi-surgeon, single-centre, consecutive series. 321 THAs who had intra-operative, post-cup impaction, AP pelvic radiograph, in the operative position were included; 167 were performed with the patient supine (anterior approach), whilst 154 were performed in the lateral decubitus (posterior approach). Cup inclination/anteversion was measured from intra- and post-operative radiographs and the difference (Δ) was determined. Change in pelvic position (tilt, rotation, obliquity) between surgery and post-operatively was calculated from Δinclination/anteversion using the Levenberg-Marquardt algorithm.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_9 | Pages 21 - 21
1 May 2018
Grammatopoulos G Gofton W Coyle M Dobransky J Kreviazuk C Kim P Beaulé P
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Introduction

The mechanisms of how spinal arthrodesis (SA) affects patient function after total hip replacement (THA) remain unclear. The objectives of this study were to a) Determine how outcome post-THA compares between patients with- and without-SA, b) Characterize sagittal pelvic changes that occur when moving between different functional positions, and test for differences between patients with- and without-SA, and c) Assess whether differences in sagittal pelvic dynamics are associated with outcome post-THA.

Patients/Materials & Methods

Forty-two patients with THA-SA (60 hips) were case-control matched for age, gender, BMI with 42 THA-only patients (60 hips). All presented for review where outcome, PROMs [including Oxford-Hip-Score(OHS)] and 4 radiographs of the pelvis and spino-pelvic complex in 3 positions (supine, standing, deep-seated) were obtained. Cup orientation and various spino-pelvic parameters [including pelvic tilt (PT) and Pelvic-Femoral-Angle (PFA)] were measured. The difference in PT between standing and seated allowed for patient classification based on spino-pelvic mobility into normal (±10–30°), stiff (<±10°) or hypermobile (>±30°).


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_9 | Pages 25 - 25
1 May 2018
Grammatopoulos G Jamieson P Dobransky J Rakhra K Carsen S Beaule P
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Introduction

This study aims to determine how the acetabular version changes during the key developmental stage of adolescence, and what contributes to this change. In addition, we examined whether patient factors (BMI, activity levels) or the femoral-sided anatomy contribute to any observed changes.

Patients/Materials & Methods

This prospective longitudinal cohort study included 19 volunteers (38 healthy hips). The participants underwent clinical examination (BMI, range of movement assessment), MRIs of both hips at recruitment and at follow-up (6 ± 2 years) and HSS Paediatric Functional Activity Brief Scale (Pedi-FABS) questionnaire. MRI scans were assessed at both time points to determine change of the tri-radiate cartilage complex (TCC), the acetabular anteversion, the degree of anterior, posterior, and superior femoral head coverage by the acetabulum, and anterior and antero-superior alpha angles. We investigated if the change in anteversion and sector angles was influenced by the BMI, range of movement measurements, the Pedi-FABS or the alpha angle measurements.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_20 | Pages 90 - 90
1 Nov 2016
Gauthier-Kwan O Dervin G Dobransky J
Full Access

An outpatient TKA program was developed by integrating advances in analgesia, rehabilitation, and minimally invasive surgical techniques with the objective of improving value in elective total knee arthroplasty (TKA) while maintaining quality standards. Previous studies have established the safety of outpatient TKA in selected populations, but the literature is devoid of outcome measures in these patients. Our goal was to investigate the quality of recovery, patient satisfaction, and safety profile in the first 90 days undergoing outpatient TKA.

One hundred TKAs in 93 consecutive patients with end-stage arthritis of the knee candidate for primary TKA were enrolled in this prospective matched cohort study. Patients that underwent inpatient TKA (47 TKAs) were compared with patients that underwent planned outpatient TKA (53 TKAs). The following 28 day post-operative scores were recorded: quality of recovery (QoR-18) and pain scores by Numerical Rating Scale (NRS-11). Satisfaction with pain control (0 to 10) and quantity of opioid use was collected. Secondary outcome measures of 90-day complications, readmissions, and emergency department (ED) visits were recorded.

Ninety-six percent of patients planned for outpatient TKA met our defined multidisciplinary criteria for same-day discharge. QoR-18 at post-operative day one was statistically higher in the outpatient TKA group. Otherwise, outcome measures were not statistically different between the 2 groups. Two patients required overnight admission: 1 for extended motor-block and 1 for vasovagal syncope. There were 7 ED visits in the in the outpatient group and 4 in the inpatient group. One outpatient was admitted for irrigation and debridement with liner exchange for an acute infection 2 weeks post-operatively. One inpatient required manipulation under anesthesia at six weeks post-operatively.

Outpatient TKA in selected patients produced a post-operative quality of recovery and patient satisfaction similar to that of inpatient TKA. Our results support that outpatient TKA is a safe alternative that should be considered due to its potential cost-savings and comparable recovery.