Recent studies indicate the benefits of total hip arthroplasty (THA) by using femoral neck-preserving short-stem implants (March et al 1999). These benefits rely on the preservation of native hip structure and improved physiological loading. However, further investigation is needed to compare the outcome of these implants versus the conventional neck-sacrificing stems particularly assessed by patient-reported outcomes (PROs). In this study, we have investigated the differences in PROs between a neck-sacrificing stem design and neck-preserving short stem design (MiniHip, Corin Inc.). We hypothesized higher PROs outcome in patients who received treatment by using neck-preserving implants. In this study, we retrospectively analyzed the pre and post-operative PROs of patients receiving THA treatment by using neck-sacrificing implant (n=90, age 57±7.9 years) and a matched (BMI, age) cohort group of neck-preserving patients (n=105, age 55.16±9.88 years). Hip disability and Osteoarthritis Outcome Scores (HOOS) were using with the follow-up of similar follow up of 412.76 ± 206.98 days (neck sacrificing implant) and 454.63 ± 226.99 days (Neck-Preserving). Multivariate analysis of variance and Mann-Whitney tests were conducted for statistical analyses. Holm-Bonferroni adjusted for multiple comparisons was used with initial significance level of 0.05.Background
Methods
Total Hip Arthroplasty (THA) has long been the standard treatment for cases in which non-surgical alternatives have failed to improve pain and function in hip osteoarthritis (OA) patients. Outcomes from THA have improved over time with better surgical techniques and improved implant designs. While conventional neck-sacrificing implants have been associated with favorable outcomes, there is evidence to suggest biomechanical advantages of newer, femoral neck-preserving short-stem implants, including the Corin MiniHip. However, there is a still a gap of knowledge regarding the potential benefits of the MiniHip stem over conventional neck-sacrificing stems in regards to patient-reported outcomes (PROs). In this study, we investigated the differences between a neck-sacrificing stem design and neck-preserving short-stem design (MiniHip, Corin Inc.) arthroplasty concerning PROs, and considering the known features of the short stem design, we hypothesized that MiniHip THA would be associated with improved PROs in comparison to a neck-sacrificing implant system. We further sought to investigate gender effects related to MiniHip or conventional stem surgery. Neck-sacrificing implant patients (n=90, age 57±7.9 years, female=58, male=32) and a matched (matching criteria: follow-up period, BMI, age) cohort group of MiniHip patients (n=105, age 55.16±9.88 years, female: 25, male: 80) reported both pre-operative and post-operative Hip disability and Osteoarthritis Outcome Scores (HOOS) at a minimum interval of 6 months post-operatively and up to three years postoperatively. We applied MANCOVA analysis to compare patient-reported outcome subscores from each group using follow-up period as a covariate and employing gender as an additional grouping factor to evaluate gender effects. Statistical significance was set at α=0.05 and Bonferroni corrections were applied to account for multiple comparisons.Background
Methods
A variety of patient reported outcome (PRO) surveys have been established and validated to evaluate the effectiveness of surgical interventions. The Hip Disability and Osteoarthritis Outcome Score (HOOS) has been validated as one method to evaluate the effectiveness of total hip arthroplasty patients. This PRO facilitates the assessment of factors that alter patient outcomes in hip arthroplasty. This retrospective study assesses the effect of psychological post-operative expectations on HOOS in total hip arthroplasty patients. In this pilot study, patient data was collected for 499 patients using the AAOS established Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) [1] and HOOS surveys. Patient data was matched using similar preoperative HOOS scores to allow for comparable room for improvement in HOOS score postoperatively. These patients were placed into groups of high performers and low performers. HOOS is based on a 0 to 100 scale, 100 as the best. High performers were defined as those with a ratio of change in HOOS score between preoperative and postoperative over the highest difference in score possible (reaching a postoperative HOOS of 100) of 1. Low performers were defined as those with the aforementioned ratio, but under the value of 0.3. Using these defined groups we were able to compare the summation of patient specific MODEMS scores using a univariate regression. The HOOS growth ratio is calculated based on the following. HOOS growth ratio = (HOOS postop – HOOS preop)/(100-HOOS preop) A principal component analysis (PCA) was conducted to identify the significant group of factors that could identify changes in the outcome of 41 patients (20 low performers and 21 high performers).Introduction
Method
Hip Resurfacing has been shown to be a valuable treatment for younger osteoarthritis patients related to functional outcomes. On the other hand, there is a higher risk for potential neck fractures and there is serious concern over metal-ion release and related health risks associated with the current metal-on-metal designs. Neck-preserving, short-stem implants may be a good alternative for younger patients. The current study investigated patient-reported outcomes from resurfacing and total hip arthroplasty (THA) with a neck preserving, short-stem implant (Corin MiniHip®). Hip disability and osteoarthritis outcome scores (HOOS) from a young group of patients (n= 52, age 48.9±6.1 years) who underwent hip resurfacing surgery and a cohort of patients who underwent MiniHip® THA surgery (n=73, age 48.2±6.6) were compared. MANCOVA analysis was conducted including follow-up period as covariate. To compare complexity of the surgical intervention, the average durations for both types of surgery were compared using non-parametric testing (Mann-Whitney's U).Introduction
Methods
The application of digital radiography in orthopaedic settings has facilitated the improvement in the retention and utilization of these images in pre and post-operative assessments [1]. In addition to the cost-effectiveness of such technology the use of digital imaging combined with advanced computer image processing software such as TraumaCadTM software system (TraumaCad, BRAINLAB, Westchester, IL, USA) can provide more accurate details about patients in total hip replacement arthroplasty (THA), a process traditionally called preoperative templating [2] by which intraoperative complications are minimized and overall surgical time is reduced[3]. In a study of 486 patients we demonstrated that patients demographic had significant effect on the outcome of the measurement and utilizing them in a predictive model had helped with improving the results [4]. In this study, we aimed to improve and optimize the proposed algorithm by utilizing more patients’ information and improving the model by using a nonlinear relationship. Our main hypothesis in this study was that the model would significantly predict the actual implant size based on the preoperative assessments. We analyzed the outcome of digital radiographs of 1018 patients who were treated with THA. Digital radiographs were acquired in the anteroposterior view of the pelvis centered over the pubic symphysis. The hip was internally rotated 10° to 15°. We evaluated multiple interactions and nonlinear models and developed the most significant model based on the available clinical data.Introduction
Method
Minimum
Maximum
Mean
Std. Deviation
Templated Acetabulum Size
44.00
64.00
54.12
4.05
Height (m)
147.32
202.20
172.02
10.73
Weight (kg)
39.10
139.10
84.44
19.67
BMI
15.48
43.06
28.33
5.18
Acetabular Size
44.00
64.00
54.25
3.75
11%–19% of patients are unsatisfied with outcomes from Total Knee Arthroplasty (TKA). This may be due to problems of alignment or soft-tissue balancing. In TKA, often a neutral mechanical axis is established followed by soft tissue releases to balance and match the flexion/extension gaps with the distal femoral and proximal tibial resections at right angles to the mechanical axis. Potential issues with establishment of soft tissue balance are due to associated structures such as bone tissue of the knee, the static (or passive) stabilizers of the joint (medial and lateral collateral ligaments, capsule, and anterior and posterior cruciate ligaments), and the dynamic (or active) stabilizers around the knee. An optimized balance among these systems is crucial to the successful outcome of a TKA. Additionally, the importance of correct femoral rotation has been well documented due to its effect on patella alignment and flexion instability, range of motion, and polyethylene wear. There are several methods used in TKA procedures to establish femoral component rotation. The more prominent ones are a conventional method of referencing to the posterior condylar axis with a standard external rotation of 3° (PCR), anterior-posterior line or “Whiteside's line” (AP axis), transepicondylar axis (TEA) (Figure 1), and the gap balancing technique, however, it is not yet clear, which method is superior for femoral rotational component alignment. In the current study, we sought to investigate an alternative method based on soft-tissue, dynamic knee balancing (DKB) while using an alternative analysis approach. DKB dictates femoral component rotation on the basis of ligament balance and force measures. DKB has become more prominent in TKA surgeries. While retaining ligament balance in TKA, it is possible that this technique also leads to higher precision of rotational alignment to the anatomical axis. The primary objective of this study was to compare efficiency of DKB versus other methods for rotational implant alignment based on post-surgery computed tomography (CT). 31 patients underwent computer-navigated total knee arthroplasty for osteoarthritis with femoral rotation established via a flexion gap balance device (Synvasive eLibra). Alternative, hypothetical alignments were assessed based on anatomical landmarks during the surgery. Postoperative computed tomography (CT) scans were analyzed to investigate post-surgery rotational alignment. Repeated measures ANOVA and Cochran's Q test were utilized to test differences between the DKB method and the other techniques.Introduction
Methods
The application of digital radiography in clinical settings has provided the opportunity to obtain high quality images while reducing the overall cost of imaging, thus this technology is gaining more popularity in clinical settings specifically in orthopaedic clinics 1. In addition, advanced computer software helps with quick and easy approach to perform preoperative measurements with high accuracy 2. Preoperative templating has become one of the standard of care procedures that prepares the surgical team to lower surgical time and more efficiently face intraoperative complications 3. Commonly, the acetabular cup size and femoral stem size are templated and used for estimation process 4. However, the goal of this study was to investigate whether patients' demographics would play a role in increasing the accuracy of templating. We hypothesized that preoperative implant templating (acetabular and femoral components), gender, weight, height, and body mass index (BMI) would contribute to higher accuracy of templating in total hip arthroplasty (THA). Digital radiographs of 468 patients treated with THA from August 2012 to December 2013 at a single institution were reviewed. They aged 59.96 ±12.50 years and 436 of them were diagnosed with osteoarthritis, 53 with avascular necrosis, 13 with failed THA, 2 with infection, 4 post trauma, and 13 with failed hemi arthroplasty. THA templating was conducted by assessing the anteroposterior view of the pelvis that was centered over the pubic symphysis, with the hips in 10° to 15° of internal rotation and we utilized a lateral frog-leg view of the affected hip. A backward stepwise multiple regression model was used to exclude the parameters that had no significant contribution to the accuracy of the measurement.Introduction
Method
