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The Bone & Joint Journal
Vol. 102-B, Issue 7 Supple B | Pages 57 - 61
1 Jul 2020
Woolson ST

Aims. To establish whether there was a consensus among the members of the Hip Society (HS) on the role of direct anterior approach (DAA) contemporary primary total hip arthroplasty (THA). Methods. An online survey was sent to all 112 active and senior members of the HS, to which 71 members responded. The survey was constructed to determine whether they believed that evidence-based medicine proves, in modern clinical practice, that the DAA has significant benefits compared to risks when contrasted with other approaches. In addition, they were asked if they currently used the DAA. Results. While only 16.9% (12/71) of respondents had been trained in a generic anterior approach during residency, 49.3% (35/71) had used the DAA in their clinical practice in the past or were using it at the present time. Unexpectedly, 42.9% (15/35) of respondents who had used the DAA in the past had abandoned it by the time of this survey. Only 22.5% (16/71) of all respondents believed that evidence-based medicine proves that the DAA has significant benefits compared to risks in contrast to other approaches. Conclusion. A comprehensive literature review found only three prospective randomized clinical trials (RCT) comparing the DAA with another approach with greater than one-year follow-up. Two showed minor benefits within the early postoperative period only, and one of those showed poorer mid-term results. Most of the published comparison studies with short follow-up show longer surgical times and greater blood loss for the DAA, and many three-month comparison studies show higher complication rates for the DAA using a proprietary traction table. The complications included problems with wound healing, lateral femoral cutaneous nerve injury, femoral component loosening, and femoral fractures. Because of the lack of evidence from RCTs showing superiority of the DAA over other approaches and reports of higher complications, the opinion of a large majority (77.5%; 55/71) of HS surgeons was that the DAA lacks sufficient evidence to warrant its use. Cite this article: Bone Joint J 2020;102-B(7 Supple B):57–61


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 24 - 24
1 Oct 2019
Florissi IS Galea VP Rojanasopondist P Sauder N Iban YEC Malchau H Bragdon CR
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Introduction. This analysis aims to provide an update of the Level-IV Partners Arthroplasty Registry (PAR), a quality-improvement initiative and research data repository. Methods. The Harris Joint Registry was founded in 1969 and has since expanded to become the Partners Arthroplasty Registry (PAR). Today, the PAR captures data on total hip and total knee arthroplasties conducted at seven hospitals in Massachusetts. Over time, data has been sourced through independent collection at a single hospital, retrospective sourcing through the Research Patient Data Registry (RPDR), and currently through the Enterprise Data Warehouse (EDW). Various statistical methods analyzed changing trends of care provided to patients across affiliated institutions. PROMs collected in the PAR are the PROMIS Physical Function and Global Health Short Forms, the HOOS and KOOS. The registry is an associate member of ISAR and will incorporate the international implant library. Results. The PAR contains demographic, implant-specifics, and radiographic data for 45,645 primary arthroplasties and 8,400 revision surgeries from 1998 to 2018. The average recorded Charlson Comorbidity Index is 0.98. Average length of stay prior to home or care facility discharge decreased from 5.00 days in 2001 to 3.00 days in 2018. The average 30-day and 90-day mortality rates for 2018 were 0. 18% and 0.28%, respectively. Home discharge increased from 30.1% to 79.0% from 2001–2018. The values for these parameters are varied across the seven sites. Conclusion. The PAR can be used to develop best practices, analyze health-care economics, and promote evidence-based medicine. We are also developing a platform for registry development that can be exported by other hospitals that utilize an Epic-based record system. For any tables or figures, please contact the authors directly


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 27 - 27
1 Oct 2019
Woolson ST
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Introduction. The direct anterior approach (DAA) total hip arthroplasty (THA) is now widely used. A recent unpublished survey of 1000 AAHKS members found that over half currently used a DAA technique and that most users felt the DAA was financially beneficial to their practice. Conversely, non-DAA users felt that their surgical volume had decreased. An online survey of Hip Society (HS) members was done to determine member's preference for a surgical approach and opinions regarding the DAA. Methods. 71 of 112 active and senior HS members (63%) responded to this 20-question survey. Results. The survey found that only 17% of respondents had trained in an anterior approach during residency, but that half (35 respondents) had used this approach in practice at one time. Subsequently, 43% of those 35 DAA users had abandoned it. The DAA learning curve was estimated at over 50 cases by 47% of respondents. Only 23% of 71 respondents answered “yes” to the statement “Do you believe that evidence-based medicine proves significant benefits over risks of the DAA THA versus other approaches?” Financial factors were common reasons for beginning to use the technique including accommodating patient requests and preventing the loss of patients to other DAA surgeons. Conclusion. 15 years after the emergence of “minimally invasive” DAA THA, a literature review finds that only one small (44 patient) clinical trial with >1-year follow-up showed small early functional benefits but with longer average surgical times and higher blood loss. If the DAA procedure has minimal benefits, is more difficult to perform with a high complication rate (LFCN injury, femoral fracture and loosening) in the hands of non-specialists and has a long learning curve (that caused a significant percentage of HS DAA users to abandon it), then financial factors must be the main reasons for its popularity. For any tables or figures, please contact the authors directly


Bone & Joint Research
Vol. 10, Issue 9 | Pages 574 - 590
7 Sep 2021
Addai D Zarkos J Pettit M Sunil Kumar KH Khanduja V

Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures.


The Bone & Joint Journal
Vol. 102-B, Issue 7 Supple B | Pages 90 - 98
1 Jul 2020
Florissi I Galea VP Sauder N Colon Iban Y Heng M Ahmed FK Malchau H Bragdon CR

Aims

The primary aim of this paper was to outline the processes involved in building the Partners Arthroplasty Registry (PAR), established in April 2016 to capture baseline and outcome data for patients undergoing arthroplasty in a regional healthcare system. A secondary aim was to determine the quality of PAR’s data. A tertiary aim was to report preliminary findings from the registry and contributions to quality improvement initiatives and research up to March 2019.

Methods

Structured Query Language was used to obtain data relating to patients who underwent total hip or knee arthroplasty (THA and TKA) from the hospital network’s electronic medical record (EMR) system to be included in the PAR. Data were stored in a secure database and visualized in dashboards. Quality assurance of PAR data was performed by review of the medical records. Capture rate was determined by comparing two months of PAR data with operating room schedules. Linear and binary logistic regression models were constructed to determine if length of stay (LOS), discharge to a care home, and readmission rates improved between 2016 and 2019.


Bone & Joint Open
Vol. 1, Issue 8 | Pages 500 - 507
18 Aug 2020
Cheruvu MS Bhachu DS Mulrain J Resool S Cool P Ford DJ Singh RA

Aims

Our rural orthopaedic service has undergone service restructure during the COVID-19 pandemic in order to sustain hip fracture care. All adult trauma care has been centralised to the Royal Shrewsbury Hospital for assessment and medical input, before transferring those requiring operative intervention to the Robert Jones and Agnes Hunt Orthopaedic Hospital. We aim to review the impact of COVID-19 on hip fracture workload and service changes upon management of hip fractures.

Methods

We reviewed our prospectively maintained trust database and National Hip Fracture Database records for the months of March and April between the years 2016 and 2020. Our assessment included fracture pattern (intrascapular vs extracapsular hip fracture), treatment intervention, length of stay and mortality.


The Bone & Joint Journal
Vol. 100-B, Issue 10 | Pages 1297 - 1302
1 Oct 2018
Elbuluk AM Slover J Anoushiravani AA Schwarzkopf R Eftekhary N Vigdorchik JM

Aims

The routine use of dual-mobility (DM) acetabular components in total hip arthroplasty (THA) may not be cost-effective, but an increasing number of patients undergoing THA have a coexisting spinal disorder, which increases the risk of postoperative instability, and these patients may benefit from DM articulations. This study seeks to examine the cost-effectiveness of DM components as an alternative to standard articulations in these patients.

Patients and Methods

A decision analysis model was used to evaluate the cost-effectiveness of using DM components in patients who would be at high risk for dislocation within one year of THA. Direct and indirect costs of dislocation, incremental costs of using DM components, quality-adjusted life-year (QALY) values, and the probabilities of dislocation were derived from published data. The incremental cost-effectiveness ratio (ICER) was established with a willingness-to-pay threshold of $100 000/QALY. Sensitivity analysis was used to examine the impact of variation.


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 6 | Pages 781 - 785
1 Jun 2005
Temmerman OPP Raijmakers PGHM Berkhof J Hoekstra OS Teule GJJ Heyligers IC

In this meta-analysis we included 32 English-language articles published between January 1975 and June 2004 on the diagnostic performance of plain radiography, subtraction arthrography, nuclear arthrography and bone scintigraphy in detecting aseptic loosening of the femoral component, using criteria based on the Cochrane systematic review of screening and diagnostic tests.

The mean sensitivity and specificity were, respectively, 82% (95% confidence interval (CI) 76 to 87) and 81% (95% CI 73 to 87) for plain radiography and 85% (95% CI 75 to 91) and 83% (95% CI 75 to 89) for nuclear arthrography. Pooled sensitivity and specificity were, respectively, 86% (95% CI 74 to 93) and 85% (95% CI 77 to 91) for subtraction arthrography and 85% (95% CI 79 to 89) and 72% (95% CI 64 to 79) for bone scintigraphy. Although the diagnostic performance of the imaging techniques was not significantly different, plain radiography and bone scintigraphy are preferred for the assessment of a femoral component because of their efficacy and lower risk of patient morbidity.