Periacetabular osteotomy (PAO) has been established as an effective technique to treat symptomatic hip dysplasia in young patients. Its role in treating borderline dysplasia and acetabular retroversion is evolving. The aim of this study was to:. Examine the prospectively collected outcomes following a minimally invasive PAO in a large cohort of patients. Compare the outcomes of patients with severe dysplasia, borderline dysplasia and acetabular retroversion. This is a
Introduction. The proportion of arthroplasties performed in the ambulatory setting has increased substantially. However, concerns remain regarding whether same-day discharge may increase the risk of complications. The purpose of this study was to compare 90-day outcomes between inpatients and patients having surgery at an ambulatory surgery center (ASC). Methods. Among a
We present the early clinical and radiological results of Articular Surface Replacement (ASR) resurfacings in 214 hips (192 patients) with a mean follow-up of 43 months (30 to 57). The mean age of the patients was 56 years (28 to 74) and 85 hips (40%) were in 78 women. The mean Harris hip score improved from 52 (11 to 81) to 95 (27 to 100) at two years and the mean University of California, Los Angeles activity score from 3.9 (1 to 10) to 7.4 (2 to 10) in the same period. Narrowing of the neck (to a maximum of 9%) was noted in 124 of 209 hips (60%). There were 12 revisions (5.6%) involving four (1.9%) early fractures of the femoral neck and two (0.9%) episodes of collapse of the femoral head secondary to avascular necrosis. Six patients (2.8%) had failure related to metal wear debris. The overall survival for our series was 93% (95% confidence interval 80 to 98) and 89% (95% confidence interval 82 to 96) for hips with acetabular components smaller than 56 mm in diameter. The ASR implant has a lower diametrical clearance and a subhemispherical acetabular component when compared with other more frequently implanted metal-on-metal hip resurfacings. These changes may contribute to the higher failure rate than in other series, compared with other designs. Given our poor results with the small components we are no longer implanting the smaller size.
Hip arthroscopy is a rapidly growing, evolving area within arthroscopic Orthopaedic Surgery, with annual rates increasing as much as 25-fold each year. Despite improvements in equipment and training, it remains a challenging procedure. Rates of revision surgery have been reported as 6.3% to 16.9%. The primary objective was to determine the success of joint preservation after hip arthroscopy. The secondary objective was to determine whether patient characteristics or PROM functional score trends could predict revision hip arthroscopy or Total Hip Arthroplasty (THA).Background
Objectives
The fourth generation Delta ceramic, in which zirconia is incorporated into the alumina matrix, was developed to provide improved fracture toughness and wear characteristics. The purpose of this study was to evaluate the minimum 5-year outcomes and bearing-specific complications in a single surgeon series of Delta ceramic-on-ceramic total hip arthroplasties (THAs). We retrospectively analysed 667 patients (749 hips) who underwent cementless THAs using Delta ceramic-on-ceramic bearings by a single surgeon. There were 315 men and 352 women with mean age of 55 years (range, 16 to 88 years) at the time of index surgery. Acetabular and femoral components were cementless in all hips. A 36 mm head was used in 472 hips and a 32 mm head was used in 227 hips. The mean duration of follow-up was 6.3 years (range, 5 to 8 years). The mean Harris hip score improved from 47.6 points preoperatively to 91.1 points at the time of final follow-up. All but one acetabular components were well-fixed, and all but one femoral components were well-fixed. No radiographic evidence of osteolysis was identified at the time of final follow-up. There were 2 (0.27%) ceramic liner fractures and no ceramic head fracture. A total of 48 hips (6.4%) exhibited an audible noise (29 clickings and 19 squeakings), but no patient required revision. Kaplan-Meier survivorship with an end point of revision for any reason was 98.7% at 6.3 years. Delta ceramic-on-ceramic THAs provide excellent clinical outcomes without osteolysis at the minimum 5-year follow-up. However, we also found 0.27% ceramic liner fractures and 6.4% audible noises associated with the use of Delta ceramic-on-ceramic bearings.
Aims. Osteoporosis can determine surgical strategy for total hip arthroplasty (THA), and perioperative fracture risk. The aims of this study were to use hip CT to measure femoral bone mineral density (BMD) using CT X-ray absorptiometry (CTXA), determine if systematic evaluation of preoperative femoral BMD with CTXA would improve identification of osteopenia and osteoporosis compared with available preoperative dual-energy X-ray absorptiometry (DXA) analysis, and determine if improved recognition of low BMD would affect the use of cemented stem fixation. Methods. Retrospective chart review of a
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
Aims. The proportion of arthroplasties performed in the ambulatory setting has increased considerably. However, there are concerns whether same-day discharge may increase the risk of complications. The aim of this study was to compare 90-day outcomes between inpatient arthroplasties and outpatient arthroplasties performed at an ambulatory surgery centre (ASC), and determine whether there is a learning curve associated with performing athroplasties in an ASC. Methods. Among a
Introduction. The long-term survival of modern ceramic-ceramic bearings in young active patients with osteonecrosis undergoing total hip arthroplasty (THA) is unknown. A previously published study of this series at 5-year follow-up demonstrated an extremely high activity level. The purpose of this study is to examine whether this very high activity level is associated with ceramic-on-ceramic THA failure at long-term follow-up. Methods. This is a retrospective review of a
Hip resurfacing has been proposed as an alternative
to traditional total hip arthroplasty in young, active patients.
Much has been learned following the introduction of metal-on-metal resurfacing
devices in the 1990s. The triad of a well-designed device, implanted
accurately, in the correct patient has never been more critical
than with these implants. . Following Food and Drug Administration approval in 2006, we studied
the safety and effectiveness of one hip resurfacing device (Birmingham
Hip Resurfacing) at our hospital in a large,
It is not known whether preservation of the capsule of the hip positively affects patient-reported outcome measures (PROMs) in total hip arthroplasty using the direct anterior approach (DAA-THA). A recent randomized controlled trial found no clinically significant difference at one year postoperatively. This study aimed to determine whether preservation of the anterolateral capsule and anatomical closure improve the outcome and revision rate, when compared with resection of the anterolateral capsule, at two years postoperatively. Two consecutive groups of patients whose operations were performed by the senior author were compared. The anterolateral capsule was resected in the first group of 430 patients between January 2012 and December 2014, and preserved and anatomically closed in the second group of 450 patients between July 2015 and December 2017. There were no other technical changes between the two groups. Patient characteristics, the Charlson Comorbidity Index (CCI), and surgical data were collected from our database. PROM questionnaires, consisting of the Oxford Hip Score (OHS) and Core Outcome Measures Index (COMI-Hip), were collected two years postoperatively. Data were analyzed with generalized multiple regression analysis.Aims
Methods
Metal-on-metal hip resurfacing (MoM-HR) has seen decreased usage due to safety and longevity concerns. Joint registries have highlighted the risks in females, smaller hips, and hip dysplasia. This study aimed to identify if reported risk factors are linked to revision in a long-term follow-up of MoM-HR performed by a non-designer surgeon. A retrospective review of consecutive MoM hip arthroplasties (MoM-HRAs) using Birmingham Hip Resurfacing was conducted. Data on procedure side, indication, implant sizes and orientation, highest blood cobalt and chromium ion concentrations, and all-cause revision were collected from local and UK National Joint Registry records.Aims
Methods
The aim of this study was to evaluate the incidence of liner malseating in two commonly used dual-mobility (DM) designs. Secondary aims included determining the risk of dislocation, survival, and clinical outcomes. We retrospectively identified 256 primary total hip arthroplasties (THAs) that included a DM component (144 Stryker MDM and 112 Zimmer-Biomet G7) in 233 patients, performed between January 2012 and December 2019. Postoperative radiographs were reviewed independently for malseating of the liner by five reviewers. The mean age of the patients at the time of THA was 66 years (18 to 93), 166 (65%) were female, and the mean BMI was 30 kg/m2 (17 to 57). The mean follow-up was 3.5 years (2.0 to 9.2).Aims
Methods
Acetabular retroversion is a recognized cause of hip impingement and can be influenced by pelvic tilt (PT), which changes in different functional positions. Positional changes in PT have not previously been studied in patients with acetabular retroversion. Supine and standing anteroposterior (AP) pelvic radiographs were retrospectively analyzed in 69 patients treated for symptomatic acetabular retroversion. Measurements were made for acetabular index (AI), lateral centre-edge angle (LCEA), crossover index, ischial spine sign, and posterior wall sign. The change in the angle of PT was measured both by the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac (PS-SI) index.Aims
Methods
Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients.Aims
Methods
There is evidence that morbidly obese patients have more intra- and postoperative complications and poorer outcomes when undergoing total hip arthroplasty (THA) with the direct anterior approach (DAA). The aim of this study was to determine the efficacy of DAA for THA, and compare the complications and outcomes of morbidly obese patients with nonobese patients. Morbidly obese patients (n = 86), with BMI ≥ 40 kg/m2 who underwent DAA THA at our institution between September 2010 and December 2017, were matched to 172 patients with BMI < 30 kg/m2. Data regarding demographics, set-up and operating time, blood loss, radiological assessment, Harris Hip Score (HHS), International Hip Outcome Tool (12-items), reoperation rate, and complications at two years postoperatively were retrospectively analyzed.Aims
Methods
We report a 12- to 15-year implant survival assessment
of a prospective
Hip arthroplasty aims to accurately recreate joint biomechanics. Considerable attention has been paid to vertical and horizontal offset, but femoral head centre in the anteroposterior (AP) plane has received little attention. This study investigates the accuracy of restoration of joint centre of rotation in the AP plane. Postoperative CT scans of 40 patients who underwent unilateral uncemented total hip arthroplasty were analyzed. Anteroposterior offset (APO) and femoral anteversion were measured on both the operated and non-operated sides. Sagittal tilt of the femoral stem was also measured. APO measured on axial slices was defined as the perpendicular distance between a line drawn from the anterior most point of the proximal femur (anterior reference line) to the centre of the femoral head. The anterior reference line was made parallel to the posterior condylar axis of the knee to correct for rotation.Aims
Methods
The unparalleled events of the year 2020 continue to evolve and challenge the worldwide community on a daily basis. The COVID-19 pandemic has had a major impact on all aspects of our lives, and has caused major morbidity and mortality around the globe. The impact of COVID-19 on the practice of orthopedic surgery has been substantial with practice shutdowns, elective surgery restrictions, heightened utilization of telemedicine platforms and implementation of precautionary measures for in-person clinic visits. During this transition period the scholarly and educational pursuits of academic surgeons have been de-emphasized as the more immediate demands of clinical practice survivorship have been the priority. This unavoidable focus on clinical practice has heightened the importance of orthopedic subspecialty societies in maintaining an appropriate level of attention on research and educational activities. Under the outstanding presidential leadership of Robert Barrack, MD, The Hip Society adapted to the profound challenges of 2020, and maintained strong leadership in the realms of education and research. The recent 2020 summer meeting of the Hip Society was a testimonial to the resilience and dedication of the Society members to ongoing innovation in research and education. Due to travel and social distancing restrictions the 2020 summer meeting was transitioned from an in-person to a virtual meeting format. Dr Barrack and Program Chair Dr John Clohisy assisted with oversight of the meeting, while Olga Foley and Cynthia Garcia ensured the success of the meeting with remarkable planning and organization. These collaborative efforts resulted in an organized, well-attended, high level scientific meeting with engaging discussion and a remarkable virtual conference environment. The Bone & Joint Journal is very pleased to partner with The Hip Society to publish the proceedings of this very unique virtual meeting. The Hip Society is based in the United States and membership is granted to select individuals for leadership accomplishments in education and research related to hip disease. The Society is focused on the mission of advancing the knowledge and treatment of hip disorders to improve the lives of patients. The vision of the Hip Society is to lead in the discovery and dissemination of knowledge related to disorders of the hip. The annual closed meeting is one of the most important events of the society as this gathering highlights timely, controversial and novel research contributions from the membership. The top research papers from The Hip Society meeting will be published and made available to the wider orthopedic community in The Bone & Joint Journal. This partnership with The Bone & Joint Journal enhances the mission and vision of The Hip Society by international dissemination of the meeting proceedings. Given the far-reaching circulation of The Bone & Joint Journal the highest quality work is available to an expanding body of surgeons, associated healthcare providers and patients. Ultimately, this facilitates the overarching Hip Society goal of improving the lives of our patients. The 2020 virtual Hip Society meeting was characterized by outstanding member attendance, high quality paper presentations and robust discussion sessions. The meeting was held over two days and encompassed 58 open paper presentations divided into ten sessions with moderated discussions after each session. All papers will be presented in this issue in abstract form, while selected full papers passing our rigorous peer review process will be available online and in The Bone & Joint Journal in a dedicated supplement in 2021. The first session of the meeting focused on issues related to complex primary THA and osteonecrosis of the femoral head. Dr Gross presented on the conversion of hip fusion to THA in 28 patents at a mean 7 years. He reported a high clinical success rate, yet complications of heterotopic ossification and neurologic injury were relatively common. Consideration of heterotopic ossification prophylaxis and the selective use of a constrained liner were recommended. Dr Pagnano summarized the use of various contemporary porous acetabular components in 38 hips in the setting of prior pelvic radiation. The mean follow-up was 5 years and 10 year survivorship was 100% with all implants radiographically fixed. Dr Bolognesi's study demonstrated that THA in solid organ transplant patients is associated with higher risk for facility placement, transfusions and readmissions. This patient population also has increased mortality risk (4.3% risk at 1 year) especially lung transplant patients. The second group of papers focused on femoral head osteonecrosis. Dr Iorio presented single center data demonstrating that CT scan was a useful adjunct for diagnosis in the staging work-up for cancer, yet was not useful for ARCO staging and treatment decision-making. On the basic science side, Dr Goodman utilized a rabbit model of steroid-induced femoral head osteonecrosis to determine that immunomodulation with IL-4 has the potential to improve bone healing after core decompression. The session was concluded by Dr Nelson's study of ceramic-on-ceramic THA in 108 osteonecrosis patients. The median 12 year results were outstanding with marked increases in PROs, maintenance of high activity levels, and a 3.7% revision rate. In the second session attention was directed to THA instability and spinopelvic mobility. Dr Sierra presented a machine learning algorithm for THA dislocation risk. Two modifiable variables (anterior/lateral approach, elevated liner) were most influential in minimizing dislocation risk. Dr Taunton's study demonstrated a deep learning artificial intelligence model derived from postoperative radiographs to predict THA dislocation risk. High sensitivity and negative predictive value suggest that this model may be helpful in assessing postoperative dislocation risk. In reviewing a large single-center, multiple surgeon cohort of 2,831 DAA procedures, Dr Moskal noted a very low dislocation rate (0.45%) at minimum 2 years. Importantly, spinopelvic pathology or prior spinal instrumentation was not associated with an increased dislocation risk (0.30%). Dr Huo and colleagues analyzed pelvic tilt during functional gait in patients with acetabular dysplasia. They detected variable pelvic tilt on different surfaces with the data suggesting that patients with more anterior pelvic tilt while standing tend to have greater compensatory posterior pelvic tilt during gait. Dr Lamontagne reported on the sagittal and axial spinomobility in patients with hip OA, and highlighted reductions in pelvic tilt, pelvic-femoral-angle, lumbar lordosis and seated maximal trunk rotation when compared to controls. Dr Dennis showed that differences in spinopelvic mobility may explain the variable accuracy of acetabular version measurements on the cross-table lateral radiographs. Dr Gwo-Chin presented on a comprehensive functional analysis of 1,592 patients undergoing THA and observed that spinopelvic abnormalities are not infrequent (14%) in THA patients. Consistent with these findings Dr Murphy and collaborators identified a low prevalence of previous spinal instrumentation (1.5%), yet a high prevalence of spine stiffness (27.6%) in 149 patients undergoing THA. Session three highlighted various aspects of treating hip disease in young patients. Dr Peters investigated the need for subsequent hip arthroscopy in 272 patients treated with an isolated PAO. Only 4.8% of these patients required subsequent arthroscopy calling into question the routine use of combined arthroscopy and PAO. Three papers addressed questions related to THA in young patients. Dr Berend's study of 2532 hips demonstrated that high activity level was not associated with an increased risk of midterm aseptic or all cause failure. Dr Nunley presented on 43 young patients with an average age of 52 years treated with a cementless stem and modular dual mobility articulation. Stress shielding was minimal and no concerning metal ion release detected. Dr Garvin summarized minimum 15 year data of THA with highly cross-linked polyethylene in patient less than 50 years. These hips performed exceptionally well with no mechanical loosening or radiographic osteolysis. Dr Engh examined 10 year results of the Birmingham Hip Resurfacing implant and reported a 92.9 % overall survivorship, with males less than 55 years achieving a 98.3% survivorship. The session was concluded by long-term data on the Conserve Plus hip resurfacing arthroplasty. Dr Amstutz presented an impressive dataset depicting an 83.1% 20 year survivorship for this early resurfacing cohort. Direct anterior approach total hip arthroplasty was the focus of session four. Dr Meneghini reported on the anesthesia and surgical times of direct anterior and posterior approaches from a large healthcare system database. These data suggested longer OR and surgical times for the DAA both in the inpatient and ASC environments. Dr Clohisy introduced the technique and early outcomes of lateral decubitus position DAA. In a learning curve experience of 257 hips. 96% of acetabular components were in the Lewinneck safe zone, the aseptic revision rate was 0.9% and there were no dislocations. Dr Beaule analyzed femoral stem cement mantle with the DAA and posterior approaches by comparing two matched cohorts. Stem alignment and cement mantle quality were equivalent with both approaches. Similarly, Dr Emerson demonstrated technical feasibility and fewer cemented femoral stem failures when compared to cementless stems in a series of 360 DAAs THAs. The final paper of the session presented by Dr Hamilton examined the impact of surgical approach on dislocation after isolated head and liner exchange. Neither the posterior nor the anterior approach was superior in reducing the dislocation rate for these high dislocation risk procedures. The fifth session explored contemporary topics related to anesthesia and pain management. Dr Byrd opened the session with a comparative study evaluating general versus spinal anesthesia for hip arthroscopy. This preliminary study was provoked by the desire to minimize aerosolized exposure early in the COVID-19 pandemic by transitioning to spinal anesthesia. Both anesthetic methods were effective. Dr Austin presented a randomized, double-blind controlled trial comparing spinal anesthetic with mepivacaine, hyperbaric bupivacaine and isobaric bupivacaine. Mepivacaine patients ambulated earlier and were more likely to be discharged the same day. Dr Mont provided a very timely study on the effects of “cannabis use disorder” and THA outcomes. This administrative database study of 44,154 patients revealed this disorder to be associated with longer hospital stays, increased complications rates and higher costs. Dr Bedair investigated whether a highly porous acetabular component submerged in an analgesic solution could enhance perioperative pain management. Interestingly, this novel strategy was associated with a reduction of postoperative pain scores and opioid consumption in 100 experimental patients compared to 100 controls. The concluding paper of the session by Dr Della Valle examined whether decreased discharge opioids led to increased postoperative opioid refills. A large single-center study of 19,428 patients detected a slight increase (5%) in opioid refills but a reduction in total refill morphine milligram equivalents. The final, sixth session of day one considered various challenging aspects of revision hip arthroplasty. Dr Nam started the session with review of preliminary results from a randomized control trial comparing closed incision negative-pressure therapy with a silver-impregnated dressing for wound management in 113 hips undergoing revision arthroplasty. Unlike previous reports, the negative pressure therapy was associated with a higher reoperation rate for wound-related complications. Dr Bostrom highlighted the potential clinical impact of basic biological interventions by establishing the presence of Neutrophil Extracellular Traps (NETS) in fibrotic tissue from human aseptic loosening specimens and in a murine model of unstable tibial implantation. NET inhibition in the murine model prevented the expected tibial implant osseointegration failure. Dr Lombardi presented early 3.3 year clinical results of a highly porous Ti6al4v acetabular component in complex primary and revision arthroplasty. Survivorship for aseptic loosening was 96.6 % and 95.3% for the primary and revision cases, respectively. Dr Schwarzkopf and colleagues explored the impact of time to revision arthroplasty on clinical outcomes. Analysis of 188 revision cases revealed early revisions (less than 2 years from primary) were associated with worse outcomes, longer hospitalizations and higher reoperation rates. Mid-term results for modular dual mobility implants in revision arthroplasty were reviewed by Dr Lachiewicz who reported on 126 hips at a mean 5.5 years. 11% of hips dislocated and the 6 year survival was 91%. An outer head diameter of 48mm or greater was associated with a lower risk of dislocation. Dr Berry concluded the session by discussing the outcomes of treating the challenging problem of interprosthetic femur fractures. A single-center study of 77 cases treated over 32 years demonstrated a 79% success rate free of reoperation at 2 years with 95% of patients being ambulatory. The second day commenced with the seventh session evaluating recent strategies to improve short-term THA outcomes. Dr Bozic and colleagues investigated the association of quality measure public reporting with hip/knee replacement outcomes. Annual trend data from 2010–2011 and 2016–2017 indicate that hospital-level complication and readmission rates decease after the start of public reporting, yet it is difficult to prove a direct effect. Dr Slover reviewed his institutions experience with the Comprehensive Care for Joint Replacement (CJR) model and emphasized that lower CJR target prices make it increasingly difficult for programs to meet target price thresholds. Cost saving strategies including same day discharge and reduction of home health services may result in smaller losses of positive margins. Dr Barsoum reported on the influence of patient and procedure-related risk factors of length of stay after THA. Patient-related risk factors provided substantial predictive value yet procedure-related risk factors (hospital site and surgical approach) remain the main drivers of predicting length of stay. Dr Hozack reviewed an impressive, single surgeon cohort of 3,977 DAA THAs and analyzed adverse events and 90 day perioperative outcomes. Simultaneous bilateral DAA THA was comparable with unilateral or staged bilateral procedures in regards to complications, readmission rate and home discharge rate but with an increased risk of transfusion. To examine the risk of complications with outpatient joint arthroplasty, Dr Della Valle performed a
Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia. It has also been proposed as a treatment for patients with acetabular retroversion. By reviewing a large cohort, we aimed to test whether outcome is equivalent for both types of morphology and identify factors that influenced outcome. A single-centre, retrospective cohort study was performed on patients with acetabular retroversion treated with PAO (n = 62 hips). Acetabular retroversion was diagnosed clinically and radiologically (presence of a crossover sign, posterior wall sign, lateral centre-edge angle (LCEA) between 20° and 35°). Outcomes were compared with a control group of patients undergoing PAO for dysplasia (LCEA < 20°; n = 86 hips). Femoral version was recorded. Patient-reported outcome measures (PROMs), complications, and reoperation rates were measured.Aims
Methods