Femoroacetabular impingement (FAI) is a common cause of hip pain in the young adult. Uncertainty regarding surgical indications, outcome assessment, management preferences and perceptions of the literature exist. We conducted a large international survey assessing the perceptions and demographics of orthopaedic surgeons regarding FAI. A survey was developed using previous literature, focus groups and a sample-to-redundancy strategy. The survey contained forty-six questions and was emailed to national orthopaedic associations and orthopaedic sports medicine societies for member responses. Members were contacted on multiple occasions to increase response rates. Nine hundred orthopaedic surgeons from twenty national and international organisations completed the survey. Surgeons responded across 6 continents, 58.2 % from developed nations with 35.4 % having sports fellowship training. North American and European surgeons reported significantly greater exposure to hip arthroscopy during residency and fellowships in comparison to international respondents (48.0% vs. 44.5% vs. 25.6% respectively; p<0.001). Surgeons performing a higher volume of FAI surgery (over 100 cases per year) were significantly more likely to have practiced for more than 20 years (OR 1.91; 95% CI 1.01 to 3.63), be practicing at an academic hospital (OR 2.25; 95% CI 1.22 to 4.15), and have formal arthroscopy training (OR 46.17; 95% CI 20.28 to 105.15). High volume surgeons were over two-fold more likely to practice in North America and Europe (OR 2.26; 95% CI: 1.08 to 4.72). The exponential rise in the diagnosis and surgical management for FAI appears to be driven largely by experienced surgeons in developed nations. Our analysis suggests that although FAI management is early in the innovation cycle we are at a tipping point towards wider uptake and utilisation. The results of this survey will help guide further research and study.
To determine if there are osteochondritis dissecans (OCD) lesions of the knee that are so unstable on MRI that they are incapable of healing without operative intervention. A secondary objective was to determine the ability of orthopaedic residents to accurately grade OCD lesions according to the Kijowski criteria of stable and unstable. A retrospective review was performed of patients who had femoral condyle OCD lesions from 2009-present. Only patients with open growth plates and serial MRIs were included. Each MRI was classified according to the Kijowski classification by a junior orthopaedic surgery resident as well as an MSK trained radiologist. A weighted kappa value was used to assess the inter-rater agreement. The final analysis included 16 patients (17 knees) with 49 MRI's. The weighted kappa agreement between reviewers for overall lesion stability was moderate (0.570 [95% CI 0.237–0.757]). The initial MRI lesion was graded as stable in 59% (10/17) of the knees. Two of these 10 knees became unstable during the study period, however, both stabilised again on subsequent MRIs, one with surgery and the other without surgery. The initial MRI was graded as unstable in 41% (7/17) of the knees. Two of the seven knees (29%) later demonstrated MRI evidence of lesion stability without surgical intervention. The most important finding in this study was the ability of unstable OCD lesions on MRI to heal without operative intervention. The ability of an orthopaedic surgery resident to grade these lesions on MRI was moderate.
Health care facilities are major contributors of waste to landfills, with operating rooms estimated to assume 20–70% of this waste. With hip arthroscopy for femoroacetabular impingement (FAI) on the rise, it is important to understand its environmental impact and identify areas for greening practices. Given its minimally-invasive nature, we hypothesise overall arthroscopic waste per FAI patient case to be approximately 5 kg, with minimal biohazard waste. The purpose of this study was to determine the amount of waste produced in FAI procedures and understand the environmental impact of the procedure to aid us in developing greening practices. A single surgeon waste audit (with descriptive statistics) of five FAI hip arthroscopy procedures – categorised by: 1) normal/landfill waste; 2) recyclable cardboards and plastics; 3) biohazard waste; 4) sharp items; 5) linens; and 6) sterile wrapping – was performed in April 2015. The surgical waste (except laundered linens) from the five FAI surgeries totalled 47.4 kg, of which 21.7 kg (45.7%) was biohazard waste, 11.7 kg (24.6%) was sterile wrap, 6.4 kg (13.5%) was normal/landfill waste, 6.4 kg (13.5%) was recyclable plastics, and 1.2 kg (2.6%) was sharp items. There was an average of 9.4 kg (excluding laundered linens) of waste produced per procedure. Considerable waste, specifically biohazard waste, is produced in FAI procedures with an average of 9.4 kg of waste produced per procedure, including 4.3 kg of biohazard waste. In Canada (population 35.7 million), approximately 18 800 kg of waste (8600 kg of biohazard waste) is produced from an estimated 2000 FAI procedures performed every year. Additional recycling programs, reducing surgical overage, and continued adherence to proper waste segregation will be helpful in reducing waste production and its environmental burden. An emphasis on “green outcomes” is also required to demonstrate environmental responsibility and effectively manage and allocate finite resources.
The recent emergence of autologous blood concentrates, such as platelet rich plasma (PRP), as a treatment option for patients with orthopaedic injuries has led to an extensive debate about their clinical benefit. Our objective was to determine the effectiveness of autologous blood concentrates compared with control therapy in improving pain in patients with orthopaedic bone and soft tissue injuries. We conducted a systematic review of MEDLINE and EMBASE from 1996 and 1947, respectively, up to July 2010. Additional studies were identified by contacting experts, searching the bibliographies of the included studies as well as orthopaedic meeting archives. We included published and unpublished randomized controlled trials or prospective cohort studies that compared autologous blood concentrates with a control therapy in patients with an orthopaedic injury. Two reviewers, working in duplicate, abstracted data on study characteristics and protocol. Reviewers resolved disagreement by consensus.Purpose
Method
Rectus femoris avulsion (RFA) injuries in paediatric patients are currently managed conservatively. However, the proximal attachment of the rectus femoris muscle lies in a critical zone in the hip joint with attachments to the anterior hip capsule and anterior inferior iliac spine. Violent avulsions therefore could cause damage to the adjacent acetabular labrum and articular cartilage initiating a process leading to early degenerative changes in the hip. To date, the association between rectus avulsions and labral tears has not been studied. The complete medical records of patients who were presented to McMaster University Medical Center with rectus femoris avulsions between 1983 and 2008 who were between the ages of 2 and 18 were identified. Patients were included if they had documented plain radiographs and magnetic resonance arthrography images of their hip. MRIs were reviewed by an independent musculoskeletal radiologist blinded from the history of the patients.Purpose
Method
Little is known about the psychological morbidity associated with orthopaedic trauma. Our study aimed to determine the extent of psychological symptoms and whether patient psychological symptoms were predictive of outcomes following orthopaedic trauma. Overall, trauma patients experienced higher intensity of psychological symptoms than population norms. Psychological symptoms, patient age, and ongoing litigation predicted functional outcomes. Patients may benefit from early interventions by social workers and psychologists to process their psychological states post injury. Little is known about the psychological morbidity associated with orthopaedic trauma. Our study aimed to determine the extent of psychological symptoms and whether patient psychological symptoms were predictive of outcomes following orthopaedic trauma. All patients attending ten orthopaedic fracture clinics at three University-affiliated Hospitals were approached for study eligibility. All consenting patients would be requested to complete a baseline assessment form, a 90-item symptom checklist-90R (SCL-90R), and the Short-Form–36. The SCL-90R constitutes nine dimensions (Somatization, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, Psychoticism) and three global indices (Global severity index, Positive symptom distress index, positive symptom total). We conducted regression analyses to determine predictors of quality of life among study patients. Of two hundred and fifteen patients, 59% were male at a mean age of 44.5 years. Over half of patients had lower extremity fractures. Trauma patients experienced greater psychological symptoms than population norms. Overall, trauma patients experienced higher intensity of psychological symptoms than population norms. Patient functional outcomes were predicted by patient age, ongoing litigation, and Positive Symptom Distress. This model predicted 21% of the variance in patient function. Patient somatization was an important psychological symptom resulting in increasing intensity of symptoms. Smoking, alcohol, open fracture, surgeons’ perception of technical outcome, level of education, and time since injury were not predictive in this model. Psychological symptoms, patient age, and ongoing litigation predicted functional outcomes. Patients may benefit from early interventions by social workers and psychologists to process their psychological states post injury. Funding: This study was funded in part by research grants from AO North America and Regional Medical Associates, McMaster University. Dr. Bhandari was funded, in part, by a 2004 Detweiler Fellowship, Royal Colleges of Physicians and Surgeons of Canada. Dr. Busse is funded by a Canadian Institutes of Health Research Fellowship Award.
