This study aimed to analyse the incidence, the operative findings and outcomes of hip arthroscopy after periacetabular osteotomy (PAO). We conducted a retrospective study of prospective collected data to report the operative findings and outcomes of hip arthroscopy for recurrent pain following PAO for acetabular dysplasia. Demographic data, radiographic and arthroscopic findings were analysed. Pre- and post-operative patient reported outcome measures (PROMs) were collected. Of 184 PAO patients, 15 hips in 15 patients (8.2%) underwent post-PAO hip arthroscopy with 2 males and 13 females at a mean time of 3.9 ±2.9(0.3–10) years. Hip arthroscopy findings included labral tears (15 hips, 100%), chondral damage (11 hips, 73%) with one Beck 1, two Beck 2, four Beck 4, and four Beck 5 damage. There were 8 (53%) isolated labral debridement, 7 (47%) labral repair, and 2 (13%) adhesiolysis. A femoral osteochondroplasty was performed in 4 (27%) hips. Four hips (27%) were finally converted to total hip replacement at a mean delay of 2.3 ±1.4 (0.7–3.2) years post hip arthroscopy and these 4 patients were significantly older than those who were not (p=0.02). There were no significant differences in PROMs pre and post hip scope. 8.2% of patients undergoing a PAO required a hip scope for persistent hip pain. Common post-PAO hip arthroscopy findings included labral tears, chondral changes and femoroacetabular impingement. 27% of patients finally underwent conversion to total hip replacement at a mean follow-up of 4.5 years post hip scope.
Over 62,000 total hip arthroplasty (THA) cases are performed each year in Canada, with an estimated annual healthcare system cost of $1.4 billion and resulting in 4 billion tonnes of waste annually (6,600 tonnes per day). The aims of this study were 1) Assess satisfaction of current/standard set-up amongst different stakeholders. 2) Assess energy, economic and waste cost of current set up and apply lean methodology to improve efficiency 3. Design and test SLIM setup based on lean principles and its ability to be safely implemented into everyday practice. A Needs Assessment Survey was circulated to OR nursing staff to assess the need for change in the current THA OR setup at an academic tertiary referral hospital. Through feedback, surgeon input, and careful analysis of current instrumentation, the “SLIM setup” was created. Standard instrument tray numbers for elective THA were reduced from 9 to 3 trays. Eighty patients were then randomised to either the standard or SLIM setup. Four staff arthroplasty surgeons each randomised 20 patients to either standard or SLIM setup. OR time, blood loss, 90-day complication rates, cost/case, instrument weight (kg/case), total waste in kg/case (non-recyclable), case set-up time, and number of times and number of extra trays required were compared between groups. The majority of nursing staff demonstrated dissatisfaction with the current THA setup and felt current processes lacked efficiency. Use of the SLIM setup, was associated with the following savings in comparison to standard (Trays = −6 (720kg/case); Waste = −1.5 kg/case; Cost = − $560 ($50.00 × 6 trays + 10min saved × $26.00 /min OR setup time)). OR time, blood loss and 90-day complication rate were not statistically different (p >0.05); however, set up time was significantly shorter in comparison to standard. Extra instrumentation was opened in < 10% of cases. A more minimalist approach to THA can be undertaken using the SLIM setup, potentially resulting in cost, energy and waste savings. Estimate savings of $560,000 and 1.65 tonnes reduction in waste per 1,000 THAs performed may be realised.
This matched cohort study aims to (a) assess differences in spinopelvic characteristics of patients having sustained a dislocation following THA and a control THA group without dislocation; (b) identify spinopelvic characteristics associated with risk of dislocation and; (c) propose an algorithm to define the optimum cup orientation for minimizing dislocation risk. Fifty patients with a history of THA dislocation (29 posterior-, 21 anterior dislocations) were matched for age, gender, body mass index, index diagnosis, and femoral head size with 100 controls. All patients were reviewed and underwent detailed quasi-static radiographic evaluations of the coronal- (offset; center-of-rotation; cup inclination/anteversion) and sagittal- reconstructions (pelvic tilt, pelvic incidence, lumbar lordosis, pelvic-femoral-angle, cup ante-inclination). The spinopelvic balance (PI-LL), combined sagittal index (CSI= Pelvic-femoral-angle + Cup Anteinclination) and Hip-User-Index were determined. sagittal index (CSI= Pelvic-femoral-angle + Cup Anteinclination) and Hip-User-Index were determined. Parameters were compared between the two groups (2-group analysis) and between controls and per direction of dislocation (3-group analysis). There were marginal coronal differences between the groups. Sagittal parameters (lumbar-lordosis, pelvic-tilt, CSI, PI-LL and Hip-User-Index) differed significantly. PI-LL (>10°) and standing pelvic tilt (>18°) were the strongest predictors of dislocation risk (sensistivity:70%/specificity:70%). All hips with a standing CSI<195° dislocated posteriorly and all with CSI>260° dislocated anteriorly. A CSI between 200–245° was associated with significantly reduced risk of dislocation (OR:6; 95%CI:2.5–15.0; p<0.001). In patients with unbalanced and/or rigid lumbar spine, standing CSI of 215–245° was associated with significantly reduced dislocation risk (OR:10; 95%CI:3.2–29.8; p<0.001). PI-LL and standing pelvic-tilt determined from pre-operative, standing, lateral spinopelvic radiograph can be useful screening tools, alerting surgeons of patients at increased dislocation risk. Measurement of the pelvic-femoral angle pre-operatively provides valuable information to determine the optimum, cup orientation associated with reduced dislocation risk by aiming for a standing CSI of 200–245°.
Our study aimed to 1) determine if there was a difference for the HOOS-PS score between patients with stiff/normal/hypermobile spinopelvic mobility and 2) to investigate if functional sagittal cup orientation affected patient reported outcome 1 year post-THA. This prospective diagnostic cohort study followed 100 consecutive patients having received unilateral THA for end-stage hip osteoarthritis. Pre- and 1-year postoperatively, patients underwent a standardized clinical examination, completed the HOOS-PS score and sagittal low-dose radiographs were acquired in the standing and relaxed-seated position. Radiographic measurements were performed for the lumbar-lordosis-angle, pelvic tilt (PT), pelvic-femoral-angle and cup ante-inclination. The HOOS-PS was compared between patients with stiff (ΔPT<±10°), normal (10°≤ΔPT≤30°) and hypermobile spinopelvic mobility (ΔPT>±30°).Aims
Methods
Our study aimed to 1) Describe the changes in spinopelvic mobility when transitioning from standing, to ‘relaxed-seated’ and thereafter to ‘deep-seated’ position and 2) Determine the change in spinopelvic mobility types 1 year post-THA compared to preoperatively. This prospective diagnostic cohort study followed 100 consecutive patients 1 year post-THA. Preoperatively and one year postoperatively, radiographic measurements were performed for the lumbar-lordosis-angle, pelvic tilt and pelvic-femoral-angle on lateral radiographs in the standing, ‘relaxed-seated’ and ‘deep-seated’ position (torso maximally leaning forward). Patients were classified according to their spinopelvic mobility type, according to the change in PT between the standing and relaxed-seated position (stiff:ΔPT<±10°, normal:10°≤ΔPT≤30°, hypermobile:ΔPT>±30°).Aims
Methods
Patients with reduced lumbar spine mobility are at higher risk of dislocation after THA as their hips have to compensate for spinal stiffness. Therefore our study aimed to 1) Define the optimal protocol for identifying patients with mobile hips and stiff lumbar spines and 2) Determine clinical and standing radiographic parameters predicting high hip and reduced lumbar spine mobility. This prospective diagnostic cohort study followed 113 consecutive patients with end-stage hip osteoarthritis (OA) awaiting THA. Radiographic measurements were performed for the lumbar lordosis angle, pelvic tilt and pelvic-femoral angle on lateral radiographs in the standing, ‘relaxed-seated’ and ‘deep-seated’ (i.e. torso maximally leaning forward) position. A “hip user index” was calculated in order to quantify the contribution of the hip joint to the overall sagittal movement performed by the femur, pelvis and lumbar spine.Introduction
Methods
The aims of the study were to determine the differences in spinopelvic mobility between a cohort of hip OA patients and a control group for the 1) standing to relaxed-seated and 2) standing to deep-seated task. A cohort of 40 patients with end-stage hip OA and a control group of 40 subjects, matched for age, gender and BMI were prospectively studied. Clinical data and lateral view radiographs in different positions were assessed. Sagittal spinopelvic mobility was calculated as the change when moving from the standing to relaxed-seated and standing to deep-seated positions for the lumbar lordosis angle, pelvic tilt and pelvic-femoral angle.Aims
Methods
The changes in sagittal spino-pelvic balance from standing to sitting in patients with end-stage osteoarthritis (OA) of the hip remain poorly characterized. Our aim was to 1) investigate the contribution of sagittal spino-pelvic movement and hip flexion when moving from a standing to sitting posture in patients with hip OA; 2) determine the proportion of OA-patients with stiff, normal or hypermobile spino-pelvic mobility and 3) identify radiographic parameters correlating with spino-pelvic mobility. This prospective diagnostic cohort study followed 116 consecutive patients with end-stage osteoarthritis awaiting THR. All patients underwent preoperative standardized radiographs (lateral view) of the lumbar spine, pelvis and proximal femur using EOS© in standing position and with femurs parallel to the floor in order to achieve a 90°-seated position. Radiographic measurements performed included lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and pelvic-femoral-angle (PFA). The difference in PT between standing and seated allowed for patient classification based on spino-pelvic mobility into stiff (<±10°), normal (±10–30°), or hypermobile (>±30°).Introduction
Methods
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. 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.Introduction
Patients/Materials & Methods
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. 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°).Introduction
Patients/Materials & Methods
The current study aimed to determine the influence of acetabular coverage and intraarticular pathology on post-operative functional outcomes of arthroscopy for cam type FAI. Based on 762 hip scopes performed by a single surgeon between 2013 and 2016, we excluded patients with previous surgery on the hip, mixed FAI, surgical hip dislocation, and missing outcome scores. From this, 97 hips between the ages 17 and 48 that underwent arthroscopy for cam deformity were identified for analysis. Every patient received a partial capsulotomy, cam resection and either labral repair or resection. Measurements for acetabular coverage consisted of pre-operative lateral edge angle (LCEA) (mean 30°, range: 15.4°–40°) and three-dimensional anterior and posterior acetabular coverages. Intraoperative Beck scores were acquired from operative reports, and Hip Disability and Osteoarthritis Outcome Score (HOOS) was collected pre- and post-operatively. Significant post-operative improvement was found in scores of all categories of the HOOS (p < 0.05). However, improvement in HOOS was not correlated with the LCEA, anterior coverage, or posterior coverage. There was a trend toward lower Beck grades (1–3) resulting in better HOOS outcomes than higher Beck grades (4–5). Also, lower Beck grades showed significantly lower alpha angle (mean = 55.86) than higher grades (mean = 73.48). We showed that cam FAI arthroscopic resection improved patient outcome, and confirmed the relationship between the Beck score and functional outcome. However, functional improvement was not related to acetabular coverage suggesting that the so-called “borderline” dysplasia is not a useful radiographic indicator for surgical management.