Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular procedures such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary cohort of patients, who underwent PAO in isolation without any intra-articular procedures. From June 2012 to March 2022, 349 rectus-sparing PAOs were performed and followed for a minimum of one year (mean 6.2 years (1 to 11)). The mean age was 24 years (14 to 46) and 88.8% were female (n = 310). Patients were evaluated at final follow-up for patient-reported outcome measures (PROMs). Clinical records were reviewed for complications or subsequent surgery. Radiographs were reviewed for the following acetabular parameters: lateral centre-edge angle, anterior centre-edge angle, acetabular index, and the alpha-angle (AA). Patients were cross-referenced from the two largest hospital systems in our area to determine if subsequent HA was performed. Descriptive statistics were used to analyze risk factors for HA.Aims
Methods
Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular work such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary PAO cohort with no intra-articular work performed at the time of PAO. From June 2012 to March 2022, 368 rectus sparing PAOs were performed and followed for a minimum of one year (mean 5.9 years). The average age was 24 (range 14–46) and 89% were female. Patients were evaluated at last follow-up for patient-reported outcomes (PROMs). Clinical records were reviewed for complications or subsequent surgery. Radiographs were reviewed for the following acetabular parameters: LCEA, ACEA, AI, and the alpha-angle (AA). Patients were cross-referenced from the two largest hospital systems in our area to determine if subsequent HA was performed. Descriptive statistics were used to analyze risk factors for HA. 16 hips (15 patients) (4.4%) underwent subsequent HA with labral repair and femoral osteochondroplasty most common. For those with a minimum of two years of follow-up, 5.3% underwent subsequent HA. No hips underwent THA; one revision PAO was performed. 14 hips experienced a complication and 99 underwent hardware removal. All PROMs improved significantly post-operatively. Radiographically 80% of hips were in goal for acetabular correction parameters with no significant differences between those who underwent subsequent HA and those who did not. Rectus sparing PAO is associated with a low rate of subsequent HA for intra-articular pathology at 5-year follow-up. Acetabular correction alone may be sufficient as the primary intervention for the majority of patients with symptomatic acetabular dysplasia.
The purpose of this study is to evaluate early outcomes with the use of a smartphone-based exercise and educational care management system after total hip arthroplasty (THA) and demonstrate decreased use of in-person physiotherapy (PT). A multicentre, prospective randomized controlled trial was conducted to evaluate a smartphone-based care platform for primary THA. Patients randomized to the control group (198) received the institution’s standard of care. Those randomized to the treatment group (167) were provided with a smartwatch and smartphone application. PT use, THA complications, readmissions, emergency department/urgent care visits, and physician office visits were evaluated. Outcome scores include the Hip disability and Osteoarthritis Outcome Score (HOOS, JR), health-related quality-of-life EuroQol five-dimension five-level score (EQ-5D-5L), single leg stance (SLS) test, and the Timed Up and Go (TUG) test.Aims
Methods
Porous metaphyseal cones can be used for fixation in revision total knee arthroplasty (rTKA) and complex TKAs. This metaphyseal fixation has led to some surgeons using shorter cemented stems instead of diaphyseal engaging cementless stems with a potential benefit of ease of obtaining proper alignment without being beholden to the diaphysis. The purpose of this study was to evaluate short term clinical and radiographic outcomes of a series of TKA cases performed using 3D-printed metaphyseal cones. A retrospective review of 86 rTKAs and nine complex primary TKAs, with an average age of 63.2 years (SD 8.2) and BMI of 34.0 kg/m2 (SD 8.7), in which metaphyseal cones were used for both femoral and tibial fixation were compared for their knee alignment based on the type of stem used. Overall, 22 knees had cementless stems on both sides, 52 had cemented stems on both sides, and 15 had mixed stems. Postoperative long-standing radiographs were evaluated for coronal and sagittal plane alignment. Adjusted logistic regression models were run to assess malalignment hip-knee-ankle (HKA) alignment beyond ± 3° and sagittal alignment of the tibial and femoral components ± 3° by stem type.Aims
Methods
Porous metaphyseal cones are increasingly used for fixation in revision total knee arthroplasty (RTKA). Both cemented shorter length stems and longer diaphyseal engaging stems are currently utilized with metaphyseal cones with no clear evidence of superiority. The purpose of this study was to evaluate our experience with 3D printed titanium metaphyseal cones with both short cemented and longer cementless stems from a clinical and radiographic perspective. In total 136 3D printed titanium metaphyseal cones were implanted. The mean patient age was 63 and 48% were female. The mean BMI was 33 and the mean ASA class was 2.5. There were 42 femoral cones in which 28 cemented and 14 cementless stems were utilized. There were 94 tibial cones in which 67 cemented and 27 cementless stems were utilized. The choice for stem fixation was surgeon dependent and in general cones were utilized for AORI type 2 and 3 bone defects on the femur and tibia. The most common fixation scenario was short cemented stems on both the femur and tibia followed by cemented stem fixation on the tibia and cementless fixation on the femur. Clinical data such as revision, complication, and PRO was collected at last follow-up (minimum follow-up 1 year). Radiographic analysis included cone bony ingrowth and coronal and sagittal alignment on long-standing radiographs. Descriptive statistics were used to compare demographics between patients who had malalignment (HKA beyond +/− 3 degrees and flexion/extension beyond +/− 3 degrees). Adjusted logistic regression models were run to assess malalignment risk by stem type.Introduction
Methods
Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular work such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose of this review was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary PAO cohort with no intra-articular work performed at the time of PAO. From June 2012 to September 2019, 272 Rectus Sparing PAOs were performed and followed for a minimum of one year (mean 4.6 years). The average age was 24 (range 14–44) and 87% were female. The average BMI was 25 and average length of hospital stay was 2.9 days. Patients were evaluated at last follow-up with PROMIS PF-CAT, pain and mental health scores. Clinical records were reviewed for complications or subsequent surgery. Pre and post-operative radiographs were reviewed for change in the following acetabular parameters: LCEA, ACEA, AI, and the alpha-angle was obtained from preoperative radiographs. Patients were cross-referenced from the two largest hospital systems in our area to determine if subsequent HA was performed. Descriptive statistics and logistic regression were used to analyze risk factors for HA.Introduction
Methods
A significant percentage of patients remain dissatisfied after total knee arthroplasty (TKA). The aim of this study was to determine whether the sequential addition of accelerometer-based navigation for femoral component preparation and sensor-guided ligament balancing improved complication rates, radiological alignment, or patient-reported outcomes (PROMs) compared with a historical control group using conventional instrumentation. This retrospective cohort study included 371 TKAs performed by a single surgeon sequentially. A historical control group, with the use of intramedullary guides for distal femoral resection and surgeon-guided ligament balancing, was compared with a group using accelerometer-based navigation for distal femoral resection and surgeon-guided balancing (group 1), and one using navigated femoral resection and sensor-guided balancing (group 2). Primary outcome measures were Patient-Reported Outcomes Measurement Information System (PROMIS) and Knee injury and Osteoarthritis Outcome (KOOS) scores measured preoperatively and at six weeks and 12 months postoperatively. The position of the components and the mechanical axis of the limb were measured postoperatively. The postoperative range of motion (ROM), haematocrit change, and complications were also recorded.Aims
Methods
Radiographic assessment of acetabular fragment positioning during periacetabular osteotomy (PAO) is of paramount importance. Plain radiographic examination is time and resource intensive. Fluoroscopic based assessment is increasingly utilized but can introduce distortion. Our purpose was to determine the correlation of intraoperative fluoroscopy-based measurements with a fluoroscopic tool that corrects for distortion with postoperative plain-film measurements. We performed a prospective validation study on 32 PAO's (28 patients) performed by a single academic surgeon. Preoperative standing radiographs, intraoperative fluoroscopic images, and postoperative standing radiographs were evaluated with lateral center edge angle (LCEA), acetabular index (AI), posterior wall sign (PWS), and anterior center edge angle (ACEA). Intraoperative fluoroscopy was adjusted to account for pelvic inclination. The fluoroscopic GRID was utilized in all cases (Phantom MSK Hip Preservation, OrthoGrid LLC, Salt Lake City, UT). Intraoperative fluoroscopic measurements were compared to preoperative and postoperative standing radiographs at 6 weeks using linear regression applied in MINITAB.Introduction
Methods
Total knee arthroplasty (TKA) reliably improves pain and function in patients with knee osteoarthritis (OA), though a substantial percentage of patients remain unsatisfied. Reasons include the presence of complications, persistent pain, and unmet expectations. The aim of this study was to determine whether the sequential addition of accelerometer-based navigation of the distal femoral cut and sensor-assisted soft tissue balancing changed complication rates, radiographic alignment, or patient-reported outcomes (PROs) compared to TKA performed with conventional instrumentation. This retrospective cohort study included 371 TKAs in 319 patients. All surgeries were performed by a single surgeon in sequential fashion using a measured resection technique with a goal of mechanical alignment. The historical control group, utilizing intramedullary guides for distal femoral resection and surgeon-guided soft tissue balancing, was compared to group 1 (accelerometer-based navigation for distal femoral resection, surgeon-guided balancing) and group 2 (navigated femoral resection, sensor-guided balancing). Primary outcome measures were PROMIS scores including physical function computerized adaptive test (PF CAT), and the Global 10 health assessment (including physical, mental, and pain scores), and Knee Injury Osteoarthritis and Outcome Score (KOOS), measured preoperatively and at 6 weeks and 12 months postoperatively. Radiographic measurements included component position and overall mechanical alignment of the limb and were made at 6 weeks by a single examiner from hip to ankle standing films. Charts were reviewed for pre- and postoperative ROM at 6 weeks, polyethylene insert morphology, and postoperative hematocrit change. Complications were recorded, including manipulation under anesthesia and reoperation. Our study was powered to detect a difference of 1 standard deviation in PF CAT score with 100 patients. Statistical analysis was performed by a statistician including t-tests, multivariate regression, and time series plot analyses.Introduction
Methods
The Bundled Payments for Care Improvement (BPCI) initiative has identified pathways for improving the value of care. However, patient-specific modifiable and non-modifiable risk factors may increase costs beyond the target payment. We sought to identify risk factors for exceeding our institution’s target payment, the so-called ‘bundle busters’. Using our data warehouse and Centers for Medicare and Medicaid Services (CMS) data we identified all 412 patients who underwent total joint arthroplasty and qualified for our institution’s BPCI model, between July 2015 and May 2017. Episodes where CMS payments exceeded the target payment were considered ‘busters’ (n = 123). Risk ratios (RRs) were calculated using a modified Poisson regression analysis.Aims
Patients and Methods
The aim of this study was to compare patient-reported outcome measures (PROMs), radiological measurements, and total hip arthroplasty (THA)-free survival in patients who underwent periacetabular osteotomy (PAO) for mild, moderate, or severe developmental dysplasia of the hip. We performed a retrospective study involving 336 patients (420 hips) who underwent PAO by a single surgeon at an academic centre. After exclusions, 124 patients (149 hips) were included. The preoperative lateral centre-edge angle (LCEA) was used to classify the severity of dysplasia: 18° to 25° was considered mild (n = 20), 10° to 17° moderate (n = 66), and < 10° severe (n = 63). There was no difference in patient characteristics between the groups (all, p > 0.05). Pre- and postoperative radiological measurements were made. The National Institute of Health’s Patient Reported Outcomes Measurement Information System (PROMIS) outcome measures (physical function computerized adaptive test (PF CAT), Global Physical and Mental Health Scores) were collected. Failure was defined as conversion to THA or PF CAT scores < 40, and was assessed with Kaplan–Meier analysis. The mean follow-up was five years (2 to 10) ending in either failure or the latest contact with the patient.Aims
Patients and Methods
Recent studies of novel healthcare episode payment models, such as the Bundled Payments for Care Improvement (BPCI) initiative, have demonstrated pathways for improving value. However, these models may not provide appropriate payments for patients with significant medical comorbidities or complications. The objective of this study was to identify risk factors for exceeding our institution's target payment, the so-called “bundle busters.” After receiving an exemption from the Institutional Review Board, we queried our institutional data warehouse for all patients (n=412) that underwent total joint arthroplasty (TJA) of the hip (n=192), knee (n=207), or ankle (n=13), and qualified for our institution's bundled payments model during the study time period (July 2015 – May 2017). Patients with medical conditions that were not well controlled or were potentially optimizable were all sent for preoperative medical optimization prior to surgery. For each 90-day episode, patient characteristics, medical comorbidities, perioperative data, and payments from the Centers for Medicare and Medicaid Services (CMS) were obtained. Episodes where Medicare payments exceeded the target payment were considered “busters”. The busters were older, and had higher comorbidity scores (all, p<0.01). Variables were summarized using descriptive statistics and risk ratios were calculated using a modified Poisson regression analysis.Introduction
Methods
The demands placed upon joint surgeons are perhaps greatest when treating the revision arthroplasty patient, who present with complications demanding skill in diagnosis and evaluation, interpersonal communication and the technical aspects of the revision procedure. However, little information exists identifying which specific tasks in revision arthroplasty are most difficult for surgeons to master, and whether the greatest challenges arise from clinical, cognitive or technical facets of patient treatment. This study was undertaken to identify which tasks associated with revision total knee replacement (TKR) are perceived as most challenging to young surgeons and trainees to guide future efforts in surgical training and curriculum development. We developed an online survey instrument consisting of 69 items encompassing pre-operative, intraoperative, and post-operative tasks that preliminary studies identified as the essential components of revision TKR. These tasks encompassed 4 domains: clinical decision-making skills (n=9), interpersonal assessment and communication (n=7), surgical decision-making (n=35) and procedural surgical tasks (n=18). Respondents rated the difficulty of each item on a 5-level Likert scale, with an ordinal score ranging from 1 (“very easy”) to 5 (“very difficult”. The survey instrument was administered to a cohort of 109 US surgeons: 31 trainees enrolled in a joint fellowship program (Fellows) and 78 surgeons who had graduated from a joint fellowship program within the previous 10 years (Joint Surgeons). Using appropriate parametric and non-parametric tests, the responses were analyzed to examine the variation of reported difficulty of each of the 69 items, in addition to the nature of the task (cognitive, surgical, clinical and interpersonal), and differences between Fellows and Surgeons.Introduction
Methods
The aim of this study was to compare patient reported outcomes, radiographic measurements, and survival free from total hip arthroplasty (THA) in patients who underwent periacetabular osteotomy (PAO) for mild, moderate, or severe developmental dysplasia of the hip (DDH). We performed a retrospective cohort study on all patients (n=223, n=274 hips) who underwent a PAO procedure between May 1996 and May 2016, by a single surgeon at one academic center. Cases with a history of retroversion (n=64), Perthes (n=5), and those with <2 years of follow-up (n=63) were excluded. Patients were evaluated based on severity of dysplasia using the preoperative lateral center edge angle (LCEA): 18° – 25° was considered mild dysplasia (n=19), 10° – 17° moderate (n=62), and <10° severe (n=61). There was no difference in patient characteristics (age, sex, body mass index, or ASA score) between then cohorts (all, p>0.05). NIH PROMIS outcome measures included the physical function computerized adaptive test (PF CAT) and the Global 10 health assessment. Generalized estimating equations were used for all comparisons and missing data was imputed using the multivariate imputation by chained equations method. A Kaplan-Meier analysis was used to assess survival. Failure was defined as conversion to THA and follow-up was ended at time of failure or at the time of last follow-up. Mean follow-up was five years (1 – 19).Introduction
Methods
For this retrospective cohort study, patients aged ≤ 30 years
(very young) who underwent total hip arthroplasty (THA) were compared
with patients aged ≥ 60 years (elderly) to evaluate the rate of
revision arthroplasty, implant survival, the indications for revision,
the complications, and the patient-reported outcomes. We retrospectively reviewed all patients who underwent primary
THA between January 2000 and May 2015 from our institutional database.
A total of 145 very young and 1359 elderly patients were reviewed.
The mean follow-up was 5.3 years (1 to 18). Logistic generalized
estimating equations were used to compare characteristics and the revision
rate. Survival was evaluated using Kaplan–Meier curves and hazard
rates were created using Cox regression.Aims
Patients and Methods
Most cases of hip osteoarthritis (OA) are believed to be caused by alterations in joint contact mechanics resulting from pathomorphologies such as acetabular dysplasia and acetabular retroversion. Over the past 13 years, our research group has focused on developing approaches for patient-specific modeling of cartilage and labrum in the human hip, and applying these approaches to study hip pathomorphology. The long term objective is to improve the understanding of the etiology of OA related to hip pathomorphology, and to improve diagnosis and treatment. The objectives of this presentation are to provide a summary of our subject-specific modeling approach, and to describe the results of our analysis of hips from three populations of subjects: normal, traditional dysplastic, and retroverted. A combined experimental and computational protocol was used to investigate contact mechanics in ten normal subjects (normal center edge angles (CEA), no history of hip pain), ten subjects with hip pain secondary to acetabular dysplasia (CEA less than 25°), and ten patients with a radiographic crossover sign, pain and clinical exams consistent with acetabular retroversion. CT arthrography was used to image cartilage and bone. Volumetric image data were segmented and discretized, and subject-specific finite element models were produced using validated methods [Fig. 1]. Boundary and loading conditions were obtained from instrumented implant and gait data. Contact mechanics were evaluated on the acetabular cartilage and labrum. Labrum contact area and peak contact stress were evaluated. Cartilage contact area, peak and average contact stress were evaluated in six anatomical regions in the acetabulum.Introduction:
Methods:
This presentation will provide an overview of the interdisciplinary research program on hip pathomorphology at the University of Utah, including studies of dysplasia and femoracetabular impingement. The discussion will emphasize the implications of the research findings for hip preserving surgery
