Moderators, Mediators, and Prognostic Indicators of Treatment With Hip Arthroscopy or Physical Therapy for Femoroacetabular Impingement Syndrome: Secondary Analyses From the Australian FASHIoN Trial.

BACKGROUND Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life. PURPOSE To explore potential moderators, mediators, and prognostic indicators of the effect of hip arthroscopy and physical therapy on change in 33-item international Hip Outcome Tool (iHOT-33) score for FAI syndrome. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Overall, 99 participants were recruited from the clinics of orthopaedic surgeons and randomly allocated to treatment with hip arthroscopy or physical therapy. Change in iHOT-33 score from baseline to 12 months was the dependent outcome for analyses of moderators, mediators, and prognostic indicators. Variables investigated as potential moderators/prognostic indicators were demographic variables, symptom duration, alpha angle, lateral center-edge angle (LCEA), Hip Osteoarthritis MRI Scoring System (HOAMS) for selected magnetic resonance imaging (MRI) features, and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score. Potential mediators investigated were change in chosen bony morphology measures, HOAMS, and dGEMRIC score from baseline to 12 months. For hip arthroscopy, intraoperative procedures performed (femoral ostectomy ± acetabular ostectomy ± labral repair ± ligamentum teres debridement) and quality of surgery graded by a blinded surgical review panel were investigated for potential association with iHOT-33 change. For physical therapy, fidelity to the physical therapy program was investigated for potential association with iHOT-33 change. RESULTS A total of 81 participants were included in the final moderator/prognostic indicator analysis and 85 participants in the final mediator analysis after exclusion of those with missing data. No significant moderators or mediators of change in iHOT-33 score from baseline to 12 months were identified. Patients with smaller baseline LCEA (β = -0.82; P = .034), access to private health care (β = 12.91; P = .013), and worse baseline iHOT-33 score (β = -0.48; P < .001) had greater iHOT-33 improvement from baseline to 12 months, irrespective of treatment allocation, and thus were prognostic indicators of treatment response. Unsatisfactory treatment fidelity was associated with worse treatment response (β = -24.27; P = .013) for physical therapy. The quality of surgery and procedures performed were not associated with iHOT-33 change for hip arthroscopy (P = .460-.665 and P = .096-.824, respectively). CONCLUSION No moderators or mediators of change in hip-related quality of life were identified for treatment of FAI syndrome with hip arthroscopy or physical therapy in these exploratory analyses. Patients who accessed the Australian private health care system, had smaller LCEAs, and had worse baseline iHOT-33 scores, experienced greater iHOT-33 improvement, irrespective of treatment allocation

Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management

Recent alarming joint registry data highlighting increased revision rates has prompted further research into the area of metal-on-metal hip replacements and resurfacings. This review article examines the latest literature on the topic of adverse reactions to metal debris and summarises the most up-to-date guidelines on patient management. Adverse reactions to metal debris can cause significant damage to soft tissue and bone if not diagnosed early. Furthermore, not every patient with an adverse reaction to metal debris will be symptomatic. As such, clinicians must remain vigilant when assessing and investigating these patients in order to detect failing implants and initiate appropriate management

Influence of femoral broach shape on stem alignment using anterior approach for total hip arthroplasty: A radiologic comparative study of 3 different stems.

BACKGROUND:Malalignment of the femoral stem in total hip arthroplasty (THA) can detrimentally affect outcome. Poor preparation of the femur intraoperatively is an important cause of stem malalignment. PURPOSES:The objective was to compare coronal alignment of three different stems using three different broaches. METHODS:Retrospective study of three groups of 60 patients following primary THA via direct anterior approach, by the same surgeon, between January 2015 and January 2016. Each group had a similar designed stem (Corail Depuy, Targos Lepine or Meije Tornier). Groups were matched for age, body mass index, gender, side, neck shaft angle and indications. The significant difference between groups was the broach shape. Broaches for the Corail and Meije stems had a prominent shoulder laterally, while the broach of the Targos stem had a rounded less prominent shape laterally. Coronal alignment was determined radiologically at 2 months. RESULTS:The mean varus was significantly lower for the Targos stems (1.1° +/-0.8) compared to the Corail (2.3° +/-1.5) and Meije stems (1.9° +/-1.2) (p<0.0001). There were significantly less Targos stems with varus greater than 3° (1.7%, n = 1) compared to the Corail (40%, n = 24) and Meije stems (20%, n = 12) (p<0.001). CONCLUSION:A femoral broach with a prominent lateral shoulder when performing a THA via direct anterior approach will increase the risk of varus femoral stem alignment compared to a less laterally prominent broach

Reproducibility of an Intraoperative Pressure Sensor in Total Knee Replacement

Appropriate soft tissue tension in total knee replacement (TKR) is an important factor for a successful outcome. The purpose of our study was to assess both the reproducibility of a modern intraoperative pressure sensor (IOP) and if a surgeon could unconsciously influence measurement. A consecutive series of 80 TKRs were assessed with an IOP between January 2018 and December 2020. In the first scenario, two blinded sequential measurements in 48 patients were taken; in a second scenario, an initial blinded measurement and a subsequent unblinded measurement in 32 patients were taken while looking at the sensor monitor screen. Reproducibility was assessed by intraclass correlation coefficients (ICCs). In the first scenario, the ICC ranged from 0.83 to 0.90, and in the second scenario it ranged from 0.80 to 0.90. All ICCs were 0.80 or higher, indicating reproducibility using a IOP and that a surgeon may not unconsciously influence the measurement. The use of a modern IOP to measure soft tissue tension in TKRs is a reproducible technique. A surgeon observing the measurements while performing IOP may not significantly influence the result. An IOP gives additional information that the surgeon can use to optimize outcomes in TKR

Does low-constraint mobile bearing knee prosthesis give satisfactory results for severe coronal deformities? A five to twelve year follow up study

PURPOSE: Severe varus and valgus knee deformities traditionally are replaced with constrained implants, with a number of disadvantages. We present our results in this challenging group using a low constraint deep-dish mobile bearing implant design. METHODS: One hundred fifty-four patients (170 arthroplasties) who underwent primary TKA using a deep-dish, mobile bearing posterior-stabilized implant for severe varus (HKA??190°) deformity between 2004 and 2009 were evaluated at a mean of 6.6years post-operatively (minimum of 5years). RESULTS: Alignment improved from a pre-operative mean (±SD) varus deformity of 167.4° (±2.6°) and a mean (±SD) valgus deformity of 194.1° (±4.0°) to an overall mean (±SD) post-operative mechanical alignment of 178.6° (±3.2°). Twenty-three patients had post-operative varus alignment, five patients had post-operative valgus alignment and 134 knees were in neutral alignment (within 3° spread). Clinical scores at final follow-up were excellent (IKS score 93.8 (±7.4) and function score 82.4 (±20.2)). Three patients were re-operated upon: one deep infection, one periprosthetic fracture and one revision at 144months for aseptic loosening of the femoral component. No patient was revised for instability or implant failure. The survival rate at fiveyears was 99.4% and at tenyears 98.6%. CONCLUSIONS: Satisfactory outcomes can be achieved in patients with substantial varus or valgus deformities using low constraint deep-dish mobile bearing implant, standard approach and appropriate soft tissue releases

Additional file 2: of Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Observations of study parameters. Parameters including. gender, age, MRI report, response to injection and arthroscopic findings. (DOCX 145 kb

Additional file 1: of Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Fluoroscopic injection of steroid and local anaesthetic into the hip joint. Pain diary that patients were asked to complete. (JPG 137 kb

The outcome of arthroscopic repair of acetabular labral tears using the iHOT-33

Abstract Background The purpose of this study was to determine patient reported outcome measures (PROMS) after arthroscopic repair of an isolated labral tear using the validated International Hip Outcome Tool (iHOT-33). The iHOT-33 specifically measures (1) symptoms and functional limitations, (2) sport and recreation limitations, (3) job related concerns and social and (4) emotional and lifestyle concerns. Methods A retrospective review was performed on 45 procedures in 43 patients between September 2012 and September 2015. Two patients had bilateral isolated labral tears. Patients were excluded if they were younger than 18 years, had prior ipsilateral hip surgery and had radiological or arthroscopic evidence of femoroacetabular impingement (FAI), hip dysplasia or other bony dysmorphism. Results Of the 43 patients undergoing arthroscopy there were 29 right and 16 left hips repaired. There were 34 females and 9 males. The mean age at surgery was 37.4 years (range 19–63 years) with a mean follow up of 1.7 years (range 1.0–2.6 years). At follow up the mean total iHOT-33 score improved from 34.1 to 67.3 (p < 0.02). The mean improvement was 33.2 (p = < 0.02). Significant improvements were described in all 4 iHOT-33 sub sections. Conclusion The study showed statistically significant favourable outcomes in selected patients with short follow-up for patients that underwent hip arthroscopy for an isolated labral tear using the validated iHOT-33. Level of Evidence IV, retrospective non-randomised study

High Midterm Survival Rate of Uncemented Total Knee Arthroplasty After High Tibial Osteotomy: A Case-Control Study

BACKGROUND: Total knee arthroplasty (TKA) following high tibial osteotomy (HTO) is technically more demanding than TKA in a native knee. Studies have reported increased intraoperative and postoperative complication of TKA with previous HTO. The aim of this study is to compare the survival and complication rates and functional outcomes of uncemented TKA with previous HTO to primary TKA at our institution over a decade. METHODS: This case-control study included 41 uncemented TKA after HTO between 2002 and 2012. For each case, 2 control patients were matched based on age and gender without previous HTO. The 2 groups were comparable for body mass index, as well as preoperative functional scores. RESULTS: The mean follow-up was 7.8 ± 2.4 (range, 5-13.6) years. At last follow-up, there was no significant difference in functional outcomes or radiological imaging, particularly the rate of radiological loosening. There was no significant difference in complications (9; 22%) in the group of TKA after HTO vs the control group (14; 17%). One revision was performed in the group of TKA after HTO for septic loosening, and no revisions in the control group. The survival rate at a mean follow-up of 8 years was 97.6% in the group TKA after HTO vs 100% in the control group. CONCLUSION: Uncemented TKAs following HTO have no significant difference in functional and radiological outcomes and survivorship compared to uncemented primary TKA at midterm follow-up

The evolution of outcomes and indications for the dual-mobility cup: a systematic review

PURPOSE: Instability following total hip arthroplasty remains a common and disabling complication. The dual mobility cup (DMC) allows a reduction in the dislocation rate. An increasing number of studies have been undertaken to better understand DMC long term outcomes and complications. The goal of this systematic review was to clarify its different uses and outcomes according to the indications. METHODS: A comprehensive literature review was performed using the keywords 'dual mobility' and 'tripolar cup' with no limit regarding the year of publication. One hundred seventy six publications were identified. RESULTS: Current literature shows that "contemporary" dual mobility cup are a significant indication to manage instability following primary and revision hip arthroplasty. Survivorship at midterm is comparable to other articulations for primary THA, but is more difficult to evaluate in revision. Intra-prosthetic dislocation, wear, and loosening are now uncommon with new generations of DMC. CONCLUSIONS: Compared to previous generations of DMC, the current "contemporary" DMC presents a significant improvement. Current literature reveals a tendency to increase the indications but further studies with long term follow up remain important to consolidate these findings