The anterior-based muscle-sparing approach is cost-effective when compared with posterolateral and direct anterior approaches for total hip arthroplasty.

Purpose: Research relating to Total Hip Arthroplasty (THA) has found the anterior-based muscle-sparing (ABMS) approach improves both intraoperative and postoperative outcomes when compared to other THA approaches. This study compares the costs and outcomes of the ABMS approach and standard of care (SOC) to determine the relative cost-effectiveness.

Methods: A decision-analytic model was utilized to estimate intraoperative outcomes (i.

Variation in Demographics, Hospital, and Patient-Reported Outcomes Following Total Hip Arthroplasty According to Biological Sex.

Background: The effect of biological sex on the outcomes of total hip arthroplasty (THA) remains unclear. Accounting for biological sex in research is crucial for reproducibility and accuracy. Average combined data may mask sex-related variation and obscure clinically relevant differences in outcomes.

The Association of Season of Surgery and Patient Reported Outcomes following Total Hip Arthroplasty.

Background: Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA). Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience. The aim of this study is to investigate if there are differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season of the index procedure to improve surgeon erative counseling.

Bilateral Total Hip Arthroplasty: Outcomes of Staged Versus Simultaneous Procedures Performed Using an Anterior-Based Muscle-Sparing Approach.

Background: The incidence of total hip arthroplasty (THA) in the United States continues to increase due to its ability to markedly improve patients' quality of life. This study investigated and compared the perioperative and postoperative outcomes of simultaneous (SI-THA) and staged (ST-THA) bilateral THA procedures using an anterior-based muscle-sparing (ABMS) approach.

Methods: This retrospective case control study evaluated perioperative and postoperative outcomes from primary bilateral SI-THA or ST-THA (within 365 days) performed with the ABMS approach by 3 surgeons at a single institution between January 2013 and August 2020.

Rural-Urban Differences in Hospital and Patient-Reported Outcomes Following Total Hip Arthroplasty.

Background: Rural patients have unique health-care factors influencing outcomes of arthroplasty, hypothetically putting these patients at increased risk for complications following total joint arthroplasty. The aim of this study is to better understand differences in patient outcomes and satisfaction between rural and urban patients receiving care in an urban setting and to provide more equitable care.

Methods: A retrospective chart review was performed on patients undergoing primary total hip arthroplasty at a single large academic center between January 2013 and August 2020.

Outcomes of the Anterior-Based Muscle-Sparing Approach in Elective Total Hip Arthroplasty in Nonagenarians.

Background: As the population ages, total hip arthroplasty has become more common in elderly patients including patients over the age of 90 years. Efficacy in this age group has been established, though literature regarding safety of total hip arthroplasty in nonagenarians is mixed. The anterior-based muscle-sparing (ABMS) approach, which exploits the intermuscular plane between the tensor fasciae latae and the gluteus medius, has proposed benefits of fast recovery, excellent stability, and reduced bleeding and may be adventitious among elderly, more fragile patients.

Outcomes of morbidly obese patients undergoing total hip arthroplasty with the anterior-based muscle-sparing approach.

Obesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of total hip arthroplasties (THAs) performed annually. This study examines the peri- and postoperative outcomes of morbidly obese (MO) patients (BMI ≥ 40 kg/m) compared to healthy weight (HW) patients (BMI 18.5 to < 25 kg/m) who underwent a THA using the anterior-based muscle-sparing (ABMS) approach.

The ABLE Anterior-Based Muscle-Sparing Approach: A Safe and Effective Option for Total Hip Arthroplasty.

Background: The direct anterior and posterior approaches are well-researched options in total hip arthroplasty (THA). The less-studied anterior-based muscle-sparing approach, also known as the ABLE advanced anterior approach, centers on minimizing surgical trauma and medical costs while maintaining or improving patient outcomes.

Material And Methods: THAs performed using the ABLE approach by 3 surgeons at a single institution between January 2013 and August 2020 were retrospectively assessed for outcomes pertaining to safety and performance intraoperatively, perioperatively, and postoperatively.

Does Deep Neuromuscular Blockade Improve Operating Conditions during Minimally Invasive Anterolateral Total Hip Replacements?: A Randomized Controlled Trial.

Background Neuromuscular blockade (NMB) is thought to improve operative conditions during certain procedures. Published descriptions of minimally invasive hip replacement techniques specify the need for "excellent relaxation", however, the optimal degree of NMB required for such cases has not been studied. We performed a randomized, single-blind study comparing the effect of moderate and deep neuromuscular blockade on surgical conditions and operating time during minimally invasive anterolateral hip replacement.

The Cost and Outcome Effectiveness of Total Hip Replacement: Technique Choice and Volume-Output Effects Matter.

Background: Total hip replacement (THR) must be managed in a more sustainable manner. More cost-effective surgical techniques and the centralization/regionalization of services are two solutions. The former requires an assessment of newer minimally invasive and muscle-sparing surgical techniques.

Current Orthopaedic Surgeon Practices for Nonarthroplasty Treatment of Osteoarthritis of Adult Hip and Knee.

Evidence-based guidelines have recently been published for the nonarthroplasty treatment of osteoarthritis of the hip and knee and are becoming an expected part of comprehensive patient care. To understand how current treatment practices correlate with these guidelines, a survey was administered to 50 consecutive hip replacement and 50 consecutive knee replacement patients immediately before arthroplasty for osteoarthritis in one group practice. This article is a compilation of patients' usage of the modalities suggested in two such exemplary guidelines and demonstrates that patient and surgeon preferences, as well as factors such as preoperative Oxford score, body mass index, age, and joint involved, affect usage of one or more of the commonly employed preoperative modalities.

A High Prevalence of Corrosion at the Head-Neck Taper with Contemporary Zimmer Non-Cemented Femoral Hip Components.

Mechanically assisted crevice corrosion (MACC) occurs at metal/metal modular junctions in which at least one of the components is fabricated from cobalt-chromium alloy and may lead to adverse local tissue reaction (ALTR) in patients with metal-on-polyethylene (MoP) total hip arthroplasty. This type of reaction has been previously described in hips with head/neck modularity, but the prevalence is unknown. We found a prevalence of 1.

Nonunion of the clavicle treated with plate fixation: a review of forty-seven consecutive cases.

Forty-seven consecutive patients underwent superior plating for clavicular nonunion between 1995 and 2005. This retrospective analysis was performed to assess the efficacy of plate fixation and the need for iliac crest bone grafting. Forty-three patients were treated with pelvic reconstruction plates and four with straight dynamic compression plates.

Fixation of Vancouver B1 peri-prosthetic fractures by broad metal plates without the application of strut allografts.

The use of allograft struts and cerclage wire, possibly augmented by plate fixation, for the treatment of Vancouver type-B1 peri-prosthetic fractures around a total hip replacement has been strongly advocated. We examined our results using plate fixation without allograft struts and compared them with the results of the use of struts alone or when combined with plate fixation. Of 20 consecutive patients with type-B1 fractures treated by open reduction and plate fixation, 19 were available for follow-up.

Femoral canal reaming in the polytrauma patient with chest injury. A clinical perspective.

It has been well documented that early fracture stabilization reduces morbidity and mortality in the patient who is multiply injured. However, controversy has developed recently concerning the timing and type of stabilization for the patient with multiple injuries who has sustained a femoral fracture and an associated severe chest injury. Reports from Europe have indicated an increased mortality rate and adult respiratory distress syndrome rate in the patient treated with reamed femoral rodding.

Rotational remodeling of malrotated femoral fractures: a model in the rabbit.

It is estimated that 20-40% of femoral fractures in children heal in malrotation, yet few patients later complain. To determine if malrotation corrects spontaneously, midshaft osteotomies were made in femurs of 16 rabbits aged 8 weeks and the distal fragments were internally rotated 45 degrees, where they were held with external fixators. The animals were killed between week 0 and week 17.

John Caffey Award paper. Avascular necrosis: early MR imaging and histologic findings in a canine model.

To examine the early MR and histologic changes of avascular necrosis, we surgically devascularized the distal femur of adult beagle dogs and performed short TR/short TE MR imaging and histologic examinations. MR showed increasing areas of low signal, and histologic examination showed changes of fat necrosis, inflammatory infiltrate, and fibrocytic and bony repair. These processes were divided into four stages.

Definitive control of mortality from severe pelvic fracture.

Within a group of 271 patients with pelvic fracture, 69 patients met criteria for severe hemorrhage. Sixty consecutive patients were treated by a combined multispecialty musculoskeletal trauma service using a protocol designed to control bleeding, rapidly diagnose and control associated injuries, as well as to prepare the patient for open reduction of the pelvic fracture, if appropriate. The pneumatic antishock garment, external fixation, and angiography were selectively used to control bleeding.

Redirection of central venous pressure catheters using a flow directed technique.

The malposition of the tip of a central venous catheter occurs in 5 to 30 per cent of the attempts. Repositioning of the catheter tip can be successfully and safely performed in 87.5 per cent of the patients using a Fogarty balloon catheter and flow directed techniques to float the CVP catheter to the ideal location in the superior vena cava.

Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state.

Fifty-six blunt multiple trauma patients (HTI-ISS 22-57) were studied for the effects of immediate versus delayed internal fixation of a femur or acetabular fracture on the pulmonary failure septic state. The pulmonary failure septic state may be defined as an alveolar arterial oxygen tension difference greater than 100, plus fever and leukocytosis. These patients were divided into four groups.