Age and Early Revision After Primary Total Hip Arthroplasty for Osteoarthritis.

Prior reports have noted an increased risk of early revision among younger patients undergoing total hip arthroplasty (THA) but have been confounded by the inclusion of various diagnoses. The purpose of this study was to assess the revision rate and the time to revision for patients undergoing THA for osteoarthritis based on age. Patients with a diagnosis of osteoarthritis who underwent both primary and revision THA at the same institution were identified.

Descriptive Epidemiology of Acetabular Dysplasia: The Academic Network of Conservational Hip Outcomes Research (ANCHOR) Periacetabular Osteotomy.

Background: Periacetabular osteotomy (PAO) is an established treatment for symptomatic acetabular dysplasia, which is a well-recognized cause of hip pain, functional limitations, and secondary osteoarthritis. The purpose of this study was to describe the demographics of patients undergoing PAO, the baseline patient-reported outcome measures for this population, and the types of adjunctive procedures performed at the time of PAO surgery.

Methods: Demographics, disease characteristics, and patient-reported functional measures were prospectively collected from all patients who underwent PAO performed by 12 surgeons from 2008 to 2013.

Patient-Reported Outcomes of Periacetabular Osteotomy from the Prospective ANCHOR Cohort Study.

Background: Current literature describing the periacetabular osteotomy (PAO) is mostly limited to retrospective case series. Larger, prospective cohort studies are needed to provide better clinical evidence regarding this procedure. The goals of the current study were to (1) report minimum 2-year patient-reported outcomes (pain, hip function, activity, overall health, and quality of life), (2) investigate preoperative clinical and disease characteristics as predictors of clinical outcomes, and (3) report the rate of early failures and reoperations in patients undergoing contemporary PAO surgery.

Preoperative Joint Space Width Predicts Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients.

Background: In a new health care economy, there is an emerging need to understand and quantify predictors of total hip arthroplasty (THA) outcomes. We investigated the association between preoperative radiographic disease (as measured quantitatively by joint space width [JSW]) and patient-reported function, activity, pain, and quality of life after THA.

Methods: We retrospectively analyzed 146 patients (146 hips) 55 years or younger with a diagnosis of osteoarthritis who underwent cementless THA between January 2009 and December 2010.

Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

Background: Tranexamic acid (TXA) has shown safety and efficacy in reducing blood loss associated with various surgical procedures. However, to our knowledge there are no studies evaluating the effect of TXA on blood loss and transfusion requirements associated with periacetabular osteotomy (PAO).

Questions/purposes: The main purpose of this study is to determine whether TXA reduces blood loss and transfusion use in patients undergoing PAO for symptomatic acetabular dysplasia.

Are there sex-dependent differences in acetabular dysplasia characteristics?

Background: Many patients who undergo periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia experience decreased pain and improved function, yet some experience inadequate clinical improvement. The etiologies of treatment failure have not been completely defined, and sex-dependent disease characteristics that may be associated with less pain relief are not understood.

Question/purposes: We sought to determine whether there were clinically important sex-specific differences between male and female patients undergoing PAO for acetabular dysplasia in terms of (1) clinical parameters (anthropomorphic traits and hip scores), (2) radiographic findings, and (3) intraoperative findings at the time of PAO, in particular findings potentially associated with femoroacetabular impingement (FAI) such as chondromalacia at the head-neck junction, impingement trough, or reduced head-neck offset.

Does previous pelvic osteotomy compromise the results of periacetabular osteotomy surgery?

Background: As the Bernese periacetabular osteotomy (PAO) has grown in popularity, specific indications and the results in patients treated for those indications need to be evaluated. Currently, although many patients undergo PAO after having had prior pelvic osteotomy, there is limited information regarding the efficacy of the PAO in these patients.

Questions/purposes: The purpose of this study was to compare the (1) early pain, function, activity, and quality of life outcomes; (2) radiographic correction; and (3) major complications and failures between patients who underwent PAO after prior pelvic reconstruction versus those who had a PAO without prior surgery.

Complications associated with the periacetabular osteotomy: a prospective multicenter study.

Background: The purpose of this prospective multicenter study was to determine and categorize all complications associated with the periacetabular osteotomy performed by experienced surgeons.

Methods: We prospectively analyzed perioperative complications in 205 consecutive unilateral periacetabular osteotomies performed at seven institutions by ten surgeons. All perioperative complications were recorded at an average of ten weeks and one year after surgery in standardized fashion using a validated complication grading scheme applied to hip preservation procedures.

Are younger patients undergoing THA appropriately characterized as active?

Background: Surgeons perform THA to address a variety of conditions in younger patients, including osteoarthritis (OA), osteonecrosis, inflammatory arthritis, and congenital deformities. Younger patients aged 50 years or younger have been characterized as active in the literature, but a direct relationship between age and activity level has not been well substantiated. Younger patients with OA may engage in higher activity levels; however, associated medical conditions in patients with other surgical indications may not support a generalization that age is a surrogate for activity level.

Patient and disease characteristics associated with hip arthroscopy failure in acetabular dysplasia.

The purpose of this study was to define the clinical and disease characteristics in patients who fail hip arthroscopy and require periacetabular osteotomy. Thirty patients (30 hips) who underwent a PAO, following a failed hip arthroscopy were identified from a multicenter database. Eighty-seven percent were female and the average age was 27.

Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery.

Background: Symptomatic femoroacetabular impingement (FAI) is associated with hip pain, functional limitations, and secondary osteoarthritis. There is limited information from large patient cohorts defining the specific population affected by FAI. Establishing a large cohort will facilitate the identification of "at-risk" patients and will provide a population for ongoing clinical research initiatives.

Why do hip arthroscopy procedures fail?

Background: Despite the successes of hip arthroscopy, clinical failures do occur, and identifying risk factors for failure may facilitate refinement of surgical indications and treatment. Knowledge regarding the reasons for treatment failures may also improve surgical decision making.

Questions/purposes: We (1) characterized patients whose symptoms recurred after hip arthroscopy necessitating a revision hip preservation procedure or hip arthroplasty, (2) determined the etiologies of failure, (3) and reported the profile of revision surgical procedures.

Unstable SCFE: review of treatment modalities and prevalence of osteonecrosis.

Background: The treatment of unstable slipped capital femoral epiphysis (SCFE) is rapidly evolving with the ability to correct epiphyseal alignment using the modified Dunn technique. Adopting a new treatment method depends on confirming that it achieves its goals, produces few, nonserious complications with no lasting sequelae, and improves the natural history of the disorder compared with known treatment methods. As such, the rates of osteonecrosis and complications after current treatments of unstable SCFE must be compared with those of newer surgical techniques.

Do fluoroscopy and postoperative radiographs correlate for periacetabular osteotomy corrections?

Background: The Bernese periacetabular osteotomy (PAO) can relieve pain and restore function in patients with symptomatic acetabular dysplasia. Accurate acetabular correction is fundamental to achieving these clinical goals and presumably enhancing survivorship of the reconstruction. Fluoroscopy is used by some surgeons to assess intraoperative acetabular correction but it is unclear whether the features observed by fluoroscopy accurately reflect those on postoperative radiographs.

Intraarticular abnormalities in residual Perthes and Perthes-like hip deformities.

Background: Residual Perthes and Perthes-like hip deformities are complex and may encompass proximal femoral deformity, secondary acetabular dysplasia, and associated intraarticular abnormalities. These intraarticular abnormalities have not been well characterized but may influence surgical technique and treatment outcomes.

Questions/purposes: We (1) determined the characteristics of intraarticular disease associated with residual Perthes-like hip deformities; and (2) correlated these intraarticular abnormalities with clinical characteristics and radiographic parameters of hip morphology.

Lower extremity-specific measures of disability and outcomes in orthopaedic surgery.

Outcome measures may be simple questions or complex measures that assess multiple interrelated domains affecting treatment outcomes. Outcome measures should be relevant to patients, easy to use, reliable, valid, and responsive to clinical changes. Joint and disease-specific outcome measures have been developed for the hip, knee, and foot and ankle.

Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy: impact upon renal function in the setting of a solitary kidney in a porcine model.

Introduction: Laparoscopic partial nephrectomy has emerged as a standard of care for small renal masses. Nevertheless, there remains concern over the potential for irreversible insult to the kidney as a result of exposure to warm ischemia. We aim to investigate the utility of selective segmental arterial clamping as a means to reduce the potential for ischemic damage to a solitary kidney during laparoscopic partial nephrectomy utilizing a porcine model.

Open versus laparoscopic retroperitoneal lymph node dissection: assessing adequacy of dissection in a porcine model.

Background And Purpose: Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is emerging as a viable alternative to traditional open retroperitoneal lymph node dissection (O-RPLND). Despite numerous reports confirming clinical oncologic equivalency between the two approaches, however, concerns still remain over the adequacy of laparoscopic dissection. We therefore sought to compare the completeness of dissection between O-RPLND and L-RPLND in a porcine model.