The incidence of subsequent hip arthroscopy after rectus-sparing periacetabular osteotomy.

Aims: 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.

Outpatient Total Joint Arthroplasty at a High-Volume Academic Center: An Analysis of Failure to Launch.

Background: Unanticipated failure to discharge home (failure to launch, FTL) following scheduled same-day discharge (SDD) total joint arthroplasty (TJA) is problematic for the surgical facility with respect to staffing, care coordination, and reimbursement concerns. The aim of this study was to review rates, etiologies, and contributing factors for FTL in SDD TJA at an inpatient academic medical center.

Methods: All patients who underwent primary TJA between February 2021 and February 2023 were retrospectively reviewed.

John Charnley Award: A Quantitative Fluoroscopic Tool Improves Acetabular Fragment Positioning in Periacetabular Osteotomy.

Background: Radiographic assessment of acetabular fragment positioning during periacetabular osteotomy (PAO) has been linked to hip survivorship. Intraoperative plain radiographs are time and resource intensive, while fluoroscopy can introduce image distortion affecting measurement accuracy. Our purpose was to determine whether intraoperative fluoroscopy-based measurements with a distortion correcting fluoroscopic tool improved PAO measurement targets.

High Survivorship of a Modular Titanium Baseplate Independent of Body Mass Index and Malalignment.

Background: Tibial component aseptic loosening remains problematic in primary total knee arthroplasty (TKA). Influential factors include component design, metallurgy, and cement technique. Additionally, reports advocate for longer tibial stem fixation in high body mass index (BMI) patients.

Evaluating the Utility of Using Text Messages to Communicate With Patients During the COVID-19 Pandemic.

Introduction: We evaluated the use of text messages to communicate information to patients whose surgeries were postponed because of the COVID-19 restriction on elective surgeries. Our hypothesis was that text messaging would be an effective way to convey updates.

Methods: In this observational study, 295 patients received text messaging alerts.

Does the sequential addition of accelerometer-based navigation and sensor-guided ligament balancing improve outcomes in TKA?

Aims: 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.

Methods: This retrospective cohort study included 371 TKAs performed by a single surgeon sequentially.

Advantages of an Anterior-Based Muscle-Sparing Approach in Transitioning From a Posterior Approach for Total Hip Arthroplasty: Minimizing the Learning Curve.

Background: Enthusiasm for anterior-based approaches for total hip arthroplasty (THA) continues to increase but there is concern for increased complications during the learning curve period associated. This study aimed to investigate if there was a difference in perioperative variables, intraoperative and immediate postoperative complications, or patient-reported outcomes when transitioning from a mini-posterior approach (mPA) to an anterior-based muscle-sparing (ABMS) approach for THA.

Methods: Retrospective cohort study on the first 100 primary THA cases (n = 96 patients) of the senior author (August 2016 to August 2017) using the ABMS approach.

Short-term functional recovery after total joint arthroplasty is unaffected by bundled payment participation.

Background: Bundled payment models for lower extremity total joint arthroplasty (TJA) aim to improve value by decreasing costs via efficient care pathways. It is unclear how such models affect patient-centered outcomes such as functional recovery. We aimed to determine whether participation in bundled payment for TJA negatively affects patients' functional recovery.

Treated Versus Untreated Depression in Total Joint Arthroplasty Impacts Outcomes.

Background: To determine if there was a difference in the change in patient-reported physical function (PF) between nondepressed and medically treated depressed or untreated depressed total joint arthroplasty (TJA) patients.

Methods: This is an Institutional Review Board exempt retrospective review of 280 TJA cases from March 2014 to May 2016. Patient-reported PF was measured as part of the routine care via the Patient Reported Outcomes Measurement Information System PF computerized adaptive test.

Adding Value to Total Joint Arthroplasty Care in an Academic Environment: The Utah Experience.

Background: Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force.

Methods: To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models.

Improving Value in Total Joint Arthroplasty: A Comprehensive Patient Education and Management Program Decreases Discharge to Post-Acute Care Facilities and Post-Operative Complications.

Background: A step-by-step approach to creating a comprehensive patient education, expectation, and management program is described with the aim of reducing discharges to post-acute care centers (PACs) following total joint arthroplasty (TJA). We hypothesized that by lowering discharges to PACs, readmissions and reoperations would also decrease.

Methods: Following the implementation of a multi-faceted patient education and management program, we retrospectively reviewed 927 TJAs who underwent surgery 12 months before (n = 465) and after (n = 462) the program was implemented.

Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip.

Background: Developmental dysplasia of the hip (DDH) is a recognized cause of secondary arthritis, which may eventually lead to total hip arthroplasty (THA). An understanding of the common acetabular and femoral morphologic abnormalities will aid the surgeon in preparing for the complexity of the surgical case.

Methods: We present the challenges associated with acetabular and femoral morphologies that may be present in the dysplastic hip and discuss surgical options to consider when performing THA.

Operative Fluoroscopic Correction Is Reliable and Correlates With Postoperative Radiographic Correction in Periacetabular Osteotomy.

Background: Intraoperative fluoroscopy is commonly used to both guide the osteotomy and judge correction of the acetabular fragment in periacetabular osteotomy (PAO). Prior studies that have compared intraoperative fluoroscopic correction with postoperative radiographic correction were small studies that did not report intra- or interreader reliability.

Questions/purposes: (1) What is the correlation between intraoperative fluoroscopic correction in PAO compared with the correction seen on postoperative radiographs? (2) What is the reliability of radiographic measures of correction in PAO?

Methods: We performed a retrospective study of 121 patients (141 hips) who underwent PAO for symptomatic hip dysplasia at a tertiary referral center.

Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults With Varying Morphologies.

Background: The anterior wall index (AWI) and posterior wall index (PWI) have been proposed to quantify anterior and posterior acetabular coverage using AP pelvic radiographs. However, these indices have only been reported in symptomatic patients with apparent pathomorphologies (dysplasia, overcoverage, and retroversion) undergoing osteochondroplasty or reorientation osteotomy.

Questions: (1) What are the ranges for AWI and PWI from measurements obtained on AP pelvic radiographs of asymptomatic senior athletes with well-functioning hips? (2) Is there a difference between the AWI and PWI in asymptomatic athletes with acetabular morphology consistent with acetabular dysplasia, overcoverage, and retroversion when compared with asymptomatic hips that do not meet the radiographic definitions for those morphologies (controls)?

Methods: Five hundred five athletes (998 asymptomatic native hips) were independently evaluated by two readers on AP pelvic radiographs for AWI and the PWI after excluding hips with prior surgery, inadequate radiographs, or poor function (modified Harris hip score < 80).

Femoral Morphology in Patients Undergoing Periacetabular Osteotomy for Classic or Borderline Acetabular Dysplasia: Are Cam Deformities Common?

Background: The primary purpose of our study was to determine the prevalence of Cam deformity in patients with symptomatic acetabular dysplasia (SAD) who underwent periacetabular osteotomy (PAO).

Methods: We retrospectively reviewed 164 SAD PAO patients from 2 institutions. Preoperative anteroposterior and frog-lateral radiographs were analyzed for lateral center edge angle (LCEA), retroversion, alpha angles, and anterior femoral head-neck offset.

Midterm Outcomes of Reverse (Anteverting) Periacetabular Osteotomy in Patients With Hip Impingement Secondary to Acetabular Retroversion.

Background: There is a paucity of data on the results of reverse (anteverting) periacetabular osteotomy (RPAO) for treatment of femoroacetabular impingement (FAI) secondary to acetabular retroversion.

Purpose: To evaluate the midterm outcomes of RPAO for FAI secondary to acetabular retroversion in those with and without hip dysplasia.

Study Design: Cohort study; Level of evidence, 3.

Can Radiographs Predict the Use of Modular Stems in Developmental Dysplasia of the Hip?

Background: Abnormal anatomy frequently results in the use of a modular stem in patients undergoing primary total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). However, because these stems are not always available in the operating room, it would be helpful if standard radiographic views could be analyzed in such a way that patients whose femoral anatomy might call for stem modularity could be anticipated before surgery. To our knowledge, no such parameters have been defined.

A Heritable Predisposition to Osteoarthritis of the Hip.

Using THA as a proxy for underlying osteoarthritis, we describe population-based familial clustering of osteoarthritis of the hip. The GIF test for excess relatedness on 1049 patients that underwent THA (and do not have a diagnostic code for other conditions leading to THA) showed excess relatedness (P<0.001).

The 2015 Frank Stinchfield Award: Radiographic Abnormalities Common in Senior Athletes With Well-functioning Hips but Not Associated With Osteoarthritis.

Background: It is not known whether morphological abnormalities of the hip are compatible with lifelong hip function and avoidance of osteoarthritis (OA). Our purpose was to investigate the prevalence of radiographic findings consistent with femoroacetabular impingement (FAI) and dysplasia (DDH) in senior athletes with well-functioning hips.

Questions/purposes: (1) What is the prevalence of FAI and DDH in senior athletes with well-functioning hips? (2) Are radiographic findings of FAI and DDH associated with OA? (3) Is a history of longer duration or more intense activity associated with hip pathomorphology? (4) Were the modified Harris hip scores and the Hip Outcome Scores lower (legacy scales) in patients with evidence of hip pathomorphology than those without?

Methods: Five hundred forty-seven individuals (55% men, 45% women; 1081 hips, 534 bilateral and 13 unilateral), mean age 67 years (SD 8 years), gave consent and qualified for this institutional review board-approved cross-sectional study of senior athletes.

The prevalence of radiographic findings of structural hip deformities in female collegiate athletes.

Background: Structural deformities of the hip, including femoroacetabular impingement (FAI) and acetabular dysplasia, often limit athletic activity. Previous studies have reported an increased prevalence of radiographic cam FAI in male athletes, but data on the prevalence of structural hip deformities in female athletes are lacking.

Purpose: (1) To quantify the prevalence of radiographic FAI deformities and acetabular dysplasia in female collegiate athletes from 3 sports: volleyball, soccer, and track and field.

Preservation of the rectus femoris origin during periacetabular osteotomy does not compromise acetabular reorientation.

Background: The early recovery period after periacetabular osteotomy (PAO) can be limited by pain and activity restrictions. Modifications of the Bernese PAO, including sparing the rectus tendon and discontinuing routine arthrotomy, may accelerate early postoperative recovery compared with the standard approach.

Questions/purposes: Does a modified approach for PAO (1) lead to improved pain control immediately after surgery; (2) lead to improved ambulation during the hospital stay; (3) lead to shorter stays, less blood loss, and shorter surgical times; and (4) compromise acetabular correction?

Methods: We retrospectively reviewed all 75 patients who underwent PAO for developmental dysplasia of the hip between August 2009 and May 2013.

Linkage mapping and whole exome sequencing identify a shared variant in CX3CR1 in a large multi-generation family.

Developmental dysplasia of the hip (DDH) is a crippling condition that affects children and adults, with an average incidence of 1-1.5 cases per 1000 live births. It results in disabling arthritis of the hip in up to 60% patients in the 20-40 year age group.

Revision total hip arthroplasty with a modular cementless femoral stem.

We retrospectively reviewed 123 patients who underwent cementless THA with modular femoral stem designs for revision THA or conversion of failed ORIF and found 75 patients available for analysis. The Harris Hip Score (HHS) improved from 52 ± 14 to 86 ± 11 (P < 0.001).

Patient-specific instrumentation in total knee arthroplasty provides no improvement in component alignment.

Improved component alignment in TKA remains a commonly cited benefit of MRI based patient-specific instrumentation (PSI). We hypothesized that PSI would lead to improved alignment versus traditional instrumentation (TI) during primary TKA. Fifty-eight knees (54 patients) that underwent TKA with PSI were compared to 62 knees that had previously undergone TKA with TI.