Improved Functional Outcomes of Combined Hip Arthroscopy and Periacetabular Osteotomy at Minimum 2-Year Follow-Up.

Purpose: To evaluate patient-reported outcomes (PROs) and survivorship at minimum 2-year follow-up after combined hip arthroscopy and periacetabular osteotomy (PAO) performed in the setting of a single anesthetic event.

Methods: Patients who underwent combined hip arthroscopy (M.J.

Trans-sacral screw fixation of posterior pelvic ring injuries: review and expert opinion.

Posterior pelvic ring injuries (i.e., sacro-iliac joint dislocations, fracture-dislocations, sacral fractures, pelvic non-unions/malunions) are challenging injury patterns which require a significant level of surgical training and technical expertise.

A new understanding of radiographic landmarks of the greater trochanter that indicate correct femoral rotation for measurement of femoral offset.

Objectives: To establish and validate a novel method for aligning femoral rotation to accurately measure femoral offset for preoperative templating and component sizing, and to identify the physical location of two radiographic lines utilized in the described method.

Materials And Methods: Cadaveric proximal femurs were skeletonized and mounted to a biaxial load frame. Two radiographic lines along the greater trochanter were identified fluoroscopically.

Outcomes after surgical treatment of acetabular fractures: a review.

Acetabular fractures are fractures that extend into the hip joint and pose a challenge for orthopaedic trauma surgeons. The first known descriptions of surgical fixation of acetabular fractures were case reports in 1943. In 1964, Robert Judet, Jean Judet, and Émile Letournel published a landmark article describing a classification system and surgical approaches to treat acetabular fractures.

Ten- and 20-year Survivorship of the Hip After Periacetabular Osteotomy for Acetabular Dysplasia.

Introduction: Acetabular dysplasia is a multifactorial condition characterized by a shallow hip socket with predisposition to osteoarthritis of the hip. The Bernese periacetabular osteotomy (PAO), developed by Reinhold Ganz in 1984, reorients the dysplastic hip joint to provide more uniform coverage of the femoral head and to extend the longevity of the native hip. Since 1987, the senior author performed the Bernese PAO on more than 430 patients.

Technical particularities of joint preserving hip surgery in osteopetrosis.

Proximal femoral fracture and coxarthrosis are the most common orthopaedic problems of osteopetrosis. Fracture fixation is difficult and one-third fail, with total hip replacement as the final solution. There is little reported experience about how to deal with this particular type of bone and what has been published to date is surprisingly non-specific.

Medical resource utilization and costs for total hip arthroplasty: benchmarking an anterior approach technique in the Medicare population.

Aims: The anterior approach (AA) for total hip arthroplasty (THA) is associated with more rapid recovery when compared to traditional approaches. The purpose of this study was to benchmark healthcare resource utilization and costs for patients with THA via AA relative to matched patients.

Materials And Methods: This study queried Medicare claims data (2012-2014) to identify patients who received THA via an AA from experienced surgeons, and matched these patients to a control cohort (all THA approaches).

Chronic Anterior Pelvic Instability: Diagnosis and Management.

Chronic anterior pelvic ring instability can cause pain and disability. Pain typically is localized to the suprapubic area or inner thigh; often is associated with lower back or buttock pain; and may be exacerbated by activity, direct impact, or pelvic ring compression. Known etiologies of chronic anterior pelvic ring instability include pregnancy, parturition, trauma, insufficiency fractures, athletics, prior surgery, and osteitis pubis.

Is the Anterior Approach Safe? Early Complication Rate Associated With 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach.

Background: Few publications have raised concern with the safety of the anterior approach (AA) to total hip arthroplasty (THA). The purpose of this study is to report the early complications with AA THA in a combined, multicenter patient population from three different institutions.

Methods: The study cohort consisted of 5090 consecutive primary procedures in 4473 patients who had undergone THA utilizing the anterior approach between August 2006 and July 2013.

Safe surgical technique: iliac osteotomy via the anterior approach for revision hip arthroplasty.

Robert Judet first performed hip arthroplasty via the anterior approach (AA) in 1947 on an orthopaedic table. Our center has a near 20-year experience on more than 3500 patients operated by AA hip arthroplasty. While primary AA total hip arthroplasty techniques have been discussed in the literature, revision AA total hip arthroplasty techniques are relatively new.

Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures.

Background: The aims of the study were (1) to determine the cumulative two to twenty-year survivorship of the hip after open reduction and internal fixation of displaced acetabular fractures, (2) to identify factors predicting conversion to total hip arthroplasty or hip arthrodesis, and (3) to create a predictive model that calculates an individual's probability of early need for total hip arthroplasty or hip arthrodesis.

Methods: Eight hundred and sixteen acetabular fractures treated with open reduction and internal fixation by one surgeon over a twenty-six-year period were analyzed. Cumulative two to twenty-year Kaplan-Meier survivorship analyses of the hip, including best and worst-case scenarios, were performed with total hip arthroplasty or hip arthrodesis as the end point.

What is the infection rate of the posterior approach to type C pelvic injuries?

Background: Pelvic ring injuries with complete disruption of the posterior pelvis (AO/OTA Type C) benefit from reduction and stabilization. Open reduction in early reports had high infectious complications and many surgeons began using closed reduction and percutaneous fixation. Multiple smaller studies have reported low infection rates after a posterior approach, but these rates are not confirmed in larger series of diverse fractures.

Gunshot wounds to the acetabulum.

Objectives: To classify the fracture patterns of gunshot wounds to the acetabulum; identify the associated injuries and complications; determine the predictors of poor outcome and deep infection; and propose a treatment algorithm based on the results.

Design: Retrospective review of two trauma registry databases over a 13-year period.

Setting: Multicenter study.

Internal fixation of symphyseal disruption resulting from childbirth.

Objectives: To investigate the clinical and radiographic results after operative treatment of complete symphyseal disruption resulting from childbirth and to evaluate residual pain and implant failure in relation to the timing of surgery.

Design: Retrospective study.

Setting: Tertiary pelvis and acetabulum care unit at a general hospital.

Total hip arthroplasty after periacetabular osteotomy.

Patients with hip dysplasia often endure multiple surgical interventions, first in attempts to preserve their biologic hips and later for total hip arthroplasty (THA). Each different surgical approach traumatizes the musculoligamentous complex of the hip. These cumulative insults can significantly affect THA success.

Simultaneous bilateral supine anterior approach total hip arthroplasty: evaluation of early complications and short-term rehabilitation.

Simultaneous bilateral anterior approach total hip arthroplasty has been a successful procedure with high patient demand and good short-term clinical results. Complication rates are acceptable and compare favorably with previously published series. The anterior approach takes advantage of supine positioning, allowing improved intraoperative monitoring and anesthesia care.

Outcomes following the single-incision anterior approach to total hip arthroplasty: a multicenter observational study.

The authors conducted a retrospective, multicenter cohort study of 1,152 patients across nine clinical sites across the United States, evaluating complications and function associated with the anterior approach to total hip arthroplasty using an orthopedic table. Eligible patients included those with primary diagnosis of hip arthritis. Outcomes included hospital stay, use of assistive devices, complications, and function.

Multicenter collaboration in observational research: improving generalizability and efficiency.

Utilizing a multicenter approach in observational clinical research allows for improved generalizability of the results, a larger sample size, and, consequently, improved efficiency. This paper highlights important issues with regard to the organization of multicenter observational studies in orthopaedic research. Specifically, we emphasize the development of trial committees, stress the importance of having a methods center for the purpose of coordinating day-to-day study activities, and describe the roles of the participating clinical sites.

Skeletal deformity after anterior external fixation of the pelvis.

Objective: To study the deformity of acutely injured unstable pelves before and after emergent application of an anterior external fixator.

Design: Retrospective.

Setting: Large pelvic fracture referral practice.

The final straw: a qualitative study to explore patient decisions to undergo total hip arthroplasty.

Background: Research focusing on the complex factors leading to patients decisions to replace their arthritic hip has been limited in favor of quantitative studies focusing on surgery outcomes. The purpose of this study was twofold: (1) to further explore patients experiences and their decision-making processes to undergo total hip arthroplasty and (2) to examine the factors that influenced patients decisions about the type of surgical procedure (approach, implants).

Methods: In 2005, 18 patients who were either scheduled for an upcoming total hip arthroplasty or had completed total hip arthroplasty participated in semi-structured interviews (N = 9) or a focus group (N = 9) regarding their decision to undergo hip arthroplasty.

Table-skeletal fixation as an adjunct to pelvic ring reduction.

The reduction of displaced pelvic ring injuries remains a technical challenge, especially when treatment is delayed. A pelvic frame (Orthopaedic Systems Inc, Union City, California) provides a means of external skeletal fixation, rigidly stabilizing the intact hemipelvis to the operating room table. The fractured and displaced fragments can then be manipulated around the securely fixed uninjured hemipelvis, allowing the application of more directions and magnitudes of force for reduction maneuvers than allowed by the traditional means of pelvic reduction.

Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective.

The ilioinguinal surgical approach was found to be effective for treatment of 119 (about 33%) of the 373 acetabular fractures treated operatively by the author over a 10-year period. It is indicated for anterior wall, anterior column, associated anterior and posterior hemitransverse fractures, as well as certain both column and transverse fractures. The approach offers the advantages of a cosmetic incision, rapid recovery of muscle function, and minimal ectopic bone formation.

Single-incision anterior approach for total hip arthroplasty on an orthopaedic table.

Unlabelled: Dislocation remains the leading early complication of total hip arthroplasty; surgical approach and implant positioning have been recognized as factors influencing total hip arthroplasty stability. We describe a total hip arthroplasty technique done through a single, tissue sparing anterior approach that allows implantation of the femoral and acetabular components without detaching or sectioning any of the muscles and tendons around the hip joint. A series of 437 consecutive, unselected patients who had 494 primary total hip arthroplasty surgeries done through an anterior approach on an orthopaedic table from September 1996 to September 2004 was reviewed.

Trans-sacral fixation for failed posterior fixation of the pelvic ring.

Introduction: In the treatment of certain pelvic ring pathologies (non-unions and failure of ilio-sacral screw fixation) trans-sacral fixation (i.e. fixation from iliac wing to the other traversing the body of S1) may be necessary.