Accuracy of cup placement compared with preoperative surgeon targets in primary total hip arthroplasty using standard instrumentation and techniques: a global, multicenter study.

Background: Acetabular cup positioning in total hip arthroplasty (THA) is closely related to outcomes. The literature has suggested cup parameters defined by the Lewinnek safe zone; however, the validity of such measures is in question. Several studies have raised concerns about the benefits of using the Lewinnek safe zone as a predictor of success.

Spinopelvic challenges in primary total hip arthroplasty.

There is no universal safe zone for cup orientation. Patients with spinal arthrodesis or a degenerative lumbar spine are at increased risk of dislocation. The relative contributions of the hip (femur and acetabulum) and of the spine (lumbar spine) in body motion must be considered together.

Contemporary, non-navigation, cup orientation techniques improve accuracy and eliminate differences seen between the anterior and posterior approach in THA.

Background: This study aimed to: (1) Determine the ability to achieve the surgeons' desired cup orientation, without navigation, using contemporary measures with the anterior- (AA) and posterior- approaches (PA); and (2) assess whether surgical approach is associated with cup orientation accuracy, as previously reported, when contemporary measures are used.

Methods: A prospective, 2-centre, multi-surgeon study of 400 THAs (200 AA; 200 PA) was performed. Intraoperative radiographs were obtained with the AA.

Cup orientation following posterior approach THA - the effect of different visual aids and pelvic supports.

Introduction: This study aims to compare cup inclination achieved (1) Using two orientation guides, whilst using the same 3-point pelvic positioner and (2) Using two types of pelvic positioners, whilst measuring intra-operative cup inclination with an inclinometer.

Materials And Methods: This is a prospective, diagnostic cohort study of a consecutive series of 150 THAs performed through a posterior approach. Two types of 3-point pelvic positioners were used (Stulberg and modified Capello Hip Positioners) and the cup was positioned freehand using one of two orientation guides (mechanical guide or digital inclinometer).

Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics.

Acetabular component orientation and position are important factors in the short- and long-term outcomes of total hip arthroplasty. Different definitions of inclination and anteversion are used in the orthopaedic literature and surgeons should be aware of these differences and understand their relationships. There is no universal safe zone.

Early outcomes and predictors of patient satisfaction after TKA: a prospective study of 200 cases with a contemporary cemented rotating platform implant design.

Purpose: The purpose of the study was to identify the earliest time point where subjects realized the greatest clinical improvement after TKA, and the time when post-operative scores became superior to pre-operative scores. Post-hoc exploratory analyses were conducted to investigate predictors of early post-operative outcomes and patient satisfaction.

Methods: Six investigators across 4 sites in the Netherlands prospectively implanted 200 subjects with a contemporary cemented rotating platform device.

Comparative Analysis Investigating the Impact of Implant Design on Hospital Length of Stay and Discharge Destination in a Dutch Hospital With an Established Enhanced Recovery Program.

Background: Global demand for total knee arthroplasty (TKA) is increasing, driven by an aging and increasingly overweight patient population, culminating in higher healthcare costs. In the Netherlands, the number of TKA surgeries performed annually increased from 21,000 in 2010 to 29,000 in 2017. This study aimed to assess the impact of implant design on hospital length of stay (LOS), surgery time, and discharge destination (home vs a rehabilitation center) in a Dutch hospital with an established enhanced recovery program and short baseline LOS.

Surgical technique description : Transosseous 'over the top' reconstruction of capsule and tendons in primary total hip arthroplasty using a posterior approach.

Dislocation after total hip arthroplasty (THA) remains a devastating complication and a primary cause for revision arthroplasty. Historical data indicate that a posterior approach is associated with a higher dislocation rate. In this study, we present a highly reliable and anatomical reconstruction, based on the biomechanical findings of a previous cadaveric experiment.

Scaphoid screw fixation perpendicular to the fracture plane: Comparing volar and dorsal approaches.

Introduction: To percutaneously fixate a midwaist scaphoid fracture, both volar and dorsal approaches are considered valid options although they may have different screw insertion angles relative to the scaphoid fracture plane influencing fixation stability. In this virtual simulation study, we investigated the accessibility of placing a screw perpendicularly to the fracture plane in transverse and horizontal oblique scaphoid midwaist fracture models and compared standard volar and dorsal approaches.

Material And Methods: Computed tomography scans of 38 healthy wrists were used to obtain virtual 3-dimensional wrist models in flexion and extension.

The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study.

Background: Medical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients' length of stay (LOS), quality and safety of care, and patient experiences with the provided care.

Percutaneous, Transtrapezial Fixation without Bone Graft Leads to Consolidation in Selected Cases of Delayed Union of the Scaphoid Waist.

 We evaluated clinical and radiographic outcome of percutaneous transtrapezial fixation of the scaphoid delayed union or nonunion using a headless bone screw without bone grafting.  Sixteen patients with delayed union or nonunion of the scaphoid were included in this retrospective study between 2006 and 2011. All patients had a delayed presentation of scaphoid fracture, and none of them was treated conservatively elsewhere.

The direct anterior approach in total hip arthroplasty: a systematic review of the literature.

Aims: The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of dislocation, faster recovery, reduced pain and fewer surgical complications. This systematic review aims to evaluate the current evidence for the use of this approach in THA.

Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique.

Aims: One goal of total hip arthroplasty is to restore normal hip anatomy. The aim of this study was to compare displacement of the centre of rotation (COR) using a standard reaming technique with a technique in which the acetabulum was reamed immediately peripherally and referenced off the rim.

Patients And Methods: In the first cohort the acetabulum was reamed to the floor followed by sequentially larger reamers.

Estimating Scaphoid Lengths Using Anatomical Measurements in the Wrist.

Purpose: In reconstructive surgery of scaphoid nonunions with humpback deformity, some surgeons recommend restoration of the normal scaphoid length whereas others overexpand the normal length to ensure carpal realignment and prevent late collapse. To be able to define overexpansion and investigate which levels of overexpansion yield optimal clinical results, a precise method for estimating the original scaphoid length is required. The purpose of this anatomic study was to investigate the precision of estimating normal scaphoid lengths based on intact adjacent bone dimensions, compared with using the contralateral scaphoid length.

Transtrapezial Approach for Fixation of Acute Scaphoid Fractures.

Introduction: The transtrapezial approach for fixation of acute scaphoid fractures facilitates precise percutaneous placement of a screw along the central axis of the scaphoid, which has been shown to be biomechanically superior.

Step 1 Position The Patient Surgeon And Fluoroscopy Equipment: Correctly position the patient, surgeon, and fluoroscopy equipment before starting the procedure.

Step 2 Mark The Skin: Mark the central axis of the scaphoid on the skin along the anteroposterior and lateral (optional) planes as the markings allow visual control for insertion of the guidewire.

Transtrapezial Approach for Fixation of Acute Scaphoid Fractures: Rationale, Surgical Techniques, and Results: AAOS Exhibit Selection.

The ideal position for a screw used for scaphoid fixation is central. The purpose of this study was to compare the current volar percutaneous approaches used for scaphoid fracture fixation, explore different options to improve central screw placement, and describe our experience with the transtrapezial approach.

The difference between the radiographic and the operative angle of inclination of the acetabular component in total hip arthroplasty: use of a digital protractor and the circumference of the hip to improve orientation.

A high radiographic inclination angle (RI) contributes to accelerated wear and has been associated with dislocation after total hip arthroplasty (THA). With freehand positioning of the acetabular component there is a lack of accuracy, with a trend towards a high radiographic inclination angle. The aim of this study was to investigate whether the use of a digital protractor to measure the operative inclination angle (OI) could improve the positioning of the acetabular component in relation to a 'safe zone'.

Comparison of two percutaneous volar approaches for screw fixation of scaphoid waist fractures: radiographic and biomechanical study of an osteotomy-simulated model.

Background: When a surgeon uses a percutaneous volar approach to treat scaphoid waist fractures, central screw placement is complicated by the shape of the scaphoid and by obstruction by the trapezium. In this study, we used radiographs and biomechanical tests to compare the standard volar percutaneous approach with the transtrapezial approach, with regard to central screw placement at the distal pole of the scaphoid.

Methods: Fourteen matched pairs of cadaveric wrists were randomly assigned to two treatment groups.

The use of the transverse acetabular ligament for determining the orientation of the components in total hip replacement: a randomised controlled trial.

The orientation of the acetabular component can influence both the short- and long-term outcomes of total hip replacement (THR). We performed a prospective, randomised, controlled trial of two groups, comprising of 40 patients each, in order to compare freehand introduction of the component with introduction using the transverse acetabular ligament (TAL) as a reference for anteversion. Anteversion and inclination were measured on pelvic radiographs.