Jade S Owens, Benjamin R Saks, Kara B Miecznikowski, David R Maldonado, Andrew E Jimenez, Ajay C Lall, Benjamin G Domb
Labral calcification may be part of the natural history of untreated femoroacetabular impingement syndrome (FAIS) in certain patients, making it a potential target for intervention with the goal of preserving the hip joint. The purpose of this study was to investigate if calcified labra create the appearance of lateral joint space narrowing and report minimum 2-year patient-reported outcome measures (PROMs) after treating patients with arthroscopic acetabuloplasty and labral reconstruction. Prospectively collected data on patients who underwent primary hip arthroscopy for FAIS and labral tearing from February 2015 to April 2021 were reviewed. Patients treated with primary labral reconstruction for an intraoperatively confirmed diagnosis of labral calcification were included. A sub-analysis was performed for patients with a minimum of 2-year follow-up. Preoperative and postoperative PROMs for the modified Harris hip score, nonarthritic hip score, the International Hip Outcome Tool-12 and visual analog scale for pain were recorded. Forty-six hips (46 patients) were included, with 19 hips in the sub-analysis. There was a significant increase in apparent lateral joint space width (JSW) measured on supine anteroposterior (AP) pelvis radiographs with no significant changes in medial and central JSW and significant decreases in the lateral and anterior center-edge angles and alpha angle. Patients experienced significant increases in PROMs and high rates of achieving psychometric thresholds. Patients presenting with FAIS and calcified labra may have apparent lateral joint space narrowing on pre-operative supine AP pelvis radiographs. These patients have low rates of full-thickness femoral head and acetabular cartilage pathology, this apparent narrowing can be corrected and excellent outcomes and survivorship can be achieved, with primary labral reconstruction.
{"title":"It's not arthritis! Resolution of the illusion of joint space narrowing with acetabuloplasty and labral reconstruction for the calcified labrum.","authors":"Jade S Owens, Benjamin R Saks, Kara B Miecznikowski, David R Maldonado, Andrew E Jimenez, Ajay C Lall, Benjamin G Domb","doi":"10.1093/jhps/hnac044","DOIUrl":"https://doi.org/10.1093/jhps/hnac044","url":null,"abstract":"<p><p>Labral calcification may be part of the natural history of untreated femoroacetabular impingement syndrome (FAIS) in certain patients, making it a potential target for intervention with the goal of preserving the hip joint. The purpose of this study was to investigate if calcified labra create the appearance of lateral joint space narrowing and report minimum 2-year patient-reported outcome measures (PROMs) after treating patients with arthroscopic acetabuloplasty and labral reconstruction. Prospectively collected data on patients who underwent primary hip arthroscopy for FAIS and labral tearing from February 2015 to April 2021 were reviewed. Patients treated with primary labral reconstruction for an intraoperatively confirmed diagnosis of labral calcification were included. A sub-analysis was performed for patients with a minimum of 2-year follow-up. Preoperative and postoperative PROMs for the modified Harris hip score, nonarthritic hip score, the International Hip Outcome Tool-12 and visual analog scale for pain were recorded. Forty-six hips (46 patients) were included, with 19 hips in the sub-analysis. There was a significant increase in apparent lateral joint space width (JSW) measured on supine anteroposterior (AP) pelvis radiographs with no significant changes in medial and central JSW and significant decreases in the lateral and anterior center-edge angles and alpha angle. Patients experienced significant increases in PROMs and high rates of achieving psychometric thresholds. Patients presenting with FAIS and calcified labra may have apparent lateral joint space narrowing on pre-operative supine AP pelvis radiographs. These patients have low rates of full-thickness femoral head and acetabular cartilage pathology, this apparent narrowing can be corrected and excellent outcomes and survivorship can be achieved, with primary labral reconstruction.</p>","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 4","pages":"232-239"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/93/hnac044.PMC9993452.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9099409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
At the age of 25, my father-in-law, who recently qualified from St Mary’s Hospital Medical School [1], was posted to a small rural hospital in the Kenyan rift valley. With no more than the 10th edition of Bailey & Love’s Short Practice of Surgery [2], illuminated by a kerosene lamp [3], he learned to operate under the eagle-eyed guidance of his surgical assistant, the aged hospital orderly. When I started my surgical career, my father-in-law advised me never to underestimate the importance of the surgical assistant. How right he proved to be. There is only so much that two hands can achieve, and few things have given me as much pleasure as the four-handed dance that my assistant and I have learned to perform. In Australia, retired surgeons serve as surgical assistants to their successors, and I marvel at the brilliance of this system. In my travels, I have noticed that many of the finest surgeons work with an assistant who has found his or her way into the operating theatre by the most unlikely route. Just as some surgeons are blessed with ‘magic hands’, it is only when the surgeon finds a similarly talented assistant that they achieve their finest work. Sadly, the remuneration that surgical assistants enjoy, in the United Kingdom [4], often fails to recognise or reflect the value of their role in our operating rooms. The best surgical assistants are intuitively able to make surgery easier, faster and more elegant but, few have any experience or interest in academic research [5, 6] and, those who do, are unlikely to be funded to undertake the additional work needed to gather, process and report clinical data. Many of our most innovative and academic colleagues attract trainees who displace the surgical assistants and oblige their trainer to work with third and fourth hands that are focused on becoming the surgical lead. At the Journal of Hip Preservation Surgery ( JHPS), we are aware that there is a paucity of literature on the role played by surgical assistants, their influence on the use of operating room time and the outcome of our interventions. We invite you to share studies related to the involvement of surgical assistants and other operating room personnel in hip preservation surgery. Over the next decade, augmented reality systems will be adopted to enhance surgical training [7, 8], robotic-assisted surgery will become commonplace in our operating rooms [9, 10], the role of our surgical assistants will evolve and a new generation of computer-savvy technicians will join our teams. The value of these new technologies will need to be assessed and justified both for their economic [11, 12] and clinical benefits. JHPS would welcome manuscripts focusing on these changes, and we look forward to disseminating evidence to guide the hip preservation community as new technologies become available. In JHPS Issue 9.4, the costs incurred in providing periacetabular osteotomy surgery are explored by Joel Williams and his colleagues [13] at the Rush Univ
{"title":"Surgical Assistants","authors":"Richard A. Field","doi":"10.7748/nm.3.9.6.s12","DOIUrl":"https://doi.org/10.7748/nm.3.9.6.s12","url":null,"abstract":"At the age of 25, my father-in-law, who recently qualified from St Mary’s Hospital Medical School [1], was posted to a small rural hospital in the Kenyan rift valley. With no more than the 10th edition of Bailey & Love’s Short Practice of Surgery [2], illuminated by a kerosene lamp [3], he learned to operate under the eagle-eyed guidance of his surgical assistant, the aged hospital orderly. When I started my surgical career, my father-in-law advised me never to underestimate the importance of the surgical assistant. How right he proved to be. There is only so much that two hands can achieve, and few things have given me as much pleasure as the four-handed dance that my assistant and I have learned to perform. In Australia, retired surgeons serve as surgical assistants to their successors, and I marvel at the brilliance of this system. In my travels, I have noticed that many of the finest surgeons work with an assistant who has found his or her way into the operating theatre by the most unlikely route. Just as some surgeons are blessed with ‘magic hands’, it is only when the surgeon finds a similarly talented assistant that they achieve their finest work. Sadly, the remuneration that surgical assistants enjoy, in the United Kingdom [4], often fails to recognise or reflect the value of their role in our operating rooms. The best surgical assistants are intuitively able to make surgery easier, faster and more elegant but, few have any experience or interest in academic research [5, 6] and, those who do, are unlikely to be funded to undertake the additional work needed to gather, process and report clinical data. Many of our most innovative and academic colleagues attract trainees who displace the surgical assistants and oblige their trainer to work with third and fourth hands that are focused on becoming the surgical lead. At the Journal of Hip Preservation Surgery ( JHPS), we are aware that there is a paucity of literature on the role played by surgical assistants, their influence on the use of operating room time and the outcome of our interventions. We invite you to share studies related to the involvement of surgical assistants and other operating room personnel in hip preservation surgery. Over the next decade, augmented reality systems will be adopted to enhance surgical training [7, 8], robotic-assisted surgery will become commonplace in our operating rooms [9, 10], the role of our surgical assistants will evolve and a new generation of computer-savvy technicians will join our teams. The value of these new technologies will need to be assessed and justified both for their economic [11, 12] and clinical benefits. JHPS would welcome manuscripts focusing on these changes, and we look forward to disseminating evidence to guide the hip preservation community as new technologies become available. In JHPS Issue 9.4, the costs incurred in providing periacetabular osteotomy surgery are explored by Joel Williams and his colleagues [13] at the Rush Univ","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 1","pages":"209 - 210"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42407829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To decrease hip abductor dysfunction after periacetabular osteotomy using a lateral/trochanteric approach, we aimed to modify transposition osteotomy of the acetabulum (TOA) to not cut the greater trochanter and abductor-iliac crest detachment. We subsequently compared abductor muscle strength recovery between TOAs with [conventional TOA (C-TOA)] and without [modified TOA (M-TOA)] trochanteric osteotomy. C-TOA and M-TOA were performed in 27 and 34 hips, respectively. Hip abduction, flexion and knee extension muscle strength were measured preoperatively and at 3, 5, 10, 24 and 52 weeks postoperatively. The muscle strength ratio of the affected and contralateral lower limbs was compared between the C-TOA and M-TOA groups. Neither the mean Merle d'Aubigné-Postel score at the final follow-up nor the postoperative center-edge angle showed significant differences between the M-TOA and C-TOA groups (15.7 versus 16.4 points; P = 0.25 and 38.5° versus P = 0.62 and 39.8°, respectively). The mean muscle strength ratios of hip abduction at 5, 12 and 24 weeks postoperatively were significantly higher in the M-TOA group than in the C-TOA group (0.62 versus 0.39, 0.76 versus 0.59 and 0.94 versus 0.70; P = 0.03, 0.04 and 0.01, respectively). There were no significant differences between groups at Postoperative Week 52 (P = 0.36). Discomfort at the greater trochanter was observed in 18 hips (66.7%) in the C-TOA group but only in 4 hips (11.2%) in the M-TOA group. In conclusion, M-TOA is less invasive than C-TOA and allows an earlier recovery of abductor muscle strength without significant correction loss.
为了减少髋臼周围行外侧/粗隆入路截骨后髋外展肌功能障碍，我们的目的是修改髋臼转位截骨术(TOA)，使其不切割大转子和外展髂骨脱离。随后，我们比较了[常规TOA (C-TOA)]和[改良TOA (M-TOA)]转子截骨术的外展肌力量恢复情况。C-TOA和M-TOA分别在27髋和34髋进行。术前及术后3周、5周、10周、24周和52周分别测量髋关节外展、屈曲和膝关节伸肌力量。比较C-TOA组和M-TOA组患侧和对侧下肢肌力比。M-TOA组和C-TOA组在最后随访时Merle d' aubigne - postel平均评分和术后中心边缘角均无显著差异(15.7分对16.4分;P = 0.25和38.5°，P = 0.62和39.8°)。术后5周、12周和24周，M-TOA组髋外展的平均肌力比明显高于C-TOA组(0.62 vs 0.39, 0.76 vs 0.59, 0.94 vs 0.70;P分别= 0.03、0.04、0.01)。术后第52周各组间差异无统计学意义(P = 0.36)。C-TOA组有18髋(66.7%)出现大转子不适，而M-TOA组只有4髋(11.2%)。综上所述，M-TOA比C-TOA侵入性更小，可以更早地恢复外展肌力量，而不会造成明显的矫正损失。
{"title":"Abductor recovery after muscle-sparing periacetabular osteotomy using a lateral approach.","authors":"Yasuharu Nakashima, Daisuke Hara, Masanobu Ohishi, Goro Motomura, Ichiro Kawano, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Ryosuke Yamaguchi, Takeshi Utsunomiya, Kenji Kitamura","doi":"10.1093/jhps/hnac047","DOIUrl":"https://doi.org/10.1093/jhps/hnac047","url":null,"abstract":"<p><p>To decrease hip abductor dysfunction after periacetabular osteotomy using a lateral/trochanteric approach, we aimed to modify transposition osteotomy of the acetabulum (TOA) to not cut the greater trochanter and abductor-iliac crest detachment. We subsequently compared abductor muscle strength recovery between TOAs with [conventional TOA (C-TOA)] and without [modified TOA (M-TOA)] trochanteric osteotomy. C-TOA and M-TOA were performed in 27 and 34 hips, respectively. Hip abduction, flexion and knee extension muscle strength were measured preoperatively and at 3, 5, 10, 24 and 52 weeks postoperatively. The muscle strength ratio of the affected and contralateral lower limbs was compared between the C-TOA and M-TOA groups. Neither the mean Merle d'Aubigné-Postel score at the final follow-up nor the postoperative center-edge angle showed significant differences between the M-TOA and C-TOA groups (15.7 versus 16.4 points; <i>P</i> = 0.25 and 38.5° versus <i>P</i> = 0.62 and 39.8°, respectively). The mean muscle strength ratios of hip abduction at 5, 12 and 24 weeks postoperatively were significantly higher in the M-TOA group than in the C-TOA group (0.62 versus 0.39, 0.76 versus 0.59 and 0.94 versus 0.70; <i>P</i> = 0.03, 0.04 and 0.01, respectively). There were no significant differences between groups at Postoperative Week 52 (<i>P</i> = 0.36). Discomfort at the greater trochanter was observed in 18 hips (66.7%) in the C-TOA group but only in 4 hips (11.2%) in the M-TOA group. In conclusion, M-TOA is less invasive than C-TOA and allows an earlier recovery of abductor muscle strength without significant correction loss.</p>","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 4","pages":"259-264"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/be/25/hnac047.PMC9993449.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9099407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to investigate the relationship between acetabular labral length and symptoms in patients with acetabular dysplasia. In a retrospective medical record review, 218 patients with acetabular dysplasia who had undergone rotational acetabular osteotomy were identified. After implementing the inclusion and exclusion criteria, 53 patients were analyzed for preoperative symptoms measured by the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), acetabular bone morphology parameters by anteroposterior pelvic radiographs and labral parameters by radial magnetic resonance imaging. Spearman's correlation coefficients were calculated among JHEQ scores, bone morphologic parameters and labral parameters. Multiple linear regression models to determine the predictive variables of JHEQ score and labral length were obtained. There was no correlation between bone morphologic parameters and JHEQ scores. Labral length measured anteriorly correlated with JHEQ pain {r [95% confidence interval (CI)] = -0.335 (-0.555, -0.071), P = 0.014}, movement subscale [r (95% CI) = -0.398 (-0.603, -0.143), P = 0.003], mental subscale [r (95% CI) = -0.436 (-0.632, -0.188), P = 0.001] and total JHEQ score [r (95% CI) = -0.451 (-0.642, -0.204), P = 0.001]. The multiple linear regression results showed that anterior labral length was independently associated with JHEQ subscales in some models. Meanwhile, age, acetabular head index and total JHEQ score were independently associated with anterior labral length in all models. Labral length, notably in anterosuperior area, in patients with symptomatic acetabular dysplasia was related to patient's symptom. Labral length may be an important objective image finding that can be used to assess the severity of cumulative hip instability.
本研究的目的是探讨髋臼唇长度与髋臼发育不良患者的症状之间的关系。在一项回顾性的医疗记录回顾中，218例髋臼发育不良患者接受了髋臼旋转截骨术。实施纳入和排除标准后，分析53例患者术前用日本骨科协会髋关节疾病评估问卷(JHEQ)测量的症状、骨盆正位片髋臼骨形态参数和桡骨磁共振成像的唇形参数。计算JHEQ评分与骨形态参数、唇形参数之间的Spearman相关系数。建立JHEQ评分和唇长预测变量的多元线性回归模型。骨形态参数与JHEQ评分无相关性。前测的唇长与JHEQ疼痛[r[95%可信区间(CI)] = -0.335 (-0.555， -0.071)， P = 0.014}，运动分量量表[r (95% CI) = -0.398 (-0.603， -0.143)， P = 0.003]，精神分量量表[r (95% CI) = -0.436 (-0.632， -0.188)， P = 0.001]和JHEQ总分[r (95% CI) = -0.451 (-0.642， -0.204)， P = 0.001]呈正相关。多元线性回归结果显示，在部分模型中，前唇长度与JHEQ亚量表独立相关。所有模型的年龄、髋臼头指数和JHEQ总分与前唇长度独立相关。有症状的髋臼发育不良患者的唇长度与患者的症状有关，尤其是在前上区域。下唇长度可能是一个重要的客观图像发现，可用于评估髋关节累积不稳定的严重程度。
{"title":"Relationship between labral length and symptoms in patients with acetabular dysplasia before rotational acetabular osteotomy.","authors":"Yuichi Shirogane, Yasuhiro Homma, Naotake Yanagisawa, Masanori Higano, Yoichiro Hirasawa, Shigeru Nakamura, Tomonori Baba, Kazuo Kaneko, Hitoshi Taneda, Muneaki Ishijima","doi":"10.1093/jhps/hnac045","DOIUrl":"https://doi.org/10.1093/jhps/hnac045","url":null,"abstract":"<p><p>The aim of this study was to investigate the relationship between acetabular labral length and symptoms in patients with acetabular dysplasia. In a retrospective medical record review, 218 patients with acetabular dysplasia who had undergone rotational acetabular osteotomy were identified. After implementing the inclusion and exclusion criteria, 53 patients were analyzed for preoperative symptoms measured by the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), acetabular bone morphology parameters by anteroposterior pelvic radiographs and labral parameters by radial magnetic resonance imaging. Spearman's correlation coefficients were calculated among JHEQ scores, bone morphologic parameters and labral parameters. Multiple linear regression models to determine the predictive variables of JHEQ score and labral length were obtained. There was no correlation between bone morphologic parameters and JHEQ scores. Labral length measured anteriorly correlated with JHEQ pain {<i>r</i> [95% confidence interval (CI)] = -0.335 (-0.555, -0.071), <i>P</i> = 0.014}, movement subscale [<i>r</i> (95% CI) = -0.398 (-0.603, -0.143), <i>P</i> = 0.003], mental subscale [<i>r</i> (95% CI) = -0.436 (-0.632, -0.188), <i>P</i> = 0.001] and total JHEQ score [<i>r</i> (95% CI) = -0.451 (-0.642, -0.204), <i>P</i> = 0.001]. The multiple linear regression results showed that anterior labral length was independently associated with JHEQ subscales in some models. Meanwhile, age, acetabular head index and total JHEQ score were independently associated with anterior labral length in all models. Labral length, notably in anterosuperior area, in patients with symptomatic acetabular dysplasia was related to patient's symptom. Labral length may be an important objective image finding that can be used to assess the severity of cumulative hip instability.</p>","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 4","pages":"240-251"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9993447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9099405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to: Does the use of i-FACTOR bone graft affect bone healing in those undergoing periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH)? A retrospective study","authors":"","doi":"10.1093/jhps/hnac042","DOIUrl":"https://doi.org/10.1093/jhps/hnac042","url":null,"abstract":"","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 1","pages":"276 - 276"},"PeriodicalIF":1.5,"publicationDate":"2022-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44162179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael J M O'Brien, Denise M Jones, Adam Ivan Semciw, Jitendra Balakumar, Rafal Grabinski, Justin Roebert, Georgia M Coburn, Inger Mechlenburg, Joanne L Kemp
The aims of this study were to compare, in patients with and without the use of i-FACTOR bone graft during periacetabular osteotomy (PAO) surgery for developmental dysplasia of the hip (DDH), (i) bone healing at six-weeks post-operatively (ii) rate of complications. This was a retrospective review of case records. Participants were people aged 15-50 years undergoing rectus-sparing minimally invasive PAO surgery for DDH. Group 1: patients with i-FACTOR, Group 2: No i-FACTOR. The primary outcome was the rate of bone healing on radiographs at 6 weeks. The likelihood of bone healing was compared using logistic regression with Generalised Estimating Equations (GEE) and expressed as odds ratios (95% confidence intervals (CIs; P < 0.05)). The occurrence of complications was extracted from surgical records. The i-FACTOR group had 3-times greater odds of partial/full union than those without [adjusted odds ratio (95% CIs, P-value)]: [3.265 (1.032 to 10.330, P = 0.044)]. The i-FACTOR group had 89% partial/full union at 6-weeks, compared to 69% of the non-i-FACTOR group. Half of the patients had leaking of bone graft in the i-FACTOR group versus 10% in the non-i-FACTOR group, 26% of the i-FACTOR group and 12% of the non-i-FACTOR group had neuropraxia of the lateral femoral cutaneous nerve (LFCN). Complication rates were low, and similar between groups. However, the rate of LFCN neuropraxia and bone graft leakage was higher in the i-FACTOR. These findings should be confirmed in a future prospective randomised clinical trial and include outcomes such as pain and quality of life.
{"title":"Does the use of i-FACTOR bone graft affect bone healing in those undergoing periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH)? A retrospective study.","authors":"Michael J M O'Brien, Denise M Jones, Adam Ivan Semciw, Jitendra Balakumar, Rafal Grabinski, Justin Roebert, Georgia M Coburn, Inger Mechlenburg, Joanne L Kemp","doi":"10.1093/jhps/hnac027","DOIUrl":"https://doi.org/10.1093/jhps/hnac027","url":null,"abstract":"<p><p>The aims of this study were to compare, in patients with and without the use of i-FACTOR bone graft during periacetabular osteotomy (PAO) surgery for developmental dysplasia of the hip (DDH), (i) bone healing at six-weeks post-operatively (ii) rate of complications. This was a retrospective review of case records. Participants were people aged 15-50 years undergoing rectus-sparing minimally invasive PAO surgery for DDH. Group 1: patients with i-FACTOR, Group 2: No i-FACTOR. The primary outcome was the rate of bone healing on radiographs at 6 weeks. The likelihood of bone healing was compared using logistic regression with Generalised Estimating Equations (GEE) and expressed as odds ratios (95% confidence intervals (CIs; <i>P</i> < 0.05)). The occurrence of complications was extracted from surgical records. The i-FACTOR group had 3-times greater odds of partial/full union than those without [adjusted odds ratio (95% CIs, <i>P</i>-value)]: [3.265 (1.032 to 10.330, <i>P</i> = 0.044)]. The i-FACTOR group had 89% partial/full union at 6-weeks, compared to 69% of the non-i-FACTOR group. Half of the patients had leaking of bone graft in the i-FACTOR group versus 10% in the non-i-FACTOR group, 26% of the i-FACTOR group and 12% of the non-i-FACTOR group had neuropraxia of the lateral femoral cutaneous nerve (LFCN). Complication rates were low, and similar between groups. However, the rate of LFCN neuropraxia and bone graft leakage was higher in the i-FACTOR. These findings should be confirmed in a future prospective randomised clinical trial and include outcomes such as pain and quality of life.</p>","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 3","pages":"165-171"},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/e6/hnac027.PMC10093896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9308990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-05eCollection Date: 2022-07-01DOI: 10.1093/jhps/hnac030
Ali Bajwa
{"title":"What the papers say.","authors":"Ali Bajwa","doi":"10.1093/jhps/hnac030","DOIUrl":"https://doi.org/10.1093/jhps/hnac030","url":null,"abstract":"","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 2","pages":"139-141"},"PeriodicalIF":1.5,"publicationDate":"2022-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/88/hnac030.PMC9291359.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40618015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-27eCollection Date: 2022-07-01DOI: 10.1093/jhps/hnac028
Richard E Field
{"title":"Uncertainty - a perennial.","authors":"Richard E Field","doi":"10.1093/jhps/hnac028","DOIUrl":"10.1093/jhps/hnac028","url":null,"abstract":"","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 2","pages":"65-66"},"PeriodicalIF":1.4,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40618016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-07eCollection Date: 2022-01-01DOI: 10.1093/jhps/hnac024
Ali Bajwa
{"title":"What the papers say.","authors":"Ali Bajwa","doi":"10.1093/jhps/hnac024","DOIUrl":"10.1093/jhps/hnac024","url":null,"abstract":"","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 1","pages":"62-64"},"PeriodicalIF":1.5,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45318417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-27eCollection Date: 2022-07-01DOI: 10.1093/jhps/hnac023
Alex M Meyer, Andrew L Schaver, Brian H Cohen, Natalie A Glass, Michael C Willey, Robert W Westermann
The Femoro-Epiphyseal Acetabular Roof (FEAR) index is a newer measurement to identify the hip instability with borderline acetabular dysplasia. The purpose of this study is to (i) validate the FEAR index in determining the stability of the hip in patients who have previously been treated surgically for femoroacetabular impingement (FAI) and/or developmental dysplasia of the hip (DDH) and (ii) to examine the relationship between the FEAR index and femoral version, lateral center edge angle, Tönnis angle and alpha angle (AA). Patient demographics and radiographic measurements of 215 hips (178 patients), 116 hips treated with hip arthroscopy for FAI and 99 hips treated with periacetabular osteotomy (PAO) for DDH were compared between groups. The sensitivity and specificity of the FEAR index to detect the surgical procedure performed (PAO or hip arthroscopy) was calculated, and a threshold value was proposed. Pearson's correlation coefficients were used to describe the relationships between the FEAR index, femoral version and other radiographic measurements. The FEAR index was higher in patients with DDH versus FAI (DDH: 2.81 ± 0.50° versus FAI: -1.00 ± 0.21°, P < 0.001). A FEAR index threshold value of 3° had a sensitivity and specificity of 80% and 81%, respectively, for correctly predicting the surgical procedure performed. Femoral version was positively associated with the FEAR index in the setting of DDH (r = 0.36, P = 0.001) but not FAI (r = 0.02, P = 0.807). A FEAR index of 3° predicted treatment with 80% sensitivity and 81% specificity. In addition, femoral version significantly correlates with the FEAR index in the setting of DDH but not FAI.
股骨骺髋臼穹隆（FEAR）指数是一种较新的测量方法，用于识别边缘性髋臼发育不良的髋关节不稳定性。本研究的目的是：(i) 验证 FEAR 指数在确定曾接受股骨髋臼撞击（FAI）和/或髋关节发育不良（DDH）手术治疗的患者的髋关节稳定性方面的作用；(ii) 研究 FEAR 指数与股骨版、外侧中心边缘角、Tönnis 角和α角（AA）之间的关系。研究比较了215个髋关节（178名患者）的患者人口统计学特征和影像学测量结果，其中116个髋关节采用髋关节镜治疗FAI，99个髋关节采用髋臼周围截骨术（PAO）治疗DDH。计算了FEAR指数检测手术方法（PAO或髋关节镜）的敏感性和特异性，并提出了一个阈值。皮尔逊相关系数被用来描述FEAR指数、股骨畸形和其他影像学测量之间的关系。DDH患者的FEAR指数高于FAI患者（DDH：2.81 ± 0.50°，FAI：-1.00 ± 0.21°，P r = 0.36，P = 0.001），但高于FAI患者（r = 0.02，P = 0.807）。FEAR指数为3°时，预测治疗的敏感性为80%，特异性为81%。此外，在 DDH 的情况下，股骨畸形与 FEAR 指数有明显的相关性，但与 FAI 无关。
{"title":"FEAR index in predicting treatment among patients with femoroacetabular impingement and hip dysplasia and the relationship of femoral version.","authors":"Alex M Meyer, Andrew L Schaver, Brian H Cohen, Natalie A Glass, Michael C Willey, Robert W Westermann","doi":"10.1093/jhps/hnac023","DOIUrl":"10.1093/jhps/hnac023","url":null,"abstract":"<p><p>The Femoro-Epiphyseal Acetabular Roof (FEAR) index is a newer measurement to identify the hip instability with borderline acetabular dysplasia. The purpose of this study is to (i) validate the FEAR index in determining the stability of the hip in patients who have previously been treated surgically for femoroacetabular impingement (FAI) and/or developmental dysplasia of the hip (DDH) and (ii) to examine the relationship between the FEAR index and femoral version, lateral center edge angle, Tönnis angle and alpha angle (AA). Patient demographics and radiographic measurements of 215 hips (178 patients), 116 hips treated with hip arthroscopy for FAI and 99 hips treated with periacetabular osteotomy (PAO) for DDH were compared between groups. The sensitivity and specificity of the FEAR index to detect the surgical procedure performed (PAO or hip arthroscopy) was calculated, and a threshold value was proposed. Pearson's correlation coefficients were used to describe the relationships between the FEAR index, femoral version and other radiographic measurements. The FEAR index was higher in patients with DDH versus FAI (DDH: 2.81 ± 0.50° versus FAI: -1.00 ± 0.21°, <i>P</i> < 0.001). A FEAR index threshold value of 3° had a sensitivity and specificity of 80% and 81%, respectively, for correctly predicting the surgical procedure performed. Femoral version was positively associated with the FEAR index in the setting of DDH (<i>r</i> = 0.36, <i>P</i> = 0.001) but not FAI (<i>r</i> = 0.02, <i>P</i> = 0.807). A FEAR index of 3° predicted treatment with 80% sensitivity and 81% specificity. In addition, femoral version significantly correlates with the FEAR index in the setting of DDH but not FAI.</p>","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"9 2","pages":"84-89"},"PeriodicalIF":1.4,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40605928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号