1
|
Ruangsomboon P, Bagouri E, Pincus D, Paterson JM, Ravi B. Association of surgeon volume with complications following direct anterior approach (DAA) total hip arthroplasty: a population-based study. Acta Orthop 2024; 95:505-511. [PMID: 39254644 PMCID: PMC11387785 DOI: 10.2340/17453674.2024.41506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Total hip arthroplasty (THA) can be performed through various surgical approaches, including direct anterior (DAA). DAA-THA may offer faster recovery but carries a higher risk of complications, which may be mitigated by surgeon volume and experience. We examined the association of surgeons' annual surgical volume with major complications after DAA-THA in a population-based sample. METHODS A population-based retrospective cohort study was carried out on primary DAA-THA patients in Ontario between April 2016 and March 2021. We used restricted cubic splines to visually define the association between annual DAA surgeon volume and the risk of major surgical complications (fractures, dislocations, infections, and revisions) within 1 year of surgery. We further compared the complication rates amongst different DAA volume categories (< 30, 30-60, and > 60 cases/year). RESULTS The study encompassed 9,672 DAA-THA patients (52% female, median age 67 years). We showed a sharp decline in the probability of complications as the surgical volume of DAA-THA increased within the lower range of 0-30 cases/year; the probability slightly increased after the surgical volume exceeded 60 cases/year. The overall complication rates were 3.09%, 2.24%, and 2.18% for the surgical experience group of < 30 cases/year, 30-60 cases/year, and > 60 cases/year, respectively. CONCLUSION There was an inverse relationship between surgical volume and complication rates in DAA-THA within the lower volume ranges. Maintaining a surgical volume of at least 30 DAA-THA cases/year can minimize complications, emphasizing the importance of surgical volume in this approach.
Collapse
Affiliation(s)
- Pakpoom Ruangsomboon
- Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Orthopaedics Surgery, Siriraj Hospital, Mahidol University, Thailand
| | - Elmunzar Bagouri
- Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Pincus
- Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Canada
| | | | - Bheeshma Ravi
- Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Canada
| |
Collapse
|
2
|
Wang G, Xu Y, Yu G, Luo F, Chen L, Lin Y, Xu J. Learning curve and initial outcomes of a novel percutaneously endoscopic-assisted total hip arthroplasty through mini bikini direct anterior approach: an observational cohort study. J Orthop Surg Res 2024; 19:420. [PMID: 39033274 PMCID: PMC11265093 DOI: 10.1186/s13018-024-04925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Although the direct anterior approach can reduce muscle damage and ensure accurate prosthesis placement, the steep learning curve and increased risk of complications associated with DAA necessitate careful consideration. Therefore, we describe a technique for a novel percutaneously endoscopic-assisted total hip arthroplasty through mini bikini direct anterior approach (mDAA) and report the learning curve and initial outcomes. METHODS The first 125 THA performed by a single surgeon between September 2020 and February 2022 using the anterior approach were included, comprising the initial 41 cases of bikini DAA (bDAA) and the subsequent 84 cases of mDAA. Outcome measures included perioperative outcomes and postoperative complications. The cumulative sum analysis (CUSUM) was used to determine the learning curve of anterior approach THA for each patient's ORT. Multivariable analysis was performed to determine risk correlation. RESULTS A total of 125 anterior approach THA completed between 2020 and 2022 were identified. Among these, 41 were performed via bDAA and 84 via mDAA. No statistically significant differences were observed between the groups in terms of age, gender distribution, BMI or follow-up time. A significant reduction in ORT was noted, from 140 min for bDAA to 130 min for mDAA. Furthermore, there was a consistent decrease in LOI, LOS, and wound-healing problems. There was no statistically significant difference between groups with respect to Harris Hip Scores and other postoperative complications. The curve inflection points of the learning curve for the bDAA and mDAA group were located in the 22nd and 68th cases, respectively. The reduction of hemoglobin indicated a predicted increase in ORT. CONCLUSIONS In this study, ORT, LOI, LOS, and wound-healing problems decreased overall in mDAA group. After mastering the bDAA technique, approximately 27 mDAA cases are needed to acquire proficiency in this technique. Hence, mDAA is a valuable alternative for those seeking smaller incisions, resolving wound healing problems, and aiming for enhanced recovery after surgery.
Collapse
Affiliation(s)
- Guiguan Wang
- Shengli Clinical College of Fujian Medical University, No.134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fuzhou, Fujian, China
- Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
| | - Yiyang Xu
- Shengli Clinical College of Fujian Medical University, No.134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fuzhou, Fujian, China
- Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
| | - Guoyu Yu
- Shengli Clinical College of Fujian Medical University, No.134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fuzhou, Fujian, China
- Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
| | - Fenqi Luo
- Shengli Clinical College of Fujian Medical University, No.134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fuzhou, Fujian, China
- Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
| | - Long Chen
- Shengli Clinical College of Fujian Medical University, No.134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fuzhou, Fujian, China
- Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China
| | - Yuan Lin
- Shengli Clinical College of Fujian Medical University, No.134 East Street, Fuzhou, Fujian, China.
- Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China.
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fuzhou, Fujian, China.
- Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China.
| | - Jie Xu
- Shengli Clinical College of Fujian Medical University, No.134 East Street, Fuzhou, Fujian, China.
- Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China.
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fuzhou, Fujian, China.
- Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fuzhou, Fujian, China.
| |
Collapse
|
3
|
Gusho C, Hoskins W, Ghanem E. A Comparison of Surgical Approaches for Hip Hemiarthroplasty Performed for the Treatment of Femoral Neck Fracture: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. JBJS Rev 2024; 12:01874474-202406000-00004. [PMID: 38889234 DOI: 10.2106/jbjs.rvw.24.00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Multiple hemiarthroplasty (HA) approaches exist for femoral neck fracture (FNF) treatment. However, there is no consensus on the superiority of one approach for postoperative outcomes. This study assessed outcomes among randomized controlled trials (RCTs) comparing the posterior approach (PA), direct lateral approach (DLA), anterolateral approach (ALA), and the direct anterior approach (DAA) in HA for FNF. METHODS PubMed, Ovid/MEDLINE, Scopus, Cochrane Central Registry of Controlled Trials, and Cochrane Database of Systematic Reviews were queried in February 2024. A frequentist model network meta-analysis of eligible prospective RCTs compared outcomes among approaches using P-scores. RESULTS Of 1,481 retrieved studies, 11 RCTs totaling 1,513 FNF patients who underwent HA through a PA (n = 446; 29.5%), DLA (n = 481; 31.8%), ALA (n = 296; 19.6%), or DAA (n = 290; 19.2%) with median (interquartile range) follow-up of 6 (4.5-12.0) months were included for meta-analysis. DAA was associated with statistically increased operative duration (mean difference [MD], 1.89 minutes; 95% CI, 0.08 to 3.69 minutes; p < 0.001) compared with a PA, whereas an ALA was associated with statistically greater blood loss compared with a PA (MD, 5.81 mL; 95% CI, 4.11 to 7.50 mL; p < 0.001). There were no differences in the incidence of fracture, dislocation, infection, complications, revision, nor 1-year mortality among approaches. There were also no differences in hip nor pain score improvement at latest follow-up, although with high heterogeneity (I2 = 85.7% and 94.2%, respectively). CONCLUSION This study found no clinical difference in improvement in pain, function, nor in revision outcomes and operative characteristics among HA approaches for FNF, and each approach had a similar adverse event profile. Despite limited randomized evidence, these findings suggest comparable short-term efficacy and safety of all approaches. LEVEL OF EVIDENCE Therapeutic, Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Charles Gusho
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | | | | |
Collapse
|
4
|
Sang W, Lai P, Xu X, Liu Y, Ma J, Zhu L. Radiographic study of direct anterior approach hip arthroplasty: a 10-15 year follow-up of Chinese patients. ARTHROPLASTY 2024; 6:25. [PMID: 38698494 PMCID: PMC11067169 DOI: 10.1186/s42836-024-00249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Controversy remains over whether different surgical approaches exert an impact on the component positioning in total hip arthroplasty. We conducted a retrospective study to reveal the long-term position of prostheses in the first group of patients in China who underwent direct anterior hip arthroplasty. METHODS Collected were data from 350 patients who underwent direct anterior hip arthroplasty between 2008 and 2013, including demographic information, imaging data, Harris hip scores, and surgical complications. Variables, measured radiographically or by CT, included hip offset, leg length discrepancy, component position, and stability within one week after surgery and at the last follow-up. The data were subjected to statistical analysis by using paired t-tests and Pearson chi-square tests. RESULTS Data were harvested by follow-up and self-reported questionnaires. The postoperative follow-up lasted for 13.1 years on average (minimum, 10 years; maximum, 15 years), and the overall survival rate of hip prostheses was 96.3%. The mean Harris score at the final follow-up was 91.8 points. After excluding patients with significant preoperative hip deformities, the incidence of postoperative limb inequality (> 5 mm) was 4.9% at the last follow-up, and the incidence of hip offset discrepancy (> 5 mm) was 14.6%. The overall proportion of the acetabular components located in the Lewinnek safe zone was 77.7%, whereas the proportion of femoral prostheses in the safe zone (< 3° inclination) was 94.0%. Based on the revised data and the last follow-up imaging, the total proportion of acetabular and femoral prostheses with a radiolucence of > 2 mm was 5.1%. CONCLUSION Direct anterior approach hip arthroplasty could achieve excellent component positioning and long-term prosthesis survival in patients without severe hip deformities.
Collapse
Affiliation(s)
- Weilin Sang
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Peng Lai
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Xun Xu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Yu Liu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Jinzhong Ma
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China.
| | - Libo Zhu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China.
| |
Collapse
|
5
|
Faldini C, Rossomando V, Brunello M, D’Agostino C, Ruta F, Pilla F, Traina F, Di Martino A. Anterior Minimally Invasive Approach (AMIS) for Total Hip Arthroplasty: Analysis of the First 1000 Consecutive Patients Operated at a High Volume Center. J Clin Med 2024; 13:2617. [PMID: 38731146 PMCID: PMC11084447 DOI: 10.3390/jcm13092617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Direct anterior approach (DAA) has recently acquired popularity through improvements such as the anterior minimally invasive surgical technique (AMIS). This retrospective study examines the first 1000 consecutive THAs performed utilizing the AMIS approach in a high-volume center between 2012 and 2017. (2) Methods: 1000 consecutive THAs performed at a single institution utilizing the AMIS approach were retrospectively analyzed with a minimum five-year follow-up. Full evaluation of demographic information, clinical parameters, intraoperative complications, and radiological examinations are reported. (3) Results: Overall complication rate was 9.4% (94/1000), including 8 dislocations, 57 femoral-cutaneous nerve injuries, 12 intraoperative femoral fractures, 9 infections and 8 leg length discrepancy. Implant survival rates were 98.5% at 1 year, 97.5% at 3 years, 97% at 5 years, and 95.3% at 7 years. Causes of failure included periprosthetic fractures (0.8%), implant dislocations (0.6%), septic loosening (0.5%), aseptic mobilizations (0.2%), and symptomatic limb length discrepancies (0.2%). (4) Conclusions: Controversies persist around the direct anterior approach (DAA) for THA, primarily regarding the increased complications rate during the learning curve. However, this study advocates for widespread adoption of the DAA approach. The results demonstrate acceptable complication rates and remarkable functional outcomes, affirming its viability in the broader orthopedic patient population.
Collapse
Affiliation(s)
- Cesare Faldini
- 1st Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (V.R.); (M.B.); (C.D.); (F.R.); (F.P.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Valentino Rossomando
- 1st Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (V.R.); (M.B.); (C.D.); (F.R.); (F.P.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Matteo Brunello
- 1st Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (V.R.); (M.B.); (C.D.); (F.R.); (F.P.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Claudio D’Agostino
- 1st Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (V.R.); (M.B.); (C.D.); (F.R.); (F.P.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Federico Ruta
- 1st Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (V.R.); (M.B.); (C.D.); (F.R.); (F.P.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Federico Pilla
- 1st Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (V.R.); (M.B.); (C.D.); (F.R.); (F.P.)
| | - Francesco Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
- Ortopedia, Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Di Martino
- 1st Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (V.R.); (M.B.); (C.D.); (F.R.); (F.P.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| |
Collapse
|
6
|
Li YW, Yu SW, Yeh JH, Ma CH, Yen CY, Tu YK. First 100 total hip arthroplasties performed by a young surgeon using the direct anterior approach: learning curve and complications. Arch Orthop Trauma Surg 2024; 144:927-935. [PMID: 37803086 DOI: 10.1007/s00402-023-05077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/17/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Most of the reported discussions about the learning curve for the direct anterior approach (DAA) in total hip arthroplasty (THA) have been by experienced surgeons. The study's aim was to describe the learning curve, short-term outcomes, complications, and adaptations to the DAA used in the first 100 THA cases experienced by a young surgeon who had received DAA training for trauma surgeries. MATERIALS AND METHODS This retrospective study summarizes the first 100 consecutive cases experienced by a young surgeon who performed the unilateral DAA for THA between 2019 and 2021. Cumulative sum (CUSUM) analysis was performed to evaluate the learning curve on the basis of operative time and overall complications. The demographics data, short-term outcomes, and complications of the first 50 and second 50 cases were compared. RESULTS The CUSUM curve declined after 49 and 55 cases, measured by operative time and overall complications, respectively. The median operative time (104 vs. 80 min) and intraoperative fluoroscopic time (38 vs. 12 s) increased significantly in the first 50 cases compared with the times in the second 50 cases. Complications tended to occur in the first 50 cases (12% vs. 6%), and the overall rate was 9%. Major complications all occurred in the first 50 cases, with a rate of 4%. Only one case, which involved a complicated periprosthetic fracture around the stem that extended to the tip, required the intervention of a senior surgeon. CONCLUSIONS Even after receiving training on the DAA for trauma surgeries, the young surgeon experienced a steep learning curve and more complications in the first 50 cases. The DAA for THA is a technically demanding procedure and may require guidance from an experienced surgeon to manage unexpected complications.
Collapse
Affiliation(s)
- Yen-Wei Li
- Department of Orthopedics, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung City, 82445, Taiwan
| | - Shang-Won Yu
- Department of Orthopedics, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung City, 82445, Taiwan
| | - Jih-Hsi Yeh
- Department of Orthopedics, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung City, 82445, Taiwan
| | - Ching-Hou Ma
- Department of Orthopedics, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung City, 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, No. 8, E-Da Road, Kaohsiung City, 82445, Taiwan
| | - Cheng-Yo Yen
- Department of Orthopedics, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung City, 82445, Taiwan
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung City, 82445, Taiwan.
- School of Medicine, College of Medicine, I-Shou University, No. 8, E-Da Road, Kaohsiung City, 82445, Taiwan.
| |
Collapse
|
7
|
Foissey C, Pineda T, Servien E, Fontalis A, Batailler C, Lustig S. Adapting hip arthroplasty practices during the COVID-19 pandemic: Assessing the impact of outpatient care sudden increase on early complications and clinical outcomes. SICOT J 2024; 10:1. [PMID: 38193980 PMCID: PMC10775906 DOI: 10.1051/sicotj/2023037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has significantly affected access to timely care for patients with hip osteoarthritis requiring total hip replacement (THR). This study aimed to assess the changes in surgical activity, outpatient treatment, length of stay (LOS), discharge destinations, readmission rates, clinical outcomes, and patient satisfaction before and after the pandemic at our institution. MATERIALS AND METHODS This retrospective study encompassed patients undergoing primary THR through the direct anterior approach at a single university hospital. Data on demographic characteristics, surgical technique, perioperative management, LOS, discharge destinations, complications, and clinical outcomes were collected. Furthermore, a comparative analysis between the pre-pandemic (2019) and post-pandemic (2022) periods was conducted. RESULTS There was a 14% increase in surgical activity post-pandemic, with 214 patients undergoing surgery in 2019 versus 284 in 2022. The percentage of patients managed as outpatients significantly increased from 0.5% in 2019 to 29.6% in 2022 (p < 0.001). LOS decreased from 2.7 ± 1 [0-8] days to 1.4 ± 1.1 [0-12] days (p < 0.001), and the rate of discharge to rehabilitation centres declined from 21.5% to 8.8% (p < 0.001). No significant increase in the readmission rates was observed (1.4% in both periods). At two months postoperatively, the mean HHS and satisfaction rates were comparable between the two groups (p = 1 and p = 0.73, respectively). DISCUSSION Despite the challenges posed by the COVID-19 pandemic, surgical activity at our institution demonstrated an increase compared to the pre-pandemic levels by expanding outpatient care, reducing LOS, and increasing rates of home discharges. Importantly, these changes did not adversely affect rehospitalization rates or early clinical outcomes. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Constant Foissey
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Tomas Pineda
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
- LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility Claude Bernard Lyon 1 University Lyon France
| | - Andreas Fontalis
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust 235 Euston Rd. London NW1 2BU UK
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
- Division of Surgery and Interventional Science, University College London Gower Street London WC1E 6BT UK
| |
Collapse
|
8
|
Forsbacka N, Kolari T, Talme M, Bister V. Surgical Residents´ Results Seem to be Non-Inferior Comparing to More Experienced Surgeons in Femoral Neck Fracture Osteosynthesis. Indian J Orthop 2023; 57:2018-2023. [PMID: 38026839 PMCID: PMC10673761 DOI: 10.1007/s43465-023-00992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023]
Abstract
Purpose of the Study Femoral neck fracture osteosynthesis is usually performed by using dynamic hip screw (DHS) or multiple parallel cannulated screws (MCS). In orthopedic surgery training, certain hip fractures are one of the most common operations performed by residents. It has been questioned, whether residents can provide as safe treatment and patient outcomes as those of more experienced surgeons. The aim of this study was to evaluate the effect of surgical experience on risk of complications by comparing the surgical performance and clinical outcomes in femoral neck osteosyntheses between surgical residents and orthopaedic surgeons. Methods All patients with femoral neck fracture admitted to Helsinki and Uusimaa Hospital District (HUS) Hyvinkää Hospital from 2011 to 2016 were collected as research material. 88 hip fractures (87 patients) treated with DHS or MCS osteosyntheses were included in this study. The patients were divided into 2 groups, based on the surgeon's experience: an orthopedic surgeon group (n = 68) and a surgical resident group (n = 20). All data from complications, reoperations, and the duration of operations were collected. Results There was no significant difference in characteristics of operated patients between orthopaedics and residents group. There was no significant difference in complications or re-operations between groups (p = 0.4, p = 0.2). Surgical residents had statistically longer surgical time (mean 76 min, 95% CI 62.92 min, mean 46 min, 95% Cl 42.51 min; p-value < 0.001). Still surgical time was not a risk factor for complication (p-value 0.5). Conclusion Our results show that surgical residents´ outcomes in femoral neck fracture osteosynthesis seem to be as favorable as those of orthopedic surgeons; the operations just last slightly longer.
Collapse
Affiliation(s)
- Nora Forsbacka
- Turku University Hospital Trauma Unit, Turku University Hospital, Turku, Finland
| | - Terhi Kolari
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Marjo Talme
- Helsinki University Hospital, Hyvinkää Hospital, Hyvinkää, Finland
| | - Ville Bister
- Helsinki University Hospital Trauma Unit, Töölö Hospital, Helsinki, Finland
- Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Peijas Hospital, Vantaa, Finland
| |
Collapse
|
9
|
Foissey C, Batailler C, Coulomb R, Giebaly DE, Coulin B, Lustig S, Kouyoumdjian P. Image-based robotic-assisted total hip arthroplasty through direct anterior approach allows a better orientation of the acetabular cup and a better restitution of the centre of rotation than a conventional procedure. INTERNATIONAL ORTHOPAEDICS 2023; 47:691-699. [PMID: 36348089 DOI: 10.1007/s00264-022-05624-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim was to investigate the contribution of robotics assisted total hip arthroplasty (THA) through direct anterior approach (DAA) in improving radiographic precision, functional results and complications. METHODS This retrospective study compared 100 primary conventional THA (cTHA) to 50 primary robotic THA (rTHA) through DAA. All cups were placed with the objective of having no anterior overhang while respecting the safe zones (SZ). Radiographic analysis included cup inclination and anteversion, vertical and horizontal changes of the rotation centre (ΔVCOR, ΔHCOR), acetabular and femoral offset. SZ were 30-50° of inclination and 10-30° of anteversion. Outliers were defined as medial displacement of the COR > 5 mm, vertical displacement of the COR > 3 mm superiorly. Harris hip score (HHS) and complications were compared at one year of follow-up. RESULTS The robotic cups were better oriented with 98% in the global SZ versus 68% in the cTHA group (p = 0.0002). The COR was on average better restored in the robotic group in both the horizontal and vertical planes (Δ HCOR = - 5.0 ± 5.0 vs - 3.4 ± 4.9, p = 0.03; Δ VCOR = 1.6 ± 3.3 vs 0.2 ± 2.7, p = 0.04). There were fewer outliers in the rTHA group concerning VCOR (28% versus 10%, p = 0.03). There was no significant difference in HHS and complication rate at one year. CONCLUSION The use of robotics for THA by DAA provided an advantage in controlling the orientation of the cup and the restoration of its rotation centre. Thanks to the 3D planning on CT scan, it allowed to respect the thresholds while avoiding the anterior overhangs.
Collapse
Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France.
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Rémy Coulomb
- 2 Rue de L'École de Médecine, France - Laboratoire de Mécanique Et Génie Civile (LMGC), CNRS-UM1, Centre Hospitalo-Universitaire de Nîmes, Rue du Pr. Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 860 Rue de St-Priest, 34090, Montpellier, France
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedics Surgery, University College Hospital, London, UK
| | - Benoit Coulin
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Pascal Kouyoumdjian
- 2 Rue de L'École de Médecine, France - Laboratoire de Mécanique Et Génie Civile (LMGC), CNRS-UM1, Centre Hospitalo-Universitaire de Nîmes, Rue du Pr. Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 860 Rue de St-Priest, 34090, Montpellier, France
| |
Collapse
|
10
|
Shatrov J, Foissey C, Batailler C, Gunst S, Servien E, Lustig S. How long does image based robotic total knee arthroplasty take during the learning phase? Analysis of the key steps from the first fifty cases. INTERNATIONAL ORTHOPAEDICS 2023; 47:437-446. [PMID: 36355082 DOI: 10.1007/s00264-022-05618-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Robotically assisted total knee arthroplasty (RA-TKA) is an emerging surgical tool. The purpose of this study was to analyze the length of time taken to perform the key steps of a RA-TKA for a surgeon and centre new to the MAKO robotic system. METHOD This was a prospective cohort study of the first 50 patients undergoing TKA using a robotic platform (Mako, Stryker, Kalamazoo, MI, USA) performed by a single surgeon. Each key surgical step was recorded. The first 50 patients were chronologically allocated into five groups of ten and compared. RESULTS Mean operation length was 59.4 ± 7.4 min with significant improvement after 30 cases. A significant effect on certain steps of the surgery also occurred over 50 cases: after 30 cases for pre-operative planning (3.8 min in group 1 versus 1.2 min in group 4, p < 0.005), ten cases for registration time (5.2 min in group 1 versus 3.8 in group 2, p = 0.039) and ten cases for tibial cutting time (1.6 min in group 1 versus 1.3 in group 2, p < 0.005). Nurse setup, femur cutting, and intraoperative planning did not demonstrate a significant improvement in time over 50 cases. CONCLUSION A significant decrease in total operating length occurred after the 30th case. Anatomical registration and tibial cutting time demonstrated the largest improvements. MAKO image-based robotically assisted TKA is not a time-intensive intervention for both the surgeon and scrub nursing staff, and significant improvements in total surgical time occurs early in the learning phase.
Collapse
Affiliation(s)
- Jobe Shatrov
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France. .,Sydney Orthopaedic Research Institute (SORI) at Landmark Orthopaedics- St. Leonards, Sydney, Australia.
| | - Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Stanislas Gunst
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.,Interuniversity Laboratory of Human Movement Science, Université Lyon 1, 7424, Lyon, EA, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.,UMR_T9406, Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, 69622, Lyon, LBMC, France
| |
Collapse
|
11
|
Foissey C, Batailler C, Rajput V, Premkumar AB, Servien E, Lustig S. No dislocation and low complication rate for a modern dual mobility cup with pre-impacted femoral head in primary hip replacement: A consecutive series of 175 hips at minimum 5-year follow-up. SICOT J 2023; 9:1. [PMID: 36648274 PMCID: PMC9878999 DOI: 10.1051/sicotj/2022050] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Despite its excellent results in preventing dislocation, the dual mobility cup (DMC) is still struggling to be adopted by some teams due to premature wear and loosening reported on first-generation implants. Therefore, this study aimed to assess the mid-term survivorship of a modern DMC with a pre-impacted head and the radio-clinical results at a minimum follow-up of 5 years. METHODS This was a retrospective single-centre study performed on patients who had a primary total hip replacement for osteoarthritis in 2016. The cup was a third-generation DMC with a pre-impacted femoral head. Clinical (harris hip score (HHS)) and radiological (cup abduction, anteversion, overhang, and radiolucent lines) results were recorded, as well as complications, particularly dislocations and survivorship. A minimum of five years of follow-ups was required. RESULTS One hundred and seventy-five hips (167 patients) met the inclusion criteria. Five hips (2.9%, 5/175) were lost to follow-up and excluded from the postoperative analysis. The mean follow-up period was 70 ± 2.9 months [63.6-76.5]. Three cups needed revision surgery (1.8%, 3/170): one for septic loosening, and two for chronic infection. At 77 months, the global survival probability was 98.2% ± 1, and the survival probability excluding septic aetiology was 100%. There was a significant improvement in the HHS from pre-operatively (48.3 ± 6.0 [14.0-70.0]) to post-operatively (96 ± 4.5 [50-100]) (p < 0.0001). There were no postoperative dislocations recorded, nor any iliopsoas-impingement or symptomatic cam-effect. DISCUSSION This study showed excellent survival and good radiological and clinical results of this dual mobility cup at a mid-term follow-up. None of the patients had dislocation or any specific complication feared with dual mobility cups.
Collapse
Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France,Corresponding author:
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France
| | - Vishal Rajput
- The Midyorkshire Hospitals NHS Trust WF14DG Wakefield United Kingdom
| | | | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1 69100 Lyon France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
| |
Collapse
|
12
|
Moharrami A, Mirghaderi SP, Marzban S, Moazen-Jamshidi SMM, Shakoor D, Mortazavi SMJ. Total Hip Arthroplasty via direct anterior approach for osteonecrosis; comparison with primary hip osteoarthritis in a mid term follow up. J Clin Orthop Trauma 2022; 34:102042. [PMID: 36263249 PMCID: PMC9574779 DOI: 10.1016/j.jcot.2022.102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/03/2022] [Accepted: 09/27/2022] [Indexed: 10/31/2022] Open
Abstract
Background To determine the mid-term outcomes of conventional cementless Total Hip Arthroplasty (THA) in patients with avascular necrosis (AVN) of the femoral head and compare to patients with primary hip osteoarthritis (OA). Method A total of 330 consecutive primary THA procedures (AVN and OA) performed between 2010 and 2013 by a single surgeon and in a single center using the direct anterior approach (DAA) were included. Assessments including SF-36, WOMAC, and Harris Hip Scores (HHS) were retrieved from patients before the surgery and at the latest follow-up. Clinical and functional outcomes were compared between the AVN and OA groups. Results A total of 294 consecutive THA (AVN = 107, OA = 187) with 104.4 ± 6.2 months follow-up were analyzed, which AVN patients were significantly younger (32.0 vs. 59.6 y/o). Corticosteroid 34 (31.8%), idiopathic AVN 31 (29.0%) and use of unapproved weight gain supplements (UWGS) 23 (21.5%) were the main reasons for AVN. Despite that preoperative scores were comparable (P > 0.05), the HHS, SF-36, and WOMAC scores are significantly higher in the AVN group after THA surgery (P < 0.05). Moreover, flexion and abduction ROM were significantly higher in the AVN group (P < 0.05). Regarding each complication, no significant difference was observed between groups. In the whole sample, there were 5 (1.7%) revisions due to loosening of acetabular components, all the OA group (P > 0.05). Conclusion Conventional cementless THA with highly cross-linked polyethylene provides satisfactory mid-term results in patients with AVN with a low rate of postoperative complications. Compared to primary OA patients, this group reaches superior postoperative scores.
Collapse
Affiliation(s)
- Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Peyman Mirghaderi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Marzban
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Delaram Shakoor
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
13
|
Kolodychuk NL, Raszewski JA, Gladnick BP, Kitziger KJ, Peters PC, Waddell BS. Handheld Navigation Improves Accuracy in Direct Anterior Total Hip Replacement. Arthroplast Today 2022; 17:58-65. [PMID: 36032791 PMCID: PMC9399378 DOI: 10.1016/j.artd.2022.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/17/2022] [Accepted: 06/23/2022] [Indexed: 01/14/2023] Open
Abstract
Background This study sought to determine the accuracy in placing the acetabular component, estimation of leg length, offset, radiation time and dose, and operative time using a handheld navigation device compared to conventional anterior total hip arthroplasty (THA). It also examined the learning curve of the handheld navigation device. Methods Data were prospectively collected for a consecutive series of 159 THAs; 99 THAs with handheld navigation and 60 conventional THAs. Thresholds of <5°, ≥5° to <10°, and ≥10° for acetabular inclination and version and thresholds of <5 mm, ≥5 mm to <10 mm, and ≥10 mm for leg-length and combined offset discrepancy were used to assess accuracy. Fluoroscopy time and exposure, operative time, and complications were compared. Learning curve was determined using operative time. Statistical analysis was performed for the different accuracy thresholds with P values set a <0.05 for significance. Results The handheld navigation device demonstrated a mean accuracy of 3.2° and 1.8° for version and inclination, respectively. The handheld navigation group had significantly fewer outliers in version (P < .001), inclination (P < .001), leg-length discrepancy (P < .001), and offset discrepancy (P < .001). Fluoroscopic dose and time (P < .001) were lower in the handheld navigation cohort. The learning curve for handheld navigation was 31-35 cases. The mean operative time after the learning curve was similar to that in the conventional fluoroscopy group (P = .113). Conclusions Handheld navigation technology provided more accurate results while mitigating radiation exposure to the surgeon and patient. There were fewer outliers in the handheld navigation group. After the learning curve, all metrics improved in accuracy, and operative time was similar to that of the conventional technique.
Collapse
Affiliation(s)
- Nicholas L. Kolodychuk
- Fifth Year Orthopaedic Surgery Resident, Class of 2023, Cleveland Clinic, Akron General, Akron, OH, USA
| | - Jesse A. Raszewski
- Third Year Orthopaedic Surgery Resident, Class of 2024, Kettering Health – Grandview Medical Center, Dayton, OH, USA
| | - Brian P. Gladnick
- Board Certified Orthopedic Surgeon, Fellowship Trained, Carrell Clinic, Dallas, TX, USA
| | - Kurt J. Kitziger
- Board Certified Orthopedic Surgeon, Fellowship Trained, Carrell Clinic, Dallas, TX, USA
| | - Paul C. Peters
- Board Certified Orthopedic Surgeon, Fellowship Trained, Carrell Clinic, Dallas, TX, USA
| | - Bradford S. Waddell
- Board Certified Orthopedic Surgeon, Fellowship Trained, Carrell Clinic, Dallas, TX, USA
- Corresponding author. Bradford S. Waddell, MD, Board Certified Orthopedic Surgeon, Fellowship Trained, Carrell Clinic, 9301 N. Central Expressway, Tower I – Suite 500, Dallas, TX 75231, USA. Tel.: +1 404 401 3555.
| |
Collapse
|
14
|
Khan IA, Magnuson JA, Arshi A, Krueger CA, Freedman KB, Fillingham YA. Direct Anterior Approach in Hip Hemiarthroplasty for Femoral Neck Fractures: Do Short-Term Outcomes Differ with Approach?: A Systematic Review and Meta-Analysis. JBJS Rev 2022; 10:01874474-202209000-00001. [PMID: 36053029 DOI: 10.2106/jbjs.rvw.21.00202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hip hemiarthroplasty (HA) is commonly used to treat femoral neck fractures, but it remains unclear if the surgical approach impacts patient outcomes for this commonly performed procedure. The objective of this systematic review and meta-analysis was to assess early postoperative outcomes in patients undergoing HA for femoral neck fracture with the direct anterior approach (DAA) compared with other approaches. METHODS The Cochrane Central Registry of Controlled Trials, MEDLINE, and Google Scholar databases were searched for randomized controlled trials, prospective nonrandomized trials, and retrospective studies published prior to September 7, 2021, comparing DAA with other approaches (anterolateral approach [ALA], direct lateral approach [DLA], and posterior-based approach [PA]) in HA for femoral neck fractures. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes included functional outcomes, total complications, prosthetic dislocation, periprosthetic fracture, periprosthetic joint infection (PJI), reoperation, mortality, pain, operative time, and perioperative blood loss. Fixed effect odds ratios, along with their 95% confidence intervals, were used to analyze dichotomous variables. Significance was set at p < 0.05. Meta-analysis was conducted with Review Manager 5.4. RESULTS In total, 19 studies were included for qualitative analysis and 16 studies were included for quantitative analysis, with a total of 1,604 cases analyzed (723 DAA, 215 ALA, 301 DLA, and 365 PA). Compared with other approaches, the use of the DAA for HA was associated with improved early postoperative functional outcomes, lower early postoperative pain scores, fewer total complications, and fewer prosthetic hip dislocations. The rates of periprosthetic fracture, PJI, and reoperation, pain scores beyond 40 days, operative time, perioperative blood loss, and mortality were not significantly different between surgical approaches. CONCLUSIONS Utilizing the DAA while performing HA for femoral neck fractures is associated with improved functional outcomes, lower early postoperative pain scores, lower incidence of prosthetic hip dislocation, and potentially fewer total complications. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Irfan A Khan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | | | | | | |
Collapse
|
15
|
Reichert JC, Wassilew GI, von Rottkay E, Noeth U. Compared learning curves of the direct anterior and anterolateral approach for minimally invasive hip replacement. Orthop Rev (Pavia) 2022; 14:37500. [PMID: 36034727 PMCID: PMC9404252 DOI: 10.52965/001c.37500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Minimally invasive hip arthroplasty becomes increasingly popular. It is technically challenging and the approaches used are associated with a considerable learning curve. This nurtures concerns regarding patient safety, surgical training, and cost effectiveness. Consequently, we initiated a study comparing the learning curves of a supervised trainee surgeon utilizing both the anterolateral and direct anterior approach (DAA) when introduced to minimally invasive hip replacement surgery. Outcome measurements included the Harris hip score (HHS), cup inclination and anteversion, offset and leg length, stem placement, surgical time and complications. Time from incision to suture decreased significantly over time but did not differ between both groups. The functional outcomes (HHS) after six weeks and three months were comparable (p=0.069 and 0.557) and within the expected range equalling 90.3 (anterior) and 89.2 (anterolateral) points. With both approaches safe component placement was readily achieved. Both offset and leg length, however, were reconstructed more reliably with the DAA (p=0.02 and 0.001). A higher rate of dislocations was seen with the anterior, more perioperative infections with the anterolateral approach. We suggest that supervision by an experienced surgeon favourably influences the learning curves for both the minimally invasive DAA and anterolateral approach and conclude that the greatest improvement is seen within the first 60 cases.
Collapse
Affiliation(s)
- Johannes C Reichert
- Department of Orthopedics and Orthopaedic Surgery, University Medicine Greifswald; Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
| | - Georgi I Wassilew
- Department of Orthopedics and Orthopaedic Surgery, University Medicine Greifswald
| | - Eberhard von Rottkay
- Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
| | - Ulrich Noeth
- Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
| |
Collapse
|
16
|
Soza D, Pujol O, Lara Y, Castellanos S, Hernández A, Barro V. A comparative of a single novice surgeon's direct anterior approach and posterior approach learning curves in total hip arthroplasty: a retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022; 32:767-774. [PMID: 34129119 DOI: 10.1007/s00590-021-03039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The purpose of the present study was to compare a novice surgeon's learning curves with the direct anterior approach and posterior approach in total hip arthroplasty. METHODS A consecutive series of 376 total hip arthroplasties performed from November 2014 to September 2019 in a level-one healthcare center by a single surgeon (V.B) were retrospectively studied. Demographic data, functional outcomes, and complications were collected and compared. RESULTS Within the ranks of the patients studied, we found differences between groups with respect to dislocation rate and length of stay; these were lower in the direct anterior approach (DAA) group. The approach was not associated with an increase in complications, but rather with a decrease in the rate of dislocations and better functional outcomes at 1-year follow-up. Operative time was initially higher with this approach, but equalized during the learning curve. CONCLUSION The DAA can be safe even in the early stages of a novice surgeon's learning curve. It does not present a higher complication rate than the posterior approach, either in infection rate or in periprosthetic fractures. However, the DAA may provide greater functionality, lower dislocation rate and a shorter hospital stay. It can also be concluded that after having performed a certain number of interventions, operative time for the DAA can be comparable to that of other approaches.
Collapse
Affiliation(s)
- Diego Soza
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Oriol Pujol
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Yuri Lara
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Sara Castellanos
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Alejandro Hernández
- Hip Surgery Unit, Orthopedic Surgery Department, Josep Trueta University Hospital, Av. França s/n, 17007, Girona, Spain
| | - Víctor Barro
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| |
Collapse
|
17
|
Shen K, Feng E, Lin F, Weng Y, Chen J. Learning Curve of Total Hip Arthroplasty in Direct Anterior Approach without Requiring Corrective Osteotomy for Hip Dysplasia. Orthop Surg 2022; 14:840-850. [PMID: 35388599 PMCID: PMC9087452 DOI: 10.1111/os.13231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To explore the learning curve of total hip arthroplasty in direct anterior approach (DA-THA) without requiring corrective osteotomy for patients with unilateral developmental dysplasia of the hip (DDH) through the evaluation of clinical and radiographic results. METHOD From December 2015 to January 2021, we retrospectively evaluated a surgeon's first 100 patients with unilateral hip dysplasia (Crowe I-III) who underwent DA-THA. All procedures were performed by a fellowship-trained joint surgeon. Cementless hemispheric porous-coated acetabular cups and tapered cementless stems were used in all hips. The radiographic data, including leg length, the height of the center of rotation, femoral head offset, the cup anteversion and inclination angle, were measured. The cumulative sum analysis (CUSUM) and risk-adjusted cumulative sum analysis (RA-CUSUM) were used to determine the learning curve of DA-THA for each patient's operation time. By analyzing the operation time, complication rate, postoperative length of hospitalization and creatine kinase (before surgery and the third day after surgery), estimated blood loss, Harris score, radiographic data were compared between the different stages of the learning curve. RESULTS The mean follow-up time was 35.45 ± 16.82 months. The CUSUM method obtained the maximum turning point of the curve at 43 cases, which divided the learning curve into Learning Period and Mastery Period. The CUSUM learning curve was best modeled as a cubic curve with the equation: CUSUM (min) = 0.001x3 - 0.495x2 + 33.60x - 10.00, which had a higher R2 value of 0.967. The pre-operative data, creatine kinase, estimated blood loss and postoperative Harris scores of the two stages were not statistically significant (P > 0.05). The mean operation time was 118 min in the Learning Period and 87 min in the Mastery Period. Statistically significant differences were detected in the operation time (P < 0.001), postoperative length of hospitalization(P = 0.024), and postoperative leg length discrepancy (P = 0.012) between the two stages. The overall complication rates were 27.9% in the Learning Period and 12.3% in the Mastery Period (p = 0.049). The overall outliers of radiographic data were 34 cases in the Learning Period and 31 cases in the Mastery Period (79.07% vs 54.39%, P = 0.010). CONCLUSIONS The DA-THA is a valuable alternative to achieve satisfactory clinical results for mild-to-moderate DDH patients. Furthermore, accurate analysis of the learning curve of DA-THA for hip dysplasia by the CUSUM method showed that the surgeons need to finish about 43 cases to master the technique.
Collapse
Affiliation(s)
- Kaiwei Shen
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Eryou Feng
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Feitai Lin
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Yan Weng
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Jinhua Chen
- Medical Department of Fujian Medicine University Union Hospital, Fuzhou, China
| |
Collapse
|
18
|
D’Ambrosi R, Toni A, Czubak J, Guadilla J, Lieber L, Mariani I, Ursino N. Satisfactory clinical and radiologic outcomes with a new shorter and modular stem for end-stage hip osteoarthritis: an international prospective multicentre pilot study. SICOT J 2022; 8:9. [PMID: 35380533 PMCID: PMC8982177 DOI: 10.1051/sicotj/2022005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction: This multicenter prospective cohort study aimed to assess the safety and clinical and radiologic performance of the CLS® BreviusTM Stem with Kinectiv® Technology. Material and Methods: A total of 222 consecutive subjects, recruited in five different centers, qualifying for primary total hip arthroplasty (THA), were enrolled in the study. All the subjects received the CLS® BreviusTM Stem with Kinectiv® Technology. All the enrolled study subjects underwent pre-operative clinical and radiographic evaluation. Additionally, all subjects underwent post-operative clinical, functional and radiographic evaluations at 6 months and 1, 2, 3, and 5 years. These evaluations included implant survival, pain and functional performance (Harris Hip Score [HHS], University of California, Los Angeles [UCLA] Activity Score, Oxford Hip Score), subject quality-of-life (EQ-5D), radiographic parameters, complications, and concentration of metal ions (aluminum and titanium) in blood. Results: No revisions were performed during the follow-up period. Of the 222 patients, only 76 completed the 5-year follow-up. Only 7 and 5 patients had aluminum and titanium 5-year evaluations, respectively. All the clinical parameters showed an overall improvement in the overtime measured with ANOVA for repeated measures; furthermore, the clinical scores showed a statistically significant improvement at 5 years with respect to pre-operative value (p < 0.001). Aluminum and titanium showed no variation for repeated measures at different time points (p > 0.05). A total of six complications were reported, of which only two were hip-related. Conclusions: The function of the CLS® BreviusTM Stem with Kinectiv® Technology indicated that subject well-being significantly increased following THA regardless of age, gender, BMI, previous surgery, primary diagnosis, and lifestyle.
Collapse
Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi 20161 Milano Italy
- Corresponding author:
| | - Aldo Toni
- IRCCS Istituto Ortopedico Rizzoli 40136 Bologna Italy
| | | | | | | | - Ilaria Mariani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” 34137 Trieste Italy
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi 20161 Milano Italy
| |
Collapse
|
19
|
Sang W, Xue S, Xu Y, Liu Y, Zhu L, Ma J. Bikini Incision Increases the Incidence of Lateral Femoral Cutaneous Nerve Injury in Direct Anterior Approach Hip Arthroplasty: A Prospective Ultrasonic, Electrophysiological, and Clinical Study. J Arthroplasty 2021; 36:3463-3470. [PMID: 34074541 DOI: 10.1016/j.arth.2021.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Lateral femoral cutaneous nerve (LFCN) injury has been widely reported as one of the most common complications of direct anterior approach (DAA) hip arthroplasty. Bikini incision is considered to increase the incidence of this complication. METHODS A prospective randomized study was conducted after including ninety-nine bikini and ninety-six longitudinal incision DAA cases from May to November 2020. The occurrence of LFCN was examined using ultrasound before and after surgery. The recovery of injury symptoms was evaluated by continuous clinical follow-up until six months, and the patients were treated with mecobalamin and/or celecoxib. Sensory conduction velocity and sensory action potential amplitude of the LFCN were measured after surgery in symptomatic patients. RESULTS Eighty five (43.6%), sixty seven (34.4%), and forty three (22.0%) cases of LFCN were of the anterior trunk, posterior trunk, and fan types, respectively, before surgery. All one hundred ninety five patients completed the follow-up period. Fifty-seven patients had symptoms of LFCN injury, including thirty six and twenty one patients in the bikini group and longitudinal group, respectively, with significantly different incidence rates (36.4% and 21.9%, respectively; P < .05). Of these, thirty two (56.1%), thirteen (22.8%), and twelve (21.1%) cases were of the anterior trunk, posterior trunk, and fan types, respectively. Sensory conduction velocity and sensory action potential amplitude significantly decreased after surgery in both groups (P < .05). Seventeen cases showed reduction of symptoms within three months. Forty six cases showed self-recovery within six months and eleven cases showed persistent symptoms at the final follow-up. CONCLUSION Bikini incision DAA hip arthroplasty may increase the incidence of LFCN injury, and the anterior trunk distribution type is most likely to be affected. (Clinical Trial Registration Number: CHICTR2000035107).
Collapse
Affiliation(s)
- Weilin Sang
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Song Xue
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yiming Xu
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yu Liu
- Department of Orthopedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Libo Zhu
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jinzhong Ma
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
20
|
Nairn L, Gyemi L, Gouveia K, Ekhtiari S, Khanna V. The learning curve for the direct anterior total hip arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:1971-1982. [PMID: 33629172 DOI: 10.1007/s00264-021-04986-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty (THA) is a muscle-sparing approach thought to have less post-operative pain and quicker recovery, with similar functional outcomes to other approaches. However, it is technically challenging and transitioning surgeons may experience increased complication rates. The purpose of this systematic review is to identify reported learning curves associated with the DAA. METHODS Three databases (MEDLINE, Embase, and Web of Science) were searched using terms including "total hip arthroplasty," "direct anterior approach," and "learning curve." Study characteristics, patient demographics, learning curve analyses, and complications were abstracted. RESULTS Twenty-one studies met inclusion criteria, with a total of 9738 patients (60% female), an average age of 63.7 years (range: 13-94), body mass index of 27.0 kg/m2 (range: 16.8-58.9), and follow-up of 19 months (range: 1.5-100). There were five retrospective cohort studies and 13 case series representing fair methodological quality. Six studies depicted a true learning curve, with mean operative time of 156.59 ± 41.71 minutes for the first case, 93.18 ± 14.68 minutes by case 30, and 80.45 ± 12.28 minutes by case 100. Mean complication rate was 20.8 ± 12.7% in early groups and decreased to 7.6 ± 7.1% in late groups. CONCLUSION This review demonstrated a substantial learning curve associated with the DAA to THA. Operative time plateaued after approximately 100 cases. Complication rates decreased substantially from early to late groups.
Collapse
Affiliation(s)
- Leah Nairn
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
| | - Lauren Gyemi
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| |
Collapse
|
21
|
Pujol O, Soza D, Lara Y, Castellanos S, Hernández A, Barro V. Restoring hip biomechanics during the learning curve of a novice surgeon: Direct anterior approach vs posterior approach. J Orthop 2021; 26:72-78. [PMID: 34349397 DOI: 10.1016/j.jor.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/11/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction It remains controversial whether the direct anterior approach (DAA) or the posterior approach (PA) allows better restoration of hip biomechanics after total hip arthroplasty (THA). Besides, it is not certain which approach is best for a novice surgeon to avoid implant malposition, neither during the learning curve nor once the curve plateau has been reached. Methods We performed a retrospective cohort study of THAs operated on between 2014 and 2019 by a single novice surgeon (DAA, n = 187; PA, n = 184). The surgeon used both approaches, and thus went through parallel learning curves. Results While the DAA presented a greater number of acetabular cup implantations within Lewinnek's "safe zone" for inclination (84.5% vs. 79.3%; p = 0.003), the PA returned superior results for anteversion (77.7% vs. 68.4%; p = 0.000). The PA showed a tendency to verticalize acetabular cups, while the DAA tended to antevert them. The DAA resulted in fewer patients with leg length discrepancy (3.2% vs. 8.2%, p = 0.041). No differences were found in stem coronal alignment or femoral offset. Conclusion Both approaches are safe and reliable for restoring hip biomechanics through THA surgery during the learning curve of a novice hip surgeon. Similar radiological outcomes are also seen once the surgeon has reached the learning curve plateau.
Collapse
Affiliation(s)
- Oriol Pujol
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Diego Soza
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Yuri Lara
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Sara Castellanos
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Alejandro Hernández
- Hip Surgery Unit, Orthopedic Surgery Department, Josep Trueta University Hospital, Girona, Spain
| | - Víctor Barro
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| |
Collapse
|
22
|
Feeley A, Feeley I, Merghani K, Sheehan E. A pilot study to evaluate the face & construct validity of an orthopaedic virtual reality simulator. Injury 2021; 52:1715-1720. [PMID: 33926708 DOI: 10.1016/j.injury.2021.04.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/10/2021] [Indexed: 02/07/2023]
Abstract
AIMS This study aimed to identify the face and construct validity of the Precision OS trauma module proximal femoral nail procedure. Secondary outcomes included perceived use of simulation in surgical training, with structured feedback from participants. METHODS A comparative interventional study was carried out in a regional orthopaedics trauma unit hospital. Volunteers were stratified into novice, intermediate and expert groups based on self-reported levels of experience. Each participant carried out a simulated proximal femoral nail on an immersive virtual platform following instruction on its use, with objective metrics such as time and x-rays, and novel metrics calculated by the simulation module recorded. Face validity was also assessed. RESULTS The proximal femoral nail module demonstrated construct validity. Kruskal Wallis test demonstrated a statistically significant difference across all group's novel performance (p=.018). Intermediate surgeons performed significantly better than novices (P=.022), with shorter procedural times (P=.018) Three of the intermediate group achieved the proficiency level set by the expert group, with no significant difference noted between these two groups (=.06). Time taken to completion for expert surgeons was less than intermediate group, although this did not reach significance (P=.19). CONCLUSION The proximal femoral nail module on the Precision OS platform demonstrated good face, and construct validity. Further research evaluating use of virtual platform simulation in surgical trauma training is needed.
Collapse
Affiliation(s)
- Aoife Feeley
- Midlands Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly R35 NY51, Ireland.
| | - Iain Feeley
- Midlands Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly R35 NY51, Ireland
| | - Khalid Merghani
- Midlands Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly R35 NY51, Ireland
| | - Eoin Sheehan
- Midlands Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly R35 NY51, Ireland
| |
Collapse
|
23
|
Jassim SS, Varma SK, Ramachandran M, Akhtar KSN. Survey of trainee attitudes to skill development and simulation training in
trauma and orthopaedics. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:154-158. [DOI: 10.1136/bmjstel-2020-000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 11/03/2022]
Abstract
Background
Simulation training in surgery is widespread and allows surgeons to
practise novel operative techniques and acquaint themselves with unfamiliar
surgical procedures. The use of box or virtual reality simulators in many
surgical specialities is established; however, its use within trauma and
orthopaedics (T&O) in the UK and the attitudes of trainee towards it are
not known. The aim of this study is to explore the experiences and opinions of
T&O trainees towards simulation training.
Methods
An electronic survey consisting of 11 questions on the experiences of
simulation training and attitudes towards it was sent to all T&O speciality
trainees in London.
Results
Fewer than 10% of the responders had used or had ready access to
simulators to prepare for unfamiliar operations, with almost 90% preferring to
read about them in a journal or watch them on an online video site. Over half
had only seen simulators on courses or been aware of them. Over 75% of the
responders believed that simulators should be available for trainees, but most
did not feel that they should be used as part of formal assessments.
Conclusions
Methods for preparing for new operations have expanded over the past
20 years, yet the use of simulator machines is not widespread. Many trainees
believe current machines are not widely available nor realistic enough to be
useful, with most preferring online videos and operative technique books for
preparing for an unfamiliar operation.
Collapse
|
24
|
Fontalis A, Epinette JA, Thaler M, Zagra L, Khanduja V, Haddad FS. Advances and innovations in total hip arthroplasty. SICOT J 2021; 7:26. [PMID: 33843582 PMCID: PMC8040589 DOI: 10.1051/sicotj/2021025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
Total hip arthroplasty (THA) has been quoted as one of the most successful and cost-effective procedures in Orthopaedics. The last decade has seen an exponential rise in the number of THAs performed globally and a sharp increase in the percentage of young patients hoping to improve their quality of life and return to physically demanding activities. Hence, it is imperative to review the various applications of technology in total hip arthroplasty for improving outcomes. The development of state-of-the-art robotic technology has enabled more reproducible and accurate acetabular positioning, while long-term data are needed to assess its cost-effectiveness. This opinion piece aims to outline and present the advances and innovations in total hip arthroplasty, from virtual reality and three-dimensional printing to patient-specific instrumentation and dual mobility bearings. This illustrates and reflects the debate that will be at the centre of hip surgery for the next decade.
Collapse
Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
| | | | - Martin Thaler
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan 20161, Italy
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Box 37, Addenbrookes Hospital, Cambridge CB2 0QQ, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
| |
Collapse
|
25
|
Batailler C, Caton J, Lustig S. Global perspective of Innovation in Hip and Knee Replacement in 2020. SICOT J 2020; 6:E1. [PMID: 33320807 PMCID: PMC7738158 DOI: 10.1051/sicotj/2020043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Cécile Batailler
- FIFA Medical Center of Excellence, Orthopaedic Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 69004 Lyon, France - LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, 69003 Lyon, France
| | - Jacques Caton
- Groupe Lépine, 175 rue Jacquard - CS 50307, 69727 Genay Cedex, France
| | - Sébastien Lustig
- FIFA Medical Center of Excellence, Orthopaedic Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 69004 Lyon, France - LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, 69003 Lyon, France
| |
Collapse
|