Preetesh D. Patel

Influence of technique with distally fixed modular stems in revision total hip arthroplasty.

Distally fixed modular implants have seen a recent increase in use, to manage proximal femoral bone loss often encountered during revision total hip arthroplasty (THA). Forty-three distally fixed modular stems implanted at our institution between 1999 and 2006 were clinically and radiographically reviewed. These patients had either a minimum 2-year follow-up (average, 2.4 years; range, 2-5.6 years) or failure (ie, explant or rerevision required). Eleven stems subsided, and 4 were rerevised (n = 4), for a rate of 9.3%. All revised stems were radiographically undersized, emphasizing the importance of the technique. Although being a valuable option in revision THA, these stems are not free of complications. The high rate of subsidence encountered in our early experience shows that there is a learning curve. This complication is preventable by avoiding undersizing.

Accuracy of Fluoroscopic Guided Acetabular Component Positioning During Direct Anterior Total Hip Arthroplasty

Acetabular component malposition contributes to increased complications and early revision. Supine positioning during direct anterior approach (DAA) THA facilitates the use of fluoroscopy to improve component positioning. This study evaluated the accuracy of acetabular component orientation using intraoperative fluoroscopy in DAA THA. A total of 780 surgeries by two surgeons were retrospectively reviewed over a 3-year period. Ranges for abduction (30°-50°) and version (5°-250) were employed. Overall, 92% fell within the targeted abduction range, 93% fell within the targeted anteversion range, and 88% met both criteria. The accuracy of component positioning for combined abduction and anteversion improved yearly (79.2%, 2011; 90.9%, 2012; and 95.6%, 2013). Fluoroscopy in DAA THA is a useful tool to improve acetabular component orientation, though a learning curve exists with its interpretation.

One-stage versus two-stage exchange.

Liaison: Paul Lichstein MD, MSLeaders: Thorsten Gehrke MD (International), Adolph Lombardi MD, FACS (US), Carlo RomanoMD (International), Ian Stockley MB, ChB, MD, FRCS (International)Delegates: George Babis MD, Jerzy Bialecki MD, La´szlo´ Bucsi MD, Xu Cai MD, Li Cao MD, Briande Beaubien MD, Johannes Erhardt MD, Stuart Goodman MD, PhD, FRCSC, FACS, FBSE,William Jiranek MD, Peter Keogh, David Lewallen MD, MS, Paul Manner MD, WojciechMarczynski MD, J. Bohannon Mason MD, Kevin Mulhall MB, MCh, FRCSI, Wayne PaproskyMD, Preetesh Patel MD, Francisco Piccaluga MD, Gregory Polkowski MD, Luis Pulido MD, IanStockley MBBS, ChB, FRCS, Juan Suarez MD, Fritz Thorey MD, Rashid Tikhilov MD, JobDiego Velazquez MD, Heinz Winkler MD

Incidence of Heterotopic Ossification in Direct Anterior Total Hip Arthroplasty: A Retrospective Radiographic Review

Heterotopic ossification (HO) is a complication following total hip arthroplasty (THA) with traditional approaches. The direct anterior approach (DAA) has become a popular approach for THA; however, no study has evaluated HO formation following DAA THA. We examined the incidence of HO in a consecutive series of THA using the DAA in two separate hospitals. Standard preoperative radiographs were examined to determine the type of degenerative arthritis, and follow-up radiographs of at least 6 months after surgery were evaluated for the presence and classification of HO. The overall incidence of HO after DAA THA in this study was 98/236, or 41.5%, which falls within the reported range from recent studies involving more traditional approaches to the hip.

One-stage vs two-stage exchange.

Liaison: Paul Lichstein MD, MSLeaders: Thorsten Gehrke MD (International), Adolph Lombardi MD, FACS (US),Carlo Romano MD (International), Ian Stockley MB, ChB, MD, FRCS (International)Delegates: GeorgeBabisMD,JerzyBialeckiMD,LaszloBucsiMD,XuCaiMD,LiCaoMD,BriandeBeaubienMD,Johannes Erhardt MD, Stuart Goodman MD, PhD, FRCSC, FACS, FBSE, William Jiranek MD,PeterKeoghFRCSI,DavidLewallenMD,MS,PaulMannerMD,WojciechMarczynskiMD,J.BohannonMasonMD,Kevin Mulhall MB, MCh, FRCSI, Wayne Paprosky MD, Preetesh Patel MD, Francisco Piccaluga MD,Gregory Polkowski MD, Luis Pulido MD, Ian Stockley MBBS, ChB, FRCS, Juan Suarez MD, Fritz Thorey MD,Rashid Tikhilov MD, Job Diego Velazquez MD, Heinz Winkler MD

Fluoroscopic Imaging of Acetabular Cup Position During THA Through a Direct Anterior Approach

Mobile image intensifiers are more readily used to assess acetabular cup placement when performing a total hip arthroplasty through a direct anterior approach. However, patient positioning affects pelvic tilt and rotation, which in turn requires proper C-arm fluoroscopy adjustments for image interpretation. The authors provide insight into the interpretation of acetabular cup positioning based on the fluoroscopic images obtained to ensure appropriate cup positioning using the direct anterior approach for total hip arthroplasty.

Comprehensive approach to the evaluation of groin pain

&NA; Groin pain is often related to hip pathology. As a result, groin pain is a clinical complaint encountered by orthopaedic surgeons. Approximately one in four persons will develop symptomatic hip arthritis before age 85 years. Groin injuries account for approximately 1 in 20 athletic injuries, and groin pain accounts for 1 in 10 patient visits to sports medicine centers. Many athletes with chronic groin pain have multiple coexisting pathologies spanning several disciplines. In treating these patients, the orthopaedic surgeon must consider both musculoskeletal groin disorders and nonorthopaedic conditions that can present as groin pain. A comprehensive history and physical examination can guide the evaluation of groin pain.

Prospective, Randomized Trial to Evaluate Efficacy of a Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty

Total knee arthroplasty (TKA) can be associated with substantial blood loss, leading to increased morbidity and transfusion rates. The study objective was to evaluate routine use of a thrombin-based topical hemostatic matrix in reducing blood loss and transfusion requirements in primary TKA. 108 patients were enrolled in a prospective, randomized, single-center trial. Patients receiving the hemostatic agent demonstrated a lower mean calculated blood loss (1325.2±464.8mL vs. control, 1509.3±432.8mL; P=0.02), drain output (415.6±202.0mL vs. control, 579.9±306.7mL; P=0.008), and length of stay (3.3±0.8days vs. control, 3.7±1.1days; P=0.03), without a statistically significant difference in mean hemoglobin loss or transfusion requirements. The clinical utility of this hemostatic agent to reduce transfusions after uncomplicated, primary TKA continues to remain unclear.

Prospective, Randomized Trial to Evaluate Efficacy of a Bipolar Sealer in Direct Anterior Approach Total Hip Arthroplasty

Total hip arthroplasty can be associated with substantial blood loss requiring allogenic transfusions. Intraoperative blood loss patterns in DAA differ from other approaches. This study evaluated the hemostatic efficacy of a bipolar sealer in DAA THA on surgical blood loss and transfusion requirements. 118 patients were enrolled in this prospective, randomized, double-blinded trial. Primary outcome measure was transfusion rate, while secondary measures included calculated blood loss. A lower transfusion rate was found in the treatment group (3.5 % vs 16.4%, P=.03). There were differences in Hemoglobin-drop (P=.04), calculated blood loss (P=.02), and hidden blood loss (P=.02), favoring the treatment group. The use of a bipolar sealer decreased intraoperative blood loss and transfusion requirements in the study population.

Design, Implementation, and Comparison of Methods for Collecting Implant Registry Data at Different Hospital Types

Practical issues surrounding the official establishment of a national arthroplasty registry in the United States remain. The purpose of this study was to compare compliance and accuracy rates associated with 3 methods for voluntarily collecting implant registry data at 3 different hospital types. Methods examined included (1) scannable paper forms, (2) online forms comprising keypunching for implant data input, and (3) the same electronic form but incorporating barcode scanning for implant data entry. Overall compliance was low (930/1761; 52.8%) and decreased with each successive data collection phase. Total accuracy rate was 62.5% (578/925) and varied significantly among sites (P < .001). Even with relatively simple reporting systems, compliance was poor. This emphasizes the need for direct surgeon involvement, strict oversight, and a feedback system to ensure validity, particularly if a volunteer-based system is used.