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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_6 | Pages 21 - 21
1 Mar 2017
Domb B Suarez-Ahedo C Gui C Martin T Chandrasekaran S Lodhia P
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Purposes

To compare the acetabular component size relative to the patient's native femoral head size between conventional THA (CTHA) approach and robotic-guided THA (RGTHA) to infer which of these techniques preserves more acetabular bone.

Methods

Patients were included if they had primary osteoarthritis (OA) and underwent total hip replacement between June 2008 and March 2014. Patients were excluded if they had missing or rotated postoperative anteroposterior radiographs. RGTHA patients were matched to a control group of CTHA patients, in terms of pre-operative native femoral head size, age, gender, body mass index (BMI) and approach. Acetabular cup size relative to femoral head size was used as a surrogate for amount of bone resected. We compared the groups according to two measures describing acetabular cup diameter (c) in relation to femoral head diameter (f): (1) c-f, the difference between cup diameter and femoral head diameter and (2) (c-f)/f, the same difference as a fraction of femoral head diameter.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_3 | Pages 62 - 62
1 Feb 2017
Domb B Chandrasekaran S Darwish N Martin T Lodhia P Suarez-Ahedo C
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Introduction

Accurate component placement in total hip arthroplasty (THA) improves post-operative stability and reduces wear and aseptic loosening. Methods for achieving accurate stem placement have not been as extensively studied as cup placement.

Objectives

The purpose of this study is to determine how consistently femoral stem version can be corrected to an ideal of 15 +/− 5 degrees using robotic guidance. Furthermore, the study aims to identify other factors related to approach and patient demographics, which may influence the degree of correction obtained.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_21 | Pages 23 - 23
1 Dec 2016
Lodhia P Gui C Martin T Chandrasekaran S Suarez-Ahedo C Domb B
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We present to you a match-controlled study assessing co-existing arthroscopic findings during hip arthroscopy in patients with an intraoperative diagnosis of a central acetabular osteophyte (CAO). We feel that this manuscript is both pertinent and timely.

Recent literature has described the entity of central acetabular impingement, in which an osteophyte of the cotyloid fossa impinges against the superomedial femoral head and fovea. The technique for central acetabular decompression has also been described to treat this entity. The primary purpose of this study was to report the prevalence of femoral head articular damage in a matched cohort of patients with and without central acetabular osteophyte (CAO) that was identified during hip arthroscopy. A secondary purpose was to identify the rates of co-existing intraarticular pathology in both patient groups.

Intraoperative data was collected prospectively on all patients undergoing hip arthroscopy at our institution between February 2008 to March 2015,. The inclusion criteria for this study were the presence of a CAO identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement (FAI). Exclusion criteria were revision surgeries, Tönnis grade 1 and higher, and previous hip conditions such as Legg-Calves-Perthes disease, avascular necrosis, and prior surgical intervention. The matched cohort control group was selected based on gender, age within 5 years, body mass index (BMI), and workers' compensation claim, on a 1:3 ratio to patients who underwent hip arthroscopy for a labral tear and/or FAI and did not have a CAO.

The CAO group consisted of 126 patients, which were matched to 378 patients in the control group. The grades of femoral and acetabular chondral damage were significantly different between the two groups (p<0.01).

This study showed that patients with CAO had a significantly higher prevalence of femoral and acetabular chondral damage, size of articular defects on both surfaces and the prevalence of LT tears compared to matched controls.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_21 | Pages 18 - 18
1 Dec 2016
Lodhia P Gui C Chandrasekaran S Suarez-Ahedo C Domb B
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We present a prospective two-year follow-up study of 1038 hip arthroscopies performed at a high volume tertiary referral centre for hip preservation. We feel that this manuscript is both pertinent and timely due to the advances in the field of hip preservation.

We used four validated patient-reported outcome (PRO) scores along with the visual analog scale (VAS) and patient satisfaction scores to assess preoperative and postoperative outcomes in all patients undergoing hip arthroscopy. We divided the entire cohort into patients undergoing primary and revision hip arthroscopies. We found a statistically significant improvement from preoperative to two-year postoperative PRO scores in the two subgroups. We also found a significant difference in the PRO scores at three months, one year, and two years postoperatively between the primary and revision subgroups. The revision subgroup had inferior VAS and patient satisfaction compared to the primary subgroup, however these results were not significant. The conversion to total hip arthroplasty/hip resurfacing (THA/HR) was 5.6% and 11.2% in the primary and revision subgroups, respectively. This resulted in a relative risk of 2.0 for conversion to THA/HR in the revision subgroup. We had a complication rate of 5.3 (only 0.5% of which were considered major) which was similar to that reported in the literature for hip arthroscopy.

The primary purpose was to perform a survival analysis in a large mixed cohort of patients undergoing hip arthroscopy at a high volume tertiary referral centre for hip preservation with minimum two-year follow-up. The secondary purpose was to compare clinical outcomes of primary versus revision hip arthroscopy.

From February 2008 to June 2012, data were prospectively collected on all patients undergoing primary or revision hip arthroscopy. Patients were assessed pre- and post-operatively with modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10.

There were a total of 1155 arthroscopies performed, including 1040 primary arthroscopies (926 patients) and 115 revision arthroscopies (106 patients). Of these, 931 primary arthroscopies (89.5%) in 824 patients (89.0%) and 107 revision arthroscopies (93.0%) in 97 patients (91.5%), were available for follow-up and included in our study. The mean change in patient reported outcome (PRO) scores at two-year follow-up in the primary subgroup was 17.4 for mHHS, 19.7 for HOS-ADL, 23.8 for HOS-SSS, 21.3 for NAHS, and −3.0 for VAS. The mean change in PRO scores at two-year follow-up in the revision subgroup was 13.4, 10.9, 16.1, 15.4, and −2.7, respectively. All scores improved significantly compared to pre-operatively (p<0.001). PRO scores were higher at all time points for the primary subgroup compared to the revision subgroup (p<0.05). Satisfaction was 7.7 and 7.2 for primary and revision subgroups, respectively. Of 931 primary arthroscopies, 52 (5.6%) underwent THA/HR. Of 107 revision arthroscopies, 12 (11.2%) underwent THA/HR. The relative risk of a THA/HR was 2.0 after revision procedures compared to primary procedures. The overall complication rate was 5.3%.

Hip arthroscopy showed significant improvement in all PRO, VAS, and satisfaction scores at two years postoperatively. Primary arthroscopy patients showed greater PRO scores and a trend towards greater VAS compared to the revision subgroup. The relative risk of a THA/HR was 2.0 after revision procedures compared to primary procedures.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_7 | Pages 117 - 117
1 May 2016
Suarez-Ahedo C Gui C Martin T Chandrasekaran S Domb B
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Background

Preservation of acetabular bone during primary total hip arthroplasty (THA) is important, because proper stability of cementless acetabular cup during primary THA depends largely on the amount of bone stock left after acetabular reaming. Eccentric or excessive acetabular reaming can cause soft tissue impingement, loosening, altered center of rotation, bone-to-bone impingement, intraoperative periprosthetic fracture, and other complications. Furthermore, loss of bone stock during primary THA may adversely affect subsequent revision THA.

Questions/Purposes

We sought to compare the conventional THA (CTHA) approach to robotic-guided THA (RGTHA) to determine which of these techniques preserves more acetabular bone, as interpreted from the size of the acetabular component compared with the size of the native femoral head.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_7 | Pages 116 - 116
1 May 2016
Domb B Redmond J Louis S Alden K Daley R LaReau J Petrakos A Gui C Suarez-Ahedo C
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Background

Robotics assisted surgery are tools that provide successful biomechanical reconstruction of the hip. We compare the accuracy of cup placement in the safe zones described by Lewinnek et al. and Callanan et al., leg length discrepancy (LLD) and global offset (GO) measurement in total hip arthroplasty (THA) using five diferent image guided techniques performed by six diferent surgeons.

Methods

Between June 2008 and April 2014, 2330 THRs were performed by six different surgeons. Ninety-three (4.69%) patients underwent robotic-assisted THA anterior approach, 135 (6.8%) had robotic-assisted THA posterior approach, 942 (47.5%) patients underwent fluoroscopic guided THA anterior approach, 708 (35.7%) had THA without guidance using posterior approach, 43 (2.1%) patients underwent navigation-guided anterior approach and 59 (2.9%) patients underwent radiographic-guided posterior approach THAs (Figure 1).


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_5 | Pages 8 - 8
1 Feb 2016
Suarez-Ahedo C Gui C Martin T Stake C Chandrasekaran S Christopher J Domb B
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Background

Preservation of acetabular bone during primary total hip arthroplasty (THA) is important, because proper stability of cementless acetabular cup during primary THA depends largely on the amount of bone stock left after acetabular reaming. Eccentric or excessive acetabular reaming can cause soft tissue impingement, loosening, altered centre of rotation, bone-to-bone impingement, intra-operative periprosthetic fracture, and other complications. Furthermore, loss of bone stock during primary THA may adversely affect subsequent revision THA.

Questions/Purposes

The purpose of this study was to compare preservation of acetabular bone stock between conventional THA (CTHA) vs. robotic-guided THA (RGTHA). We hypothesised that RGTHA would allow more precise reaming, leading to use of smaller cups and greater preservation of bone stock.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_5 | Pages 2 - 2
1 Feb 2016
Domb B Redmond J Petrakos A Gui C Christopher J Lodhia P Suarez-Ahedo C
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Introduction

Lewinnek et al described a safe zone of acetabular component placement in Total Hip Arthroplasty (THA) to reduce complications. Callanan et al proposed a modified safe zone with a reduced range of acetabular inclination of 30–45 degrees to eliminate the steeper or more inclinated cups 2. This study compares the accuracy of cup placement in the safe zones described by Lewinnek et al and Callanan et al, leg length discrepancy (LLD) and global offset (GO) measurement in THA using five different surgical techniques performed by six different surgeons.

Methods

Between June 2008 and April 2014, 2330 THRs were performed by six different surgeons. Post-operative radiographic images were retrospectively reviewed and measured using TraumaCad® software to determine cup placement, LLD, and GOD.