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Femoral nerve palsy is a rare but devastating complication of anterior total hip arthroplasty. Its etiology is still unknown, but several studies have suggested that anterior acetabular retractors may place the femoral nerve at increased risk. This study hypothesized that hip extension and traction places tension on the femoral nerve, offering an additional explanation for the development of femoral nerve palsy. A spring device was secured across 6 transected femoral nerves from 5 lower extremity cadavers and the hip was extended and pulled into traction with and without retractor placement. The change in spring length was used to determine femoral nerve tension. The average spring length changed +8.83 mm with hip extension, +3.73 mm with traction, -0.7 mm with traction and placement of the anterior acetabular retractor, and -1.15 mm with extension and placement of the femoral retractor. Femoral nerve tension was greatest with hip extension followed by traction. Acetabular and femoral retractor placement decreased average femoral nerve tension in both traction and hip extension. This may be due to medialization of the femoral nerve by the retractors, reducing the overall distance traveled, and thereby reducing tension. Previous studies have found femoral nerve pressure to be greatest during anterior acetabular retractor placement. It is likely that both pressure and tension contribute to femoral nerve palsy. Careful retractor placement, staying safely on anterior acetabular bone, and efficient femoral preparation to decrease time under hip extension and traction may help to minimize the risk of femoral nerve palsy., (©Copyright 2022 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Total hip arthroplasty (THA) is a common orthopedic procedure which has been growing in popularity with the elderly population. With more surgeons completing anterior THAs, intraoperative radiographs have become commonplace. Unfortunately, there is a lack of education in regard to obtaining, optimizing, and interpreting these radiographs. The purpose of this study was to develop and test the efficacy of an online learning tool that medical students, residents, and C-arm technicians could use to improve their understanding of THA radiography. The learning tool taught users how to obtain an optimal AP pelvis radiograph and how to interpret radiographs so THA components could be placed in their optimal position. This learning tool was sent to medical students, orthopedic surgery residents, and C-arm technicians along with a pre-test, post-test, and feedback survey. Twenty users (eleven medical students and nine orthopedic surgery residents) completed the learning tool. Post-test scores (M=96.4%, SD=2.9%) were significantly greater than pre-test scores (M=68.3%, SD=23.9%) for all users (t=5.5069, P<.0001). The user's level of training was positively correlated with pre-test scores. Surveys from the users revealed that the learning tool provided significant learning opportunities, was relatively easy to understand, but was slightly too long. Users felt that this learning tool would be best suited for senior medical students, junior orthopedic surgery residents, and C-arm technicians. With the positive results of this study, the authors hope to further develop this learning tool for widespread adoption and to develop similar learning tools in the future., (©Copyright 2022 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

»: Surfing is safe: the risk of injury ranges from 0.26 to 0.90 injuries per surfer per year, 0.06 to 3.5 injuries per 1,000 days of surfing, and 1.1 to 13.0 injuries per 1,000 hours of surfing., »: The most common acute surfing injuries are lacerations, contusions, and sprains; the head and the neck as well as the lower extremities are the locations that are affected most., »: The most common mechanism of injury is striking a surfer's own board or that of another surfer., »: A pathology that is unique to surfers is surfer's myelopathy; bites and/or stings by sea life and infections caused by marine life also occur in surfers., Competing Interests: Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A676)., (Copyright © 2021 Written work prepared by employees of the Federal Government as part of their official duties is, under the United States Copyright Act, a ‘work of the United States Government’ for which copyright protection under that Act is not available. As such, copyright protection does not extend to the contributions of employees of the Federal Government prepared as part of their employment.)

Understanding the impact of pathologic spinopelvic mobility on total hip arthroplasty instability requires an appreciation of the dynamic interplay between and the spine, hip and pelvis. This complex interdependent relationship changes with position, pathology and surgical intervention. Spinal pathology may prevent normal dynamic motion leading to spinopelvic stiffness and abnormal pelvic position. Patients at high risk for pathologic spinopelvic motion and subsequent total hip arthroplasty (THA) dislocation should be assessed with a functional imaging series with lateral standing, sitting and AP standing radiographs. Common patterns of stiffness and imbalance as well as proposed surgical treatment algorithms are presented and discussed in this review., Competing Interests: None of the authors identify any conflicts of interest., (©Copyright 2019 by University Health Partners of Hawai‘i (UHP Hawai‘i).)