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Background: Positive deviance (PD) seminars, which have shown excellent results in improving the quality of surgical practices, use individual performance feedback to identify team members who outperform their peers; the strategies from those with exemplary performance are used to improve team members' practices. Our study aimed to use the PD approach with arthroplasty surgeons and nurses to identify multidisciplinary strategies and recommendations to improve operating room (OR) efficiency. Methods: We recruited 5 surgeons who performed high-volume primary arthroplasty and had participated in 4-joint rooms since 2012, and 29 nurses who had participated in 4-joint rooms and in at least 16 cases in our data set. Three 1-hour PD sessions were held in February and March 2021: 1 with surgeons, 1 with nurses, and 1 with both surgeons and nurses to select recommendations for implementation. The sessions were led by a member of the nonorthopedic surgical faculty who was familiar with the subjects discussed and with PD seminars. To determine the success of the recommendations, we compared OR efficiency before and after implementation. We defined success as performance of 4 joint procedures within 8 hours. Results: Eleven recommendations were recorded from the session with nurses and 7 from the session with surgeons, of which 11 were selected for implementation. During the month after implementation, there were great improvements across all time intervals of surgical procedures, with the greatest improvements seen in mean anesthesia preparation time in the room (4.51 min [26.3%]), mean procedure duration (9.75 min [14.0%]) and mean anesthesia finish time (5.78 min [44.0%]) (allp < 0.001). The total time saved per day was 49.84 minutes; this led to a success rate of 69.0%, a relative increase of 73.8% from our 2012-2020 success rate of 39.7% (p < 0.001). Conclusion: The recommendations and increased motivation owing to the individualized feedback reduced time spent per case, allowing more days to finish on time. Positive deviance seminars offer an inexpensive, efficient and collegial means for process improvement in the OR. Contexte : Les séminaires de déviance positive (DP), une approche qui a déjdonné d'excellents résultats en termes d'amélioration de la qualité des pratiques chirurgicales, recourent à la rétroaction sur le rendement individuel pour identifier les membres des équipes dont le rendement excède celui de leurs pairs; les stratégies associées à tout rendement exemplaire servent à améliorer les pratiques des membres des équipes. Notre étude visait à utiliser la DP comme approche pour les chirurgiennes et chirurgiens et le personnel infirmier spécialisés en arthroplastie afin d'identifier des stratégies et des recommandations multidisciplinaires pour améliorer l'efficience des blocs opératoires (BO). Méthodes : Nous avons recruté 5 spécialistes dont le volume d'interventions pour arthroplastie primaire était élevé et qui oeuvraient dans des blocs à 4 interventions chirurgicales depuis 2012, et 29 membres du personnel infirmier ayant participé à la même cadence d'interventions et à au moins 16 cas de notre ensemble de données. Trois séances d'une heure ont eu lieu en février et mars 2021 : 1 avec les chirurgiens, 1 avec le personnel infirmier et 1 avec les 2 équipes pour choisir les recommandations à mettre en oeuvre. Les séances étaient animées par un membre de la Faculté de chirurgie (non orthopédique) qui connaissait les sujets abordés et les séminaires de DP. Pour déterminer la réussite des recommandations, nous avons comparé l'efficience des BO avant et après leur mise en oeuvre. La réussite se définissait par la réalisation de 4 arthroplasties en 8 heures. Résultats : Onze recommandations ont été dégagées de la séance avec le personnel infirmier et 7 de la séance avec les chirurgiennes et chirurgiens; 11 ont été retenues en vue de leur application. Durant le mois suivant leur mise en oeuvre, la durée des interventions s'est grandement améliorée; les améliorations les plus marquantes concernaient la durée moyenne de la préparation de l'anesthésie au bloc opératoire (4,51 min [26,3 %]), la durée moyenne des interventions (9,75 min [14,0 %]) et le temps de réveil moyen (5,78 min [44,0 %]) (tous p < 0,001). Le temps total gagné quotidiennement a été de 49,84 min; le taux de réussite a donc été évalué à 69,0 %, correspondant à une augmentation relative de 73,8 % par rapport à notre taux de réussite en 2012-2020 de 39,7 % (p < 0,001). Conclusion : Les recommandations et la motivation accrue découlant de l'exercice de rétroaction individualisée a réduit le temps requis pour chaque cas et a permis de terminer plus de journées à temps. Les séminaires de DP sont une façon peu coûteuse, efficiente et collégiale d'améliorer les procédés au bloc opératoire., Delivery of health care is coming to an inflection point in regard to supply and demand, with joint replacement demand in Canada increasing from 2014 to 2019 by 20.1% for [...]

The association between preoperative pain catastrophizing and postoperative patient-reported outcome measures of patients with pre-arthritic hip disease was evaluated. All patients scheduled for joint-preserving surgeries of the hip (JPSH) at our institution were approached. Patient demographics (age, sex, body mass index (BMI)), pain intensity (Numeric Pain Scale (NPS)) and pain catastrophizing (Pain Catastrophizing Scale (PCS)) were collected preoperatively. Patient function (12-Item International Hip Outcome Tool (iHot-12)) and physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS-10) mental/physical) were collected preoperatively, three-month and one-year postoperatively. The analysis consisted of multivariate linear regression models fitted for continuous scores of outcome measures at three-month and one-year. Correlation between preoperative PCS and iHot-12 was assessed using the Pearson correlation coefficient. A total of 274 patients completed the PCS and were included in the multivariate linear regression models. Most patients were females (66.8%), mean age was 33 (SD 9), mean BMI was 26.5 (SD 5.8) and most were diagnosed with femoro-acetabular impingement (46.0%) and underwent arthroscopy (77.0%). There were statistically significant correlations between PCS and iHot-12 (preoperatively −0.615, P  < 0.001; three-month −0.242, P  = 0.002). Statistically significant associations were found for function (three-month PCS P  = 0.046, age P  = 0.014, NPS P  = 0.043; one-year BMI P  = 0.005, NPS P  = 0.014), physical health (three-month BMI, P  = 0.002, NPS P  = 0.008; one-year BMI P  = 0.002, NPS P  = 0.013) and mental health (three-month BMI P  = 0.047; one-year BMI P  = 0.030). There is an association between function and preoperative pain catastrophizing in patients with pre-arthritic hip disease undergoing JPSH. When considering confounding variables, preoperative pain catastrophizing is associated with short-term recovery. [ABSTRACT FROM AUTHOR]

Background: The Hueter-Anterior Approach (HAA) with its limited soft tissue and internervous dissection has been shown to be an effective approach for primary total hip and hip resurfacing arthroplasty (HRA). The purpose of this study is to evaluate the clinical outcome of patients requiring revision of HRA to total hip replacement using the HAA, assessing function and complications. Methods: We performed a retrospective review of a prospectively maintained research database. Between 2006 and 2015, 555 primary metal-on-metal (MoM) HRAs were performed via the HAA; we identified 33 hips in 30 patients that required revisions for aseptic causes to THA: aseptic loosening of acetabulum in 12 and femoral in 7, 10 for pseudotumour/ALTR, 4 for femoral neck fracture. All revision surgeries were performed through a HAA by a single surgeon who had also performed the index operation. PROMs were collected preoperatively and yearly at various timepoints postoperatively. Results: The mean age at time of revision was 48.9 years (±5.3 SD) for 22 males (67%) and 11 females (33%). The mean time to revision surgery/failure of hip resurfacing was 3.3 years (±2.4 SD). There were 5 major reoperations with 3 infections, 1 acetabular loosening and 1 trunnionosis. There were significant improvements in multiple PROMs. Conclusions: The HAA is a viable surgical approach for revision of HRA with smaller initial HRA acetabular components generally requiring a relatively larger acetabular compoent at time of revision. Patients reported improvement in symptoms and function and a lower risk of subsequent reoperation than what has previously been reported for failed MoM bearings. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to: (1) describe perioperative complications amongst patients who underwent primary total hip arthroplasty (THA) using a short cementless, titanium, flat, tapered stem; (2) estimate this stem's early- to mid-term survival; (3) identify factors associated with revision arthroplasty; and (4) describe femoral remodelling at minimum 6 years postoperatively. Methods: A retrospective review of consecutive patients who underwent THA using a Taperloc Microplasty stem (Zimmer-Biomet, Warsaw, Indiana, USA) with minimum 2-year follow-up was performed. Surgeries were performed by 1 of 6, non-designer, arthroplasty surgeons between 2014 and 2018. Outcomes included perioperative complications including revision arthroplasty, and survival. Cox analysis was used to analyse the effect of different factors on risk of revision arthroplasty. Radiographs with 6-year follow-up served to describe femoral remodelling. Results: In 1205 patients, followed for 5.1 ± 1.4 years, the incidence of perioperative complication was 5.2% for which 29 patients (2.4%) required revision arthroplasty. The 5- and 7-year survival rates were 97.8% (95% CI, 96.9–98.5) and 97.0% (95% CI, 95.6–98.0), respectively. The only factor associated with revision arthroplasty was proximal femur morphology, as per Dorr classification (HR 1.24 [95%CI, 1.09–1.41]; p = 0.005). During radiographic assessment, 12% of patients showed ⩾25% of relative change in cortical thickness in Gruen zones 3 or 5. We observed calcar remodelling in 50% of radiographs while 10% showed presence of a pedestal sign. Conclusions: The 7-year survivorship of the Taperloc Microplasty stem is within National Institute for Health and Care Excellence (NICE) guidelines. Patients ⩽65 years with osteoarthritis and Dorr A/B femoral morphology may be ideal candidates for THA with this stem. Femoral remodelling is common and not associated with adverse outcome. [ABSTRACT FROM AUTHOR]