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Porous tantalum augments are versatile tools in reconstructing complex acetabular defects during revision total hip arthroplasty (THA). This study examines the clinical and radiographic outcomes of porous tantalum augments placed in the type I (flying buttress) configuration at two to 17-year follow-up in the largest cohort to-date in the literature.We retrospectively analyzed 59 consecutive revision THAs involving the use of flying buttress augments between 2003 and 2018. The mean patient age and follow-up duration were 63.9 ± 11.6 years (range, 35-87) and 8 years (range, 2-17), respectively. The Oxford hip score was used to assess clinical outcome. The modified Moore classification was used to assess acetabular augment and shell osseointegration. Kaplan-Meier survival analysis with 95% confidence interval (CI) was used to assess implant survivorship.The mean Oxford hip score improved from 15.9 ± 6.2 preoperatively to 35.0 ± 6.5 at a mean follow-up of eight years (P.0001). Radiographic assessment using the modified Moore classification demonstrated five signs of osseointegration in 49 hips (83.1%), four signs in six hips (10.2%), three signs in one hip (1.7%), and one sign in one hip (1.7%). Kaplan-Meier analysis demonstrated ten-year survivorship of 88.9% (95% CI 74.4-95.4) with all-cause revision as end point and 94.3% (95% CI 83.1-98.2) with revision for acetabular aseptic loosening as end point.Treatment of superolateral acetabular defects during revision THA using porous tantalum augments placed in the type I (flying buttress) configuration provides excellent implant survivorship and favorable clinical outcomes at mid-term follow-up.Therapeutic Level IV.

Purpose To provide a comprehensive review of the current clinical and biomechanical evidence for the use of knotless suture anchors during arthroscopic Bankart repair. Methods A comprehensive search of 5 electronic databases from inception to July 2020 was performed for clinical and biomechanical studies in English evaluating outcomes following arthroscopic Bankart repair using knotless suture anchors. Two independent reviewers assessed articles for inclusion. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORs) criteria. Clinical outcomes of interest and key findings from biomechanical studies were summarized. Results Ten clinical studies (430 knotless repairs), including 4 cohort studies directly comparing knotless (N = 117) to knot-tying repairs (N = 192), were deemed eligible. Four biomechanical studies were also identified. Heterogeneity and the lack of randomized studies precluded data pooling and quantitative meta-analysis. Rates of redislocation ranged from 2.2% to 14.7% and 1.5% to 23.8% for knot-tying and knotless repair, respectively. Both knot-tying and knotless repair demonstrated excellent postoperative functional outcome, as assessed by visual analog scale, Constant-Murley, Rowe, and QuickDASH scores, with 80% to 94% of patients returning to sports participation. Biomechanical studies showed similar stiffness and load to failure between knot-tying and knotless repairs, with the most common mode of failure being retear at the suture–soft tissue interface. Conclusions Current level II to IV clinical and biomechanical evidence supports knotless arthroscopic Bankart repair as an effective procedure with excellent functional outcomes and low rates of complication and reoperation. Level of Evidence Level IV, systematic review of level II to IV studies.

Nonunion and proximal trochanteric migration is a known complication of trochanteric osteotomy. This study examines the effect of osteotomy length on proximal greater trochanter (GT) migration.We analyzed 113 modified trochanteric slide osteotomies and 73 extended trochanteric osteotomies performed between 2008 and 2016. All osteotomies were fixed using cerclage wires and had minimum 6-month radiographic follow-up. Spearman correlations were used to assess association between osteotomy length and GT migration distance. Chi-squared test and logistic regression were used to assess association between patient and surgical factors and GT migration1 cm. Receiver operating characteristic curves were constructed to determine the optimal cutoff osteotomy length for predicting GT migration1cm.Mean osteotomy length was 6.1 cm (range 3-12) for modified trochanteric slide osteotomies and 14.8 cm (range 8-23) for extended trochanteric osteotomies. Osteotomy length was negatively correlated (r = -0.340, P.001) with GT migration distance. Longer osteotomy length was protective against GT migration1 cm (odds ratio 0.67, P = .002). Receiver operating characteristic curve analysis demonstrated an optimal cutoff osteotomy length of 9.8 cm for predicting GT migration1 cm (sensitivity 0.971, specificity 0.461). Among osteotomies10 cm, those fixed using at least one distal wire below the lesser trochanter and vastus ridge demonstrated less mean GT migration (3.86 vs 7.12 mm, P = .009) and higher mean union rate (68.8% vs 31.2%, P.001).Osteotomies shorter than 10 cm are at higher risk of developing proximal GT migration1 cm. A distal cerclage wire below the lesser trochanter and vastus ridge may help decrease the amount of GT migration.Prognostic Level IV.

Youth and young adults who previously experienced foster care are prone to negative life events, such as physical injuries, and adverse childhood experiences (ACE), such as abuse, neglect, and household dysfunction. The purpose of the present study was to identify the prevalence of traumatic brain injury (TBI), ACE, and poor sustained attention and the associations of these events in this group of vulnerable persons. Participants completed standardized questionnaires on the prevalence of self-reported TBI (TBI) and ACE and performed the Sustained Attention to Response Task (SART) test to measure sustained attention. Chi-squared and Kruskal-Wallis rank-sum tests were used to assess demographic differences and associations between TBI and ACE. Sustained attention was assessed using analysis of variance and linear modeling. Seventy-one participants?46 youth and young adults who previously experienced foster care (vulnerable group) and 25 age-matched healthy controls?completed the standardized questionnaires. Analyses indicated that vulnerable participants reported markedly higher rates of TBI and ACE than healthy controls. Vulnerable persons with TBI reported significantly higher Total ACE scores (p?=?0.02), were more likely to have a history of family dysfunction (p?=?0.02), and were more likely to have lived with a mentally ill guardian (p?=?0.01) than vulnerable persons with no TBI. TBI was significantly associated with Total Errors (p?=?0.001 and p?=?0.02) and Omission Errors (p?0.001 and p?=?0.01) in all participants and in vulnerable participants, respectively, after adjusting for education level.

Patients with lumbar disc herniation may greatly benefit from microdiscectomy. Although spine surgeons performing microdiscectomy routinely obtain informed consent, the potential adverse events they disclose often vary. Moreover, little is known about what disclosures are deemed most valuable by patients. The aim of this mixed-methods study was to determine practice variations among spine surgeons in regard to the disclosure of potential adverse events during informed consent discussions for lumbar microdiscectomy and to determine which topics patients perceived to be valuable in the consent discussion.A survey evaluating the frequency with which spine surgeons disclose 15 potential adverse events related to lumbar microdiscectomy during informed consent discussions was distributed among Canadian Spine Society members. Additionally, semistructured interviews were conducted with preoperative patients, postoperative patients, attending spine surgeons, spine fellows and orthopedic residents. Interview transcripts were analyzed using thematic analysis with open coding.Fifty-one Canadian Spine Society members completed the survey. The number of potential adverse events not routinely discussed was greater among orthopedic surgeons than among neurosurgeons (relative risk 1.83; 95% confidence interval 1.22-2.73; p = 0.003). Three preoperative patients, 7 postoperative patients, 6 attending spine surgeons, 3 spine fellows and 5 orthopedic residents participated in the semistructured interviews. The interviews identified gaps in information provided to patients, particularly on topics relating to postoperative care such as expected recovery time, activity restrictions and need for a caregiver.There is variation in the disclosure of potential adverse events during informed consent discussions for lumbar microdiscectomy among Canadian spine surgeons. Patients desire more information regarding their postoperative care. Further research should focus on developing guidelines to reduce practice variation and optimize the effectiveness of consent discussions.Les patients atteints d’une hernie discale lombaire pourraient profiter grandement d’une microdiscectomie. Bien que les chirurgiens spécialistes de la colonne vertébrale réalisant des microdiscectomies obtiennent toujours le consentement éclairé du patient, les événements indésirables potentiels présentés varient souvent. De plus, on en connaît peu sur les informations les plus importantes du point de vue des patients. L’objectif de cette étude à méthodes mixtes était de déterminer les différentes pratiques des chirurgiens en ce qui a trait à la présentation des événements indésirables potentiels pendant les discussions sur le consentement éclairé pour les microdiscectomies lombaires et de déterminer les sujets les plus importants pour les patients pendant ces discussions.Un sondage sur la fréquence à laquelle les chirurgiens présentent 15 événements indésirables potentiels associés à la microdiscectomie lombaire pendant les discussions sur le consentement éclairé a été distribué aux membres de la Société canadienne du rachis. De plus, des entretiens semi-dirigés ont été réalisés auprès de patients en période préopératoire, de patients en période postopératoire, de chirurgiens spécialistes de la colonne vertébrale, de fellows en chirurgie spinale et de résidents en chirurgie orthopédique. Des analyses thématiques utilisant un code ouvert ont été réalisées sur les transcriptions des entretiens.Cinquante-et-un membres de la Société canadienne du rachis ont répondu au sondage. Le nombre d’événements indésirables potentiels non systématiquement mentionnés était plus élevé chez les chirurgiens orthopédiques que chez les neurochirurgiens (risque relatif 1,83; intervalle de confiance de 95 % 1,22–2,73; p = 0,003). Dans les entretiens semi-dirigés, on a recueilli les commentaires de 3 patients en période préopératoire, de 7 patients en période postopératoire, de 6 chirurgiens spécialistes de la colonne vertébrale, de 3 fellows en chirurgie spinale et de 5 résidents en chirurgie orthopédique. Les entretiens ont révélé des lacunes dans l’information transmise aux patients, particulièrement sur les soins postopératoires, comme le temps de récupération attendu, les restrictions quant aux activités et la nécessité d’un soignant.On a trouvé une variation dans la présentation des événements indésirables potentiels pendant les discussions sur le consentement éclairé pour les microdiscectomies lombaires chez les chirurgiens spécialistes de la colonne vertébrale au Canada. Les patients veulent en savoir plus sur les soins postopératoires. Des lignes directrices devraient être établies pour réduire les différences entre les pratiques et optimiser l’efficacité des discussions sur le consentement.

Controversy remains over the surgical management of large osteochondral lesions of the femoral head in young, active patients. The purpose of this study is to assess midterm clinical and radiographic outcomes after fresh osteochondral allograft transplantation (OAT) for large femoral head lesions at minimum 2-year follow-up.A retrospective review of prospectively collected data was performed for 22 patients under the age of 50 years with defined femoral head osteochondral lesions who underwent fresh OAT between 2008 and 2015. Patients were assessed clinically using the modified Harris Hip Score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and KellgrenLawrence Grade for osteoarthritis severity. Complications and reoperation were assessed by chart review. Kaplan-Meier survivorship analyses with 95% confidence intervals were performed for the end point of conversion to total hip arthroplasty.At a mean follow-up of 68.8 months (26-113), the mean mHHS improved significantly (P.001) from 48.9 (19-84) to 77.4 (35-98). Sixteen of 22 patients (72.7%) had an mHHS ≥70 at the latest follow-up. Arthritic progression, as indicated by an increase in the KellgrenLawrence Grade, occurred in 4 of 22 hips (18.2%). Five patients (22.7%) underwent conversion to total hip arthroplasty. Graft survivorship was 86.4 ± 7.3% at 2 years, 78.5 ± 10.0% at 5 years, and 67.3 ± 13.5% at 9 years.Fresh OAT may be a viable treatment option for osteochondral defects of the femoral head in young, active patients with minimal preexisting joint deformity.

BACKGROUND The indications and technique for the transtrochanteric approach to the hip have evolved greatly since its initial popularization in the 1960s. The purpose of this systematic review was to assess current uses of this approach on the basis of indications, osteotomy technique, trochanteric fixation method, complications, and functional outcome. METHODS A comprehensive search of MEDLINE and Embase databases from January 2000 to July 2017 was performed in accordance with the PRISMA guidelines. Articles were divided into 3 major categories on the basis of the type of hip surgery performed: (1) primary arthroplasty, (2) revision arthroplasty, and (3) joint-preserving procedures. Patient data were then analyzed according to these 3 categories. RESULTS Seventy-six studies (5,028 hips), mainly of Level-IV evidence, were included. Four types of osteotomy were reported for a variety of indications. Rates of nonunion were 6.0% (303 of 5,028) across all studies, 4.2% (39 of 921) for primary arthroplasty, 6.7% (114 of 1,690) for revision arthroplasty, and 4.4% (56 of 1,278) for joint-preserving procedures. Rates of dislocation were 1.5% (14 of 921) for primary arthroplasty and 4.6% (77 of 1,690) for revision arthroplasty. The rate of osteonecrosis after joint-preserving procedures was 1.1% (14 of 1,278). Rates of deep infection were 1.1% (55 of 5,028) across all studies, 0.1% (1 of 921) for primary arthroplasty, 2.1% (36 of 1,690) for revision arthroplasty, and 0.6% (8 of 1,278) for joint-preserving procedures. CONCLUSIONS The transtrochanteric approach remains useful in cases requiring extensile exposure of the acetabulum or femoral medullary canal. However, trochanteric complications continue to pose a clinical challenge. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background The optimal system for greater trochanteric fixation following osteotomy or fracture remains unknown. This systematic review aims to synthesize the available English-language literature on 5 commonly reported trochanteric fixation methods to quantify and compare rates of complications and reoperation. Methods A comprehensive search of MEDLINE and Embase databases from January 1946 to June 2017 was performed for articles in English describing fixation of trochanteric osteotomies and fractures using wires, cables, cable-plate devices, claw or locking plates, and trochanteric bolts. Pooled mean rates of complications and reoperation with 95% confidence intervals (CIs) were analyzed using a random-effects model. Results Fifty-seven studies involving 10,956 hips were eligible for inclusion. Five studies had Level-III evidence and 52 had Level-IV evidence. The pooled mean rate of nonunion was 4.17% (95% CI, 3.21% to 5.13%; I = 79%) for wires, 5.07% (95% CI, 0.37% to 9.77%; I = 74%) for cables, 16.11% (95% CI, 10.85% to 21.37%; I = 89%) for cable-plate systems, 9.60% (95% CI, 2.23% to 16.97%; I = 59%) for claw or locking plates, and 12.42% (95% CI, 3.41% to 21.43%; I = 75%) for trochanteric bolts. Substantial heterogeneity in the data precluded formal statistical comparison of outcomes and complications between implants. Conclusions Available literature on the various trochanteric fixation implants is heterogeneous and consists primarily of retrospective case series. Based on the current literature, it is difficult to support the use of one implant over another. Despite superior mechanical properties, rates of complication and reoperation following cable-plate fixation remains suboptimal, especially in complex revision scenarios. Additional rigorous prospective randomized and cohort studies are needed to make definitive recommendations regarding the most reliable method of trochanteric fixation. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.