How Reliable Is the Measurement of the Lateral Center Edge Angle on Scoliosis Radiographs for Detecting Acetabular Dysplasia?

PURPOSE: Hip dysplasia reportedly occurs in up to 12% of the general population and may be higher in patients with adolescent idiopathic scoliosis (AIS). When using lateral center edge angle (LCEA) measurements to help identify hip dysplasia, it is uncertain if this measurement can be performed reliably on scoliosis radiographs due to parallax. The purpose of this study is to evaluate the reliability of measuring LCEA on scoliosis radiographs compared with standard pelvis radiographs. METHODS: This study evaluated 40 hips on 20 patients (mean age 12.5 years ± 3.1; 50% Female) who received PA scoliosis radiographs and AP pelvis radiographs within 1 year of each other. Review was performed by 4 pediatric radiologists (2 general, 2 MSK), 2 pediatric orthopaedic surgeons, and 1 research fellow. Radiographic measurement of the LCEA for each hip was first performed on the scoliosis radiograph. After a minimum of 3 days, the LCEA was measured on a pelvis radiograph of the same individual obtained within 1 year of the scoliosis radiograph. Pearson coefficient was used to measure agreement between scoliosis and pelvis radiograph measurements. Intraclass correlation coefficient (ICC) was used to evaluate intraobserver and interobserver agreement. ICC values <0.5 were classified as poor reliability, 0.5 to 0.75 were classified moderate, 0.75 to 0.90 were classified good, and >0.9 indicated excellent reliability. RESULTS: The mean difference between scoliosis and pelvis radiographs was 54 ± 79 days. There was good-to-excellent interobserver agreement on LCEA measurements made between readers on scoliosis radiographs (ICC: 0.94, 95% CI: 0.90-0.96, P<0.001) and pelvis radiographs (ICC: 0.91, 95% CI: 0.83-0.95, P<0.001), and moderate-to-excellent intraobserver agreement for scoliosis radiographs (ICC range: 0.68 to 0.98; P<0.001) and pelvis radiographs (ICC range: 0.62 to 0.96; P<0.001). There was a strong correlation between LCEA measurements made on scoliosis and pelvis radiographs (r2=0.66, P<0.001), and the intermodality agreement between scoliosis and pelvis radiograph LCEA measurements were moderate to good (ICC range: 0.68 to 0.89, P<0.001). CONCLUSIONS: Overall, there was good-to-excellent agreement between readers on scoliosis and pelvis radiographs, respectively, and moderate-to-excellent intraobserver agreement between LCEA measurements made on scoliosis radiographs and pelvis radiographs, respectively. LCEA measurements made on scoliosis radiographs strongly correlated to the measurements made on pelvis radiographs, and the intermodality ICC was also considered moderate to good. Dedicated pelvis radiographs may not be necessary during scoliosis workup and follow-up surveillance, thereby decreasing radiation exposure, cost, and improving patient care workflow. LEVEL OF EVIDENCE: Level IV-diagnostic study.

A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty.

INTRODUCTION: This study aimed to develop a modified frailty index (MFI) to predict the risks of revision total hip arthroplasty (THA). METHODS: Data from the American College of Surgeons - National Surgical Quality Improvement Program were analyzed for patients who underwent revision THA from 2015 to 2020. An MFI was composed of the risk factors, including severe obesity (body mass index > 35), osteoporosis, non-independent function status prior to surgery, congestive heart failure within 30 days of surgery, hypoalbuminemia (serum albumin < 3.5), hypertension requiring medication, type 1 or type 2 diabetes, and a history of chronic obstructive pulmonary disease or pneumonia. The patients were assigned based on the MFI scores (MFI0, no risk factor; MFI1, 1-2 risk factors; MFI2, 3-4 risk factors; and MFI3, 5+ risk factors). Confidence intervals were set at 95% with a P value less than or equal to 0.05 considered statistically significant. RESULTS: A total of 17,868 patients (45% male, 55% female) were included and had an average age of 68.5 ± 11.5 years. Odds of any complication, when compared to MFI0, were 1.4 (95% CI [1.3, 1.6]) times greater for MFI1, 3.2 (95% CI [2.8, 3.6]) times greater for MFI2, and 10.8 (95% CI [5.8, 20.0]) times greater for MFI3 (P < 0.001). Odds of readmission, when compared to MFI0, were 1.4 (95% CI [1.3, 1.7]) times greater for MFI1, 2.5 (95% CI [2.1, 3.0]) times greater for MFI2, and 4.1 (95% CI [2.2, 7.8]) times greater for MFI3 (P < 0.001). CONCLUSION: Increasing MFI scores correlate with increased odds of complication and readmission in patients who have undergone revision THA. This MFI may be used to predict the risks after revision THA.

How Often Do Patients Presenting With Severe Adolescent Idiopathic Scoliosis Have Underlying Hip Dysplasia?

INTRODUCTION: Adolescent idiopathic scoliosis radiographic screening will often include the hips. The purpose of this study is to evaluate the prevalence of hip dysplasia by lateral center edge angle (LCEA) on scoliosis radiographs in patients presenting with severe range (>45 deg) idiopathic curves. METHODS: We reviewed 200 consecutive patients (400 hips) with idiopathic scoliosis with major coronal curves ≥45 degrees between October 2009 and October 2022. The presenting scoliosis radiograph PA were reviewed for the following variables: major coronal curve direction, coronal balance, and lateral center edge angles. An LCEA value ≤18 was considered dysplastic. To assess potential measurement variability related to parallax of the scoliosis radiographs, the intermodality intraclass correlation coefficient (ICC) was measured from a subset of 20 hip LCEA values from patients with both scoliosis and pelvis radiographs. RESULTS: A total of 200 patients [mean age: 13.6 (1.8) years; Female: 79%] were reviewed. The mean major curve (SD) was 58.6 degrees (11.4 deg). Overall 19% (37/200) patients or 11% (43/400) of hips had hip dysplasia. Of the dysplastic hips, 16% (6/43, P <0.001) were bilateral and 57% (21/43, P =0.04) were right sided. There was no association between dysplastic hip laterality and ipsilateral or contralateral coronal balance ( P =0.26) or curve direction ( P =0.49). The interobserver ICC for assessment of LCEA on scoliosis radiographs was 0.85, and the intermodality ICC between pelvic and scoliosis radiographs was 0.78. CONCLUSION: Hip dysplasia was present in 19% of patients presenting with large major curves, and many of these patients had right sided hip dysplasia. There was no association between hip dysplasia laterality and the patient's major curve direction or coronal balance. There was good intermodality reliability (ICC=0.78) between LCEA values in patients who had both scoliosis and pelvis radiographs, and good inter-rater reliability between raters. Radiographic interpretation of adolescent idiopathic scoliosis should focus not only on the description of the curve and ruling out underlying segmentation anomalies but should also include critical assessment of the hips to exclude co-existing hip dysplasia. LEVEL OF EVIDENCE: Therapeutic study-level IV.

Analyzing the quality and educational value of Achilles tendinopathy-related videos on TikTok.

BACKGROUND: Social media platforms, like TikTok, have become popular options for the consumption and distribution of healthcare information. Due to the lack of scientific oversight, the consistency of healthcare-related videos has become a focus of the current literature. However, orthopaedic surgery has lagged behind other specialties in acknowledging the widespread utilization of TikTok videos for medical information. This study aims to assess the quality and educational benefits of Achilles tendinopathy-related TikTok videos. METHODS: TikTok was queried using the hashtags "#achillestendonexercises", "achillestendonitisexercises", "achillestendinosisexercises", and "achillestendinopathyexercises". 100 videos (25 for each term) were included after applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content was graded using DISCERN (a well-validated informational analysis tool) and ATEES (a self-designed tool for exercise evaluation). RESULTS: The total number of views of the 100 videos was 1647,148, with a median of 7562.5 (IQR = 2,281- 19,575). The videos collectively received 73,765 likes, 1125 comments, 14,491 favorites and 6897 shares with a median of 283 (IQR= 73.8-957.8), 7 (IQR= 1.8-16.0), 61.5 (IQR= 8.8-184.3), and 18.5 (IQR= 2.0-49.8), respectively. General users uploaded slightly less (48%) when compared to healthcare professionals (52%). Healthcare professionals had more videos graded as "very poor" (43.4%) in comparison to the general users (36.2%). General users had more videos graded as "poor" (63.8%) in comparison to healthcare professionals (54.7%). However, there were no significant differences between the groups on either of the video grading scales. CONCLUSION: Although TikTok is a powerful tool for information distribution, the educational value of the videos related to Achilles tendinopathy exercises was poor. With only 1% of videos receiving a grade of 'fair,' and no videos reaching a score of 'good' or 'excellent', healthcare professionals should be aware of the high viewership of low-quality content easily accessible on TikTok.

Fracture through Pre-Existing Tarsal Coalition: A Narrative Review.

Tarsal coalitions are abnormal fibrous or bony connections between the tarsal bones of the foot. While not always symptomatic, coalitions can cause pain, alterations in forefoot and hindfoot morphology, and alterations in foot and ankle biomechanics. Previous research has described the association of tarsal coalitions with fractures of the lower extremity. Multiple reports of acute fracture in the presence of tarsal coalition have been presented, as have reports of stress fractures of the foot and ankle with concomitant coalition, insidious in onset and thought to be related to aberrancies in foot and ankle biomechanics. The purpose of this review is to discuss the biomechanics seen in tarsal coalitions and to describe reports of fracture occurring concomitantly with tarsal coalitions. We will discuss diagnostic options and treatment approaches in the setting of fracture with preexisting tarsal coalition.