Results of the learning curve for interventional hip arthroscopy: a prospective study.

This prospective study aims to explore hip arthroscopy, outcome and the effect of the learning curve. Using the non-arthritic hip score preoperatively and postoperatively in 120 patients with an average 23-month follow-up, a median improvement of 16 points was seen at 6 months (p < 0.0001, Wilcoxon's signed ranks) remaining at 2 years (15, p < 0.05). Dividing patients into consecutive chronological groups of 40, the learning curve was explored. At six-months scores improved by 12 (p < 0.05) in first 40, 15 (p < 0.0001) in second and 20 (p < 0.0001) in third. A reduction in THR (22.5%, 5%, 2.5%) and revision rates (10%, 7.5%, 0) was seen. An increase in cumulative percentage satisfaction (defined as minimum 10 points increase) was seen from 20th (45%) to 100th procedure (65%). Results significantly improve as experience increases, possibly due to improved surgical skill, preoperative workup or improved understanding of operative indications.

Magnetic resonance arthrography for labral tears and chondral wear in femoroacetabular impingement.

Magnetic resonance arthrography (MRA) is a useful pre-operative investigation for patients with clinical signs and symptoms of femoroacetabular impingement. Our aim was to assess the diagnostic accuracy of MRA in detecting labral tears and chondral wear in this context. Sixty nine hips were included in the study after exclusions. All patients underwent pre-operative MRA and then subsequent hip arthroscopy. The findings at MRA were compared to those found intraoperatively. For labral tears, sensitivity, specificity and accuracy were 81%, 51% and 58% respectively. For chondral wear these figures were 17%, 100%, and 55% respectively. In our institution, MRA was therefore not as accurate as previously published work suggests.

A 14-year longitudinal comparison study of two treatment methods in clubfoot: Ponseti versus traditional.

The optimal management of idiopathic clubfoot has changed over three decades. Recently there has been an enthusiastic embracing of the Ponseti technique with a move away from the traditional stretch and strap technique. The purpose of this 14-year comparative prospective longitudinal study was to directly assess the differences in results between these two treatment methods. Over the period of this study there were 52,514 births in the local population and all newborns with clubfoot were referred directly to the paediatric orthopaedic surgeon. Patient demographics, the Harrold & Walker Classification, and associated risk factors for clubfoot were collected prospectively and analyzed. If conservative treatment failed to correct the deformity adequately, a radical subtalar release (RSR) was undertaken (the primary outcome measure of the study). There were 114 feet (80 patients): 64 feet treated 'traditionally' and 50 feet with the Ponseti technique. Idiopathic clubfoot was present in 76.25% of patients. Mean time to RSR was 333 and 44.1 weeks for the traditional and Ponseti groups respectively. In the traditional group 65.6% (CI: 53.4 to 76.1%) of feet underwent RSR surgery compared to 25.5% (CI : 15.8 to 383%) in the Ponseti group. When idiopathic clubfoot alone was analysed, these rates reduce to 56.5% (CI: 423 to 69.8%) and 15.8% (CI: 7.4 to 30.4%) respectively. The Relative Risk of requiring RSR in traditional compared to Ponseti groups was 2.58 (CI: 1.59 to 4.19) for all patients and 3.58 (CI: 1.65 to 7.78) for idiopathic clubfoot. Introduction of the Ponseti technique into our institution significantly reduced the need for RSR in fixed clubfoot.

The accuracy of computer-assisted percutaneous iliosacral screw placement.

The benchmark fluoroscopic technique of iliosacral screw insertion is disadvantaged by its reliance on ionizing radiation and presentation of dynamic information in only one plane. Multiplane targeting requires interpolation, which may be associated with inherent errors. Computer-assisted surgery enables surgeons to monitor their screw trajectory in 3-D space. The clinical application of computer-assisted surgery requires validation of its accuracy when tested against a benchmark technique. We simulated surgical implantation of cannulated screws in 10 embalmed human cadavers. Two specimens had sacral dysplasia. We inserted 20 screws into the S1 body, the left side by the benchmark fluoroscopic technique and the right side by a fluoroscopically registered computer-assisted surgery technique. All specimens were intact with no simulated injuries. A postoperative high-definition computed tomography scan showed the screw track. The actual track was compared with the intended screw track by a graphical technique. There was no deviation from the intended screw path in any of the simulated screw paths. With both techniques, two of the 10 tracks penetrated the sacral cortex in dysplastic pelvices. A fluoroscopic computer-assisted surgery technique appears as accurate as the standard fluoroscopic technique but no more so. Caution is recommended in dysplastic pelvices.