Camdon Fary | University of Melbourne (original) (raw)
Papers by Camdon Fary
Praxis, Apr 1, 2012
© 2012 Verlag Hans Huber, Hogrefe AG, Bern DOI 10.1024/1661-8157/a000940 Die Verwendung von Metal... more © 2012 Verlag Hans Huber, Hogrefe AG, Bern DOI 10.1024/1661-8157/a000940 Die Verwendung von Metallgleitlagern für den Hüftgelenkund Oberflächenersatz führt bei vielen Patienten zu unerwünschtenReaktionen auf Metallabrieb. Dieser Artikel befasst sich mit der Beurteilung und Behandlung von Patienten mit einer Metall/MetallTotalendoprothese der Hüfte, die mit potenziellemGelenkversagenvorstellig werden. Als im Jahr 2005 viel versprechende Fünf-Jahres-Ergebnisse für den Hüftgelenkersatz mit Grosskopfprothese und Metall/Metall-Gleitpaarung [1] veröffentlicht wurden, stieg die Zahl der Chirurgen, die diesen Eingriff durchführten, zügig an, und auch immer mehr Endoprothesenhersteller brachten eigeneOberflächenersatzmodelle auf denMarkt.Dabei wurden unerwünschte Reaktionen auf den Metallabrieb weder erwartet noch vorhergesehen. Mittlerweile sind im Rahmen endoprothetischer Ersatzoperationen an der Hüfte – von denen die meisten Oberflächenersatz-Eingriffe waren – weltweit mehr als 250 000Metall/Metall-Grosskopfprothesen implantiert worden [2]. Inzwischen verzeichnen dasNationale Britische und das Nationale Australische Gelenkregister einen statistisch signifikanten Anstieg der Revisionsraten bei bestimmten Metall/Metall-Totalprothesen imVergleich zu den konventionellen Metall/Kunststoff-Totalprothesen [3–5]. Unerwünschte Reaktionen des Weichteilgewebes auf Partikel, die aus den Metallimplantaten freigesetzt werden (Metallabrieb), können zu vorzeitigem Prothesenversagen führen und eine chirurgische Revision erforderlich machen. Diese unerwünschten Reaktionen auf einen solchen Metallabrieb können zwar mit nur geringfügigen Symptomen einhergehen, lokal jedoch auch hochdestruktive Läsionen hervorrufen, sodass der revisionschirurgische Eingriff sehr anspruchsvoll sein kann. Kürzlich erfolgte international der Rückruf einer bestimmten Metall/MetallProthese, der zu einer kritischen Auseinandersetzung mit der Evaluation, Einführung und Zulassung neuer Medizinprodukte Anlass gegeben hat (BMJ 2011; 342: d2905). Allerdings kann es durchaus sein, dass sich etliche Patienten mit Prothesenversagenmit stummenoder symptomatischen unerwünschten Reaktionen auf die Prothesen ihremArzt noch gar nicht vorgestellt haben, weshalb die Inzidenz fehlgeschlagener Metall/MetallHüftgelenkoperationen wahrscheinlich noch anwachsen wird und zu einer relevanten gesundheitlichen wie auch ökonomischen Belastung für Patienten bzw. Gesundheitsbehörden werden kann. Im vorliegenden Beitrag befassen wir uns mit der Beurteilung und Behandlung aller Patienten mit Metall/MetallHüfttotalendoprothesen, die mit potenziellemGelenkversagen vorstellig werden, und beziehen uns dabei auf neuere Leitlinien, auf die Evidenz in der Literatur (die sich auf Fall-Kontroll-, Kohortenund Fallstudien beschränkt) sowie unsere eigenen Erfahrungen. Was versteht man unter einer Metall/Metall-Hüftendoprothese?
International Orthopaedics, May 11, 2020
Purpose Cup positioning is important for optimum hip stability, avoiding component impingement an... more Purpose Cup positioning is important for optimum hip stability, avoiding component impingement and decreasing both bearing surface wear and revision rate. Transitioning from posterior approach in a lateral position to direct anterior approach (DAA) in a supine presents unique challenges for surgeons. The aim of this study was to examine the learning curve when using standard instrumentation that was not specific to DAA. Methods A consecutive retrospective series of 537 total hip arthroplasty by DAA from May 2013 to December 2017. Cup positioning was analysed on radiographs and classified whether inside or outside two safe zones (inclination 30-50°and anteversion 10-30°). The demographic data (age, BMI, gender, neck shaft angle (NSA)), surgeon's dominant side and experience were assessed as risk factors. Results Eighty per cent of cups (n = 426) were in the combined safe zones. Eighty-eight per cent (n = 470) were in appropriate anteversion and 87% (n = 463) abduction. Two factors that were significant were identified: Cups of left hips operated by righthanded surgeons were more anteverted (OR = 4.06) and more vertical (OR = 2.23); females had a higher anteversion of the cup (OR = 2.42). Obesity, age and NSA were not risk factors for cup malposition. There was a spike of cups too horizontal at the beginning of the experience (OR = 3.86), and no learning curve was observed in the other orientations. Conclusion With our DAA technique using standard instrumentation, there were no risk factors linked to the patient identified for cup malposition. DAA-specific instrumentation is not required to achieve optimum positioning of the cup. Surgeon has to be aware of an excess of abduction at the beginning of his experience and an excess of anteversion and adduction when performing THA on the opposite side of his dominant hand.
SICOT-J, 2020
Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques ... more Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee's learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.
Orthopaedic Proceedings, Feb 1, 2023
Advances in algorithms developed with sensor data from smart phones demonstrates the capacity to ... more Advances in algorithms developed with sensor data from smart phones demonstrates the capacity to passively collect qualitative gait metrics. The purpose of this feasibility study was to assess the recovery of these metrics following joint reconstruction. A secondary data analysis of an ethics approved global, multicenter, prospective longitudinal study evaluating gait quality data before and after primary total knee arthroplasty (TKA, n=476), partial knee arthroplasty (PKA, n=139), and total hip arthroplasty (THA, n=395). A minimum 24 week follow-up was required (mean 45±12, range 24 - 78). Gait bouts and gait quality metrics (walking speed, step length, timing asymmetry, and double support percentage) were collected from a standardized smartphone operating system. Pre- and post-operative values were compared using paired-samples t-tests (p<0.05).A total of 595 females and 415 males with a mean age of 61.9±9.3 years and mean BMI of 30.2±6.1 kg/m2 were reviewed. Walking speeds were lowest at post-operative week two (all, p<.001). Speeds exceeded pre-operative means consistently by week 21 (p=0.015) for PKA, and week 13 (p=0.007) for THA. The average weekly step length was lowest in post-operative week two (all, p<0.001). PKA and THA cases achieved pre-operative step lengths by week seven (p=0.064) and week 9 (p=0.081), respectively. The average weekly gait asymmetry peaked at week two post-operatively (all, p <0.001). Return to pre-operative baseline asymmetry was achieved by week 11 (p=0.371) for TKA, week six (p=0.541) for PKA, and week eight (p=.886) for THA. Double limb support percentages peaked at week two (all, p<0.001) and returned to pre-operative levels by week 24 (p=0.089) for TKA, week 12 (p=0.156) for PKA, and week 10 (p=0.143) for THA.Monitoring gait quality in real-world settings following joint reconstruction using smartphones is feasible, and may provide the advantage of removing the Hawthorne effect related to typical gait assessments and in-clinic observations.
Sensors
Gait quality parameters have been used to measure recovery from total hip arthroplasty (THA) but ... more Gait quality parameters have been used to measure recovery from total hip arthroplasty (THA) but are time-intensive and previously could only be performed in a lab. Smartphone sensor data and algorithmic advances presently allow for the passive collection of qualitative gait metrics. The purpose of this prospective study was to observe the recovery of physical function following THA by assessing passively collected pre- and post-operative gait quality metrics. This was a multicenter, prospective cohort study. From six weeks pre-operative through to a minimum 24 weeks post-operative, 612 patients used a digital care management application that collected gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-sample t-test. Recovery was defined as the post-operative week when the respective gait metric was no longer statistically inferior to the pre-operative value. To cont...
Orthopaedic Proceedings, Feb 1, 2023
Knee, Mar 1, 2011
We present a case of chronic disruption of the patellar tendon in a patient with Osteogenesis Imp... more We present a case of chronic disruption of the patellar tendon in a patient with Osteogenesis Imperfecta. This patient was treated with a customized extensor mechanism allograft. Results were excellent at 5 years follow up. To our knowledge this treatment has not previously been published in this situation. We present this as a reliable treatment option.
Sensors
Advances in algorithms developed from sensor-based technology data allow for the passive collecti... more Advances in algorithms developed from sensor-based technology data allow for the passive collection of qualitative gait metrics beyond step counts. The purpose of this study was to evaluate pre- and post-operative gait quality data to assess recovery following primary total knee arthroplasty. This was a multicenter, prospective cohort study. From 6 weeks pre-operative through to 24 weeks post-operative, 686 patients used a digital care management application to collect gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-samples t-test. Recovery was operationally defined as when the respective weekly average gait metric was no longer statistically different than pre-operative. Walking speed and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-operative (p < 0.0001). Walking speed recovered at 21 weeks (1.00 m...
The American Journal of Sports Medicine
Background:Although randomized controlled trials comparing hip arthroscopy with physical therapy ... more Background:Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life.Purpose:To explore potential moderators, mediators, and prognostic indicators of the effect of hip arthroscopy and physical therapy on change in 33-item international Hip Outcome Tool (iHOT-33) score for FAI syndrome.Study Design:Cohort study; Level of evidence, 2.Methods:Overall, 99 participants were recruited from the clinics of orthopaedic surgeons and randomly allocated to treatment with hip arthroscopy or physical therapy. Change in iHOT-33 score from baseline to 12 months was the dependent outcome for analyses of moderators, mediators, and prognostic indicators. Variables investigated as potential moderators/prognostic indicators were demographic variables, symptom duration, alpha angle, lateral center...
HIP International
Background: Bony morphology is central to the pathomechanism of femoroacetabular impingement synd... more Background: Bony morphology is central to the pathomechanism of femoroacetabular impingement syndrome (FAIS), however isolated radiographic measures poorly predict symptom onset and severity. More comprehensive morphology measurement considered together with patient factors may better predict symptom presentation. This study aimed to determine the morphological parameter(s) and patient factor(s) associated with symptom age of onset and severity in FAIS. Methods: 99 participants (age 32.9 ± 10.5 years; body mass index (BMI 24.3 ± 3.1 kg/m2; 42% females) diagnosed with FAIS received standardised plain radiographs and magnetic resonance scans. Alpha angle in four radial planes (superior to anterior), acetabular version (AV), femoral torsion, lateral centre-edge, anterior centre-edge (ACEA) and femoral neck-shaft angles were measured. Age of symptom onset (age at presentation minus duration of symptoms), international Hip Outcome Tool-33 (iHOT-33) and modified UCLA activity scores were ...
Medicine & Science in Sports & Exercise
Sensors
Appropriate soft tissue tension in total knee replacement (TKR) is an important factor for a succ... more Appropriate soft tissue tension in total knee replacement (TKR) is an important factor for a successful outcome. The purpose of our study was to assess both the reproducibility of a modern intraoperative pressure sensor (IOP) and if a surgeon could unconsciously influence measurement. A consecutive series of 80 TKRs were assessed with an IOP between January 2018 and December 2020. In the first scenario, two blinded sequential measurements in 48 patients were taken; in a second scenario, an initial blinded measurement and a subsequent unblinded measurement in 32 patients were taken while looking at the sensor monitor screen. Reproducibility was assessed by intraclass correlation coefficients (ICCs). In the first scenario, the ICC ranged from 0.83 to 0.90, and in the second scenario it ranged from 0.80 to 0.90. All ICCs were 0.80 or higher, indicating reproducibility using a IOP and that a surgeon may not unconsciously influence the measurement. The use of a modern IOP to measure soft...
The Journal of Arthroplasty, 2021
BACKGROUND Genu recurvatum is a rare knee deformity. Total knee arthroplasty (TKA) in severe preo... more BACKGROUND Genu recurvatum is a rare knee deformity. Total knee arthroplasty (TKA) in severe preoperative recurvatum requires surgical adjustments. Few studies have assessed the clinical and radiological results of TKA in recurvatum. The aim was to compare the clinical and radiological outcomes, complications, and revision rates after posterior-stabilized TKA in severe recurvatum with those without recurvatum. METHODS Between 1987 and 2015, 32 primary posterior-stabilized TKA were performed with a preoperative genu recurvatum greater than 10° and minimum follow-up of 60 months. In severe genu recurvatum, the extension gap needs to be decreased compared with flexion gap. To achieve this, the distal femoral cut is distalized, whereas the posterior femoral and tibial cuts are performed as usual. They were compared with 64 matched posterior-stabilized TKAs without recurvatum. The demographic data were similar between groups. The clinical and radiological outcomes, complications, and revision rates were assessed at the last follow-up. RESULTS At a mean follow-up of 7.4 years ± 1.9, there was no significant difference in International Knee Score functional score (77.5 vs. 73.4; P = .50) and knee score (86.6 vs. 89.5; P = .37) between the recurvatum group and the control group, respectively. 6 patients had a postoperative recurvatum equal or superior to 10° in the recurvatum group (18.8%). There was no difference between both groups in radiological outcomes, complication, or revision rates. No instability was found in the recurvatum group. CONCLUSION Posterior-stabilized TKA with controlled distalization of the femoral component in the setting of severe preoperative genu recurvatum achieves good clinical and radiological outcomes at a minimum follow-up of 5 years and similar to TKA without preoperative recurvatum. LEVEL OF EVIDENCE III.
Additional file 2: Supplementary Table 1. FASHION Per-protocol analysis: dGEMRIC (ms): Change fro... more Additional file 2: Supplementary Table 1. FASHION Per-protocol analysis: dGEMRIC (ms): Change from Baseline (B) and 12 month (12M) assessments (N=39). Supplementary Table 2. dGEMRIC (ms) Combined: Change from Baseline (B) and 12 month (12M) assessments (N=53). Subgroup analysis FAI type. Supplementary Table 3. FASHION: dGEMRIC (ms) Combined: Change from Baseline (B) and 12 month (12M) assessments (N=53). Supplementary Table 4. FASHION: dGEMRIC (ms) Combined: Change from Baseline (B) and 12 month (12M) assessments (N=50). Supplementary Table 5. dGEMRIC Combined (ms): Change from Baseline (B) and 12 month (12M) assessments (N=53). Subgroup analysis: Public vs Private. Supplementary Table 6. Intervention Fidelity. Supplementary Table 7. All patient-reported adverse events n (%). Supplementary Table 8. FASHION: Comparison of Baseline Characteristics for patients with dGEMRIC data vs missing (N=99). Supplementary Table 9. Baseline MRI HOAMS features. Numbers are n (%).
Additional file 1: Appendix 1. CONSORT Checklist. Appendix 2. MRI missing data. Appendix 3. Detai... more Additional file 1: Appendix 1. CONSORT Checklist. Appendix 2. MRI missing data. Appendix 3. Details on rationale for reduced sample size. Appendix 4. Statistical analysis plan. Appendix 5. Protocol.
Fluoroscopic injection of steroid and local anaesthetic into the hip joint. Pain diary that patie... more Fluoroscopic injection of steroid and local anaesthetic into the hip joint. Pain diary that patients were asked to complete. (JPG 137 kb)
Prostheses made from metal alloys have been successfully utilised within medicine for hundreds of... more Prostheses made from metal alloys have been successfully utilised within medicine for hundreds of years. Among these, cobalt-chromium (Co-Cr) alloys have seen extensive use in orthopaedic applications, including hip and knee joint replacements. Despite all the research and development that has gone into optimising these implants, however, a small proportion of them ultimately fail and require revision after a number of years. While the reasons for this are diverse, the reaction of metal nanoparticles to human tissues is a recognised complication of implanting these alloys within the body. This chapter explores the orthopaedic use of metal alloys within the human body as well as the local and systemic effects of these metal nanoparticles, with emphasis on large-diameter metal-on-metal hip replacements.
Arthroscopy, Sports Medicine, and Rehabilitation, 2021
Purpose To assess the radiation attenuation of lead screens in comparison to lead gowns in a simu... more Purpose To assess the radiation attenuation of lead screens in comparison to lead gowns in a simulated hip arthroscopy setting. Methods In this quantitative laboratory study, a phantom pelvis was used to simulate the scatter produced by patients during hip arthroscopy. Radiation measurements were taken using a handheld radiation detector positioned perpendicular to the phantom pelvis at 1.5 m and 2 m. Measurements were taken without shielding as a control, behind a lead gown (0.4-mm lead equivalent), and behind a lead screen (0.5-mm lead equivalent). Results With the detector at 1.5 m perpendicular to the hip, equivalent radiation was attenuated by the lead screen (94%) and the lead gown (94%). With the detector at 2 m perpendicular to the hip, the lead screen at 1.7 m attenuated 95% of radiation. Conclusions In hip arthroscopy, using lead screens is a safe and more comfortable alternative to wearing lead gowns. The lead screen should be at least 1.2 m from the radiation source, wit...
The Journal of Arthroplasty, 2011
The aim of this study was to compare the immediate stability of collared vs collarless uncemented... more The aim of this study was to compare the immediate stability of collared vs collarless uncemented femoral stems in total hip arthroplasty. A bilateral comparative study of 20 cadavers (40 hips: 20 collarless, 20 collared) was performed. Forces in the vertical and horizontal planes required to initiate subsidence of femoral stem and subsequent femoral fracture were measured. In vertical plane, subsidence began at an average force of 3129 ± 494 N for collarless stems and 6283 ± 3584 N for collared stems (P = .02). Fracture occurred at a significantly higher force for collared stems (P = b.001). In horizontal plane, subsidence began at an average force of 540 ± 170 N for collarless stems and 678 ± 206 N for collared stems (P = .01). Fracture occurred at a significantly higher force for collared stems (P = .005). Collared uncemented stems have significantly greater immediate stability than collarless. They are able to withstand greater vertical and horizontal forces before the initiation of subsidence and subsequent fracture.
Praxis, Apr 1, 2012
© 2012 Verlag Hans Huber, Hogrefe AG, Bern DOI 10.1024/1661-8157/a000940 Die Verwendung von Metal... more © 2012 Verlag Hans Huber, Hogrefe AG, Bern DOI 10.1024/1661-8157/a000940 Die Verwendung von Metallgleitlagern für den Hüftgelenkund Oberflächenersatz führt bei vielen Patienten zu unerwünschtenReaktionen auf Metallabrieb. Dieser Artikel befasst sich mit der Beurteilung und Behandlung von Patienten mit einer Metall/MetallTotalendoprothese der Hüfte, die mit potenziellemGelenkversagenvorstellig werden. Als im Jahr 2005 viel versprechende Fünf-Jahres-Ergebnisse für den Hüftgelenkersatz mit Grosskopfprothese und Metall/Metall-Gleitpaarung [1] veröffentlicht wurden, stieg die Zahl der Chirurgen, die diesen Eingriff durchführten, zügig an, und auch immer mehr Endoprothesenhersteller brachten eigeneOberflächenersatzmodelle auf denMarkt.Dabei wurden unerwünschte Reaktionen auf den Metallabrieb weder erwartet noch vorhergesehen. Mittlerweile sind im Rahmen endoprothetischer Ersatzoperationen an der Hüfte – von denen die meisten Oberflächenersatz-Eingriffe waren – weltweit mehr als 250 000Metall/Metall-Grosskopfprothesen implantiert worden [2]. Inzwischen verzeichnen dasNationale Britische und das Nationale Australische Gelenkregister einen statistisch signifikanten Anstieg der Revisionsraten bei bestimmten Metall/Metall-Totalprothesen imVergleich zu den konventionellen Metall/Kunststoff-Totalprothesen [3–5]. Unerwünschte Reaktionen des Weichteilgewebes auf Partikel, die aus den Metallimplantaten freigesetzt werden (Metallabrieb), können zu vorzeitigem Prothesenversagen führen und eine chirurgische Revision erforderlich machen. Diese unerwünschten Reaktionen auf einen solchen Metallabrieb können zwar mit nur geringfügigen Symptomen einhergehen, lokal jedoch auch hochdestruktive Läsionen hervorrufen, sodass der revisionschirurgische Eingriff sehr anspruchsvoll sein kann. Kürzlich erfolgte international der Rückruf einer bestimmten Metall/MetallProthese, der zu einer kritischen Auseinandersetzung mit der Evaluation, Einführung und Zulassung neuer Medizinprodukte Anlass gegeben hat (BMJ 2011; 342: d2905). Allerdings kann es durchaus sein, dass sich etliche Patienten mit Prothesenversagenmit stummenoder symptomatischen unerwünschten Reaktionen auf die Prothesen ihremArzt noch gar nicht vorgestellt haben, weshalb die Inzidenz fehlgeschlagener Metall/MetallHüftgelenkoperationen wahrscheinlich noch anwachsen wird und zu einer relevanten gesundheitlichen wie auch ökonomischen Belastung für Patienten bzw. Gesundheitsbehörden werden kann. Im vorliegenden Beitrag befassen wir uns mit der Beurteilung und Behandlung aller Patienten mit Metall/MetallHüfttotalendoprothesen, die mit potenziellemGelenkversagen vorstellig werden, und beziehen uns dabei auf neuere Leitlinien, auf die Evidenz in der Literatur (die sich auf Fall-Kontroll-, Kohortenund Fallstudien beschränkt) sowie unsere eigenen Erfahrungen. Was versteht man unter einer Metall/Metall-Hüftendoprothese?
International Orthopaedics, May 11, 2020
Purpose Cup positioning is important for optimum hip stability, avoiding component impingement an... more Purpose Cup positioning is important for optimum hip stability, avoiding component impingement and decreasing both bearing surface wear and revision rate. Transitioning from posterior approach in a lateral position to direct anterior approach (DAA) in a supine presents unique challenges for surgeons. The aim of this study was to examine the learning curve when using standard instrumentation that was not specific to DAA. Methods A consecutive retrospective series of 537 total hip arthroplasty by DAA from May 2013 to December 2017. Cup positioning was analysed on radiographs and classified whether inside or outside two safe zones (inclination 30-50°and anteversion 10-30°). The demographic data (age, BMI, gender, neck shaft angle (NSA)), surgeon's dominant side and experience were assessed as risk factors. Results Eighty per cent of cups (n = 426) were in the combined safe zones. Eighty-eight per cent (n = 470) were in appropriate anteversion and 87% (n = 463) abduction. Two factors that were significant were identified: Cups of left hips operated by righthanded surgeons were more anteverted (OR = 4.06) and more vertical (OR = 2.23); females had a higher anteversion of the cup (OR = 2.42). Obesity, age and NSA were not risk factors for cup malposition. There was a spike of cups too horizontal at the beginning of the experience (OR = 3.86), and no learning curve was observed in the other orientations. Conclusion With our DAA technique using standard instrumentation, there were no risk factors linked to the patient identified for cup malposition. DAA-specific instrumentation is not required to achieve optimum positioning of the cup. Surgeon has to be aware of an excess of abduction at the beginning of his experience and an excess of anteversion and adduction when performing THA on the opposite side of his dominant hand.
SICOT-J, 2020
Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques ... more Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee's learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.
Orthopaedic Proceedings, Feb 1, 2023
Advances in algorithms developed with sensor data from smart phones demonstrates the capacity to ... more Advances in algorithms developed with sensor data from smart phones demonstrates the capacity to passively collect qualitative gait metrics. The purpose of this feasibility study was to assess the recovery of these metrics following joint reconstruction. A secondary data analysis of an ethics approved global, multicenter, prospective longitudinal study evaluating gait quality data before and after primary total knee arthroplasty (TKA, n=476), partial knee arthroplasty (PKA, n=139), and total hip arthroplasty (THA, n=395). A minimum 24 week follow-up was required (mean 45±12, range 24 - 78). Gait bouts and gait quality metrics (walking speed, step length, timing asymmetry, and double support percentage) were collected from a standardized smartphone operating system. Pre- and post-operative values were compared using paired-samples t-tests (p<0.05).A total of 595 females and 415 males with a mean age of 61.9±9.3 years and mean BMI of 30.2±6.1 kg/m2 were reviewed. Walking speeds were lowest at post-operative week two (all, p<.001). Speeds exceeded pre-operative means consistently by week 21 (p=0.015) for PKA, and week 13 (p=0.007) for THA. The average weekly step length was lowest in post-operative week two (all, p<0.001). PKA and THA cases achieved pre-operative step lengths by week seven (p=0.064) and week 9 (p=0.081), respectively. The average weekly gait asymmetry peaked at week two post-operatively (all, p <0.001). Return to pre-operative baseline asymmetry was achieved by week 11 (p=0.371) for TKA, week six (p=0.541) for PKA, and week eight (p=.886) for THA. Double limb support percentages peaked at week two (all, p<0.001) and returned to pre-operative levels by week 24 (p=0.089) for TKA, week 12 (p=0.156) for PKA, and week 10 (p=0.143) for THA.Monitoring gait quality in real-world settings following joint reconstruction using smartphones is feasible, and may provide the advantage of removing the Hawthorne effect related to typical gait assessments and in-clinic observations.
Sensors
Gait quality parameters have been used to measure recovery from total hip arthroplasty (THA) but ... more Gait quality parameters have been used to measure recovery from total hip arthroplasty (THA) but are time-intensive and previously could only be performed in a lab. Smartphone sensor data and algorithmic advances presently allow for the passive collection of qualitative gait metrics. The purpose of this prospective study was to observe the recovery of physical function following THA by assessing passively collected pre- and post-operative gait quality metrics. This was a multicenter, prospective cohort study. From six weeks pre-operative through to a minimum 24 weeks post-operative, 612 patients used a digital care management application that collected gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-sample t-test. Recovery was defined as the post-operative week when the respective gait metric was no longer statistically inferior to the pre-operative value. To cont...
Orthopaedic Proceedings, Feb 1, 2023
Knee, Mar 1, 2011
We present a case of chronic disruption of the patellar tendon in a patient with Osteogenesis Imp... more We present a case of chronic disruption of the patellar tendon in a patient with Osteogenesis Imperfecta. This patient was treated with a customized extensor mechanism allograft. Results were excellent at 5 years follow up. To our knowledge this treatment has not previously been published in this situation. We present this as a reliable treatment option.
Sensors
Advances in algorithms developed from sensor-based technology data allow for the passive collecti... more Advances in algorithms developed from sensor-based technology data allow for the passive collection of qualitative gait metrics beyond step counts. The purpose of this study was to evaluate pre- and post-operative gait quality data to assess recovery following primary total knee arthroplasty. This was a multicenter, prospective cohort study. From 6 weeks pre-operative through to 24 weeks post-operative, 686 patients used a digital care management application to collect gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-samples t-test. Recovery was operationally defined as when the respective weekly average gait metric was no longer statistically different than pre-operative. Walking speed and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-operative (p < 0.0001). Walking speed recovered at 21 weeks (1.00 m...
The American Journal of Sports Medicine
Background:Although randomized controlled trials comparing hip arthroscopy with physical therapy ... more Background:Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life.Purpose:To explore potential moderators, mediators, and prognostic indicators of the effect of hip arthroscopy and physical therapy on change in 33-item international Hip Outcome Tool (iHOT-33) score for FAI syndrome.Study Design:Cohort study; Level of evidence, 2.Methods:Overall, 99 participants were recruited from the clinics of orthopaedic surgeons and randomly allocated to treatment with hip arthroscopy or physical therapy. Change in iHOT-33 score from baseline to 12 months was the dependent outcome for analyses of moderators, mediators, and prognostic indicators. Variables investigated as potential moderators/prognostic indicators were demographic variables, symptom duration, alpha angle, lateral center...
HIP International
Background: Bony morphology is central to the pathomechanism of femoroacetabular impingement synd... more Background: Bony morphology is central to the pathomechanism of femoroacetabular impingement syndrome (FAIS), however isolated radiographic measures poorly predict symptom onset and severity. More comprehensive morphology measurement considered together with patient factors may better predict symptom presentation. This study aimed to determine the morphological parameter(s) and patient factor(s) associated with symptom age of onset and severity in FAIS. Methods: 99 participants (age 32.9 ± 10.5 years; body mass index (BMI 24.3 ± 3.1 kg/m2; 42% females) diagnosed with FAIS received standardised plain radiographs and magnetic resonance scans. Alpha angle in four radial planes (superior to anterior), acetabular version (AV), femoral torsion, lateral centre-edge, anterior centre-edge (ACEA) and femoral neck-shaft angles were measured. Age of symptom onset (age at presentation minus duration of symptoms), international Hip Outcome Tool-33 (iHOT-33) and modified UCLA activity scores were ...
Medicine & Science in Sports & Exercise
Sensors
Appropriate soft tissue tension in total knee replacement (TKR) is an important factor for a succ... more Appropriate soft tissue tension in total knee replacement (TKR) is an important factor for a successful outcome. The purpose of our study was to assess both the reproducibility of a modern intraoperative pressure sensor (IOP) and if a surgeon could unconsciously influence measurement. A consecutive series of 80 TKRs were assessed with an IOP between January 2018 and December 2020. In the first scenario, two blinded sequential measurements in 48 patients were taken; in a second scenario, an initial blinded measurement and a subsequent unblinded measurement in 32 patients were taken while looking at the sensor monitor screen. Reproducibility was assessed by intraclass correlation coefficients (ICCs). In the first scenario, the ICC ranged from 0.83 to 0.90, and in the second scenario it ranged from 0.80 to 0.90. All ICCs were 0.80 or higher, indicating reproducibility using a IOP and that a surgeon may not unconsciously influence the measurement. The use of a modern IOP to measure soft...
The Journal of Arthroplasty, 2021
BACKGROUND Genu recurvatum is a rare knee deformity. Total knee arthroplasty (TKA) in severe preo... more BACKGROUND Genu recurvatum is a rare knee deformity. Total knee arthroplasty (TKA) in severe preoperative recurvatum requires surgical adjustments. Few studies have assessed the clinical and radiological results of TKA in recurvatum. The aim was to compare the clinical and radiological outcomes, complications, and revision rates after posterior-stabilized TKA in severe recurvatum with those without recurvatum. METHODS Between 1987 and 2015, 32 primary posterior-stabilized TKA were performed with a preoperative genu recurvatum greater than 10° and minimum follow-up of 60 months. In severe genu recurvatum, the extension gap needs to be decreased compared with flexion gap. To achieve this, the distal femoral cut is distalized, whereas the posterior femoral and tibial cuts are performed as usual. They were compared with 64 matched posterior-stabilized TKAs without recurvatum. The demographic data were similar between groups. The clinical and radiological outcomes, complications, and revision rates were assessed at the last follow-up. RESULTS At a mean follow-up of 7.4 years ± 1.9, there was no significant difference in International Knee Score functional score (77.5 vs. 73.4; P = .50) and knee score (86.6 vs. 89.5; P = .37) between the recurvatum group and the control group, respectively. 6 patients had a postoperative recurvatum equal or superior to 10° in the recurvatum group (18.8%). There was no difference between both groups in radiological outcomes, complication, or revision rates. No instability was found in the recurvatum group. CONCLUSION Posterior-stabilized TKA with controlled distalization of the femoral component in the setting of severe preoperative genu recurvatum achieves good clinical and radiological outcomes at a minimum follow-up of 5 years and similar to TKA without preoperative recurvatum. LEVEL OF EVIDENCE III.
Additional file 2: Supplementary Table 1. FASHION Per-protocol analysis: dGEMRIC (ms): Change fro... more Additional file 2: Supplementary Table 1. FASHION Per-protocol analysis: dGEMRIC (ms): Change from Baseline (B) and 12 month (12M) assessments (N=39). Supplementary Table 2. dGEMRIC (ms) Combined: Change from Baseline (B) and 12 month (12M) assessments (N=53). Subgroup analysis FAI type. Supplementary Table 3. FASHION: dGEMRIC (ms) Combined: Change from Baseline (B) and 12 month (12M) assessments (N=53). Supplementary Table 4. FASHION: dGEMRIC (ms) Combined: Change from Baseline (B) and 12 month (12M) assessments (N=50). Supplementary Table 5. dGEMRIC Combined (ms): Change from Baseline (B) and 12 month (12M) assessments (N=53). Subgroup analysis: Public vs Private. Supplementary Table 6. Intervention Fidelity. Supplementary Table 7. All patient-reported adverse events n (%). Supplementary Table 8. FASHION: Comparison of Baseline Characteristics for patients with dGEMRIC data vs missing (N=99). Supplementary Table 9. Baseline MRI HOAMS features. Numbers are n (%).
Additional file 1: Appendix 1. CONSORT Checklist. Appendix 2. MRI missing data. Appendix 3. Detai... more Additional file 1: Appendix 1. CONSORT Checklist. Appendix 2. MRI missing data. Appendix 3. Details on rationale for reduced sample size. Appendix 4. Statistical analysis plan. Appendix 5. Protocol.
Fluoroscopic injection of steroid and local anaesthetic into the hip joint. Pain diary that patie... more Fluoroscopic injection of steroid and local anaesthetic into the hip joint. Pain diary that patients were asked to complete. (JPG 137 kb)
Prostheses made from metal alloys have been successfully utilised within medicine for hundreds of... more Prostheses made from metal alloys have been successfully utilised within medicine for hundreds of years. Among these, cobalt-chromium (Co-Cr) alloys have seen extensive use in orthopaedic applications, including hip and knee joint replacements. Despite all the research and development that has gone into optimising these implants, however, a small proportion of them ultimately fail and require revision after a number of years. While the reasons for this are diverse, the reaction of metal nanoparticles to human tissues is a recognised complication of implanting these alloys within the body. This chapter explores the orthopaedic use of metal alloys within the human body as well as the local and systemic effects of these metal nanoparticles, with emphasis on large-diameter metal-on-metal hip replacements.
Arthroscopy, Sports Medicine, and Rehabilitation, 2021
Purpose To assess the radiation attenuation of lead screens in comparison to lead gowns in a simu... more Purpose To assess the radiation attenuation of lead screens in comparison to lead gowns in a simulated hip arthroscopy setting. Methods In this quantitative laboratory study, a phantom pelvis was used to simulate the scatter produced by patients during hip arthroscopy. Radiation measurements were taken using a handheld radiation detector positioned perpendicular to the phantom pelvis at 1.5 m and 2 m. Measurements were taken without shielding as a control, behind a lead gown (0.4-mm lead equivalent), and behind a lead screen (0.5-mm lead equivalent). Results With the detector at 1.5 m perpendicular to the hip, equivalent radiation was attenuated by the lead screen (94%) and the lead gown (94%). With the detector at 2 m perpendicular to the hip, the lead screen at 1.7 m attenuated 95% of radiation. Conclusions In hip arthroscopy, using lead screens is a safe and more comfortable alternative to wearing lead gowns. The lead screen should be at least 1.2 m from the radiation source, wit...
The Journal of Arthroplasty, 2011
The aim of this study was to compare the immediate stability of collared vs collarless uncemented... more The aim of this study was to compare the immediate stability of collared vs collarless uncemented femoral stems in total hip arthroplasty. A bilateral comparative study of 20 cadavers (40 hips: 20 collarless, 20 collared) was performed. Forces in the vertical and horizontal planes required to initiate subsidence of femoral stem and subsequent femoral fracture were measured. In vertical plane, subsidence began at an average force of 3129 ± 494 N for collarless stems and 6283 ± 3584 N for collared stems (P = .02). Fracture occurred at a significantly higher force for collared stems (P = b.001). In horizontal plane, subsidence began at an average force of 540 ± 170 N for collarless stems and 678 ± 206 N for collared stems (P = .01). Fracture occurred at a significantly higher force for collared stems (P = .005). Collared uncemented stems have significantly greater immediate stability than collarless. They are able to withstand greater vertical and horizontal forces before the initiation of subsidence and subsequent fracture.