scholarly journals APP-guided assessment of acetabular defects in hip revision arthroplasty: a structured approach to a complex situation

2021 ◽  
Author(s):  
Max Jaenisch ◽  
Dieter Christian Wirtz ◽  
Hendrik Kohlhof ◽  
Martin Gathen ◽  
Koroush Kabir ◽  
...  
Keyword(s):  
Medical Students ◽  
Revision Arthroplasty ◽  
Ease Of Use ◽  
Acetabular Defect ◽  
Rater Agreement ◽  
Complex Situation ◽  
Planning Stage ◽  
Orthopedic Surgeons ◽  
Acetabular Defects ◽  
Specialist Group

Abstract Introduction Acetabular defect recognition and classification remains a challenging field of practice for orthopedic surgeons. Recently, the Acetabular Defect Classification (ADC) has been introduced to provide a reliable, reproducible and intuitive classification system. In order to improve ease of use and efficiency of the ADC, a browser-based application has been created. We hypothesized that the ADC application can improve rating performance of non-specialists (medical students) to achieve good inter- and intra-rater agreement and will compare favorable to the results of specialists (experienced surgeons) without the help of the application. Materials and methods The ADC is based on the integrity of the acetabular rim and the supporting structures. It consists of four main types of defects ascending in severity. These defects are further subdivided in A–C, narrowing down defect location. 80 randomized radiographs were graded according to ADC by three non-specialists (medical students) with help of the ADC application and by three specialists (orthopedic surgeons) without help of the application to evaluate the difference in inter-rater agreement between groups. To account for intra-rater agreement, the rating process was repeated after a reasonable wash-out period. Results Inter-rater and intra-rater agreement within the non-specialist group rated lower when compared to the specialist group while still falling into the good agreement range. The student group presented with k values of 0.61 for inter-rater agreement and 0.68 for intra-rater agreement, while the surgeon group displayed k values of 0.72 for inter-rater agreement and 0.83 for intra-rater agreement. Conclusion The app-guided assessment of acetabular defects offers a promising innovative approach to simplify complex situations. It makes the challenging field of acetabular revision arthroplasty more approachable especially for less experienced surgeons and offers insight and guidance in the planning stage as well as intra-operative setting.

scholarly journals Treatment of an extensive acetabular defect in a patient with aseptic instability of a total hip arthroplasty

2020 ◽  
Vol 27 (3) ◽  
pp. 60-66
Author(s):  
Hovakim A. Aleksanyan ◽  
Hamlet A. Chragyan ◽  
Sergey V. Kagramanov ◽  
Nikolay V. Zagorodniy
Keyword(s):  
Acetabular Component ◽  
Hip Joint ◽  
Revision Arthroplasty ◽  
Acetabular Defect ◽  
Total Arthroplasty ◽  
Total Endoprosthesis ◽  
Reconstructive Operations ◽  
Fresh Frozen ◽  
Joint Revision ◽  
The Right

The aim of the study is to demonstrate, using a clinical example, the possibility of treating a patient with a severe acetabular defect by performing a one-stage revision arthroplasty using an individual design. Materials and methods. A 45-year-old female patient was admitted with complaints of pain, limitation of movement in the right hip joint, and gait disturbance. From anamnesis at the age of 5 years, reconstructive operations of the hip joints were performed. In 1991, CITO performed primary total arthroplasty of the right hip joint with an endoprosthesis from ESKA Implants. In 1998, due to the instability of the acetabular component of the total endoprosthesis of the right hip joint, revision arthroplasty was performed, and the cup was placed with a cement fixation. In 2001, for left-sided dysplastic coxarthrosis, primary total arthroplasty of the left hip joint was performed. In 2012, due to the instability of the total endoprosthesis of the left hip joint, revision arthroplasty was performed using an ESI anti-protrusion ring (ENDOSERVICE) with a cement cup and a Zweimller-type femoral component; the femur defect was repaired using a fresh frozen cortical graft. In October 2019, instability of the total endoprosthesis of the right hip joint was revealed, for which revision endoprosthetics was performed using an individual acetabular component. Results. The HHS index before revision arthroplasty was 21 points, after 1 month after surgery 44 points, after 3 months after surgery 65, after 6 months 82. Quality of life was assessed according to the WOMAC scale: before surgery 73 points, after 1 month after surgery 54 points, after 3 months 31, after 6 months 15 points. At the time of the last consultation, the patient moves with a cane, lameness persists, associated with scar reconstruction and atrophy of the gluteal muscles. Conclusion. The use of individual structures allows to restore the support ability of the lower limb and the function of the hip joint in the case of an extensive defect of the pelvic bones of the pelvic discontinuity type.

scholarly journals The Evolving Impact of COVID-19 on Medical Student Orthopedic Education: Perspectives From Medical Students in Different Phases of the Curriculum

2020 ◽  
Vol 11 ◽  
pp. 215145932095172 ◽  
Author(s):  
Michelle A. Richardson ◽  
Wasif Islam ◽  
Matthew Magruder
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Medical Profession ◽  
School Curriculum ◽  
Application Process ◽  
Program Coordinators ◽  
Orthopedic Surgeons ◽  
Fourth Year Medical Students ◽  
Residency Application ◽  
The Impact

Introduction: The world-wide lockdown caused by Coronavirus Disease 2019 (COVID-19) has upended the trajectories of lives everywhere. The medical profession has been on the front lines of this rapidly developing situation, which in turn has called for unprecedented changes in the medical school curriculum. These changes have severe implications for medical students interested in applying to competitive surgical specialties like orthopedics. Methods: As medical students in 3 different class years pursuing orthopedic surgery, we provide our perspectives on the impact that COVID-19 has had on medical student orthopedic education. Results: With the removal of away rotations and a shift to virtual interviews, rising fourth year medical students are arguably the most impacted as they prepare for the orthopedic residency application process. Third year students, who are in the exploratory phase of choosing a specialty, also face uncertainties in the shift to a “new” clerkship experience that may (1) be of shorter duration, (2) implement shifts to limit overcrowding of clinical space, and (3) increase the use of telehealth over direct patient contact. Discussion: The COVID-19 pandemic has altered the course of medical students’ orthopedic education in unprecedented ways. We believe the following suggestions may be helpful for students seeking alternative, supplemental ways of learning: (1) read up on major orthopedic journals, (2) reach out to orthopedic surgeons in areas of interest, (3) reach out to program directors/medical clerkship directors/program coordinators for opportunities to attend their educational curriculum virtually, (4) attend online lectures and hospital grand rounds, and (5) practice suturing technique with a practice kit. Conclusions: While the medical education landscape remains uncertain amid the evolving conditions of COVID-19, as medical students we strive to learn from this pandemic and respond to future unforeseen challenges with resilience, dedication, and compassion: all qualities we admire in orthopedic surgeons.

scholarly journals Developing the Evidence Base for M-Learning in Undergraduate Radiology Education: Identifying Learner Preferences for Mobile Apps

2019 ◽  
Vol 70 (3) ◽  
pp. 320-326
Author(s):  
Kathryn E. Darras ◽  
Jeroen J. G. van Merriënboer ◽  
Matthew Toom ◽  
Nathan D. Roberson ◽  
Anique B. H. de Bruin ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Experience ◽  
Mobile Apps ◽  
Statistical Significance ◽  
Image Interpretation ◽  
Evidence Base ◽  
Ease Of Use ◽  
Content Organization ◽  
Learner Preferences ◽  
Delivery Strategies

Purpose There is a lack of evidence for developing radiology mobile apps for medical students. This study identifies the characteristics which students perceive as most valuable to teaching radiology with mobile apps (m-learning). Methods An online anonymous survey was administered to second- to fourth-year medical students at a single institution. The survey, which was based on established theoretical framework, collected students' preferred content organization, content presentation, and delivery strategies. The Copeland method was used to rank student preferences and a 2-tailed t test was used to determine if student responses were related to their clinical experience, with statistical significance at P < .05. Results The response rate was 25.6% (163/635). For content organization, image interpretation (66.9%), imaging anatomy (61.3%), and common pathological conditions (50.3%) were selected as the most important. For content presentation, quizzes (49.1%) and case presentations (46.0%) were selected as the most useful. Students with clinical experience rated algorithms as more important ( P < .01) and quizzes as less important ( P = .03). For delivery strategies, ease of use (92.6%), navigation (90.8%), and gestural design (74.8%) were deemed the most applicable. Conclusion This study documents medical students' preferences for m-learning in radiology. Although learner preferences are not the only feature to consider in the development of educational technology, these provide the initial framework for radiologists wishing to develop and incorporate mobile apps into their teaching.

Use of cementless acetabular component with a hook and iliac flanges in revision arthroplasty for massive acetabular defect

2012 ◽  
Vol 17 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Ki-Choul Kim ◽  
Yong-Chan Ha ◽  
Bun-Jung Kang ◽  
Young-Kyun Lee ◽  
Hyung-Min Ji ◽  
...  
Keyword(s):  
Acetabular Component ◽  
Revision Arthroplasty ◽  
Acetabular Defect ◽  
Cementless Acetabular Component

scholarly journals Seamens’ Sign: A Novel Electrocardiogram Prediction Tool for Left Ventricular Hypertrophy

2021 ◽  
Author(s):  
Philip Walker ◽  
Cathy Jenkins ◽  
Jeremy Hatcher ◽  
Clifford Freeman ◽  
Nickolas Sr ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Retrospective Chart Review ◽  
Left Ventricular ◽  
Ease Of Use ◽  
Rater Agreement ◽  
Study Objective ◽  
Test Characteristics ◽  
Common Criteria ◽  
New Criterion

Abstract Study Objective: We developed a novel, quick, easy to use electrocardiogram (ECG) screening criterion (Seamens’ Sign) for left ventricular hypertrophy (LVH). This new criterion was defined as the presence of QRS complexes touching or overlapping in two contiguous precordial leads. Methods: This study was a retrospective chart review of 2184 patient records. The primary outcome was whether Seamens’ Sign was noninferior in confirming LVH compared to other common criteria. Test characteristics were calculated for each of the LVH criteria. Inter-rater agreement was assessed on a random sample using Cohen’s Kappa. Results: Median age was 63, 52% of patients were male and there was a 35% prevalence of LVH by transthoracic echocardiogram (TTE). Nine percent were positive for LVH on ECG based on Seamens’ Sign. Seamens’ Sign had a specificity of 0.92. Tests assessing noninferiority indicated Seamens’ Sign was non-inferior to all criteria (p < 0.001) except for Cornell criterion for women (p = 0.98). Seamens’ Sign had 90% (0.81-1.00) inter-rater agreement, the highest of all criteria in this study. Conclusion: When compared to both the Sokolow-Lyon criteria and the Cornell criterion for men, Seamens’ Sign is noninferior in ruling in LVH on ECG. Additionally, Seamens’ Sign has higher inter-rater agreement compared to both Sokolow-Lyon criteria as well as the Cornell criteria for men and women, perhaps related to its ease of use.

scholarly journals Prescribing competency assessment for Canadian medical students: a pilot evaluation

2019 ◽  
Vol 10 (1) ◽  
pp. e103-110 ◽  
Author(s):  
Anne Holbrook ◽  
J. Tiger Liu ◽  
Michael Rieder ◽  
Michelle Gibson ◽  
Mitchell Levine ◽  
...  
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Medical Schools ◽  
Ease Of Use ◽  
Student Feedback ◽  
Assessment Process ◽  
Secondary Outcome ◽  
Competency Assessment ◽  
Perceived Fairness ◽  
Discriminative Ability

Background: The knowledge and ability to prescribe safely and effectively is a core competency for every graduating medical student. Our previous research suggested concerns about medical student prescribing abilities, and interest in a standardized assessment process. Methods: A multi-year cross-sectional study evaluating the feasibility, acceptability, and discriminative ability of an online prescribing competency assessment for final year Canadian medical students was conducted. Students at nine sites of four Ontario medical schools were invited to participate in an online one-hour exam of eight domains related to prescribing safely. Student feedback on perceived fairness, clarity, and ease of use formed the primary outcome. Exam performance and parity between schools were the secondary outcome.  Results: A total of 714 students completed the assessment during spring final review courses between 2016 and 2018. Student feedback was more favourable than not for appropriateness of content (53.5% agreement vs 18.3% disagreement), clarity of questions (65.5% agreement vs 11.6% disagreement), question layout and presentation (70.8% agreement vs 12.2% disagreement), and ease of use of online interface (67.1% agreement vs 13.6% disagreement). Few (23.6% believed their course work had prepared them for the assessment. Mean total exam score was 70.0% overall (SD 10.4%), with 47.6% scoring at or above the pass threshold of 70%. Conclusion: Our prescribing competency assessment proved feasible, acceptable, and discriminative, and indicated a need for better medical school training to improve prescribing competency. Further evaluation in a larger sample of medical schools is warranted.

scholarly journals An OxPLORE Initiative Evaluating Children’s Surgery Resources Worldwide: A Cross-sectional Implementation of the OReCS Document

2021 ◽  
Author(s):  
Krupa Ravi ◽  
Annabel Killen ◽  
Angus Alexander ◽  
Frances Bell-Davies ◽  
James Biganiro Sebintu ◽  
...  
Keyword(s):  
Medical Students ◽  
Surgical Care ◽  
Ease Of Use ◽  
User Evaluation ◽  
Audit Tool ◽  
Evaluation Tool ◽  
Local Hospital ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Global Initiative

Abstract Background The Global Initiative for Children's Surgery (GICS) group produced the Optimal Resources for Children’s Surgery (OReCS) document in 2019, listing standards of children’s surgical care by level of healthcare facilities within low resource settings. We have previously created and piloted an audit tool based on the OReCS criteria in a high-income setting. In this study, we aimed to validate its use in identifying gaps in children’s surgery provision worldwide. Methods Our OReCS audit tool was implemented in 10 hospitals providing children’s surgery across eight countries. Collaborators were recruited via the Oxford Paediatrics Linking Our Research with Electives (OxPLORE) international network of medical students and trainees. The audit tool measured a hospital’s current capacity for children’s surgery. Data were analysed firstly to express the percentage of ‘essential’ criteria met for each specialty. Secondly, the ‘OxPLORE method’ was used to allocate each hospital specialty a level based on procedures performed and resources available. A User Evaluation Tool (UET) was developed to obtain feedback on the ease of use of the tool. Results The percentage of essential criteria met within each category varied widely between hospitals. The level given to hospitals for subspecialties based on OReCS criteria often did not reflect their self-defined level. The UET indicated the audit tool was practicable across multiple settings. Conclusions We recommend the use of the OReCS criteria to identify areas for local hospital improvement and inform national children’s surgical plans. We have made informed suggestions to increase usability of the OReCS audit tool.

scholarly journals The use of pararectus approach for Type 3B Paprosky acetabular defect with intrapelvic cup migration. Case report

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 11
Author(s):  
Mohammad K. Abdelnasser ◽  
Ahmed A. Khalifa ◽  
Yaser E. Khalifa ◽  
Hatem M. Bakr ◽  
Mohammad A. Mahran ◽  
...  
Keyword(s):  
Case Report ◽  
Male Patient ◽  
Anterior Column ◽  
Acetabular Defect ◽  
Pelvic Discontinuity ◽  
Pararectus Approach ◽  
Acetabular Defects

Case: A case of Type 3B Paprosky acetabular defect with intrapelvic cup migration where anterior column plating and cup extraction was done through an abdominal pararectus approach. A male patient 63 years old reported progressive pain and walking disability after five years of cementless THR for right hip AVN. CT pelvis showed loose intrapelvic migrated cup, extensive osteolytic acetabular defects, and pelvic discontinuity. Pararectus approach was used to remove the cup and the head with concomitant plating of the anterior column Conclusion: The pararectus approach is a valid option for intrapelvic cup extraction and pelvic discontinuity fixation.

scholarly journals Reverse augmentation technique in hip revision arthroplasty: a new strategy for the management of acetabular reconstruction

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Christian Götze ◽  
Christian-Dominik Peterlein
Keyword(s):  
Revision Arthroplasty ◽  
Technical Note ◽  
Polyethylene Liner ◽  
Acetabular Reconstruction ◽  
Outer Diameter ◽  
Acetabular Defect ◽  
Hip Revision ◽  
Center Of Rotation ◽  
Total Hip ◽  
Rotation Center

Abstract Background The principle of acetabular total hip revision (THR) is based on acetabular reconstruction and restoration of the center of rotation. The use of augmentation in high cranial acetabular defects combined with a cementless revision shell was studied sufficiently. This study aimed to report a case with the use of an augment inside a cementless revision shell as a reverse augmentation technique. Methods We describe the case of an 86-year-old female patient with a massive acetabular defect during second revision for total hip arthroplasty (THA). Two problems occurred: (1) a fixed cemented stem with a nonmodular head size of 33 mm and (2) a high acetabular defect with an elevated rotation center. Results With the distraction technique, allograft filling was used to reconstruct the acetabular defect. A cementless revision shell (REDAPT, Smith and Nephew) with a size of 78 mm was used to stabilize the defect. Locking screws placed cranially and distally were used to stabilize the cup for secondary osseointegration. An augment was placed inside the cup to reconstruct the rotation center. A customized polyethylene liner (outer diameter, 54 mm/inner diameter, 33 mm) was positioned below the augment in the revision cup to reconstruct the center of rotation. An 18-month postoperative X-ray analysis showed a stable construct with full secondary osseointegration. Conclusion This is the first report of an augment used for a reverse technique inside a cementless shell to restore the center of rotation with the use of a customized polyethylene liner. This might be a reliable option for reconstruction of the center of rotation in large cementless revision cups in acetabular Paprosky type III defects. This technical note shows the possibility of using an augment as a reverse technique in a cementless revision cup.

Reconstruction of Severe Acetabular Bone Defects in Revision Hip Arthroplasty Management options and clinical outcomes

2018 ◽  
Vol 69 (8) ◽  
pp. 2217-2221
Author(s):  
Stefan Mogos ◽  
George Viscopoleanu ◽  
Monica Dascalu ◽  
Radu Orfanu
Keyword(s):  
Revision Arthroplasty ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Management Options ◽  
Acetabular Bone ◽  
Type Iiia ◽  
Acetabular Bone Defects ◽  
The Mean ◽  
Acetabular Defects

The objective of this study was to evaluate the effectiveness of different surgical implants for the reconstruction of severe acetabular bone defects in revision arthroplasty of the hip. The current study is a retrospective study on 32 patients with Paprosky type IIIA or IIIB acetabular defects operated between January 2012-December 2015 in a single hospital. The mean follow-up was 21 months (12-43 months). Five different types of reconstruction methods were used: primary uncemented cups with or without screws, cemented acetabular cups, tantalum cups, metal augments and antiprotrusio cages. Bone allograft was available in all cases. Functional outcome after surgery was evaluated using Harris Hip Score. Based on Paprosky classification, the study included 16 type IIIA and 16 type IIIB acetabular defects. Bone graft was used in 71.8% of the cases (23 out of 32 patients). Tantalum cups were used in 15 cases (46.9%), being the preferred implant. Primary uncemented cups were used in 2 cases, cemented acetabular cups were used in 4 cases, trabecular metal augments were used in 5 cases and antiprotrusion cages were used in 6 cases. The mean Harris Hip Score improved from 37.3�7.4 pre-operatively to 82.1�7.2 at final follow-up. In conclusion, the current study demonstrates that various methods of reconstruction are efficient in the short and medium-term.

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