A Four-Letter Focus Word I have really been thinking about my focus word for 2024!  Words that I have nurtured in the past several years have focused on...
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Demographic, Comorbidity, and Episode of Care Trends in Primary Hip Arthroplasty: 2008 to 2018 Background While previous studies have provided insight into time-trends in age and comorbidities of total hip arthroplasty (THA) patients, there is limited recent literature from within the past decade. The implication of these findings is relevant due to the projected THA volume increase and continued emphasis on healthcare system cost-containment policies. Therefore, the purpose of this study was to identify trends in THA patient demographics, comorbidities, and episode of care from 2008 to 2018.
Methods The National Surgical Quality Improvement Program (NSQIP) was queried to identify patient demographics, comorbidities, and episodes of care outcomes in patients undergoing primary THA from 2008 to 2018 (n = 216,524). Trends were analyzed using analysis of variances for continuous variables, while categorical variables were analyzed using chi-squared or Monte Carlo tests, where applicable.
Results From 2008 to 2018, there were no clinically significant differences in age and body mass index (BMI) in patients with BMI over 40 kg/m2. However, modifiable comorbidities including patients with hypertension (60.2% in 2008, 54.3 in 2018%, p < 0.001) and anemia (19% in 2008, 11.2%, in 2016, p < 0.001) improved. Functional status and the overall morbidity probability have improved with a decrease in hospital lengths of stay (4.0 ± 2.8 days in 2008, 2.1 ± 2.2 days in 2018, p < 0.001), 30-day readmissions (4.2% in 2009, 3.3% in 2018, p < 0.001), and significant increase in home-discharges (70.1% in 2008, 87.3% in 2018, p < 0.001).
Conclusion Patient overall health status improved from 2008 to 2018. While conjectural, our findings may be a reflection of a global shift toward value-based comprehensive care centering on patient optimization prior to arthroplasty, quality-of-care, and curtailing costs by mitigating perioperative adverse events.This study's level of evidence is III.
http://dx.doi.org/10.1055/s-0041-1740179

Hip Profile in World Elite Junior Badminton Players: Impingement and Range of Motion Data from the World Junior Badminton Championship 2018 Badminton is played with repetitive high loading to the hip with lunging and jumps. In sports like soccer there is a high prevalence of femoroacetabular impingement syndrome in youth populations which may predispose them to osteoarthritis (OA). Internal rotation deficit in the hip of football players is a predictor of hip and groin pain and differences in the range of motion (ROM) of the hip between sex and different ethnicities exist. Early hip replacements in former elite badminton players due to OA seem to be a problem. There are no published values for ROM and impingement of the hip in badminton. The purpose is to report ROM and impingement of the hip in elite junior badminton players and to report any differences between sex and ethnicities. Players at the World Junior Championship 2018 were examined for hip flexion, rotation, and impingement test. Injury history was obtained from a questionnaire. Two hundred and eighty-four players of 433 aged 16 to 18 years were examined. One hundred and forty-three players answered the questionnaire. Females demonstrated greater hip ROM than males. In the dominant side hip flexion was (137.7 degrees [ ± 9.1] vs. 132.2 degrees [ ± 11.1], p < 0.001), internal rotation range of motion or IROM (60.0 degrees [ ± 10.9] vs. 49 degrees [ ± 11.1], p < 0.001) and external rotation range of motion or EROM (57.9 degrees [ ± 9.9] vs. 54.7 degrees [ ± 8.9], 0.004). Hip flexion was higher in Asian players compared with non-Asian players (139.1 degrees [ ± 8.4] vs. 130.3 degrees [ ± 10.7], p < 0.001). One hundred (35%) players had at least one positive impingement test. A possible relationship between a positive FADIR and a decrease in hip flexion was found in the dominant hip, OR 1.06 (1.02–1.11) p = 0.005. A total of 104 previous injuries lasting over 30 days were reported with five hip-related injuries. No correlation between injury and examinations was found. Females and Asians demonstrated higher ROM in the hip than males and non-Asians. Impingement of the hip is frequent and may be related to low hip flexion.
http://dx.doi.org/10.1055/s-0041-1739457

Postoperative Doxycycline Did Not Improve Early Postoperative Outcomes in Hip Arthroscopy Patients: A Retrospective Cohort Study Doxycycline has been shown to reduce fibroblast activity in the treatment of multiple pathologies, and was utilized as part of the postoperative medication protocol to help prevent adhesions from developing after hip arthroscopy. The purpose of this study was to compare early postoperative pain outcomes between consecutive case series of femoroacetabular impingement syndrome (FAIS) patients treated with or without a 7-day postoperative course of doxycycline following hip arthroscopy. We hypothesized that the doxycycline-treated group would have superior patient-reported outcomes at 6 weeks, and the effect would be more pronounced for patients with low preoperative mental health scores.Our institutional review board–approved prospective outcomes registry was queried for patients who had undergone arthroscopic femoral osteochondroplasty and/or labral repair or reconstruction secondary to FAIS performed by a single, fellowship-trained surgeon. A 7-day postoperative course of doxycycline was initiated in 2018. Six-week postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) global (HOOSglobal) and International Hip Outcome Tool (iHOT) scores were compared between the consecutive series treated with versus without doxycycline. Additional subgroup analysis was performed on patients with low preoperative Veterans RAND 12-Item Health Survey (VR-12) mental component scores to determine possible additional benefit of postoperative doxycycline in this group.A total of 134 patients (98 female, 36 male, age = 36.2 ± 13.4 years, body mass index [BMI] = 27.2 ± 5 kg/m2) were identified between 2013 and 2020. There were no differences between the control (n = 84) and doxycycline group (n = 5 in age, sex, or BMI. Postoperative HOOSglobal scores (control = 58.5 ± 13.1, doxycycline = 58.7 ± 14.7, p = 0.96) and iHOT scores (control = 54.4 ± 22.2, doxycycline = 52.3 ± 24.8, p = 0.61) did not differ between groups. The subset of 83 patients with low preoperative mental scores showed no differences in HOOSglobal (control = 51.6 ± 13.3, doxycycline = 57.3 ± 7.4, p = 0.12) or iHOT scores (control = 45.5 ± 20.3, doxycycline = 53.6 ± 23.1, p = 0.25.Our results do not support the hypothesis that postoperative doxycycline leads to significant improvement in early postoperative pain scores or functional outcomes in patients undergoing hip arthroscopy for FAIS.
http://dx.doi.org/10.1055/s-0041-1739456

The Effect of Femoral Malrotation in Offset Templating for Total Hip Arthroplasty: A Cadaveric Study and Curvilinear Analysis Techniques allow assessment of preoperative offset in hip arthroplasty. This study assessed femoral rotation in preoperative offset templating using a cadaveric model. Ten femurs were imaged at degrees of rotation. Offset was measured. A generalizable equation predicting change in offset was derived with a curvilinear model. Statistically significant differences at rotational positions were found. For 30 degrees of internal rotation, 2.1 mm change in adjusted mean offset existed; for 30 degrees of external rotation, 8.4 mm change existed. Improved awareness of malrotation of the proximal femur and templating adjustments may improve total hip arthroplasty outcomes. This study reflects level of evidence III.
http://dx.doi.org/10.1055/s-0041-1732367