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Brian D. Busconi - One of the best experts on this subject based on the ideXlab platform.
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Hip Arthroscopy in the pediatric population : Hip Arthroscopy
Clinical Orthopaedics and Related Research, 2003Co-Authors: Nicola A. Deangelis, Brian D. BusconiAbstract:Hip Arthroscopy has obvious advantages over arthrotomy in the pediatric population. Hip Arthroscopy, used as a diagnostic or therapeutic tool, is significantly less invasive than arthrotomy and allows for quicker recovery and return to activities. In addition, Arthroscopy avoids dislocation of the femoral head and the corresponding risk of osteonecrosis. Current indications for hip Arthroscopy in pediatric patients include septic arthritis, labral disorders, slipped capital femoral epiphysis, and Legg-Calve-Perthes disease. The role of hip Arthroscopy in the pediatric population will continue to expand because of its attractiveness as a less invasive option for evaluating the hip.
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Hip Arthroscopy in the pediatric population.
Clinical orthopaedics and related research, 2003Co-Authors: Nicola A. Deangelis, Brian D. BusconiAbstract:Hip Arthroscopy has obvious advantages over arthrotomy in the pediatric population. Hip Arthroscopy, used as a diagnostic or therapeutic tool, is significantly less invasive than arthrotomy and allows for quicker recovery and return to activities. In addition, Arthroscopy avoids dislocation of the femoral head and the corresponding risk of osteonecrosis. Current indications for hip Arthroscopy in pediatric patients include septic arthritis, labral disorders, slipped capital femoral epiphysis, and Legg-Calve-Perthes disease. The role of hip Arthroscopy in the pediatric population will continue to expand because of its attractiveness as a less invasive option for evaluating the hip.
Vikas Khanduja - One of the best experts on this subject based on the ideXlab platform.
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History of hip Arthroscopy
Journal of Arthroscopic Surgery and Sports Medicine, 2020Co-Authors: Shivani Shukla, Matthew Pettit, Karadi Hari Sunil Kumar, Vikas KhandujaAbstract:Hip Arthroscopy is a minimally invasive therapeutic and diagnostic procedure appropriate for an evolving list of conditions. It is routinely used for the treatment of intra- and extra-articular pathology of the hip joint. The development of endoscopy paved the way for the development of Arthroscopy. Hip Arthroscopy was first described in 1931 by Michael Burman, and its widespread adoption was only achieved some 60 years later during the 1990s. Dr. Watanabe, from Japan, has been credited with the development of modern Arthroscopy for his work in developing a practical arthroscope and advancement of both explorative Arthroscopy and surgical arthroscopic techniques. More recently, the use of distraction proved as a significant step in the utility of hip Arthroscopy and paved the way for future innovations in the procedure. The authors provide a brief overview of the history hip Arthroscopy, relevant developments which have paved the way for this procedure and the current state of Arthroscopy as a diagnostic and therapeutic procedure.
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The learning curves of a validated virtual reality hip Arthroscopy simulator
Archives of Orthopaedic and Trauma Surgery, 2020Co-Authors: Jonathan D. Bartlett, John E Lawrence, Emmanuel Audenaert, Borna Guevel, Max E. Stewart, Vikas KhandujaAbstract:Introduction Decreases in trainees’ working hours, coupled with evidence of worse outcomes when hip arthroscopies are performed by inexperienced surgeons, mandate an additional means of training. Though virtual reality simulation has been adopted by other surgical specialities, its slow uptake in arthroscopic training is due to a lack of evidence as to its benefits. These benefits can be demonstrated through learning curves associated with simulator training—with practice reflecting increases in validated performance metrics. Methods Twenty-five medical students with no previous experience of hip Arthroscopy completed seven weekly simulated arthroscopies of a healthy virtual hip joint using a 70° arthroscope in the supine position. Twelve targets were visualised within the central compartment, six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. Task duration, number of collisions (bone and soft-tissue), and distance travelled by arthroscope were measured by the simulator for every session of each student. Results Learning curves were demonstrated by the students, with improvements in time taken, number of collisions (bone and soft-tissue), collision length and efficiency of movement (all p
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the learning curves of a validated virtual reality hip Arthroscopy simulator
Archives of Orthopaedic and Trauma Surgery, 2020Co-Authors: Jonathan Bartlett, John E Lawrence, Emmanuel Audenaert, Borna Guevel, Max E. Stewart, Vikas KhandujaAbstract:Decreases in trainees’ working hours, coupled with evidence of worse outcomes when hip arthroscopies are performed by inexperienced surgeons, mandate an additional means of training. Though virtual reality simulation has been adopted by other surgical specialities, its slow uptake in arthroscopic training is due to a lack of evidence as to its benefits. These benefits can be demonstrated through learning curves associated with simulator training—with practice reflecting increases in validated performance metrics. Twenty-five medical students with no previous experience of hip Arthroscopy completed seven weekly simulated arthroscopies of a healthy virtual hip joint using a 70° arthroscope in the supine position. Twelve targets were visualised within the central compartment, six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. Task duration, number of collisions (bone and soft-tissue), and distance travelled by arthroscope were measured by the simulator for every session of each student. Learning curves were demonstrated by the students, with improvements in time taken, number of collisions (bone and soft-tissue), collision length and efficiency of movement (all p < 0.01). Improvements in time taken, efficiency of movement and number of collisions with soft-tissue were first seen in session 3 and improvements in all other parameters were seen in session 4. No differences were found after session 5 for time taken and length of soft-tissue collision. No differences in number of collisions (bone and soft-tissue), length of collisions with bone, and efficiency of movement were found after session 6. The results of this study demonstrate learning curves for a hip Arthroscopy simulator, with significant improvements seen after three sessions. All performance metrics were found to improved, demonstrating sufficient visuo-haptic consistency within the virtual environment, enabling individuals to develop basic arthroscopic skills.
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virtual reality hip Arthroscopy simulator demonstrates sufficient face validity
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Jonathan Bartlett, John E Lawrence, Vikas KhandujaAbstract:To test the face validity of the hip diagnostics module of a virtual reality hip Arthroscopy simulator. A total of 25 orthopaedic surgeons, 7 faculty members and 18 orthopaedic residents, performed diagnostic supine hip arthroscopies of a healthy virtual reality hip joint using a 70° arthroscope. Twelve specific targets were visualised within the central compartment; six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. This task was immediately followed by a questionnaire regarding the realism and training capability of the system. This consisted of seven questions addressing the verisimilitude of the simulator and five questions addressing the training environment of the simulator. Each question consisted of a statement stem and 10-point Likert scale. Following similar work in surgical simulators, a rating of 7 or above was considered an acceptable level of realism. The diagnostic hip Arthroscopy module was found to have an acceptable level of realism in all domains apart from the tactile feedback received from the soft tissue. 23 out of 25 participants (92%) felt the simulator provided a non-threatening learning environment and 22 participants (88%) stated they enjoyed using the simulator. It was most frequently agreed that the level of trainees who would benefit most from the simulator were registrars and fellows (22 participants; 88%). Additionally, 21 of the participants (84%) agreed that this would be a beneficial training modality for foundation and core trainees, and 20 participants (80%) agreed that his would be beneficial for consultants. This VR hip Arthroscopy simulator was demonstrated to have a sufficient level of realism, thus establishing its face validity. These results suggest this simulator has sufficient realism for use in the acquisition of basic arthroscopic skills and supports its use in orthopaedics surgical training. I.
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testing the construct validity of a virtual reality hip Arthroscopy simulator
Arthroscopy, 2017Co-Authors: Vikas Khanduja, John E Lawrence, Emmanuel AudenaertAbstract:Purpose To test the construct validity of the hip diagnostics module of a virtual reality hip Arthroscopy simulator. Methods Nineteen orthopaedic surgeons performed a simulated arthroscopic examination of a healthy hip joint using a 70° arthroscope in the supine position. Surgeons were categorized as either expert (those who had performed 250 hip arthroscopies or more) or novice (those who had performed fewer than this). Twenty-one specific targets were visualized within the central and peripheral compartments; 9 via the anterior portal, 9 via the anterolateral portal, and 3 via the posterolateral portal. This was immediately followed by a task testing basic probe examination of the joint in which a series of 8 targets were probed via the anterolateral portal. During the tasks, the surgeon's performance was evaluated by the simulator using a set of predefined metrics including task duration, number of soft tissue and bone collisions, and distance travelled by instruments. No repeat attempts at the tasks were permitted. Construct validity was then evaluated by comparing novice and expert group performance metrics over the 2 tasks using the Mann–Whitney test, with a P value of less than .05 considered significant. Results On the visualization task, the expert group outperformed the novice group on time taken ( P = .0003), number of collisions with soft tissue ( P = .001), number of collisions with bone ( P = .002), and distance travelled by the arthroscope ( P = .02). On the probe examination, the 2 groups differed only in the time taken to complete the task ( P = .025) with no significant difference in other metrics. Conclusions Increased experience in hip Arthroscopy was reflected by significantly better performance on the virtual reality simulator across 2 tasks, supporting its construct validity. Clinical Relevance This study validates a virtual reality hip Arthroscopy simulator and supports its potential for developing basic arthroscopic skills. Level of Evidence Level III.
Nicola A. Deangelis - One of the best experts on this subject based on the ideXlab platform.
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Hip Arthroscopy in the pediatric population : Hip Arthroscopy
Clinical Orthopaedics and Related Research, 2003Co-Authors: Nicola A. Deangelis, Brian D. BusconiAbstract:Hip Arthroscopy has obvious advantages over arthrotomy in the pediatric population. Hip Arthroscopy, used as a diagnostic or therapeutic tool, is significantly less invasive than arthrotomy and allows for quicker recovery and return to activities. In addition, Arthroscopy avoids dislocation of the femoral head and the corresponding risk of osteonecrosis. Current indications for hip Arthroscopy in pediatric patients include septic arthritis, labral disorders, slipped capital femoral epiphysis, and Legg-Calve-Perthes disease. The role of hip Arthroscopy in the pediatric population will continue to expand because of its attractiveness as a less invasive option for evaluating the hip.
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Hip Arthroscopy in the pediatric population.
Clinical orthopaedics and related research, 2003Co-Authors: Nicola A. Deangelis, Brian D. BusconiAbstract:Hip Arthroscopy has obvious advantages over arthrotomy in the pediatric population. Hip Arthroscopy, used as a diagnostic or therapeutic tool, is significantly less invasive than arthrotomy and allows for quicker recovery and return to activities. In addition, Arthroscopy avoids dislocation of the femoral head and the corresponding risk of osteonecrosis. Current indications for hip Arthroscopy in pediatric patients include septic arthritis, labral disorders, slipped capital femoral epiphysis, and Legg-Calve-Perthes disease. The role of hip Arthroscopy in the pediatric population will continue to expand because of its attractiveness as a less invasive option for evaluating the hip.
Marc R Safran - One of the best experts on this subject based on the ideXlab platform.
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a prospective blinded multicenter clinical trial to compare the efficacy accuracy and safety of in office diagnostic Arthroscopy with magnetic resonance imaging and surgical diagnostic Arthroscopy
Arthroscopy, 2018Co-Authors: Thomas J Gill, Marc R Safran, Bert R Mandelbaum, Bryan Huber, Ralph A Gambardella, John W XerogeanesAbstract:Purpose The purpose of this study was to compare the efficacy, accuracy, and safety of in-office diagnostic Arthroscopy with magnetic resonance imaging (MRI) and surgical diagnostic Arthroscopy. Methods A prospective, blinded, multicenter, clinical trial was performed on 110 patients, ages 18 to 75 years, who presented with knee pain. The study period was April 2012 to April 2013. Each patient underwent a physical examination, an MRI, in-office diagnostic imaging, and a diagnostic arthroscopic examination in the operating room. The attending physician completed clinical report forms comparing the in-office arthroscopic examination and surgical diagnostic Arthroscopy findings on each patient. Two blinded experts, unaffiliated with the clinical care of the study's subjects, reviewed the in-office arthroscopic images and MRI images using the surgical diagnostic Arthroscopy images as the "control" group comparison. Patients were consecutive, and no patients were excluded from the study. Results In this study, the accuracy, sensitivity, and specificity of in-office Arthroscopy was equivalent to surgical diagnostic Arthroscopy and more accurate than MRI. When comparing in-office Arthroscopy with surgical diagnostic Arthroscopy, all kappa statistics were between 0.766 and 0.902. For MRI compared with surgical diagnostic Arthroscopy, kappa values ranged from a low of 0.130 (considered "slight" agreement) to a high of 0.535 (considered "moderate" agreement). The comparison of MRI to in-office Arthroscopy showed very similar results as the comparison of MRI with surgical diagnostic Arthroscopy, ranging from a low kappa of 0.112 (slight agreement) to a high of 0.546 (moderate agreement). There were no patient-related or device-related complications related to the use of in-office Arthroscopy. Conclusions Needle-based diagnostic imaging that can be used in the office setting is statistically equivalent to surgical diagnostic Arthroscopy with regard to the diagnosis of intra-articular, nonligamentous knee joint pathology. In-office diagnostic imaging can provide a more detailed and accurate diagnostic assessment of intra-articular knee pathology than MRI. Based on the study results, in-office diagnostic imaging provides a safe, accurate, real-time, minimally invasive diagnostic modality to evaluate intra-articular pathology without the need for surgical diagnostic Arthroscopy or high-cost imaging. Level of Evidence Level II, comparative prospective trial.
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Incorporating Hip Arthroscopy Into A Practice.
Instructional course lectures, 2018Co-Authors: Marc R Safran, Asheesh Bedi, J.w. Thomas Byrd, Carlos A. Guanche, Victor M. Ilizaliturri, T. Sean Lynch, Hal D. Martin, Dean K. Matsuda, Joseph C. Mccarthy, Marc J. PhilipponAbstract:Hip Arthroscopy is one of the most rapidly growing areas in orthopaedic surgery because of increased awareness of nonarthritic hip pathologies, advanced imaging modalities, and advanced techniques to reproducibly manage nonarthritic hip pathologies within a deep soft-tissue envelope and a constrained joint. In addition, more academic medical centers are providing residents with education on hip Arthroscopy, and many hip preservation fellowships and courses are helping increase awareness of nonarthritic hip pathologies. Nonarthritic hip pathologies currently managed via hip Arthroscopy include nonrepairable labral lesions, femoroacetabular impingement, hip instability, and hip fractures. Periarticular hip pathologies currently managed via endoscopy include greater trochanteric pain syndrome, tendinopathy and tears of the gluteus medius and minimus, partial and complete hamstring avulsions, and sciatic nerve entrapment. Ischiofemoral impingement may be addressed endoscopically via the deep gluteal space. Orthopaedic surgeons should understand the role and safety of hip Arthroscopy in the pediatric population, specifically in the management of slipped capital femoral epiphysis, Legg-Calve-Perthes disease, and septic arthritis of the hip. The efficacy of hip Arthroscopy is limited, and hip Arthroscopy is relatively contraindicated in patients with osteoarthritis and hip dysplasia. Complications can occur and likely are underreported in patients who undergo hip Arthroscopy. Orthopaedic surgeons should understand practical issues associated with incorporating hip Arthroscopy into a practice, including the difficult learning curve associated with hip Arthroscopy and the reluctance of some payors to reimburse procedures performed arthroscopically because hip Arthroscopy is a relatively new technology.
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Hip Arthroscopy A Brief History
Clinics in sports medicine, 2016Co-Authors: Abdurrahman Kandil, Marc R SafranAbstract:Hip Arthroscopy is a fast-growing and evolving field. Like knee and shoulder Arthroscopy, hip Arthroscopy began as a diagnostic procedure and then progressed to biopsy and resection of abnormalities. Subsequently, it has evolved to repair of various tissues and treatment of underlying causes. As the understanding of the hip joint and its associated pathophysiology grows, indications will continue to expand for this diagnostic and therapeutic modality. This article outlines the historic developments of hip Arthroscopy, including advancements in instrumentation and techniques from the days of the first hip arthroscopies to the present day.
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Hip Arthroscopy: from the beginning to the future—an innovator’s perspective
Knee Surgery Sports Traumatology Arthroscopy, 2014Co-Authors: James M. Glick, Frank Valone, Marc R SafranAbstract:Hip Arthroscopy is one of the fastest-growing areas of orthopaedic surgery. There are many reasons for this, including a better understanding of the pathophysiology of damage to the hip joint, improvements in imaging and technology advancements in arthroscopic instrumentation. This manuscript documents the historical development of hip Arthroscopy, in general, as well as advances and ideas that have led to common techniques with regard to portal placement, traction and instrumentation. These advances have led to expanding indications for hip Arthroscopy. This manuscript ends with some thoughts about the future of hip Arthroscopy from the perspective of one of the leaders who helped shape hip Arthroscopy, as it is performed today.
Martin Lind - One of the best experts on this subject based on the ideXlab platform.
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Clinical outcomes after revision hip Arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) are inferior compared to primary procedures. Results from the Danish Hip Arthroscopy Registry (DHAR)
Knee Surgery Sports Traumatology Arthroscopy, 2020Co-Authors: Bjarne Mygind-klavsen, Torsten Grønbech Nielsen, Bent Lund, Martin LindAbstract:Purpose As many as 10% of primary hip arthroscopies end up with a revision Arthroscopy procedure when treating patients suffering from femoroacetabular impingement syndrome (FAIS). In general, revision procedures are indicated because of residual impingement, but only a few studies present outcome data from revision hip Arthroscopy after failed FAIS surgical treatment. The purpose of this study was to evaluate clinical outcomes after revision hip Arthroscopy in a FAIS cohort and compare outcomes with a primary FAIS hip Arthroscopy cohort and describe potential causes of failure after the primary hip Arthroscopy. It was hypothesized that subjective outcomes improve after revision hip Arthroscopy although outcomes were expected to be inferior to primary hip arthroscopic outcomes. Methods Three-hundred and thirty-one arthroscopic revision hip FAIS patients were included from the Danish Hip Arthroscopy Registry (DHAR). Patient-related outcome measures (PROM’s), Copenhagen Hip and Groin Outcome Scores (HAGOS), Hip Sports Activity Scale (HSAS), EQ-5D and Numeric Rating Scale (NRS) pain, were assessed in the study cohort prior to the primary procedure and at revision and at follow-up one year after the revision procedure. These data were compared with 4154 primary hip arthroscopic FAIS patients. Results One-year after revision surgery, mean follow-up (in months ± SD): 12.3 ± 1.6, significant improvements ( p
