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Vikas Khanduja - One of the best experts on this subject based on the ideXlab platform.

  • virtual reality Hip Arthroscopy simulator demonstrates sufficient face validity
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Jonathan Bartlett, John E Lawrence, Vikas Khanduja
    Abstract:

    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.

  • testing the construct validity of a virtual reality Hip Arthroscopy simulator
    Arthroscopy, 2017
    Co-Authors: Vikas Khanduja, John E Lawrence, Emmanuel Audenaert
    Abstract:

    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.

Marc J. Philippon - One of the best experts on this subject based on the ideXlab platform.

  • survivorsHip and outcomes 10 years following Hip Arthroscopy for femoroacetabular impingement labral debridement compared with labral repair
    Journal of Bone and Joint Surgery American Volume, 2017
    Co-Authors: Travis J Menge, Karen K Briggs, Grant J Dornan, Shannen Mcnamara, Marc J. Philippon
    Abstract:

    Background:Studies have demonstrated Hip Arthroscopy to be an effective treatment for femoroacetabular impingement (FAI) with associated labral tears. The purposes of this study were to report 10-year outcomes and Hip survival following Hip Arthroscopy for FAI and to compare labral debridement with

  • Hip Arthroscopy in patients age 40 or older a systematic review
    Arthroscopy, 2017
    Co-Authors: Nolan S Horner, Marc J. Philippon, Marc R Safran, Nicole Simunovic, Seper Ekhtiari, Olufemi R Ayeni
    Abstract:

    Purpose To (1) report clinical outcomes, complication rates, and total Hip arthroplasty (THA) conversion rates for patients age 40 or older who underwent Hip Arthroscopy, and (2) report any age-related predictors of outcome identified in the literature. Methods MEDLINE, EMBASE, and PubMed were searched for relevant studies and pertinent data were abstracted from eligible studies. No meta-analysis was performed because of heterogeneity amongst studies. Results Seventeen studies were included in this review comprising 16,327 patients, including 9,954 patients age 40 or older. All studies reported statistically significant improvements in outcomes after Hip Arthroscopy for femoral osteochondroplasty, labral repair, or unspecified indications. In patients 40 or older who underwent labral debridement, these improvements were not clinically significant. Obesity and osteoarthritic changes predicted poorer outcomes. Only 1 of 3 studies directly comparing the 2 groups found that patients 40 or older had a significantly less improvement in a standardized Hip outcome score than patients under 40 after Hip Arthroscopy, but all found that patients 40 or older had significantly higher rates of THA conversion. The rate of conversion to THA was 18.1% for patients 40 or older, 23.1% for patients over 50, and 25.2% for patients over 60 with a mean of 25.0 months to THA. Conclusions Indications for Hip Arthroscopy including femoral osteochondroplasty and labral repair resulted in clinically significant improvements in patients 40 or older in most research studies examined in this review, whereas labral debridement did not produce clinically significant improvements postoperatively in the same studies. In these studies, the rate of conversion to THA is higher than in patients under 40 and increases with each decade of life, with many individual studies showing a significant increase in the rate of THA conversion. Hip Arthroscopy may be suitable for some patients 40 or older, but patient selection is key and patients should be informed of the higher risk of conversion to THA. Level of Evidence Level IV, systematic review of Level III and IV studies.

  • predictors of length of career after Hip Arthroscopy for femoroacetabular impingement in professional hockey players
    American Journal of Sports Medicine, 2016
    Co-Authors: Travis J Menge, Karen K Briggs, Marc J. Philippon
    Abstract:

    Background:Previous studies have shown that professional hockey players return to sport at a high rate after Hip Arthroscopy, although it is unknown how long players continue to compete at a professional level after surgery.Purpose:To determine the prevalence of athletes who continued playing in the National Hockey League (NHL) for a minimum of 5 years after Hip Arthroscopy for treatment of symptomatic femoroacetabular impingement (FAI) and to determine predictors associated with length of career.Study Design:Case series; Level of evidence, 4.Methods:A total of 60 professional hockey players (69 Hips) underwent Hip Arthroscopy for FAI by a single surgeon between 2005 and 2010. Data were retrieved from NHL.com and Hockey-reference.com regarding information on each player’s professional career. Position played, age, surgical procedure, and intraoperative findings were also used in data analysis.Results:There were 12 centers, 15 defensemen, 16 goalies, and 17 wings studied. Of the 60 athletes, 40 (67%) conti...

  • gross instability after Hip Arthroscopy an analysis of case reports evaluating surgical and patient factors
    Arthroscopy, 2016
    Co-Authors: Marco Yeung, Marc J. Philippon, Nicole Simunovic, Muzammil Memon, Etienne L Belzile, Olufemi R Ayeni
    Abstract:

    Purpose Gross Hip instability is a rare complication after Hip Arthroscopy, and there is limited literature surrounding this topic. This systematic review investigates cases of gross Hip instability after Arthroscopy and discusses the risk factors associated with this complication. Methods A systematic search was performed in duplicate for studies investigating gross Hip instability after Hip Arthroscopy up to October 2015. Study parameters including sample size, mechanism and type of dislocation, surgical procedure details, patient characteristics, postoperative rehabilitation protocol, and level of evidence were analyzed. Results The systematic review identified 9 case reports investigating gross Hip instability after Hip Arthroscopy (10 patients). Anterior dislocation occurred in 66.7% of patients, and most injuries occurred with a low-energy mechanism. Common surgical factors cited included unrepaired capsulotomy (77.8%) and iliopsoas release (33.3%), whereas patient factors included female gender (77.8%), acetabular dysplasia (22.2%), and general ligamentous laxity (11.1%). Postoperative restrictions and protocols were variable and inconsistently reported, and their relation to post-Arthroscopy instability was difficult to ascertain. Conclusions This systematic review discussed various patient, surgical, and postoperative risk factors of gross Hip instability after Arthroscopy. Patient characteristics such as female gender, Hip dysplasia, and ligamentous laxity may be risk factors for post-Arthroscopy dislocation. Similarly, surgical risk factors for iatrogenic Hip instability may include unrepaired capsulotomies and iliopsoas debridement, although the role of capsular closure in iatrogenic instability is not clear. The influences of postoperative restrictions and protocols on dislocation are also unclear in the current literature. Surgeons should be cognizant of these risk factors when performing Hip Arthroscopy and be mindful that these factors appear to occur in combination. Level of Evidence Level IV, systematic review of Level IV studies.

  • revision Hip Arthroscopy indications and outcomes a systematic review
    Arthroscopy, 2015
    Co-Authors: Vandit Sardana, Marc J. Philippon, Asheesh Bedi, Nicole Simunovic, Olufemi R Ayeni
    Abstract:

    Purpose To identify the indications and outcomes in patients undergoing revision Hip Arthroscopy. Methods The electronic databases Embase, Medline, HealthStar, and PubMed were searched from 1946 to July 19, 2014. Two blinded reviewers searched, screened, and evaluated the data quality of the studies using the Methodological Index for Non-Randomized Studies scale. Data were abstracted in duplicate. Agreement and descriptive statistics are presented. Results Six studies were included (3 prospective case series and 3 retrospective chart reviews), with a total of 448 Hips examined. The most common indications for revision Hip Arthroscopy included residual femoroacetabular impingement (FAI), labral tears, and chondral lesions. The mean interval between revision Arthroscopy and the index procedure was 25.6 months. Overall, the modified Harris Hip Score improved by a mean of 33.6% (19.3 points) from the baseline score at 1-year follow-up. In 14.6% of patients, further surgical procedures were required, including re-revision Hip Arthroscopy (8.0%), total Hip replacement (5.6%), and Hip resurfacing (1.0%). Female patients more commonly underwent revision Hip Arthroscopy (59.7%). Conclusions The current evidence examined in this review supports revision Hip Arthroscopy as a successful intervention to improve functional outcomes (modified Harris Hip Score) and relieve pain in patients with residual symptoms after primary FAI surgery, although the outcomes are inferior when compared with a matched cohort of patients undergoing primary Hip Arthroscopy for FAI. The main indication for revision is a candidate who has symptoms due to residual cam- or pincer-type deformity that was either unaddressed or under-resected during the index operation. However, it is important to consider that the studies included in this review are of low-quality evidence. Surgeons should consider incorporating a minimum 2-year follow-up for individuals after index Hip-preservation surgery because revisions tended to occur within this time frame. Level of Evidence Level IV, systematic review of Level III and IV studies.

Jonathan Bartlett - One of the best experts on this subject based on the ideXlab platform.

  • virtual reality Hip Arthroscopy simulator demonstrates sufficient face validity
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Jonathan Bartlett, John E Lawrence, Vikas Khanduja
    Abstract:

    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.

John E Lawrence - One of the best experts on this subject based on the ideXlab platform.

  • virtual reality Hip Arthroscopy simulator demonstrates sufficient face validity
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Jonathan Bartlett, John E Lawrence, Vikas Khanduja
    Abstract:

    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.

  • testing the construct validity of a virtual reality Hip Arthroscopy simulator
    Arthroscopy, 2017
    Co-Authors: Vikas Khanduja, John E Lawrence, Emmanuel Audenaert
    Abstract:

    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.

Richard N. Villar - One of the best experts on this subject based on the ideXlab platform.

  • does the modified harris Hip score reflect patient satisfaction after Hip Arthroscopy
    American Journal of Sports Medicine, 2012
    Co-Authors: Alessandro Aprato, Nimal Jayasekera, Richard N. Villar
    Abstract:

    BACKGROUND: No published studies have explored the relationsHip between commonly reported clinical outcomes and patient satisfaction after Hip Arthroscopy. PURPOSE: To compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a 2-year period. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We reviewed our institutional database for prospectively collected mHHS and patient satisfaction data from 697 patients. Patients were evaluated preoperatively and at 1 and 2 years after surgery. RESULTS: The mHHS correlated with patient satisfaction at 1 year (P < .001, Pearson R = 0.451) and at 2 years (P < .001, Pearson R = .454). Considering scores from excellent to good as positive results and from fair to poor as negative results, sensitivity was 73% at 1 year and 77% at 2 years. Respectively, the specificity was 64% and 73%, positive predictive value 86% and 91%, negative predictive value 45% and 46%, and accuracy 71% and 76%. At 1- and 2-year follow-up, a respective 55% and 54% of patients with fair to poor mHHS were satisfied with the outcome of Hip Arthroscopy. In contrast, for those patients with an excellent to good mHHS at 1 and 2 years after surgery, 14% and 9%, respectively, were dissatisfied with their outcome. CONCLUSION: Our results show a correlation between patient satisfaction and the mHHS but also demonstrate a limitation of the mHHS as an outcome measure in the prediction of patient satisfaction. Further investigation is required to assess factors beyond current standard orthopaedic clinical outcome measures that may influence patient satisfaction after Hip Arthroscopy.

  • does the modified harris Hip score reflect patient satisfaction after Hip Arthroscopy
    American Journal of Sports Medicine, 2012
    Co-Authors: Alessandro Aprato, Nimal Jayasekera, Richard N. Villar
    Abstract:

    BACKGROUND: No published studies have explored the relationsHip between commonly reported clinical outcomes and patient satisfaction after Hip Arthroscopy. PURPOSE: To compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a 2-year period. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We reviewed our institutional database for prospectively collected mHHS and patient satisfaction data from 697 patients. Patients were evaluated preoperatively and at 1 and 2 years after surgery. RESULTS: The mHHS correlated with patient satisfaction at 1 year (P < .001, Pearson R = 0.451) and at 2 years (P < .001, Pearson R = .454). Considering scores from excellent to good as positive results and from fair to poor as negative results, sensitivity was 73% at 1 year and 77% at 2 years. Respectively, the specificity was 64% and 73%, positive predictive value 86% and 91%, negative predictive value 45% and 46%, and accuracy 71% and 76%. At 1- and 2-year follow-up, a respective 55% and 54% of patients with fair to poor mHHS were satisfied with the outcome of Hip Arthroscopy. In contrast, for those patients with an excellent to good mHHS at 1 and 2 years after surgery, 14% and 9%, respectively, were dissatisfied with their outcome. CONCLUSION: Our results show a correlation between patient satisfaction and the mHHS but also demonstrate a limitation of the mHHS as an outcome measure in the prediction of patient satisfaction. Further investigation is required to assess factors beyond current standard orthopaedic clinical outcome measures that may influence patient satisfaction after Hip Arthroscopy.

  • Hip Arthroscopy current concepts and review of literature
    British Journal of Sports Medicine, 2007
    Co-Authors: Vijay D Shetty, Richard N. Villar
    Abstract:

    Diagnosis and treatment of intra-articular Hip problems in young patients present a challenge to Hip surgeons. Previous studies have shown that non-invasive investigations such as radiography, computed tomography and magnetic resonance imaging provide limited help. Non-operative treatment is likely to result in persistent symptoms, and surgical options for intra-articular Hip problems involve open arthrotomy of the Hip joint, which carries potential risks associated with joint dislocation. Arthroscopy of the Hip joint, therefore, seems to be an attractive option. It was once thought that introduction of a straight arthroscope into the ball-and-socket Hip joint was almost impossible. Hip Arthroscopy has seen several advances since then, and the speed at which it developed in recent years directly corresponded to the rate at which the conditions affecting the Hip joint were identified. Athletes and other young individuals with Hip injuries are increasingly being diagnosed with an ever evolving series of conditions. Many of these conditions were previously unrecognised and thus left untreated, resulting in premature ends to the patients’ competitive careers. Hip Arthroscopy, as with any procedure, is not without risks. The procedure is not widely available as it requires specialist equipment and takes a long time to learn. Complications are few, occurring in