RESUMO
BACKGROUND: Accurate hip reconstruction is associated with improved biomechanical behavior following total hip arthroplasty (THA). However, whether this is associated with improved patient-reported outcome measures (PROs) is unknown. HYPOTHESIS/PURPOSE: This study aimed to: 1) Describe the ability to reconstruct coronal geometry during THA without advanced technology; 2) Assess whether restoration of global offset (GO) and leg length (LL) is associated with improved PROs; and 3) Investigate whether increased femoral offset (FO) to compensate for reduced acetabular offset (AO) influences PROs. METHOD: This was a prospective, multi-center, consecutive cohort study of 500 patients treated with primary THA without robotics or navigation. The Oxford Hip Score (OHS) was obtained pre-operatively and at 1-year follow-up. Supine anteroposterior (AP) pelvic radiographs were analyzed to determine AO, FO, GO, and LL relative to the native contralateral side. Contour plots for ΔOHS based on ΔLL and ΔGO were created, and ΔOHS was calculated within and outside various ranges (± 2.5, ± 5, or ± 10 mm). RESULTS: The mean GO and LL differences between sides were 0 ± 7 mm and 0 ± 8 mm, respectively. In the operated hip, mean FO increased to 3 ± 6 mm (range, -16 to 27), while AO decreased to 2 ± 4 mm (range, -17 to 10). The contour graph for ± 2.5 mm zones showed the best outcomes (ΔOHS > 25) with GO and LL centered on 0 ± 2.5 mm (P < 0.01). However, only 10% achieved such reconstruction. When GO and LL differences were within ± 10 mm, ΔOHS was superior when both AO and FO were within ± 5 mm (mean: 24 ± 10; range, -5 to 40) compared to when FO was above 5 mm to compensate for a reduction in AO (mean: 22 ± 11; range, -10 to 46; P = 0.040). DISCUSSION: Mean GO and LL reconstruction were both 0 mm, with a precision of 7 and 8 mm, respectively, using manual techniques. The PROs were associated with biomechanical reconstruction, and the best clinical improvement can be expected when GO and LL differences are both within 2.5 mm. Maintenance of AO is important, as compensation by increasing FO is associated with inferior OHS.
RESUMO
BACKGROUND: Reduction of waste and carbon footprint can be optimized. Awareness of carbon sources and quantification of the waste are two key parameters. To our knowledge, there is no study in France on waste production by the surgical team during the operation in orthopedic surgery, in a global scope. Therefore, we performed an observational investigation aiming to: (1) quantify and characterize the weight of the wastes generated after a panel of orthopedic procedures, (2) calculate the CO2 footprint generated by these wastes and extrapolate the figure at the national scale. HYPOTHESIS: Waste production is highly variable according to the types of procedures and infectious clinical waste is still a predominant source of waste and CO2 emission. MATERIALS AND METHODS: It is a comparative and prospective study in which a total of 14 procedures were selected as a representative panel: arthroplasties (hip, knee), spine fusions, arthroscopic procedures (shoulder, knee), nerve release, forefoot osteotomies, trauma procedures. The main outcome was the average total weight of waste for each of the fourteen categories (280 measurements: 140 times 2, at the end of each procedure), expressed in kilograms (kg), and the proportions of infectious clinical waste (ICW) and household wastes (HW), expressed in percentages. Ten measures were prospectively recorded for each type of procedure in a single teaching hospital from January to September 2022. The theoretical carbon footprint generated by the treatment of the wastes was estimated in kilograms of CO2 equivalent (KgEqCO2). The national extrapolation of the carbon footprint was performed by collecting the total number of procedures in France in 2021 using the VisuChir tool. RESULTS: A total of 937kg of waste were produced for the 140 procedures, amongst which 514kg of ICW (54.8%) and 423kg of HW (45.2%). The overall median waste weight was 5.9kg (Q1: 4.4, Q3: 8.1), ranging from 1.8kg to 18.3kg. The overall median waste weight for HW was 2.8kg (Q1: 2.5, Q3: 3.4), ranging from 1.8kg to 17.8kg. The overall median waste weight for ICW was 3.8kg (Q1: 2.7, Q3: 4.8), ranging from 0.8kg to 7.2kg. The knee surgeries were responsible for the heaviest waste weight; the least waste-productive procedures were the foot and the carpal tunnel release. The median proportions of ICW varied from 39% for the total knee replacements to 72% for the femoral nails. There was a significant inverse correlation between the total waste weight and the proportion of ICW: r=-0.47, p<10-4. The total median estimated carbon footprint was 4.3KgCO2Eq (Q1: 3.1, Q3: 5.8), ranging from 1.59KgCO2Eq (Q1: 1.5, Q3: 1.8) and 7.07KgCO2Eq (Q1: 6.7, Q3: 8.17). The total median estimated carbon footprint was 3.5KgCO2Eq for ICW (Q1: 2.5, Q3: 4.5) and 0.76KgCO2Eq (Q1: 0.54, Q3: 1.3) for HW. The national median estimated carbon footprint was 10.1 million KgEqCO2 in 2021 for orthopedic surgery. CONCLUSION: Our study revealed that in most cases more than half of the wastes were ICW. The total estimated national carbon footprint for orthopedic procedures was 10 million kilograms. The reduction of the ICW constitutes a cornerstone, as they are responsible for more carbon emissions. LEVEL OF EVIDENCE: III; prospective comparative observational in vivo study.
