<% '**** Page Variables - volume variable is required, others are optional **** headerLogo = "ojhms" headerPhoto = "" headerMainTitle = "" authorName = "" authorTitle = "" bgTile = "" volume = "volume9" %>
Mark C. Gebhardt, MD
Third Session
Moderator: Mark C. Gebhardt, MD

Micahel N. Fehm, MD Daniel Estok, MD
Repair of Massive Abductor Loss After Total Hip Replacement Using Achilles Tendon Allograft
Micahel N. Fehm, MD
Discussor: Daniel Estok, MD
Advisor: Dennis, W. Burke, MD

Abductor failure after total hip arthroplasty is a rare but debilitating problem. Dr. Fehm reviewed a new technique using fresh-frozen Achilles tendon allograft with an attached calcaneal bone graft to reconstruct a deficien abductor mechanism. At an average follow-up of 25 months, he found the average post-reconstruction Harris Hip Score to be 85.9 and average pain score to be 38.9 compared to 34.7 and 11.4, respectively, in the pre-reconstructed hips. He concluded that in his series, the technique offers significant pain relief and improvement in function at early follow-up.

Dr. Estok praised Dr. Fehm’s work explaining that even with all the advances in THR the loss of the abductors remained an unsolved problem. He asked whether there was any role for modalities such as EMG to help with decision making. Dr. Fehm responded that while they didn’t directly look at this, there could be a useful role. He also suggested that modalities such as MRI to look for abductor fatty degeneration (analogous to what’s done in rotator cuff disease) may be a useful adjunct.

George S.M. Dyer, MD Kevin Raskin, MD
Improving Evaluation of Orthopaedic Surgical Teaching
George S.M. Dyer, MD
Discussor: Kevin Raskin, MD
Advisor: James Herndon, MD, MBA

Surgical teaching in the operating room is the cornerstone of orthopaedic residency training. Dr. Dyer explained that the existing tools for evaluating surgical teaching are inadequate and frustrating, for trainee and staff surgeon alike and an ideal evaluation tool should meaningfully measure key teaching behaviors relevant to instruction in surgery. His study sought to improve methods for evaluation and feedback of orthopaedic surgical residents and to improve the mentorship and instruction that defines academic orthopaedic surgery. Dr. Raskin stated that Dr. Dyer’s work was of critical importance in today’s surgical educational climate. There are more and more external pressures to develop tools to ensure that surgical residents are properly trained. Dr. Raskin asked with specific reference to our own program how a better teaching environment could be achieved. Dr. Dyer pointed out that two factors are at play: He noted the need for longer resident rotations so that attendings could become more familiar with residents and the need for patience on the part of attendings.

Stefan R. Jibodh, MD Dennis Burke, MD
Comparison of Modular and Non-Modular Cementless Stems in Revision Total Hip Arthroplasty
Stefan R. Jibodh, MD
Discussor: Dennis Burke, MD
Advisor: Daniel Estok, MD

The gold standard for revision total hip arthroplasty is non-modular cementless implants. Recently modular implants were introduced in an attempt to improve on these results. Dr. Jibodh compared two groups of patients with modular and non-modular implants at a minimum of 5 year follow-up with clinical and radiographic outcomes. While the Harris hip scores were similar in the two groups, there was a trend toward more early failures in the nonmodular group and a significant increase in the amount of proximal ingrowth in the modular group. A large percentage of the modular stems demonstrated a pattern of dual (proximal and distal) ingrowth.

Dr. Burke asked Dr. Jibodh about the incidence of stem fractures in the ZMR (modular) group. Dr. Jibodh noted that the documented risk of stem fracture in the modular group is very low and can be minimized by ensuring stem implantation with adequate proximal support. Dr. Burke agreed with Dr. Jibodh’s analysis that there was a wealth of products on the market but very little comparative data. He then recounted his own experience with modular stems and asked Dr. Jibodh about the problem of stem dissociation and breakage. Dr. Jibodh agreed that this was a problem with modular stem design, but in his analysis it didn’t rise to the level of being a significant problem.