Response to Letter to the Editor, "Who Restores Hip Biomechanics More Effectively After a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed Either by Hip Surgeons or Orthopedic Residents".

Abstract

We have read with particular interest the comments made by the author on our recent article published in Arthroplasty Today, entitled “Who restores hip biomechanics more effectively after a femoral neck fracture? Comparison of total hip arthroplasties performed either by hip surgeons or orthopedic residents”. First, we would like to thank our colleague for reading our article and the pertinent and precise comment. We would like to address our colleague's inquiries, acknowledging the study's limitations that might also lead to the misinterpretation of the results. We agreed with the author's comment regarding the underestimation of the differences in the leg length measurements. Even though we correctly describe the leg length discrepancy measurement in the Methods section under the subheading Leg-length discrepancy, we made a mistake when drawing the measured parameters. As the correspondent author, I assume the entire responsibility for this misinterpretation. In this sense, the green line in Figure 1a representing the leg length discrepancy measurement should be proximally moved to the center of the femoral head, to explain our description in the Methods section. Once the leg length discrepancy was measured using the teardrop and lesser trochanter horizontal lines and to get an accurate measurement avoiding underestimation, the discrepancy of the center of rotation must be subtracted to exclude the acetabular factor and obtain the discrepancy only from the femur [1Sarangi P.P. Bannister G.C. Leg length discrepancy after total hip replacement.Hip Int. 1997; 7: 121Crossref Scopus (19) Google Scholar, 2Keršič M. Dolinar D. Antolič V. Mavčič B. The impact of leg length discrepancy on clinical outcome of total hip arthroplasty: comparison of four measurement methods.J Arthroplasty. 2014; 29: 137Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 3Flecher X. Ollivier M. Argenson J.N. Lower limb length and offset in total hip arthroplasty.Orthop Traumatol Surg Res. 2016; 102: S9Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar]. It is well-known that preoperative templating helps orthopedic surgeons assess leg length discrepancy [[4]Sculco P.K. Cottino U. Abdel M.P. Sierra R.J. Avoiding hip instability and limb length discrepancy after total hip arthroplasty.Orthop Clin North Am. 2016; 47: 327Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar,[5]Meermans G. Malik A. Witt J. Haddad F. Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty.Clin Orthop Relat Res. 2011; 469: 1677Crossref PubMed Scopus (103) Google Scholar], but it is influenced by changes in the position of limbs, pelvis, and radiographic technique. Different methods have been reported to determine discrepancies [1Sarangi P.P. Bannister G.C. Leg length discrepancy after total hip replacement.Hip Int. 1997; 7: 121Crossref Scopus (19) Google Scholar, 2Keršič M. Dolinar D. Antolič V. Mavčič B. The impact of leg length discrepancy on clinical outcome of total hip arthroplasty: comparison of four measurement methods.J Arthroplasty. 2014; 29: 137Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 5Meermans G. Malik A. Witt J. Haddad F. Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty.Clin Orthop Relat Res. 2011; 469: 1677Crossref PubMed Scopus (103) Google Scholar], but the question remains to be answered, Which better provides the correct measurement? In this sense, we can suggest that radiographic measurements must be associated with clinical measurement methods during preoperative and postoperative assessments to achieve a complete and more accurate analysis. We are aware of the limitations of our study. However, we want to highlight the importance of performing these types of studies to understand how we supervise and train our residents to develop future training methods and programs. We hope that with these amendments, we correctly answered our colleague's comments. The authors declare there are no conflicts of interest. The study was performed at the Italian Hospital of Buenos Aires, Argentina. Download .pdf (.05 MB) Help with pdf files Conflict of Interest Statement for Agustin Download .pdf (.06 MB) Help with pdf files Conflict of Interest Statement for Fernando Download .pdf (.05 MB) Help with pdf files Conflict of Interest Statement for Fernando Download .pdf (.06 MB) Help with pdf files Conflict of Interest Statement for Francisco Download .pdf (.07 MB) Help with pdf files Conflict of Interest Statement for Gerardo Download .pdf (.06 MB) Help with pdf files Conflict of Interest Statement for Jose Ignacio Download .pdf (.06 MB) Help with pdf files Conflict of Interest Statement for Lionel Download .pdf (.06 MB) Help with pdf files Conflict of Interest Statement for Martin Alejandro Download .pdf (.06 MB) Help with pdf files Conflict of Interest Statement for Martin Download .pdf (.05 MB) Help with pdf files Conflict of Interest Statement for Pablo Ariel Isidoro Letter to the Editor, “Who Restores Hip Biomechanics More Effectively After a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopedic Residents”Arthroplasty TodayVol. 7PreviewFirst, thank you to the authors of the article, “Who Restores Hip Biomechanics More Effectively After A Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopedic Residents” [1]. This is an interesting topic as currently there is literature demonstrating complications decrease with yearly volume in total joint arthroplasty such that it is difficult to define what is an adequate number of cases a trainee needs before obtaining competency [2]. In the United States, the number of hip arthroplasties required by the American Accreditation of Graduate Medical Education before completion of a residency is only 30 over a 5-year period [3], which would be considered low volume by surgeon standards such that these data are a helpful contribution to the literature in establishing competency of trainees. Full-Text PDF Open Access