All Publications

  • Case-Controlled Analysis of the Direct Superior and Mini-Posterior Approach for Total Hip Arthroplasty at a Minimum of Two Years of Follow Up. Surgical technology international Ezzibdeh, R., Korth, M. J., Arora, P., Amanatullah, D. F. 2021; 37


    INTRODUCTION: The direct superior approach to total hip arthroplasty (THA) is a recently developed technique aimed at sparing the iliotibial band, obturator externus tendon, and quadratus femoris muscle while working within the familiar anatomical landscape of the posterior approach. While the direct superior approach has been used for more than a decade, there is a lack of midterm outcomes and safety data. This study elaborates on promising short-term results and aims to investigate the midterm outcomes of the direct superior approach.MATERIALS AND METHODS: We present a unicentric, retrospective case-controlled analysis of a minimum two-year follow up of the direct superior approach in comparison to those of the more conventional and established mini-posterior approach.RESULTS: The results indicate that patient recovery, as measured by Harris Hip Score and timed-up-and-go at three months and two years, are virtually identical. There was no difference in gait aid utilization or frequency of narcotic use. However, there was a statistically significant reduction in length of stay by over one day associated with the direct superior approach (p=0.003). There was no compromise in acetabular component position or observed lucencies over time.CONCLUSION: Overall, the direct superior approach appears to be safe and warrants longer-term study to evaluate its effect on hospital-related cost, same-day discharge, and hip stability.

    View details for PubMedID 33463694

  • Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up. Surgical technology international Korth, M. J., Ezzibdeh, R., Arora, P., Amanatullah, D. F. 2021; 37


    This study aims to establish the midterm safety and performance for the direct superior approach to minimally invasive surgery total hip arthroplasty (MIS-THA). We used a unicentric, single-surgeon, retrospective, consecutive case series analysis of the first 40 patients who received primary unilateral direct superior MIS-THA. Special attention was given to functional recovery by measuring Harris Hip Score (HHS) and timed-up-and-go (TUG) with a mean follow up of 2.2 ± 0.4 years. A radiologic evaluation was performed. HHS and TUG improved significantly at three months and one year (p < 0.001). All components were placed within the Lewinnek safe zone with no change position or signs of loosening at two years. With a minimum of two years of follow up, the direct superior approach appears to be safe without any obvious or consistent postoperative complications-clinically or radiographically-with excellent functional recovery. Additionally, our subgroup analysis supported no late learning curve effect.

    View details for PubMedID 33463695

  • Learning Curve for the Direct Superior Approach to Total Hip Arthroplasty ORTHOPEDICS Ezzibdeh, R. M., Barrett, A. A., Arora, P., Amanatullah, D. F. 2020; 43 (4): E237–E243


    Surgical learning curves are a representation of the number of cases required for a surgeon to reach a stable rate of outcomes and complications. In this study, the authors present the learning curve for the direct superior (DS) approach to total hip arthroplasty, which is a muscle-sparing modification to the mini-posterior technique. This was a retrospective analysis of the first 40 primary DS cases done by a single surgeon. These cases were divided into 2 groups of 20 and compared for intra- and postoperative complications, acetabular component positioning, and Harris Hip Score at 90 days after surgery. As a control, the first 20 primary mini-posterior cases were analyzed as the baseline performance of the surgeon and the DS approach. There was no statistically significant difference between the first and second sets of DS patients regarding Harris Hip Score, intraoperative complications, dislocations, estimated blood loss, length of hospital stay, and components positioned within the Lewinnek safe zone. The only statistically significant difference between the first and second sets of DS cases was a decrease in operating time (P<.001). This suggests that the learning curve is less than 20 patients. The results also indicate that the first 20 DS cases ambulated farther (P=.007) and had a shorter length of stay (P=.007), outperforming the mini-posterior approach. This study suggests that the DS learning curve is short for surgeons trained in the posterior approach. The data could be especially pertinent as 90-day results and safety are becoming increasingly important in evaluating performance for bundled-payment models. [Orthopedics. 2020;43(4):e237-e243.].

    View details for DOI 10.3928/01477447-20200404-05

    View details for Web of Science ID 000565459300008

    View details for PubMedID 32271934

  • Short-Term Safety of the Direct Superior Approach for Total Hip Arthroplasty SURGICAL TECHNOLOGY INTERNATIONAL-INTERNATIONAL DEVELOPMENTS IN SURGERY AND SURGICAL RESEARCH Ezzibdeh, R. M., Barrett, A., Arora, P., Kaplan, L., Roger, D., Ward, D., Mas Martinez, J. J., Amanatullah, D. F. 2020; 36
  • The impact of COVID-19 on global disparities in surgical training in pediatric otolaryngology. International journal of pediatric otorhinolaryngology Munjal, T. n., Kavanagh, K. R., Ezzibdeh, R. M., Valdez, T. A. 2020; 138: 110267


    To assess global trends in otolaryngologic and non-otolaryngologic education in response to COVID-19, specifically with regard to surgical simulation and personnel reallocation needs in case of patient demand.Online survey.A multiple-choice survey regarding operative caseload and impact on resident education was sent to Otolaryngology residents and Pediatric Otolaryngology faculty globally. The survey was open for responses for ten days in March 2020.A total of 96 completed surveys were received across 22 countries. 87.5% of respondents reported that no supplementary operative education is being provided. Despite 71.43% of responses indicating that simulation was useful for all levels of residents, 20.95% of responses indicated that simulation is not possible at their institution, with the majority of these being skewed toward responses from South America.Despite the majority of respondents stating that simulation was helpful, there were disparities in access to simulation seen across countries. The results inform the need for a coordinated effort to expand educational efforts outside of the operating room and clinical environment. A major limitation of this study is the low domestic response rate.

    View details for DOI 10.1016/j.ijporl.2020.110267

    View details for PubMedID 32705990

  • Short-Term Safety of the Direct Superior Approach for Total Hip Arthroplasty. Surgical technology international Ezzibdeh, R. M., Barrett, A., Arora, P., Kaplan, L., Roger, D., Ward, D., Mas Martinez, J. J., Amanatullah, D. F. 2019; 36


    INTRODUCTION: Minimally invasive surgery total hip arthroplasty (MIS-THA) is becoming increasingly popular. There are several approaches to MIS-THA that vary according to anatomical access to the hip joint. The direct superior (DS) approach is a recent modification of an MIS posterior approach that spares the iliotibial band and most of the short external rotators of the hip, particularly the quadratus femoris. While FDA approved, there is a lack of data in the current literature on DS outcomes and the safety of this approach is yet to be systematically evaluated.MATERIALS AND METHODS: The goal of this study is to provide a quantitative analysis of the safety and complications of primary DS-total hip arthroplasty at 90 days post-surgery through a retrospective multicenter case series of 301 patients. Special attention was given to intra- and postoperative complications, readmissions, mean operative time, hospital-stay length, and postoperative ambulation distance.RESULTS: Surgical complications included three (1%) intraoperative calcar fractures and four (1%) postoperative peri-prosthetic fractures. The postoperative medical complication rate was 3% with four (1%) patients requiring readmission. The mean operative time was 70 ± 19 minutes, hospital-stay length 41 ± 19 hours, and the estimated blood loss (EBL) was 213 ± 129 ml. There were no acute episodes of instability at 90-day follow up. The intra- and postoperative results are similar with those reported in the literature for both the anterior and posterior approaches.CONCLUSION: This study indicates that the DS approach appears to be safe with a low complication rate at 90 days that is comparable to more conventional approaches, such as the direct anterior and posterior techniques. This information is also valuable for the evaluation of reimbursements for DS-THA as current bundled-payment models heavily emphasize 90-day outcomes and complications. Long-term direct comparative studies with the anterior and posterior approaches is required to fully evaluate DS-THAs.

    View details for PubMedID 31821527

  • Utilization of a pneumatic exoskeleton after total knee arthroplasty. Arthroplasty today Ezzibdeh, R., Arora, P., Amanatullah, D. F. 2019; 5 (3): 314–15


    Exoskeletons are wearable, powered devices intended to support and augment limb function. With the aging population and increasing demand for total knee arthroplasty, exoskeletons could prove a valuable tool for regaining function and minimizing the number of patients discharged to skilled nursing facilities. However, the safety of these devices in postoperative populations remains unexplored. A lightweight pneumatic device was piloted on three patients after primary total knee arthroplasty. The patients were asked to perform simple locomotive tasks followed by a questionnaire to assess their experience and safety using the exoskeleton. All patients indicated the exoskeleton did not interfere with their wound and made them feel stable on their feet, and two of the three patients stated it was manageable and safe to operate. This report pilots the general safety of a pneumatic exoskeleton, laying the groundwork for larger and more comprehensive studies.

    View details for DOI 10.1016/j.artd.2019.02.008

    View details for PubMedID 31516973