Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 9 Articles
In effort to reduce the revision burden of total knee arthroplasty (TKA), industry emphasis has focused on replacing manual\ntechniquesââ?¬â?which are subject to variabilityââ?¬â?with technological implements. Unfortunately, technological innovation often\ncontinues before adequate time for critical evaluation has passed. Therefore, the purpose of this descriptive literature review was to\ncollect a large sample of international data and report on the clinical and economic efficacy of three major types of technologically\nassisted TKA: navigation, patient-specific instrumentation, and sensorized trials....
Primary total hip arthroplasty is a successful procedure, although complications such as dislocation can occur. In certain patient\npopulations if this is recurrent, it can be difficult to manage effectively. We present a retrospective analysis of our experience of\nusing a capture/captive cup over an 8-year period for frail elderly patients who presented with recurrent hip dislocations. Our\nfindings show no re dislocations in our cohort and a survival analysis demonstrates just less than half surviving at 2 years after\nsurgery. Furthermore, Harris Hip Scores were generally calculated to be good. A constrained acetabular component provides\ndurable protection against additional dislocations without substantial deleterious effects on component fixation. Such components\nshould be considered especially in a group of patients with comorbidities or those who are fragile, elderly, and low-demand in\nnature....
Posterior lumbar interbody fusion using cages, titaniumrods, and pedicle screws is considered today as the gold standard of surgical\ntreatment of lumbar degenerative disease and has produced satisfying long-term fusion rates. However this rigid material could\nchange the physiological distribution of load at the instrumental and adjacent segments, a main cause of implant failure and adjacent\nsegment disease, responsible for a high rate of further surgery in the following years. More recently, semirigid instrumentation\nsystems using rods made of polyetheretherketone (PEEK) have been introduced. This clinical study of 21 patients focuses on\nthe clinical and radiological outcomes of patients with lumbar degenerative disease treated with Initial VEOS PEEKÃ?Â-Optima\nsystem (Innovââ?¬â?¢Spine, France) composed of rods made from PEEK-OPTIMAÃ? polymer (Invibio Biomaterial Solutions,UK) without\narthrodesis.With an average follow-up of 2 years and half, the chances of reoperation were significantly reduced (4.8%), quality of\nlife was improved (ODI = 16%), and the adjacent disc was preserved in more than 70% of cases. Based on these results, combined\nwith the biomechanical and clinical data already published, PEEK rods systems can be considered as a safe and effective alternative\nsolution to rigid ones....
Elbow fracture-dislocation is always demanding\nto manage due to the considerable soft-tissue swelling\nor damage involved, which can make an early open\napproach and ligamentous reconstruction impossible. The\npurpose of this study was to evaluate the role of elbow\nhinged external fixation (HEF) as a definitive treatment in\npatients with elbow dislocations associated with Reganââ?¬â??\nMorrey (R-M) type I and II coronoid fractures and softtissue\ndamage. We treated 11 patients between 2010 and\n2012 with HEF. Instability tests and standard X-ray\nexaminations were performed before surgery and 1ââ?¬â??3 to\n3ââ?¬â??6 months after surgery, respectively. All patients\nunderwent a preoperative CT scan. Outcomes were assessed\nwith a functional assessment scale (Mayo Elbow Performance\nScore, MEPS) that included 4 parameters: pain,\nROM, stability, and function. The results were good or\nexcellent in all 11 patients, and no patient complained of\nresidual instability. Radiographic examination showed\nbone metaplasia involving the anterior and medial sides of\nthe joint in 5 patients. HEF presented several advantages: it\nimproves elbow stability and it avoids long and demanding\nsurgery in particular in cases with large soft tissue damage.\nWe therefore consider elbow HEF to be a viable option for\ntreating R-M type I and II fracture-dislocations....
Accelerated rehabilitation following total joint replacement (TJR) surgery has become more common in contemporary orthopaedic\npractice. Increased utilization demands improvements in resource allocation with continued improvement in patient outcomes.\nWe describe an accelerated rehab protocol (AR) instituted at a community based hospital. All patients undergoing total knee\narthroplasty (TKA) and total hip arthroplasty (THA) were included. The AR consisted of preoperative patient education,\nstandardization of perioperative pain management, therapy, and next day in-home services consultation following discharge.\nOutcomes of interest include average length of stay (ALOS), discharge disposition, 42-day return to Urgent Care (UC), Emergency\nDepartment (ED), or readmission. A total of 4 surgeons performed TJR procedures on 1,268 patients in the study period (696 TKA,\n572 THA). ALOS was reduced from3.5 days at the start of the observation period to 2.4 days at the end. Discharge to skilled nursing\nreduced from 25%to 14%. A multifaceted and evidence based approach to standardization of care delivery has resulted in improved\npatient outcomes and a reduction in resource utilization. Adoption of an accelerated rehab protocol has proven to be effective as\nwell as safe without increased utilization of UC, ER, or readmissions....
Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction\nrepresents an attractive alternative to amputation when the whole scapula is invaded\nwith tumor and the neurovascular bundle can be preserved during tumor resection. We report a\ncase of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive\nallograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was\nseen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection\nof the proximal end of the humerus followed by a reconstruction with osteochondral allograft\nand nail osteosynthesis was performed. The postoperative course was uneventful. In September\n2009, 17 years later, the patient presented with a huge tumor developed at the level of the\nscapula. There was no vascular or neurological symptom. Plain radiography showed an expansive\nosteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment\nrevealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence\nof osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which\nwas completely invaded at its proximal portion and the complete reconstruction of the scapula\nand the proximal humerus with allograft was made. One year postoperatively, we note a favourable\noutcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable\noutcome. Although shoulder function was almost completely eliminated following surgery,\npreservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative\nlimb function. This reconstruction appears to be an attractive technique to be used in similar\ncases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount....
The cementless stem Excia (B. Braun, Melsungen, Germany) implant has a rectangular cross-sectional shape with back-and-forth\nflanges and a plasma-sprayed, dicalcium phosphate dihydrate coating from the middle to proximal portion to increase initial\nfixation and early bone formation.Here, the conformity of the Excia stem to the femoral canal morphologywas three-dimensionally\nassessed using computed tomography. Forty-three patients (45 hips)were examined after primary total hip arthroplasty with amean\nfollow-up of 27 Ã?± 3 months (range: 24ââ?¬â??36 months). Spot welds occurred at zone 2 in 16 hips and at zone 6 in 24 hips, with 83%\n(20/24 hips) of those occurring within 3 months after surgery. First- (...
Introduction: The motion of the distal syndesmosis correlates highly with the instability, while an accurate kinematic\ndescription of the distal tibiofibular joint during normal gait has not previously been presented.\nMaterial and methods: Sixteen healthy syndesmoses of sixteen living subjects (8 male and 8 female) were studied\nduring stance phase of the normal gait. Data of CT scanning were collected first and used to create the 3D models\nof the distal tibia and fibula. The lateral X-ray images of the syndesmosis were captured by fluoroscopy when the\nsubject was walking. Seven key-pose images were selected for subsequent 3D to 2D bone model registration and six\ndegrees-of-freedom (DOF) motions of syndesmosis were then calculated. A validation experiment was also conducted\nto confirm the accuracy of the 3D/2D technique for the syndesmosis.\nResults: During the stance phase, the distal tibiofibular joint exhibited with 2.98 �± 1.10�° of dorsi/plantarflexion, 5.94 �±\n1.52�° of inversion/eversion, and 5.99 �± 2.00�° of internal/external rotation; 2.63 �± 1.05 mm on medial/lateral, 3.86 �±\n1.65 mm on anterior/posterior, and 4.12 �± 1.53 mm on superior/inferior translation. From heel strike to mid-stance,\nthe syndesmosis demonstrated 1.69�° of dorsiflexion, 3.61�° of eversion, and 3.95�° of external rotation. Likewise, from\nmid-stance to heel-off, the syndesmosis presented 1.04�° of plantarflexion, 4.95�° of inversion, and 5.13�° of internal rotation.\nConclusion: During the stance phase of normal gait, internal/external rotation and vertical motion play dominant roles\nin terms of rotation and translation, respectively....
Aim. To evaluate whether aseptic hypertrophic nonunion in the long bones of the lower extremity can be treated successfully with\nLISS applied with closed methods without grafting. Materials and Methods. The study included 7 tibias and 9 femurs of 16 patients.\nAll cases had hypertrophic nonunion. Initial surgical treatment was with intramedullary nailing in 14 cases, 6 of which had required\nan exchange of intramedullary nail. All the patients were treated with LISS plate with closed methods. Results. Union was obtained\nat mean 7 months in all patients. No implant loosening or breakage of the implant was observed and there was no requirement for\nsecondary surgery. Conclusion. Cases of hypertrophic nonunion have excellent blood supply and biological potential. Therefore,\nthere is no need for bone grafting and the addition of fracture stability is enough to achieve full union. Using a limited approach\nand percutaneous screw insertion, LISS provides fracture stabilization with soft tissue protection....
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