MDJobScout :: Medicine :: Surgery :: Orthopedics (58)

Archives of Orthopaedic and Trauma Surgery (Browse Results)

A new method to measure ligament balancing in total knee arthroplasty: laxity measurements in 100 knees
Sun, 13 May 2012 05:55:27 -0000
Abstract Background  Ligament balancing is considered a prerequisite for good function and survival in total knee arthroplasty (TKA). However, there is no consensus on how to measure ligament balance intra-operatively and the degree of stability obtained after different balancing techniques is not clarified. Purpose  This study presents a new method to measure ligament balancing in TKA and reports on the results of a try-out of this method and its inter-observer reliability. Methods  After the implantation of the prosthesis, spatulas of different thickness were used to measure medial and lateral condylar lift-off in flexion and extension in 70 ligament-balanced knees and in 30 knees were ligament balancing was considered unnecessary. Inter-observer reliability for the new method was estimated and the degree of medial–lateral symmetry in extension and in flexion, and the equality of the extension gaps and flexion gaps were calculated. Results  The method was feasible in all operated knees, and found to be very reliable (intraclass correlation coefficient = 0.88). We found no statistically significant difference in condylar lift-off between the ligament-balanced and the non ligament-balanced group, however, there was a tendency to more outliers in flexion in the ligament-balanced group. Conclusions  Our method for measuring ligament balance is reliable and provides valuable information in assessing laxity intra-operatively. This method may be a useful tool in further research on the relationship between ligament balance, function and survival of TKA. Content Type Journal ArticleCategory Knee ArthroplastyPages 1-9DOI 10.1007/s00402-012-1536-1Authors Eirik Aunan, Department of Surgery, Innlandet Hospital Trust, Anders Sandvigs Gate 17, 2629 Lillehammer, NorwayThomas Kibsgård, Department of Orthopedics, Oslo University Hospital, Postboks 4950, Oslo, NorwayJohn Clarke-Jenssen, Department of Orthopedics, Oslo University Hospital, Postboks 4950, Oslo, NorwayStephan M. Röhrl, Department of Orthopedics, Oslo University Hospital, Postboks 4950, Oslo, Norway Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
Bridging knee arthrodesis for limb salvage using an intramedullary cemented nail: a retrospective outcome analysis of a case series
Sun, 13 May 2012 05:55:26 -0000
Abstract Introduction  Failed total knee replacement with compromised bone and soft-tissues can be challenging. In these situations, arthrodesis remains a treatment option of a limb-saving procedure. Methods  We investigated the outcome of treatment with an intramedullary cemented knee arthrodesis nail implanted in 22 consecutive patients with forlorn situations after failed total knee replacement. Results  There were three major complications due to re-infection and two minor complications due to wound-healing disturbances that healed with the implant retained after an average follow-up of 3.4 years. Clinical examination, Short Form-36 and Oxford knee scores revealed low pain levels, safe implant anchorage, and improved stability of the knee, whilst autonomous mobility utilizing walking aids was still possible. Conclusion  Bridging knee arthrodesis with an intramedullary nail is a valuable salvage procedure with acceptable clinical results. As recurring infection remains the most challenging complication, regular clinical and radiological follow-up examinations are necessary following implant-related knee arthrodesis to allow timely intervention in case of loosening. Content Type Journal ArticleCategory Knee Revision SurgeryPages 1-7DOI 10.1007/s00402-012-1534-3Authors Carl Neuerburg, Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, GermanyRalf Bieger, Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, GermanySebastian Jung, Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, GermanyThomas Kappe, Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, GermanyHeiko Reichel, Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, GermanyRalf Decking, Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
A “sandwich” method of reconstruction of the medial patellofemoral ligament using a titanium interference screw for patellar instability in skeletally immature patients
Thu, 10 May 2012 06:09:47 -0000
Abstract Background  No standard surgical procedure for medial patellofemoral ligament (MPFL) reconstruction exists in skeletally immature patients with patellar instability. This study aimed to evaluate the clinical effectiveness of a novel reconstruction technique for the MPFL in patients with patellar instability because of non-closure of the epiphyseal line. Methods  The “sandwich” method was fixation of the patella between a double-stranded semitendinosus tendon through the posterior third of the femoral insertion of the medial collateral ligament (MCL) as a pulley with a titanium interference screw in a single patellar tunnel. Five knees in five patients were studied: four with recurrent and one with habitual patellar dislocations. Subjects underwent MPFL reconstruction with or without lateral release. Patients were evaluated using pre-operative and post-operative physical and radiographic examinations, including apprehension testing, assessment of tilting and congruence angles, medial and lateral shift ratios under stress measured using X-ray imaging, and Kujala and Lysholm scores. Results  No patient experienced recurrent post-operative episodes of dislocation or subluxation. By the final follow-up, patellar apprehension had disappeared in all patients. In addition, all patients showed significant improvement in the following: tilting angle, congruence angle, lateral shift ratio, Kujala score, and Lysholm score. Conclusions  The MPFL reconstruction methods, using a double-stranded semitendinosus autograft and sparing the femoral physeal line in non-closure of the epiphyseal line, provide acceptable short-term results for the treatment of patellar instability. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-7DOI 10.1007/s00402-012-1516-5Authors Nobuyuki Kumahashi, Department of Orthopaedics, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, JapanSuguru Kuwata, Department of Orthopaedics, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, JapanTaku Tadenuma, Department of Orthopaedics, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, JapanMasaru Kadowaki, Department of Orthopaedics, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, JapanYuji Uchio, Department of Orthopaedics, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
Outcomes of total hip replacement in patients with slipped capital femoral epiphysis
Thu, 10 May 2012 06:09:45 -0000
Abstract Background  Total hip replacement has been advocated for the treatment of degenerative hip diseases secondary to slipped capital femoral epiphysis; nonetheless, outcomes of this procedure have not been well established. We reviewed the outcomes of modern total hip replacements in patients who suffered from slipped capital femoral epiphysis. Methods  A retrospective study was carried out on 32 total hip replacements performed on 28 patients who suffered from slipped capital femoral epiphysis from August 1994 to January 2007. The average age at the time of surgery was 45 years. Clinical evaluation was performed using the Harris Hip Score, radiographic assessment measuring cup and stem orientation, the extent of osteolysis around the implant, and leg length discrepancy. The average follow-up was 98 months (range 25–204 months). Results  Two total hip replacements failed, one for stem aseptic loosening and the other for modular neck failure. The cumulative survival rate at 9 years was 92.8 %. If the end point was revision for implant loosening, the survival rate improved to 96.8 % at 9 years. The only complication recorded was an intraoperative fracture of the lesser trochanter immediately treated with cerclage wire. At the latest follow-up, the Harris Hip Score averaged 86 (range 70–97). Leg length discrepancies greater than 1 cm were present in 18 cases before surgery, and in only 6 cases after surgery. Discussion  We recommend total hip replacement for patients who suffer from slipped capital femoral epiphysis because of the satisfactory survival, low complication rate, and the possibility of restoring leg length. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-7DOI 10.1007/s00402-012-1538-zAuthors Francesco Traina, 1st Department of Hip and Knee Surgery, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, ItalyMarcello De Fine, 1st Department of Hip and Knee Surgery, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, ItalyCaterina Novella Abati, 1st Department of Hip and Knee Surgery, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, ItalyBarbara Bordini, Laboratory for Medical Technology (LTM), Rizzoli Orthopaedic Institute, Bologna, ItalyAldo Toni, 1st Department of Hip and Knee Surgery, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
Core decompression combined with implantation of a demineralised bone matrix for non-traumatic osteonecrosis of the femoral head
Tue, 08 May 2012 06:01:13 -0000
Abstract Introduction  Core decompression is the standard surgical procedure in the treatment of early stage non-traumatic osteonecrosis of the femoral head (ONFH). However, there is still a debate whether decompression in combination with supplementary augmentation by bone grafts, growth factors, or cell implementation is superior to conventional decompression alone. This study evaluated patients after core decompression combined with an augmentation by a demineralised bone matrix, and particularly aimed to report long-term conversion rates to total hip replacement (THR). Materials and methods  14 patients with 18 hips suffering from ONFH (Ficat stage I-IIB) underwent this surgical procedure. All patients underwent radiographic and MRI investigations at baseline and at follow-up periods of 12 and 24 months. The clinical follow-up was done using the Merle d’Aubigné-score for an average period of 9 years after surgery. Results  14 of the 18 subjects (77 %) achieved at least a good clinical result after 2 years. The Merle d’Aubigné-score improved significantly after 12 (p = 0.0001) and 24 months (p = 0.0002). However, the MRI volumetric analysis showed an increased necrotic bone volume from 3.16 ± 0.54 to 3.88 ± 0.62 cm3 (p = 0.04). Within 9 years, 13 out of 18 cases (72 %) required further surgery by THR. Only 7 out of 18 subjects (39 %) reported an ongoing postoperative clinical benefit, and would retrospectively redo the same surgical approach again. The five patients that did not require THR were still satisfied after 9 years. Conclusions  In patients with early- stage femoral head osteonecrosis core decompression combined with the implantation of a demineralised bone matrix leads to a limited, temporary pain relief as seen in core decompression alone. However, long-term results were not encouraging with a high rate of conversion to arthroplasty. Therefore, core decompression with implantation of a demineralised bone matrix may be not appropriate to avoid THR in the long term. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-9DOI 10.1007/s00402-012-1526-3Authors L. Helbig, Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, GermanyH. G. Simank, Orthopädisches Centrum Hochfranken, Hof, GermanyM. Kroeber, Hirslanden Klinik St. Anna, Neuro-u. Wirbelsäulenzentrum, Luzern, SwitzerlandG. Schmidmaier, Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, GermanyP. A. Grützner, BG Unfallklinik Ludwigshafen, Klinik für Orthopädie und Unfallchirurgie, Ludwigshafen, GermanyT. Guehring, BG Unfallklinik Ludwigshafen, Klinik für Orthopädie und Unfallchirurgie, Ludwigshafen, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
Adjuncts in posterior lumbar spine fusion: comparison of complications and efficacy
Sun, 06 May 2012 06:24:38 -0000
Abstract Purpose  The purpose of this study was to define the efficacy of recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) and Demineralized Bone Matrix (DBM) compared to autograft in posterior lumbar spine fusion by comparing complication rates. Methods  During a 7-year period (2003–2009), all patients undergoing posterior lumbar fusion were retrospectively evaluated within a large orthopedic surgery private practice. Patient demographics, comorbidities, number of levels, type of surgery, and types of bone void filler and osteobiologics were analyzed. Complications were defined as reoperation secondary to failed symptomatic fusion, hyper-reaction with fluid collections, bone overgrowth, and infections. Results  1,398 patients were evaluated with 41.1 % males and 58.9 % females. Mean age was 60 years and BMI 30.6 kg/m². Patients were subdivided in treatment groups: rhBMP-2, 947 (67.7 %), DBM 306 (21.9 %), and autograft 145 (10.4 %). The overall infection rate was 2.1 %. No significant differences were found between the three groups. The incidence of seroma formation was higher in the BMP group (3.2 %) than in the DBM or autograft group (2.0 and 1.4 %, respectively) but this was not significant (p = 0.286 and p = 0.245, respectively). 103 patients (7.4 %) underwent redo surgery for clinically significant nonunion. We found significantly fewer nonunions (4.3 %) in the rhBMP-2 group (p < 0.001) compared to the DBM or autograft group (13.1 and 15.2 %, respectively). Conclusion  ICBG is the gold standard. DBM leads to comparable fusion rates and does not increase infection or seroma formation. rhBMP-2 supplementation instead of ICBG or bone marrow aspirate results in higher fusion rates compared to autograft alone or autograft plus DBM. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-6DOI 10.1007/s00402-012-1529-0Authors Martin F. Hoffmann, Grand Rapids Medical Education Partners, 1000 Monroe Ave NW, Grand Rapids, MI 49503, USAClifford B. Jones, Michigan State University/Orthopaedic Associates of Michigan, 230 Michigan St. NE, Grand Rapids, MI 49503, USADebra L. Sietsema, Michigan State University/Orthopaedic Associates of Michigan, 230 Michigan St. NE, Grand Rapids, MI 49503, USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

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