Reconstructive Review最新文献

{"title":"Early Results of a Modular Cementless Tibial Component for Total Knee Arthroplasty","authors":"R. Sinha, Cristian Balcescu","doi":"10.15438/RR.4.3.77","DOIUrl":"https://doi.org/10.15438/RR.4.3.77","url":null,"abstract":"Cementless components in TKA have been used for almost 3 decades, despite mixed success rates. However, biologic fixation remains attractive, especially for younger patients, because of the potential of unlimited durability. This paper is the first to report results on a modular tibial base plate using trabecular metal as a fixation surface. Twenty-four primary TKAs were evaluated clinical and radiographically at mean 1.9 year followup. Excellent clinical results were obtained. There was no significant subsidence or change in orientation of any component. One component was probably loose radiographically but was insufficiently symptomatic to warrant revision. Five components showed nonprogressive radiolucent lines. One reoperation was performed for stiffness, at which time the components were well fixed. Thus, it would appear that excellent bony fixation can be achieved with a modular cementless tibial component with excellent short-term clinical results.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"27-30"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67679679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Hip Stem Classification System","authors":"H. S. T. McTighe, J. Keggi, D. Stulberg, L. Keppler, D. Brazil, E. McPherson","doi":"10.15438/RR.V4I2.70","DOIUrl":"https://doi.org/10.15438/RR.V4I2.70","url":null,"abstract":"The aim of this paper is to review the influx of short stems for total hip arthroplasty. Not all short stems are created equal concerning fixation points for implant stability and length of engagement of the device in the proximal femur. Some devices are stabilized in the head, neck, metaphysis and metaphysis/diaphysis. Depending on stabilization and engagement area different short stems can have different indications, contraindications and clinical outcomes. As a result of our findings JISRF developed a classification system based on implant stabilization point and overall stem length.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67687294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subgroup Analysis of Topical Tranexamic Acid in Total Knee Arthroplasty","authors":"John R Tuttle, Bs Walter Anazonwu, L. Rubin","doi":"10.15438/RR.V4I2.72","DOIUrl":"https://doi.org/10.15438/RR.V4I2.72","url":null,"abstract":"Evidence continues to accumulate for the efficacy of tranexamic acid (TXA) use in primary total knee arthroplasty (TKA). An essential question that remains is to determine which specific subgroups of patients undergoing TKA will benefit from TXA use and if surgeons should be more selective in its administration. We performed a retrospective cohort study involving 187 TKA patients who received intraarticular (“topical”) TXA, and compared these to 168 historical controls who did not receive TXA. These patients were then subdivided into groups based on gender, age, BMI, and preoperative hemoglobin for analysis. All patients, despite their demographics, saw an improvement in primary outcome measures without a detectable increase in complications.  Based on these data, there are no restrictions on the use of TXA. Obese patients, females, and those over 65 years of age undergoing total knee arthroplasty may benefit from TXA most consistently.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67687848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osseointegration Implant Post Coupling With External Prosthetic Limb – Continuation of Previous Case Reports “Stage III”","authors":"R. Hillock, Bcp Danny Tatum, Pt Edward Dolegowski","doi":"10.15438/RR.V4I2.68","DOIUrl":"https://doi.org/10.15438/RR.V4I2.68","url":null,"abstract":"An ongoing update of the progress case report for the first patient treated with the Longitude™ osseointegration prosthesis implanted in an amputated residual femur is presented. The patient was given an intensive physical therapy program of strengthening and conditioning in anticipation of coupling to the external prosthesis. A custom prosthesis was fabricated based on the Plie’ 2.0 microprocessor knee system. The patient was then successfully trained on use and care of the prosthesis for ambulation without any complications. Keywords : Amputation, Osseointegration Acknowledgement : Design concept by Concept Design & Development, LLC (CDD,LLC); Development and Manufacturing by Signature Orthopaedics, LTD; Centennial Hills Hospital Medical Center, Las Vegas, NV; and Institutional Review Board (IRB) by Joint Implant Surgery & Research Foundation.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"13-16"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67687038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Medial Collateral Ligament Injury During Primary Total Knee Arthroplasty: A Systematic Review","authors":"P. Torre, A. Stephens, H. Oh, Akshay Kamra, B. Zicat, P. Walker","doi":"10.15438/RR.V4I2.69","DOIUrl":"https://doi.org/10.15438/RR.V4I2.69","url":null,"abstract":"Medial collateral ligament injury during primary total knee arthroplasty is a recognised complication potentially resulting in valgus instability, suboptimal patient outcomes and a higher rate of revision or reoperation. Options for management include primary repair with or without augmentation, reconstruction or immediate conversion to prosthesis with greater constraint, in conjunction with various postoperative rehabilitation protocols. Inconsistent recommendations throughout the orthopaedic literature have made the approach to managing this complication problematic. The objective of this study was to review the available literature to date comparing intraoperative and postoperative management options for primary total knee arthroplasty complicated by recognised injury to the medial collateral ligament. This systematic literature review was prospectively registered with PROSPERO (#CRD42014008866) and performed in accordance with PRISMA guidelines including a PRISMA flow diagram. Five articles satisfied the inclusion criteria. Each was a retrospective, observational cohort or case series with small numbers reported, inconsistent methodology and incompletely reported outcomes. Four of the five studies managing medial collateral ligament injury during total knee arthroplasty (47/84 patients) with direct repair with or without autograft augmentation reported good outcomes with no revision or reoperation required for symptomatic instability over a follow-up period of 16 months to almost 8 years. The fifth study with a follow-up to 10 years and a high rate of conversion to unlinked semi constrained total knee arthroplasty implant (30/37 patients) reported a greater incidence of revision due to instability, in patients in whom the medial collateral ligament injury was directly repaired without added constraint. Overall balance of evidence is in favour of satisfactory outcomes without symptomatic instability following direct repair with or without augmentation of an medial collateral ligament injury recognised intraoperatively during total knee arthroplasty. An implant with greater constraint may have reduced longevity in younger, more active patients through aseptic loosening. In elderly or less mobile patients, and in situations where the medial collateral ligament repair is deemed poor quality or incomplete, an implant with greater constraint would seem prudent. In patients where direct repair with or without augmentation was used, a period of 4-6 weeks of unrestricted rehabilitation in a hinged knee brace should be followed.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"17-23"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67687166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Pre-Operative Flexion in Primary TKA: A Surgical Technique Emphasizing Knee Flexion with 5-Year Follow-Up","authors":"Facs Edward McPherson, D. Portugal, Ba Matthew Dipane, S. Sherif","doi":"10.15438/RR.V4I2.71","DOIUrl":"https://doi.org/10.15438/RR.V4I2.71","url":null,"abstract":"This study prospectively reviews a consecutive series of 228 primary total knee arthroplasty (TKA) procedures utilizing a technique to optimize knee flexion. The main features include: (1)the use of a “patellar friendly” femoral component and reduced thickness patellar components, (2) patient individualized adjustment of the femoral component rotation set strictly to the anterior-posterior femoral axis, (3)a rigorous flexion compartment debridement to remove non-essential posterior femoral bone with a Z-osteotome, and (4)incorporation of a rapid recovery protocol with features to promote knee flexion. Results were categorized into three groups: low pre-op flexion (90 degrees and below), regular pre-op flexion (91-125 degrees), and high pre-op flexion (126 degrees and above). Average flexion in the low flexion group improved by 20 degrees at 6 weeks, 28 degrees at 3 months, 31 degrees at 1 year, and 30 degrees at 5 years. In the regular flexion group, average flexion improved by 2 degrees at 6 weeks, 10 degrees at 3 months, 12 degrees at 1 year, and 13 degrees at 5 years. Finally, in the high flexion group, average flexion decreased by 7 degrees at 6 weeks, regained preoperative levels at 3 months, and increased by 3 degrees at 1 year and 4 degrees at 5 years. In summary, a technique that emphasizes patellofemoral kinematics can consistently improve flexion in TKA in short and long-term follow-up.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"29-36"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67687714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grateful for Medical Advancements","authors":"T. Mctighe","doi":"10.15438/rr.v4i1.60","DOIUrl":"https://doi.org/10.15438/rr.v4i1.60","url":null,"abstract":"“Grateful” has been described as warmly or deeply appreciative of kindness or benefits received. This commentary will express my personal gratefulness for benefits received by recent Medical Advancements. Most readers are well aware of my orthopaedic career over the past forty-four years and the many benefits that my family and I have received. However, recent benefits received gives me reason to pause and reflect, and to acknowledge their receipt.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"49-50"},"PeriodicalIF":0.0,"publicationDate":"2014-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67687482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Massive Pseudotumor in a 28mm Ceramic-Polyethylene Revision THA: A Case Report","authors":"Facs Edward McPherson, Ba Matthew Dipane, S. Sherif","doi":"10.15438/RR.V4I1.53","DOIUrl":"https://doi.org/10.15438/RR.V4I1.53","url":null,"abstract":"This report reviews the findings of a massive pseudotumor detected pre-operatively in a 13-year-old revision total hip arthroplasty. The case is unique in that the bearing involved was a 28mm zirconia ceramic head on a polyethylene liner. We propose that the pseudotumor arose from ultrafine titanium par ticles liberated from the proximal porous coating of the femoral stem. We suspect that the osteolysis produced from polyethylene wear exposed the proximal porous coating and, via a process of mechanical abrasion with the surrounding soft tissues, liberated ultrafine titanium particles. We believe the pseudotumor formed because the patient was pre-sensitized to metal debris based upon a pre-operative lymphocyte T-cell proliferation test (LTT). Based upon this unique case, we feel that pseudotumors more likely form when there is a high rate of ultrafine metal particles generated in a pre-sensitized patient. Finally, we introduce what we believe are the main biologic wear responses in THA. Further research is needed to validate this proposed model.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"11-17"},"PeriodicalIF":0.0,"publicationDate":"2014-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67686621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Performance of a Self- Unplugging Surgical Suction Instrument: A Randomized Controlled Trial","authors":"M. Stiehl","doi":"10.15438/RR.V4I1.54","DOIUrl":"https://doi.org/10.15438/RR.V4I1.54","url":null,"abstract":"Introduction: Obstruction of the surgical suction instrument is a common problem in orthopaedic surgery. Previous attempts have tried to address this problem. The ‘Super Sucker’ has a screen compartment that can be unclogged upon disassembly. The Yankauer sucker has small holes in its tip that strain larger bits of debris. The aim of this study is to clinically evaluate a new gas-actuated suction instrument in which a special screen at its tip is cleared, as needed, by a rapid burst of pressurized carbon dioxide gas. Methods: This IRB-approved, prospective, randomized study compared a gas-actuated suction instrument with the Super Sucker and Yankauer in 70 consecutive primary total joint arthroplasty cases. Outcome measures included: incidence of complete suction loss due to suction instrument obstruction; time lost while unplugging the suction instrument; number of additional suction instruments needed; and a subjective surgeon-assessed performance score (1 to 5, with 5 being most favorable) for type of suction instrument. Results: There were no cases in which the gas-actuated suction instrument could not be rapidly cleared of debris. The Super Sucker completely plugged in 71% of cases, requiring 67 minutes total to unplug (3.9 minutes per case, range 0 to 12 minutes). In four cases, replacement Super Suckers were required to finish the case. The Yankauer completely plugged in 47% of cases, requiring 52 minutes total to unplug (2.8 minutes per case, range 0 to 10 minutes). In three cases, replacement Yankauers were required to finish the case. The average performance score was 2.7 for the Super Sucker, 3.6 for the Yankauer, and 5 for the gas-actuated suction instrument on a scale of 1 to 5, with 5 being most favorable. Discussion: This study evaluated a suction instrument in which a screen tip prevents obstruction, and a burst of pressurized carbon dioxide gas clears debris from the tip. The new suction instrument was successful in 100% of cases, with considerably less time lost compared to the other suction instruments. The gas-actuated suction tool actively and rapidly cleared obstructive debris with minimal disruption to the surgical flow. Recent clinical experience has shown the gas-actuated suction tool to be particularly enabling in the settings of tourniquet-free total knee replacement, small incision total hip replacement, bipolar hemiarthroplasty, and revision total hip replacement.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"4 1","pages":"18-22"},"PeriodicalIF":0.0,"publicationDate":"2014-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67686801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MOM Failure Modes: An In-Depth Look at Metal Ions and Implant Wear","authors":"T. Donaldson, E. McPherson, Michelle Burgett Ba, I. Clarke","doi":"10.15438/RR.V4I1.56","DOIUrl":"https://doi.org/10.15438/RR.V4I1.56","url":null,"abstract":"Contemporary MOM bearings (large-diameter heads) offered the perceived benefits of much greater range of motion and greater stability with reduced risk of impingement and dislocation. A variety of design and Both positive [1-3] and negative reports [4-8] have now emerged with regard to total hip arthroplasty (THA) and resurfacing arthroplasty. As a result, there has been an avalanche of studies focused on critical issues such as: surgical positioning, shallow cups (face angles 144-170°) [9-11] and “edge loading”. [5,7,12-17] However, there are several, possibly synergistic, risk scenarios that could trigger adverse MOM wear and very little progress has been made in understanding such interacting parameters. In an effort to understand the role of metal ion analysis and how it relates to revision surgery and implant wear, selected MOM revised cases were reviewed [28]. Retrieval data was included in conjunction with metal ion analyses and intraoperative observations to determine various failure modes.  We suggest MOM devices that are well fixed but fail after 2 years can be classified into one of six modes: (i) normal, (ii) allergic reaction, (iii) 3 rd body wear, (iv) repetitive subluxation with metal impingement, (v) multi-directional subluxation with soft tissue impingement, and (vi) repetitive subluxation with soft tissue impingement.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"35 1","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2014-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67687158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}