Reconstructive Review最新文献

{"title":"Perioperative Complications Following One-Stage Bilateral and Unilateral Total Hip Arthroplasty via Direct Anterior Approach","authors":"John Attenello, Maria I Opanova, Anne R. Wright, M. Saruwatari, Kelvin Naito, Sean Chan, Sean Saito, Samantha N. Andrews, Cass K. Nakasone","doi":"10.15438/RR.8.2.216","DOIUrl":"https://doi.org/10.15438/RR.8.2.216","url":null,"abstract":"Background A single stage bilateral total hip arthroplasty utilizing the direct anterior approach has been reported to have a similar incidence of perioperative complications as unilateral total hip arthroplasty.  However, previous studies have included various surgeons with differences in contraindications, protocol, technique and/or experience. Questions/Purposes The purpose of this retrospective review was to compare perioperative outcomes in single-stage bilateral and unilateral total hip arthroplasties via the direct anterior approach performed by a single, fellowship trained, high volume arthroplasty surgeon. Methods A retrospective review was completed on consecutive single-stage bilateral total hip arthroplasties performed between 2009 and 2017 and compared to consecutive unilateral total hip arthroplasties performed between 2014 and 2016.  Perioperative data and complications occurring within 90 days were collected for all included patients.  Student t-tests were performed to detect differences between bilateral and unilateral surgical variables. Results A total of 349 patients (531 hips) were included, consisting of 182 BTHA patients (364 hips) and 167 unilateral THA patients. Patients undergoing unilateral THA had significantly lower operating time, shorter length of stay, lower estimated blood loss, lower rate of transfusions and higher rate of home discharge compared to BTHA (p<0.001). Complications were present in four unilateral THA patients, three requiring revision, and nine BTHA patients, three requiring revision. Conclusions There was no difference in complications, as well as no perioperative mortalities or systemic complications, within 90 days following surgery between unilateral and bilateral patients.  Based on these results, single-stage DAA BTHA is a safe procedure to perform, and did not appear to result in higher rates of complications when compared to patients receiving a DAA unilateral THA.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46371067","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":"Understanding Iliotibial Band-Sparing Total Hip Arthroplasty: Alternatives to Traditional THA Approaches","authors":"R. Nevins, Kevin Sagers","doi":"10.15438/RR.8.2.209","DOIUrl":"https://doi.org/10.15438/RR.8.2.209","url":null,"abstract":"Excellent long term results in total hip arthroplasty (THA are achievable through a variety of surgical techniques. However, the push for cost savings and higher patient expectations has shifted the focus to improving short term outcomes such as length of stay and in-hospital narcotic requirements. While approximately 87% of surgeons worldwide continue to prefer traditional posterolateral (PL) or lateral approaches for arthroplasty,1alternative approaches that spare the iliotibial band have emerged over the last several years in hopes of improved outcomes. This review explores the iliotibial band-sparing approaches, their advantages and disadvantages, and provides an overview of their published results.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43856767","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":"Effects of Acetabular Cup Orientation and Implant Design on Psoas Impingement in Total Hip Arthroplasty","authors":"A. Faizan, Laura Y. Scholl, Jingwei Zhang, M. Ries","doi":"10.15438/rr.9.1.220","DOIUrl":"https://doi.org/10.15438/rr.9.1.220","url":null,"abstract":"Background:  Durable fixation has been demonstrated with use of large (jumbo) cementless cups in revision total hip arthroplasty (THA).    However, anterior protrusion of the cup rim may impinge on the iliopsoas tendon and cause groin pain.  The purpose of this study was to assess the effect of cup position and implant design on iliopsoas impingement.Methods:  THA was performed on six cadaver hips using oversized (jumbo) acetabular components, 60 to 66mm. A stainless steel cable was inserted into the psoas tendon sheath to identify the location of the psoas muscle.  CT scans were performed on each cadaver and imported in an imaging software. The acetabular shells, cables, and pelvi were segmented to create separate solid models of each. The shortest distance between each shell and cable was measured. To determine the influence of cup inclination and anteversion, the inclination (30°/40°/50°) and anteversion (10°/20°/30°) angles were varied in the virtual model for both a hemispheric and offset head center shell design. Results:  The shell to wire distance increased linearly with greater cup anteversion (R2>0.99) while inclination had less effect.  The distance was greater for the offset head center cup in comparison to the hemispheric cup.  Our results indicate that psoas impingement is related to both cup position and implant geometry. Conclusions:  For an oversized jumbo cup, psoas impingement is reduced by greater anteversion while cup inclination has little effect.   An offset head center cup with an anterior recess was helpful in reducing psoas impingement in comparison to a conventional hemispherical geometry. ","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49342723","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":"Decreased Incidence of Periprosthetic Joint Infection in Total Hip Arthroplasty with Use of Topical Vancomycin","authors":"David A. Crawford, K. Berend, Joanne B. Adams, A. Lombardi","doi":"10.15438/rr.8.1.201","DOIUrl":"https://doi.org/10.15438/rr.8.1.201","url":null,"abstract":"Background: Periprosthetic joint infections following total hip arthroplasty (THA) can cause significant patient morbidity and carry with them a substantial cost burden to the healthcare system.  The purpose of this study was to assess whether the addition of topical vancomycin decreased the incidence of superficial and deep infections after primary total hip arthroplasty?    Methods: We performed a retrospective analysis of patients who underwent primary THA with (1070 hips) and without (815 hips) the use of topical vancomycin.  Records were reviewed to determine incidence of PJI. Infections were categorized as deep or superficial. Medical comorbidity data was evaluated for known risk factors including diabetes, rheumatoid arthritis, and BMI. Records were further reviewed to determine surgical approach used and bacterial cause of PJI.    Results: The overall incidence of infection in the control group was 1.47% (12 hips) and significantly decreased to 0.47% (5 hips) with the addition of topical vancomycin (p=0.022). Deep infections also decreased from 0.86% (7 hips) in the control group to 0.09% (1 hip) in the vancomycin group (p=0.011).  There was no difference in BMI or percent of patients with diabetes between groups.       In all patients, regardless of vancomycin use, the incidence of infection in the direct lateral approach was higher (2.04%, 9 hips) than the anterior approach (0.055%, 8 hips)  (p=0.004). Conclusions:  We found a lower incidence of periprosthetic joint infection after THA with the addition of topical vancomycin. We also found a decreased incidence of infection in patients who had surgery through an anterior approach compared with those who had a direct lateral approach.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45116755","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":"Popliteal Artery Complications of Total Knee Replacement – Our Experience In Large Volume Centre and Review of Literature","authors":"Nithin Sunku, A. Reddy, S. Muralidhar","doi":"10.15438/RR.8.1.199","DOIUrl":"https://doi.org/10.15438/RR.8.1.199","url":null,"abstract":"Total Knee replacement is one of the successful operations performed for arthritis of knee joint. Popliteal artery occlusion after total knee arthroplasty occurs at a very low incidence. We here describe the incidence of popliteal artery complications in one of the large volume centre in Asia. Our case had complete occlusion of the popliteal artery at the 1st post-operative day. Our reported case of post-TKR popliteal artery thrombosis was without known risk factors. Reason for concern is because of poor collateral circulation, severe ischemia may give rise to irreversible tissue damage necessitating amputation if we do not recognize early and treat them. We reviewed cases from the literature in terms of incidence, prognosis, treatment, potential risk factors and measures to prevent injury.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46292172","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":"Manipulation Rate Is Not Increased After Customized Total Knee Arthroplasty","authors":"A. Kay, W. Kurtz, Gregory Martin, B. Huber, R. Tait, T. Clyburn","doi":"10.15438/RR.8.1.210","DOIUrl":"https://doi.org/10.15438/RR.8.1.210","url":null,"abstract":"Introduction Manipulation under anesthesia (MUA) is a standard treatment for arthrofibrosis after total knee arthroplasty (TKA), with reported rates of 1.5-6%.  Customized TKA may have better outcomes by matching individual patient anatomy.  However, a previous study reported an unacceptably high rate of MUA for customized TKAs.  This study reports the incidence of MUA in a large cohort of second generation customized TKAs.  Methods:Data was collected prospectively on 360 2nd generation ConforMIS iTotal cruciate retaining TKAs.  MUA was performed for clinically significant arthrofibrosis.  Range of motion (ROM) and New Knee Society Scores (KSS) were evaluated at regular intervals for two years.   Results: 11/360 (3.05%) knees underwent MUA.  ROM overall improved from 115° to 125°, and from 112° to 122° in patients undergoing MUA.  KSS objective and functional scores in MUA patients increased from 57 to 98 and 41 to 90, respectively, and in the entire cohort increased from 65 to 96 and 45 to 86 at 2 years (p<0.05). No MUA patients underwent revision surgery.   Discussion and Conclusion:Customized TKA with second generation ConforMIS iTotal implants results in a MUA rate consistent with the literature for all designs. Additionally, patients exhibit significant increases in ROM and Knee Society Scores.  ","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44431683","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":"Conversion Knee Arthroplasty Using a Rotating Hinge as a Salvage Prosthesis Following Periprosthetic Joint Infection and Ligamentous Insufficiency: A Case Report","authors":"J. Minter","doi":"10.15438/RR.8.1.208","DOIUrl":"https://doi.org/10.15438/RR.8.1.208","url":null,"abstract":"BackgroundIn the event of a complex revision TKA in which there is extensor mechanism involvement and ligamentous instability or insufficiency, non-linked levels of constraint may not be adequate for achieving restoration of patient function. Total knee arthroplasty devices that incorporate a linked level of constraint are successful alternatives to unlinked devices (PS and PS-Constrained) in this clinical context.Case PresentationWe present the case of a 62 year-old male patient that required a non-articulating knee fusion and multiple total knee arthroplasty revisions in conjunction with a ruptured and repaired extensor mechanism, ligamentous instability, bone loss and periprosthetic joint infection.  (Revision knee prosthesis that includes a increasing degree of nodularity and physical constraint).  The subsequent risk factors associated with the loss of bone and ligamentous insufficiency required performing conversion arthroplasty with a knee prosthesis that includes an increasing degree of modularity and physical constraint not commonly used in revision total knee arthroplasty.DiscussionThe authors report on a patient who underwent multiple operative procedures, we outline the step wise decision making progression that lead to the successful eradication of the PJI and reimplant device strategy based on the confounding factors presented.  We assess the use of revision TKA systems that offer extreme degrees of constraint which should be considered in complex revision knee revision procedures.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44443504","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":"Correction of Femoral Acetabular Impingement at the Time of Primary THA","authors":"E. McPherson, S. Sherif, Madhav Chowdhry, M. Dipane","doi":"10.15438/rr.8.1.206","DOIUrl":"https://doi.org/10.15438/rr.8.1.206","url":null,"abstract":"Background: Primary total hip arthroplasty (THA) is considered one of the most cost effective and functionally beneficial procedures to treat end-stage coxarthrosis worldwide. However, in all regions of the world, there is a small percentage of patients that are plagued by residual anterior hip pain and have limited hip flexion. One explanation for this problem is bone and soft tissue impingement in the anterior hip region. In the native hip, the problem is described as femoral acetabular impingement (FAI). FAI is a form of developmental dysplasia of the hip (DDH). Not infrequently, these dysplastic acetabula are also retroverted. In primary THA, a retroverted boney acetabulum adversely affects prosthetic hip function. Specifically, when the acetabular cup is inserted in an anteverted position and the native acetabulum is retroverted, the proximal femur will still impinge upon the retroverted acetabular bone with flexion and internal rotation. This causes mechanical instability, pain, and prosthetic subluxation. We aptly name this condition prosthetic femoral acetabular impingement (PFAI).Methods: In this study we address PFAI with an anterior acetabular bone wall reduction (AABWR). In a consecutive series of 426 primary THA’s, we prospectively removed all impinging anterior retroverted bone during the THA procedure. All acetabular cups were placed between 25-35 degrees of anteversion. Retroverted acetabular bone extending beyond the acetabular cup was removed along with impinging capsular tissues. All femoral stems were positioned between 15-20 degrees.Results: The study group consisted of 426 THA’s. Three hundred patients (70%) had an AABWR. There were 140 females (47%) and 160 males (53%). The average amount of bone resected in the AABWR group was 1.32 cm (0.3 cm to 3.4 cm). For females, the average bone resection measured 1.1 cm (0.3 to 2.0 cm). For males, the average bone resection measured 1.53 cm (0.3 cm to 3.4 cm). Harris Hip Scores (HHS) at minimum of 1 year follow-up (range 1 to 11.5 years) averaged 91 (64 to 100) for the entire group. In the AABWR group, HHS averaged 92 (71 to 100). Average hip flexion was 110 degrees (100 to 130 degrees). In the non-AABWR group, HHS averaged 87 (71 to 100). Average flexion was 109 degrees (88 to 125 degrees). In the AABWR group, 12 patients (4%) experienced groin pain symptoms. On a scale from 0 to 4, the peak groin pain rating was 1 in 10 of the 12 patients and the remaining 2 rated his/her pain at a 2. As time progressed, 50% of these patients saw their groin pain resolve. In the non-AABWR group, 2 patients (1.6%) experienced groin pain and both patients rated his/her pain at a 1.Discussion: Maximizing hip flexion and function for the active patient undergoing primary THA requires meticulous surgical technique. PFAI may be one reason for unexplained anterior hip pain in the highly active patient that demands higher hip flexion and rotation. Our experience shows that the anterior acetabular rim and p","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48074483","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":"Search Engine Optimization for Medical Publishing","authors":"D. Faroo","doi":"10.15438/rr.7.4.198","DOIUrl":"https://doi.org/10.15438/rr.7.4.198","url":null,"abstract":"Search engine optimization is becoming increasingly important for medical publishing professionals. They know the value of writing papers and articles that help expand the knowledge of their specific area of expertise. They also know that in today’s online environment their publications need to be found in relevant web searches to be cited by fellow researchers. But if authors ignore the basics of keyword research and search engine optimization they run the risk of their research being lost in a vast sea of search results. What good is all that work if it never reaches the intended audience? The purpose of this commentary is to provide submitting authors basic yet important suggestions to help optimize their articles for online publishing with Reconstructive Review.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43900580","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":"Femoral Head-Trunnion Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty – A Unique Case Report","authors":"Nick N Patel, George N Guild, Greg A. Erens","doi":"10.15438/RR.7.4.196","DOIUrl":"https://doi.org/10.15438/RR.7.4.196","url":null,"abstract":"Background : Gross trunnion failure (GTF) after total hip arthroplasty is a rare complication and has only been reported in a few case series. Some of the associated risk factors have been described in the literature and include larger femoral heads, greater offset, and increased BMI. Despite this, the mechanism behind GTF is poorly understood and early diagnosis and treatment continues to be challenging. Case Presentation : We present the case of complete femoral head and trunnion dissociation in a 63 year-old female nine years after total hip arthroplasty. Unique to this case is the lack of classic patient and implant risk factors for GTF along with the acute onset nearly nine years after implantation.  Discussion : This case presentation highlights the fact that the contributing factors and mechanism behind GTF continue to be poorly understood. There is a need for future research to help better understand this phenomenon and to help potentially identify those at risk for GTF.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46986842","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}