JBJS Essential Surgical Techniques最新文献

{"title":"Robotic-Assisted Total Hip Arthroplasty Through the Posterior Approach.","authors":"Maria T Schwabe, Joseph T Gibian, Kimberly A Bartosiak, Ilya Bendich, Andrew M Schneider","doi":"10.2106/JBJS.ST.24.00010","DOIUrl":"10.2106/JBJS.ST.24.00010","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted total hip arthroplasty (THA) through the posterior approach is indicated in cases of symptomatic hip arthritis. The goal of the procedure is to relieve pain and restore function while minimizing postoperative complications such as dislocation. Dislocation often occurs despite traditionally well placed components<sup>1,2</sup>. The hip-spine relationship can be a causative factor in postoperative instability, particularly in patients with altered spinopelvic kinematics as a result of spinal fusions or degenerative spine disease, in whom component placement based on anatomic landmarks may lead to functional malpositioning<sup>3,4</sup>. Therefore, we present our technique for robotic-assisted THA through the posterior approach, which incorporates patient-specific spinopelvic kinematic data to maximize impingement-free range of motion and minimize the risk of dislocation.</p><p><strong>Description: </strong>Preoperative computed tomography (CT) scans are obtained in order to generate a 3D model of the patient's unique hip anatomy. Lateral lumbar radiographs with the patient in the sitting and standing positions are also obtained preoperatively. The sacral slope is measured in each position, imported into the robotic software, and utilized to aid in positioning the components for optimal leg length, offset, and stability of the hip replacement based on the patient's unique spino-kinematic profile. The procedure begins with 3 partially threaded pins being driven into the ipsilateral iliac crest about 2 cm posterior to the anterior superior iliac spine. The robotic pelvic array is fastened to the pins. A standard posterior approach to the hip is utilized. Skin and subcutaneous tissues are dissected down to the iliotibial band and gluteus maximus fascia. The fascia is longitudinally incised, and a small metallic pin is malleted into the distal aspect of the greater trochanter. Initial leg length and offset values are captured. The short external rotators and posterior hip capsule are elevated. The hip is dislocated, and a neck resection is made at a level determined preoperatively with use of the robotic software. The acetabulum is exposed, and osseous registration is carried out to establish a relationship between the 3D model built with use of the robotic software and the patient's anatomy in vivo. The acetabulum is single-reamed, and the final cup is impacted in the desired position. The proximal femur is broached with increasingly sized broaches until rotational and axial stability has been achieved. A trial femoral neck and head are attached to the final broach, and the hip is reduced. Posterior and anterior hip stability are assessed, and leg length and offset are rechecked via the robotic system. Once the surgeon is satisfied, the hip is dislocated, the broach is removed, and the final femoral stem and head are manually implanted. The hip is then reduced for the final time. Closure is performed acc","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopically Assisted Lower Trapezius Transfer Using Peroneus Longus Autograft for Irreparable Posterosuperior Rotator Cuff Tears.","authors":"Silvampatti Ramasamy Sundararajan, Rajagopalakrishnan Ramakanth, Bandlapally Sreenivasa Guptha Sujith, Terence Dsouza, Karthikeyan Pratheeban, Shanmuganathan Rajasekaran","doi":"10.2106/JBJS.ST.23.00047","DOIUrl":"10.2106/JBJS.ST.23.00047","url":null,"abstract":"<p><strong>Background: </strong>Massive retracted rotator cuff tears are disabling in physically active patients. In patients with persistent pain in whom nonoperative treatment has failed, multiple surgical treatment options are available. Lower trapezius tendon transfer is a promising surgical procedure that can decrease pain, improve external rotation strength, and recreate more normal glenohumeral kinematics. In the present video article, we describe the surgical technique for successful arthroscopic (\"scopy\")-assisted lower trapezius transfer (SALTT) with use of an easily accessible peroneus longus autograft.</p><p><strong>Description: </strong>The patient is positioned in a beach-chair position with the ipsilateral half of the posterior shoulder girdle included in the draping for surgical access. Joint was viewed through the standard posterior and posterolateral portals, while anterolateral and anterosuperior portals were utilized as the working portals. Subacromial and superior capsular adhesions are released, and a partial cuff repair is performed. A 3 to 4-cm vertical incision is made along the scapular spine. The superior and inferior borders of the lower trapezius are delineated and completely detached from where they insert at the scapular spine. A 3-cm vertical incision is made at the posterior border of the lateral malleolus. The fascia is incised. The peroneus longus is identified and detached with the foot in maximum dorsiflexion and eversion and is harvested with use of a closed tendon stripper. Whip stiches are placed at 1 end of the autograft. With use of a large grasping clamp, starting from the anterolateral portal and aiming toward the medial scapular incision, the autograft is shuttled and the stitched end of the autograft is fixed to the humeral head with a knotless anchor. With the shoulder in maximum external rotation and 0° of abduction, tenodesis of the autograft is performed to the lower trapezius tendon with a Pulvertaft technique. The shoulder is then immobilized in 40° to 60° of external rotation in a custom brace for 6 to 8 weeks. Passive and gradual active-assisted shoulder exercises should begin at 6 to 8 weeks postoperatively.</p><p><strong>Alternatives: </strong>Surgical alternatives for irreparable tears include partial rotator cuff repair with biceps superior capsular reconstruction, superior capsular reconstruction with fascia lata graft, subacromial balloon spacer, and reverse shoulder arthroplasty. Tendon transfers are preferred in younger patients.</p><p><strong>Rationale: </strong>The lower trapezius has adequate tension, a similar line of pull as the infraspinatus, and enough tension to replace the function of the infraspinatus<sup>1</sup>. Biomechanical studies have shown that the maximum external rotation moment arm generated with use of a lower trapezius transfer with the arm at the side is superior to that with either latissimus dorsi or teres major transfer<sup>2</sup>, and lower trapezius transfe","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Press-Fit Bone-Anchored Prosthesis for Individuals with Transtibial Amputation.","authors":"Jan Paul M Frölke, Robin Atallah, Ruud Leijendekkers","doi":"10.2106/JBJS.ST.ER.23.00006","DOIUrl":"10.2106/JBJS.ST.ER.23.00006","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.ST.23.00006.].</p>","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Regenerative Peripheral Nerve Interface (RPNI) Surgery for Mitigation of Neuroma and Postamputation Pain.","authors":"Christine S W Best, Paul S Cederna, Theodore A Kung","doi":"10.2106/JBJS.ST.ER.23.00009","DOIUrl":"10.2106/JBJS.ST.ER.23.00009","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.ST.23.00009.].</p>","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Press-Fit Bone-Anchored Prosthesis for Patients with Short Transfemoral Amputation.","authors":"Jan Paul Frölke, Robin Atallah, Ruud Leijendekkers","doi":"10.2106/JBJS.ST.23.00007","DOIUrl":"10.2106/JBJS.ST.23.00007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This video article describes the use of a bone-anchored prosthesis in patients with high above-the-knee amputations resulting in short residual limbs, most typically from trauma, cancer, infections, or dysvascular disease. The use of a socket prosthesis is usually unsuccessful in patients with a high transfemoral amputation because such prostheses have an unstable connection and often require additional waist belts for better attachment to the short residual limb. In most cases, a bone-anchored prosthesis results in substantial improvements in wear time, mobility, and quality of life in these patients. These patients may also be excellent candidates for early osseointegration implant surgery, given the knowledge that socket prostheses are rarely successful.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;This procedure is preferably performed in a single stage. After the surgical procedure, most patients stay 1 or 2 nights in the hospital, depending on the magnitude of the surgery (e.g., bilateral implantation of an osseointegration implant) and their comorbidities. Procedure steps include (1) preoperative implant planning, (2) patient positioning and setup, (3) soft-tissue correction (optional) and exposure of residual bone, (4) revision osteotomy with guided shortening, (5) preparation of the medullary canal and perpendicular cutoff plane, (6) marking of the lag screw with a custom-made aiming device and dummy prosthesis, (7) insertion of the intramedullary component with optional bone augmentation, (8) insertion of the lag screw, (9) soft-tissue contouring and closure, and (10) stoma creation and dual cone assembly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Simultaneous major leg amputation and implantation of an osseointegration prosthesis is not advocated as treatment. First, a rehabilitation program with a socket-suspended prosthesis should be trialed before a patient can apply for a bone-anchored prosthesis. After rehabilitation, satisfaction with a socket prosthesis may be adequate, making a bone-anchored prosthesis unnecessary; however, patients with very short residual limbs and/or irregular soft-tissue conditions may be candidates for early implantation of a bone-anchored prosthesis. Contraindications for osseointegration implant surgery are severe diabetes (with complications), severe bone deformity, immature bone, bone diseases (chronic infection or metastasis), current chemotherapy, severe vascular diseases, pain without a clear cause, body mass index of &gt;30 kg/m&lt;sup&gt;2&lt;/sup&gt;, and smoking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;About half of patients with a major lower-limb amputation who use an artificial leg are able to function acceptably well with use of a socket-suspended prosthesis; however, in cases with a high transfemoral amputation level, severe limitations may be expected, resulting in reduced prosthesis use, mobility, and quality of life. In these cases, energy transfer from limb to prosthesis is poor because of","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prone Transpsoas Lumbar Interbody Fusion for Degenerative Disc Disease.","authors":"Daniel K Park, Philip Zakko, Matthew S Easthardt, Philip K Louie","doi":"10.2106/JBJS.ST.23.00090","DOIUrl":"10.2106/JBJS.ST.23.00090","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Prone transpsoas lumbar interbody fusion (PTP) is a newer technique to treat various spinal disc pathologies. PTP is a variation of lateral lumbar interbody fusion (LLIF) that is performed with the patient prone rather than in the lateral decubitus position. This approach offers similar benefits of lateral spinal surgery, which include less blood loss, shorter hospital stay, and quicker recovery compared with traditional open spine surgery. PTP offers additional benefits over traditional lateral positioning, with a more familiar patient position for spine surgeons, the ability to perform simultaneous posterior decompression and fusion without repositioning, and improved sagittal alignment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;PTP is performed with the patient under general anesthesia and with use of somatosensory evoked potentials (SSEP) and electromyography (EMG) neuromonitoring. The patient is positioned prone with the aid of specialized patient positioners. Once the patient is positioned and draped, the disc space of interest is marked with use of fluoroscopic guidance. An incision is made, and blunt dissection is performed through the external oblique, internal oblique, and transversalis muscles. The psoas muscle is palpated, and dilators are placed at the target disc level under fluoroscopic guidance, with care taken to protect the peritoneum and lumbar plexus. Specialized retractors are then positioned. Anulotomy and disc removal, disc space preparation, trialing, and final interbody placement are performed. The procedure ends with obtaining hemostasis and closure of the incision.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Before surgery is performed, nonoperative treatment should be attempted, including the use of nonsteroidal anti-inflammatory drugs, physical therapy, and spinal injections. Surgical alternatives include posterior lumbar laminectomy with or without fusion, as well as other procedures in the anterior column, such as LLIF, anterior lumbar interbody fusion, oblique lumbar interbody fusion, transforaminal lumbar interbody fusion, and posterior lumbar interbody fusion. These alternatives must be considered, especially when working at the L4-S1 disc spaces, because of potential limitations to lateral surgery, such as in cases of high-riding iliac crests, a rising psoas, and previous abdominal surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Lateral spinal surgery evolved as a means to approach the anterior column of the spine in order to treat various spine disorders, such as degenerative disc disease, tumors, infection, and spinal deformity. With the PTP procedure, the patient is in the prone rather than the lateral decubitus position, which allows the psoas muscle to retract more posteriorly because it is under tension, pulling the lumbar plexus away from the target point of the procedure. In addition, the prone position results in improved sagittal alignment compared with the lateral position. With respect ","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Surgical Technique Guide for Percutaneous Screw Fixation for Metastatic Pelvic Lesions.","authors":"Jayson Lian, Rui Yang, Noel O Akioyamen, Jichuan Wang, David H Ge, Milan K Sen, Bang Hoang, David S Geller","doi":"10.2106/JBJS.ST.22.00034","DOIUrl":"https://doi.org/10.2106/JBJS.ST.22.00034","url":null,"abstract":"<p><strong>Background: </strong>The pelvis is one of the most common areas for metastatic bone disease. We recently described the use of a minimally invasive percutaneous screw fixation of metastatic non-periacetabular pelvic lesions, with excellent results.</p><p><strong>Description: </strong>The procedure can be completed in a standard operating theater without the need for special instruments. In our video we describe the appropriate intraoperative patient positioning, surgical equipment, surgical approach, and obtainment of the necessary fluoroscopic views for placement of various pelvic percutaneous screws.</p><p><strong>Alternatives: </strong>Alternative treatments include surgical procedures such as curettage, cement packing, and modified Harrington total hip arthroplasty through extensive open approaches. Additionally, as an alternative to standard fluoroscopy, intraoperative navigation and an O-arm could be utilized for the placement of screws. In our experience, intraoperative navigation has been helpful for confirmation of final screw placement and length. Overreliance on intraoperative navigation in the setting of poor bone quality and an abandonment of tactile feedback and the various tips described in this video article can lead to inadvertent extraosseous screw placement and injury. Furthermore, as navigation involves only a virtually computed image, we have found it challenging to utilize in complex, curved bones, such as the superior pubic ramus.</p><p><strong>Rationale: </strong>Percutaneous screw fixation is safe and effective for the treatment of metastatic non-periacetabular pelvic lesions. Given the simplicity of the technique and instrumentation, and the tolerance of concomitant treatments, this approach is worthy of broader consideration.</p><p><strong>Expected outcomes: </strong>In our recent study, 22 consecutive patients with painful non-periacetabular pelvic metastatic cancer underwent percutaneous screw fixation. There were no surgical complications. Postoperatively, there was significant improvement in visual analog scale pain scores and functional Eastern Cooperative Oncology Group scores, as compared with baseline³.</p><p><strong>Important tips: </strong>Despite the simplicity of the intraoperative set-up and instrumentation, the procedure is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging.</p><p><strong>Acronyms and abbreviations: </strong>CT = computed tomographyASIS = anterior superior iliac spineGT = greater trochanterAP = anteroposteriorAIIS = anterior inferior iliac spineSI = sacroiliacTSTI = transsacral-transiliacVAS = visual analog scaleECOG = Eastern Cooperative Oncology GroupDVT = deep vein thrombosis.</p>","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11692961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Flexor Hallucis Longus Tendon Transfer for the Treatment of Chronic Achilles Tendon Defects.","authors":"Andrew Rust, Logan Roebke, Kevin D Martin","doi":"10.2106/JBJS.ST.23.00075","DOIUrl":"https://doi.org/10.2106/JBJS.ST.23.00075","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;An all-inside endoscopic flexor hallucis longus (FHL) tendon transfer is indicated for the treatment of chronic, full-thickness Achilles tendon defects. The aim of this procedure is to restore function of the gastrocnemius-soleus complex while avoiding the wound complications associated with open procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;This procedure can be performed through 2 endoscopic portals, a posteromedial portal (the working portal) and a posterolateral portal (the visualization portal). The FHL tendon is identified, and the joint capsule is debrided to identify the subtalar joint. A shaver is utilized to circumferentially debride the FHL at the level of the subtalar joint, allowing for full visualization of the tendon. Care is taken to avoid the posteromedial neurovascular bundle by keeping the shaver against the tendon. An endoscopic suture-passing device is utilized to pierce the FHL tendon and shuttle a nonabsorbable suture through the tendon; this step is done 2 times. The tendon is then cut at its distal-most aspect (adjacent to the subtalar joint) with an endoscopic cutter. The tendon is then brought through the posteromedial portal and prepared for transosseous passage with nonabsorbable suture. Next, the anterior insertion of the Achilles tendon is endoscopically identified and debrided. With use of needle endoscopy-targeted pin placement, a Beath pin is placed at the anterior footprint of the Achilles via the posteromedial portal. The pin is advanced dorsal to plantar and out the bottom of the foot and is confirmed on fluoroscopy. With use of an appropriately sized reamer, the Beath pin is loaded with the 2 grasping sutures and shuttled plantarly. The needle endoscope is then placed in the posterolateral portal to visualize the FHL tendon, advancing into the tunnel with the foot held in 15° of plantar flexion. An appropriately sized interference screw is then placed in the tunnel, using direct endoscopic visualization to confirm placement and depth of the screw.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Chronic Achilles tendon ruptures with symptomatic weakness often necessitate operative treatment; however, high-risk patients may be better managed nonoperatively with an ankle-foot orthosis. These patients often demonstrate improved gait and function with this orthosis&lt;sup&gt;1&lt;/sup&gt;. The choice of operative technique for the treatment of chronic Achilles tendon defects is primarily based on tendon gap length; options include end-to-end repair, fascial advancement, and turn-down procedures with or without transferring the FHL, peroneus brevis, or flexor digitorum longus tendons. These techniques require substantial incisions and violation of the posterior compartments and Achilles paratenon, creating substantial postoperative scarring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Chronic Achilles tendon ruptures with defects or gaps leave the patient with weakness and biomechanical loss of the gastrocnemius-s","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11692965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debridement Technique for Single-Stage Revision Shoulder Arthroplasty.","authors":"Logan Kolakowski, Monica Stadecker, Justin Givens, Christian Schmidt, Mark Mighell, Kaitlyn Christmas, Mark Frankle","doi":"10.2106/JBJS.ST.23.00093","DOIUrl":"https://doi.org/10.2106/JBJS.ST.23.00093","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The incidence of revision shoulder arthroplasty continues to rise, and infection is a common indication for revision surgery. Treatment of periprosthetic joint infection (PJI) in the shoulder remains a controversial topic, with the literature reporting varying methodologies, including the use of debridement and implant retention, single-stage and 2-stage surgeries, antibiotic spacers, and resection arthroplasty&lt;sup&gt;20&lt;/sup&gt;. Single-stage revision has been shown to have a low rate of recurrent infection, making it more favorable because it precludes the morbidity of a 2-stage operation. The present video article describes a meticulous debridement technique as it applies to revision shoulder arthroplasty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;The previous deltopectoral incision should be utilized, with extension 1 to 1.5 cm proximally and distally, removing any draining sinuses. First, develop subcutaneous flaps above the muscle layer to better establish normal tissue planes. A large medial subcutaneous flap will allow for identification of the superior border of the pectoralis major. The pectoralis can be traced laterally to its humeral insertion, which is often in confluence with the deltoid insertion. Hohmann retractors can be placed sequentially, working distal to proximal, under the deltoid in order to recreate the subdeltoid space. Next, reestablish the subpectoral space by releasing any scar tissue tethering the pectoralis muscle and conjoined tendon. Dislocate the prosthesis and remove modular components. Restore the subcoracoid space by dissecting between the subscapularis and the conjoined tendon, allowing for axillary nerve identification. Complete a full capsular excision circumferentially around the glenoid, taking care to protect the axillary nerve as it passes from the subcoracoid space under the inferior glenoid to the deltoid muscle. The decision to remove well-fixed components should be made by the surgeon. Any exposed osseous surfaces should undergo debridement to reduce bacterial burden. Reimplantation should focus on obtaining stable bone-implant interfaces to minimize any micromotion that may increase risk of reinfection. Our preference is to irrigate with 9 L of normal saline solution, Irrisept (Irrimax), and Bactisure Wound Lavage (Zimmer Biomet). Multiple cultures should be taken and followed carefully postoperatively to allow tailoring of the antibiotic regimen with infectious disease specialists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Two-stage revision is the most common alternative treatment for shoulder PJI and consists of removal of components, debridement, and delayed component reimplantation; however, it requires at least 1 return to the operating room for definitive treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Serum laboratory studies and joint aspiration are not reliable predictors of shoulder PJI because of the high rate of &lt;i&gt;Cutibacterium acnes&lt;/i&gt; infections&lt;sup&gt;21,22&lt;/sup&gt;. The inc","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11692968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Conversion of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty.","authors":"Nicolas S Piuzzi, Nickelas Huffman, Alex Lancaster, Matthew E Deren","doi":"10.2106/JBJS.ST.24.00004","DOIUrl":"10.2106/JBJS.ST.24.00004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Unicompartmental knee arthroplasty (UKA) procedures have become much more common in the United States in recent years, with &gt;40,000 UKAs performed annually&lt;sup&gt;1&lt;/sup&gt;. However, it is estimated that 10% to 40% of UKAs fail and thus require conversion to total knee arthroplasty (TKA)&lt;sup&gt;2-5&lt;/sup&gt;. In the field of total joint arthroplasty, robotic-assisted surgeries have demonstrated advantages such as better accuracy and precision of implant positioning and improved restoration of a neutral mechanical axis&lt;sup&gt;6-9&lt;/sup&gt;. These advantages may be useful in UKA to TKA conversion surgeries, as the use of robotic assistance may result in improved bone preservation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;Robotic-assisted TKA is performed with the patient in the supine position, under spinal anesthesia, and with use of a tourniquet. A limited incision is made approximately 1 cm medial to a standard midline incision, through the previous UKA incision. A medial parapatellar arthrotomy and partial synovectomy are performed. Array pins are placed in a standard fashion: intra-incisional in the femoral diaphysis and extra-incisional in the distal tibial diaphysis. Femoral and tibial bone registration is performed, along with functional knee balancing to adjust implant positioning. The robotic arm-assisted system is then utilized to achieve the planned bone resections. After completing all bone cuts, trial components are inserted. Trial reduction is then performed, and knee extension, stability, and range of motion are assessed. The final implant is cemented into place. We utilize a cruciate-retaining TKA implant. No augments are required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;An alternative treatment option is manual UKA to TKA conversion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Robotic-assisted conversion of UKA to TKA is especially useful for patients requiring bone preservation. For example, 1 case series found that the use of robotic-assisted conversion of UKA to TKA resulted in a decreased use of augments and a smaller average polyethylene insert thickness compared with manual conversion. Furthermore, mechanical bone loss may occur secondary to implant loosening. Thus, in patients with aseptic loosening, robotic-assisted conversion of UKA to TKA may be useful&lt;sup&gt;10&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Expected outcomes: &lt;/strong&gt;Results of robotic-assisted conversion of UKA to TKA have thus far been excellent. In a study of 4 patients undergoing robotic-assisted conversion of UKA to TKA, all patients experienced uneventful recoveries without any need for subsequent re-revision&lt;sup&gt;10&lt;/sup&gt;. In a case report of a robotic-assisted conversion of UKA to TKA, the patient was pain-free at both 6 months and 1 year postoperatively, with a range of motion of 0° to 120° at 6 months and 0° to 130° at 1 year, and excellent component alignment on radiographs at 1 year&lt;sup&gt;11&lt;/sup&gt;. In another case report, the patient had full range of motion and a normal, pain","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"14 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}