Surgical Technology International
36th Edition
Contains 69 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
472 pages
May 2020 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
New Technology for Total Knee Arthroplasty Provides Excellent Patient-Reported Outcomes: A Minimum Two-Year Analysis
Arthur L. Malkani, MD, Associate Professor, Langan Smith, BS, University of Louisville, Louisville, Kentucky, Martin W. Roche, MD, Director of Robotic Joint Reconstruction, Rushabh Vakharia, MD, Holy Cross Orthopedic Institute, Ft. Lauderdale, Florida, Frank R. Kolisek, MD, Charles Jaggard, MS, Clinical Trial Manager, OrthoIndy, Greenwood, Indiana, Kenneth A. Gustke, MD, University of South Florida, Temple Terrace, Florida, William J. Hozack, MD, Thomas Jefferson University, Philadelphia, Pennsylvania, Nipun Sodhi, MD, Long Island Jewish Medical Center, Northwell Health, Queens, New York, Alexander Acuña, BS, Cleveland Clinic Foundation, Cleveland, Ohio, Hytham S. Salem, MD, Michael A. Mont, MD, System Chief of Joint Reconstruction, Vice President, Strategic Initiatives, Lenox Hill Hospital, Northwell Health, New York, New York
1231
Introduction: Robotic-assisted total knee arthroplasty has been demonstrated to help increase various patient-reported, clinical, and surgical outcome metrics (PROMs). However, the current literature is limited regarding PROMs data for longer follow-up periods beyond one year. Therefore, the purpose of this study was to 1) report multicenter patient-reported outcomes with multiple metrics, as well as 2) postoperative surgeon-specific outcomes at a minimum two-year follow-up.
Materials and Methods: Five fellowship-trained, high-volume surgeons performed a total of 188 total knee arthroplasty surgeries using the enhanced preoperative planning and real-time intraoperative feedback of a robotic-assisted device. Patients from all surgeons followed similar postoperative rehabilitation beginning on postoperative day one. Patients were evaluated based on the Short Form-12 Questionnaire (SF-12), the Forgotten Joint Score (FJS), and Knee Society total and subscores (KSS). The SF-12 was subdivided into two components: mental composite score (MCS) and physical composite score (PCS). The KSS was subdivided into functional and knee scores. Additionally, surgical outcomes from the latest follow-up visit were evaluated. All patients were evaluated at a minimum of two years follow-up time.
Results: All patients reported excellent postoperative outcomes for all three PROMs. The mean postoperative SF-12 MCS and PCS scores were both 57 points, with 50 as the threshold for norm-based scoring (MCS range: 42 to 69 points; PCS range: 41 to 68 points). The mean FJS was 75 points (range: 14 to 100 points). The mean KSS functional score was 84 points (range: 20 to 100) while the mean Knee Score was 92 points (range: 40 to 100). Similarly, we found that the aseptic revision rates were low (n=2, 1.06%, one for unexplained pain, and another for a post-traumatic tibial fracture) with few other postoperative complications (n=7 patients [3.7%]) in our cohort.
Conclusion: Our analysis found that patients had excellent outcomes across multiple PROM metrics. Future work can build on these results with large patient populations over longer follow-up intervals. Nevertheless, these results provide the foundation and evidence to support the continued use of this innovative technology for total knee arthroplasties.
Order Digital ePrint:
PDF Format - $115.00
1 Year Subscription
including this article:
Online PDF - $399.00
Knee Osteonecrosis: Cell Therapy with Computer-assisted Navigation
Philippe Hernigou, MD, Professor of Orthopedic Surgery, University of Paris Est, Paris, France, David Gerber, MD, Henri-Mondor University Hospital, Créteil, France, Jean Charles Auregan, MD, Assistant Professor, Hôpital Antoine-Béclère Université Paris-Sud, Clamart, France
1151
Background: The knee is the second-most common location for osteonecrosis, although it is affected much less often than the hip. Core decompression by precise drilling into ischemic lesions of the femoral condyle while remaining extra-articular is a challenge, particularly in obese patients. For cell therapy, exact localization of the injection point is important to avoid intra-articular injection.
Methods: The precision of drilling with computer-based navigation was compared to that of conventional fluoroscopy-based drilling. A prospective, randomized study was conducted using both surgical trainees without experience and expert surgeons. First, participants performed the surgical task (core decompression) on a cadaver knee using fluoroscopic guidance or computer-based navigation. Performance was determined by the radiographic analysis of trocar placement. Next, 12 consecutive patients with bilateral symptomatic secondary (corticosteroids) osteonecrosis without collapse were included in a clinical prospective, randomized, controlled study. The 24 knees were treated using conventional fluoroscopy with expert surgeons on one side and computer-based navigation with surgical trainees on the contralateral side. Bone marrow aspirated from the two iliac crests was mixed before concentration. Each side received the same volume of concentrated bone marrow and the same number of cells (95,000 ± 25,000 cells; counted as CFU-F).
Results: In the cadaver tests, the distance to the desired center-point of the lesion in the navigated group (1.6 mm) was significantly less than that in the control group (5.9 mm; p<0.001). Significant differences were also found in the number of drilling corrections (p<0.001), the radiation time needed (p<0.001), the risk of intra-articular penetration, and the risk of ligament injuries. In patients, computer navigation achieved results closer to the ideal position of the trocar, with better trocar placement in terms of tip-to-subchondral distance and ideal center position within the target for injection of stem cells. At the most recent follow-up (5 years), an increase in precision with computer-assisted navigation resulted in less collapse (4 vs. 1) and better volume of repair (11.4 vs 4.2 cm3) for knees treated with the computer-assisted technique. Failures were related to missing the target with intra-articular penetration.
Conclusions: Computer-assisted navigation improved precision with less radiation. The findings of this study suggest that computer navigation may be safely used in a basic procedure for the injection of stem cells in knee osteonecrosis.
Order Digital ePrint:
PDF Format - $115.00
1 Year Subscription
including this article:
Online PDF - $399.00
A Single-Centre Feasibility Randomised Controlled Trial Comparing the Incidence of Asymptomatic and Symptomatic Deep Vein Thrombosis Between a Neuromuscular Electrostimulation Device and Thromboembolism Deterrent Stockings in Post-Operative Patients Recovering from Elective Total Hip Replacement Surgery
Thomas W. Wainwright, PgDip, PgCert, BSc (Hons), MCSP, Associate Professor, Louise C. Burgess, BSc (Hons), Robert G. Middleton, MA, MBBchir, FRCS (Orth) CCST, Professor in Orthopaedics, Orthopaedic Research Institute, Bournemouth, UK
1253
Background: Total hip replacement is recognised as a major risk factor for deep vein thrombosis (DVT). The aim of this study was to investigate the feasibility of using a novel neuromuscular electrical stimulation device (NMES) for DVT prevention in patients recovering from elective hip replacement surgery.
Methods: Twenty-eight patients undergoing total hip replacement were randomised to receive postoperative treatment with either the NMES device or compression stockings continually from post-surgery until discharge (day 4). The primary outcome measure was the presence of symptomatic or asymptomatic DVT at 48 hours post-surgery and on the day of discharge from hip replacement surgery, as assessed by Duplex ultrasound. Secondary outcomes included hemodynamic responses to the devices, lower limb oedema, sit-to-stand and timed-up-and-go (TUG) scores, and hip range of motion.
Results: In the compression stockings group, two cases of asymptomatic DVT were identified by Duplex ultrasound at 48 hours post-surgery. No cases were found in the NMES group. Patients in the NMES group demonstrated a general trend of a decrease in leg volume from post-surgery to discharge, whereas leg volume largely remained static for the compression stockings group. In addition, positive hemodynamic effects were found in favour of the NMES group in the non-operated leg. The change in TUG scores also favoured the NMES group (NMES: 150 ± 152%, compression stockings: 363 ± 257% (p=0.03)), whereas no differences in sit-to-stand scores or hip range of motion were observed.
Conclusions: This study supports the feasibility of NMES as an alternative mechanical prophylaxis worn in the postoperative phase until discharge and provides important findings for clinicians considering novel mechanical prophylaxis options.
Does Patellar Resurfacing in Primary Total Knee Arthroplasty Increase the Risk of Manipulation?
David A. Crawford, MD, Jason M. Hurst, MD, Michael J. Morris MD, Joint Implant Surgeons, Keith R. Berend, MD, Vice President, Joint Implant Surgeons, Inc., New Albany, Ohio, White Fence Surgical Suites, New Albany, Ohio, Mount Carmel Health System, Columbus, Ohio
1211
Introduction: Patellar resurfacing in primary total knee arthroplasty (TKA) remains a controversial topic. The purpose of this study is to evaluate whether patellar resurfacing affects early complications and outcomes with a symmetric femoral component design.
Materials and Methods: Retrospective review was performed from 2015 to 2019 of all primary TKAs performed with the Klassic® Knee System (Total Joint Orthopedics, Inc., Salt Lake City, Utah) yielding a cohort of 526 patients (674 knees). Patients were compared based on whether the patella was resurfaced (391 knees, 58%) or unresurfaced (283 knees, 42%). Pre- and postoperative range of motion (ROM), University of California Los Angeles (UCLA) activity score, and Knee Society clinical (KSC), functional (KSF) and pain (KSP) scores were assessed between groups. Manipulation under anesthesia (MUA) and revisions were evaluated. The resurfaced group was significantly younger and had significantly more female patients, but they had no differences in preoperative body mass index (BMI), knee ROM, or Knee Society scores. One-year minimum follow up was available in 240 patients.
Results: Mean follow up was seven months (range, 1 to 35 months, SD ±7 months). MUAs were performed on 12 knees (4.2%) in the unresurfaced group and 37 knees (9.5%) in the resurfaced group (p=0.01). One patient (0.3%) in the unresurfaced group underwent a revision 1.5 years after the index surgery for a patellar resurfacing and polyethylene exchange. No other revisions were performed in either group. In patients with one-year minimum follow up, there was no significant difference in ROM or clinical or functional outcomes between groups.
Conclusion: Patients who underwent a primary TKA with the TJO Klassic® Knee System with a resurfaced patella had a significantly higher incidence of manipulation under anesthesia than those with an unresurfaced patella. At most recent follow up, there was no significant difference in mean ROM or clinical outcome scores.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Do Demographic or Anthropometric Factors Affect Lateralization of the Tibial Tubercle in a Diverse Population? A Magnetic Resonance Imaging Analysis
Isaac Livshetz, MD, Mitchell B. Meghpara, MD, Joseph A. Karam, MD, Benjamin A. Goldberg, MD, Associate Professor of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, Hytham S. Salem, MD, Michael A. Mont, MD, Chief of Joint Reconstruction, Lenox Hill Hospital, New York, New York, Omar T. Hassan, MD, Rosalind Franklin University of Medicine & Science, Chicago, Illinois
1213
Background: In revision total hip arthroplasty (THA), modular femoral components aid the surgeon in reconstructing joints compromised by loss of bone and soft-tissue integrity, providing customization to address bony deficits, deformity, limb length, and offset challenges. The purpose of this study was to review the survival and outcomes at minimum five-year follow up of patients who underwent revision THA at our center with a single modular femoral revision hip system offering a wide range of proximal body and distal stem geometries and sizing options.
Materials and Methods: A query of our practice arthroplasty registry revealed 66 consented patients (69 hips) who underwent revision THA using a modular femoral stem between December 2009 and July 2013 with minimum five-year follow up. There were 35 men (53%) and 31 women (47%). Mean age was 65.2 years (range, 36–87). Etiology for index revision was 32 aseptic loosening, 20 infection, nine periprosthetic fracture, three nonunion of internal fixation, three instability, one stem breakage, and one metal complication.
Results: Mean follow up was 6.3 years (range, 5–9). Harris Hip Scores improved from a mean of 45.4 preoperatively to 72.0 at most recent evaluations. There have been four re-revisions of the femoral stem: one infection, two periprosthetic femoral fracture, and one (proximal segment only) for instability. Radiographic assessment revealed satisfactory position, fixation, and alignment in all hips. Radiographic subsidence of 6–10mm occurred in four (none revised), and none had subsidence > 10mm. There were no modular junction failures. Kaplan-Meier survival to endpoint of femoral revision was 93.3% (95% CI ±3.3%) at 8.7 years.
Conclusions: The minimum five-year results of this modular THA revision system are promising, with low rates of aseptic failure, minimal subsidence, and no modular junction failures. While there may be roles for the use of non-modular revision stems, the mid-term clinical results in this cohort of patients was found to be acceptable.
Order Digital ePrint:
PDF Format - $115.00
1 Year Subscription
including this article:
Online PDF - $399.00
Tips and Tricks to Optimize Surgical
Outcomes After ACL Repair Using
Dynamic Intraligamentary Stabilization
Christiaan HW Heusdens, MD, Lieven Dossche, MD, Katja Zazulia, MSc, Jozef Michielsen, MD, Pieter Van Dyck, MD, Professor of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
1214
Purpose: This paper describes technical difficulties and outcomes for the first 15 patients treated with Dynamic Intraligamentary Stabilization (DIS) for anterior cruciate ligament (ACL) repair.
Methods: The first 15 patients treated with DIS were included. To optimize the inclusion process, a new pre-operative pathway was developed. All intra-operative technical problems were recorded. During the 2-year follow-up period, patient-related outcome measures, return to work, anterior-posterior knee laxity using a Rolimeter and ACL healing as revealed by MRI follow-up scans were recorded.
Results: During 11 DIS procedures, 15 technical problems were encountered. Six were surgeon-related and 9 were material-related. All problems were resolved intra-operatively. Repeat surgery was performed in 4 patients due to arthrofibrosis and in 1 due to a cyclops lesion. The DIS implant was removed in all 5 patients. According to the Tegner score, 7 of 10 (70%) patients returned to the pre-injury level of sporting activity within 6 months. The mean return to work time was 5.4 (SD 3.6) weeks. On MRI, 10 patients showed normal ACL healing (Grade 1) and 3 showed a high repair signal intensity (Grade 2). Although 2 patients showed no signs of ACL healing on MRI (Grade 3), no instability was reported or measured post-operatively or after the DIS implant was removed.
Conclusion: All intra-operative technical problems were resolved and did not lead to conversion to ACL reconstruction. We share tips and tricks that could assist surgeons who are just starting to use the DIS technique.
Short-Term Safety of the Direct Superior Approach for Total Hip Arthroplasty
Rami M. Ezzibdeh, MSc , Prerna Arora, M. Tech, Derek F. Amanatullah, MD, PhD, Assistant Professor, Stanford Hospital and Clinics, Redwood City, California, Andrew Barrett, MD, University of Pittsburgh Medical College-Hamot, Erie, Pennsylvania, Lige Kaplan, MD, Beaumont Hospital, Royal Oak, Michigan, Douglas Roger, MD, Desert Regional Medical Center, Palm Springs, California, Daniel Ward, MD, Assistant Professor, New England Baptist Hospital, Boston, Massachusetts, Jesus J. Mas Martinez, MD, Vistahermosa Traumatology, Clinica HLA Vistahemosa Avda, Alicante, Spain
1216
Introduction: Minimally invasive surgery total hip arthroplasty (MIS-THA) is becoming increasingly popular. There are several approaches to MIS-THA that vary according to anatomical access to the hip joint. The direct superior (DS) approach is a recent modification of an MIS posterior approach that spares the iliotibial band and most of the short external rotators of the hip, particularly the quadratus femoris. While FDA approved, there is a lack of data in the current literature on DS outcomes and the safety of this approach is yet to be systematically evaluated.
Materials and Methods: The goal of this study is to provide a quantitative analysis of the safety and complications of primary DS-total hip arthroplasty at 90 days post-surgery through a retrospective multicenter case series of 301 patients. Special attention was given to intra- and postoperative complications, readmissions, mean operative time, hospital-stay length, and postoperative ambulation distance.
Results: Surgical complications included three (1%) intraoperative calcar fractures and four (1%) postoperative peri-prosthetic fractures. The postoperative medical complication rate was 3% with four (1%) patients requiring readmission. The mean operative time was 70 ± 19 minutes, hospital-stay length 41 ± 19 hours, and the estimated blood loss (EBL) was 213 ± 129 ml. There were no acute episodes of instability at 90-day follow up. The intra- and postoperative results are similar with those reported in the literature for both the anterior and posterior approaches.
Conclusion: This study indicates that the DS approach appears to be safe with a low complication rate at 90 days that is comparable to more conventional approaches, such as the direct anterior and posterior techniques. This information is also valuable for the evaluation of reimbursements for DS-THA as current bundled-payment models heavily emphasize 90-day outcomes and complications. Long-term direct comparative studies with the anterior and posterior approaches is required to fully evaluate DS-THAs.
Order Digital ePrint:
PDF Format - $115.00
1 Year Subscription
including this article:
Online PDF - $399.00
Computer-Assisted Navigation in Total Knee Arthroplasty
Kevin K. Mathew, BS, Kevin B. Marchand, BS, John M. Tarazi, MD, Hytham S. Salem, MD, William DeGouveia, BS, MS, Joseph O. Ehiorobo, MD, Michael A. Mont, MD, System Chief of Joint Reconstruction, Vice President, Strategic Initiatives, Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, Nipun Sodhi, MD, Northwell Health Orthopaedics, Long Island Jewish Medical Center, New York, New York
1224
Manual total knee arthroplasty (TKA) has successfully treated end-stage knee osteoarthritis for several years. However, recent technological advancements have enabled surgeons to perform TKA with more accuracy and precision. Aligning the femoral and tibial components perpendicular to the mechanical axes of the femur and tibia is a fundamental principle for restoring knee kinematics and soft-tissue balance. Computer-assisted robotic TKA has proven its ability to fine tune lower leg alignment, component position, and soft-tissue balancing. Furthermore, robotic-assisted TKA (RATKA) offers the additional benefit of improving soft-tissue protection compared to manual techniques. Numerous systems have been developed in the advancement of technology in computer processing, and the number of robotic surgical systems is increasing as well. The three main categories of navigation systems can be classified as: image-based console navigation, imageless console navigation, and accelerometer-based handheld navigation systems. The purpose of this review was to describe emerging technologies for TKA. Specifically, we outline the available literature pertaining to each system with regards to their: (1) accuracy and precision of component alignment; (2) soft-tissue protection; (3) postoperative outcomes; and (4) other reported outcomes such as costs.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
All-Inside Arthroscopic Meniscal Repair with the Arthrex Meniscal Cinch™ II
Joanne M Jenkins, MBBS, BSc, MRCS, Glasgow Royal Infirmary, Glasgow, Scotland, Graeme P Hopper, MBChB, MSc, MRCS, University of Glasgow, Glasgow, Scotland, Gordon M Mackay, MD, FRCS (Orth), FFSEM (UK), Professor, University of Stirling, Stirling, Scotland
1225
Meniscal tears are the most common indication for knee surgery. An appreciation of the limitations associated with the gold-standard inside-out meniscal repair technique has resulted in the development of newer all-inside techniques that overcome many of these issues. This paper describes, with a video illustration available online, a one-handed all-inside meniscal repair technique using the Meniscal Cinch™ II (Arthrex, Inc., Naples, FL).
Order Digital ePrint:
PDF Format - $115.00
1 Year Subscription
including this article:
Online PDF - $399.00
Manipulation Under Anesthesia Rates in Technology-Assisted versus Conventional-Instrumentation Total Knee Arthroplasty
Arthur L. Malkani, MD, Associate Professor, Langan Smith, BS, University of Louisville, Louisville, Kentucky, Martin W. Roche, MD, Rushabh Vakharia, MD, Holy Cross Orthopedic Institute, Ft. Lauderdale, Florida, Frank R. Kolisek, MD, Charles Jaggard, MS, OrthoIndy, Greenwood, Indiana, Kenneth A. Gustke, MD, University of South Florida, Florida Orthopaedic Institute, Temple Terrace, Florida, William J. Hozack, MD, Thomas Jefferson University, Philadelphia, Pennsylvania, Nipun Sodhi, MD, Long Island Jewish Medical Center, Northwell Health, Queens, New York, Alexander Acuña, BS, Cleveland Clinic Foundation, Cleveland, Ohio, Hytham S. Salem, MD, Lenox Hill Hospital, Northwell Health, New York, New York, Michael A. Mont, MD, System Chief of Joint Reconstruction, Vice President, Strategic Initiatives, Lenox Hill Hospital, Northwell Health, New York, New York
1232
Introduction: Various technological advancements, specifically robotic assistance, have been implemented for total knee arthroplasty (TKA) procedures to attempt to improve patient outcomes and decrease complication rates. Manipulations under anesthesia have been considered a surrogate for knee stiffness, an undesired postoperative outcome that can potentially be avoided. Currently, there is a lack of information regarding the impact that these new technologies have on manipulations under anesthesia (MUA) rates following TKA. Therefore, the purpose of this study was to evaluate rates of MUAs between a consecutive series of patients who underwent robotic-assisted surgery compared to patients who underwent TKA with conventional instrumentation.
Materials and Methods: A total of 188 consecutive robotic-assisted total knee arthroplasties were performed by five fellowship-trained, high-volume surgeons at academic and community institutions. Patients were paired to a consecutive equal number of control patients by each of the specific surgeon for comparison. All patients followed similar postoperative rehabilitation starting on postoperative day one. Rates of MUAs were evaluated within and between cohorts. Additionally, the percent difference of rates was calculated to compare cohorts. All patients were evaluated at a minimum of two years follow-up time from the index procedure. Chi-square analyses was performed to statistically compare MUA rates between the cohorts.
Results: The overall manipulation under anesthesia rate for the study cohort was 1.06% (2/188 patients), while it was 4.79% in the control cohort (9/188) (p=0.032). A 127.5% difference in manipulation under anesthesia rates was found between the two cohorts. No individual surgeons had higher MUA rates in their robotic-assisted group.
Conclusion: Our study found that patients undergoing robotic-assisted TKA experienced a significant, 4.5-fold decrease in rates of manipulation under anesthesia (p=0.032). Given that MUAs can be a marker of knee stiffness following total knee arthroplasty, the lower rate indicates that study cohort patients had less knee stiffness and, therefore, greater initial postoperative range of motion than the control cohort. Based on these data, assistive technologies may have an advantageous role contributing to enhanced patient outcomes.
Order Digital ePrint:
PDF Format - $115.00
1 Year Subscription
including this article:
Online PDF - $399.00
One-Step Reconstruction with Custom-made 3D-printed Scapular Prosthesis, After Partial or Total Scapulectomy
Stefano Grossi, M.D., Antonio D’Arienzo, M.D., Federico Sacchetti, M.D., Matteo Ceccoli, M.D., Fabio Cosseddu, M.D., Elisabetta Neri, M.D., Simone Colangeli, M.D., Paolo Domenico Parchi, M.D., Associate Professor, Lorenzo Andreani, M.D., Rodolfo Capanna, M.D., Full Professor, Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
1243
En bloc scapulectomy with covering muscles was historically considered the only procedure available for surgical treatment of bone and soft tissue tumors of the scapula. When possible, reconstruction with scapular allograft is the gold standard, and gives satisfactory functional, cosmetic, and oncological outcomes. While good results have recently been reported with 3D-printed prostheses for reconstruction of bone loss, there is little information available in the medical literature regarding scapula reconstruction with a 3D-printed prosthesis. Between 2016 and 2018, we performed four scapular resections (two total and two involving the superior 1/3) followed by reconstruction with a 3D-printed prosthesis made of a porous titanium alloy (Ti-6Al-4V, diameter between 100 and 400 mm), using computer-aided design (CAD) and patient-specific implants (PSI) with previously acquired CT-MR fusion images. At 2 years follow-up, the patients with partial scapulectomy had an MSTS score of 76%, no local or systemic recurrence, good clinical results and no pain. At 1 year 6 months follow-up, the patients with total scapulectomy had an MSTS score of 46%, no local or systemic recurrence, fair clinical results and no pain. Thus, custom-made 3D-printed prostheses appear to be valuable in orthopedic surgery. However, a larger cohort and longer-term analysis are needed to evaluate the scapular 3D-printed prosthesis as a reliable reconstruction technique.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Transtrochanteric Anterior Rotational Osteotomy Combined with Re-Sphericalization of the Collapsed Femoral Head Using Calcium Phosphate Cement Filling
Goro Motomura, MD, PhD, Associate Professor, Yusuke Kubo, MD, PhD, Takeshi Utsunomiya, MD, PhD, Satoshi Hamai, MD, PhD, Assistant Professor, Satoshi Ikemura, MD, PhD, Assistant Professor, Masanori Fujii, MD, PhD, Assistant Professor, Yasuharu Nakashima, MD, PhD, Professor and Chairman, Takuaki Yamamoto, MD, PhD, Professor and Chairman, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
1244
Introduction: Transtrochanteric anterior rotational osteotomy (ARO) is an established joint-preserving surgery for collapsed osteonecrosis of the femoral head (ONFH) in which the collapsed necrotic lesion is rotated anteriorly. Recently, preoperative collapse of more than 2.98mm was reported to be the most influential factor for progressive collapse of the anteriorly transposed necrotic lesion after ARO, the main cause of secondary osteoarthritic changes and clinical failure. We attempted to prevent progressive collapse with re-sphericalization of the collapsed femoral head using calcium phosphate cement (CPC) filling in conjunction with ARO.
Materials and Methods: Between May 2015 and April 2018, five consecutive hips with ONFH, femoral head collapse of ³3mm, and one-third or more of the posterior region of the femoral head intact, were prospectively recruited for re-sphericalization with ARO. This report describes intraoperative surgical techniques focusing on re-sphericalization of the collapsed femoral head using CPC and short-term effects of this additional procedure on progressive collapse of the transposed necrotic lesion, defined as ³2mm progression on lateral radiographs.
Results: After anterior rotation of the proximal fragment, followed by fixation of the transtrochanteric osteotomy site, a 5mm fenestration was made in the collapsed region of the anterior femoral head cartilage, through which the collapsed surface was carefully lifted with an elevatrium. Subsequently, CPC paste was injected into the lifted subchondral space with a small needle. After CPC paste injection, the femoral head was maintained at 40°C for 10 minutes to promote solidification of the CPC paste. With the re-sphericalization method, the mean level of collapse decreased from 4.1mm before surgery to 2.0mm after surgery. Subsequently, progressive collapse of the transposed necrotic lesion was confirmed in two hips. One of these hips had a deep infection that required complete curettage of CPC three weeks after the initial surgery. All hip joints have been preserved without conversion to prosthesis during a mean follow up of 2.1 years.
Conclusion: A joint-preserving procedure for ONFH with severe collapse remains a challenging problem for surgeons. When ARO is indicated based on one-third or more of the posterior region of the femoral head being intact, the current re-sphericalization method could be worth considering as an additional procedure in cases with severe collapse.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Newer Generation of Cementless Total Knee Arthroplasty: A Systematic Review
Heather S. Haeberle, BS, Baylor University School of Medicine, Houston, Texas, Hytham S. Salem, MD, Joseph O. Ehiorobo, MD, Michael A. Mont, MD, Lenox Hill Hospital, New York, New York, Nipun Sodhi, MD, Long Island Jewish Medical Center, Northwell Health, New York, New York
1248
Introduction: Although the use of cementless implants in total knee arthroplasty (TKA) has increased in recent years, there is still ongoing debate regarding the optimal method of fixation. The purpose of this review was to evaluate the evidence regarding cementless versus cemented total knee arthroplasty (TKA) with regard to: (1) all-cause survivorship and aseptic survivorship; and (2) patient-reported outcome measures (PROMs) of newer generation TKAs.
Materials and Methods: A systematic review of all reports on cementless TKA published from January 2010 to February 2019 was performed. A total of 221 articles were evaluated and 39 studies met inclusion criteria for final analysis. Metrics evaluated included all-cause survivorship, aseptic survivorship, and Knee Society Scores (KSS).
Results: Modern cementless TKA provides excellent survivorship and patient-reported outcomes as compared to cemented designs.
Conclusions: Recent studies have demonstrated that newer generation cementless TKAs provide similar functional outcomes and survivorship as compared to cemented TKA. However, additional prospective, randomized trials with long-term follow up are necessary to further compare the outcomes of cementless versus cemented TKA.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Piriformis-Sparing Technique in Total Hip Arthroplasty with Posterolateral Approach
Vinay H. Siddappa, MD, Adult Reconstruction Fellow, BronxCare Hospital Center, New York, New York, , Morteza Meftah, MD, Associate Professor , NYU Langone Orthopedic Hospital, New York, New York
1284
Introduction: Hip dislocation is a devastating complication after total hip arthroplasty (THA), which is slightly higher when using the traditional posterior approach. The piriformis tendon is the most important dynamic posterior stabilizing structure. The piriformis-sparing technique provides a reproducible method for THA, greatly reducing the dislocation rate.
Materials and Methods: After exposure and identifying piriformis, the inferior border of the piriformis is released from the short rotators and capsule with a BOVIE® (Symmetry Surgical, Inc, Nashville, Tennessee). This dissection is continued to the lesser trochanter as one sleeve and then tagged. The anterior/inferior capsule is released with a BOVIE® from the femur to aid in acetabular exposure. The femur is roughly placed in 30° of adduction, 70° of flexion, and slight internal rotation. An anterior retractor is used to displace the proximal femur anteriorly and superiorly.
The reamer is placed inside the acetabulum through the inferior approach. Next, the acetabulum is progressively reamed to the appropriate size and depth, and the final component is placed in proper anteversion and abduction angles based on preoperative functional assessment. After insertion of final components and final hip reduction, the interval beneath the piriformis tendon and superior portion of the capsule is repaired with ETHIBOND® sutures (Johnson & Johnson Inc., New Brunswick, New Jersey). Then, two tunnels in the proximal femur with a 2.7mm drill bit is made and posterior capsule and short rotators are secured through these tunnels.
Results: This technique was used in 150 THAs with a minimum follow up of six months and a mean of 1.2 years ± 1.5 years. There was no dislocation at final follow up. The mean anteversion and abduction was 23 ± 2.7 and 42 ± 3.1, respectively.
Conclusion: Preserving the piriformis tendon may cause less visualization of the superior portion of the acetabulum. However, the anterior/inferior capsular release, and proper placement of the femur with flexion, internal rotation, and adduction, makes it possible to achieve highly reproducible results.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Benefits of CT Scanning for the Management of Hip Arthritis and Arthroplasty
Hytham S. Salem, MD, Kevin B. Marchand, BS, Joseph O. Ehiorobo, MD, John M. Tarazi, MD, Chelsea N. Matzko, BS, Matthew S. Hepinstall, MD, Michael A. Mont, MD, Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, Nipun Sodhi, MD, Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New York, New York
1249
Introduction: Imaging studies for preoperative planning of total hip arthroplasty (THA) are typically obtained by two-dimensional (2D) anteroposterior radiographs. However, CT imaging has proven to be a valuable tool that may be more accurate than standard radiographs. The purpose of this review was to report on the current literature to assess the utility of CT imaging for preoperative planning of THA. Specifically, we assessed its utility in the evaluation of: 1) hip arthritis; 2) femoral head osteonecrosis; 3) implant size prediction; 4) component alignment; 5) limb length evaluation; and 6) radiation exposure.
Materials and Methods: A literature search was performed using search terms “computed tomography”, “radiograph”, “joint” “alignment”, “hip,” and “arthroplasty”. Our initial search returned a total of 562 results. After applying our criteria, 26 studies were included.
Results: CT scans were found to be more accurate than radiographs in predicting implant size and alignment preoperatively and provide improved visualization of extraarticular deformities that may be essential to consider when planning a THA. Although radiation is a potential concern, newer imaging protocols have minimized the radiation to levels comparable to x-ray.
Conclusion: The current literature suggests that CT has several advantages over radiographs for preoperative planning of THA including more accurate planning of implant size, component alignment, and postoperative leg length. It is also superior to x-ray in identifying extraarticular hip deformities using the minimum effective dose for CT and the minimum scan length required by templating software. The radiation can be reduced to values similar to radiography.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
A Novel Vector-Based Computer Tomography Alignment Measurement Protocol for Total Knee Arthroplasty
Scott A. Persohn, BA, Meenakshisundaram Paramasivam, MS, Robert H. Choplin, MD, Associate Professor of Radiology, Paul R Territo, PhD, Associate Research Professor, Indiana University School of Medicine, Indianapolis, Indiana, Jingwei Zhang, PhD, MBA, Manoshi Bhowmik-Stoker, PhD, Jason Otto, PhD, Stryker Orthopaedics, Mahwah, New Jersey, Ahmad Wahdan, MD, Suez Canal University School of Medicine, Ismailia, Egypt, Hytham S. Salem, MD, Northwell Health Orthopaedics, Michael A. Mont, MD, Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
1272
Introduction: Component position and overall limb alignment following total knee arthroplasty (TKA) have been shown to influence implant survivorships and clinical outcomes. While most surgeons utilize standard x-ray imaging for preoperative joint assessments, computer tomography scans (CT), coupled with automated digital analyses have been shown to provide additional surgical and clinical benefits. However, to date, a postoperative CT measurement protocol has not been reported for robotic-arm assisted TKA (RATKA). Therefore, the purpose of this paper was to assess the validity of a novel, vector-based CT alignment measurement protocol. Specifically, we compared: 1) final versus planned component alignment and placement; 2) inter-observer reliability; and 3) intra-observer reliability.
Materials and Methods: The CT-based technique utilized mathematical models to calculate prosthetic alignments from anatomical landmarks. To assess the models, 30 CT scans from multiple centers were collected on RATKA patients at six weeks postoperatively and analyzed using the proposed technique. Results were compared to the surgeons’ preoperative plans for accuracy. Analyses were performed on the same protocol to determine inter-observer reliability. These analyses were repeated 30 days later to assess for intra-observer variability.
Results: The mean measurement errors compared between final versus planned component positions and alignments were: 0.79±1.48o varus in overall limb alignment (p=0.004); 0.34±1.20o varus (p=0.121); and 0.35±1.15o varus (p=0.17) for femoral and tibial varus/valgus alignment; 0.71±1.77o flexion (p=0.18) and 0.38±1.88o posterior (p=0.41) for femoral flexion and tibial slope. There was strong reproducibility between observers. Correlation analyses showed low variabilities, with slopes between 0.8 to 1.0 and all R>0.8.
Conclusion: As robotic technologies become widely available in orthopaedic surgery, it is critical to have tools, such as CT protocols, which can quantitatively verify operative decisions concerning limb alignment and component placement. This study described a novel, vector-based, CT alignment measurement protocol for RATKA which has not previously been defined. The method demonstrated excellent accuracy to plan and low intra- and inter-observer variability. This is a valuable analysis tool for RATKA studies where component accuracy is assessed using postoperative CT images.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Dual Mobility Total Hip Arthroplasty in the United States: A Review of Current and Novel Designs
John F. Dankert, MD, PhD, Katherine Lygrisse, MD, Ran Schwarzkopf, MD, MSc, Associate Professor, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, Michael A. Mont, MD, Lenox Hill Hospital, Northwell Health, New York, New York
1283
Dual mobility constructs have become an increasingly popular option for primary and revision total hip arthroplasty. Two monoblock implants and three modular implants are available for use in the United States. Although short- and mid-term outcome data have been positive overall for these systems, each construct has unique features that the orthopaedic surgeon might consider when selecting the appropriate implant for his or her patient. In this review article, we discuss the design specifications and published literature for each dual mobility system and organize this information into a concise resource that can be easily referenced during preoperative planning.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
The Case for Cementless Total Knee Arthroplasty
Peter Aaron Gold, MD, Luke Garbarino, MD, Nipun Sodhi, MD, Long Island Jewish Medical Center, Northwell Health, New York, New York, Robert Barrack, MD, Professor Orthopaedic Surgery, Washington University, St. Louis, Missouri, Bryan D. Springer, MD, OrthoCarolina, Charlotte, North Carolina, Michael A. Mont, MD, Chief of Joint Reconstruction, Lenox Hill Hospital, Northwell Health, New York, New York
1255
The demographics of total knee arthroplasty (TKA) patients are changing. Individuals are more active, younger, and more obese. These changing demographics and a higher demand for longevity creates a new challenge for reliable and long-term implant fixation. Historically, cemented fixation has remained the gold standard, as cementless design and techniques from the 1980s and 1990s did not obtain long-term positive outcomes due to a failure of ingrowth onto the implants. Advances in the modern-day cementless TKA designs appear to have overcome their initial challenges, indicating the dependence of cementless TKA on implant design. However, there remains the perception that cementless total knee arthroplasty are inferior to cemented TKA. This review discusses the longer-term survivorship data for recent systems, which has shown the potential advantages of cementless fixation.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Mid-Term Follow Up of Newer-Generation Morphometric Wedge Stems for Total Hip Arthroplasty (THA)
Frank R. Kolisek, MD, Charles E. Jaggard, MS, Anthony J. Milto, BS, OrthoIndy South, Greenwood, Indiana, Arthur L. Malkani, MD, Associate Professor, Langan S. Smith, BS, University of Louisville, Louisville, Kentucky, Ethan A. Remily, DO, Wayne A. Wilkie, DO, Nequesha S. Mohamed, MD, Ronald E. Delanois, MD, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
1281
Introduction: Proximally coated, morphometric wedge femoral stems illustrated excellent survivorship and clinical outcomes at a minimum five-year postoperative follow up. Materials and Methods: We completed a retrospective review of 186 THA patients from three high-volume surgeons to assess clinical- and patient-reported outcomes five years after implantation with a cementless, proximally coated morphometric wedge femoral stem. We reviewed Gruen zones on early postoperative and mid-term radiographs for signs of osteolysis, loosening, and wear. Clinical- and patient-reported outcomes were compared with previously published two-year outcomes for these femoral stems. Results: No progression of radiolucencies or loosening was observed radiographically when comparing minimum one-year and five-year follow up. Reactive radiodense lines were observed in 23 cases (12.64%), and 13 cases (7.14%) exhibited true radiolucencies of 1–3mm, and all remained unchanged between follow ups or were no longer present on the five-year film. Cortical hypertrophy was noted in Gruen zones 3 and/or 5 in 11 cases (6.04%). No stems were revised for mechanical loosening or for periprosthetic fracture. Nine (9) patients (4.87%) underwent revisions during the follow-up period for periprosthetic infection, femoral head and/or acetabular component revisions, and impingement requiring release and femoral head change. Average Harris Hip Scores were excellent at five years and improved slightly when compared to a two-year follow up; however, this change was not statistically significant. Health-related quality of life mental component and physical component scores were a mean of 48.45 and 43.10 at 5 years, respectively. All cause Kaplan-Meier survivorship of the femoral stem was calculated at 98.4% at an average 65.7 months post implantation. Additionally, this cohort exhibited 100% aseptic survivorship during the follow-up period. Conclusion: Newer-generation morphometric wedge femoral stems for THA exhibit excellent radiographic stability, patient satisfaction, and clinical outcomes five years post implantation.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Latest Advances in Limb Lengthening Using Magnetically Controlled Intramedullary Lengthening Nails
Christopher A. Makarewich, MD, Philip K. McClure, MD, Adjunct Professor, University of Utah, Salt Lake City, Utah, John E. Herzenberg, MD, FRCSC, FAAOS, Clinical Professor, University of Maryland School of Medicine, Baltimore, Maryland
1280
Magnetically controlled intramedullary lengthening nails (MCILN) have revolutionized the field of limb lengthening and deformity correction. They allow for accurate and precise distraction with excellent patient outcomes and satisfaction. Though potentially technically easier than external fixation, general deformity principles and bone and soft-tissue biology must be considered for successful use. MCILN can address deformities of a wide range of etiologies including congenital, posttraumatic, post-infectious, tumor, and many others with excellent healing rates and outcomes as well as better patient satisfaction and similar cost compared to external fixation. Of the approximately 10,000 MCILN that have been implanted (written communication, NuVasive, Inc., San Diego, California), about 749 cases have been reported in the published literature. Applications outside of deformity correction are on the rise, with new uses reported in reconstruction after tumor resection and acute trauma. This review of MCILN summarizes the history, recent advances, and results of MCILN treatment in a multitude of clinical applications.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Short-Term Clinical Outcomes of a Conical Prosthesis Used in Revision Total Hip Arthroplasty
Akhil Katakam, BA, Hany S. Bedair, MD, Associate Professor , Christopher M. Melnic, MD, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, George Hanson, MD3, G2 Orthopaedic Department, Hennepin Healthcare System, Minneapolis, Minnesota
1282
Introduction: Although primary total hip arthroplasty (THA) stem designs have evolved from conventional lengths to shorter lengths, revision stems have not undergone a similar change. Tapered, conical prostheses have performed well in primary THA, however their use in revision THA has not been thoroughly investigated. Our purpose was to report the short-term radiographic and clinical outcomes of the Wagner Cone Prosthesis® (Zimmer Biomet, Warsaw, Indiana) in revision THA.
Materials and Methods: An institutional review board approved retrospective study was performed to identify all revision THAs with minimum one-year clinical and radiographic follow up between January 1, 2007 and December 31, 2018, which used a short conical tapered stem to reconstruct the femur. Demographic, surgical, and radiographic variables were collected for each patient.
Results: Fifteen hips that fit inclusion criteria were identified. Implant survivorship was 93.3% with a mean follow up of 33.6 months. Radiographic analysis revealed mean subsidence of 2.57mm ± 4.31mm and a limb-length difference of 0.69mm ± 12.4mm longer than the contralateral side. Furthermore, pedestal sign was observed on preoperative radiographs of six patients, none of whom suffered periprosthetic fracture or femoral cortex perforation upon insertion of the conical prosthesis.
Conclusion: Our findings suggest that the Wagner Cone Prosthesis® is as a useful implant for revision THA. In our sample, it had excellent survivorship, impressive postoperative radiographic measurements obtained from most recent follow up, minimal mean subsidence, and minimal complication rates. Further prospective studies with longer follow up are needed to determine the efficacy of this stem in revision THA.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Total Hip Arthroplasty: National Bearing Surface Trends for 20- to 50-Year-Old Patients
Iciar M. Davila-Castrodad, MD, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey , Ethan A. Remily, DO, Nequesha S. Mohamed, MD, Wayne A. Wilkie, DO, MHSA, Yarelis Segui Acevedo, BS, Victoria Barg, BS, Ronald E. Delanois, MD, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
1275
Introduction: Total hip arthroplasty (THA) is reaching a broader spectrum of younger patients who struggle with incapacitating hip disease. This study aimed to explore national bearing surface trends for young THA recipients. Specifically, we evaluated bearing surface utilization, patient demographics, and hospital demographics in 20- to 50-year-old THA recipients in the United States from 2009 to 2016.
Materials and Methods: The National Inpatient Sample database was queried for patients aged 20 to 50 who underwent primary THA from 2009–2016 (n=279,190). Patients were grouped according to bearing surface type (metal-on-polyethylene [MOP], metal-on-metal [MOM], ceramic-on-ceramic [COC], and ceramic-on-polyethylene [COP]). Demographics included sex, age, race, obesity status, age-adjusted Charlson Comorbidity Index (CCI), primary payer, median household income, region, and teaching status. Chi-square analyses were employed for categorical variables, while independent t-tests were utilized for continuous variables.
Results: The incidence of THA for patients aged 20 to 50 increased slightly from 33,003 in 2009 to 33,545 in 2016 (p<0.001). Overall, bearing surface type was reported in 46.8% (n=127,876) of THAs. Of the THAs with bearing surface codes, the use of MOP (29.6 to 18.7%) and MOM (39.6 to 4.4%) decreased, while COC (9.0 to 14.3%) and COP (21.8 to 62.6%) utilization increased (p<0.001 for all). Those receiving COC implants had the youngest average age (42 years) (p<0.001). Females were more likely to receive COC (44.2%) or COP (43.6%) implants (p<0.001). Obese individuals were more likely to receive MOP (21.3%) or COP (21.2%) (p<0.001).
Conclusion: Over an 8-year period, considerable shifts in bearing surface trends have occurred across the United States among 20 to 50-year-old patients. Advantages of ceramic femoral heads, along with increased acceptance of highly cross-linked polyethylene, appear to be reasons for the selection of COP over other bearing surfaces.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
The Accuracy of Acetabular Cup Positioning Using Patient-Specific 3D Orientation Guidance in Total Hip Arthroplasty
Stephen J McMahon, MBBS, FRACS, FAOrthA, Adjunct Clinical Associate Professor, Maxim U.S.I. Christmas, BSc, MBBS, DM , Jack McMahon , Ryan McMahon, MD , Malabar Orthopaedic Clinic, Melbourne, Australia, School of Clinical Sciences, Monash University, Malabar Orthopaedic Clinic, Melbourne Australia , Jim Pierrepont, PhD, M.Eng , Corin (Australia) Pty Limited , Pymble, Australia
1279
Introduction: Malpositioning of the acetabular cup during total hip arthroplasty (THA) increases the risk of certain complications and shortens the lifespan of the prosthetic joint. Therefore, the accurate placement of the acetabular component during a THA is a necessary contributing factor to its successful outcome. The different methods of intraoperative estimation of acetabular component positioning are quite varied and sometimes may be inaccurate. The purpose of this study was to assess the accuracy of intraoperative acetabular component orientation with the assistance of three-dimensional (3D), patient-specific guidance alone.
Materials and Methods: At a single institution, a total of 56 patients were prospectively enrolled into this study. Acetabular cup positioning was achieved with a described method using a laser beam technique minus the placement of pelvic pins. Comparison was made between the planned, preoperative inclination and version angles with the achieved postoperative inclination and version of the acetabular component in all THAs performed. The accuracy of placement of the acetabular cup was assessed using postoperative computed tomography (CT) scans. Evaluation was performed by an independent orthopaedic surgeon.
Results: Fifty-eight hips were included in the present study. The mean absolute deviation from the preoperative planned inclination and anteversion was 4.0° (0.1° to 14.6°; p<0.05) and 4.4° (0.2° to 12.2°; p<0.05) respectively. The planned inclination and anteversion were achieved within a +/- 10° target in 98% of the cases respectively.
Conclusion: Accuracy of acetabular cup orientation in total hip arthroplasty can be achieved to a high degree with 3D patient-specific guidance alone. This eliminates the pins in the pelvis and has the potential to reduce costs and patient trauma without impacting accuracy.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Customized Knee Articulating Cement Spacer with Stem Extension for Treatment of Chronic Periprosthetic Joint Infection
Vinay Hosuru Siddappa, MD, Assistant Professor, Baylor College of Medicine, Houston, Texas, Morteza Meftah, MD, Associate Professor, NYU Langone Orthopedic Hospital, New York, New York
1278
Introduction: Choice of articulating spacer in selected Methicillin-resistant Staphylococcus aureus (MRSA) patients with instability that do not qualify for a second-stage revision (i.e., due to significant co-morbidities, multiple persistent infections, open wound ulcers) is challenging. To avoid a recurrent biofilm when using a cruciate-retaining (Cr/Cb) femoral implant, we have utilized a polymer femoral implant and constraint all-polyethylene (all-poly) tibia with stem extensions as a permanent spacer. Materials and Methods: After removal of prior implants and final debridement, appropriate-sized trial femur and proper thickness all-poly tibia are selected. Two chest tubes are loaded with cement with a delivery gun to make the extension rods. A Steinmann pin is inserted into the stem of the tibial insert. The components are inserted and the knee is reduced, then flexion and extension gaps are assessed. Small adjustments can be made to fill the gaps with extra cement. If there is collateral insufficiency, a constrained polyethylene (poly) can be used with the extension rod. An appropriate antibiotic is used based on the final culture, sensitivity, and availability in powder form. Results: This technique has been performed on 32 MRSA prosthetic joint infection (PJI) cases, followed for a minimum of nine months (nine months to three years). The mean final range of motion was 70 ± 15 degrees (30–110 degrees). Final radiographs do not show any sign of subsidence, loosening, or failure of the spacer. Rate of eradication of infection was 97% in the remaining 31 cases. One patient required amputation due to lack of wound coverage. Conclusion: Custom-made articulating spacer using all-poly tibia and a trial femur with stem extension can provide reproducible outcomes in treating PJI while maintaining mobility.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Reliability and Correlation of the Force-PRO Device and Computer-Assisted Navigation System for Measurement of Acetabular Cup Position in Total Hip Arthroplasty
Chaiyanun Vijittrakarnrung, Dipl, Siwadol Wongsak, Dipl, Assistant Professor, Paphon Sa-ngasoongsong, Dipl, Associate Professor, Udomporn Manupibul, MEng, Warakorn Charoensuk, PhD (Elec Eng), Assistant Professor, Mahidol University, Nakhon Pathom, Thailand
1292
Introduction: Acetabular cup malposition is very common in total hip arthroplasty (THA) and is significantly associated with many serious postoperative complications, such as dislocation, wear and loosening, and decreased range of motion. To improve the accuracy of intraoperative assessment, we recently developed an innovative sensor-based navigation system (Force-PRO device) using an inertial measurement unit and a 3D-printed liner for acetabular cup measurement, and aimed to evaluate its reliability and correlate its accuracy with that of a computer-assisted navigation system (CANS).
Design: Method-comparison study between the Force-PRO device and a standard CANS in a 1:1 pelvic bone model.
Methods: The test-retest reliability of both the Force-PRO device and CANS, and agreement between the Force-PRO device and CANS, for the measurement of acetabular inclination and anteversion angles, were examined using 40 random acetabular cup positions. Statistical analysis was performed by using limits of agreement and intraclass correlation coefficient (ICC).
Results: The mean differences in the inclination angle and anteversion angle in test-retest of the Force-PRO device were -0.43°±1.03° and -0.40°±0.78°, respectively. The mean differences in the inclination angle and anteversion angle between the Force-PRO device and CANS were 0.70°±0.94° and -0.10°±0.44°, respectively. Excellent reliability in the inclination and anteversion angles of the Force-PRO device and excellent agreement between the Force-PRO device and CANS were demonstrated, with ICC values of 0.994 and 0.997, and 0.993 and 0.999, respectively.
Conclusion: The Force-PRO device showed excellent reliability equivalent to CANS with excellent agreement in acetabular cup position measurement comparable to that with CANS. Future clinical studies will be needed to evaluate the efficacy of this device.
Open Access
