Acta Orthopaedica Belgica
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Cryotherapy after Total Knee Arthroplasty provides faster recovery and better ranges of motion in short term follow up - Results of a prospective comparative study
No full textPurpose: Cryotherapy is applied in Total Knee Arthroplasty (TKA) to improve functional outcome. The aim of this study is to investigate whether an advanced cryotherapy device does not increase the risk of complications and improves knee function or decreases swelling.Methods: A prospective cohort of TKA patients was formed by a cryotherapy group and a control group. The primary outcome was complication ratio. Our secondary outcomes were functional results and swelling.Results: No significant differences were found in complications ratio between 31 patients in the cryotherapy group and 31 patients in the control group. The cryotherapy group showed a significant better knee flexion and less swelling in the early rehabilitation phase. No differences were found at the other follow-up moments or in the other outcomes.Conclusions: This advanced cryotherapy device is safe in respect of postoperative complications, improves knee function and decreases swelling in the early rehabilitation phase. However, it is questionable if an advanced cryotherapy device with its additional costs is necessary to provide the desired effects of cryotherapy
Surgical treatment of acromioclavicular dislocation associated with midshaft fracture of the ipsilateral clavicle
No full textAcromioclavicular dislocation combined with a midshaft clavicle fracture is a rare traumatic shoulder problem. Various treatment options have been described in literature. We describe a new technique using a hook plate and coracoclavicular sling to replace the ruptured coracoclavicular ligaments in combination with plate osteosynthesis of the clavicle fracture. Furthermore, we provide a short overview of the few cases described in literature and their treatment options.
Non-invasive navigation in total knee arthroplasty: a validation study
No full textThe purpose of this study was to evaluate intraoperative alignment during total knee arthroplasty using a handheldnavigation system, iAssist, in comparison with conventional optical surgical navigation. Sixty-two consecutive patients were enrolled in this prospective study. iAssist was used to determine implantcomponent positioning. Orientation of the cuts were verified using a conventional optical surgical navigation system. We compared the iAssist system with the conventional system in terms of accuracy, percentage of outliers, bias, and precision.The occurrence of component malalignment was low. Taking standard radiography as the reference, there were no relevantdifferences between the handheld device and optical navigation in terms of measurement of accuracy or in outlier occurrence. Bias was small for both technologies, and precision was comparable. The study provides preliminary evidence that the use of iAssist leads to satisfactory implant alignment. The results from this study imply that iAssist could be a viable alternative to conventional optical navigation
Learning curve of direct anterior total hip arthroplasty: a single surgeon experience.
No full textThere is strong evidence that the direct anterior approach for primary total hip arthroplasty (DAA-THA) is responsible for a faster return to function and an enhanced short-term recovery and rehabilitation. The effect of the learning curve on patient safety and surgical outcome remains unclear. This single surgeon study presents the postoperative results of the initial 200 cases after implementing the direct anterior approach (DAA). The effect of the learning curve has been described in operative parameters, overall complications and radiological component placement. The complication rate of the initial 100 cases after commencing with the direct anterior operation technique was high and declined thereafter. The learning phase in performing the direct anterior hip replacement is rather long but the incidence of complications decreases with greater surgeon experience and does not increase after implementing a new time-based fast-track program. In this study the learning curve could be defined over 100 cases
The Accessory muscles of the Axilla
No full textThe axilla is a region of clinical and surgical importance with plenty of anatomical variations. One of these is the presence of accessory muscles. The literature was reviewed in order to identify the different supernumerary muscles that are described in the axilla. Variant muscle slips arising from the pectoral muscle or latissimus dorsi muscle have been described. There still remains controversy regarding the phylogenetic origin of these different muscles. We described the most frequently reported muscles, their origin, and course. Further research is required regarding the innervation and influence on glenohumeral and scapulothoracic kinematics.
Patient specific instrumentation for corrective osteotomy in case of posttraumatic cubitus varus in children
No full textMalunion in cubitus varus results most often from inadequate supracondylar fracture reduction or from secondary displacement. Treatment of cubitus varus needs an accurate preoperative planning to obtain a good functional and esthetical outcome. Planning based on conventional radiology is source of inaccuracy and clinical results are variable. Developments of computer-assisted orthopaedic surgery (CAOS) and of patient specific instruments (PSI) have made accurate three dimensional (3D) preoperative simulation possible. This original technique based on 3D-osteotomy planning and using PSI was developed to correct cubitus varus deformity in the three dimensions. Results: At the latest follow-up, the correction of cubitus varus obtained was satisfying in the five cases of our series and all the patients had pain free elbow mobility. Ulnar nerve palsy complicated the evolution by one patient, which fully recovered within 6 months.Conclusions: Advantages of this technique include a decreased operating time and a smaller surgical incision. Moreover, results showed increased correction accuracy without the need of fluoroscopy during the osteotomy procedure. These benefits are counterbalanced by the need of a preoperative CT-scan of the distal humerus and the additional cost for the PSI
Anatomical superficial medial collateral ligament reconstruction with posteromedial capsule reefing successfully restores valgus knee laxity
No full textIntroductionThe goal of this study was to present the results of an anatomical superficial medial collateral ligament (sMCL) reconstruction combined with reefing of the posteromedial capsule in 10 patients series with symptomatic valgus instability complaints in combined injuries of the knee.Materials and MethodsAll patients underwent an sMCL reconstruction with reefing of the posteromedial capsule. If cruciate ligament insufficiency was present, this was reconstructed as well. Pre- and postoperatively, multiple subjective knee outcome scores were obtained, and valgus stress radiographs objectively evaluated laxity.ResultsMedian valgus laxity of the injured knee on valgus stress radiographs improved significantly. There was no statistically significant difference between postoperative valgus laxity of the injured knee and valgus laxity of the uninjured knee. All subjective knee outcome scores improved significantly compared with the preoperative situation.ConclusionThe described procedure restores valgus laxity to a level comparable to the uninjured knee
Total hip arthroplasty using a modular “short-stem” femoral prosthesis vs. a standard prosthesis; a five-year follow-up study
No full textBackground : The objective was to compare the results and radiological stability of a short stem with a standard stem.Methods : We compared a series of 44 patients with a short stem Vitae® (Adler®) compared to a control group of 33 patients who had the same procedure with a standard stem Hydra® (Adler®). Both cementless stems were modular. The surgical technique was identical by the same surgeon. The groups were comparable in preoperative (age, sex, BMI, functional scores). We studied the migration of the stem to 5 years of follow up and its functional repercussion with the factors that can influence it.Results : Mean subsidence was 2.2 mm + 1.7 in group 1 and 3.1 mm + 2.2 in group 2 (p = 0.08 ). The mean varus tilt was 2.7 ° ± 2.2 in group 1 and 0.5 ° ± 0.5 in group 2 (p <0.05 × 10- 5). We regret one recovery for painful migration in group 1. All functional scores were improved without significant difference.Conclusion : Despite greater radiological migration in short stems group, functional results were comparable between the two groups. These results led us to suspend the use of this model of short stems
Anatomic Reconstruction of the Medial Collateral Ligament in Multi-ligaments knee injury using Achilles Allograft: A Modification of Marx’s Technique
No full textMedial Collateral Ligament (MCL) injury may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. While good results have been reported using the Marx technique, some issues have been observed. To address the mentioned issues, we have devised a modification to the Marx technique.11 patients were enrolled and their ligaments were repaired according to this technique. At the last follow up the ROM, knee ligament laxity and functional outcome scores, subjective [IKDC] and Lysholm score were evaluated and recorded.Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degree of knee flexion. Both were treated for combined MCL and PCL tear, the rest were stable. Average IKDC-subjective score was 93 ± 4 and average Lysholm score was 92 ± 3. All patients were satisfied and returned to their previous level of activity.In this technique, the superficial MCL was reconstructed closer to its anatomical construct. Patients didn’t have any complaints of hardware under skin and the need for second surgery for hardware removal was avoided. Also reconstructing the ligaments in 2 stages helped preserving the knee motion
A prospective comparative study between a cooling device and manual cooling after total knee arthroplasty
No full textBackground Studies have shown that the use of cryotherapy after a total knee arthroplasty can have beneficial effect on blood loss, pain and medication usage. In this study, the effect of the applied cryotherapy procedure is investigated.Methods 52 patients underwent a total knee arthroplasty. The test group received continuous cooling, whereas the control group received manual conventional cooling with ice dressing. The knee circumference and range of motion, medication use, satisfaction and pain were investigated.Results There is no statistical significant difference in pain and medication usage. A significant difference is observed in the swelling of the knee on the first postoperative day, the range of motion on the 7th, 10th, 11th and 12th postoperative day, and the satisfaction rate.Conclusion This study shows that continuous cooling has a positive effect on the swelling and range of motion of the knee, and on the satisfaction of the treatment