102 research outputs found
Minimally invasive orthopedic surgery: First results in navigated total hip arthroplasty
No full textMinimally invasive hip approaches decrease soft tissue damage but reduce the view of the operating field. The combination of minimally invasive approaches with navigation techniques can resolve this conflict. A modified anterolateral approach was used for minimally invasive implantation of hip, endoprostheses, in combination with a navigation technique. A newly developed femoral clamp was used in the study, which allowed a secure fixation of the navigation reference frame without compromising the visibility of the small incision. The results included short skin incisions and hip joint muscle preservation, with only a moderate increase in operating times
Minimally invasive orthopedic surgery: First results in navigated total hip arthroplasty
No full textMinimally invasive hip approaches decrease soft tissue damage but reduce the view of the operating field. The combination of minimally invasive approaches with navigation techniques can resolve this conflict. A modified anterolateral approach was used for minimally invasive implantation of hip, endoprostheses, in combination with a navigation technique. A newly developed femoral clamp was used in the study, which allowed a secure fixation of the navigation reference frame without compromising the visibility of the small incision. The results included short skin incisions and hip joint muscle preservation, with only a moderate increase in operating times
Closed reduction and percutaneus Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2–10 years
No full textIntroduction To reduce complications, a minimally invasive technique for the treatment of dislocated intraarticular fractures of the calcaneus was used. Therefore previously described closed reduction and internal fixation techniques were combined and modified. Materials and methods Sixty-seven out of 92 calcaneal fractures could be retrospectively evaluated with an average follow-up time of 5.7 years (minimum 2-10 years follow-up). For radiographic evaluation, plain radiographs and CT scans were obtained. The Zwipp score was used for clinical evaluation. Sanders type II, III and IV fractures were diagnosed. Results Length of surgery averaged 61 min (range 20-175 min). The incidence of subtalar arthritis was correlated to the severity of fracture. Bohler's angle was restored in 70.1% (47 of 67) of the cases. On the last follow-up evaluation the average Zwipp score was 130 points (range 48-186 points). The majority (77.7%) of patients were content with their treatment result. The rate of significant complications was 6.5%. Discussion Compared to open techniques the presented minimally invasive technique showed comparable results with a low rate of serious complications and is a viable alternative for the treatment of intraarticular, dislocated calcaneal fractures
Revision arthroplasty of the hip
No full textModular parts in femoral components used for hip arthroplasty are reported to be predilection sites for mechanical failure. The possible benefit of their use is therefore controversial. We report the outcome of 97 revision hip arthroplasties using a non-cemented femoral component with a modular metaphyseal part and an interchangeable neck (ProfemurA (R)). The femoral defects treated included Paprosky types I-III. The average follow-up was 5 years (range 3-10 years). No mechanical failure of the modular parts and taper connections has been observed so far. The percentage of patients with a balanced leg length increased from 32% preoperative to 65% postoperative. The mean leg length discrepancy could be reduced from 1.4 cm preoperative to 0.5 cm postoperative. A total of 5 re-revisions were required, including 2 cases of infection. The cumulative survival of the implants due to aseptic loosening was 96.5%. Because of the achieved results the use of the modular stem investigated in this study can be classified as safe and effective for revision hip arthroplasty. The interchangeable neck proved to be a useful completion of the revision system
Process optimization in navigated total knee arthroplasty
No full textAlthough navigation achieves better alignment results in total knee arthroplasty (TKA), it is generally assumed that navigation also needs more time and effort than conventional surgeries. After optimizing the treatment procedure of navigated TKA, the operation times needed for navigated surgeries were documented and compared with the average time of conventional surgeries, I registered before the introduction of the navigation system. Sixty consecutive patients for uncemented TKAs were included in the navigated series. Results show an average of 49 minutes for the navigated surgeries, which is less than the average of the manual surgeries. For all patients, alignment was within 3 degrees varus/valgus postoperatively, and the mean Knee Society Score improved from 25 points preoperatively to 83 points 6 weeks postoperatively
Process optimization in navigated total knee arthroplasty
No full textAlthough navigation achieves better alignment results in total knee arthroplasty (TKA), it is generally assumed that navigation also needs more time and effort than conventional surgeries. After optimizing the treatment procedure of navigated TKA, the operation times needed for navigated surgeries were documented and compared with the average time of conventional surgeries, I registered before the introduction of the navigation system. Sixty consecutive patients for uncemented TKAs were included in the navigated series. Results show an average of 49 minutes for the navigated surgeries, which is less than the average of the manual surgeries. For all patients, alignment was within 3 degrees varus/valgus postoperatively, and the mean Knee Society Score improved from 25 points preoperatively to 83 points 6 weeks postoperatively
Accuracy of Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction: The Effect of a Nearly True-Lateral Fluoroscopic View
No full textBackground: Reconstruction of the medial patellofemoral ligament (MPFL) is an established operative procedure for patients with recurrent episodes of lateral patellar instability. However, recent articles have reported remarkable complication rates, with nonanatomic femoral tunnel positioning in up to 64% of patients. Purpose: To evaluate the sensitivity of femoral tunnel placement using lateral fluoroscopic guidance to minor degrees of deviation from the true-lateral view using established radiographic landmarks. Study Design: Controlled laboratory study. Methods: Six human cadaveric femora were used for this study. A 6-mm radiopaque eyelet was used to mark the native femoral insertion of the MPFL according to previously described radiographic landmarks. Radiographic landmarks were also applied with the femur positioned in 2.5 degrees and 5 degrees of internal and external rotation, respectively, and with the femur in 2.5 degrees and 5 degrees of hip abduction and adduction, respectively. The distance between the center of the 6-mm eyelet to the center of the native femoral MPFL insertion, as established in the true-lateral view, was measured and determined as the degree of shift in each position. Results: Hip adduction, abduction, and internal and external rotations of 2.5 degrees resulted in a shift from the native femoral MPFL insertion point to a more distal (adduction), proximal (abduction), anterior (internal rotation), and posterior location (external rotation) of 2.7 0.7, 2.0 0.7, 2.7 +/- 1.1, and 3.0 +/- 1.3 mm, respectively (all P < .05). Malpositioning increased to a distance of 5.0 +/- 0.7 mm distally, 3.6 +/- 1.0 mm proximally, 5.2 +/- 0.8 mm anteriorly, and 6.2 +/- 0.6 mm posteriorly to the native insertion point when the attachment was marked with 5 degrees of divergence from the true-lateral view (all P < .05). Conclusion: The results of this study indicate the high sensitivity of femoral tunnel placement using lateral fluoroscopic guidance to minor degrees of deviation from the true-lateral view. Clinical Relevance: The study highlights the importance of an exact lateral view when fluoroscopic guidance is used for femoral tunnel positioning in the daily practice of MPFL reconstruction, and a possible explanation for the high incidence of nonanatomic tunnel placement is suggested
Early Results and Patient Satisfaction after Total Hip Arthroplasty using a Minimally Invasive Anterolateral Approach
No full text Rehabilitation and patient satisfaction following a modified anterolateral approach for implantation of a total hip replacement (THR) were reviewed following 72 consecutive cases. The Harris Hip and merle d'Aubigné Scores were recorded at 6 and 12 weeks postoperatively. The patient's satisfaction with regard to the surgical result and the need for analgesia for mobilization were recorded. Rehabilitation was assessed by postoperative crutch use. Significant improvements of the Harris Hip and merle d'Aubigné scores were demonstrated. All patients thought their surgical outcome was good or better. 2 patients needed pain medicine on an irregular basis and 4 patients used crutches at 12 weeks. This study demonstrates patient satisfaction and satisfactory rehabilitation following a modified anterolateral approach for minimally-invasive implantation of THR. </jats:p
Early results and patient satisfaction after total hip arthroplasty using a minimally invasive anterolateral approach
No full textRehabilitation and patient satisfaction following a modified anterolateral approach for implantation of a total hip replacement (THR) were reviewed following 72 consecutive cases. The Harris Hip and Merle d'Aubigne Scores were recorded at 6 and 12 weeks postoperatively. The patient's satisfaction with regard to the surgical result and the need for analgesia for mobilization were recorded. Rehabilitation was assessed by postoperative crutch use. Significant improvements of the Harris Hip and Merle d'Aubigne scores were demonstrated. All patients thought their surgical outcome was good or better. 2 patients needed pain medicine on an irregular basis and 4 patients used crutches at 12 weeks. This study demonstrates patient satisfaction and satisfactory rehabilitation following a modified antero-lateral approach for minimally-invasive implantation of THR. (Hip International 2009; 19: 367-71
A New Posterolateral Approach Without Fibula Osteotomy for the Treatment of Tibial Plateau Fractures
No full textThe selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. These aims are difficult to reach through a lateral or anterolateral approach. The standard posterolateral approach with fibula osteotomy and release of the posterolateral corner is a traumatic procedure, which includes the risk of fragment denudation. Isolated posterior approaches do not allow sufficient visual control of fracture reduction, especially if the fracture is complex. Therefore, the aim of this work was to present a surgical approach for posterolateral tibial plateau fractures that both protects the soft tissue and allows for good visual control of fracture reduction. The approach involves a lateral arthrotomy for visualizing the joint surface and a posterolateral approach for the fracture reduction and plate fixation, which are both achieved through one posterolateral skin incision. Using this approach, we achieved reduction of the articular surface and stable fixation in six of seven patients at the final follow-up visit. No complications and no loss of reduction were observed. Additionally, the new posterolateral approach permits direct visual exposure and facilitates the application of a buttress plate. Our approach does not require fibular osteotomy, and fragments of the posterolateral corner do not have to be detached from the soft tissue network
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