1,720,993 research outputs found
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
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
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
Sensitivity and specificity of plain radiographs for detection of medial-wall perforation secondary to osteolysis
No full textMedial-wall perforation secondary to pelvic osteolysis impacts planning of acetabular revision surgery and may result in pelvic fracture. We compared commonly used radiographic signs for detecting medial-wall perforation (ballooning or discontinuity of Kohler's line or the iliopubic line) to findings from computed tomography (CT) in 27 cementless total hip arthroplasty patients with pelvic osteolysis. Used alone, none of the radiographic signs examined were reliable for detecting medial-wall perforation. When assessed together, however, the development of a discontinuity of Kohler's line, the iliopubic line, or both on anteroposterior pelvic radiographs was a reliable indicator for the presence of medial-wall perforation. Thus, the authors recommend a CT scan to evaluate the integrity of the medial wall when a discontinuity of Kohler's line or the iliopubic line has occurred and a revision surgery is planned
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
The Nottingham health profile - experiences after hip revision arthroplasty
No full textIntroduction:Considering patients after hip revision arthroplasty postoperative quality controls allows an evaluation of the individual implant situation as well as the achieved postoperative quality of life. With regard to a possible loss of data reliable statements about the used implant system with special consideration to the implant survival rate could not be received. In this connection standardized self-assessment questionnaires like the Nottingham Health Profile (NHP) are in the centre of interest. The main focus of this study was to demonstrate a correlation between the Nottingham Health Profile and the Merle d'Aubigne (MDA) Score. Patients and methods: Fifty-one patients after femoral stem revision were re-examined. All patients received a written appointment for an ambulatory re-examination together with the NHP 4 weeks before. The clinical evaluation was carried out by using the MDA Score. Correlations between the NHP and the MDA were calculated. Results: Overall the data of 39 patients could be evaluated completely. Three patients (5.9%) did not appear to the ambulatory re-examination, four patients (7.8%) deceased in the meantime. With further five patients (9.8%) the NHP questionnaire could not be rated due to an incorrect treatment. The mean follow-up after revision was 5.8 years. Correlations between the category 'Pain' NHP/MDA as well as to the combination of the NHP-categories 'Pain'+'Physical Mobility' and the total MDA-Score could be demonstrated. Conclusion: Out of our personal experiences the use of the NHP makes an individual follow-up evaluation after revision hip arthroplasty possible. Patient-referred changes can lead to direct re-examinations. Correlation coherences between the NHP and the MDA could be demonstrated equivalent to already published results. In what way a survival rate analysis of an implant by using the NHP is possible could not be answered clearly. It has to be included that wrong answered questionnaires lead to an additional drop-out rate beneath the lost to follow-up rate
Five- to 10-year results using a noncemented modular revision stem without bone grafting
No full textThe aim of the study was to evaluate the 5- to 10-year results (mean, 6.2 years) of a modular uncemented revision stem (Profemur-R). From a total series of 184 consecutive stem revisions, the first 73 were evaluated. The implant was fixed without bone grafting in all cases. The average Harris hip score increased from 40 to 75. A complete remodeling of bone defects could be documented radiographically in 70% of the cases and a partial restoration in 30%. Progressive subsidence appeared in 2 stems. Three rerevisions were required, including 1 septic case. The survival rate with aseptic loosening as the end point was 96% over an average of 10 years. The revision prosthesis examined in this study can be considered a viable and useful option to reconstruct femoral defects in revision hip arthroplasty
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
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