Minimally invasive total knee replacement : techniques and results

In this review, we outlined the definition of minimally invasive surgery (MIS) in total knee replacement (TKR) and described the different surgical approaches reported in the literature. Afterwards we went through the most recent studies assessing MIS TKR. Next, we searched for potential limitations of MIS knee replacement and tried to answer the following questions: Are there selective criteria and specific patient selection for MIS knee surgery? If there are, then what are they? After all, a discussion and conclusion completed this article. There is certainly room for MIS or at least less invasive surgery (LIS) for appropriate selected patients. Nonetheless, there are differences between approaches. Mini medial parapatellar is easy to master, quick to perform and potentially extendable, whereas mini subvastus and mini midvastus are trickier and require more caution related to risk of hematoma and VMO nerve damage. Current evidence on the safety and efficacy of mini-incision surgery for TKR does not appear fully adequate for the procedure to be used without special arrangements for consent and for audit or continuing research. There is an argument that a sudden jump from standard TKR to MIS TKR, especially without computer assistance such as navigation, patient specific instrumentation (PSI) or robotic, may breach a surgeon's duty of care toward patients because it exposes patients to unnecessary risks. As a final point, more evidence is required on the long-term safety and efficacy of this procedure which will give objective shed light on real benefits of MIS TKR

The avoidability of head and neck injuries in ice hockey : an historical review

Traumatologie du hockey sur glace : étude statistique intégrant une approche historique. Effet des progrès en matière d'équipement de protection (casques, visières, protège-dents), et de l'évolution des règles depuis le début du 20e siècle sur l'incidence et la gravité des blessures du hockeyeur : lésions oculaires, blessures du visage, de la machoire et des dents, traumatismes craniens et commotions cérébrales, blessures de la nuque et lésions de la moelle épinière avec paraplégie ..

Patient-controlled interscalene analgesia with ropivacaine after major shoulder surgery: PCIA vs PCA

We have compared the efficacy of patient-controlled interscalene analgesia (PCIA) using ropivacaine with patient-controlled analgesia (PCA) using nicomorphine in 60 patients (n = 30 in each group), in a prospective, randomized study. In both groups, all patients received interscalene block with 0.75% ropivacaine before induction of anaesthesia. Six hours after interscalene block, patients in group PCIA received continuous infusion of 0.2% ropivacaine at a rate of 5 ml h-1 with a bolus dose of 3 or 4 ml and a lockout time of 20 min; patients in group PCA received continuous infusion of nicomorphine 0.5 mg h-1 and a bolus dose of 2 or 3 mg with a lockout time of 20 min. Control of pain was significantly better from 12 to 48 h after operation (except at 42 h) in group PCIA. Nausea and pruritus occurred significantly more frequently in group PCA. Patient satisfaction was greater in group PCIA. We conclude that the use of 0.2% ropivacaine using PCIA was an efficient way of managing pain after major shoulder surgery and compared favourably with PCA nicomorphine in terms of pain relief, side effects and patient satisfactio

Patient-controlled interscalene analgesia with ropivacaine after major shoulder surgery: PCIA vs PCA

We have compared the efficacy of patient-controlled interscalene analgesia (PCIA) using ropivacaine with patient-controlled analgesia (PCA) using nicomorphine in 60 patients (n = 30 in each group), in a prospective, randomized study. In both groups, all patients received interscalene block with 0.75% ropivacaine before induction of anaesthesia. Six hours after interscalene block, patients in group PCIA received continuous infusion of 0.2% ropivacaine at a rate of 5 ml h-1 with a bolus dose of 3 or 4 ml and a lockout time of 20 min; patients in group PCA received continuous infusion of nicomorphine 0.5 mg h-1 and a bolus dose of 2 or 3 mg with a lockout time of 20 min. Control of pain was significantly better from 12 to 48 h after operation (except at 42 h) in group PCIA. Nausea and pruritus occurred significantly more frequently in group PCA. Patient satisfaction was greater in group PCIA. We conclude that the use of 0.2% ropivacaine using PCIA was an efficient way of managing pain after major shoulder surgery and compared favourably with PCA nicomorphine in terms of pain relief, side effects and patient satisfactio

Gibt es einen Zusammenhang zwischen erhöhten S100β-Werten und postkommotionellen Symptomen nach einer leichten Gehirnerschütterung?

In den letzten Jahren zeigte sich immer deutlicher, dass auch nach einer leichten Gehirnerschütterung bedeutungsvolle Langzeitprobleme für die betroffenen Patienten resultieren können. Um ein schlechtes Outcome nach leichter Gehirnerschütterung vorhersehen und allenfalls objektivieren zu können, versuchten wir mittels einer prospektiven Studie (n = 73) im Raum Oberengadin anhand der Asservierung des S100β (3 Stunden nach Unfall) einen prädiktiven Wert herauszuarbeiten. Es ließ sich jedoch keine Korrelation zwischen erhöhten S100β-Werten und PCS (auch nicht einzelner Symptome davon) nachweisen. Somit bleibt die Diagnose eines postkommotionellen Syndroms aufgrund fehlender bildgebender und laborchemischer Korrelation weiterhin sehr schwierig. Ein objektiver Nachweis ist nicht möglich. Die ausführliche Anamnese und klinische Untersuchung zusammen mit einem negativen CT-Befund sind weiterhin das Mittel der Wahl. Abstract: In the past a lot of patients suffered from post-concussive symptoms (PCS) after mild traumatic brain injury (mTBI). The present prospective study (n = 73) was intended to help predict the outcome after mTBI with blood asservation for analysis of S100beta 3 hours after trauma. There was no statistically significant correlation be-tween PCS or even of single symptoms and elevat-ed marker levels. Serum S100beta appears to be a poor predictor of the outcome following mild TBI. Establishing a diagnosis of "PCS" will still be hard in future, since no objective diagnostic -method exists. The most important facts are a precise examination and a history of the patient with a negative CT scan of the head

Joint line is well restored when navigation surgery is performed for total knee arthroplasty.

PURPOSE: The incorrect restoration of the joint line during TKA can result in joint instability, anterior knee pain, limited range of motion, and joint stiffness. The joint line level is usually measured only on pre- and post-operative radiographs. Current knee navigation systems can now potentially support intra-operatively joint line restoration by controlling the exact amount of the bone-cartilage removed and the corresponding overall thickness of the components implanted. The aim of this study was to assess how well the joint line level is restored and the tibiofemoral overstuffing prevented when standard knee surgical navigation is used carefully also with these purposes. Intra-operative measurements during navigated TKA were taken. METHODS: Sixty-seven primary TKAs were followed prospectively. The variation before and after prosthesis component implantation of the joint line level, both in the femoral and tibial reference, was measured intra-operatively by an instrumented probe. Overstuffing was measured as the difference between the overall craniocaudal thickness of the femoral and tibial prosthesis components inserted and the thickness of the bone-cartilage removed. RESULTS: A significant elevation in the joint line level after prosthesis implantation was found with respect to the tibial reference (1.9 ± 2.4 mm, mean ± SD), very little to the femoral reference (0.3 ± 2.1 mm), perhaps accounted for the femur-first operative technique utilized. Overstuffing was on the average of 2.2 ± 3.0 mm. CONCLUSIONS: These results suggest that a knee navigation system can also support well a proper restoration of the joint line level and limit the risk of overstuffing when relevant measurements are taken carefully during operation. LEVEL OF EVIDENCE: III