Operative techniques in joint reconstruction surgery/ Edwin P. Su, Seth Jerabek

Includes bibliographical references and index"Derived from Sam W. Wiesel and Todd J. Albert's four-volume Operative Techniques in Orthopaedic Surgery, this single-volume resource contains a comprehensive, authoritative review of a full range of joint reconstruction surgical procedures. In one convenient place, you'll find the entire Adult Reconstruction section, as well as relevant chapters from the Trauma section of Operative Techniques in Orthopaedic Surgery. Superb full-color illustrations and step-by-step explanations help you master surgical techniques, select the best procedure, avoid complications, and anticipate outcomes. Written by global experts from leading institutions, Operative Techniques in Joint Reconstruction Surgery, Third Edition, clearly demonstrates how to perform the techniques, making this an essential daily resource for residents, fellows, and practitioners"--1 online resourc

Technology in Arthroplasty: Are We Improving Value?

Total joint arthroplasty is regarded as a highly successful procedure. Patient outcomes and implant longevity, however, are related to proper alignment and position of the prostehses. In an attempt to reduce outliers and improve accuracy and precision of component position, navigation and robotics have been introduced. These technologies, however, come at a price. The goals of this review are to evaluate these technologies in total joint arthroplasty and determine if they add value.Recent studies have demonstrated that navigation and robotics in total joint arthroplasty can decrease outliers while improving accuracy in component positioning. While some studies have demonstrated improved patient reported outcomes, not all studies have shown this to be true. Most studies cite increased cost of equipment and longer operating room times as the major downsides of the technologies at present. Long-term studies are just becoming available and are promising, as some studies have shown decreased revision rates when navigation is used. Finally, there are relatively few studies evaluating the direct cost and value of these technologies. Navigation and robotics have been shown to improve component position in total joint arthroplasty, which can improve patient outcomes and implant longevity. These technologies offer a promising future for total joint arthroplasty

Which Safe Zone Is Safe in Total Hip Arthroplasty? The Effect of Bony Impingement

“Safe zones” for cup position are currently being investigated in total hip arthroplasty (THA). This study aimed to evaluate the impact of bony impingement on the safe zone and provide recommendations for cup position in THA. CT scans were performed on 123 patients who underwent a cementless THA. Using the implant data and bone morphology from the CT scans, an impingement detection algorithm simulating range of motion (ROM) determined the presence of prosthetic and/or bony impingement. An impingement-free zone of motion was determined for each patient. These zones were then compared across all patients to establish an optimized impingement-free “safe zone”. Bony impingement reduced the impingement-free zone of motion in 49.6% (61/123) of patients. A mean reduction of 23.4% in safe zone size was observed in relation to periprosthetic impingement. The superposition of the safe zones showed the highest probability of impingement-free ROM with cup position angles within 40–50° of inclination and 20–30° of anteversion in relation to the applied cup and stem design of this study. Virtual ROM simulations identified bony impingement at the anterosuperior acetabular rim for internal rotation at 90° of flexion and at the posteroinferior rim for adduction as the main reasons for bony impingemen

Postoperative outcomes of total knee arthroplasty compared to unicompartmental knee arthroplasty: A matched comparison

Background: The purpose of this study was to evaluate early postoperative outcomes in patients following UKA (unicompartmental knee arthroplasty) compared to a matched cohort of TKA (total knee arthroplasty) patients. Methods: Patients who met radiographic criteria for a medial UKA who underwent either a TKA or UKA at a single institution were matched based on age, gender, and BMI. Results: One hundredy and fifty UKA in 138 patients and 150 TKA in 148 patients were included in this retrospective analysis. Mean age was 62.6 ± 9 years and 65.2 ± 9 years in the UKA and TKA groups respectively (p = .01). Patients who underwent UKA had significantly less pain at two and six weeks postoperatively compared to TKA patients with mean Numeric Pain Rating Scale (NPRS) scores of 3.7 ± 1.1 vs. 7.8 ± 1.2, p < .001 and 2.6 ± 1.3 vs. 4.6 ± 1.6, p < .001 respectively. Knee Society Scores (KSS) were higher in the UKA group at six weeks and two years postoperative (86.5 ± 2.8 vs. 81.4 ± 3.6, p < .001 and 89.5 ± 2.4 vs. 84.5 ± 3.3, p < .001 respectively). Return to work was faster in the UKA group (mean 20.6 ± 7.89 vs. 38.6 ± 6.23 days, p < .001). The UKA group also had higher mean Forgotten Joint Scores of 90.5 ± 3.6 vs. 79.5 ± 9.5 (p < .001). Conclusions: Patients with primarily medial compartment OA who underwent UKA had less postoperative pain, earlier return to work, and higher KSS compared to a matched group who underwent TKA

The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium

Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review. This document provides an overview of these 4 areas, the consensus each group arrived at, and directions for future research