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Gro S Dyrhovden, Anne M Fenstad, Ove Furnes, Øystein Gøthesen
Background and purpose - The long-term effects of computer-assisted surgery in total knee replacement (CAS) compared to conventionally operated knee replacement (CON) are still not clear. We compared survivorship and relative risk of revision in CAS and CON based on data from the Norwegian Arthroplasty Register. Patients and methods - We assessed primary total knee replacements without patellar resurfacing reported to the Norwegian Arthroplasty Register from 2005 through 2014. The 5 most used implants and the 3 most common navigation systems were included...
October 24, 2016: Acta Orthopaedica
William T Obremskey, Norele Cutrera, Christopher M Kidd
BACKGROUND: The purpose of this study was to determine optimal treatment of stable tibial shaft fractures using intramedullary nailing (IMN) or casting. MATERIALS AND METHODS: We performed a multi-center prospective study cohort. Patients with stable tibia shaft fractures meeting Sarmiento's criteria (isolated closed fractures with less than 12 mm of shortening and 10° of angulation) were enrolled prospectively and treated with either a reamed IMN with static interlocking screws or closed reduction followed by long-leg casting...
October 21, 2016: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
M Aurich, D Albrecht, P Angele, C Becher, S Fickert, J Fritz, P E Müller, P Niemeyer, M Pietschmann, G Spahn, M Walther
Background: Osteochondral lesions (OCL) of the ankle are a common cause of ankle pain. Although the precise pathophysiology has not been fully elucidated, it can be assumed that a variety of factors are responsible, mainly including traumatic events such as ankle sprains. Advances in arthroscopy and imaging techniques, in particular magnetic resonance imaging (MRI), have improved the possibilities for the diagnosis of OCLs of the ankle. Moreover, these technologies aim at developing new classification systems and modern treatment strategies...
October 21, 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Lindsay V Slater, Joseph M Hart
The squat is an assessment of lower extremity alignment during movement, however there is little information regarding altered joint kinetics during poorly performed squats. The purpose of this study was to examine changes in joint kinetics and power from altered knee alignment during a squat. Thirty participants completed squats while displacing the knee medially, anteriorly, and with neutral alignment (control). Sagittal and frontal plane torques at the ankle, knee, and hip were altered in the descending and ascending phase of the squat in both the medial and anterior malaligned squat compared to the control squat...
October 12, 2016: Journal of Electromyography and Kinesiology
Heather A Vallier
Displaced distal tibia shaft fractures are effectively treated with standard plates and intramedullary nails. Plate fixation performed with meticulous soft tissue handling results in minimal risks of infection and poor wound healing. Standard plates have high rates of primary union, whereas locking plates may delay union because of increased stiffness. Tibial healing may also be delayed after plating of the fibula, although fibula reduction and fixation may aid accuracy of reduction of the tibia. Malalignment occurs more often with infrapatellar intramedullary nailing versus plates, and early results of suprapatellar nailing appear promising in minimizing intraoperative malalignment...
November 2016: Journal of Orthopaedic Trauma
Andrea Veljkovic, Joshua Tennant, Chamnanni Rungprai, Kaniza Zahra Abbas, Phinit Phisitkul
BACKGROUND: Open calcaneal osteotomy using traditional methods is associated with complications such as sural nerve injury and potential wound healing problems. We hypothesized that by using novel minimally invasive techniques, these potential risks could be mitigated. This anatomic cadaveric study serves to assess the safety of percutaneous endoscopically assisted calcaneal osteotomy (PECO) compared to a traditional open osteotomy technique. METHODS: Anatomic safety of PECO was assessed using 8 fresh-frozen cadaver below-knee specimens...
October 20, 2016: Foot & Ankle International
Myoung Seok Lee, Jeong Yeon Cho, Sang Youn Kim, Seung Hyup Kim, Joong Shin Park, Jong Kwan Jun
Purpose: The purpose of this study was to evaluate the feasibility and usefulness of sagittal color Doppler ultrasonography (CDUS) for the diagnosis of fetal cleft lip (CL) and cleft palate (CP). Methods: We performed targeted ultrasonography on 25 fetuses with CL and CP, taking coronal and axial images of the upper lip and maxillary alveolar arch in each case. The existence of defects in and malalignment of the alveolus on the axial image, hard palate defects on the midsagittal image, and flow-through defects on CDUS taken during fetal breathing or swallowing were assessed...
August 6, 2016: Ultrasonography
Louis M Day, Subaraman Ramchandran, Cyrus M Jalai, Bassel G Diebo, Barthelemy Liabaud, Renaud Lafage, Themistocles Protopsaltis, Peter G Passias, Frank J Schwab, Shay Bess, Thomas J Errico, Virginie Lafage, Aaron J Buckland
STUDY DESIGN: Retrospective clinical and radiographic single-center study OBJECTIVE.: Assess simultaneous cervical spine and lower extremity compensatory changes with changes in thoracolumbar spinal alignment. SUMMARY OF BACKGROUND DATA: Full-body stereoradiographic imaging allows better understanding of reciprocal changes in cervical and lower extremity alignment in the setting of thoracolumbar malalignment. Few studies describe the simultaneous effect of alignment correction on these mechanisms...
October 17, 2016: Spine
Joshua M Abzug, Karan Dua, Andrea Sesko Bauer, Roger Cornwall, Theresa O Wyrick
Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits for fractures in the United States. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
Qing-Hang Zhang, Andrew Cossey, Jie Tong
Periprosthetic bone strain distributions in some of the typical cases of total knee replacement (TKR) were studied with regard to the selection of material, design and the alignments of tibial components to examine which conditions are more forgiving than the others to stress shielding post a TKR. Four tibial components with two implant designs (cruciate sacrificing and cruciate retaining) and material properties (metal-backed (MB) and all-polyethylene (AP)) were considered in a specimen-specific finite element tibia bone model loaded in a neutral position...
October 10, 2016: Medical Engineering & Physics
Daniel S Hill, Kuntal Patel, Deepak Herlekar
BACKGROUND: Highly cross-linked polyethylene in total hip arthroplasty (THA) has been shown to decrease wear rate compared with a conventional polyethylene liner. However, it has also been reported that the manufacturing processes can cause early failure of the implant. CASE: We describe early catastrophic failure at <4 years following primary THA surgery of a PINNACLE MARATHON® polyethylene acetabular liner resulting from a malaligned PINNACLE DUOFIX HA® acetabular shell with resultant point loading...
October 13, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Romain Gaillard, Simone Cerciello, Sebastien Lustig, Elvire Servien, Philippe Neyret
PURPOSE: Total knee arthroplasty (TKA) malalignment may result in pain and limited range of motion. The present study assessed the influence of different surgeon's and patient's related factors on the post-operative tibial tray coronal alignment. METHODS: The charts and the x-rays of a continuous prospective series of 1417 TKAs operated upon between 1987 and 2015 were retrospectively reviewed. The long-leg AP views were performed at two months post-op and the tibial mechanical angle of the tibial tray was measured...
October 13, 2016: International Orthopaedics
A Dell'Isola, R Allan, S L Smith, S S P Marreiros, M Steultjens
BACKGROUND: Knee Osteoarthritis (KOA) is a heterogeneous pathology characterized by a complex and multifactorial nature. It has been hypothesised that these differences are due to the existence of underlying phenotypes representing different mechanisms of the disease. METHODS: The aim of this study is to identify the current evidence for the existence of groups of variables which point towards the existence of distinct clinical phenotypes in the KOA population. A systematic literature search in PubMed was conducted...
October 12, 2016: BMC Musculoskeletal Disorders
Jorge Chahla, Chase S Dean, Justin J Mitchell, Gilbert Moatshe, Raphael Serra Cruz, Robert F LaPrade
Genu varus malalignment can lead to medial compartment overload and progression of ipsilateral compartment osteoarthritis. To slow this process, a medial opening wedge proximal tibial osteotomy (PTO) can be performed. This type of PTO is indicated in patients with genu varus malalignment and isolated medial compartment osteoarthritis of the knee, prior to or concurrent with medial compartment cartilage procedures or meniscal transplants, chronic posterolateral corner deficiency, or chronic anterior cruciate ligament deficiency...
August 2016: Arthroscopy Techniques
Justin J Mitchell, Chase S Dean, Jorge Chahla, Gilbert Moatshe, Tyler R Cram, Robert F LaPrade
Valgus knee alignment in excess of physiological valgus leads to excessive loading of the lateral compartment, which can potentially increase the risk of osteoarthritis and can place the medial knee structures at risk of chronic attenuation. Varus-producing distal femoral osteotomies have been proposed for correction of valgus malalignment, to relieve tension on medial-sided structures, as well as to off-load the lateral compartment. Understanding that symptomatic valgus deformity of the knee represents a complex problem that is magnified in the setting of lateral compartment arthritis or medial ligamentous incompetence, we present our preferred technique for a varus-producing distal femoral osteotomy using plate osteosynthesis and cancellous bone allograft...
August 2016: Arthroscopy Techniques
Michael O'Malley, Patrick J Reardon, Ayoosh Pareek, Aaron Krych, Michael J Stuart
Varus knee malalignment caused by medial compartment arthritis results in progressive asymmetric wear of the tibiofemoral joint. This wear can cause progressively painful gonarthrosis. Surgical methods to address varus knee malalignment include lateral closing-wedge proximal tibial osteotomy, medial opening-wedge osteotomy, and arthroplasty. Medial opening-wedge proximal tibial osteotomy is an effective procedure for restoring proper coronal alignment and reducing knee pain. In this technical note, we present a reproducible technique for proximal tibial osteotomy...
August 2016: Arthroscopy Techniques
Michael P O'Malley, Ayoosh Pareek, Patrick J Reardon, Michael J Stuart, Aaron J Krych
Coronal limb malalignment is a significant contributor to asymmetric joint wear, gait abnormalities, and the development and progression of degenerative joint disease. Osteotomies about the knee were developed to realign the mechanical axis of the limb to unload the affected compartment. Valgus malalignment is less common than varus malalignment, but can contribute to a variety of clinical conditions, including lateral compartment cartilage defects and arthritis, lateral patellofemoral instability, and medial collateral ligament laxity...
August 2016: Arthroscopy Techniques
Michael E Steinhaus, Alexander S McLawhorn, Shawn S Richardson, Patrick Maher, David J Mayman
BACKGROUND: Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery. QUESTIONS/PURPOSES: The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV). METHODS: After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon...
October 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Justin J Mitchell, Jorge Chahla, Robert F LaPrade
Lateral compartment osteoarthritis of the knee can be a challenging problem to address in the younger, active population. The challenge is compounded by limited treatment options and high patient expectations, with patients often desiring a return to impact high intensity activity. Distal femoral osteotomy has been reported to be one potential treatment option; however, a highly heterogeneous literature exists for both opening and closing wedge distal femoral osteotomies for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment...
October 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Vincent Ukachukwu, Rachel Duncan, John Belcher, Michelle Marshall, Joshua Stefanik, Kay Crossley, Martin J Thomas, George Peat
Objective To determine the comparative prevalence, associations with selected patient characteristics and clinical outcomes of medial and lateral compartment patellofemoral joint (PFJ) osteoarthritis (OA). Methods Information was collected by questionnaires, clinical assessment and x-rays from 745 eligible community-dwelling symptomatic adults aged ≥50 years. PFJ joint space narrowing (JSN) and osteophytes (OP) were scored from skyline radiographs using the OARSI atlas. Multilevel models were used to assess associations of compartmental PFJOA with age, gender, BMI and varus/valgus malalignment, while median regression was used to examine associations with clinical outcomes (current pain intensity 0-10NRS and WOMAC Function 0-68)...
October 1, 2016: Arthritis Care & Research
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