Returning to sports after total joint replacements and tibial osteotomies: is it possible?

Total joint replacement and tibial osteotomies have been used for decades to return the individual to activities and relieve pain. According to the American Academy of Orthopaedic Surgeons, joint replacement is considered one of the most successful medical innovations of the 20th century. Hip and knee-replacement operations are increasing in frequency and are continuing to achieve pain relief and improve function for patients with arthritic joints.

Sensitivity enhancement of guided-wave surface-plasmon resonance sensors.

It is demonstrated theoretically and experimentally that, by using the guided-wave surface-plasmon sensor configuration with a top layer of dielectric thin film (10-15 nm) having a high value of the real part of the dielectric function, it is possible to improve the sensitivity of the sensor up to 1 order of magnitude. The stability is improved because the thin nanolayer acts as a protection layer for the metal. The enhancement is due to the increase in the interaction volume and the evanescent field enhancement near the top layer-analyte interface.

Minimizing leg-length inequality in total hip arthroplasty: use of preoperative templating and an intraoperative x-ray.

Leg-length inequality after total hip arthroplasty remains a controversial issue. In the study reported here, we sought to determine whether significant leg-length discrepancies (> 6 mm) can be minimized with use of an intraoperative x-ray. In each case, preoperative templating was carefully performed, an intraoperative pelvis x-ray was obtained to assess accuracy, and appropriate adjustments were made.

The "banana peel" exposure method in revision total knee arthroplasty.

We present an exposure technique, the "banana peel," that has been used exclusively for revision total knee arthroplasty (TKA) for more than 20 years. We retrospectively reviewed use of this technique in 102 consecutive patients (mean age, 62 years; range, 41-92 years) who underwent tibial-femoral stemmed revision TKA. There were 5 deaths, leaving 97 patients (98 knees) for the study.

Does celecoxib have an adverse effect on bone remodeling and ingrowth in humans?

Although celecoxib may provide perioperative pain relief, the effect of the short-term use of celecoxib on bone ingrowth into porous-coated devices has not been previously studied in humans. Bone ingrowth into titanium and tantalum plugs was measured in nine patients who underwent staged bilateral total knee arthroplasty (TKA) and were taking celecoxib as part of a perioperative pain relief protocol. Patients were given tetracycline to measure the mineral apposition rate before and after celecoxib administration.

Clinical outcomes following osteochondral autologous transplantation (OATS).

This study evaluated the clinical outcome in 21 patients (22 knees) undergoing osteochondral autologous transplantation (OATS) in the knee over a 5-year period. Sixteen knees in 15 patients were available for follow-up at an average of 40 months after the procedure. The clinical outcome was analyzed using the IKDC and Knee and Osteoarthritis Outcome Score (KOOS) evaluation forms, a subjective questionnaire, and a clinical examination.

Surgical treatment options for patella tendon rupture, part II: chronic.

Patella tendon rupture is a debilitating injury that often occurs in the setting of preexisting tendon degeneration. Prompt diagnosis and treatment is essential to prevent retraction of the patella with subsequent adhesions and quadriceps contractures. In the setting of a chronic rupture, augmentation with hamstring tendons or allograft reconstruction generally is necessary.

Surgical treatment options for patella tendon rupture, Part I: Acute.

Patella tendon rupture is a debilitating injury. Prompt diagnosis and treatment is essential to prevent retraction of the patella with subsequent adhesions and quadriceps contractures. In a young patient with an acute rupture, primary repair usually is possible with various methods described to protect the repair.

Percutaneous reduction and Kirschner-wire fixation of impacted intra-articular fractures and volar lip fractures of the proximal interphalangeal joint.

We retrospectively review the cases of 5 men with closed, impacted intra-articular fractures of the middle phalanx at the proximal interphalangeal joint and describe a new technique-involving percutaneous reduction and Kirschner-wire fixation-that minimizes surgical trauma, allows fixation for early range of motion, and provides results as good as, if not superior to, those obtained with existing techniques.

Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation.

We report on a series of 7 patients who presented with patella dislocation and were found to have osteochondral fracture (OCF) of the weight-bearing portion of the lateral femoral condyle either through preoperative studies or by identification of the lesion during arthroscopy. Treatments included open reduction and internal fixation, debridement, and microfracture of the lateral femoral condyle. Although not as common as osteochondral injuries to the medial facet of the patella and the anterior lateral portion of the lateral femoral condyle, osteochondral injury to the weight-bearing portion of the mid-lateral femoral condyle does occur with patella dislocation and was recognized in these 7 patients.

Allograft reconstruction of the patellar tendon: 12-year follow-up.

We present 12-year follow-up results of a bone-tendon-bone allograft reconstruction technique for a defect of the patellar tendon. Of the reports in the literature, this is the longest follow-up of a reconstruction technique used in the trauma setting and involving complete loss of the patella tendon. This method of reconstruction, using the native patella remnant in conjunction with allograft patella tendon, provides the surgeon with an additional option for this difficult case.

Evaluation of a new power-operated PMMA vacuum mixing and delivery system for cemented femoral stem insertion.

Variations exist in the manual preparationand delivery of cement during primary total hip arthroplasty. The incorporation of a power source may standardize cement mantle manufacturing. This study prospectively compared the use of a new power-operated polymethylmethacrylate vacuum mixing and delivery system to a commonly used manually powered industry standard.

The management of anterior dislocation of the shoulder with proximal humerus fracture, bony Bankart lesion, and associated glenoid labrum avulsion: a report of 2 cases.

Proximal humerus fractures are common in the older population. These fractures can be associated with dislocation of the shoulder. Four-part fracture-dislocations and head-splitting 3-part fractures are generally indicated for shoulder hemiarthroplasty in the older population.