Advances and Refinement in Hyaluronic Acid Facial Fillers.

Fillers temporarily augment deflated or ptotic facial compartments to restore a youthful appearance. Hyaluronic acids predominate the fillers market because of their focal volumization, duration of effect, low incidence of adverse reactions, and reversibility. Being able to properly perform these in-office procedures will ensure safety for patients and provide aesthetically optimal results.

The Role of the Superwet Technique in Face Lift: An Analysis of 1089 Patients over 23 Years.

Background: The use of superwet technique of infiltration and autologous tissue sealants during rhytidectomy has benefits of decreasing bleeding and edema, improving visualization, and easing dissection. The purpose of this study was to analyze whether these intraoperative strategies resulted in more consistent and reproducible outcomes and significantly decreased hematoma rates.

Methods: A retrospective review was performed on 1089 consecutive face lifts performed by a single surgeon.

Laser Resurfacing at the Time of Rhytidectomy.

Background: Laser resurfacing with simultaneous rhytidectomy has been used to augment aesthetic results and decrease overall patient recuperative time, yet presents a potential dual insult to the microvasculature supply of facial skin flaps. This study describes the authors' experience with rhytidectomy and simultaneous laser resurfacing.

Methods: Between May of 1999 and January of 2013, 85 face lifts with concomitant erbium laser resurfacing were reviewed retrospectively.

Refining the anesthesia management of the face-lift patient: lessons learned from 1089 consecutive face lifts.

Background: The importance of anesthetic technique is often underappreciated in face-lift procedures and is sparsely written about in the literature. Appropriate control of blood pressure, anxiety, pain, and nausea is essential for reducing the complications of face lift, primarily, hematoma risk. This study discusses the standard anesthetic protocol provided at the authors' institution and describes the preoperative, intraoperative, and postoperative management of face-lift patients resulting in low hematoma and complication rates.

Critical review of minimally invasive approaches in knee arthroplasty.

Despite high survivorship for total knee arthroplasty, many reports have described low patient-satisfaction rates. Standard parapatellar approaches have been linked with decreased quadriceps muscle strength, which may in turn lead to prolonged rehabilitation and altered kinematics. Although technically demanding, minimally invasive techniques offer the potential for shorter recovery times and improved strength.

Comparison of 2 polyethlene inserts for a new cruciate-retaining total knee arthroplasty prosthesis.

Cruciate-retaining total knee arthroplasty has had high success rates but does not always have optimal functional outcomes. The purpose of this study was to compare 2 polyethylene inserts of varying constraint that were used in a new cruciate-retaining total knee arthroplasty design to determine whether differences were found in clinical or functional outcomes. The use of the newer cruciate-retaining total knee arthroplasty design showed comparable results with both polyethylene inserts at short-term follow-up.

New technologies in knee arthroplasty.

Advances in surgical technique and implant design have increased the treatment options available to joint reconstruction surgeons. New technologies for component alignment such as custom cutting blocks and disposable cutting blocks hold the potential for more anatomic component positioning and less instrument turnover which may decrease infection rates. Improved component alignment may also be obtained with the use of computer-assisted surgery.

The ACL in the arthritic knee: how often is it present and can preoperative tests predict its presence?

Background: TKA with retention of the anterior cruciate ligament (ACL) may improve kinematics and function. However, conflicting reports exist concerning the prevalence of intact ACLs at the time of TKA.

Questions/purposes: Therefore, we asked: (1) what was the ACL status at TKA; (2) what was the sensitivity and specificity of the Lachman test; (3) did MRI ACL integrity correlate with intraoperative observation; (4) did MRI tibial wear patterns correlate with ACL integrity; and (5) did ACL status depend on age or sex?

Methods: We evaluated 200 patients for ACL integrity at the time of TKA.

Use of a static progressive stretch orthosis to treat post-traumatic ankle stiffness.

Background: Chronic ankle stiffness can develop for numerous reasons after traumatic injury, and may adversely affect patient gait, mobility, and function. Although standard physical therapeutic techniques typically resolve this stiffness, some cases may be recalcitrant to these measures, making it difficult to restore range-of-motion. The purpose of this study was to evaluate a static progressive stretch orthosis for the treatment of chronic ankle stiffness.

Efficacy of erythrocyte sedimentation rate and C-reactive protein level in determining periprosthetic hip infections.

The diagnosis of periprosthetic hip infections is often challenging. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level blood laboratory tests are commonly used to aid in the diagnosis. We studied the sensitivity, specificity, and false-negative rates of ESR and CRP level in a prospective group of patients who underwent revision total hip arthroplasty between 2000 and 2008.

A Comparison Study of Two Cruciate-Retaining Total Knee Designs: A Preliminary Report.

Cruciate-retaining total knee arthroplasties have had high success rates. The purpose of this study was to compare a newer cruciate-retaining design to a previously used implant to determine if there were any changes in clinical or functional outcome. A total of 461 patients (553 knees) were identified who had total knee arthroplasty with this newer design.

Use of cementless, tapered femoral stems in patients who have a mean age of 20 years.

Young patients who undergo total hip arthroplasty are a unique group who has been challenging to successfully treat; however, newer prosthetic materials and designs have the potential to increase implant longevity. Fifty-three hips (40 patients who had a mean age of 20 years) underwent a total hip arthroplasty using a cementless, proximally hydroxyapatite-coated, tapered, femoral stem and a cementless acetabular cup. There was a 96% overall survivorship at approximately 5 years of mean follow-up (range, 2-7 years) with no femoral side failures.

Unicompartmental and total knee arthroplasty in the same patient.

This prospective randomized study compared the clinical and radiographic outcomes of unicompartmental knee arthroplasty versus total knee arthroplasty. The group consisted of 34 patients (19 males and 15 females), who had a mean age of 73 years (range, 49 to 86 years), and who fit the criteria for bilateral unicompartmental knee arthroplasty. Each patient received a unicompartmental prosthesis in one knee and a total knee arthroplasty in the other during a single anesthetic session.

Early outcomes of sequentially cross-linked thin polyethylene liners with large diameter femoral heads in total hip arthroplasty.

Unlabelled: Two important issues affecting the outcome of total hip arthroplasty have been dislocation and wear, despite excellent clinical results. Larger femoral heads have had success in decreasing dislocation rates; however, there are concerns regarding the subsequent use of thinner polyethylene liners, and their effects on wear rates. Historically, high stresses on thin polyethylene bearings have caused concerns, including rim cracking and catastrophic implant failure with polyethylene thicknesses less than 5 millimeters.

Is there a new learning curve with transition to a new resurfacing system?

Unlabelled: Metal-on-metal hip resurfacing has been proven to be a successful option for treating hip osteoarthritis in young, active patients. However, compared to a standard primary hip arthroplasty, hip resurfacing has a higher degree of technical difficulty. While all resurfacing systems utilize similar principles, there can be some variation in surgical technique.

The outcomes of Cormet hip resurfacing compared to standard primary total hip arthroplasty.

Introduction: Metal-on-metal hip resurfacing has provided an alternative to standard total hip arthroplasty in younger, more active patients. However, detractors argue that many of the benefits of resurfacing can be obtained with the use of larger femoral heads. The purported advantages of the resurfacing procedure include preservation of femoral bone stock, increased range of motion, decreased dislocation rate, excellent performance in high-activity patients, and a potentially easier revision than total hip arthroplasty.

Results of MIS TKA at mean nine year follow-up.

The first 103 consecutive minimally invasive total knee arthroplasties performed by a single surgeon were assessed to determine the clinical and radiographic outcomes at a mean of 9-year follow-up (range, 8 to 10 years). Patients who died before final follow-up were 10 (13 knees), leaving 90 knees in 69 patients for final review. Outcome was evaluated using Knee Society pain and functional scores.

Review of total hip resurfacing and total hip arthroplasty in young patients who had Legg-Calvé-Perthes disease.

Patients with Legg-Calvé-Perthes disease can often be successfully treated with femoral head-preserving measures, such as bracing, or containment procedures with osteotomies. However, in some cases, after resolution of the disease, the femoral head may proceed to collapse or progress to severe arthritis at a young age. If nonoperative methods have failed, the only treatment options available for these adolescents or young adults may be a total hip resurfacing or a total hip arthroplasty (THA).

Do we need gender-specific total joint arthroplasty?

Background: Gender-specific differences in knee and hip anatomy have been well documented. Although it has been accepted these differences exist, there is controversy regarding if and how these differences should be addressed with gender-specific implant designs.

Questions/purposes: (1) What are the anatomic and morphologic differences, if any, in the knee and hip between men and women? (2) Do gender-specific TKA designs provide better clinical functioning, survivorship, and improved fit in women? (3) How have anatomic differences in the hip been addressed, if at all, by THA?

Methods: We conducted a systematic review of the MEDLINE database to identify all articles reviewing basic science and clinical outcomes of gender-specific total knee and total hip implants.