Osteochondral allografts: applications in treating articular cartilage defects in the knee.

Chondral injury in the knee is a unique challenge to the orthopaedic surgeon. Given the high probability of progression to knee arthrosis, the treatment of symptomatic cartilage defects of the knee has become an important surgical intervention in young, active patients. The demand for an alternative to prosthetic resurfacing has driven the trend towards biologic resurfacing and joint preservation.

Patella tendon rupture after arthroscopic resection of the prepatellar bursa--a case report.

The use of arthroscopic techniques for excision of the pre-patellar bursa has become more common in recent years for the treatment of prepatellar bursitis. The current literature includes several case series that report few complications with this technique. We report the case of a 73-year-old male who sustained a low-energy patella tendon rupture 2 months after arthroscopic resection of the prepatellar bursa.

Subtrochanteric femoral fractures in patients receiving long-term alendronate therapy: imaging features.

Objective: A paradoxical association between long-term alendronate therapy and low-energy subtrochanteric femoral fractures has been recently recognized. A retrospective review of 34 such femoral fractures was performed.

Conclusion: Subtrochanteric femoral fractures associated with long-term alendronate therapy present with minimal trauma, may be chronic, and when incomplete may be missed.

Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy.

Background: While alendronate therapy has been shown to decrease the risk of vertebral and femoral neck fractures in postmenopausal osteoporotic patients, recent reports have associated long-term alendronate therapy with unilateral low-energy subtrochanteric and diaphyseal femoral fractures in a small number of patients. To our knowledge, there has been only one report of sequential bilateral femoral fractures in patients on long-term bisphosphonate therapy.

Methods: We retrospectively reviewed the case log of the senior author over the last four years to identify patients who presented with a subtrochanteric or diaphyseal femoral fracture after a low-energy mechanism of injury (a fall from standing height or less) and who had been taking alendronate for more than five years.

Operative experience in an orthopaedic surgery residency program: the effect of work-hour restrictions.

Background: The implementation of Section 405 of the New York State Public Health Code and the adoption of similar policies by the Accreditation Council for Graduate Medical Education in 2002 restricted resident work hours to eighty hours per week. The effect of these policies on operative volume in an orthopaedic surgery residency training program is a topic of concern. The purpose of this study was to evaluate the effect of the work-hour restrictions on the operative experiences of residents in a large university-based orthopaedic surgery residency training program in an urban setting.

Massive femoral osteolytic lesion secondary to disengagement of a total knee tibial locking pin: case report.

The Anatomic Modular Knee (AMK; Depuy, Warsaw, Ind) was one of the first designs to incorporate a modular locking mechanism for the tibial insert; fixation was secured using a screw-in tibial tray-locking pin. This case report describes a patient who presented with instability and worsening knee pain 15 years following a primary total knee arthroplasty using the AMK prosthesis. Radiographs and intraoperative assessment revealed proximal migration of the tibial tray-locking pin into the medial femoral condyle resulting in a large osteolytic defect.

Clinical outcome of total hip arthroplasty using the normalized and proportionalized femoral stem with a minimum 20-year follow-up.

Currently, there are several femoral stem designs available for use, but few have an extended track record. We have previously reported on 10- and 15-year outcome studies of total hip arthroplasty (THA) using a cemented normalized and proportionalized femoral stem from a single surgeon series. This is a follow-up study reporting the minimum 20-year outcome of this femoral stem design.

Component asymmetry in simultaneous bilateral total knee arthroplasty.

Component size asymmetry and knee scores were determined in a review of 253 patients undergoing simultaneous or same-day, bilateral total knee arthroplasty (TKA). Asymmetry in component sizes was found in 22 (8.7%) pairs of femoral components, 17 (6.

Surgical approaches in mini-incision total knee arthroplasty.

Mini-incision total knee arthroplasty can be accomplished through versions of exposures used in standard total knee arthroplasty. Modifications of the medial parapatellar, subvastus, and midvastus approaches are presented, and potential advantages and disadvantages of each approach are reviewed. When making the transition to smaller incisions and arthrotomies, the medial parapatellar seems to be the most versatile.