Indirect decompression of lumbar stenosis with transpsoas interbody cages and percutaneous posterior instrumentation.

Background: The minimally invasive lateral transpsoas retroperitoneal approach to address lumbar stenosis offers advantages to traditional approaches, including sparing of the AP annulus and longitudinal ligament and less risk to the peritoneal contents and retroperitoneal vascular structures. Few studies have presented longitudinal measures of radiographic indirect decompression and relief of pain and restoration of function using the lateral approach to spine fusion.

Question/purposes: We determined (1) whether radiographic measures suggestive of decompression were achieved after surgery and maintained 1 year after surgery, (2) whether the intervention resulted in sustained improvements in patient-reported outcomes scores 1 year after surgery, and (3) the frequency of pseudarthrosis on CT scans at 1 year after surgery in patients with moderate or severe lumbar stenosis treated with the approach.

A cadaveric radiographic analysis on the effect of extreme lateral interbody fusion cage placement with supplementary internal fixation on indirect spine decompression.

Study Design: Cadaveric Biomechanical and Radiographic Analysis.

Objective: The purpose of this study was to quantify the changes in intervertebral height and lateral and central recess areas afforded by lateral interbody fusion cages with 2 supplemental forms of internal fixation in cadaveric specimens.

Background Data: When conservative treatment for symptomatic lumbar stenosis fails, traditional intervention has been direct posterior decompression.

Effects on inadvertent endplate fracture following lateral cage placement on range of motion and indirect spine decompression in lumbar spine fusion constructs: A cadaveric study.

Background: The lateral transpsoas approach to interbody fusion is gaining popularity. Existing literature suggests that perioperative vertebra-related complications include endplate breach owing to aggressive enedplate preparation and poor bone quality. The acute effects of cage subsidence on stabilization and indirect decompression at the affected level are unknown.

Hip abductor moment arm--a mathematical analysis for proximal femoral replacement.

Background: Patients undergoing proximal femoral replacement for tumor resection often have compromised hip abductor muscles resulting in a Trendelenberg limp and hip instability. Commercially available proximal femoral prostheses offer several designs with varying sites of attachment for the abductor muscles, however, no analyses of these configurations have been performed to determine which design provides the longest moment arm for the hip abductor muscles during normal function.

Methods: This study analyzed hip abductor moment arm through hip adduction and abduction with a trigonometric mathematical model to evaluate the effects of alterations in anatomy and proximal femoral prosthesis design.

Enhancing soft tissue ingrowth in proximal femoral arthroplasty with aortograft sleeve: a novel technique and early results.

Hip abductor function is critical to joint stability after proximal femoral arthroplasty. Normal soft tissue relationships are often violated during this procedure for complete tumor resection. Abductor insufficiency leads to abnormal gait mechanics and poor function.

What is the emotional acceptance after limb salvage with an expandable prosthesis?

Background: Limb preservation surgery for extremity sarcomas offers the promise of improved function and cosmesis over amputation. Application of limb salvage surgery for pediatric patients with expandable metallic endoprostheses is gaining acceptance. The few studies reporting these devices have focused on functional outcomes; one has addressed quality of life.

Proximal and total humerus reconstruction with the use of an aortograft mesh.

Background: The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction.

Hemostasis using a bipolar sealer in primary unilateral total knee arthroplasty.

Previous studies have shown that, compared with standard electrocautery, a bipolar sealer reduces tissue damage and smoke production during surgery. We conducted a multicenter, prospective, randomized study to compare a bipolar sealer with standard electrocautery for hemostasis. Sixty-nine primary total knee arthroplasties were performed.

Percutaneous drilling for the treatment of atraumatic osteonecrosis of the ankle.

Atraumatic osteonecrosis of the ankle can be severely debilitating and can lead to joint collapse. A relatively new technique of percutaneous drilling has previously been used to relieve the symptoms of osteonecrotic hips and knees. The purpose of the present study was to examine the results of this technique when used to treat osteonecrosis of the ankle.

Purse-string capsule repair to reduce proximal femoral arthroplasty dislocation for tumor--a novel technique with results.

Hip joint dislocation is the most common complication after proximal femoral arthroplasty with a large endoprosthesis. Average dislocation rates are around 15%. In an attempt to decrease dislocations after proximal femoral arthroplasty for tumor resections, we devised a novel closure of the hip capsule.

Perioperative management for orthopaedic patients with sickle cell anaemia.

Purpose: To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries.

Methods: 12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician.

Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty.

Arthrofibrosis is a relatively common complication after total knee arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory knee stiffness after total knee arthroplasty.

Small-diameter percutaneous decompression for osteonecrosis of the shoulder.

Core decompression of the humeral head has previously been used as a joint-preserving procedure for treatment of symptomatic osteonecrosis of the shoulder. In this article, we describe a new decompression technique, which involves multiple small-diameter (3-mm) percutaneous perforations. In our study population (early-stage disease), shoulder arthroplasty was avoided in all 15 patients (26 shoulders) for a mean follow-up of 32 months (range, 24-41 months).

Early clinical experience with the use of the Birmingham hip resurfacing system.

This study reviews the early clinical experience with the Birmingham Hip resurfacing system (Smith & Nephew, Memphis, Tenn) in the United States since its approval by the FDA. A total of 230 patients were followed for a mean of 16 months (range, 6 months). There was a significant improvement in the mean preoperative Oxford hip score at the latest follow-up (44 points [range, 30-58 points] to 17 points [range, 12-28 points]).

Orthopedic surgery implications of breast cancer.

Breast cancer is the most common malignancy and the second leading cause of death in women. The metastatic involvement of bone denotes disease progression and decreased survival. Controversy exists regarding the exact pathophysiologic mechanism of metastasis and the different pathways that determine an osteoblastic versus osteoclastic bone compromise.

Reductions in blood loss with a bipolar sealer in total hip arthroplasty.

Altogether, 50 primary total hip arthroplasties were performed in a prospective, blinded, randomized study comparing a bipolar sealer device to standard electrocautery for hemostasis. Cohorts were evaluated for intra- and postoperative blood loss, transfusion rate, hemoglobin levels and modified Harris hip scores. Variables such as age, gender and body mass index were correlated to transfusion requirements.

Orthopedic surgery options for the treatment of primary osteosarcoma.

Background: Osteosarcoma is the most common malignant primary neoplasm of bone. Orthopedic procedures are essential components in the multidisciplinary treatment of osteosarcoma. Limb-salvaging procedures offer adequate disease control comparable to the results obtained by amputations.

Resurfacing for Perthes disease: an alternative to standard hip arthroplasty.

Metal-on-metal total hip resurfacing is an alternative to conventional total hip arthroplasty with several reports describing the benefits of this procedure in young patients. We retrospectively compared the clinical (including range-of-motion and leg length restoration) and radiographic outcome of resurfacing in young patients with Legg-Calvé-Perthes to those of patients of a similar age treated with a standard total hip arthroplasty. Eighteen patients (19 hip resurfacings) who had a mean age of 33 years (range, 18-34 years) were followed for a minimum of 26 months (mean, 51 months; range, 26-72 months).

Core decompression and nonvascularized bone grafting for the treatment of early stage osteonecrosis of the femoral head.

Osteonecrosis of the femoral head is a devastating disease with many patients ultimately requiring a total hip arthroplasty. When the disease is diagnosed in its early stages (before collapse of the femoral head), various procedures such as core decompression (with and without bone grafting), osteotomies, as well as nonvascularized and vascularized bone grafting can be used in an effort to preserve the joint. The efficacy of core decompression has been peer-reviewed in more than 40 studies.

New treatment approaches for osteonecrosis of the femoral head: an overview.

Osteonecrosis of the femoral head is a debilitating disease that ultimately leads to hip joint destruction. Various efforts have been made in an attempt to enhance the healing of osseous defects in the femoral head before collapse occurs. Examples of noninvasive treatment modalities include pharmacologic measures, electrical stimulation, shock wave therapy, and electromagnetic field therapy.

Use of metal-on-metal total hip resurfacing for the treatment of osteonecrosis of the femoral head.

Background: Recently, with the advent of improved metal-on-metal prostheses, total hip resurfacing has emerged as a viable arthroplasty option. However, it remains controversial whether this procedure should be used in patients with osteonecrosis when the femoral resurfacing component is cemented onto dead bone. The purpose of this study was to analyze the clinical and radiographic outcomes of metal-on-metal total hip resurfacing arthroplasty in patients with osteonecrosis of the femoral head.

Systematic analysis of classification systems for osteonecrosis of the femoral head.

Background: Multiple classification systems for osteonecrosis of the hip have been developed to assist physicians in the diagnosis and treatment of this potentially debilitating disorder. The purpose of this analysis was to delineate the classification systems utilized in reports published since 1985 and, through a comparison of the most commonly used systems, to identify consistent factors that would allow for cross-publication comparisons to be made.

Methods: We performed a PubMed search for reports of outcome studies concerning treatment methods for osteonecrosis of the hip.

Surgical treatment and customized rehabilitation for stiff knee arthroplasties.

Unlabelled: Treating patients who have arthrofibrotic or stiff knees after total knee arthroplasty can be difficult. Treatment with arthroscopic débridement, arthrolysis of adhesions with polyethylene spacer exchange, or complete revision arthroplasty often has led to less than optimal range of motion and functional outcomes. We used a combination of surgical arthrolysis and an intensive postoperative rehabilitation protocol, including functional bracing, to treat this condition.