Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs.

Purpose: The aim of this study was to comprehensively evaluate contemporary tibial component designs against global tibial anatomy. We hypothesized that anatomically designed tibial components offer increased morphological fit to the resected proximal tibia with increased alignment accuracy compared to symmetric and asymmetric designs.

Methods: Using a multi-ethnic bone dataset, six contemporary tibial component designs were investigated, including anatomic, asymmetric, and symmetric design types.

Dilemma of high rate of conversion from knee arthroscopy to total knee arthroplasty.

We tried to reduce our rate of conversion from index knee arthroscopy to total knee arthroplasty (TKA) for degenerative pathology (primarily meniscal) in the setting of coexisting arthritis in patients 50 years or older. We hypothesized that, by using a 2-surgeon independent evaluation method, we could reduce the rate to less than 10% by 3-year follow-up. Forty-two consecutive patients were initially evaluated by the knee replacement surgeon to determine if they were TKA candidates.

Effect of total knee prosthesis design on patellar tracking and need for lateral retinacular release.

Intraoperative lateral retinacular release (LRR) during primary total knee arthroplasty (TKA) is discouraged, except when LRR is necessary to centralize patellofemoral tracking. This study compares the LRR rates in four designs of total knee implants and correlates how changes in prosthesis design affect LRR rates. 2881 primary TKAs performed by one surgeon using a single surgical technique were reviewed.

In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty.

The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee.

Tibial component fixation in total knee arthroplasty: a comparison of pegged and stemmed designs.

This study compares midterm radiographic, functional, and quality-of-life outcomes in patients receiving a cemented tibial component that has either a short intramedullary stem or one that has a pegged tibial component. A cohort of 181 patients received 225 NexGen cruciate-retaining implants (84 stemmed, 141 pegged) during total knee arthroplasty, with annual follow-up examinations for up to 7 years. Both types of tibial components were associated with excellent radiographic and clinical results with no radiographic evidence of implant loosening or osteolysis.

The orthopedist as clinical densitometrist: cost- and time-effectiveness.

We tested the hypothesis that an orthopedic surgeon and his or her staff can efficiently and economically provide a bone densitometry service. This hypothesis reflects a philosophy that orthopedists should take a more active role in identifying patients at risk for osteoporosis. We evaluated the cost- and time-effectiveness of an orthopedic surgeon and his medical assistant in completing reports and related correspondence for dual-energy x-ray absorptiometry scans conducted in an orthopedic subspecialty clinic.

Cruciate-retaining total knee arthroplasty at 5 to 7 years followup.

Unlabelled: Cruciate-retaining total knee implants may improve postoperative function in total knee arthroplasty, but whether patients experience good restoration of kinematics, undue wear, or increased revision rates is debatable. I evaluated clinical results, radiographs, and survival rates of the NexGen posterior cruciate-retaining implant at 5-7 years followup in 251 knees (198 patients) in a prospective, consecutive total knee replacement series done from 1996-1997. A consistent improvement in knee scores and range of motion was observed from preoperative evaluation through 5 years followup.

Minimally invasive outpatient total hip arthroplasty: a financial analysis.

Unlabelled: Costs of outpatient total hip arthroplasties were compared with costs of a matched group of patients having inpatient total hip arthroplasties. Ten patients were in each group and had surgery by the same surgeon in the same hospital. The average hospital bill for the outpatients was $4000 less than for the inpatients.

Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach.

Mini-incision total hip replacement seeks to eliminate some complications of traditional extensile exposure and also attempts to facilitate more rapid rehabilitation of patients after surgery. Different surgical approaches historically have been used to do hip replacement surgery. Anterior or anterolateral approaches have often been selected to decrease the risk of posterior dislocation.

In vivo determination of posterior femoral rollback for subjects having a NexGen posterior cruciate-retaining total knee arthroplasty.

This study determines the in vivo kinematics during a deep-knee bend activity for subjects implanted with a posterior cruciate-retaining total knee arthroplasty having asymmetric geometries. Of 20 subjects, 19 experienced posterior femoral rollback (PFR) of the lateral condyle (average -3.9 mm), and 13 subjects experienced PFR of the medial condyle (average -3.

Repair of transverse sternal nonunions using metal plates and autogenous bone graft.

Transverse sternal nonunion is a complication of sternal fracture or partial sternotomy, and requires surgical treatment. Three patients with repeated failure of standard sternal repair were treated with a technique using metal plates and autogenous bone graft, which resulted in bone union in all patients. Metal plating of the sternum, accompanied by autogenous bone graft, is an effective method of treating transverse sternal nonunion.