Oncoplastic Breast-Conserving Surgery: Can We Reduce Rates of Mastectomy and Chemotherapy Use in Patients with Traditional Indications for Mastectomy?

Introduction: Traditional indications for mastectomy include multiple ipsilateral lesions and/or disease spanning ≥ 5 cm. Neoadjuvant chemotherapy increases breast conservation but does not improve survival. We hypothesized that oncoplastic breast-conserving surgery (OPS) may allow for breast conservation while providing full staging and tumor profiling information to guide systemic therapy decisions, thereby permitting more judicious chemotherapy use.

Evaluating Need for Additional Imaging and Biopsy After Oncoplastic Breast-Conserving Surgery.

Introduction: Breast-conserving therapy (BCT) using oncoplastic surgery (OPS) allows for larger resections and improved aesthetics though volume redistribution and tissue rearrangement. Data regarding the impact of OPS on surveillance imaging and need for additional biopsies are limited.

Methods: This observational cohort underwent BCT at a single institution from 2009 to 2018; standard breast-conserving surgery (BCS) was the predominant approach until OPS was introduced in 2012.

Extreme oncoplasty: Expanding indications for breast conservation.

Introduction: Presence of multiple lesions and/or tumor span ≥5 cm are traditional indications for mastectomy. Patient desire for breast conservation has increased the interest in extreme oncoplastic breast conserving surgery (EOBCS) to avoid mastectomy; however, perioperative outcomes in this population have not been well described.

Methods: This is an observational cohort of breast cancer patients with multiple lesions and disease span ≥5 cm who underwent EOBCS.

Revision knee arthroplasty including reconstruction of the lateral collateral ligament by allograft: a case report.

A 53-year-old woman presented with an unstable and painful total knee arthroplasty 6 months after the index procedure. Disruption of both collateral ligaments as a young adult and the subsequent development of traumatic arthritis required repeated surgical and extensive conservative treatment before a prosthesis was implanted. Examination disclosed marked instability of the lateral collateral ligament (LCL) and loosening of the tibial and the femoral components.

Early results with the Genesis II Posterior Stabilized High Flexion knee prosthesis. A one year follow-up study.

The aim of this prospective study was to assess the range of motion (ROM) achieved with the Genesis II Posterior Stabilized High Flexion knee prosthesis. The ROM was compared with that of a historical study group with the standard PS insert and an identical study design. Sixty three patients with primary knee osteoarthritis (37 female, 26 male; average age: 67.

Retrieval analysis of femoral zirconium components in total knee arthroplasty: preliminary results.

Safety of oxidized zirconium (OxZr) in total knee arthroplasty (TKA) has been supported by biomechanical, clinical, and radiologic data. Retrieved OxZr femoral components and corresponding polyethylene (PE) inserts were examined to rule out patterns leading to early failure. Sixteen retrieved TKA with an OxZr femoral component were included.

Is minimally invasive surgery-total knee arthroplasty truly less invasive than standard total knee arthroplasty? A quantitative evaluation.

With recent technical advancements, the number of operative manipulations in the knee joint by minimally invasive surgery-total knee arthroplasty (MIS-TKA) is now considered to be the same as that using standard TKA (S-TKA). The question still remains, however, if MIS-TKA improves recovery compared to S-TKA. We compared MIS-TKA and S-TKA patients' physical activity as measured by an accelerometer.

Varus gonarthrosis predisposes to varus malalignment in TKA.

Postoperative alignment is a predictor for long-term survival of total knee arthroplasty (TKA). The purpose of this study was to evaluate whether or not preoperative deformities predispose to intraoperative malposition of TKA components. A retrospective radiographic analysis of 53 primary TKA cases was performed.

Ligament tension in the ACL-deficient knee: assessment of medial and lateral gaps.

Obtaining symmetric and balanced gaps under equilateral loads is a common goal in posterior cruciate ligament (PCL)-retaining and -sacrificing TKAs. Owing to limitations in existing surgical tensors, however, tensing knee ligaments with standardized and symmetric loads has been possible only with the patella subluxated or everted. We therefore determined the influences of (1) patellar eversion versus complete reduction, (2) PCL resection, and (3) load magnitude on gap symmetry and balance in the anterior cruciate ligament (ACL)-deficient knee.

The mini-incision mid-vastus approach for total knee arthroplasty.

Objective: Rapid functional recovery and improved range of motion after total knee arthroplasty (TKA) without compromising implant position.

Indications: Osteoarthritis of the knee requiring TKA.

Contraindications: Preoperative flexion < 80 degrees.

The classic: modular total knee-replacement arthroplasty. A review of eighty-nine patients. 1976.

Fifty-eight osteoarthritic and thirty-one rheumatoid patients underwent modular total knee-replacement arthroplasty. The major indication for the operation was relief of pain. Contraindications to this resurfacing arthroplasty included varus-valgus instability of over 20 degrees, combined varus-valgus instability with flexion contracture of over 40 degrees, marked recurvatum, and predominant patellofemoral symptoms.

The classic: total condylar knee replacement in patients who have rheumatoid arthritis. A ten-year follow-up study. 1990.

Eighty knee replacements with a total condylar prosthesis in patients who had rheumatoid arthritis were followed for ten years. At ten years, nineteen knees needed revision and sixty-one prostheses were still functioning. The major reasons for revision were loosening of the tibial component or late bacteremic seeding from another site.

Prolonged operative time correlates with increased infection rate after total knee arthroplasty.

Risk stratification has proven to be a useful tool in surgical site infection prevention. The duration of the surgical procedure has been recommended for use in surgical site infection (SSI) risk stratification (Infect Control Hosp Epidemiol 20:247-248, 1999). A retrospective analysis of 6489 patients who underwent total knee replacement (TKR) between 1993 and 1999 assessed the association between the duration of the surgical procedure and the risk of postoperative infection.

Intramedullary arthrodesis of the knee in the treatment of sepsis after TKR.

Infection is a devastating complication following total knee replacement (TKR). In the majority of cases, single- or two-stage revision has excellent results in eradicating infection and restoring function. Rarely, recurrent infection requires alternative treatments such as resection, amputation, or arthrodesis.

ASA physical status classification is not a good predictor of infection for total knee replacement and is influenced by the presence of comorbidities.

The American Society of Anesthesiologists Physical Status Classification System (ASA) ranks patients for risk of adverse events during a surgical procedure. The ASA classification is used as a surrogate for the patient's underlying severity of illness and has been recommended for use in Surgical Site Infection (SSI) and risk stratification. We assessed the predictive power of the ASA score for total knee replacement surgery infection, and compared it to a comorbidity score.

Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty.

We analyzed the National Hospital Discharge Survey to elucidate temporal changes in the demographics, comorbidities, hospital stay, in-hospital complications, and mortality of patients undergoing primary total knee arthroplasties (TKAs) in the United States. Three 5-year periods were created (1990-1994, 1995-1999, and 2000-2004), and temporal changes were analyzed. The number of TKAs performed increased by 125% for the 3 periods.

A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja.

Our aim in this study was to evaluate the prevalence of patella baja after total knee arthroplasty (TKA) using 2 different surgical techniques. Postoperative changes in patella height were measured on serial radiographs of 74 TKAs implanted using a mini-midvastus capsular approach without patella eversion (group 1) and 57 TKAs implanted using a standard medial parapatellar capsular approach with patella eversion (group 2). Preoperative and postoperative Knee Society scores, operative data, and complications were compared.

The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty.

Compared to a statistically similar cohort, patients implanted with a high-flex poster-stabilized prosthesis achieved greater return of flexion than that with a standard posterior stabilized implant. In addition, patients with a high flexion arc preoperatively retained this high arc of flexion after surgery. Finally, there was an increase in the range of flexion seen after surgery in both groups of patients, but larger in the group in which the modified high-flexion implant was used.

Ten-year results of the first 100 Genesis II total knee replacement procedures.

The first 100 consecutive Genesis II (Smith & Nephew; Memphis, Tenn) total knee replacements (TKR) procedures performed in 97 patients by the senior investigators (RBB, RSL) had a Kaplan-Meier survivorship of 96% +/- 2% at 12 years with any reoperation as the endpoint. Significant improvements in health-related quality-of-life outcome measures were noted. There were no revisions for implant-related factors (ie, polyethylene wear, osteolysis, or aseptic loosening).

What would you do? Challenges in knee surgery.

Evaluation and management of 4 challenging knee case scenarios were discussed in an interactive session with a moderator and 5 experts in knee reconstruction. Case-based discussion included total knee arthroplasty in the presence of femoral deformity, deficient patellar bone, and patella baja, and treatment of infected total knee arthroplasty.

Surgical exposure for total knee arthroplasty: for everything there is a season.

The author has used a mini midvastus lesser-invasive knee approach for 5 years for patients undergoing a primary total knee arthroplasty. The approach involves a modified capsular and muscular incision, displacement but not eversion of the patella, and avoidance of anterior dislocation of the tibia before bony resections. This has resulted in a more rapid return of flexion and functional ability with a lesser amount of postoperative pain as compared with previous larger median parapatellar approaches with patellar eversion.

Computer-assisted navigation in TKA: where we are and where we are going.

When compared to standard intramedullary and extramedullary referencing systems, computer-assisted navigation systems have been shown in multiple randomized studies to increase the accuracy of bone resections in total knee arthroplasty. Accuracy to within 1 degrees in the coronal plane resections can routinely be obtained. Recent modifications of the software programs address the problem of proper soft tissue balance.

VenaFlow plus Lovenox vs VenaFlow plus aspirin for thromboembolic disease prophylaxis in total knee arthroplasty.

Two hundred seventy-five patients undergoing unilateral total knee arthroplasty were prospectively randomized to receive spinal epidural anesthesia (SEA), a VenaFlow calf compression device, and enoxaparin (group A) or SEA, VenaFlow, and aspirin (group B). Aspirin was started on the day of surgery, whereas enoxaparin was started 48 hours after surgery. Anticoagulants were continued for 4 weeks after surgery.