Biomechanical Evaluation of the Effect of Varying Humeral Implant Length in Total Elbow Replacement: A Finite Element Analysis.

Background: Total elbow arthroplasty (TEA) is increasingly used for expanding indications but complications like aseptic loosening and periprosthetic fractures persist. Our objective is to examine the biomechanical behavior of the total elbow implant in response to varying implant lengths by investigating the stresses and the stress shielding effect in the bone-implant assembly using finite element (FE) modelling.

Methods: A fourth-generation synthetic humerus sawbone and its corresponding digital model were used in this study.

Quantifying the Positional Deviation Between the True Flexion-Extension and Epicondylar Axes of the Elbow: A 3D Computational Study.

Background and objective The epicondyles are commonly used surgical reference landmarks for elbow arthroplasty and external fixator application. This study aimed to investigate whether the epicondylar axis differed from the elbow's true flexion-extension (F-E) axis in terms of both rotational difference and translational offset. Methods Three-dimensional (3D) models of 15 cadaver elbows were created.

Percutaneous Ultrasound-Guided Coracohumeral Ligament Release for Refractory Adhesive Capsulitis: A Prospective, Randomized, Controlled, Crossover Trial Demonstrating One-Year Efficacy.

Background: Adhesive capsulitis (AC) is a painful and disabling condition with restricted range of motion (ROM) that affects 2% to 3% of the population and up to 20% of patients with diabetes. AC can be idiopathic, iatrogenic, or secondary to shoulder injuries. Some associated conditions include diabetes mellitus, thyroid disorders, dyslipidemia, stroke, prolonged immobilization, and autoimmune conditions.

Elbow stiffness: Interview with professor Bernard Morrey.

Stiff elbow is a complex condition whose diagnosis and management are sometimes quite a challenge. Compared to the other joints, the elbow is disproportionately affected by loss of motion following trauma or surgery. It is unclear why the elbow tends to develop stiffness; its anatomical complexity, namely the presence of three highly congruent joints in the same capsule and synovial space, the tautness of the lateral and medial collateral ligaments through the whole range of motion, and the very close relationship among tendons, muscles, and skin 2 may account for this characteristic.

Review of bone deficiency in total elbow arthroplasty revision.

Total elbow arthroplasty revision rates have been increasing over time due to the increasing use of the procedure with the accompanying increase in complications. The most common complications that typically require revision surgery include aseptic loosening, periprosthetic fractures, infection, and component failure. The associated instability has an overall revision rate reported to be as high as 13%.

All-polyethylene versus metal-backed tibial components in total knee arthroplasty: a meta-analysis of randomized controlled trials.

Objectives: The design of tibial trays for total knee arthroplasty (TKA) has been a topic of research for several decades. Although all-polyethylene trays were developed to address issues such as osteolysis and to enhance the longevity of the prosthesis, as well as knee range of motion, metal-backed designs have remained the most commonly used type of prosthesis. This meta-analysis aimed to compare the clinical, radiological, and survival outcomes of both designs.

AOA Critical Issues Symposium: Leadership and Education During and After COVID-19: Back to the Future or a New Normal.

The devastating impact of COVID-19 has reshaped how we lead and train our future surgeons in the field of orthopaedics. Overnight, leaders in our field had to dramatically shift their mindset to continue to lead a hospital, department, journal, or residency or fellowship program in the face of an unprecedented level of adversity in the history of the United States. This symposium discusses the role of physician leadership during and after a pandemic, as well as the adoption of technology for training surgeons in the field of orthopaedics.

Medial Elbow Pain Syndrome: Current Treatment Strategies.

Medial elbow pain is a common presentation that can be a challenge to appropriately treat for the orthopedic surgeon. Causes include medial epicondylitis, ulnar neuritis, ulnar collateral ligament injury, flexor pronator strain, or snapping medial triceps. A good outcome is typically achieved with adequate treatment of tendon degeneration at the common flexor tendon origin.

Unexpected high early failure rate of the Nexel total elbow arthroplasty.

Background: Aseptic loosening, polyethylene wear, and mechanical failure have limited the use of total elbow arthroplasty (TEA) in physically demanding patients. Newer implant designs have been introduced to improve mechanical performance. The purpose of this study was to report the results obtained after implantation of the Nexel TEA.

Predictors of reoperation after internal fixation of intra-articular distal humerus fractures.

Background: Despite good reported outcomes with open reduction and internal fixation of intra-articular distal humerus fractures, complication rates remain high. The objective of this work is to identify factors associated with reoperation.

Methods: Sixty-three patients treated with open reduction and internal fixation for intra-articular ( type C) distal humerus fractures between 2004 and 2010 were identified using an institutional trauma registry, 62 of which were followed for a minimum of six months.

Mitigating Surgical Skill Decay in Orthopaedics Using Virtual Simulation Learning.

Background: The COVID-19 pandemic has interrupted orthopaedic training structures for both surgeons and trainees. The concept of skill decay must be considered during inactivity of elective practice. The purpose of this study was to provide an evidence-based curriculum in association with immersive virtual reality (iVR) to prevent skill decay during periods of training cessation and beyond.

causing native hip joint septic arthritis.

is a bacterium normal to oral and gastrointestinal flora that has been implicated in cases of discitis, osteomyelitis, and prosthetic joint infections, often involving dental procedures or periodontal disease. It is an extremely rare cause of infection outside of these circumstances. We describe a case of septic arthritis of the native hip joint due to .

A review of the surgical management of distal humerus fractures and nonunions: From fixation to arthroplasty.

Distal humeral fractures in adults are challenging injuries. They often require surgical intervention in form of internal fixation or total elbow arthroplasty which is being increasingly used in physiologically elderly patients with comminuted fractures. Careful preoperative evaluation including type of fracture, quality of bone, pre-existing conditions and functional demand help in deciding optimal treatment.

Interposition arthroplasty: Current indications, technique and expectations.

The ultimate means of functional restoration of joints with end stage arthritis is prosthetic replacement. Even though there is reluctance to replace the joint of a younger individual, the mean age of joint replacement continues to decrease. This is due to three factors: 1) social expectations, 2) uncertainty with many joint preservation procedures and 3) the ever-increasing reliability and longevity of prosthetic replacement.

Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months.

Background: In a study from our institution, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon for recalcitrant lateral elbow tendinopathy showed excellent safety profiles, high tolerability, efficiency, sustained pain relief, functional improvement, and sonographic evidence of tissue healing in 20 patients at 3 years' follow-up.

Purpose: To explore the long-term clinical and sonographic results of ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon.

Study Design: Case series; Level of evidence, 4.

Leadership in the medical profession - it's not rocket science.

Cite this article: 2020;5:354-360. DOI: 10.1302/2058-5241.

Distal Biceps Tendon Repair and Reconstruction.

Distal biceps tendon ruptures can result in functionally significant loss of supination and flexion strength, as well as decreased resistance to fatigue. Although the diagnosis of distal biceps tendon ruptures remains straightforward, substantial debate continues with regards to surgical indications, pertinent surgical anatomy, single- versus double-incision surgical technique, and fixation options. This review discusses the latest evidence-based literature regarding distal biceps tendon repair/reconstruction including types of tears, demographics, clues for diagnosis, surgical indications, anatomy with special attention to how the distal tendon inserts distally and the relevant tuberosity anatomy (height and cam effect), common reconstruction techniques (single- vs double-incision and single-incision power optimizing cost-effective technique), fixation techniques (bone tunnels, distal biceps button, interference screw, button plus screw), surgical technique pearls, postoperative rehabilitation, postoperative outcomes, as well as the treatment of chronic tears with special reconstruction techniques including Achilles allograft, pedicled latissimus transfer, and the use of a free innervated gracilis.

Translating Orthopaedic Technologies Into Clinical Practice: Challenges and Solutions.

Despite the wealth of innovation in the orthopaedic sciences, few technologies translate to clinical use. By way of a 2-day symposium titled "AAOS/ORS Translating Orthopaedic Technologies into Clinical Practice: Pathways from Novel Idea to Improvements in Standard of Care Research Symposium," key components of successful commercialization strategies were identified as a passionate entrepreneur working on a concept aimed at improving patient outcomes and decreasing the cost and burden of disease; a de-risking strategy that has due recognition of the regulatory approval process and associated costs while maximizing the use of institutional, state, and federal resources; and a well thought-out and prepared legal plan and high quality, protected intellectual property. Challenges were identified as a lack of education on the scale-up and commercialization processes; few opportunities to network, get feedback, and obtain funding for early stage ideas; disconnect between the intellectual property and the business model; and poor adoption of new technologies caused in part by un-optimized clinical trials.

Ultrasonic Percutaneous Tenotomy of Common Extensor Tendons for Recalcitrant Lateral Epicondylitis.

Tennis elbow is a common musculoskeletal condition affecting middle-aged patients with symptoms usually lasting from 6 months to 2 years. The vast majority of individuals will respond to conservative therapy; however, some will require surgical intervention. A new treatment system has been developed for use with ultrasound guidance in the ultrasonic microresection of tendinopathic tissue.