The direct anterior approach (DAA) is one of the muscle sparing approaches in total hip arthroplasty (THA). The advantages of the DAA-THA include low dislocation rate, quick recovery with less pain, and accurate implantation. However, complications related to the learning curve have been reported. The aim of this study was to analyze the first 100 cases of DAA-THA performed by 2 surgeons. The records of first 100 consecutive primary DAA-THAs performed by 2 orthopedic surgeons who have np experience of DAA-THA previously were retrospectively reviewed. All operations were performed using DAA in the supine position without the special traction table. The surgical result, the early clinical results, complications, and accuracy of prosthesis placement were investigated.Background:
Methods:
In anterior approaches for total hip arthroplasty (THA), the femoral part of the procedure requires the release of the capsule from the greater trochanter. However, it is unknown whether any other tendons of the short external rotator muscles are also damaged during capsular release procedures. The aim of this cadaveric study was to identify the bony landmarks on the greater trochanter, which indicate the individual short external rotator muscle insertions. Forty-four hip regions from 28 embalmed cadavers were dissected. At first, micro-computed tomography (micro-CT) images were obtained to identify bony impressions on the greater trochanter. Then, the soft tissues around the greater trochanter were removed and their insertions were identified to assess correlation with micro-CT images.Background:
Methods:
In TKA, it is important to make the equal extension and flexion gap (EG and FG) of the knee. Although, this principal concept applies to all knees, flexion contracture is known to have difficulties to achieve the equal EG and FG because of its smaller EG than usual. Whereas, it is also well known that PCL resection makes FG wider than EG, however, many surgeons recommend PCL resection in case of flection contracture because it is easy to manage during surgery, nevertheless the risk of further gap unbalance. Although, flexion contracture is not rare in TKA, the controversial problem of the PCL resection for the flexion contracture still remains even in today. To investigate this contradiction, we measured intra-operative EG and FG of the knee with 20 degree or more pre-operative flexion contracture. The gaps were measured by 3 different ways; a tension device system with 30 and 40 pound tension (group 1 and 2) and a spacer block system which had 1 mm increment thickness variation (group 3). The cases were 41, 46 and 51 knees in group 1, 2 and 3 respectively. Group 1 and 2 have overlapping in 27 knees.Introduction
Materials and methods
Although, the total knee arthroplasty (TKA) procedure is performed to make the same extension gap (EG) and flexion gap (FG) of the knee, it is not clear how the gaps can be created equally. According to earlier reports, the gaps after bone resection (bone gaps) differ from the gaps after the trial component of the femur is set (component gaps), because of the thickness of the posterior condyle of the femoral component and the tension of the posterior capsule. The surgeon can only check the component gaps after completing the bone resection and setting the trial component and it difficult to adjust the gaps even when the acquired component gaps are inadequate. To resolve this problem, we developed a “pre-cut trial component” for use in a pre-cut technique for the femoral posterior condyle (Fig. 1). This specially made trial component allows us to check the component gaps before the final bone resection of the femur. The pre-cut trial component is composed of an 8-mm-thick usual distal part and a 4-mm-thick posterior part of the femoral component, and lacks an anterior part of the femoral component. With this pre-cut trail component, 152 knees were investigated. The EG was made by standard resection of distal femur and proximal tibia. The FG was made by a 4 mm pre-cut from the posterior condylar line of the femoral posterior condyle (Fig. 2). The rotation of the pre-cut line is initially decided by anatomical landmarks. Once all of the osteophytes are removed and the bone gaps are checked, the pre-cut trial component is attached to the femur and the component gaps are estimated with the patella reduction (Fig. 3). In our experiments, these gaps were the same as the component gaps after the usual trial component was set via the measured resection technique. Finally, the femur is completely resected according to the measurements of the component gaps with the pre-cut trial component.Introduction
Materials and methods
Short stem has potential advantages of bone and muscle preservation. Current papers demonstrate that direct anterior approach (DAA) is a significant minimally invasive muscle-sparing approach to total hip arthroplasty. Theoretically, a short length stem with a reduced lateral shoulder is the most appropriate design for DAA. To clarify the necessity of the standard length stem in tapered-wedge stem.Background
Objectives
Minimally invasive surgery is being widely used in the field of total hip arthroplasty (THA). The advantages of the direct anterior approach (DAA), which is used in minimally invasive surgery, include low dislocation rate, quick recovery with less pain, and accuracy of prosthesis placement. However, minimally invasive surgery can result in more complications related to the learning curve. The aim of this study was to evaluate the learning curve of DAA-THA performed by a senior resident. Thirty-three consecutive patients (33 hips) who underwent primary THA were enrolled in this study. All operations were performed by a senior resident using DAA in the supine position without the traction table. The surgeon started using DAA exclusively for all cases of primary THA after being trained in this approach for 6 months. Operative time, intraoperative blood loss, complications, and accuracy of prosthesis placement were investigated.Background
Methods
We have often experienced a change of the tone of the hammering sound during the press-fit implantation of cementless acetabular components in total hip arthroplasty (THA). The tone of the impact sound before the press-fit of acetabular components seems to differ from the tone after the press-fit. This change of tone may depend on the accuracy of the fit of the acetabular component, or it may simply be a subjective perception. The aim of this study is to evaluate the impact sounds in the press-fit implantation of cementless acetabular components. The hammering sounds in press-fit implantation of acetabular components were studied intraoperatively in 22 patients (28 hips) who underwent primary THA for treatment of advanced osteoarthritis. All operations were performed via the direct anterior approach in a supine position. The hemispherical titanium-alloy acetabular component (TriAD; stryker) was implanted in all patients. A sound level meter (NA-28; RION) was used to record and analyze the sounds. The hammering sounds of the first three hits and last three hits were recorded as the “before press-fit” and “after press-fit” sound samples, respectively. A frequency analysis was then performed at the point of peak sound pressure in each sample.Background
Methods
There is no criteria to select cruciate retaining (CR) or posterior substitute (PS) component in total knee arthroplasty (TKA). In this study, extension and flexion gaps were measured intra-operatively with posterior cruciate ligament (PCL) remained to reveal characteristics of the gaps. Component type selection, CR or PS, was decided intra-operatively according to the gaps in each knee. One hundred and sixty knees with osteoarthritis were investigated. Extension gap (EG) was made by resection of 8 mm distal femur and 10 mm proximal tibia. After measurement of femoral AP size, about 4 mm bigger 4-in-1 femoral cutting guide than measured size was used for pre-cut of femoral posterior condyle[Figure 1]. With this technique, flexion gap (FG) was made 4 mm smaller than usual measured resection. The gaps were measured by a tension device with 30 pounds tension and FG was corrected by the amount of pre-cut. According to the EG and corrected FG, component type was decided. Too small FG usually needed PCL resection or (and) smaller size of femoral component to make enough final FG. On the other hand, large FG needed careful consideration to sacrifice PCL for adequate final FG. In these cases, CR component was selected usually. If necessary, soft tissue was released for good ligament balance. As the final step of the surgical procedure, the size of femoral component was decided for adequate final FG. It was changeable up to 4 mm larger than measured size[Figure 2].Introduction
Materials and methods
The purpose of this study is to call attention to the diagnosis of spinal cyst caused by lumbar disc herniation. Reviewing a total of 11 cases of lumbar spinal cyst that have been encountered in our spinal practice, we propose our views concerning the pathology of this lesion. The clinical findings of lumbar spinal cyst are identical to those in acute disc herniation such as low back pain and radiculopathy. The characteristics of imaging study are as follows; The magnetic resonance imaging (MRI) demonstrates a relatively large, rounded mass postero-laterally to the vertebral body. These lesions are isointense relative to the intervertebral disc on T1-weighted images and homogeneously hyperintense on T2. A gadolinium -DTPA-enhanced MRI shows a rim-enhancing lesion. A discogram reveals leakage of the contrast medium into the mass. The operative findings demonstrated encapsulated soft tissue masses which contained bloody fluid and small fragments of herniated disc tissue. The pathologic examinations revealed fibrous tissue with hemosiderin deposit in cyst wall and degenerative disc materials with inflammatory cell infiltration. This type of lumbar spinal cyst has been recognized as spinal epidural hematoma in recent years. Wiltse suggested that epidural hematoma may result from tearing of fragile epidural veins due to acute disc disruption. However, MRI characteristics of hematoma are not identical with those with lumbar spinal cyst. It is more likely that the lesions showing the pattern of changes are herniated disc tissue accompanied by hemorrhage and inflammation. If hernial tissue is covered with some membranous susbtance, formation of cystic lesions is understandable. Hence, we hypothesize that lesions, in which lysis liquefaction and absorption of the herniated disc tissue associated with inflammatory response have progressed, and the herniated disc tissue has completely disappeared, may be filled solely with bloody fluid, showing an appearance like cysts.
The purpose of this study is to introduce our treatment by skeletal traction in brace and to report the safety and easiness of this method and low incidence of cubitus varus. In 1980 we developed a specially designed brace for treating the supracondylar fracture, along with a technique of spontaneous reduction by skeletal traction to develop an easy and safe treatment. The brace is made of plastics and aluminum alloy that are radiolucent. The humeral slide bar with attached axillary pad can be moved up and down to adjust the height of the upper arm for each patient. From 1980 to 1999 we have treated 190 children with displaced supracondylar fracture of the humerus. Their ages ranged from 2 to 14 years old and average of age was 7 years old. The fractures occurred most frequently between the ages of 5 to 6. More boys than girls were injured and the left elbow were more often than the right. Among 190 cases, severely displaced cases were most common. (64%) and moderate case 20%, mild case 16%. The period of follow up was 6 months to 11 years, mean 4 years. Placing the arm in the brace with the elbow flexed at right angle, unstable fracture site will be stabilized first. Skeletal traction is performed by a spring through the winged screw. The traction is maintained for three to four weeks. Spontaneous reduction of the displaced fragment can be expected and we emphasize that any manipulative technique is not performed during the treatment at all. Among 190 patients, cubitus varus occurred in only 3 (1.6%) cases because of technical failure. All patients except one obtained excellent functional results, one had 25 degrees of limitation of the elbow flexion. There were no vascular problems or Volkmann’s contracture and ectopic ossification. The results were satisfactory. Our treatment utilizing the brace and skeletal traction for supracondylar fracture of the humerus in children is safe and effective in preventing cubitus varus.
