Motorised intramedullary lengthening nails are considered more expensive than external fixators for limb lengthening. This research aims to compare the cost of femoral lengthening in children using the PRECICE magnetic lengthening nail with external fixation Patients: Retrospective analysis of 50 children who underwent femoral lengthening. One group included patients who were treated with PRECICE lengthening nails, the other group included patients who had lengthening with external fixation. Each group included 25 patients aged between 11–17 years. The patients in both groups were matched for age. Cost analysis was performed following micro-costing and analysis of the used resources during the different phases of the treatments.Introduction
Materials and Methods
The purpose of this research is to compare the quality of life in children during gradual deformity correction using external fixators with intramedullary lengthening nails. Prospective analysis of children during lower limb lengthening. Group A included children who had external fixation, patients in group B had lengthening nails. Patients in each group were followed up during their limb reconstruction. CHU-9D and EQ-5DY instruments were used to measure quality of life at fixed intervals. The first assessment was during the distraction phase (1 month postop.), the second was during the early consolidation phase (3 months postop.) and the final one was late consolidation phase (6–9 months depends on the frame time)Introduction
Materials and Methods
This is a report of the outcome of management of congenital pseudoarthrosis of the tibia (CPT) at skeletal maturity. Retrospective study. Inclusion criteria:
CPT Crawford IV Skeletally maturity. Availability of radiographs and medical records. Outcome: union rate, healing time, residual deformities, ablation and refracture.Introduction
Materials and Methods
Surgical wound closure is not the surgeon”s favorite part of the total knee arthroplasty (TKA) surgery however it has vital rule in the success of surgery. Knee arthoplasty wounds are known to be more prone to infection, breakdown or delayed healing compared to hip arthroplasty wounds, and this might be explained by the increased tensile force applied on the wound with knee movement. This effect is magnified by the enhanced recovery protocols which aim to obtain high early range of movement. Most of the literature concluded that there is no difference between different closure methods We conducted an independent study comparing the complication rate associated with using barbed suture (Quill-Ethicon), Vicryl Rapide (polyglactins910-Ethicon) and skin staples for wound closure following TKABackground
Objectives
Complete Abductor Detachament, Direct Lateral Approach, Abductor Insuffenciency, Hip Arthroplasty Approach of Total hip replacement (THR) is a very important part of the surgery, the approach dictates the postoperative complications. Lateral approach is one of the most commonly used approaches. The initial lateral approach relied on bony (trochanteric) osteotomy which was later modified to tendon detachment, there are many versions of the lateral approach but the main goal is to detach the hip abductors mechanism to gain access to the underlying joint. One of the modifications is to completely detach the abductors tendon, this offers superior exposure compared to the traditional partial detachment (Hardinge) approach.Keywords
Backgroung
The knee joint morphology varies according to gender and morphotype of the patients. To measure the dimensions of the proximal tibia and distal femur of osteoarthritic knees in a group of patients from the same ethnic group (Arabs) and to compare these measurements with the dimensions of six total knee implants.Background
Objectives
Aim: To compare between the number of steps and instruments required for total knee arthroplasty (TKA) using 3 different techniques. The proposed techniques were conventional technique, conventional technique with patient-specific pin locators and CAOS technique using patient-specific templates (PST). Patients and methods: Zimmer/Nexgen was used as the standard implant and templating system for TKA. A Comparison was done on the number of steps and instruments required for TKA when performed with conventional technique, conventional technique with patient-specific pin locators and CAOS technique with patient-specific templates (PST) used as cutting guides. Results: The essential steps and instruments required for conventional TKA without surgical approach or bone exposure were average 70 steps with 183 different instruments; for conventional technique with patient-specific pin locators, they were average 20 steps with 40 instruments and two templates; for CAOS technique using PST, they were average 10 steps with two templates and 15 accessory instruments. CAOS PST technique required an average of 4 days for preoperative preparation and templates fabrication. Conclusion: CAOS technique using PST could make TKA less complicated in light of essential steps and instrumentation required. Although this technique required accurate preoperative preparation, it could offer less technical errors and shorter operative time compared to conventional TKA techniques. The errors’ rate for each technique was still depending on the surgeon's skills and training; however, CAOS technique with PST required shorter learning curve.
To compare computer-assisted total knee arthroplasty with the conventional technique in operative time. 30 patients with different degrees and forms of knee osteoarthritis were divided into 2 groups. Group 1 (15 patients) had TKA using patient specific instrumentations (PSI). Group 2 (15 patients) had TKA using the conventional technique. Operative time was measured for each patient of each group.Objectives
Materials and Methods
To create a more “normal” anatomy for the repaired joint structure, which can be provided that by the following factors: (1) the available implant component require a normalized anatomical support structure, (2) the available repair components are designed and/or tested to only recreate and/or replicate more normalized anatomical structures and/or joint motion, (3) the surgeon is familiar and comfortable with more normalized joint motion and thus attempts to create such “normal” motion within the repaired anatomical structures. We could discover a method of making an implant component for a knee joint of a patient which includes deriving information regarding a first joint line of the joint based on patient-specific information. This method also includes determining a planned level of resection for a first portion of a bone of the joint based on the patient-specific information. Further, the dimension of the implant component is determined based on the derived information regarding the first joint line and the planned level of resection for the first portion of the bone. Also, we discovered an implant component for treating a patient's joint that includes a medial bone-facing surface. The medial bone-facing surface is positioned to engage a cut bone surface of a medial portion of a proximal tibia at a first level. The implant component also includes a lateral bone-facing surface. The lateral bone-facing surface is positioned to engage a cut bone surface of a lateral portion of the proximal tibia at a second level. The first level is offset from the second level. The implant component additionally includes one or more joint-facing surfaces having a curvature based on patient-specific information. Furthermore, we discovered a system for treating a joint of a patient that includes one or more patient-specific instruments. The system further includes a medial tibial implant component. The medial tibial implant component has a bone-facing surface and a joint-facing surface. The joint-facing surface has a curvature based on patient-specific information. The system also includes a lateral tibial implant component, which has a bone-facing surface and a joint-facing surface. The joint-facing surface of the lateral tibial implant has a curvature based on patient-specific information. The bone-facing surface of the medial tibial implant component is configured to engage a cut bone surface that is at a level offset from the level of a cut bone surface to which the bone-facing surface of the lateral tibial implant component is configured to engage. The system further includes a femoral implant component, which has a joint-facing surface with a curvature based on patient-specific information.Aim
Methods
Total knee arthroplasty is the standard treatment for advanced knee osteoarthritis. Patient-specific instrument (PSI)has been reported by several authors using different techniques produced by implant companies. The implant manufacturers produce PSI exclusively for their own knee implants and for easy straightforward cases. However, the PSI has become very expensive and unusable as a universal or an open platform. In addition, planning the implant is done by technicians and not by surgeons and needs long waiting time before surgery (6 weeks). We proposed a new technique which is a device and method for preparing a knee joint in a patient undergoing TKA surgery of any knee implant (prosthesis). The device is patient specific, based on a method comprised of image-based 3D preoperative planning (CT, MRI or computed X-ray) to design the templates (PSI) that are used to perform the knee surgery by converting them to physical templates using computer-aided manufacturing such as computer numerical control (CNC) or additive-manufacturing technologies. The device and method are used for preparing a knee joint in a universal and open-platform fashion for any currently available knee implant.Introduction
Methods
Computer assisted orthopaedic surgery (CAOS) is an emerging and expanding filed. There are some old classification systems that are too comprehensive to cover all new CAOS tools and hybrid devises that are currently present and others that are expected to appear in the near future. Based on our experience and on the literature review, we grouped CAOS devises on the basis of their functionality and clinical use into 6 categories, which are then sub-grouped on technical basis. In future, new devices can be added under new categories or subcategories. This grouping scheme is meant to provide a simple guide on orthopaedic systems rather than a comprehensive classification for all computer assisted systems in surgical practice. For example, the number and diversity of tasks of surgical robots is enormous, up to 159 surgical robots with different mechanisms and functions reported in the literature. These can be classified according to their tasks, mechanism of actions, degree of freedom and level of activity but for the purpose of simplicity we subcategorised the orthopaedic robots to only industrial, hand-held and bone-mounted. Table 1 shows the classification system with the 6 categories and other subcategories.
This community Arthroplasty Register is an individual initiative to document arthroplasty procedures performed from 2007 to date in a sample area in Cairo, Egypt. Currently, there is no published study or official documentation of the indications for arthroplasty, types of implants or the rate of total hip and knee arthroplasty (THA & TKA). Although the population of Egypt reached 80,394,000, the unofficial estimate of the rate of joint replacement is less than 10,000 per year. This rate is less than 10% of what is currently done in UK, a country with similar or even less population than Egypt. This indicates the unmet need for TKA in Egypt, where the knee OA is prevailing and there is a call for documentation and a registry. The registry sheet is 3 pages; pre-, intra- and post-operative. It is available in printed format and online as demonstrated below Introduction
Methods
Recently, a new technique of custom-made cutting guides for TKA is introduced to clinical practice. However, no published data yet on the comparison between this new technique against both navigation and conventional techniques. The author prospectively compared between custom-made cutting guides, navigation and conventional techniques. A total number of 90 cases were included in this study with 30 consecutive cases for each technique. The highest number of medically unfit patients and those with articular and extra articular deformities were in custom guides groups. The results showed one case of aseptic loosening after one year in custom guides, one case of superficial infection and loose pins but with no fracture in navigation group, and higher need for blood transfusion in conventional. One case in the custom guide group had a periprosthetic fracture 3 weeks postoperatively diagnosed as insufficiency fracture after a relatively minor trauma to an osteoporotic bone. Navigation was the most accurate in alignment but custom guides was the most accurate in implant sizing and had the least bleeding. This clinical study showed some advantages of custom-made cutting guides over conventional instrumentation. It eliminated medullary guides, reduced operative time, and provided better accuracy. The technique was proved to be useful in complex cases of deformities and unfit patients.
The purpose of this retrospective study was to review the outcome of THA in the treatment of bilateral hip ankylosis of different causes; surgical, septic or spontaneous. 20 THA procedures in 10 patients were included in the study, 5 males and 5 females all had bilateral fusion. Previous pathologies included: ankylosing spondylitis, AVN, septic arthritis and surgical arthrodesis. Flexion deformity ranged (10°-45°). Shortening as compared to normal anatomy was up to 6 cm and leg length discrepancy (LLD) ranged from 1 cm to 2.5 cm. Most unified X-ray finding was massive osteophytes formation with 3 patients showing severe narrowing of the femoral canal. Operative time averaged 147 minutes (70–210) and lateral approach was used in all patients, anesthesia was general with only 3 undergoing spinal anesthesia.Introduction
Methods & Material
Digital templating was used in 50 patients who underwent THA using Merge Ortho software, Cedara. Clinical examination was performed first, to measure leg lengths and account for pelvic obliquity and flexion deformity. Good quality digital radiographs were obtained with anteroposterior and lateral views extending beyond the tip of the femoral component and the cement restrictor. A coin was placed on the ASIS to help in determining radiological magnification Digital radiographs were saved in DICOM format and imported to EndoMap software system. A 6-step technique was used for templating as follows:
Intraoperatively, the surgeon performed the femoral neck osteotomy at the level determined by preoperative templating. Postoperatively, the leg length was measured and compared to the preoperative leg length. Preoperatively, the leg length discrepancy ranged from 5 to 30 mm. In all cases, the leg was short on the side of THR (ipsilateral). Leg length discrepancy was adjusted in all THR cases. Postoperatively, the accuracy of the correction was found to be within 5 millimeters i.e. less than 5mm of shortening or lengthening). Intraoperatively, the level of femoral neck cut ranged from 1 to 44 mm. Digital templating is useful in adjusting leg length discrepancy. In addition, there were other benefits such as predication of femoral and acetabular implant sizes, restoration of normal hip centre, and optimization of femoral offset.
There is a controversy with regard to the treatment of osteoarthritis (OA) of the knee in patients with considerable deformities of the femoral or tibial shafts. Some surgeons prefer to correct the deformity while performing TKA at the level of the knee joint. However, this technique requires accurate planning and execution of the planned cuts. In addition, the use of intramedullary guides in such cases may not be possible or desirable and may lead to complications. There is a strong indication for using navigation in such cases. The navigation technique was used in both laboratory and clinical setting, First, we compared between navigational and conventional techniques in performing TKA in 24 plastic knee specimens (Sawbones, Sweden) that have osteoarthritic changes and complex tibial or femoral deformities. A demo kit for conventional instrumentation of posterior stabilised TKA (Scorpio, Stryker) was used for 12 cases and an image-free navigation system (Stryker) was used for a corresponding 12 cases. There were 4 different deformities; severe mid-shaft tibial varus, severe distal third femoral valgus, complex deformity distal femur and deformity following a revision TKA. The surgical procedures were performed by 3 arthroplasty surgeons, each surgeon operated on 8 knee specimens (4 knees in each arm of the study with 4 different deformities). Deformities were corrected at the level of the knee joint during TKA without prior osteotomies. For conventional techniques, surgeons used a combination of both intramedullary and extramedullary guides. Postoperative long leg radiographs were used to assess coronal alignment. Second, we used the same navigational technique clinically to perform TKA in patients with extra-articular deformities.Introduction
Methods
Shockwave treatment in our unit is provided in conjunction with our Urological colleagues. Shock Wave Therapy has been used as a last option in patients with difficult and chronic Orthopaedic conditions with an informed consent for all patients.
Patients were consented by the Orthopaedic surgeon and the treatment was administered by urologist The cases included:
4 Humeral fractures: 1 Case in HIV +ve 19 years old 5 Femoral non-union: 1 case bilateral in Osteogenesis imperfecta 4 Tibial non-union: 1 Recurent Fracture in 65 years old man 2 Osteochondritis of the Talus 2 Osteochondritis of the knee 4 Scaphoid fractures: 1 case had been fixed and grafted. Medial Epicondyle fracture non union 5th Metacarpal Fracture Trochanteric Bursitis Tennis Elbow 4 Planter fasciitis – The Shock wave Machine used is Storz SLX – F2 Electromagnetic shock wave generator which focus the shock wave low energy high frequency in focal zone with no harm to other tissues. Frequency 4 htz = 4 shockwave/sec – Energy level 1–3 generate pressure value in the focal area of 5–30 megapascal – Size of focal zone 9X 50 mm or 6X 28 mm – Total shock wave applied per session 2000 to 3000 shock – large focus and small focus were used in fracture of large bones and small bones respectively. Most of cases required 2–3 session with 4–6 weeks interval. – in Soft tissue Treatment Less energy was used and patients required 1 to 2 sessions.
– Clinical and radiological union in 3 of the 4 Humeral Fracture including HIV+ve and in 2 of 3 tibial fracture and 1 of 2 scaphoid. – 50% pain relief in Psedo arthrosis – Union is promoted by Cellular stimulation and pain relief is by unknown mechanism but explained by increase vascularity and neuro-modulation. – None of the patient’s have so far required subsequent operative interventions, several had residual symptoms.
