Aims. The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of
Aims. The optimal procedure for the treatment of ossification of the
Introduction. The treatment of
Aims.
Introduction. Robotic TKA allows for quantifiable precision performing bone resections for implant realignment within acceptable final component and limb alignments. One of the early steps in this robotic technique is after initial exposure and removal of medial and lateral osteophytes, a “pose-capture” is performed with varus and valgus stress applied to the knee in near full extension and 90° of flexion to assess gaps. Component alignment adjustments can be made on the preoperative plan to balance the gaps. At this point in the procedure any
Introduction. Ligament reconstruction following knee soft tissue injuries, such as
Aims. Excessive
Aims. The optimal management of
Aims.
Knee arthroscopy is typically approached from the anterior, posteromedial and posterolateral portals. Access to the
The
The
Introduction: Despite the advances in total hip arthroplasty (THA), a dislocation after THA remains a disturbing complication. Dislocation after revision hip arthroplasty has been an underemphasized cause of failure in revision hip arthroplasty despite its higher dislocation rate than after primary THA. The effectiveness of
Purpose. We sought to determine whether there was a difference in the
Background. Surgical site infection following spine surgery is associated with increased morbidity, mortality and increased cost for the health care system. The reported pooled incidence is 3%. Perioperative antibiotic prophylaxis is a key factor in lowering the risk of acquiring an infection. Previous studies have assessed perioperative cefuroxime concentrations in the anterior column of the cervical spine with an anterior surgical approach. However, the majority of surgeries are performed in the
Aims. Arthroplasty has become increasingly popular to treat end-stage ankle arthritis. Iatrogenic
Abstract. Background. Elderly patients with degenerative lumbar disease are increasingly undergoing
As Total Hip Replacement (THR) rates increase healthcare providers have sought to reduce costs, while at the same time improving patient safety and satisfaction. Up to 50% of patients may be appropriate for Day Case THR, and in appropriately selected patients’ studies show no increase in complication rate while affording a significant cost saving and maintaining a high rate of patient satisfaction. Despite the potential benefits, levels of adoption of Day Case THR vary. A common cause for this is the perception that doing so would require the adoption of new surgical techniques, implants, or theatre equipment. We report on a Day-Case THR pathway in centres with an established and well-functioning Enhanced Recovery pathway, utilising the
Use of ultrasonic bone scalpel (UBS) is becoming popular in spinal surgery. This study presents the safety profile of UBS for
Aims. The aim of this study was to compare a bicruciate-retaining (BCR) total knee arthroplasty (TKA) with a
We investigated the incidence of anomalies in
the vertebral arteries and Circle of Willis with three-dimensional
CT angiography in 55 consecutive patients who had undergone an instrumented
posterior fusion of the cervical spine. We recorded any peri-operative and post-operative complications.
The frequency of congenital anomalies was 30.9%, abnormal vertebral
artery blood flow was 58.2% and vertebral artery dominance 40%. . The
Poor availability of allografts in South Africa has led to an increased use of synthetic augmentation to stabilize knee joints in the treatment of knee dislocations. This study aims to evaluate multiligament knee injuries treated with a
The
Introduction. Diaphyseal tibial fractures account for approximately 1.9% of adult fractures. Studies have demonstrated a high proportion have ipsilateral occult
The pelvic girdle and spine vertebral column work as a long chain influenced by pelvic tilt. Spinal deformities or other musculoskeletal conditions may cause patients to compensate with excessive pelvic tilt, producing alterations in the degree of lumbar lordosis and subsequently causing pain. The objective of this study is to assess the effect of open and closed chain anterior or
Aims. Historically, patients undergoing surgery for adolescent idiopathic scoliosis (AIS) have been nursed postoperatively in a critical care (CC) setting because of the challenges posed by prone positioning, extensive exposures, prolonged operating times, significant blood loss, major intraoperative fluid shifts, cardiopulmonary complications, and difficulty in postoperative pain management. The primary aim of this paper was to determine whether a scoring system, which uses Cobb angle, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and number of levels to be fused, is a valid method of predicting the need for postoperative critical care in AIS patients who are to undergo scoliosis correction with
Purpose of the study: Posterior shoulder instability is a rare condition. Several surgical treatments have been proposed. Material and methods: This was a retrospective series of 21
A number of classification systems exist for
Background:. We studied the effect of
Abstract. Introduction. There is growing interest in the use of robotic Total Knee Arthroplasty (TKA) to improve accuracy of component positioning. This is the first study to investigate the radiological accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Tibial Slope, Patella Height and
Lateral lumbar interbody fusion (LLIF) has biomechanical advantages due to the preservation of ligamentous structures (ALL/PLL), and optimal cage height afforded by the strength of the apophyseal ring. We compare the biomechanical motion stability of multiple levels LLIF (4 segments) utilising PEEK interbody 26mm cages to stand-alone cage placement and with supplemental
Introduction. Scoliosis surgery is a life-changing procedure, but not devoid of perioperative complications. Often patients' scoring systems do not cover their real-life needs, including return to pre-surgery activity. Return to school, physical education (PE) is an important indirect marker of recovery. Although anterior spinal fusion (ASF) may have advantages, compared to
The purpose of this study was to investigate the influence of surgical approach on femoral stem version in THA. This was a retrospective database review of 830 THAs in 830 patients that had both preoperative and postoperative CT scans. All patients underwent staged bilateral THAs and received CT-based 3D planning on both sides. Stem version was measured in the second CT-scan and compared to the native neck axis measured in the first CT-scan, using the
Treatment of
Aims. The primary aim of this study was to address the hypothesis that fracture morphology might be more important than
Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann’s kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion. A retrospective review of patients treated surgically for Scheuermann’s kyphosis between 2006 and 2014 was performed. A total of 62 patients were identified, with 31 in each group. Parameters were compared to evaluate postoperative outcomes using chi-squared tests, independent-samples Aims
Methods
Introduction: 360 degree combined anterior and
INTRODUCTION: 360 degree combined anterior and
Introduction: When conservative treatment of
Introduction. A bicruciate retaining (BCR) TKA is thought to maintain a closer resemblance to the native knee kinematics compared to a
Aims. In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the
Introduction. While additional resources associated with direct anterior (DA) approach total hip arthroplasty (THA) such as fluoroscopy, staff, and special tables are well recognized, time consumption is not well studied. The purpose of this study was to analyze anesthesia and surgical time in DA and
Periprosthetic femur fracture (PFF) is a major complication following total hip arthroplasty (THA) that carries significant morbidity, mortality, and economic burden. Currently, uncemented stems are highly preferred in primary THA, but have been associated with higher risk of PFF compared to cemented stems. The use of collared stems in uncemented primary THA has shown promise in reducing PFF rates postoperatively. This retrospective study included 2,294 uncemented primary THAs using the
Aims. Unicompartmental knee arthroplasty (UKA) has become a popular method of treating knee localized osteoarthritis (OA). Additionally, the
Range of Motion (ROM) assessments are routinely used during joint replacement to evaluate joint stability before, during and after surgery to ensure the effective restoration of patient biomechanics. This study aimed to quantify axial torque in the femur during ROM assessment in total hip arthroplasty to define performance criteria against which hip instruments can be verified. Longer term, this information may provide the ability to quantitatively assess joint stability, extending to quantitation of bone preparation and quality. Joint loads measured with strain-gaged instruments in five cadaveric femurs prepared using
Purpose: The objective of this study was to compare the results of a single mini-incision
Aims. Total knee arthroplasty (TKA) with a highly congruent condylar-stabilized (CS) articulation may be advantageous due to increased stability versus cruciate-retaining (CR) designs, while mitigating the limitations of a posterior-stabilized construct. The aim was to assess ten-year implant survival and functional outcomes of a cemented single-radius TKA with a CS insert, performed without
Introduction In an attempt to decrease the incidence of
Recurrent
The direct superior approach (DSA) is a modification of the
Introduction and Aims: The dilemma to retain or sacrifice the
The optimal management of rotationally-unstable ankle fractures involving the
The influence of
The
The
Background. Partial facetectomies with pedicle screw instrumentation is widespread and a well described technique for achieving
Introduction. Thoracic wall surgery can cause severe pain and inhibition of coughing with effects. (1) Various local anaesthetic (LA) techniques have been tried successfully to mitigate the use of opioids alone. We believe this is the first time that a serratus plane block using an epidural catheter (SABER)has been studied in anterior spinal fusion (ASF) procedures. Our aim was to ascertain how it would affect ASF compared to gold standard
We evaluated the accuracy of six clinical tests for
Introduction. In
Postoperative surgical site infection in patients treated with lumbosacral fusion has been believed to be caused by perioperative contamination (Perioperative Inside-Out infections) in patients with comorbidities. With the proximity of these incisions to the perianal region and limited patient mobility in the early post-operative period, local contamination from gastrointestinal and/or urogenital flora (Postoperative Outside-In infections) should be considered as a major source of complication. A single center, retrospective review of adult patients treated with open
Background. Osteophytes in the
Surgical site infections (SSIs) after spinal fusion surgery increase healthcare costs, morbidity and mortality. Routine measures of obesity fail to consider site specific fat distribution. We aimed to assess the association between the spine adipose index and deep surgical site infection and determine a threshold value for spine adipose index that can assist in preoperative risk stratification in patients undergoing
Purpose. To report clinical results and demonstrate any
The aim of this study was to report the restauration of the normal vertebral morphology and the absence of curve progression after removal the instrumentation in AIS patients that underwent
Introduction and Aims: Trans-laminar screw fixation is a popular method of posterior stabilisation when performing a 360-degree lumbar fusion, but many have concerns over the biomechanical stability of this construct. The objective of this paper is to compare the fusion rate and clinical outcome of this method with pedicle screw fixation. Method: During 2001, 31 patients underwent combined anterior and
The purpose of this study is to evaluate risk factors for distal construct failure (DCF) in
Pelvic tilt can vary over time due to aging and the possible appearance of sagittal spine disorders. Cup position in total hip arthroplasty (THA) can be influenced due to these changes. We assessed the evolution of pelvic tilt and cup position after THA and the possible appearance of complications for a minimum follow-up of ten years. 343 patients received a THA between 2006 and 2009. All were diagnosed with primary osteoarthritis and their mean age was 63.3 years (range, 56 to 80). 168 were women and 175 men. 250 had no significant lumbar pathology, 76 had significant lumbar pathology and 16 had lumbar fusion. Radiological analysis included sacro-femoral-pubic (SFP), acetabular abduction (AA) and anteversion cup (AV) angles. Measurements were done pre-operatively and at 6 weeks, and at five and ten years post-operatively. Three measurements were recorded and the mean obtained at all intervals. All radiographs were evaluated by the same author, who was not involved in the surgery. There were nine dislocations: six were solved with closed reduction, and three required cup revision. All the mean angles changed over time; the SFP angle from 59.2º to 60º (p=0.249), the AA angle from 44.5º to 46.8º (p=0.218), and the AV angle from 14.7º to 16.2º (p=0.002). The SFP angle was lower in older patients at all intervals (p<0.001). The SFP angle changed from 63.8 to 60.4º in women and from 59.4º to 59.3º in men, from 58.6º to 59.6º (p=0.012). The SFP angle changed from 62.7º to 60.9º in patients without lumbar pathology, from 58.6º to 57.4º in patients with lumbar pathology, and from 57.0º to 56.4º in patients with a lumbar fusion (p=0.919). The SFP cup angle was higher in patients without lumbar pathology than in the other groups (p<0.001), however, it changed more than in patients with lumbar pathology or fusion at ten years after THA (p=0.04).
Introduction. Recently, tibial insert design of cruciate-substituting (CS) polyethylene insert is employed. However, in vivo kinematics of using CS polyethylene insert is still unclear. In this study, it is hypothesized that CS polyethylene insert leads to stability of femolo-tibial joint as well as posterior-stabilized (PS) polyethylene insert, even if PCL is sacrificed after TKA. The purpose of this study is an investigation of in vivo kinematics of femolo-tibial joint with use of CS polyethylene insert before and after PCL resction using computer assisted navigation system intra-operatively in TKA. Materials and Methods. Twenty-four consecutive patients who had knees of osteoarthritis with varus deformity were investigated in this study. All TKAs (Triathlon, Stryker) were performed using computer assisted navigation system. In all patients, difference between extension and flexion gap was under 3mm after bony cut of femur and tibia. During surgery, CS polyethylene tibial trial insert were inserted after trial implantation of femoral and tibial components, before and after resection of PCL, respectively. The kinematic parameters of the soft-tissue balance, and amount of coronal (valgus/varus), sagittal (anterior/posterior) and rotational relative movement between femur and tibia were obtained by interpreting kinematics, which display tables throughout the range of motion (ROM) (Figure1). During record of kinematics, the surgeon gently lifted the experimental thigh three times, flexing the hip and knee. In each ROM (30, 45, 60, 90, max degrees), the data were analyzed with paired t-test, and an ANOVA test, and mean values were compared by the multiple comparison test (Turkey HSD test) (p < 0.05). Results. In coronal (valgus/varus) movement, there are no difference between before and after resection of PCL in all ROM. Regarding to amount of sagittal movement of tibia, tibia was slightly shifted approximately 0.75mm
Meniscal root tears can result from traumatic injury to the knee or gradual degeneration. When the root is injured, the meniscus becomes de-functioned, resulting in abnormal distribution of hoop stresses, extrusion of the meniscus, and altered knee kinematics. If left untreated, this can cause articular cartilage damage and rapid progression of osteoarthritis. Multiple repair strategies have been described; however, no best fixation practice has been established. To our knowledge, no study has compared suture button, interference screw, and HEALICOIL KNOTLESS fixation techniques for meniscal root repairs. The goal of this study is to understand the biomechanical properties of these fixation techniques and distinguish any advantages of certain techniques over others. Knowledge of fixation robustness will aid in surgical decision making, potentially reducing failure rates, and improving clinical outcomes. 19 fresh porcine tibias with intact medial menisci were randomly assigned to four groups: 1) native
Introduction. In total knee arthroplasty (TKA) the knee may be found to be too stiff in extension, causing a flexion contracture. One proposed surgical technique to correct this extension deficit is to recut the distal femur, but that may lead to excessively raising the joint line. Alternatively, full extension may be gained by stripping the
Introduction and Objective.
Aims. The aims of this study were to assess the exposure and preservation of the abductor mechanism during primary total hip arthroplasty (THA) using the
Aim: To analyse the
Abstract. Objective. Radial to axillary nerve and spinal accessory (XI) to suprascapular nerve (SSN) transfers are standard procedures to restore function after C5 brachial plexus dysfunction. The anterior approach to the SSN may miss concomitant pathology at the suprascapular notch and sacrifices lateral trapezius function, resulting in poor restoration of shoulder external rotation. A
Background. Instability is one of the most common complications after total hip arthroplasty (THA), particularly when using the
Internal fixation is currently the standard of care for Garden I and II femoral neck fractures in the elderly. However, there may be a degree of
To compare
Total knee arthroplasty has been the main treatment method among advanced osteoarthritis (OA) patients. The main post-operative evaluation considers the level of pain, stability and range of motion (ROM). The knee flexion level is one of the most important categories in the total knee arthroplasty patient's satisfaction in Asian countries due to consistent habits of floor-sitting, squating, kneeling and cross legged sitting. In this study, we discovered that the
Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of
Aims. The aim of this study was to assess the effect of
One hundred and ninety patients requiring total knee arthroplasty were randomized to one of two treatments: retaining or sacrificing the
Introduction: The
Introduction. The hip hemiarthroplasty in
Aims. It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the
There is an increasing acceptance that the clinical outcomes following
Introduction. Oriental people habitually adopt formal sitting and squatting postures, the extreme flexion of the knees allowing of this. The influence exercised by pressure and posture are, therefore, found at the
Aims. The morphometry of the distal femur was largely studied to improve
bone-implant fit in total knee arthroplasty (TKA), but little is
known about the asymmetry of the
The purpose of this study was to describe the
radiological characteristics of a previously unreported finding: posterior
iliac offset at the sacroiliac joint and to assess its association
with pelvic instability as measured by initial displacement and
early implant loosening or failure. Radiographs from 42 consecutive
patients with a mean age of 42 years (18 to 77; 38 men, four women)
and mean follow-up of 38 months (3 to 96) with Anteroposterior Compression
II injuries, were retrospectively reviewed. Standardised measurements
were recorded for the extent of any diastasis of the pubic symphysis,
widening of the sacroiliac joint, static vertical ramus offset and
a novel measurement (posterior offset of the ilium at the sacroiliac
joint identified on axial CT scan). Pelvic fractures with posterior
iliac offset exhibited greater levels of initial displacement of
the anterior pelvis (anterior sacroiliac widening, pubic symphysis
diastasis and static vertical ramus offset, p <
0.001,0.034 and
0.028, respectively). Pelvic fractures with
The purpose of this study was to compare the outcomes of arthroscopic unilateral surgery and simultaneous bilateral surgery for
Objectives.
Summary. Quantification of Three-Dimensional Computed Tomography (Q3DCT) is a reliable and reproducible technique to quantify and characterise ankle fractures with a
Introduction. Whether anterior referencing (AR) or
Background. The cruciate ligaments are important structures for biomechanical stability of the knee. For total knee arthroplasty (TKA), understanding of the exact function of the (PCL) and anterior (ACL) cruciate ligament during walking is important in the light of recent designs of bicruciate TKAs. However, studies evaluating in vivo function of the PCL during daily activities such as walking are scarce. We aimed to assess the role of the PCL during gait by measuring kinematics and kinetics of individuals with PCL deficiency and compare them with individuals with ACL deficiency and healthy young adults. Methods. Individuals with unilateral PCL deficiency (PCLD; n=9), unilateral ACL deficiency (n=10) and healthy young adults performed (n=10) 10 walk trials (5 for each leg) in which they walked over a force platform. Motion analysis (Vicon Motion Capture System) was used to calculate joint angles and internal moments around the knee, hip and ankle in the sagittal plane. Joint angles and moments of the injured knee (in PCLD and ACLD) or left knee (in HYA) were compared between groups at weight acceptance, mid-stance and push-off phases (see Fig. 1). Clinical assessment included passive knee laxity (Kneelax) for anterior (in 20–30° knee flexion) and
To restore a physiologic kinematic is one of the goals of total knee replacement (TKR). This study compared the intra-operative registration of the knee kinematics during standard, navigated TKR performed either with a well validated floating platform design with
Introduction. Direct anterior approach (DAA) total hip arthroplasty (THA) has been reported to improve early outcomes as compared to
Abstract. Objectives. To evaluate the safety and efficacy of vertebroplasty with short segmented cement augmented pedicle screws fixation for severe osteoporotic vertebral compression fractures (OVCF) with
Aims. Involvement of the
Introduction. The direct anterior approach (DAA) and the
Most