We present the indications and outcomes of a series of
Complex acetabular reconstruction for oncology and bone loss are challenging for surgeons due to their often hostile biological and mechanical environments. Titrating concentrations of silver ions on implants and alternative modes of delivery allow surgeons to exploit anti-infective properties without compromising bone on growth and thus providing a long-term stable fixation. We present a case series of 12
Proximal femoral focal deficiency is a congenital disorder of malformation of the proximal femur and/or the acetabulum. Patients present with limb length discrepancy and clinical features along a spectrum of severity. As these patients progress through to skeletal maturity and on to adulthood, altered biomechanical demands lead to progression of arthropathy in any joint within the lower limb. Abnormal anatomy presents a challenge to surgeons and conventional approaches and implants may not necessarily be applicable. We present a case of a 62-year-old lady with unilateral proximal femoral focal deficiency (suspected Aitken Class A) who ambulated with an equinus prosthesis for her entire life. She presented with ipsilateral knee pain and instability due to knee arthritis but could not tolerate a total knee arthroplasty due to poor quadriceps control. A
INTRODUCTION. Postoperative functional limitations after Total Knee Arthroplasty (TKA) are caused, in part, by a mismatch between a patient's natural anatomy and conventional “off-the-shelf” implants. To address this, we propose a new concept combining off-the-shelf femur and tibia implants with
Knee replacement is a proven and reproducible procedure to alleviate pain, re-establish alignment and restore function. However, the quality and completeness to which these goals are achieved is variable. The idea of restoring function by reproducing condylar anatomy and asymmetry has been gaining favor. As knee replacements have evolved, surgeons have created a set of principles for reconstruction, such as using the femoral transepicondylar axis (TEA) in order to place the joint line of the symmetric femoral component parallel to the TEA, and this has been shown to improve kinematics. However, this bony landmark is really a single plane surrogate for independent 3-dimensional medial and lateral femoral condylar geometry, and a difference has been shown to exist between the natural flexion-extension arc and the TEA. The TEA works well as a surrogate, but the idea of potentially replicating normal motion by reproducing the actual condylar geometry and its involved, individual asymmetry has great appeal. Great variability in knee anatomy can be found among various populations, sizes, and genders. Each implant company creates their specific condylar geometry, or “so called” J curves, based on a set of averages measured in a given population. These condylar geometries have traditionally been symmetric, with the individualised spatial placement of the (symmetric) curves achieved through femoral component sizing, angulation, and rotation performed at the time of surgery. There is an inherent compromise in trying to achieve accurate, individual medial and lateral condylar geometry reproduction, while also replicating size and avoiding component overhang with a set implant geometry and limited implant sizes. Even with patient-specific instrumentation using standard over-the-counter implants, the surgeon must input his/her desired endpoints for bone resection, femoral rotation, and sizing as guidelines for compromise. When all is done, and soft tissue imbalance exists, soft tissue release is the final, common compromise. The
The
The
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
Hypothesis.
Introduction.
The treatment of extensive bone loss and massive acetabular defects is a challenging procedure, especially the concomitant pelvic discontinuity (PD) can be compounded by several challenges and pitfalls. The appropriate treatment strategy is to restore a stable continuity between the ischium and the ilium and to reconstruct the anatomical hip center. Antiprotrusio cages, metal augments, reconstruction cages with screw fixation, structural allograft with plating, jumbo cups, oblong cups and custom-made triflange acetabular components have been reported as possible treatment options. Nevertheless, the survivorship following acetabular revision with extensive bone loss is still unsatisfactory. The innovation of three-dimensional printing (3DP) has become already revolutionary in engineering and product design. Nowadays, the technology is becoming part of surgical practice and suitable for the production of precise and bespoke implants. The technique of a 3D-printed
Introduction. CT based systems that are used to create
Revision of total hip arthroplasty (THA) is being performed with increasing frequency. However, outcomes of repeated revisions have been rarely reported in the literature, especially for severe defects. Cup revision can be a highly complex operation depending on the bone defect. In acetabular defects like Paprosky types 1 and 2 porous cementless cups maybe fixed with screws give good results. Modern trabecular metal designs improve these good results. Allografts are useful for filling cavitary defects. In acetabular defects Paprosky types 3A and 3B, impacted morselised allografts with a cemented cup technique produce good results. Difficult cases with pelvic discontinuity require reconstruction of the acetabulum with acetabular plates or large cup-cages to solve these difficult problems. However, there is still no consensus regarding the best option for reconstructing hips with bone loss. Although the introduction of ultraporous metals has significantly increased the surgeon's ability to reconstruct severely compromised hips, there remain some that cannot be managed readily using cups, augments, or cages. In such situations
Revision of total hip arthroplasty (THA) is being performed with increasing frequency. However, outcomes of repeated revisions have been rarely reported in the literature, especially for severe defects. Cup revision can be a highly complex operation depending on the bone defect. In acetabular defects like Paprosky types 1 and 2 porous cementless cups fixed with screws give good results. Modern trabecular metal designs improve these good results. Allografts are useful for filling cavitary defects. In acetabular defects Paprosky types 3A and 3B, especially the use of trabecular metal cups, wedges, buttresses and cup-cage systems can produce good results. Difficult cases in combination with pelvic discontinuity require reconstruction of the acetabulum with acetabular plates or large cup-cages to solve these difficult problems. However, there is still no consensus regarding the best option for reconstructing hips with bone loss. Although the introduction of ultraporous metals has significantly increased the surgeon's ability to reconstruct severely compromised hips, there remain some that cannot be managed readily using cups, augments, or cages. In such situations
Patients with osteochondrodysplasia frequently require Total Hip Arthroplasty at a younger age, as a result of early degenerative disease of the hip joint. The outcome of Modular Total Hip Arthroplasty in this group of patients has been reported previously. In this retrospective study we evaluated the outcome of
We present the medium to long term clinical results of 112 Uncemented
Treatment of Paprosky type 3A and 3B defects in revision surgery of a hip arthroplasty is challenging. In previous cases such acetabular defects were treated with massive structural allograft bone reconstructions using cemented all-polyethylene cups. In our department we started using
Aim. The aim of this study is to outline the steps and techniques required to create a patient specific 3D printed guide for the accurate placement of the origin of the femoral tunnel for single bundle ACL reconstruction. Introduction. Placements of the femoral tunnels for ACL reconstruction have changed over the years 1,2. Most recently there has been a trend towards placing the tunnels in a more anatomic position. There has been subsequent debate as to where this anatomic position should be 3. The problem with any attempt at consensus over the placement of an anatomic landmark is that each patient has some variation in their positioning and therefore a fixed point for all has compromise for all, as it is an average 4. Our aim was to attempt to make a cost effective and quick
In patients requiring two-stage procedures, stabilization of large skeletal defects after radical debridement must be attained in order to successfully treat the infection. With the use of standard rod plus antibiotic impregnated PMMA spacers limb salvage may be attempted with satisfactory results. Between 1992 and 2014, 23 patients were treated for hip, knee, or shoulder musculoskeletal infections resulting in an average skeletal defect of 22 cm. There were 13 males and 10 females. Twelve patients had infected tumor prostheses, seven patients had an infected total joint arthroplasty, and four patients had a primary infection involving a large skeletal defect. The mean time from the index procedure until infection was 22 months. Following debridement, the defect was stabilized with Tobramycin and Vancomycin impregnated PMMA and intramedullary nails. Patients were treated with IV and oral antibiotics for six weeks each. In 18 patients who had resection about the knee stabilization was achieved with a single femoral or tibial nail in nine patients and with two nails joined by a screw or cerclage wire in the other nine. In four patients a cephalomedullary femoral nail was used for stabilization after resection of the proximal or total femur. One patient had a
Patients with skeletal dysplasia are prone to developing advanced degenerative knee disease requiring total knee replacement (TKR) at a younger age than the general population. TKR in this unique group of patients is a technically demanding procedure due to the bone deformity, flexion contracture, generalised hypotonia and ligamentous laxity. We set out to retrospectively review the outcome of 11 TKR's performed in eight patients with skeletal dysplasia at our institution using the SMILES custom-made rotating-hinge total knee system. There were 3 males and 5 females with mean age 57 years (range, 41–79 years), mean height 138 cm (range, 122–155 cm) and mean weight 56 kg (range, 40–102 kg). Preoperative diagnoses included achondroplasia, spondyloepiphyseal dysplasia, pseudoachondroplasia, multiple epiphyseal dysplasia, morquio syndrome, diastrophic dysplasia and Larson's Syndrome. Patients were followed clinically and radiographically for a mean of 7 years (range, 3–11.5 years). Knee pain and function improved in all 11 joints. Mean Knee Society clinical and function scores improved from 24 (range, 14–36) and 20 points (range, 5–40) preoperatively to 68 (range, 28–80) and 50 points (range, 22–74) respectively at final follow-up. Four complications were recorded (36%), including a patellar fracture following a fall, a tibial periprosthetic fracture, persistent anterior knee pain and a femoral component revision for aseptic loosening. Our results suggest that