Introduction

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

Introduction

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.

Introduction

This is a report of the outcome of management of congenital pseudoarthrosis of the tibia (CPT) at skeletal maturity.

Background

The knee joint morphology varies according to gender and morphotype of the patients.

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.

Objectives

To compare computer-assisted total knee arthroplasty with the conventional technique in operative time.

Aim

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.

Introduction

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).

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.

Introduction

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.

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.

Introduction

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.

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:

Radiographic assessment; looking at the quality of bone, amount of bone stock, dysplasia, osteophytes, and other abnormalities

Correction of leg length discrepancy and measuring length of neck resection; the height of the femoral stem was adjusted to correct any leg length discrepancy by placing the center of the head above the center of the cup by the same length of discrepancy. Then the level of the neck resection was marked at the level of the stem collar and the femoral neck cut was measured by a digital ruler from the tip of the lesser trochanter to the mark of neck resection. In case of leg length discrepancy, the height of the femoral neck cut was adjusted accordingly to compensate for the leg length discrepancy. For example, if the affected leg is 20 mm short, place the centre of the head 20 mm above the centre of the cup.

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.

Introduction

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.