Cement restrictors are used for maintaining good filling and pressurization of bone cement during hip and knee arthroplasties. The limitations of certain cement restrictors include the inability to accommodate for large medullary canals particularly in revision procedures. We describe a technique using SurgicelTM (Johnson & Johnson) and SPONGOSTAN™ (Johnson & Johnson) (Fig 1) to form a cement restrictor that can accommodate for large canal diameters and provide excellent pressurisation. The technique involves the application of SPONGOSTAN™ (Johnson & Johnson) foam onto a SurgicelTM (Johnson & Johnson) mesh which is then rolled onto the SPONGOSTAN™ foam forming a uniform cylindrical structure Figs 2,3. The diameter of the restrictor can be adjusted according to the desired femoral canal diameter through increasing the thickness of the SPONGOSTAN™ (Johnson & Johnson) foam. The restrictor is then inserted into the desired position in the medullary canal where it expands uniformly creating an effective restrictor and bone plug Fig 4. Bone cement is then applied and pressurisation commenced prior to the insertion of the implant Fig5. SPONGOSTAN™ is an absorbable haemostatic sponge intended for haemostatic use by applying to a bleeding surface. It consists of a sterile, water-insoluble, malleable, porcine gelatin absorbable sponge. Surgicel ™ is an absorbable hemostatic agent composed of oxidized regenerated cellulose. It is a sterile, absorbable knitted fabric that is flexible and adheres readily to bleeding surfaces. Both products are routinely used for their haemostatic properties in various surgical disciplines.Background
Technique
Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. In an attempt to assess the survivorship and patient outcome as well as peri- and postoperative complications and possible risk factors, we retrospectively analyzed the demographics, clinical outcome and radiographic characteristics of 100 ankle prostheses (97 patients). Between 3/2005 and 5/2010 114 S.T.A.R. Prostheses were implanted by one surgeon at our institution. Indication for TAA was primary and secondary osteoarthritis, 81 cases were posttraumatic. From the 53 female and 44 male patients the mean age was 63 and the mean BMI was 28,4. 11 patients had been smoking for longer than 12 years, 29 patients either had a history of diabetes, peripheral vascular or cardiovascular disease or varicosis. All operations were performed with a tourniquet, using a standard anterior midline incision. All patients received the same postoperative rehabilitation and follow up program. Postoperative evaluation included the AOFA Score and clinical radiographic follow ups 6 weeks after surgery and yearly thereafter. Additional procedures during surgery included lengthening of the Achilles tendon for 12 patients and fusion of the subtalar ankle for 5 patients.Introduction
Patients and methods
Several options exist for the treatment of periprosthetic osteolysis in revision knee surgery. We describe our preliminary short-term experiences using trabecular metal (TM) technology in order to fill bony defects either on the femoral or on the tibial side. 52 revision knee surgeries in which this TM technology had been used were retrospectively reviewed clinically and radiographically. Indication for revision included 51 cases with aseptic loosening of Total Knee Arthroplasty. In one case of periprostheti infection, a staged revision procedure was performed. Assessment of bone loss included the AORI classification (1989) and was performed pre- and intraoperatively. Clinical evaluation was performed using the HSS score. In 6 cases in addition to usng the TM cones, an impaction grafting technique was performed.Introduction
Material and Methods
Studies have documented encouraging results with the use of fluted, tapered, modular, titanium stems in revision hip arthroplasty with bone loss. However, radiographic signs of osseointegration and patterns of reconstitution have not been previously categorized. 64 consecutive hips with index femoral revision using a particular stem of this design formed the study cohort. Serial radiographs were retrospectively reviewed by an independent observer. Bone loss was determined by Paprosky's classification. Osseointegration was assessed by a slight modification of the criteria of Engh et al. Femoral restoration was classified according to Kolstad et al. Pain and function was documented using Harris Hip Score (HHS).Introduction
Materials and Methods
