Abstract:

More than 30 years ago John Charnley and others created total hip replacement. The problems they faced were formidable. Two major problems dominated the scene: namely fixation and wear. Fifty years ago Austin Moore devised a new replacement for aged patients with fractured neck of the femora, but he did not achieve total fixation, nor was this necessary in the ambience of the patient's functional demands.

Authors:

Ronald J. Furlong, F.R.C.S.

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Abstract:

The etiology of surgical failure should be defined before revision total knee arthroplasty (TKA) is contemplated, since revision surgery without a clear reason may fail to correct the underlying problem. The causes of mechanical failure include component loosening, instability, polyethylene wear, component malposition, extensor mechanism dysfunction, and loss of motion. Revision that is required because of an infection is also acomplex situation, which requires skill and meticulous technique in order to restore a functional outcome. A successful revision needs to account for ligamentous balance, bone loss, alignment, and fixation.

Authors:

Giles R. Scuderi, M.D., F.A.C.S., John N. Insall, M.D.

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Abstract:

Pulmonary embolism (PE) is a major cause of death in a hospitalized population, In North America, there are about 260,000 cases of clinically recognized venous thromboembolism (VTE) each year with an in-hospital case fatality rate of 12%. Considering the difficulties of making an accurate diagnosis in this commonly silent disease, there may be as many as 600,000 clinically significant cases per year.

Authors:

Louis Desjardins, M.D., F.R.C.P. (C)

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Abstract:

Conservative-functional treatment of fresh humeral shaft fractures remains the method of choice, even though operative stabilization is increasingly being considered as an alternative. Among the surgical options, humeral nailing becomes more and more popular. Different humeral nail systems have been introduced for antegrade implantation. Many of them are criticized as problematic, or even insufficient, because of difficulties in implantation, damage of the humeral head cartilage, shoulder impingement, or rotatory instability.

Authors:

J. Blum, M.D., P.M. Rommens, M.D., Ph.D.

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Abstract:

A chondral/osteochondral defect involving the articular surface of a joint is still a therapeutic problem. The goal of articular cartilage repair is restoration of cartilage congruity, accomplishing a full pain free range of motion and elimination of cartilage deterioration. Current treatment modalities include debridement and drilling, picking or abrasion of the subchondral bone, fresh osteochondral allografts, periosteal or perichondral grafting, periosteal grafting with chondrocyte transplant, and joint replacement. The use of autologous grafts was first repor ted in 1964.

Authors:

Andreas B. Imhoff, M.D., Georg M. Oettl, M.D.

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Abstract:

The incidence of glenohumeral joint instability is estimated to effect between 2 and 8% of the population. It represents at least one third of all shoulder related emergency room visits. When one considers the spectrum of shoulder instability, including transient subluxation, the true incidence of glenohumeral instability is probably grossly under-reported. Although any age group can be affected, shoulder instability is primarily a disease of the young. The occurrence of instability is inversely proportional to the age of the patient and the time of original injury. A patient who dislocates for the first time as a teen can expect a redislocation rate approaching 90% in his or her lifetime. Therefore, many authors recommend early surgical treatment to repair the lesion.

Authors:

Marc A. Samson, M.D., Michael F. Dillingham, M.D., Gary S. Fanton, M.D., Josua S. Madsen, B.S.

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Abstract:

The advent of the arthroscope has revolutionized orthopaedic surgery, particularly for injuries to the knee or shoulder. The enhanced visualization accompanied by minimal soft tissue injury afforded by the arthroscope has been applied successfully to the treatment of many shoulder girdie pathologies, most notably impingement syndrome and rotator cuff injuries. As such, the traditional open surgery with the incumbent morbidity, while still utilized for more complex tears is finding less application in smaller tears to the rotator cuff. This review will address the history, indications, technique, and results of arthroscopic rotator cuff repair.

Authors:

Laurence D. Higgins, M.D., Duke University Medical Center, Durham, NC, David M. Dines, M.D.

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Abstract:

In the 1930s, Mixter and Barr reported their results with laminectomy and discectomy, setting forth the concept that radicular pain is associated with disc herniation. Since then, investigators have attempted to findalternatives to laminectomy and discectomy to enhance operative efficacy and decrease postoperative complications such as destabilizing and scarring the spinal canal. The trend has been toward minimizing the invasiveness of procedures that currently includes microdiscectomy and percutaneous procedures.

Authors:

Anthony T. Yeung, M.D.

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Abstract:

The meniscus arrow is a T-shaped fastener that provides an "all inside" technique for repair of longitudinal meniscal tears in the vascular zone through arthroscopic portals. No posterior incisions are needed and there are no sutures to tie. The arrow is made of proprietary self-reinforced polylactic acid and is rigid enough to allow impaction across a torn meniscus. The design allows the "T" of the head to be driven into and hold onto the surface of the meniscus, while the shaft, with its "fish hook" barbs, crosses the tear to fix to the periphery. The arrows begin to degrade in 4 to 6 months and are absorbed in 18 to 24 months.

Authors:

Saul N. Schreiber, M.D.

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