Abstract:

The recent evolution of total knee arthroplasty (TKA) has been substantial and unlike that of total hip arthroplasty (THA). The current THA technique is similar to that initially developed and perfected by Professor John Charnley in the mid 1960s. The ball-and-socket articulation of the hip is simple and reproducible biomechanically. The long term (20 years and longer) results with total hip arthroplasty have been very satisfactory. The THA prosthetic designs of today remain similar to those of years past. Improvements have been in biomaterials, methods of fixation and surgical technique. The total knee arthroplasty prostheses of today differ greatly from their predecessors.

Authors:

R. Barry Sorrells, M.D., F.A.C.S.., F.A.A.O.S.

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Abstract:

Arthritis of the trapezio metacarpal joint (TMJ) is a very frequent condition, which affects women more than men, especially in the fifth or sixth decade of life. It can be very painful and disabling and the patient will need surgery for relief even if it can result in painless stiffening (in adduction of the metacarpal and hypertension of the metacarpal, which in turn is very disabling). TMJ arthritis is rarely primary or idiopathic; in general, it is secondary to instability of the joint, which, in turn, may be primary or secondary.

Authors:

Giorgio A. Brunelli, M.D., Luisa Monini M.D.

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Abstract:

Closed antegrade intramedullary nailing is the current standard of care for the treatment of femoral shaft fractures. This technique has been shown to have excellent results demonstrated by a high rate of fracture union and the low incidence of infection. However, there are complications specific to antegrade intramedullary nailing, as well as specific injury patterns that make this treatment less attractive.

Authors:

Keith B. Hutchinson, MSIV, Thomas A. DeCoster, M.D., George A. Brown, M.D., Mark K. Crawford, M.D., Brian Robinson, M.D.

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Abstract:

A septic loosening and osteolysis can compromise the available host bone in patients requiring revision hip arthroplasty. Secure fixation of revision femoral components may not be possible if reliant only on proximal femoral bone for biologic fixation or cement interdigitation. The challenge for the revision arthroplasty surgeon is to find the best method to secure the implant in a femur with deficient bone proximally that will provide stability for load bearing and motion. In addition to providing stability, the implant must be durable and maintain long-term fixation. With over 16 years of experience with fully porous coated femoral revision implants, we have found that maximizing prosthetic-bone fit in the proximal femoral diaphyseal bone provides reliable long-term fixation in the majority of femoral revision cases.

Authors:

Nelson Greidanus, M.D., F.R.C.S.C, John Antoniou, M.D., Ph.D., F.R.C.S.C., Wayne Paprosky, M.D.F.A.C.S

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Abstract:

Femoral revision in total hip replacement (THR) is often demanding due to severe bone defects of the proximal femur. The surgical technique must provide sufficient stability in the distal femur. However, long-term stability depends on preserving or even rebuilding proximal bone stock.

Authors:

Christoph Eingartner, M.D., Ruediger Volkmann, M.D., Eugen Wintrr, M.D., Kuno Weise, M.D., Sigfried Weller, M.D.

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Abstract:

Venous thromboembolic disease remains a common and potentially fatal complication after total joint arthroplasty. The incidence of deep vein thrombosis (DVT) has been reported to be between 5% and 60% in a number of studies using a variety of prophylaxis regimens. Symptomatic pulmonary embolism has been documented as high as 23%, while fatal pulmonary embolism, although relatively infrequent, remains one of the most catastrophic complications of total joint arthroplasty.

Authors:

Alexander Miric, M.D., Paul Lombardi, M.D., Thomas P. Sculco, M.D.

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Abstract:

The surgical approach is an important element in the quality of total hip replacement. Adequate surgical exposure based upon thorough fundamental knowledge of anatomy facilitates surgery and ensure optimum results in total hip replacement. Several surgical exposure techniques are utilized and have been described in the literature; all stress the importance of visualization of the acetabulum and the proximal femur in affording an atraumatic, expedient entry into the hip joint. Additionally, surgical exposure should be versatile, allowing for development to easily accommodate revision scenarios.

Authors:

Adolph V. Lombardi, Jr., M.D., F A.C.S., Thomas H. Mallory, M.D., F.A.C.S., Robert A. Fada, M.D.

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Abstract:

Medial migration of the acetabular cup and protrusio of the medial wall is a well recognized failure mechanism of acetabular fixation in cemented total hip arthroplasty. In the protruded acetabulum, a medialized position of the acetabular component is associated with increased medial cortical bone stresses, while more lateral positioning reduces the medial stresses. Use of a protrusio ring or medial wire mesh may limit medial migration. However, late failure of acetabular revision reconstructions can occur when cemented protrusio rings or wire mesh reinforcement are used without bone grafting.

Authors:

Michael D. Ries, M.D.

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Abstract:

Computer modeling has had an undoubtedly enormous impact on the field of bone research in recent years. Development of advanced computer based models has permitted researchers to explore a vast area of musculoskeletal science from the complex biophysical stimuli at the cellular level to the mechanical behavior of heterogeneous skeletal structures. Furthermore, computer modeling has given significant impetus to the impressive progress of modern bone implant development. With recent advances in computers, faster hardware and increasingly sophisticated software, the prospects for the future of computer-based bone research appear more exciting than ever.

Authors:

Ioannis A. Karnezis, M.D., F.R.C.S., Emmanuel G. Fragatadakis, M.D.

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