Abstract:

A prospective study of 110 Corail® uncemented hemiarthroplasties performed for fresh femoral neck fractures in 110 patients was carried out. The patients were followed during 10 years, unless they died before. Mean patient age was 84 (63-99) years; 75% were women and 25% had mental impairment. Implantation was uneventful in all patients except 7 (6 calcar cracks and 1 major trochanter fracture). Full-weight-bearing was allowed in almost every uncomplicated case, with only one 9-mm subsidence explained by the use of an undersized implant. A comprehensive radiographic analysis was undertaken in 44 hemiarthroplasties with a minimal implantation time of five years. A constant pattern of radiologic changes was identified and described. No loosening was noted; however, 7 radiolucent lines were seen in Zone 1 and 3 in Zone VII. Results of this prospective survey indicated that the HA-coated Corail prosthesis produces favorable functional and radiological outcomes for these elderly and frail patients.

Authors:

Dominique C.R. Hardy, M.D., Consultant Surgeon, Department of Orthopedic Surgery, Free University of Brussels, Brussels, Belgium

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Abstract:

Mobile-bearing unicompartmental knees facilitate decreased polyethylene wear and restoration of knee kinematics. The purpose of this study was to quantify tibial strains during bearing mobility in UKA. Composite tibiae were implanted with cemented metal-backed tibial components and coated with photoelastic material, allowing "full-field" strain analysis. A fully congruent mobile polyethylene bearing was loaded in six separate locations on the tibial tray, simulating bearing translation during knee motion. Strains were noted to be greatest in the anteromedial tibia, 2 cm distal to the joint line, which correlates with the area occasionally noted to have residual pain following UKA. This study demonstrates the important role that bearing movement plays in load distribution throughout the tibia after UKA and may illuminate a biomechanical process of tibial remodeling that influences pain and implant loosening.

Authors:

Scott R. Small, M.S., Engineering Director, Joint Replacement Surgeons of Indiana Research Foundation, Mooresville, IN, Michael E. Berend, M.D., Fellowship Director, Joint Replacement Surgeons of Indiana Research Foundation, Mooresville, IN, Merrill A. Ritter, M.D., Research Director, Joint Replacement Surgeons of Indiana Research Foundation, Mooresville, IN, Christine A. Buckley, Ph.D., Associate Professor of Applied Biology and Biomedical Engineering, Rose-Hulman Institute of Technology, Terre Haute, IN

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Abstract:

Posterior cruciate ligament (PCL) retaining total knee arthroplasty (TKA) is bone conserving and relies on the retained ligament to provide posterior stability. PCL sacrifice allows for easier correction of deformity, a better range of motion, and predictable kinematics. It was hypothesized that using a novel single radius TKA design, coupled with a double-dished articular geometry, would yield satisfactory stability and outcomes by sacrificing the PCL without substitution. A consecutive series of 94 cemented Scorpio (Stryker Orthopaedics) single radius PCL retaining total knee arthroplasties using that strategy, with a minimum 8-year follow-up, is presented. An early return of range of motion and extensor mechanism function was also demonstrated. No cases of instability and no revisions related to the technique occurred. As predicted, clinical and radiographic outcomes were excellent regarding pain relief and functional activities.

Authors:

Steven F. Harwin, MD, FACS, Chief of Adult Reconstructive Surgery of the Hip and Knee, Beth Israel Medical Center, Associate Professor of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York, USA, Mark Kester, PhD, Senior Director Research, Stryker Orthopaedics, Mahwah, New Jersey, USA

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Abstract:

Lisfranc injuries are not very common. Surgical options available for treatment of Lisfranc injuries have produced chronic pain and disability due to the damage to the articular surface, leading to early arthritis. We describe the technique of extra-articular fixation using dorsal plates for Lisfranc injury, avoiding any damage to the articular surface.

Authors:

Balaji Purushothaman, M.R.C.S. (Ed.), Specialty Trainee, Trauma & Orthopaedics, Northern Deanery, Newcastle Upon Tyne, UK, Elaine Robinson, M.R.C.S. (Ed.), Specialist Registrar, Trauma & Orthopaedics, Northern Ireland Deanery, Belfast, UK, Palaniappan Lakshmanan, M.S. (Orth.), F.R.C.S. (Orth.), Spinal Fellow, Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham, UK, Malik Siddique M.D., M.Ch. (Orth.), F.R.C.S. (Orth.), Consultant Orthopaedic Surgeon, Freeman Hospital, Newcastle Upon Tyne, UK

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Abstract:

Despite the advancement of surgical techniques in endoscopic spine surgeries, treatment of central and paracentral disc herniations, especially disc extrusions and disc sequestrations, remains challenging. On the basis of our experience with treating disc tears, disc herniations, and other spinal diseases, we have developed a new technique we call the "between" technique. This technique involves positioning the opening of the endoscope access cannula at the edge of the targeted disc with half of the opening being positioned inside the disc and the other half positioned in the epidural space. The "between" technique uses a blunt-ended dilator as a navigating tool in the epidural space to find the ideal access path and initial location for the access cannula. The technique is safe, effective, and easy to use. It has been proven particularly efficacious for the treatment of central and paracentral extruded disc herniations and sequestered disc herniations. The purpose of this Chapter is to describe this technique and introduce its application in removing central and paracentral disc extrusions and sequestrations.

Authors:

Kai-Xuan Liu, M.D, Ph.D., Atlantic Spinal Care, Edison, New Jersey, USA, Bryan Massoud, M.D., New Jersey Back Institute, Fairlawn, New Jersey, USA

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Abstract:

Degenerated spinal disc and spinal stenosis are common problems requiring decompressive spinal surgery. Traditional open spinal discectomy is associated with significant tissue trauma, greater morbidity/complications, scarring, often longer term of convalescence, and even destabilization of the spine. Therefore, the pursuit of less traumatic minimally invasive spine surgery (MISS) began. The trend of spinal surgery is rapidly moving toward MISS. MISS is a technologically dependent surgery, and requires increased utilization of advanced endoscopic surgical instruments, imaging-video technology, and tissue modulation technology for performing spinal surgery in a digital operating room (DOR). It requires seamless connectivity and control to perform the surgical procedures in a precise and orchestrated manner. A new integrated DOR, the technological convergence and control system SurgMatix®, was created in response to the need and to facilitate MISS with "organized control instead of organized chaos" in the endoscopic OR suite. It facilitates the performance, training, and further development of MISS.

Authors:

John C. Chiu, M.D., D.Sc., F.R.C.S., Director, Neurospine Surgery, Department of Neurosurgery, California Spine Institute, Thousand Oaks, CA, Ali M. Maziad, M.D., MSc., Spine Surgery and Surgical Informatics Fellow, California Spine Institute - IPILAB, University of Southern California, Los Angeles, CA, George Rappard, M.D., Neuro-Interventional Radiologist, Los Angeles Brain and Spine Institute, Los Angeles, CA, James T. Thacker, M.D., Interventional Pain Management Specialist, California Spine Institute, Thousand Oaks, CA, Brent Liu, Ph.D., Associate Professor of Radiology, Image Processing and Informatics Lab (IPILAB), University of Southern California, Los Angeles, CA, Jorge Documet, Ph.D., Post Doctorate Fellow, Image Processing and Informatics Lab (IPILAB), University of Southern California, Los Angeles, CA

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Abstract:

The use of external fixation has been described for various conditions but has never become a popular technique in spine surgery. The objective of this study is to describe the successful application of external fixation of the spine in three cases of complex spine infection. The first case is a 51-year-old male with T2-T3 spinal osteomyelitis secondary to Actinomyces lung infection causing epidural abscess and signs of cord compression. Laminectomy and debridement of the epidural abscess was performed, and external fixation was applied percutaneously spanning C7-T5. The second case is an 18-year-old soldier with a gunshot wound to the abdominal cavity with small bowel perforation and fracture of L1 and L2. Retroperitoneal infection developed at this level and was drained percutaneously. External fixation of T10-L4 was performed. The third case is a 60-year-old male who underwent resection of a locally invasive lung tumor at T3. Postoperative CSF leak and widespread infection was noted, mandating debridement and removal of the infected hardware. External fixation of T1-T8 was applied for temporary stabilization. All patients tolerated the procedure well, and rapid ambulation and physical therapy was initiated. Under broad-spectrum antibiotic therapy, resolution of infection was noted in all three cases as well as good sagittal and coronal axis alignment on follow-up imaging. We conclude that external fixation of the spine is a safe and effective surgical technique that can be considered as salvage treatment for spinal infections accompanied by segmental spinal instability.

Authors:

Harel Arzi, M.D., Spine Fellow, University of Kansas Medical Center, Kansas City, KS, USA, Moshe Levinkopf, M.D., Senior Surgeon, Spine Deformity Unit, Orthopaedic Department, Sheba (Tel-Hashomer) Medical Center, Ramat-Gan, Israel, The Sackler School of, Medicine, Tel Aviv University, Israel, Israel Caspi, M.D., Head Spine Unit, Spine Deformity Unit, Orthopaedic Department, Sheba (Tel-Hashomer) Medical Center, Ramat-Gan, Israel, The Sackler School of Medicine, Tel Aviv University, Israel, Paul M. Arnold, M.D., Professor of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA

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