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1.
Matthew G. Teeter Kevin I. Perry Xunhua Yuan James L. Howard Brent A. Lanting 《The Journal of arthroplasty》2018,33(3):740-745
Background
Contact kinematics between total knee arthroplasty components is thought to affect implant migration; however, the interaction between kinematics and tibial component migration has not been thoroughly examined in a modern implant system.Methods
A total of 24 knees from 23 patients undergoing total knee arthroplasty with a single radius, posterior stabilized implant were examined. Patients underwent radiostereometric analysis at 2 and 6 weeks, 3 and 6 months, and 1 and 2 years to measure migration of the tibial component in all planes. At 1 year, patients also had standing radiostereometric analysis examinations acquired in 0°, 20°, 40°, and 60° of flexion, and the location of contact and magnitude of any condylar liftoff was measured for each flexion angle. Regression analysis was performed between kinematic variables and migration at 1 year.Results
The average magnitude of maximum total point motion across all patients was 0.671 ± 0.270 mm at 1 year and 0.608 ± 0.359 mm at 2 years (P = .327). Four implants demonstrated continuous migration of >0.2 mm between the first and second year of implantation. There were correlations between the location of contact and tibial component anterior-posterior tilt, varus-valgus tilt, and anterior-posterior translation. The patients with continuous migration demonstrated atypical kinematics and condylar liftoff in some instances.Conclusion
Kinematics can influence tibial component migration, likely through alterations of force transmission. Abnormal kinematics may play a role in long-term implant loosening. 相似文献2.
Tomohiro Fujiwara Toshiyuki Kunisada Ken Takeda Joe Hasei Eiji Nakata Ryuichi Nakahara Aki Yoshida Toshifumi Ozaki 《Journal of orthopaedic science》2018,23(6):1045-1050
Background
Although emerging evidence has suggested that computer-assisted navigation allows surgeons to plan the optimal level of resection without compromising the surgical margins, the precise accuracy of the procedures has been unclear. The aim of this study was to investigate the accuracy and safety of the musculoskeletal tumor resection using O-arm/Stealth intraoperative navigation assistance.Methods
A retrospective study of six patients with bone and soft tissue tumors who underwent surgical resection using O-arm/Stealth navigation system was performed. The histological diagnosis was osteosarcoma, metastatic bone tumor, leiomyosarcoma, undifferentiated sarcoma, and synovial sarcoma, respectively. Tumor resection was performed according to planned osteotomy planes determined on O-arm/Stealth three-dimensional intraoperative images. The resection accuracy, length of time for the procedures, surgical margins, and perioperative complications were evaluated.Results
The distances between the entry and exit points for the planned and actual cuts were 1.5 ± 0.3 mm and 2.3 ± 0.3 mm, respectively, and the mean discrepancy of the osteotomy angle was 2.8 ± 1.2°. The mean length of time required for navigation was 14 min. A histological examination revealed clear margins in all patients. There were no complications related to navigation, and no patients developed local recurrence during a mean follow-up of 30.6 months.Conclusions
The O-arm/Stealth intraoperative CT navigation system provides safe and accurate osteotomy in musculoskeletal tumor resections. However, surgeons should keep in mind and be careful of minimal errors during osteotomy, which are around 2 mm from the planned line. 相似文献3.
Tomoharu Mochizuki Osamu Tanifuji Yoshio Koga Ryosuke Hata Takahiro Mori Katsutoshi Nishino Takashi Sato Koichi Kobayashi Go Omori Makoto Sakamoto Yuji Tanabe Naoto Endo 《Journal of orthopaedic science》2017,22(3):501-505
Introduction
The relative torsional angle of the distal tibia is dependent on a deformity of the proximal tibia, and it is a commonly used torsional parameter to describe deformities of the tibia; however, this parameter cannot show the location and direction of the torsional deformity in the entire tibia. This study aimed to identify the detailed deformity in the entire tibia via a coordinate system based on the diaphysis of the tibia by comparing varus osteoarthritic knees to healthy knees.Methods
In total, 61 limbs in 58 healthy subjects (age: 54 ± 18 years) and 55 limbs in 50 varus osteoarthritis (OA) subjects (age: 72 ± 7 years) were evaluated. The original coordinate system based on anatomic points only from the tibial diaphysis was established. The evaluation parameters were 1) the relative torsion in the distal tibia to the proximal tibia, 2) the proximal tibial torsion relative to the tibial diaphysis, and 3) the distal tibial torsion relative to the tibial diaphysis.Results
The relative torsion in the distal tibia to the proximal tibia showed external torsion in both groups, while the external torsion was lower in the OA group than in the healthy group (p < 0.0001). The proximal tibial torsion relative to the tibial diaphysis had a higher external torsion in the OA group (p = 0.012), and the distal tibial torsion relative to the tibial diaphysis had a higher internal torsion in the OA group (p = 0.004) in comparison to the healthy group.Conclusion
The reverse torsional deformity, showing a higher external torsion in the proximal tibia and a higher internal torsion in the distal tibia, occurred independently in the OA group in comparison to the healthy group. Clinically, this finding may prove to be a pathogenic factor in varus osteoarthritic knees.Level of evidence
Level Ⅲ. 相似文献4.
K. Keely Boyle Scott R. Nodzo Joseph T. Ferraro David J. Augenblick Sonja Pavlesen Matthew J. Phillips 《The Journal of arthroplasty》2018,33(4):1082-1088
Background
Aseptic loosening of cemented and uncemented tibial components continues to be a source of implant failure after total knee arthroplasty (TKA) in the obese population. There is limited literature reviewing uncemented cruciate retaining (CR) components in the obese population.Methods
A clinical and radiographic review was performed on 325 patients who underwent a cemented or uncemented TKA with a CR knee prosthesis and body mass index ≥30 kg/m2 between January 2010 and June 2013. Charts were reviewed for the incidence of revision due to aseptic loosening of the tibial baseplate, revision for any reason, incidence of radiolucent lines around the tibial baseplate, range of motion, and patient reported outcomes.Results
There was no statistically significant difference between groups in survivorship for aseptic loosening of the tibial component (99.4% uncemented, 99.3% cemented, P = .94) and overall survivorship (98.1% uncemented, 98.3% cemented, P = .90). The Lower Extremity Activity Scale and Forgotten Joint Score-12 clinical outcome measures were similar between groups (10.2 ± 3.7 vs 9.7 ± 3.4 and 66.1 ± 28.2 vs 64.9 ± 24.3, P = .33, P = .78, respectively). Postoperative knee flexion was similar between groups (114.6 ± 9.3 vs 114.1 ± 9.3, P = .67).Conclusion
Our study demonstrated similar survivorship of this CR design for aseptic loosening of the tibial baseplate and overall revision rates in obese patients undergoing either an uncemented or cemented TKA. The uncemented and cemented groups had comparable clinical and radiographic short to mid-term outcomes when implanted in good alignment when treating end-stage knee osteoarthritis. 相似文献5.
Tatsuo Mae Konsei Shino Ryo Iuchi Kazutaka Kinugasa Ryohei Uchida Shigeto Nakagawa Hideki Yoshikawa Ken Nakata 《Journal of orthopaedic science》2017,22(5):886-891
Purpose
To clarify 1) the force sharing between two portions of BTB graft in anatomic rectangular tunnel (ART) reconstruction and 2) the knee stability in ART technique under anterior tibial load.Methods
Eleven fresh cadaveric knees were used. First, anterior-posterior (A-P) laxity was measured with Knee Laxity Tester® in response to 134 N of A-P tibial load at 20° on the normal knees. Then ART ACL reconstruction was performed with a BTB graft. For graft, the patellar bone plug and tendon portion was longitudinally cut into half as AM and PL portions. After the tibial bone plug was fixed at femoral aperture, AM/PL portions were connected to the tension-adjustable force gauges at tibial tubercle, and were fixed with 10 N to each portion at 20°. Then the tension was measured 1) under anterior tibial load of 134 N at 0, 30, 60, and 90°, and 2) during passive knee extension from 120 to 0°. Next the graft tension was set at 0, 10, 20, 30, or 40 N at 20°, and the A-P laxity was measured by applying A-P load of 134 N. By comparing the laxity for the normal knee, the tension to restore the normal A-P laxity (LMP) was estimated.Results
The AM force was significantly smaller at 0° and larger at 90° than the PL force under anterior load, while the force sharing showed a reciprocal pattern. During knee extension motion, the tension of both portions gradually increased from around 5 N to 20–30 N with knee extended. And the LMP was 1.6 ± 1.0 N with a range from 0.3 to 3.5 N.Conclusion
The pattern of force sharing was similar to that in the normal ACL in response to anterior tibial load and during passive knee extension motion. LMP in this procedure was close to the tension in the normal ACL.Level of evidence
Level IV, a controlled-laboratory study. 相似文献6.
Zi-Zheng Wu Jian-Dong Wang Xiao-Xi Ji Zhi-Jian M Jian-Hong Wu Qiu-Gen Wang 《中华创伤杂志(英文版)》2018,21(6):356-359
Purpose
Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the four main approaches to the elbow. The aim of this study was to compare the exposure of distal articular surfaces of these surgical approaches.Methods
Twelve cadavers were used in this study. Each approach was performed on six elbows according to previously published procedures. After completion of each approach, the exposed articular surfaces were marked by inserting 0.5 mm K-wires along the margins. The elbow was then disarticulated and the exposed articular surfaces were painted. The distal humeral articular surfaces were then closely wrapped using a piece of fibre-glass screen net with meshes. The exposed articular surfaces and the total articular surfaces were calculated by counting the number of meshes, respectively.Results
The average percentages of the exposed articular surfaces for the anterior, posterior olecranon osteotomy, medial and lateral approaches were 45.7% ± 2.0%, 53.9% ± 7.1%, 20.6% ± 4.9% and 28.5% ± 6.3%, respectively.Conclusion
The anterior and posterior approaches provide greater exposures of distal humeral articular surface than the medial and lateral ones in the treatment of distal humeral fractures. 相似文献7.
Omar A. Behery Sean M. Kearns Justin M. Rabinowitz Brett R. Levine 《The Journal of arthroplasty》2017,32(5):1510-1515
Background
The ideal fixation for modern tibial components in total knee arthroplasty (TKA) remains controversial with uncertainty on whether cementless implants can yield equivalent outcomes to cemented fixation in early follow-up.Methods
A series of 70 consecutive cases with reverse hybrid cementless fixation were matched to 70 cemented cases from 2008 to 2015 based on implant design and patient demographics.Results
Cementless TKA demonstrated greater aseptic loosening (7 vs 0, P = .013) and revision surgery (10 vs 0, P = .001) than cemented fixation within 5 years of follow-up, but with no clinically significant differences in outcome scores.Conclusion
It remains unclear whether early aseptic loosening in cementless TKA can be reduced with enhanced adjunct fixation and what proportion of early failure justifies the potential lifelong fixation through biologic ingrowth of cementless tibial components. 相似文献8.
Hong-Geun Jung Dong-Oh Lee Sang-Hun Lee Joon-Sang Eom 《Journal of orthopaedic science》2017,22(3):468-473
Background
Moderate to severe midfoot–forefoot varus deformities are commonly found in several conditions. However, few techniques are available to correct these deformities. So, we evaluated the clinical and radiological outcomes of patients who underwent midfoot derotational osteotomy to achieve plantigrade foot.Methods
From 2006 to 2014, 6 patients (7 feet) underwent midfoot derotational osteotomy. A visual analog scale (VAS) pain and the American Orthopedic Foot & Ankle Society (AOFAS) functional score were evaluated. Radiographic parameters, including tibiocalcaneal angle (TCA) and navicular height (NH), were assessed.Results
The mean patient age at surgery was 48.0 years (37–58). From before the operation to the final follow-up, the mean VAS score decreased from 6.5 (2–9) to 1.3 (0–4) and the mean AOFAS score improved from 42.7 (34–58) to 77 (68–87). All patients were satisfied with outcomes. The mean TCA significantly improved from 33.8° (9.9–66.7) to 12.7 (5.1–27.6) (p = 0.018)and the mean NH decreased from 46.7 mm (32.8–67) to42.6 (30.1–60.8) (p = 0.018).Conclusion
Severe midfoot–forefoot varus deformities can be efficiently corrected by midfoot derotational osteotomy resulting in favorable clinical and radiological outcomes and high patient satisfaction.Level of evidence
IV, case series. 相似文献9.
Masashi Uehara Jun Takahashi Shugo Kuraishi Masayuki Shimizu Shota Ikegami Toshimasa Futatsugi Hiroki Oba Hiroyuki Kato 《Journal of orthopaedic science》2017,22(2):218-223
Study design
A retrospective single-center and single-surgeon study.Objectives
This study investigated the clinical and radiological results of skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS).Summary of background data
At present, the generally used technique for pedicle screw fixation for the surgical correction of AIS entails inserting a pedicle screw into every segment on the corrective side and into every or every other segment on the supportive side. To reduce operation time, blood loss, and cost, we developed skip pedicle screw fixation to achieve correction of AIS using fewer pedicle screws.Methods
We evaluated 62 consecutive patients who had undergone computer-assisted skip pedicle screw fixation from August 2005 to June 2014. All patients were followed up for at least two years. We investigated the clinical results of skip pedicle screw fixation for AIS.Results
The mean number of fused vertebrae was 10.3 ± 2.0, the mean surgical time was 242 ± 78 min, and the mean blood loss volume was 1060 ± 688 ml. The mean Cobb angle of main thoracic (MT) curve two years after surgery improved significantly compared with that before surgery (p < 0.01). The mean correction rate of MT curve immediately after surgery was 62.4 ± 12.4% and correction loss of MT curve at two years after surgery was 1.9 ± 5.8°. The SRS-22 subtotal score two years after surgery improved significantly compared to that before surgery (p < 0.01). Although no patients experienced major complications, eight (12.9%) encountered minor complications (two [3.2%] had massive blood loss [>3000 ml], three [4.8%] had a broken screw, one [1.6%] had a set-screw that dropped out, one [1.6%] experienced deep vein thrombosis, one [1.6%] experienced acute renal failure, and one [1.6%] experienced intercostal neuralgia). Revision surgery was not performed.Conclusions
Subjects with AIS who underwent skip pedicle screw fixation had significantly improved clinical and radiological parameters at two years after surgery, indicating that skip pedicle screw fixation could be used to successfully treat AIS.Level of evidence
Level 4 相似文献10.
Background
The integration of general and endocrine surgery was studied as a potential career model for fellowship trained general surgeons.Methods
Case logs collected from 1991–2016 and academic milestones were examined for a single general surgeon with a focused interest in endocrine surgery. Operations were categorized using CPT codes and the 2017 ACGME “Major Case Categories” and there frequencies were determined.Results
10,324 operations were performed on 8209 patients. 412.9 ± 84.9 operations were performed yearly including 279.3 ± 42.7 general and 133.7 ± 65.5 endocrine operations. A high-volume endocrine surgery practice and a rank of tenured professor were achieved by years 11 and 13, respectively. At year 25, the frequency of endocrine operations exceeded general surgery operations.Conclusion
Maintaining a foundation in broad-based general surgery with a specialty focus is a sustainable career model. Residents and fellows can use the model to help plan their careers with realistic expectations. 相似文献11.
Brian P. Chalmers Peter K. Sculco Keith A. Fehring Michael J. Taunton Robert T. Trousdale 《The Journal of arthroplasty》2017,32(2):570-574
Background
Fluoroscopically assisted radiographs theoretically improve detection of total knee arthroplasty (TKA) implant loosening by providing a better evaluation of the true implant interface, but their utility has not been well studied. We sought to determine whether fluoroscopically guided radiographs improve the sensitivity, specificity, and interobserver reliability of determining TKA implant loosening compared to standard radiographs.Methods
Standard anteroposterior and lateral and fluoroscopically assisted radiographs were retrospectively obtained from 60 patients within 6 months before revision TKA. Thirty knees were revised for aseptic loosening and 30 knees for other indications, most commonly instability. The radiographs were randomized. Four reviewers independently determined whether each tibial and femoral component was radiographically loose or stable. Intraoperative determination of implant stability was utilized as the gold standard.Results
Fluoroscopically guided radiographs had a significantly higher sensitivity for detecting tibial component loosening compared to standard radiographs (85.3% vs 74.8%, P = .02). Sensitivity in detecting femoral component loosening was poor overall and not improved by fluoroscopic enhancement compared to standard radiographs (58.8% vs 66.5%, P = .33). Fluoroscopically guided radiographs did not improve the specificity of detecting well-fixed implants in either tibial or femoral components nor affect the mean interobserver reliability over standard radiographs (kappa = 0.58 vs kappa = 0.60, P = .6).Conclusion
Fluoroscopically assisted radiographs increased the sensitivity of detecting tibial component loosening over standard radiographs, but this clinical significance is unclear. Fluoroscopically guided radiographs may provide benefit in diagnosing aseptic loosening in select patients with painful TKAs. 相似文献12.
Atsunori Murase Masahiro Nozaki Masaaki Kobayashi Hideyuki Goto Masahito Yoshida Sanshiro Yasuma Tetsuya Takenaga Yuko Nagaya Jun Mizutani Hideki Okamoto Hirotaka Iguchi Takanobu Otsuka 《Journal of orthopaedic science》2017,22(5):874-879
Background
Recently several authors have reported on the quantitative evaluation of the pivot-shift test using cutaneous fixation of inertial sensors. Before utilizing this sensor for clinical studies, it is necessary to evaluate the accuracy of cutaneous sensor in assessing rotational knee instability. To evaluate the accuracy of inertial sensors, we compared cutaneous and transosseous sensors in the quantitative assessment of rotational knee instability in a cadaveric setting, in order to demonstrate their clinical applicability.Methods
Eight freshly frozen human cadaveric knees were used in this study. Inertial sensors were fixed on the tibial tuberosity and directly fixed to the distal tibia bone. A single examiner performed the pivot shift test from flexion to extension on the intact knees and ACL deficient knees. The peak overall magnitude of acceleration and the maximum rotational angular velocity in the tibial superoinferior axis was repeatedly measured with the inertial sensor during the pivot shift test. Correlations between cutaneous and transosseous inertial sensors were evaluated, as well as statistical analysis for differences between ACL intact and ACL deficient knees.Results
Acceleration and angular velocity measured with the cutaneous sensor demonstrated a strong positive correlation with the transosseous sensor (r = 0.86 and r = 0.83). Comparison between cutaneous and transosseous sensor indicated significant difference for the peak overall magnitude of acceleration (cutaneous: 10.3 ± 5.2 m/s2, transosseous: 14.3 ± 7.6 m/s2, P < 0.01) and for the maximum internal rotation angular velocity (cutaneous: 189.5 ± 99.6 deg/s, transosseous: 225.1 ± 103.3 deg/s, P < 0.05), but no significant difference for the maximum external rotation angular velocity (cutaneous: 176.1 ± 87.3 deg/s, transosseous: 195.9 ± 106.2 deg/s, N.S).Conclusions
There is a positive correlation between cutaneous and transosseous inertial sensors. Therefore, this study indicated that the cutaneous inertial sensors could be used clinically for quantifying rotational knee instability, irrespective of the location of utilization. 相似文献13.
Tomohito Hino Takayuki Furumatsu Masataka Fujii Yuya Kodama Shinichi Miyazawa Yusuke Kamatsuki Kazuki Yamada Toshifumi Ozaki 《Journal of orthopaedic science》2017,22(6):1084-1088
Background
To compare the plain knee radiograph finding of tibial eminence width between knees with complete discoid lateral meniscus, incomplete discoid lateral meniscus, and normal lateral meniscus.Materials and methods
The study included 27 knees with discoid lateral meniscus, including 13 knees with complete discoid lateral meniscus and 14 knees with incomplete discoid lateral meniscus. A control group of 14 knees with normal lateral meniscus was also included. Tibial eminence width and the lateral slope angle of the medial tibial eminence were assessed using plain frontal knee radiographs. Individual differences in knee size were corrected by dividing tibial eminence width by tibial width to obtain the tibial eminence width percentage.Results
Mean tibial eminence width and tibial eminence width percentage in the complete discoid lateral meniscus group was significant larger than other groups. Mean lateral slope angle in the complete discoid lateral meniscus group was significantly smaller than other groups. A tibial eminence width cut-off of 13.9 mm showed a sensitivity and specificity of 100% and 83%, respectively. A tibial eminence width percentage cut-off of 18.8% showed a sensitivity and specificity of 100% and 90%, respectively. A lateral slope angle cut-off of 27.1° showed a sensitivity and specificity of 71% and 83%, respectively.Conclusion
There were clear differences in tibial eminence width, tibial eminence width percentage, and lateral slope angle between the complete discoid lateral meniscus group and the other groups. The plain radiographic parameters identified by this study could be useful for complete discoid lateral meniscus screening.Study design
Clinical. 相似文献14.
Kyeong-Hyeon Park Joon-Woo Kim Hee-June Kim Hee-Soo Kyung Jong-Keon Oh Tae-Joon Cho Il Seo Chang-Wug Oh 《Journal of orthopaedic science》2017,22(3):474-480
Purpose
Varus or valgus deformity of the distal femur may progress into knee osteoarthritis. To delay or prevent this, various types of corrective osteotomy techniques have been used to shift the mechanical axis from the diseased compartment to the healthy one. We introduced a new, minimally invasive osteotomy of the distal femur with the assistance of temporary external fixation.Methods
We retrospectively studied 25 legs that underwent open-wedge osteotomy of the distal femur, involving insertion of a Schanz pin at the medial femoral condyle and another pin at the distal diaphysis of the femur. At the meta-diaphyseal junction, osteotomy was performed. After achieving angular correction, two pins were locked for temporary external fixation and a locking plate was fixed at the lateral side of the femur submuscularly. Radiological and functional outcomes were evaluated, including mechanical lateral distal femoral angle (m-LDFA), mechanical axis deviation, tibiofemoral angle, osseous union, and knee joint motion.Results
The minimum follow-up was 12 months (mean, 39 months; range, 12–88 months). Bone healing occurred in all legs, with an average of 16.6 weeks. The m-LDFA was corrected from 77.7° (18 valgus) and 104.6° (7 varus) to 88.1° after surgery, with an average correction of 12.9°. At the final follow-up, the mechanical axis deviation averaged 7.6 mm and the tibia-femoral angle averaged 5.6°. Most of legs (88%) achieved acceptable m-LDFA (87° ± 3°).Conclusions
A new, minimally invasive osteotomy of the distal femur offers excellent bone healing with few complications, attributable to preserved blood supply. 相似文献15.
Ki-Mo Jang Jong-Hee Lee Il Youp Cho Bong-Kyung Park Seung-Beom Han 《The Journal of arthroplasty》2017,32(3):756-760
Background
The purpose of this study was to assess the reliability of pre-, intra operative, and postoperative limb alignment measurements and investigate the correlation between the measurements in biplanar medial opening-wedge high tibial osteotomy.Methods
This study enrolled 59 knees undergoing biplanar opening-wedge high tibial osteotomy for primary medial osteoarthritis with varus deformity. Preoperative and postoperative standing lower leg radiographs and intraoperative fluoroscopic images were taken. Two independent examiners analyzed the radiologic data to assess lower limb alignment and mechanical axis (MA) deviation (percentage of MA position on tibial plateau). The effect of preoperative hip-knee-ankle angle and MA deviation, age, sex, body mass index (BMI), and joint line convergence angle on the discrepancy between intraoperative and postoperative MA deviation was analyzed.Results
The mean preoperative hip-knee-ankle angle and MA deviation were varus 7.7 ± 3.3° and 14.1 ± 15.1%, respectively. After osteotomy, the mean intraoperative postosteotomy MA deviation was 57.9 ± 2.1% in supine position, and the mean post-operative MA deviation increased to 63.9 ± 2.9% on standing radiographs. The mean difference between intraoperative postosteotomy MA deviation and postoperative MA deviation was 6.1 ± 2.2%. Linear regression analysis between intraoperative postosteotomy MA deviation and postoperative MA deviation showed a statistically significant linear relationship (R2 = 0.449; P < .001). Multivariate regression analysis revealed that preoperative joint line convergence angle (β = 0.856; P < .001) and BMI (β = 0.349; P < .001) were significant positive predictors for the difference in MA deviation.Conclusion
There was a significant linear relationship between intraoperative postosteotomy MA deviation and postoperative MA deviation following biplanar medial opening-wedge high tibial osteotomy. A greater discrepancy between MA deviations was significantly associated with higher BMI and joint line convergence angle. 相似文献16.
Shoji Seki Yasuhito Yahara Hiroto Makino Yoshiharu Kawaguchi Tomoatsu Kimura 《Journal of orthopaedic science》2018,23(3):488-494
Background
Ponte osteotomy is a useful method in posterior spinal release. However, it is unclear whether Ponte osteotomy itself contributes to vertebral derotation in surgery for adolescent idiopathic scoliosis (AIS) patients compared to inferior facetectomy alone. This study aimed to assess the effect of Ponte osteotomy on the magnitude of periapical vertebral body rotation compared to inferior facetectomy alone. This study was a prospective collected data.Methods
The study included 63 patients with AIS (Thoracic curve type, 35; thoracolumbar/lumbar curve type, 27), who underwent surgery between August 2011 and January 2015. All AIS patients underwent posterior spinal fusion with uniplanar screws and Ponte osteotomies on three periapical intervertebral segments. We measured and analyzed the flexibility of periapical intervertebral rotation pre- and post-bilateral inferior facetectomy, and post-Ponte osteotomy with our device (three times). The difference in intervertebral rotation between pre- and post-Ponte osteotomy was analyzed.Results
The mean increase in angle was 5.6° for thoracic curves and 6.4° for thoracolumbar curves. The increase in angle for thoracolumbar curves was significantly larger than that for thoracic curves (P < 0.05). The more an apical region of the scoliosis was located at caudal side of spine, the more the flexibility due to Ponte osteotomy increased (P < 0.05). The significant differences of the increase in intervertebral flexibility between inferior facetectomies and Ponte osteotomies were recognized at middle thoracic and thoracolumbar regions (P < 0.005).Conclusions
Our data suggest that Ponte osteotomy has a loosening effect on periapical scoliotic curvature compared to inferior facetectomy alone. Ponte osteotomy is likely to be associated with an increase in loosening of the middle thoracic and thoracolumbar regions. 相似文献17.
Naofumi Taniguchi Tetsuya Jinno Daisuke Koga Tetsuo Hagino Atsushi Okawa Hirotaka Haro 《The Journal of arthroplasty》2017,32(5):1547-1552
Background
Appropriate stem anteversion is important for achieving stability of the prosthetic joint in total hip arthroplasty. Anteversion of a cementless femoral stem is affected by the femoral canal morphology and varies according to stem geometry. We investigated the difference and variation of the increase in anteversion between 2 types of cementless stems, and the correlation between each stem and the preoperative femoral anteversion.Methods
We retrospectively compared 2 groups of hips that underwent total hip arthroplasty using a metaphyseal filling stem (78 hips) or a tapered wedge stem (83 hips). All the patients had osteoarthritis due to hip dysplasia. Computed tomography was used to measure preoperative femoral anteversion at 5 levels and postoperative stem anteversion.Results
The increase in anteversion of the tapered wedge stem group (22.7° ± 11.6°) was more than that of the metaphyseal filling stem group (17.2° ± 8.3°; P = .0007). The variation of the increase in the tapered wedge stem group was significantly larger than that in the metaphyseal filling stem group (P = .0016). The metaphyseal filling stem group was more highly and positively correlated with femoral anteversion than the tapered wedge stem group.Conclusion
Femoral anteversion affects stem anteversion differently according to stem geometry. The tapered wedge stems had greater variation of the increase in anteversion than did the metaphyseal filling stems. Based on the results of this study, it is difficult to preoperatively estimate the increase in stem anteversion for tapered wedge stems. 相似文献18.
Maurizio Montalti Francesco Castagnini Federico Giardina Enrico Tassinari Federico Biondi Aldo Toni 《The Journal of arthroplasty》2018,33(6):1813-1819
Background
Total hip arthroplasty (THA) in severe developmental dysplasia of the hip (DDH) is a challenging procedure. The most used techniques involve anatomic cup positioning, augmentation femoral osteotomy. However, anatomic cup positioning is not always feasible in severe DDH and osteotomy nonunion may ensue. The purpose of the study was to assess the survivorship, the hip score results, the radiological parameters (fixation, loosening, component position) of a large cohort of patients with Crowe III and IV DDH, treated with high hip center and modular necks THAs.Methods
Eighty-four THAs in Crowe III and IV DDH were evaluated, achieving a final follow-up of 15.1 years. All the patients were treated with the same cementless implant (modular necks and ceramic-on-ceramic coupling) and the same approach (high cup placement with slight medialization). The patients were clinically evaluated (Harris Hip score and Merle d'Aubigne and Postel score). A radiographic evaluation was performed, analyzing the orientation of the cup.Results
Eighty patients were available at the last follow-up. The clinical scores were good at the final follow-up. Two sciatic lesions occurred: one patient fully recovered. The overall survivorship was 90.5% at 15 years: only 2 cases of aseptic loosening were reported. The mean center of rotation height was 33 ± 8 mm and the medialization was 30 ± 5 mm.Conclusion
A high cup placement with slight medialization is a valid technique in DDH patients. A good restoration of the offset, ceramic-on-ceramic coupling and a porous socket may provide durable results, overcoming the effects of increasing joint reaction forces related to high cup placement. 相似文献19.
Chung Kia Ng Jerry Yongqiang Chen Jared Ze Yang Yeh Jade Pei Yuik Ho Azhar M. Merican Seng Jin Yeo 《The Journal of arthroplasty》2018,33(6):1936-1944
Background
We hypothesized that there is a correlation between the distal femoral rotation and proximal tibial joint line obliquity in nonarthritic knees. This has significance for kinematic knee arthroplasty, in which the target knee alignment desired approximates the knee before disease.Methods
Fifty computed tomography scans of nonarthritic knees were evaluated using three-dimensional image processing software. Four distal femoral rotational axes were determined in the axial plane: the transepicondylar axis (TEA), transcondylar axis (TCA), posterior condylar axis (PCA), and a line perpendicular to Whiteside's anterior-posterior axis. Then, angles were measured relative to the TEA. Tibial joint line obliquity was measured as the angle between the proximal tibial plane and a line perpendicular to the axis of the tibia.Results
There was a strong positive correlation between PCA-TEA and tibial joint line obliquity (r = 0.68, P < .001) as well as TCA-TEA and tibial joint line obliquity (r = 0.69, P < .001). In addition, the tibial joint line obliquity and TCA-TEA angles were similar, 3.7° ± 2.2° (mean ± standard deviation) and 3.5° ± 1.7°, respectively (mean difference, 0.2° ± 0.2°; P = .369).Conclusion
Both PCA-TEA and TCA-TEA strongly correlated with proximal tibial joint line obliquity indicating a relationship between distal femoral rotational geometry and proximal tibial inclination. These findings could imply that the native knee in flexion attempts to balance the collateral ligaments toward a rectangular flexion space. A higher tibial varus inclination is matched with a more internally rotated distal femur relative to the TEA. 相似文献20.
Huijun Kang Kunpeng Fu Conglei Dong Fei Wang 《Acta orthopaedica et traumatologica turcica》2018,52(5):372-375