Transosseous capsuloplasty improves the outcomes of Lindgren–Turan distal metatarsal osteotomy in moderate to severe hallux valgus deformity

Introduction

Lindgren–Turan osteotomy used in hallux valgus deformity is a subcapital, transverse displacement osteotomy of the first metatarsal without any additional capsular repair. The aims of this study are to describe a transosseous capsuloplasty technique in this procedure and evaluate whether capsuloplasty would improve the clinical and radiological outcomes in patients with moderate to severe hallux valgus deformity.

Methods

Twenty-three feet operated by Lindgren–Turan osteotomy (Group B) and 25 feet operated by the same osteotomy combined with transosseous capsuloplasty (Group A) were evaluated retrospectively for the correction of the hallux valgus, intermetatarsal and distal metatarsal articular angles, sesamoid reduction, American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Scale as well as patient satisfaction. The mean postoperative follow-up was 14 (range 12–28) months.

Results

All radiological parameters improved considerably as a result of both groups. However, postoperative improvements in intermetatarsal and distal metatarsal articular angles were greater in Group A. Complete reduction of medial sesamoid was achieved in 52% of patients in Group A, whereas 17.4% of patients in Group B had complete reduction. AOFAS scores and number of patients with complete satisfaction in Group A were significantly greater than that in Group B.

Conclusion

Better clinical and radiological outcomes can be achieved in patients with moderate to severe hallux valgus deformity operated by Lindgren–Turan distal metatarsal osteotomy, when it combines with transosseous capsuloplasty.     

Cotyloplasty in Cementless Total Hip Arthroplasty for an Insufficient Acetabulum

Background

Cotyloplasty is a technique that involves making a perforation of the medial wall of a shallow acetabulum and then inserting an acetabular cup with the medial aspect of its dome beyond the Kohler line. The purpose of this study was to evaluate the results of cementless total hip arthroplasty (THA) using cotyloplasty with focusing on the amount of medial cup protrusion.

Methods

Sixteen hips with insufficient acetabulum in sixteen patients were treated by cementless THA using cotyloplasty. The average patient age was 47 years. The diagnoses included dysplastic hip (12) and infection sequelae (4). All the patients were followed up for at least 2 years. Clinically, the Harris hip scores were assessed and radiologically, the amount of cup protrusion, the hip center movement and cup fixation were evaluated.

Results

The average Harris hip score improved from 57 to 94 postoperatively. The average proportion of cup surface beyond the Kohler line was 44.1% and the hip centers were medialized by an average of 23 mm. Stable fixation of the acetabular cup was achieved in all the cases except one. In this one case, migration of the cup was detected 2 weeks postoperatively and a reoperation was performed.

Conclusions

Using cotyloplasty, good coverage of the acetabular cup was obtained without a block bone graft, and the hip joint centers were medialized. However, the safety margin for the amount of protrusion should be established.     

Robotic total mesorectal excision for the treatment of rectal cancer

Robotic techniques have been developed to facilitate endoscopic surgery and to overcome its disadvantages. Thus, we performed robotic total mesorectal excison (TME) in a patient with rectal cancer, using the da Vinci^® Surgical System. To our knowledge, this is the first robotic low anterior resection, based on standard TME principles, with pelvic autonomic nerve preservation. In conclusion, this robotic system is an excellent instrument for performing the standard TME procedure in rectal cancer patients.     

Relative contribution of body composition to bone mineral density at different sites in men and women of South Korea

We examined the relative contribution of body composition to bone mineral density (BMD) at various sites in 1406 Korean rural men and women, aged 19–80 years, from July to August 2004. The BMD was measured at peripheral (distal forearm and calcaneus) and central (lumbar spine at L1–L4, femoral neck, trochanter, and Ward's triangle) using dual-energy X-ray absorptiometry. In multivariate analyses, the linear regression models were adjusted for relevant covariates. In premenopausal women, only lean mass had a significant positive correlation with BMD at all sites. In postmenopausal women, fat mass was significantly positively correlated with BMD at all sites, except the Ward's triangle; fat mass was the only determinant of BMD at the lumbar, distal forearm, and calcaneus sites, whereas both lean and fat mass contributed to BMD at the hip, with the effect of lean mass being slightly greater than that of fat mass. In younger men, lean mass had a significant positive contribution to BMD at all sites, whereas fat mass appeared to contribute negatively to BMD at all sites, except the calcaneus. In older men, lean mass made a significant positive contribution to the BMD at all sites; fat mass also made a significant positive contribution to the BMD at the forearm and calcaneus. These data indicate that in the Korean rural population, lean mass may be an important determinant of the BMD, whereas fat mass may contribute positively to BMD only in postmenopausal women and older men.     

Multicenter Study of Robotic Thyroidectomy: Short-Term Postoperative Outcomes and Surgeon Ergonomic Considerations

Background  

Robotic thyroidectomy (RT) has recently emerged as a viable approach to thyroid surgery, resulting in better functional and cosmetic outcomes than afforded by open thyroidectomy (OT). The present multicenter study assessed the perioperative outcomes of RT and compared physician perspectives on the musculoskeletal ergonomic parameters associated with OT, endoscopic thyroidectomy (ET), and RT.     

Defining the Origins of the Iliofemoral, Ischiofemoral, and Pubofemoral Ligaments of the Hip Capsuloligamentous Complex Utilizing Computer Navigation

Purpose  

To use computer navigation software to investigate the specific origins of the hip capsuloligamentous complex.     

Radiographic results of an accelerometer-based, handheld surgical navigation system for the tibial resection in total knee arthroplasty

In total knee arthroplasty (TKA), intramedullary and extramedullary tibial alignment guides are not proven to be highly accurate in obtaining alignment perpendicular to the mechanical axis in the coronal plane. The objective of this study was to determine the accuracy of an accelerometer-based, handheld surgical navigation system in obtaining a postoperative tibial component alignment within 2° of the intraoperative goal in both the coronal and sagittal planes. A total of 151 TKAs were performed by 2 surgeons using a handheld surgical navigation system to perform the tibial resection. Postoperatively, standing anteroposterior hip-to-ankle radiographs and lateral knee-to-ankle radiographs were performed to determine the varus/valgus alignment and the posterior slope of the tibial components relative to the mechanical axis in both the coronal and sagittal planes. Findings showed that 95.3% of the tibial components were placed within 2° of the intraoperative goal in the coronal plane and 96.1% of the components were placed within 2° of the intraoperative goal in the sagittal plane. Overall, mean postoperative lower-extremity alignment was -0.3°±2.1°, with 97% of patients having an alignment within 3° of a neutral mechanical axis. The handheld surgical navigation system improves the accuracy of the tibial resection and subsequent tibial component alignment in TKA. It is able to combine the accuracy of computer-assisted surgery systems with the ease of use and familiarity of conventional, extramedullary alignment systems, and the ability to adjust both the coronal and sagittal alignments intraoperatively may prove clinically useful in TKA.     

Radiographic analysis of a hand-held surgical navigation system for tibial resection in total knee arthroplasty

Tibial intramedullary or extramedullary alignment guides have not been shown to be highly accurate in performing the tibial resection in total knee arthroplasty (TKA). Since May 2010, a total of 42 knees underwent a TKA using a hand-held, accelerometer-based surgical navigation system for performing the tibial resection (KneeAlign; OrthAlign Inc, Aliso Viejo, Calif). Postoperative standing anteroposterior hip-to-ankle and lateral knee-to-ankle radiographs demonstrated that 97.6% of the tibial components were placed within 90° ± 2° to the mechanical axis in the coronal plane, and 96.2% of the components were placed within 3° ± 2° to the mechanical axis in the sagittal plane. The KneeAlign greatly improves the accuracy of tibial component alignment in TKA.