Technique Tip : Modified Extended Trochanteric Osteotomy

Saphenous vein was retracted in a dorsal postion, linear incision made in the periosteum. The calcaneo and the talonavicular joint were carefully exposed. Cartillage, or what was remaining of cartilage was removed. There were extreme osteoarthritic thoughout. Essentially 5%-10% of cartilage remained. The osteophytes were carefully excised with osteotome, the joint was prepared with microfracture using an osteotome on both sides of the joint.

PROCEDURE IN DETAIL: The patient was brought into the operating room, after satisfactory anesthesia, was placed in the left lateral dicubitis position. The right hip was prepped and draped. A previous made incision was reopened over the greater trochanter and carried down to Illiotibial (IT) band. The IT band was opened in the direction of the skin incision. The anterior 1/3 of the gluteus medius/minimus group was reflected off the trochanter over to the anterior brim of the pelvis. The hip was dislocated. The femoral component was easily removed. It was loose in the cement. The polyethylene was loose and easily removed. There was a lot of cement in and around the acetabulum. We debridement most of this. There was a wired mesh plug that went medially into the pelvis that was left in place. There was also one in the ishium that was quite stable and it was left in place. There was a large defect in the medial wall of the acetabulum about the size of a silver dollar.

The left metatarsophalangeal and interphalangeal (great and lesser toes) joints are held at slight flexion pressed against the ground by a concentric contraction of the flexor halluces longus, flexor digitorum longus, flexor digitorum longus. The left talocrural (ankle) is plantar flexed using a concentric contraction of the gastrocnemius and the soleus. The right talocrural (ankle) is plantar flexed by a concentric contraction of the tibialis anterior, extensor digitorum longus, peroneus tertius. The left tibiofermoral (knee) joints are being extended by a concentric contraction of the quadriceps muscles (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius). The right metatarsophalangeal and interphalangeal (great and lesser toes) are being held plantar flexed due to an isometric contraction of the flexor halluces longus, flexor digtorum longus. The right tibiofermoral (knee) joints are flexed at a 90-degree angle by a concentric contraction of the biceps femoris, semitendinous, semimembranosus. During this phase the left acetabular fermoral (hip) joint is flexed due to an eccentric contraction of the rectus femoris, pectineus, iliacus, and psoas. The right acetabular fermoral (hip) joint is at slight extension due to a concentric contraction of the biceps femoris, semitendinosus, semimembranosus, and the gluteus

An incision will be made in your hip. Your surgeon will take out any damaged cartilage and bone.

Long term goal is to achieve complete healing of broken bones and repair of associated damaged tissues and ligaments

In this video a patient is having surgery performed on rotator cuff. Usually this kind of surgery is very server to treat. In the video the surgeon inserts an instrument to see what damage is done to the knee joint. While the instrument is inserted the surgeon can monitor the scope on the T.V.Surgery is needed if the shoulder strength does not improve. In the video the instrument used is silver tube about quarter inch in length. The tube is the size of pencil that also has camera so the surgeon can see on the t.v. screen. This kind of surgery is performed under sterile condition. In the video three incisions are cut so there three incisions are only quarter inch in length. Normal saline is used to help with washing out bleeding. This type of surgery involves joints and local anesthesia to be administered. The procedure they are performing is rotator cuff surgery. Personal experience this pass December, I had to have arthroscopy surgery on my right knee I tore my meniscus.

Primarily, when a patient has a TAA their ankle range of motion is preserved. With either surgery, the motions of the foot are preserved since the fusion is only at the ankle bones and not the foot bones. With keeping the motion at the ankle, we also get the prevention of an abnormal gait pattern. If the ankle joints range of motion is maintained, the patient is able to avoid shortened step lengths with the unaffected lower extremity and more difficulty walking on uneven surface due to decreased plantar flexion and dorsiflexion. Another benefit of a TAA is the removal of the other joint surfaces. In turn, arthritis will not affect the other joints of the ankle as it would with an ankle fusion (Daniels, Sagar,

Femoroacetabular impingement (FAI) is a condition where the bones of the acetabulum are abnormally shaped, making them not fit together properly. This can be due to irregular growths of the femur and or the iliac spine. This abnormality, then causes the hip bones to rub together, leading to damage within the joint. There are three types of FAI: pincer, cam and combined impingement. Pincer impingement occurs because of an extra bony growth that extends over the normal rim of the acetabulum. Conversely, cam impingement is formed when the femoral head is not round and cannot rotate smoothly inside the acetabulum. Combined impingement is a combination of pincer and cam (Figure 1). The causes of FAI typically relate to abnormal formation of the

The surgeons do this for many reasons. Arthroscopic surgery is easier to see and work on, it uses smaller incisions, it can be done at the same time as diagnostic arthroscopy, and it is a lot safer than open surgery. All arthroscopic surgeries are done under anesthesia or general anesthesia. During arthroscopic ACL surgery, the surgeon makes about two or three small incisions around the knee. The surgeon then pumps sterile saline solution (salt) through one of the incisions. This process expands the knee and washes the blood out from the area. This allows the surgeon to see the knee composition more clearly. An arthroscope is then inserted into one of the incisions. There is a camera on the end of the arthroscope that transfers pictures from the inside of the knee to a TV monitor in the operating room. Next, surgical drills enter through the small incisions. The surgeon drills compact holes into the lower and upper leg bones. This is where the bones come together at the knee joint. The surgeon will then begin to take a

Despite contrary belief, hip replacement is not necessarily negative. Many Americans believe that in order to have a hip replacement, your condition must be terrible. A survey conducted in 2012 said that almost 1/3 of respondents to the hip replacement survey felt they would have benefited from having their surgery done earlier. This procedure has and continues to change the lives’ of many people in our world. Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain. According to the Centers for Disease Control and Prevention, 332,000 total hip replacements are performed in the United States each year. “Hip Replacement.” Questions and Answers about. N.p., n.d. Web. 21 Oct. 2013.

Hip osteoarthritis is a cause of severe pain and disability but it can be treated well with total hip arthroplasty surgery. Short term THA studies have reported a great improvement in the general health and quality of life and functionality of the hip in subjects with OA. Patient who undergo total hip arthroplasty may have impaired long-term self-reported physical quality of life and hip functionality, but still, they perform physically in a better condition than the ones who are untreated with advanced hip

Slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes (LCP) disease are developmental conditions (1, 2) with SCFE being described as a common source of pain and disability, and the most common cause of degenerative hip disease in middle-aged patients (3, 4). Proximal femoral osteotomies following SCFE aim to restore more normal anatomy, improve function and reduce the morbidity and complications of pain, reduced range of movement, early arthritis and leg length discrepancy (3). Up to 50% of involved hips do well with no intervention but these hips are always at risk of developing secondary arthritis and similarly adult hip joints of patients with SCFE are more prone to develop advanced osteoarthritis (5). In general outcomes of

The knee joint is formed by the articulation of the distal end of the femur and the proximal end of the tibia. The fibula is only involved to the extent that it serves as an attachment site for connective tissue. In this paper, the anatomy of the joint will be discussed.

One device used in treating a complex acetabular defect, fracture, or THA revision is an acetabular cage, shown in Figure 1. This type of device is necessary for fractures or defects in which acetabular bone loss is severe, and typical fixation methods will not be effective. The cage is made of a replacement acetabular cup with flanges for attachment and fixation to pelvic bone in order to keep the cup in place. Important factors included in the placement of these devices are the anatomic position and alignment, which is necessary to equalize leg length and allow for joint functionality, as well as the fixation to the bone. While a cage is often what is used, a commercially-available cage is often not the best fit for a patient with a severe

One of Omaha’s best orthopedic surgeons, Dr. Dolf R. Ichtertz, can be found at Nebraska Hand & Shoulder Institute, P.C. Dr. Ichtertz has been performing shoulder surgeries since 1985. He is especially adept at one of the newest and most effective types of rotator cuff surgery, reverse total shoulder replacement.