Introduction: Unicompartmental knee arthroplasty (UKA) is gaining popularity due to its less invasiveness and quicker recovery than total knee arthroplasty (TKA). However, incidence of tibia-related complications such as tibial component subsidence and fracture has been increased. These may be due to improper surgical technique selection such as excessive removal of tibia plateau, including excessive posterior slope, exposing soft metaphyseal bone prone to fracture and implant subsidence. Mobile-bearing UKA allows minimal tibial bone resection because thinner polyethylene bearing can be used since there are less concerns about polyethylene wear.
Objectives: We proposed UKA surgical technique for fix-bearing UKA to resect minimal amount of tibial, mainly to leave hard subchondral bone under tibial component in order to prevent tibial component subsidence and fracture.
Methods: Retrospective study comparing
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The subchondral-sparring group were operated during 2010-2013 and consisted of 179 patients. Other than different mean follow-up period, there was no significant difference regarding patient demographics. There were 5 tibia-related complications (3 gross component subsidence and loosening and 2 tibial plateau fracture). All these complications were detected within 6 months after index surgery. One patient with subsidence and 2 patients with fracture required revision to TKA. There were no tibia-related complication in subchondral-sparring group. The incidence of tibia-related complication between the two groups are statistically significant. (Fisher exact test, 5/166 VS 0/179; p=0.025). There was no femur-related complication. Two patients in measure-resection group require revision to TKA due to progression of disease in lateral compartment at 5 and 7 years post-op. Clinical outcomes at 2-year when excluding cases with complications were similar in both
Once again Dr. Armin Tehrany was asked to share his professional opinion, based on his decade’s long experience and profound orthopedic knowledge.
Department of Orthopedic Surgery, The First Affiliated Hospital, 3Department of Pharmacy, Dalian Medical University, and 2Institute of Reconstructive Surgery, Dalian University, Dalian, China
There may also be associated bony lesions: avulsion fractures of the ACLu or PCL, frank utibial plateau or distal femur condylar fractures, or ipsi-lateral tibial or femoral shaft ufracture. ( 9 )
During the weeks of February 7 through February 17, I observed a total hip arthroplasty on a 56-year-old Caucasian female patient who suffered from a femoral neck fracture and damage to the acetabulum. The fracture was a result from a car accident where the patient's knees collided with the dashboard, forcing the femur into the hip and breaking the femur.
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.
Many believe that all Native American tribes can be stereotypically grouped together and referred to as one in the same. However, this is simply not true. Each tribe has its own language and its own culture none were as impressive as that of the Iroquois, whom belonged originally to the Northwestern Woodland portion of North America. In modern times they are referred to as the Haudenosaunee or the Six Nations that comprise the Iroquois Confederacy. These nations include: the Mohawk, Oneida, Onondaga, Cayuga, Seneca, and Tuscarora (who joined in the 1800's). Known numbers of the Iroquois currently stand at roughly 125,000 with only 80,000 currently residing in the United States and 45,000 in Canada.
A patient arrives at the hospital for their knee replacement surgery that has been scheduled for today. The patient is checked in at admitting and is called back to the pre-operative area by the nurse. The patient changes and the nursing staff begin to take the patient’s vital signs, review the patient’s history, draw blood for lab work and they let the patient know what to expect before, during and after surgery. The surgeon arrives and checks in with the patient, asks if they have any final questions before surgery and then leaves for the operating room to prepare. The patient is taken to the operating room, anesthesia is given, and the operation begins. The procedure goes smoothly and the patient is taken to the post-op area. When the patient comes out of the anesthesia, the surgeon
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,
Surgical dislocation of the hip gives a sheltered intends to treat FAI. It is conceivable to completely assess the femoral head-neck junction, and to examine the labrum and adjacent acetabular cartilage . An entire 360º perspective of the acetabulum can be obtained . With a blunt probe, the articular cartilage assessed and the integrity of the labrum and the articular cartilage is determined. This methodology gives access to perform osteochondroplasty and labral reattachment as required. By restoring the congruency between the femoral head and the acetabulum, this approach might permit the patient to come back to appeal exercises without encountering the manifestations and dynamic joint obliteration seen with FAI. [22]
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.
A total knee replacement (TKA) is the most common joint surgery performed in the United States (Turner, 2011, pp. 27-32). Each year, over 650,000 Americans undergo this surgery (Wittig-Wells, 2015, pp. 45-49). It is an invasive surgery that involves an incision on top of the knee and replacing damaged parts of the knee with artificial parts that are either metal, ceramic or plastic. Someone would get a total knee replacement for damage of the joint, osteoarthritic, posttraumatic, or inflammatory arthritis. The cartilage is damaged, wears away and then you develop bony deformity and contracture of ligaments but it starts out with specific defects or wear of cartilage. The top nursing priorities for a total knee arthroplasty is to “prevent complications, promote optimal mobility, alleviate pain, and provide information about diagnosis, prognosis, and treatment needs” (Doenges, 2014, pg. 627). A possible nursing diagnosis from the patient who is undergoing a TKA might be ‘impaired physical mobility related to pain and discomfort as evidenced by reluctance to attempt movement.’ Another one could be ‘acute pain related to chronic joint disease as evidenced by reports of pain’ (Vera, 2014).
The CRA-method for rotational alignment of the femoral component in TKA is accurate and precise, and there is no need for special instruments or additional preoperative
From January 2001 to December 2014, a single surgeon (TPG) performed 3777 consecutive metal-on-metal HRA procedures, of which, 27% were women. Choosing December 2014 as our date range cut-off point ensured a minimum of 2 years of follow-up results for both study groups. Group 1 consisted of 357 cases in 309 females performed before 2008, prior to the establishment of the newly developed surgical interventions. Group 2 comprises 654 resurfacings in 556 females. Group 2 females were significantly older, at a mean of 54 years compared to 50 years (p30% uncovered, and in all patients who have had an acetabular complication on the opposite hip, or who have a DEXA scan T-score 30. We have also demonstrated that a slowed weight bearing protocol and alendronate can prevent EFF [26]. Over time we evolved to develop a comprehensive protocol which establishes three groups based on proven risk factors: Group A, femoral neck T-score >0 and BMI 30; and Group C, Femoral neck T-score< -1.5.
There are actually three reasons the doctor (an orthopedic surgeon) will recommend an artificial knee. These are: 1) to relieve pain 2) to restore function and 3) to achieve stability. As the arthritic knee becomes more painful, the patient will use it less. Function, therefore, is lost. As the arthritic knee continues to deform, the patient will feel that the joint is wobbly or unstable.
Osteoarthritis is the most common joint disorder, and more than half of all Americans who are older than 65 have been diagnosed with osteoarthritis. However, recent US data has revealed knee osteoarthritis does not discriminate age, and there is growing evidence that osteoarthritis affects individuals at a young age. The annual cost of osteoarthritis due to treatment and loss of productivity in the US is estimated to be more than 65 billion dollars.1 With no cure currently available for osteoarthritis, current treatments focus on management of symptoms. The primary goals of therapy include improved joint function, pain relief, and increased joint stability. Although the exact cause of osteoarthritis is unknown, many risk factors have been identified including increased age, female gender, obesity, and trauma.2 Within these risk factors, the etiology of osteoarthritis has been divided into anatomy, body mass, and gender.