The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2008
Comparative StudyAssessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph.
While a full-length standing anteroposterior radiograph of the lower extremity provides the best radiographic method for assessing limb alignment, other methods must be used intraoperatively. We have employed intraoperative fluoroscopy with use of an electrocautery cord to assess limb alignment in the supine patient. ⋯ Intraoperative fluoroscopy with use of the electrocautery cord method is a useful tool for assessing lower limb alignment in patients with a normal body mass index and
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Reherniation within the first year following subtotal lumbar discectomy is a rare but noteworthy event. We performed a retrospective, case-controlled study to evaluate the clinical outcomes after early recurrent lumbar disc reherniation. ⋯ The rate of early reherniation after subtotal lumbar discectomy is low (1%). It is important to consider the possibility of iatrogenic instability during surgery on the lumbar spine for the treatment of reherniation. Patients who undergo reoperation because of early recurrent lumbar disc herniation can have clinical outcomes comparable with those of patients undergoing an uncomplicated subtotal lumbar discectomy.
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J Bone Joint Surg Am · Jan 2008
Effects of capsular plication and rotator interval closure in simulated multidirectional shoulder instability.
Arthroscopic treatment of multidirectional shoulder instability with use of capsular plication and rotator interval closure has been shown to be effective in several clinical studies; however, the biomechanical effects of these procedures have not been elucidated. The purpose of this study was to assess biomechanically the effect of arthroscopic capsular plication combined with rotator interval closure on rotational range of motion, humeral head position throughout rotation, and glenohumeral translation. ⋯ Capsular plication alone reduces range of motion to the intact state. Reductions in translation, however, may require the addition of rotator interval closure. Changes in translation and rotation after repair are dependent on arm position. In some positions, the addition of rotator interval closure may also result in overtightening.
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J Bone Joint Surg Am · Jan 2008
Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis.
The mobile-bearing feature of the Oxford unicompartmental knee replacement has the potential to optimize polyethylene wear, thereby leading to longer-term function of the implant. The function of the bearing requires intact soft tissues, with the ligaments being balanced throughout the range of motion intraoperatively through bone resection only. Final limb alignment is determined by the restored soft-tissue tension. The purposes of this study were to determine the limb alignment achieved in the absence of ligament release and to investigate the interplay of failure mode, survivorship, and limb alignment. ⋯ With this unicompartmental knee arthroplasty, the mechanical limb alignment resulting from balancing the knee ligaments, accomplished without releasing them, was consistently through the center of the knee. Progression of arthritis in the lateral compartment was the most common reason for late failure in this series and was not related to the initial postoperative alignment.