The Orthopedic clinics of North America
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Subtrochanteric femur fractures have demanded special consideration in orthopaedic traumatology, given the high rate of complications associated with their management. The intense concentration of compression, tensile, and torsional stresses and decreased vascularity of the region has challenged orthopaedists with problems of malunion, delayed union, and nonunion resulting from loss of fixation, implant failure, and iatrogenic devascularization of the operative exposure. Only recently has a better understanding of fracture biology, reduction techniques, and biomechanically improved implants allowed for subtrochanteric fractures to be addressed with consistent success.
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Orthop. Clin. North Am. · Apr 2004
ReviewMinimally invasive unicompartmental knee replacement: rationale and correct indications.
In the early 1990s, unicompartmental knee replacements (UKRs) were almost forgotten as an option for the management of unicompartmental arthritis of the knee, and the two principal surgical options became proximal tibial osteotomy and total knee replacement. The recent introduction of minimally invasive techniques has renewed interest in uni-compartmental knee replacement. The proposed advantages of UKR over proximal tibial osteotomy include more predictable relief of pain, quicker recovery, and better long-term results. In appropriate cases, it has advantages over total arthroplasty in providing more physiologic function, better range of movement, easier salvage in case of failure, and quicker recovery because of minimally invasive techniques.
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Orthop. Clin. North Am. · Apr 2004
Comparative StudyMinimally invasive versus standard incision anterolateral hip replacement: a comparative study.
The results of the authors' study show that total hip arthroplasty can be performed safely through a minimal incision anterolateral approach. The authors' early results with this technique have demonstrated an increase in the length of operation compared with a standard approach, despite selection of smaller patients, but the authors expect this result will change with further experience. No benefit has been found with respect to perioperative blood loss, but the authors' results do suggest that for patients without additional medical problems, this technique may lead to a reduction in the length of hospital stay. Further study is required to clarify the benefits conferred by a minimal incision anterolateral approach.
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Orthop. Clin. North Am. · Apr 2004
Computer-assisted orthopaedic surgery: minimally invasive hip and knee reconstruction.
Joint reconstructive surgery is experiencing new and important developments. Less and minimally invasive techniques for hip and knee replacement have been described recently by several investigators. ⋯ Accuracy and safety of the surgery could be increased, despite the smaller approaches, with navigation tools. Although promising,the initial clinical experience is limited and needs to be supported by further, prospective analysis.
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Orthop. Clin. North Am. · Apr 2004
Minimally invasive total knee arthroplasty: the importance of instrumentation.
MIS TKA is in the early stages of development. There are many opponents who believe that the technique is nothing more than a cosmetic modification of the standard TKA that leads to more complications and less patient satisfaction. It is important to respect these comments and to thoroughly address them. ⋯ Ideally, the computer image will allow precise visualization of the knee, particularly the lateral side. All new surgical approaches and devices must be introduced with the expectation to improve the surgical results. There is no doubt that the final goal of this work should be technical improvement without early clinical failures or complications.