Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2020
Accuracy of tibial positioning in the frontal plane: a prospective study comparing conventional and innovative techniques in total knee arthroplasty.
Coronal alignment of the tibial component determines functional outcome and survival in total knee arthroplasty (TKA). Innovative techniques for tibial instrumentation have been developed to improve accuracy and reduce the rate of outliers. ⋯ The navigation and intramedullary instrumentation provided the precise positioning of the tibial component. Outliers were most common within the PSI and extramedullary technique. Optimal alignment is dependent on the technique of tibial instrumentation and tibial component positioning determines the accuracy in TKA since mTFA correlated with MPTA pre- and postoperatively.
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Arch Orthop Trauma Surg · Jun 2020
Acetabular defects in revision hip arthroplasty: a therapy-oriented classification.
The treatment of severe acetabular bone loss remains a difficult challenge. No classification system is available that combines intuitive use, structured design and offers a therapeutic recommendation according to the current literature and modern state of the art treatment options. The goal of this study is to introduce an intuitive, reproducible and reliable guideline for the evaluation and treatment of acetabular defects. ⋯ The ADC offers an intuitive, reliable and reproducible classification system. It guides the surgeon pre- and intraoperatively through a complex field of practice.
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Arch Orthop Trauma Surg · Jun 2020
Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy.
Using a navigation system in open-wedge high tibial osteotomy (OWHTO) has higher accuracy than using the conventional method. However, unintentional over- and under-correction still exist. This study aimed to compare various factors related to over- and under-correction and to assess their predictive factors in the preoperative radiographs. ⋯ Higher preoperative standing JLCA was the predictive factor of |NCL| > 1.5°. This factor reduced the rates of under- and over-correction and resulted in better AKS score in OWHTO.
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Arch Orthop Trauma Surg · Jun 2020
Influence of patient selection, component positioning and surgeon's caseload on the outcome of unicompartmental knee arthroplasty.
Implant malpositioning, low surgical caseload, and improper patient selection have been identified as essential factors, which could negatively affect the longevity of unicompartmental knee arthroplasty (UKA). The aim of the current study was to evaluate the impact of the surgeon's caseload on patient selection, component positioning, as well as component survivorship and functional outcomes following a PSI-UKA. ⋯ Due to potential selection errors, mostly connected to a low UKA-caseload, low-volume UKA surgeons might achieve worse outcomes. Very strict indications for UKA might be recommended in low-volume surgeons to achieve excellent clinical outcomes following a UKA.
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Arch Orthop Trauma Surg · Jun 2020
Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation?
Computed tomography-based three-dimensional models may allow the accurate determination of the center of rotation, lateral and anterior femoral offsets, and the required implant size in total hip arthroplasty. In this cadaver study, the accuracy of anatomical reconstruction was evaluated using a three-dimensional planning tool. ⋯ The exact anatomy of the patient and the required size and position of the prosthesis were precisely analyzed using a templating software. Based on the present findings, the development of template-directed instrumentation is conceivable using this method. However, further technical features (e.g., navigation or robot-assisted surgery) are required for improved precision for implant positioning.