Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Aug 2013
Long-term results of a total knee prosthesis utilising an all polyethylene tibial component.
The aim of this study was to assess the long-term performance of a cemented total knee replacement utilising an All Polyethylene Tibial (APT) component and in addition to perform an engineering analysis of any failures to help refine surgical technique. ⋯ The APT component demonstrated satisfactory clinical and radiographic performance at long-term follow up. Appropriate cortical support of the APT component is important. The implant should be used with a degree of caution in patients with severe deformities and osteoporosis.
-
Arch Orthop Trauma Surg · Aug 2013
The influence of steroid administration on systemic response in laminoplasty for cervical myelopathy.
The excessive systemic inflammatory response caused by surgery has been associated with the development of major complications, such as postoperative confusion and acute respiratory distress syndrome. The serum IL-6 has been used as a predictor in the extent of surgical trauma. Several trials have reported that steroid administration reduced excessive systemic response. We investigated the systemic response caused by surgical trauma in patients with cervical laminoplasty and evaluated the influence of steroid administration on systemic response. ⋯ This study shows that the preoperative administration of steroids modified the systemic inflammatory response caused by surgical trauma in patients with cervical laminoplasty.
-
Arch Orthop Trauma Surg · Aug 2013
Reduced head-neck offset in nontraumatic osteonecrosis of the femoral head.
Risk factors for nontraumatic osteonecrosis of the femoral head have in common that they trigger intravascular coagulation and thus lead to devascularization of the femoral head. In part of the patients, however, no risk factors seem to be evident. Mechanical reasons contributing to nontraumatic osteonecrosis have not been discussed so far. We hypothesized that recurrent traumatization of the vessels supplying the femoral head by a cam-type mechanism as in femoroacetabular impingement could add to intravascular coagulation. We, therefore, asked whether structural abnormalities at the femoral head-neck junction indicative of such a mechanism could be observed in radiographs of patients with osteonecrosis of the femoral head. ⋯ A reduced head-neck offset in patients with nontraumatic osteonecrosis of the femoral head may act as a mechanical (co-)factor in developing osteonecrosis of the femoral head.
-
Arch Orthop Trauma Surg · Aug 2013
Role of navigated total knee arthroplasty for acute tibial fractures in the elderly.
The role of total knee arthroplasty (TKA) in acute tibial fractures with existing comminution/bone loss, osteoporosis or preexistent arthritis has been described in the literature. Many of these procedures necessitate the use of stems to off-load the component and augments/wedges to avoid overresection and hence restore the joint line. Conventional methods may not be consistently accurate in restoring the desired alignment within 3° of the anatomical axis in this complex scenario. Computer-assisted TKA has been demonstrated to reproducibly and accurately restore the mechanical axis and joint line in primary TKA. Literature review has sparse data on use of navigation in acute TKA. ⋯ Total knee arthroplasty should be considered a treatment option for acute upper tibial fractures in the elderly with coexistent knee arthritis and poor bone stock. Computer-assisted navigation aids in restoration of mechanical axis and component positioning.