Abstract

The vast majority of femoral revisions that an orthopaedic surgeon encounters can be treated successfully with an extensively porous coated stem. Long-term results have demonstrated that this type of implant can provide reliable initial fixation with a high propensity for long-term fixation. Depending on the degree of femoral bone loss (Paprosky Type IIIA or Type IIIB bone), a longer cementless stem may be required to obtain initial axial and rotational stability. If severe bone loss is present (Paprosky Type IV bone), large canal diameters are encountered (>19 mm), or if torsion remodeling of the proximal femur has occurred, alternative methods of fixation may be required.

Abstract

Currently, total knee arthroplasty (TKA) is one of the most successful orthopaedic surgeries. However, the results are inferior in patients with previous patellectomy because of anteroposterior instability, residual pain, and loss of the mechanical advantage of the patella. The moment arm of the quadriceps can be restored by bone grafting the patellar tendon, and thus regaining the benefits of an intact patella that results in a better outcome after TKA. Usually it requires an additional procedure with its associated co-morbidities to harvest the bone graft. As the bone graft has to articulate with the femoral prosthesis, it has to be smooth at least on one side. The authors have described a new technique in this Chapter by which bone grafting of the patellar tendon can be achieved with use of the tibial plateau obtained from the routine tibial cut during TKA. Tibial eminence can be used as the interfacetal ridge of the "created" patella.

Abstract

Fifty primary total knee arthroplasties were performed in a prospective, randomized study comparing the use of a bipolar sealer device versus conventional electrocautery as the method of hemostasis. Both cohorts were evaluated for intraoperative blood loss, transfusion rate, postoperative drainage, hemoglobin levels, and Knee Society scores. A significant reduction in postoperative and total blood loss was found (p = 0.05 and p = 0.02, respectively), as well as an absence of tissue charring and smoke production in the bipolar sealer group. No difference in knee scores was found between both cohorts. These results suggest that use of this bipolar sealing device is at least as effective as standard cautery devices and can reduce blood loss, tissue damage, and smoke production in total knee arthroplasties without affecting the results.

Abstract

Percutaneous vertebral augmentation (VA) and reconstruction with intravertebral polyethylene mesh sac (OptiMesh) and morcelized bone graft provided a minimally invasive efficacious and controlled delivery mechanism to stabilize and treat painful osteoporotic, traumatic and neoplastic vertebral compression fractures (VCFs), as well as avoided serious complications from Polymethylmethacrylate (PMMA) of Vertebroplasty and Kyphoplasty. Osteoconductive and osteoinductive and can be used to create biologic vertebral reconstruction. The adjacent vertebra integrity should be more protected by the construct with a similar elasticity and physical characteristics of the morcelized bone, more matched to that of adjacent bone than PMMA. The indications and surgical techniques are described herein.

Abstract

Management of patients following extensive orthopaedic surgery, and in particular, joint replacement surgery, represents a continuing challenge. The associated bed rest burdens a broad range of physiologic functions, exacerbating vascular, venous, and lymphatic conditions, as well as cardiovascular conditions and glucose regulation in the hyperglycemic or diabetic patient. Most of these problems arise from a lack of mobility/exercise during recuperation. In a recent series of clinical studies, non-invasive micromechanical stimulation (MMS) of the plantar surface has been demonstrated to significantly enhance skeletal muscle pump activity in the lower limbs of patients, which results in improved blood and lymphatic flow in the lower body. These studies demonstrate efficacy in both the supine and upright positions, suggesting the potential of MMS technology to significantly improve post-surgical patient care. Moreover, evidence is increasing that sustained skeletal muscle pump activity helps to maintain normal fluid flow in bone tissue, such that MMS may provide a non-drug treatment for maintaining bone mass during bed rest, or possibly increasing bone mass following extended bed rest.

Abstract

Fusions of the cervical and lumbar spine are often followed within months or several years by protrusion of discs at the adjacent level or levels. Biomechanical alterations and mobility lost at the fused levels are thought to be transferring the stress to the adjacent segments or discs, which results in accelerated degeneration of the discs and causes disc protrusion. This post-spinal fusion "junctional disc herniation syndrome" (JDHS), or the post-spinal fusion "adjacent segment disease (ASD)" can occur from 15% to 52% of post-spinal fusion, in both superior and/or inferior adjacent levels. The ways in which endoscopic minimally invasive spinal discectomy procedure can be used to treat this JDHS and preserve spinal segmental motion are discussed herein. Also, case illustrations are presente