Pub Date : 2023-12-13DOI: 10.1097/bto.0000000000000654
Lisa G.M. Friedman, H. Maniar, Daniel S. Horwitz
{"title":"Fixation of Distal Femur Fractures With the Use of Periarticular Tibial Locking Plates","authors":"Lisa G.M. Friedman, H. Maniar, Daniel S. Horwitz","doi":"10.1097/bto.0000000000000654","DOIUrl":"https://doi.org/10.1097/bto.0000000000000654","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"22 S2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139004772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-13DOI: 10.1097/bto.0000000000000653
Nathaniel Deak, Hunter Ross, James Mueller, Rahul Vaidya
{"title":"Perfect Circle Technique With C-arm Laser Augmentation","authors":"Nathaniel Deak, Hunter Ross, James Mueller, Rahul Vaidya","doi":"10.1097/bto.0000000000000653","DOIUrl":"https://doi.org/10.1097/bto.0000000000000653","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"18 4","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139004080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-12DOI: 10.1097/bto.0000000000000652
Mila Scheinberg, Matthew McCrosson, Travis Fortin, Swapnil Singh, Ashish Shah
Chronic lateral ankle instability (CLAI) with hindfoot varus is a common condition that can be treated with various surgical approaches. The Broström-Gould procedure is the gold-standard surgery for CLAI, and a sliding lateralizing calcaneal osteotomy (SLCO) is a common procedure for CLAI with hindfoot varus. The purpose of this paper is to describe a single-incision approach for the Broström-Gould repair with concomitant peroneal tendon debridement and an SLCO. The study retrospectively reviewed 189 cases of lateral ankle ligamentous repair with peroneal tendon debridement and an SLCO between 2011 and 2020. Of these, 53 patients had a single-incision approach, meeting the major inclusion criteria. The remaining patients had 2 incisions. Inclusion criteria for this study required patients to be at least 18 years of age, have a preoperative diagnosis of CLAI with hindfoot varus, and receive an isolated one-incision approach for a Broström-Gould procedure with concomitant peroneal tendon debridement and an SLCO. The single-incision technique has shown to be equally effective with potential for decreased wound and neurovascular complications in comparison to a traditional multi-incisional approach. The single-incision technique for the Broström-Gould repair with concomitant peroneal tendon debridement and an SLCO is a safe and effective approach for treating CLAI with hindfoot varus. This technique offers adequate visualization of the lateral ankle ligaments, peroneal tendons, and lateral calcaneus while still achieving excellent postoperative cosmesis.
{"title":"Single Incision Broström-Gould Surgery With Peroneal Debridement and Calcaneal Osteotomy","authors":"Mila Scheinberg, Matthew McCrosson, Travis Fortin, Swapnil Singh, Ashish Shah","doi":"10.1097/bto.0000000000000652","DOIUrl":"https://doi.org/10.1097/bto.0000000000000652","url":null,"abstract":"\u0000 \u0000 Chronic lateral ankle instability (CLAI) with hindfoot varus is a common condition that can be treated with various surgical approaches. The Broström-Gould procedure is the gold-standard surgery for CLAI, and a sliding lateralizing calcaneal osteotomy (SLCO) is a common procedure for CLAI with hindfoot varus. The purpose of this paper is to describe a single-incision approach for the Broström-Gould repair with concomitant peroneal tendon debridement and an SLCO.\u0000 \u0000 \u0000 \u0000 The study retrospectively reviewed 189 cases of lateral ankle ligamentous repair with peroneal tendon debridement and an SLCO between 2011 and 2020. Of these, 53 patients had a single-incision approach, meeting the major inclusion criteria. The remaining patients had 2 incisions. Inclusion criteria for this study required patients to be at least 18 years of age, have a preoperative diagnosis of CLAI with hindfoot varus, and receive an isolated one-incision approach for a Broström-Gould procedure with concomitant peroneal tendon debridement and an SLCO.\u0000 \u0000 \u0000 \u0000 The single-incision technique has shown to be equally effective with potential for decreased wound and neurovascular complications in comparison to a traditional multi-incisional approach.\u0000 \u0000 \u0000 \u0000 The single-incision technique for the Broström-Gould repair with concomitant peroneal tendon debridement and an SLCO is a safe and effective approach for treating CLAI with hindfoot varus. This technique offers adequate visualization of the lateral ankle ligaments, peroneal tendons, and lateral calcaneus while still achieving excellent postoperative cosmesis.\u0000","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"8 11","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138977158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1097/bto.0000000000000651
Khaled Mohamed Emara, Ramy Ahmed Diab, Khaled Abdeghaffar, Mohamed N. Essa, Ahmed K. Emara, Kyrillos Rashid, Mostafa Gemeah
Introduction: Adult-onset cavovarus foot deformity is a highly disabling condition that can seriously interfere with daily activities. Charcot-Marie-Tooth is the most common etiology associated with cavus foot. Patients and Methods: We reviewed 30 feet in skeletally mature patients with rigid cavovarus deformities who were treated with extensive posteromedial soft tissue release without performing osteotomies or internal fixation. Clinical evaluation was done using the Foot Function Index for the pain, disability, and limitation of movement. The radiologic assessment was done by measurement of the lateral talo-first metatarsal angle, the lateral calcaneal-first metatarsal angle, and the lateral tibio-calcaneal angle in standing lateral foot radiographs. All patients were followed up for a mean of 36 months postoperatively. Results: Throughout the course of the study, the Foot Function Index for pain, disability, and limitation improved from an average of 51.46 points, 47.06 points, and 22.6 points preoperatively to postoperative averages of 23.65 points, 21.88 points, and 10.2 points, respectively. Radiologically, the talo-first metatarsal angle, the calcaneo-first metatarsal angle, and the tibio-calcaneal angles had preoperative values of 28.9 degrees, 132.4 degrees, and 62.35 degrees which improved postoperatively to 7.55 degrees, 117.65 degrees and 50.35 degrees, respectively. Conclusion: The outcomes of this study shed light on the use of pure soft tissue release without associated osteotomies as a simple, safe, and effective technique in treating rigid cavovarus deformities in skeletally mature patients. This could carry some advantages regarding preserving foot function as it preserves the integrity of foot joints. Level of Evidence: Level IV.
{"title":"Extensive Posteromedial Soft Tissue Release for Skeletally Mature Patients With Rigid Pes Cavus Deformity","authors":"Khaled Mohamed Emara, Ramy Ahmed Diab, Khaled Abdeghaffar, Mohamed N. Essa, Ahmed K. Emara, Kyrillos Rashid, Mostafa Gemeah","doi":"10.1097/bto.0000000000000651","DOIUrl":"https://doi.org/10.1097/bto.0000000000000651","url":null,"abstract":"Introduction: Adult-onset cavovarus foot deformity is a highly disabling condition that can seriously interfere with daily activities. Charcot-Marie-Tooth is the most common etiology associated with cavus foot. Patients and Methods: We reviewed 30 feet in skeletally mature patients with rigid cavovarus deformities who were treated with extensive posteromedial soft tissue release without performing osteotomies or internal fixation. Clinical evaluation was done using the Foot Function Index for the pain, disability, and limitation of movement. The radiologic assessment was done by measurement of the lateral talo-first metatarsal angle, the lateral calcaneal-first metatarsal angle, and the lateral tibio-calcaneal angle in standing lateral foot radiographs. All patients were followed up for a mean of 36 months postoperatively. Results: Throughout the course of the study, the Foot Function Index for pain, disability, and limitation improved from an average of 51.46 points, 47.06 points, and 22.6 points preoperatively to postoperative averages of 23.65 points, 21.88 points, and 10.2 points, respectively. Radiologically, the talo-first metatarsal angle, the calcaneo-first metatarsal angle, and the tibio-calcaneal angles had preoperative values of 28.9 degrees, 132.4 degrees, and 62.35 degrees which improved postoperatively to 7.55 degrees, 117.65 degrees and 50.35 degrees, respectively. Conclusion: The outcomes of this study shed light on the use of pure soft tissue release without associated osteotomies as a simple, safe, and effective technique in treating rigid cavovarus deformities in skeletally mature patients. This could carry some advantages regarding preserving foot function as it preserves the integrity of foot joints. Level of Evidence: Level IV.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"81 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135221616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/bto.0000000000000650
Logan Wright, Aimee Struk, Thomas Wright
Purpose: Describe a new technique using a minimally invasive surgical intervention for the treatment of valgus-impacted proximal humerus fractures. The Kickstand technique is a novel approach that offers reliable fixation and union without the need for additional hardware. Materials and Methods: A retrospective case series of 3 patients with valgus-impacted proximal humerus fractures was treated with this Kickstand technique using an intramedullary fibular allograft. Postoperative x-rays and outcomes are presented. Results: The Kickstand technique was used to address valgus-impacted fractures in 3 patients. Postoperative range of motion and shoulder outcome scores were reported at 2 years for patients A and B, and at 1 year for patient C (Active range of motion external rotation: 28 degrees; Active range of motion elevation: 140 degrees; Simple Shoulder Test-12: 11; American Shoulder and Elbow Standardized Shoulder Assessment: 78). Postoperative Grashey and lateral x-rays for each patient show union of the valgus-impacted humerus. Conclusions: The Kickstand technique using intramedullary fibular allograft is an alternative fixation technique for displaced valgus proximal humerus fracture. It has the advantage of avoiding additional metallic hardware and allowing early motion but requires the use of intramedullary fibular allograft which can interfere with future use of stemmed humeral prosthesis.
{"title":"Kickstand Technique for Treatment of Valgus-Impacted Proximal Humerus Fractures","authors":"Logan Wright, Aimee Struk, Thomas Wright","doi":"10.1097/bto.0000000000000650","DOIUrl":"https://doi.org/10.1097/bto.0000000000000650","url":null,"abstract":"Purpose: Describe a new technique using a minimally invasive surgical intervention for the treatment of valgus-impacted proximal humerus fractures. The Kickstand technique is a novel approach that offers reliable fixation and union without the need for additional hardware. Materials and Methods: A retrospective case series of 3 patients with valgus-impacted proximal humerus fractures was treated with this Kickstand technique using an intramedullary fibular allograft. Postoperative x-rays and outcomes are presented. Results: The Kickstand technique was used to address valgus-impacted fractures in 3 patients. Postoperative range of motion and shoulder outcome scores were reported at 2 years for patients A and B, and at 1 year for patient C (Active range of motion external rotation: 28 degrees; Active range of motion elevation: 140 degrees; Simple Shoulder Test-12: 11; American Shoulder and Elbow Standardized Shoulder Assessment: 78). Postoperative Grashey and lateral x-rays for each patient show union of the valgus-impacted humerus. Conclusions: The Kickstand technique using intramedullary fibular allograft is an alternative fixation technique for displaced valgus proximal humerus fracture. It has the advantage of avoiding additional metallic hardware and allowing early motion but requires the use of intramedullary fibular allograft which can interfere with future use of stemmed humeral prosthesis.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"31 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136068391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-09DOI: 10.1097/bto.0000000000000646
Edgard de Novaes França Bisneto, Laura Filippini Lorimier Fernandes, Emygdio José Leomil de Paula, Rames Mattar Júnior
Introduction: We present 6 cases of children with atypical cleft hand and discuss a surgical technique. Clinically, participants presented with a lack of pulp-to-pulp pinch due to metacarpophalangeal ligament insufficiency and difficulty grasping large objects because of the narrowed first web. Materials and Methods: Second metacarpal resection and Z-plasty, creating a wide first web. The second extensor digitorum communis tendon was transferred to improve the thumb metacarpophalangeal joint stability. Conclusions: The surgical technique presented in this paper did improve function in oligodactyly or type-IIA atypical cleft hand.
{"title":"Atypical Cleft Hand: Surgical Technique for Grasping Improvement","authors":"Edgard de Novaes França Bisneto, Laura Filippini Lorimier Fernandes, Emygdio José Leomil de Paula, Rames Mattar Júnior","doi":"10.1097/bto.0000000000000646","DOIUrl":"https://doi.org/10.1097/bto.0000000000000646","url":null,"abstract":"Introduction: We present 6 cases of children with atypical cleft hand and discuss a surgical technique. Clinically, participants presented with a lack of pulp-to-pulp pinch due to metacarpophalangeal ligament insufficiency and difficulty grasping large objects because of the narrowed first web. Materials and Methods: Second metacarpal resection and Z-plasty, creating a wide first web. The second extensor digitorum communis tendon was transferred to improve the thumb metacarpophalangeal joint stability. Conclusions: The surgical technique presented in this paper did improve function in oligodactyly or type-IIA atypical cleft hand.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135094782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-02DOI: 10.1097/bto.0000000000000648
Ross Condell, Martin Kelly, Paul Mckenna
Direct anterior approach (DAA) has been shown to have many benefits for patients undergoing total hip replacement. These include less soft tissue damage, a low dislocation rate, and earlier postoperative recovery compared with other approaches.1,2 The accurate identification of the Smith-Peterson interval is vital to minimize unnecessary soft tissue dissection, as well as to avoid injury to nearby structures. It also allows for an internervous approach, between the sartorius muscle (femoral nerve) and the tensor fascia latae muscle (superior gluteal nerve). This has been shown to lead to improved postoperative pain control and decreased length of hospital stay.3 The interval is accessed by incising the fascia over the tensor fascia lata muscle. It is the identification of this muscle that is the key element in ensuring safe exposure of the hip. A comprehensive understanding of the anterior hip anatomy is essential when acquiring exposure to the joint. Anterior mobilization of the femur is necessary for exposure for reaming, broaching, and femoral implant positioning. Specific releases are described in detail by Rodriguez et al,4 which allow the proximal part of the femur and the greater trochanter to be elevated anteriorly in front of the acetabulum with minimal force applied to the femur. The senior author has used the DAA in over 2500 cases to date and has identified 4 constant markers that aid in identifying the Smith-Peterson interval. TECHNIQUE After incision through the skin and subcutaneous fat, the tensor fascia muscle can be identified using the following markers (Figs. 1–3): Lateral to a line drawn from the anterior superior iliac spine to the head of the fibula. Oblique orientation of the muscle fibers running from the anterior superior iliac spine proximally in an inferolateral direction distally. Presence of perforating vessels in the fascia of the tensor fascia lata. Fat streak between tensor and sartorius medially. FIGURE 1: Right hip direct anterior approach. Anatomic landmarks for identifying the Heuter interval. ASIS indictes anterior superior iliac spine; TFL, Tensor fascia lata.FIGURE 2: Once the plane is identified, the fascia overlying the bulk of the tensor fascia muscle is incised and retracted to allow for access to the Heuter Interval.FIGURE 3: Anatomical landmarks for identifying the Heuter interval. The patient consented to clinical photography, available on request. ASIS indictes anterior superior iliac spine; TFL, Tensor fascia lata.Expected Outcomes The Heuter interval can be difficult to identify. However, using these 4 markers can allow surgeons to be confident with their approach. Once identified, the fascia overlying the bulk of the tensor fascia muscle is incised and retracted to allow for access to the Heuter interval and the hip capsule with minimal soft tissue disruption. The steep learning curve to the DAA can be aided by the identification of these markers. COMPLICATIONS The lateral femoral cutaneous nerve
{"title":"Anatomic Markers for Intraoperative Identification of the Heuter Interval in the Direct Anterior Approach to the Hip","authors":"Ross Condell, Martin Kelly, Paul Mckenna","doi":"10.1097/bto.0000000000000648","DOIUrl":"https://doi.org/10.1097/bto.0000000000000648","url":null,"abstract":"Direct anterior approach (DAA) has been shown to have many benefits for patients undergoing total hip replacement. These include less soft tissue damage, a low dislocation rate, and earlier postoperative recovery compared with other approaches.1,2 The accurate identification of the Smith-Peterson interval is vital to minimize unnecessary soft tissue dissection, as well as to avoid injury to nearby structures. It also allows for an internervous approach, between the sartorius muscle (femoral nerve) and the tensor fascia latae muscle (superior gluteal nerve). This has been shown to lead to improved postoperative pain control and decreased length of hospital stay.3 The interval is accessed by incising the fascia over the tensor fascia lata muscle. It is the identification of this muscle that is the key element in ensuring safe exposure of the hip. A comprehensive understanding of the anterior hip anatomy is essential when acquiring exposure to the joint. Anterior mobilization of the femur is necessary for exposure for reaming, broaching, and femoral implant positioning. Specific releases are described in detail by Rodriguez et al,4 which allow the proximal part of the femur and the greater trochanter to be elevated anteriorly in front of the acetabulum with minimal force applied to the femur. The senior author has used the DAA in over 2500 cases to date and has identified 4 constant markers that aid in identifying the Smith-Peterson interval. TECHNIQUE After incision through the skin and subcutaneous fat, the tensor fascia muscle can be identified using the following markers (Figs. 1–3): Lateral to a line drawn from the anterior superior iliac spine to the head of the fibula. Oblique orientation of the muscle fibers running from the anterior superior iliac spine proximally in an inferolateral direction distally. Presence of perforating vessels in the fascia of the tensor fascia lata. Fat streak between tensor and sartorius medially. FIGURE 1: Right hip direct anterior approach. Anatomic landmarks for identifying the Heuter interval. ASIS indictes anterior superior iliac spine; TFL, Tensor fascia lata.FIGURE 2: Once the plane is identified, the fascia overlying the bulk of the tensor fascia muscle is incised and retracted to allow for access to the Heuter Interval.FIGURE 3: Anatomical landmarks for identifying the Heuter interval. The patient consented to clinical photography, available on request. ASIS indictes anterior superior iliac spine; TFL, Tensor fascia lata.Expected Outcomes The Heuter interval can be difficult to identify. However, using these 4 markers can allow surgeons to be confident with their approach. Once identified, the fascia overlying the bulk of the tensor fascia muscle is incised and retracted to allow for access to the Heuter interval and the hip capsule with minimal soft tissue disruption. The steep learning curve to the DAA can be aided by the identification of these markers. COMPLICATIONS The lateral femoral cutaneous nerve","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135895463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-27DOI: 10.1097/bto.0000000000000647
Sofia Marasco, Ross Crawford, Dirk van Bavel
Robotic arm-assisted surgery is becoming more widely used in total hip arthroplasty (THA) to aid surgeons in accurate component positioning. Surgical techniques describe cementless and hybrid THA implantation using robot arm-assisted systems, there is no description of cemented acetabular cup positioning and its use is considered off-label. Cemented THA has undergone technical and component improvement since the 1980s when studies first indicated high rates of loosening.1 Since this time, improved cementing techniques and cross-linked polyethylene cup introduction have demonstrated excellent results and improved survivorship.2,3 The Australian Joint Registry (AOANJRR)4 demonstrated that cemented THA has no difference from hybrid THA and a lower revision rate compared with cementless implants in the short term but with no difference long term. These results are not echoed in all registries as the later introduction of cross-linked polyethylene for cemented acetabular components compared with cementless creates a “polyethylene bias” when trying to interpret results. Since 2017, the AOANJRR has published data excluding non–cross-linked polyethylene articulations. Cemented acetabular cups are indicated for most patients who undergo THA but are particularly relevant for patients with poor quality acetabular bone stock (ie, osteoporosis and inflammatory arthritis or deficiencies that would lead to inadequate cementless fixation and revision of cup arthroplasty). These outcomes are maintained when surgeons maintain technique proficiency. The use of cemented acetabular implants also carries health and economic benefits with cemented implants costing significantly less than cementless acetabular components. The benefits extend into the postoperative period with decreased costs associated with reduced revision rates.5 We describe the surgical technique of cemented acetabular cup placement using the robot arm-assisted MAKO system (Stryker Kalamazoo). This technique is not currently described on the label, but it may be useful for surgeons who would like the benefit of haptic-controlled reaming and navigation of cemented cup implantation, as well as the potential benefits of the virtual range of motion impingement tool. TECHNIQUE Informed consent was obtained from the patient and the institution's ethical approval was obtained. Preoperative planning using the robot arm-assisted system is performed as though an uncemented acetabular component is being used. When the patient is placed in a lateral decubitus position, side support is placed at the sacral promontory and pubic bone, as a support on the anterior superior iliac spine leaves little sterile space between the post and iliac crest pins. (Fig. 1)FIGURE 1: Pelvic post against ASIS and pubic body. Note increased surgical field with post placed at the pubic body (Iliac crest marked with a dotted line and lower border of rib cage with solid line). ASIS indicate Anterior Superior Iliac Spine.Acetabular bone
{"title":"Surgical Technique of Cemented Acetabulum Component Insertion Using Robot Arm-assisted Surgery","authors":"Sofia Marasco, Ross Crawford, Dirk van Bavel","doi":"10.1097/bto.0000000000000647","DOIUrl":"https://doi.org/10.1097/bto.0000000000000647","url":null,"abstract":"Robotic arm-assisted surgery is becoming more widely used in total hip arthroplasty (THA) to aid surgeons in accurate component positioning. Surgical techniques describe cementless and hybrid THA implantation using robot arm-assisted systems, there is no description of cemented acetabular cup positioning and its use is considered off-label. Cemented THA has undergone technical and component improvement since the 1980s when studies first indicated high rates of loosening.1 Since this time, improved cementing techniques and cross-linked polyethylene cup introduction have demonstrated excellent results and improved survivorship.2,3 The Australian Joint Registry (AOANJRR)4 demonstrated that cemented THA has no difference from hybrid THA and a lower revision rate compared with cementless implants in the short term but with no difference long term. These results are not echoed in all registries as the later introduction of cross-linked polyethylene for cemented acetabular components compared with cementless creates a “polyethylene bias” when trying to interpret results. Since 2017, the AOANJRR has published data excluding non–cross-linked polyethylene articulations. Cemented acetabular cups are indicated for most patients who undergo THA but are particularly relevant for patients with poor quality acetabular bone stock (ie, osteoporosis and inflammatory arthritis or deficiencies that would lead to inadequate cementless fixation and revision of cup arthroplasty). These outcomes are maintained when surgeons maintain technique proficiency. The use of cemented acetabular implants also carries health and economic benefits with cemented implants costing significantly less than cementless acetabular components. The benefits extend into the postoperative period with decreased costs associated with reduced revision rates.5 We describe the surgical technique of cemented acetabular cup placement using the robot arm-assisted MAKO system (Stryker Kalamazoo). This technique is not currently described on the label, but it may be useful for surgeons who would like the benefit of haptic-controlled reaming and navigation of cemented cup implantation, as well as the potential benefits of the virtual range of motion impingement tool. TECHNIQUE Informed consent was obtained from the patient and the institution's ethical approval was obtained. Preoperative planning using the robot arm-assisted system is performed as though an uncemented acetabular component is being used. When the patient is placed in a lateral decubitus position, side support is placed at the sacral promontory and pubic bone, as a support on the anterior superior iliac spine leaves little sterile space between the post and iliac crest pins. (Fig. 1)FIGURE 1: Pelvic post against ASIS and pubic body. Note increased surgical field with post placed at the pubic body (Iliac crest marked with a dotted line and lower border of rib cage with solid line). ASIS indicate Anterior Superior Iliac Spine.Acetabular bone ","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135584290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.1097/bto.0000000000000644
Samantha L. Reiss, Peter Zeblisky, Lisa K. Cannada
{"title":"Lose the Big Retractors: Retraction Sutures for Upper Extremity Surgery","authors":"Samantha L. Reiss, Peter Zeblisky, Lisa K. Cannada","doi":"10.1097/bto.0000000000000644","DOIUrl":"https://doi.org/10.1097/bto.0000000000000644","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"83 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85605219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-28DOI: 10.1097/bto.0000000000000643
J. Choi, J. Suh, Tae Hun Song
{"title":"Protective Kirschner Wire Fixation to Reduce the Effect of Lateral Hinge Fracture During the Medial Opening Wedge Low Tibial Osteotomy: A Technical Note","authors":"J. Choi, J. Suh, Tae Hun Song","doi":"10.1097/bto.0000000000000643","DOIUrl":"https://doi.org/10.1097/bto.0000000000000643","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"59 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83557496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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