Archives of orthopaedic and trauma surgery
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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
Conventional instruments are more accurate for measuring the depth of the tibial cut than computer-assisted surgery in total knee arthroplasty: a prospective study.
The most commonly used tool for implant positioning are conventional instruments (CI) followed by computer-assisted surgery (CAS). A number of studies have investigated the cutting error of the tibial component when CAS is used, but most of them were focused on the cutting angles. The accuracy of CAS to determine the depth of the cut has not received much attention, even though implications are similar or worse, than with an angle mismatch. ⋯ The results of this study suggest that the tibial cut depth, measured by the navigation, does not match the actual bony cuts performed, even if a perfect cut was achieved in both sagittal and coronal plane. Surgeons should be aware of the measurement error in the navigation system and potentially add an additional step for verifying the achieved depth of the cut.
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Arch Orthop Trauma Surg · Jun 2020
Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union.
This study evaluated the use of a free vascularized bone graft with and without cartilage from the medial femoral condyle (MFC) in patients with recalcitrant scaphoid non-union, with a special focus on union rates and the osteochondral graft for proximal pole destruction. ⋯ The vascularized medial femoral bone graft leads to a good functional outcome in the treatment of scaphoid non-unions. The graft provides adequate blood supply and structural stability to the scaphoid. A proximal pole destruction can be replaced using an osteochondral graft with promising short-term results preventing carpal osteoarthritis and collapse.