Instructional course lectures
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Comparative Study
Mobile- versus fixed-bearing unicompartmental knee arthroplasty.
Unicompartmental knee arthroplasty using either a mobile- or fixed-bearing technique is an attractive alternative to osteotomy or total knee arthroplasty in selected patients with osteoarthritis. Both techniques appear to yield equivalent early results. ⋯ They also offer the potential for decreased long-term wear complications because of the high conformity of the articulation. The longevity of fixed-bearing components will likely be improved in the future with better prosthetic designs and improved polyethylene to minimize the incidence of late wear complications.
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The absolute number of periprosthetic fractures seen by the orthopaedic surgeon is increasing. The basic principles of fracture management include preoperative patient optimization and determining the stability of the associated components. Loose components require revision, whereas fractures associated with well-fixed implants are generally treated with internal fixation. Although these fractures are challenging to manage, advances in surgical techniques, including the use of locking plates for internal fixation and improved revision systems and biomaterials (such as highly porous metals), offer the surgeon enhanced tools for treating these complex clinical disorders.
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The demand for total hip arthroplasty is increasing, as are patients' expectations to return to high activity levels. Metal-on-metal bearings are being used in an effort to maximize the longevity of primary hip replacements. Acetabular component inclination has been a recognized aspect of surgical technique for more than 20 years; it now is considered critical, especially in hip resurfacing or implantation of a stem-type device with a larger diameter femoral head and a monoblock acetabular component. It is important to understand the indications for using metal-on-metal bearings as well as the key clinical factors for avoiding early implant failure.
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Fractures of the foot and ankle are common injuries that often are successfully treated nonsurgically; however, some injuries require surgical intervention. To restore anatomy and avoid the need for additional surgery, surgeons must pay attention to detail and understand common, avoidable complications. The surgeon should have an understanding of the pathologic characteristics of three common injuries of the foot and ankle as well as the potential complications and their prevention.
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Two factors are primarily responsible for complications after treatment of proximal femoral fractures. First, the strong deforming forces across the hip joint and proximal femur can make fracture reduction difficult. ⋯ In intertrochanteric fractures, lag screw cutout can be prevented by correct implant positioning. In femoral neck fractures, nonunion can be avoided by careful attention to reduction and hardware positioning.