Instructional course lectures
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Performing hip arthroscopy with the patient in the lateral decubitus position is advantageous in aiding in visualization of the hip joint, in maneuvering instruments in obese patients, and in facilitating entry to the hip joint in patients with spurs on the anterolateral aspect of the acetabulum. The patient is placed in the lateral decubitus position with the hip on which the surgery is being performed on the top. The leg is placed in traction and a well-padded perineal post is applied for countertraction. ⋯ A regular traction table requires adjustments of the perineal and traction posts to apply traction to the leg of a patient in the lateral decubitus position. Special traction devices make setup easier. The lateral approach to hip arthroscopy provides a safe and consistent method of entering, visualizing, and performing surgical procedures on the hip.
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The Smith-Petersen osteotomy has been a mainstay in the treatment of sagittal deformity since it was first described in 1945. The primary indication for an osteotomy is fixed sagittal deformity. When an osteotomy is performed in a patient with ankylosing spondylitis, it can be combined with an anterior column osteoclasis to achieve a correction of up to 40 degrees to 50 degrees. When performed for other indications, the osteotomy can result in approximately 10 degrees of correction per level treated.
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Total hip arthroplasty was originally indicated for older, sedentary patients because of concerns that catastrophic wear and failure would occur in younger and more active patients. With advances in implant design, tribology, and surgical technique, total hip arthroplasty has now become a viable option for younger patients seeking excellent pain relief and improvement in function. Long-term studies are needed to evaluate the outcome of hip arthroplasty in younger patients using the modern generation of implants and bearing surfaces.
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The symptoms associated with lumbar spinal stenosis can decrease quality of life and may cause patients to seek treatment. Except in rare cases of rapid neurologic progression or cauda equina syndrome, nonsurgical modalities should be the initial treatment choice. Activity modification, a variety of medications, epidural steroid injections, and other methods are recommended for pain reduction. ⋯ Arthrodesis, either with or without instrumentation, is also indicated in some patients. Several studies report that surgical treatment produces better outcomes than nonsurgical treatment in the short term; however, the results tend to deteriorate with time. Lumbar decompressive surgery can be complicated by epidural hematoma, deep venous thrombosis, dural tear, infection, nerve root injury, and recurrence of symptoms.
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Unstable pelvic ring injuries in hemodynamically unstable patients are life-threatening emergencies that many orthopaedic surgeons encounter in practice. Therefore, it is important to be up to date regarding current methods of evaluating, assessing, and treating patients with these complex and severe injuries. Surgeons should first determine whether patients have hemodynamic instability and identify the source of the hemorrhage. Patients should then be assessed for stabilization of unstable pelvic ring injuries.