Debridement, Antibiotics, and Implant Retention for an Early Periprosthetic Infection After Unicompartmental Knee Arthroplasty: A Technical NoteEarly periprosthetic joint infection in unicompartmental knee arthroplasty (UKA) is shown to have a detrimental effect on the success of UKA surgery not only because of the sequences of the infection but also due to the other healthy lateral compartment. It is well known that Oxford meniscal bearing UKA is a very precise procedure that the use of any excessive force may have an injurious effect on the future prosthesis stability with a higher risk of bearing dislocation. This technical note aims at describing how to deal with a case of early periprosthetic joint infection in a female patient who underwent debridement, wash, implant retention and change of the mobile bearing insert including the demonstration of a difficult step during this procedure.
Direct Anterior Cup-Half Cage for Revision and Complex Primary Total Hip Arthroplasty: Surgical TechniqueAs surgeons' comfort with the direct anterior approach (DAA) for total hip arthroplasty continues to increase, there is a growing interest in performing complex surgeries through this approach. Acetabular bone loss and/or pelvic discontinuity in the primary or revision setting often requires specialized implants such as a cup-cage construct. We describe our surgical technique for implanting modified cup-half cages through the DAA and show 2 case examples of how this technique was utilized in the setting of complex acetabular bone loss.
Utilizing a Prefabricated Antibiotic-Impregnated Articular Spacer Combined With an Intramedullary Device for Significant Femoral Bone Loss in Periprosthetic Hip InfectionPeriprosthetic joint infection can be a devastating complication following total hip arthroplasty, which often requires a lengthy treatment course that is fraught with complications. There are various types of antibiotic-impregnated spacers that can be used to treat periprosthetic hip infections, with articulating spacers being utilized frequently with the goal of preserving patient range of motion and functionality. Many of these articulating spacers have pre-set sizes and stem options, which accommodate the majority of patients.
Tibial Tubercle Screw Fixation on Custom Metaphyseal Cone: Surgical Tip in Severe Metaphyseal Tibia Bone LossTibial tubercle osteotomy (TTO) facilitates exposure in knee arthroplasty revision. However, it comes with complications, especially if it invades the intramedullary canal. Most revisions are characterized by compromised femur and/or tibia bone stock, and the use of metaphyseal cones or sleeves for implant fixation has become increasingly frequent. Several methods of fixation of the tibial tubercle have been proposed, such as screw fixation, cerclage wiring, and suture repair. Despite screws providing the strongest fixation for TTO, their placement around a tibial intramedullary stem or a metaphyseal tibial cone may be difficult.
Flip Autograft Technique for Anterolateral Femoral Deficiency in Total Knee ArthroplastyAnterolateral bone loss of the femur within the trochlear groove presents a unique and rare issue in primary total knee arthroplasty (TKA). Unlike distal and posterior femur bone loss for which most contemporary TKA systems have modular augments, the same does not exist for anterolateral bone loss. We present a technique in which a patient’s host bone from the standard distal femoral cuts was used to augment and provide a stable base for cementing of final femoral implants. Currently, the patient has 3-year follow-up with excellent results in terms of pain control with no evidence of component failure on the most recent radiographs.
Computer-Aided Surgery-Navigated, Functional Alignment Total Knee Arthroplasty: A Surgical TechniqueThe decision on which technique to use to perform a total knee arthroplasty has become much more complicated over the last decade. The shortfalls of mechanical alignment and kinematic alignment has led to the development of a new alignment philosophy, functional alignment. Functional alignment uses preoperative radiographic measurements, computer-aided surgery, and intraoperative assessment of balance, to leave the patient with the most “normal” knee kinematics achievable with minimal soft-tissue release.
A Modified Surgical Technique of Patellar Tendon Reconstruction in Total Knee Arthroplasty Using Achilles Tendon AllograftPatellar tendon disruption is one of the most dreaded complications after total knee arthroplasty (TKA) impacting joint function and implant longevity. Management of this condition remains controversial, and no one treatment has provided consistent clinical success. Here we propose a modified technique from the standard Achilles allograft procedure to reconstruct a ruptured patellar tendon after TKA. A fresh-frozen Achilles tendon allograft with attached calcaneal bone graft was used. Our technique offers the advantage of a more stable graft fixation by relying on both quadriceps tendon and transosseous patellar fixation and bone-to-bone allograft fixation to the tibial tuberosity.
Development of a Self-made Cement Bead Maker and Its Clinical Application for the Treatment of Periprosthetic Joint InfectionAntibiotic-loaded acrylic cement beads have a large surface area and excellent sustained-release properties. However, there are some difficulty manufacturing reasonably sized beads and their careful handling. We developed a self-made cement bead maker using a mold of a sphere with a diameter of 8 and 10 mm with a 2-mm-diameter connecting hole. With this instrument, approximately 32 beads can be made from 40 g of bone cement. We clinically applied this technique to 11 cases of periprosthetic joint infection.
Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee ArthroplastyThe tibial joint line is offset posteriorly relative to the tibial sagittal anatomic axis. This can have consequences when using stemmed implants during total knee arthroplasty. We retrospectively analyzed native knee lateral radiographs in 100 patients. The distance between the sagittal anatomic axis and the center of a simulated tibial resection was calculated as a percentage of overall tibial width. Analysis of 5 manufacturers’ baseplates showed that the tibial stem attached on average 10% anterior to the midline.
Modular Total Femur Replacement for Staged Total Femur ReplacementAs the numbers of arthroplasties performed worldwide increase, so do complications such as prosthetic joint infection. Cases that require a two-stage revision of a total femur replacement in the femur pose an ongoing challenge to the modern orthopedic surgeon. Unlike antibiotic spacers in hip and knee arthroplasty, there lacks a commercially available cement spacer for use in total femur replacements. We describe a novel technique for the intraoperative fabrication of a total femur spacer which uses modular components.
Removing Well-Fixed, Collared and Noncollared Tapered Hip Stems Without an Extended Trochanteric Osteotomy Using a Novel Stem Removal SystemImprovements in materials, components, and surgical techniques in cementless total hip arthroplasty are resulting in improved femoral stem fixation through bony ongrowth or ingrowth. While improved femoral stem fixation is one reason for the current excellent total hip survivorship, indications for stem removal such as infection, implant fracture, or osteolysis remain. A commonly used technique for fully ingrown femoral stems is an extended trochanteric osteotomy which can result in comminuted fractures of the proximal femur during stem removal requiring additional fixation.
A Modified Technique for Artificial Fusion in Unreconstructable Revision Total Knee ArthroplastyKnee arthrodesis is an acceptable treatment that leads to a stable joint with a lower rate of recurrence of infection in periprosthetic joint infections. One of the major problems in some revision cases is the bone loss that interferes with the bony union; therefore, some studies suggest artificial arthrodesis, which does not require bony union. The present descriptive retrospective study was conducted by reviewing the medical records of patients with periprosthetic joint infection complications.
Saddle to Incision Relationship: A Novel Approach to Localizing the Incision for Direct Anterior Hip ArthroplastyThe direct anterior approach for total hip arthroplasty has grown in popularity over the last decade. Incision for this approach is often based on a standardized distance from the anterior superior iliac spine. Despite this method, wound complications remain a known complication during direct anterior approach. We describe a simple and reproducible technique using fluoroscopy to identify the incision during direct anterior total hip arthroplasty. This method allows for accurate placement of incision while adding only a minimal amount of time to the procedure.
Surgical Technique of a Cement-On-Cement Removal System for Hip and Knee Arthroplasty Revision SurgeryCement removal during hip or knee arthroplasty revision surgery is technically demanding and prone to severe complications such as periprosthetic fractures, incomplete cement removal, or perforations. Several alternative techniques have been developed to enable complete, accurate, and safe removal of cement from bone, including osteotomies and cortical windows, endoscopic instruments, ultrasound devices, lithotripsy, and laser-assisted removal. We describe a cement-on-cement technique with a sterile, single-use tool for cement removal.
Safety and Efficacy of Using Fracture Tables for Prosthetic Hip DislocationsThe incidence of prosthetic hip dislocation continues to increase because of the overall increase in volume of total hip replacement surgery. Closed reduction is often the preferred treatment, particularly in the first few months after surgery. No matter the closed reduction technique, linear traction is a requirement, thus posing a physically demanding stress opening both surgeon and patient to potential injury. We describe a fracture table closed reduction technique along with outcomes and safety data for a sample of patients.
Conversion of Hip Arthrodesis Using Robotic Arm TechnologyRecent advancements in computer-assisted surgery have led to a renewed interest in robotic-assisted hip arthroplasty. This technology assists with component position which is especially useful in prior trauma or dysplasia cases. We present a case of a surgical hip fusion conversion to total hip arthroplasty with the use of robotic-assisted technology. Enhanced preoperative planning with the ability to manipulate implant position before execution can be invaluable during complex procedures. Further research is warranted before revision cases using computerized navigation systems becomes more prevalent.
Technical Note for Transfemoral Implantation of Tapered Revision Stems. The Advantage to Stay ShortThe aim was to test the hypothesis that during transfemoral implantation of a conical revision stem, the fixation of the stem at the distal tip leads to a low rate of periprosthetic fractures.
Use of Fulcrum Positioning as a Balancing Tool During Total Knee Arthroplasty on a Robotic PlatformTotal knee arthroplasty is a common procedure performed to improve pain and dysfunction attributed to arthritis, yet postoperative patient dissatisfaction rates remain relatively high. Patient satisfaction and outcomes have been linked to successful joint gap balancing in the coronal and sagittal planes intraoperatively. In previously described balancing techniques, the fulcrum used for alignment changes is customarily centered on the intramedullary axis generating symmetric changes in medial and lateral gaps.
Complex Primary Total Hip Arthroplasty: Small Stems for Big ChallengesTotal hip arthroplasty is one of the most successful operations in all of medicine. Femoral deformities from malunion, prior osteotomy, and retained surgical implants all present unique challenges. Corrective osteotomy and hardware removal add significant morbidity to an operation that typically has a fast recovery. Short stems can be used in these cases to spare patients' increased morbidity. We present a case-based illustration and surgical technique for the use of short stems in complex primary total hip arthroplasty with femoral deformity and retained hardware.