Take a comprehensive deep dive into specific clinical topics.
Our clinical experts disseminate their knowledge to orthopedic surgeons in periodic publications. They include a blend of clinical tips and literature digest to help surgeons keeping up with the current best clinical practice and the research landscape in specific reconstruction topics. Take a comprehensive deep dive into specific clinical topics.
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Volume 9, Number 3 | November 2023
Strategies for the unstable knee after total knee arthroplasty
Etiology, classification, evaluation, and treatment
Total knee arthroplasty (TKA) is a common and successful procedure associated with good outcomes. However, sometimes a patient is not fully satisfied, with pain being a common factor for patient dissatisfaction. One major cause of pain is instability after TKA. Instability is one of the leading causes of revision TKA, yet it is complex to diagnose and treat. In recent years the classification of instability has changed with the addition of midflexion instability, and the types of implants used in both primary and revision TKA have evolved. In this series of articles, Dario E Garin, Hospital Ángeles Tijuana, Tijuana, Mexico, Beatriz Montoya-Ortiz, Clinical Care Center for Joint Replacement at Clínica El Rosario in Medellín-Colombia, and Sam Oussedik, University College Hospital London, London, United Kingdom, will guide us in examining instability after total knee arthroplasty including the etiology, classification, and evaluation of instability as well as current treatment strategies.
Volume 9, Number 2 | July 2023
Total hip arthroplasty in dysplastic hips
Current best practices
Total hip arthroplasty is, in general, a very successful surgery for treating primary end-stage osteoarthritis—with good clinical outcomes, long implant survivorship, and high patient satisfaction. In dysplastic hips, however, due to abnormal bone morphology of the acetabulum and femur and soft-tissue alterations, total hip arthroplasty can be unpredictable and challenging with a potentially high complication rate. In this series of articles, Youn Soo Park and Seung-Jae Lim from the Department of Orthopedic Surgery, Samsung Medical Center, Seoul, South Korea, and Seung Beom Han, Department of Orthopedics, Korea University Medical Center, Seoul, South Korea, will guide us in examining total hip arthroplasty in three types of dysplastic hips: developmental hip dysplasia, infection sequelae, and skeletal dysplasia—descriptions and definitions, current best practices, implant selection, and expected outcomes.
Volume 9, Number 1 | March 2023
Advances in reverse shoulder arthroplasty
Incorporating new techniques and preventive measures in shoulder arthroplasty
Reverse shoulder arthroplasty (RSA) is a viable treatment option for a variety of end-stage degenerative conditions of the shoulder. The clinical success of this technique is partially due to the biomechanical advantages provided by positioning the humerus below a spherical glenoid prothesis. Despite the good implant survival rates associated with this procedure, RSA is not exempt from complications. The complexity of the surgical technique, the impact of the implant design on shoulder biomechanics as well as the appearance of infections are some of the underlying causes of RSA failure. Innovative surgical techniques have recently emerged, such as the lateralization approach or the integration of mixed reality in the operating room. Together with a systematic approach to prevent infection, these strategies are helping the surgeons to improve the clinical success of this treatment, which is the cornerstone of patient satisfaction.
Volume 8, Number 3 | November 2022
Alignment strategies in total knee arthroplasty
Paving the way for more personalized approaches
In recent years, arthroplasty surgeons have acknowledged the large variability of knee phenotypes in the general population. The strategies to correct alignment in the osteoarthritic population cannot continue to be modeled around a 'one-size-fits-all' approach initially developed when the technique emerged. Surgeons should consider a variety of factors and measures in order to determine the optimal alignment technique that fits the patient's native alignment, and even develop personalized treatment and implants to do so. Advances in robotic-assisted surgery and personalized patient implants and cutting guides are revolutionizing the way surgeons perform surgery and clearly allows them to target the needs of their patients.
Volume 8, Number 2 | August 2022
The posttraumatic knee
Tackling the complex total knee arthroplasty
Traumatic joint injury and periarticular fractures can trigger instability or overall malalignment resulting in overload of cartilage and successive progressive osteoarthritis, which can cause significant challenges for a surgeon to treat. Patients with posttraumatic osteoarthritis of the knee are often young and active adults and therefore have higher expectations and demands on their joint replacement. However, these surgeries are more complex in nature and are at risk for worse postoperative outcomes than total knee arthroplasty for primary osteoarthritis. Surgeons therefore need a systematic approach to plan the surgery and carefully communicate realistic expectations to the patient. In addition, they have to select the appropriate implant, guide the patient through the often more challenging rehabilitation, and ultimately, prepare for possible revision surgeries down the road. This series provides the knowledge necessary to tackle these often challenging surgeries.
Volume 8, Number 1 | April 2022
Short stems in primary total hip arthroplasty
Not all short stems are created equal
Short-stem total hip arthroplasty (THA) promises easier future revision, better bone stock preservation, reduced stress shielding, and has become increasingly popular. Especially in patients younger than 55 years of age, where the probability of a future revision is a real risk, the advantage of a bone-preserving primary THA may mean that younger patients would not have to delay their primary THA for fear of future revisions. Although excellent short- to midterm results have been reported after short-stem THA, one should bear in mind that the outcomes may be applicable only to the specific short stems being studied.
Volume 7, Number 3 | November 2021
Common modifiable risk factors in total joint arthroplasty
A 2021 information update
Total joint arthroplasty (TJA) is overall an effective treatment. After TJA, most patients regain good functionality and have improved quality of life. However, adverse events such as wound complications and periprosthetic joint infections can be costly, resulting in devastating consequences, and may even lead to death. To reduce postoperative complications and improve the outcome after TJA, some modifiable patient-related risk factors have been intensely discussed lately, such as diabetes, obesity, and smoking.
Volume 7, Number 2 | July 2021
Metaphyseal fixation in revision total knee arthroplasty
Looking at the evidence
The numbers of patients undergoing total knee arthroplasty (TKA) is steadily on the rise. As a logical consequence, there is also a rise in the frequency of revision TKAs. One of the most important challenges to be addressed in revision TKA is bone loss. The quantity and quality of the remaining bone stock practically dictates the options for implant anchorage. With the ultimate aim to preserve as much bone as possible, metaphyseal fixation often becomes the method of choice.
Volume 7, Number 1 | March 2021
Extensor mechanism problems after total knee arthroplasty
Why they arise and how to deal with them
In spite of the good prosthesis survival rates and clinical outcomes after TKA nowadays, significant impairment can ensue from complications related to the extensor mechanism like patellofemoral instability, patellar fractures, and extensor tendon ruptures.
As failure mechanisms are manifold, so are the corresponding treatment modalities. Identifying the individual failure mode is essential to select the appropriate treatment mode for the individual patient, which is the basis for a satisfactory outcome.
Volume 6, Number 3 | December 2020
Periprosthetic fractures after hip replacement
Achieving the best outcome—pitfalls to avoid and practices to adhere to
Surgical treatment of periprosthetic femoral fractures (PPFF) is a challenging task. Understanding individual patients’ injury histories and needs, correct diagnosis, presurgical preparation, and optimal implant selection are all part of the equation leading to good outcomes. Best patient outcomes can be achieved through a patient-centered approach and a close look at the latest findings in this very dynamic research area.
Volume 6, Number 2 | September 2020
Unicompartmental knee arthroplasty (UKA)
Treating single compartment knee osteoarthritis—options and observations
Unicompartmental knee arthroplasties (UKAs), also known as partial knee arthroplasties, can achieve outcomes and survivorship comparable to those of total knee arthroplasties (TKAs) and high tibial osteotomies (HTOs). Indications and counterindications, procedure volume considerations, and thresholds for revision are constantly being reassessed, based on increased data on reported patient outcomes. Proper patient selection remains critical to achieve good results.
Volume 6, Number 1 | July 2020
Computer-assisted surgery (CAS)
The evolution of CAS and what the future might hold for us
Robotic surgery, computer-assisted navigation, and personalized instrumentation and implants are no longer science fiction: Many institutions already use some of these technologies for precision and planning support. Computers can calculate basic operations 10 million times faster than the human brain. Will they eventually replace orthopedic surgeons in the operating room?
Volume 5, Number 2 | November 2019
Periprosthetic joint infection (PJI)
The growing risk of PJI and how to manage it
Did you know that dragonflies have a nanoscale surface pattern on their wings that prevents microorganisms from attaching to them? Researchers are studying this phenomenon, together with other innovative avenues, to advance the options available in the prevention, diagnosis, and treatment of periprosthetic joint infection (PJI). Here we consider the nuances and difficulties that surgeons encounter when dealing with deep infection in their arthroplasty patients. Expert surgeons, Olivier Borens and Andrej Trampuz, provide valuable commentary and insights about the strategies available to address PJI.
Volume 5, Number 1 | April 2019
Positioning of the acetabular component
Acetabular cup positioning—a patient-specific approach
Let us take a close look at the multi-factorial considerations in accurate acetabular cup placement during total hip arthroplasty (THA). This is a challenging aspect of the procedure as it requires knowledge and visualization of anatomy and component position in three dimensions, amongst other things. Understanding each patient’s unique kinematics and structure, screening for spinal and/or other comorbidities, and careful pre-operative planning all play an important part in providing a personalized procedure and positive outcome for patients.
Volume 4, Number 1 | March 2018
Gap balancing versus measured resection in TKA
Evidence for/against the techniques, and comparison
Which is the better technique to deliver superior patient outcomes? Will the soft tissue tensioning method of gap balancing deliver accurate femoral component rotation in TKA? Or is measured resection the superior technique to achieve this? We look at the pros and cons of both approaches, weigh the evidence, and determine whether there is a best path through this debate.
What do two practicing surgeons think about the question of gap balancing versus measured resection? We spoke to Philipp von Roth from the Charité – Universitätsmedizin Berlin (DE), and Matthew Abdel from the Mayo Clinic in Rochester, Minnesota (US). They share their perspectives and make some educated guesses about the future.
Volume 3, Number 1 | December 2017
Limb-length discrepancy in THA
Prevention, management, and dysplasia patients
A recognized and common complication of total hip arthroplasty (THA) is limb-length discrepancy (LLD). (Incidentally, this problem is the number one reason for litigation against orthopedic surgeons in the US). But there are actions surgeons can undertake to minimize leg-length issues, with prevention being at the top of the list.
Through patient evaluation/education, preoperative templating, and intraoperative assessments, strategies can be employed to lessen the risk of LLD. This three-part article series looks at the prevention and management of LLD after THA and gives special consideration to the challenges associated with the dysplastic hip.
Volume 2, Number 1 | December 2016
Risks, tools for diagnosis and surgical strategies
The last thirty years have seen many advances in the field of orthopedic medicine. The introduction of a modular taper joint for use in hip arthroplasty was embraced by surgeons for its intraoperative flexibility. However, it's been discovered that the modular taper is prone to corrosion and linked to problems such as pain, instability, pseudotumors, poor outcomes, increased revision rates, and higher rates of mortality.
Compounding the problem is the fact that researchers have not yet been able to reproduce the problem experimentally, which makes it a challenge to systematically understand the roles of contributing factors. This three-part article series on taper corrosion provides some background, looks at criteria to guide a diagnosis, as well as some points to consider when surgical intervention is under discussion.
Volume 1, Number 1 | December 2015
The Asian knee
Special surgical considerations
Increasing evidence of race-related anatomical differences is adding a level of complexity when performing total knee replacement (TKR) on Asian patients. Many of the current prosthetic options are developed using Caucasian anatomical data, which could be leading to a less-than-ideal fit and poor device performance.
In this three part article series we examine cultural demands and expectations for TKR, and some of the documented anatomical differences and surgical considerations that are unique to the Asian-Pacific region.