Unilateral Technique for Interposition Arthroplasty of the Elbow—A Technical Note
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PROVIDER: S-EPMC10838053 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
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| S-EPMC11329019 | biostudies-literature
Project description:BackgroundInterposition arthroplasty (IA) is one of the oldest reconstructive options for elbow arthritis and is an alternative to total elbow arthroplasty in young active patients with moderate to severe elbow arthritis. In literature there is very little, if any, mention about relationship of post-operative functional recovery and time. In this study we assess the clinical and functional outcome of interposition arthroplasty using abdominal dermal graft.MethodsStudy was conducted retrospective and prospectively during 2014-15 on 18 elbows of 17 patients (10 females and 7 male) which were operated between 2010 and 2015 for elbow arthritis by interposition arthroplasty using abdominal dermal graft by a single surgeon. Etiologically 10 cases were post-traumatic, 4 cases inflammatory joint disease and 4 cases were post-tubercular. All patients were operated using standard kochers approach and above elbow Plaster of Paris were applied in 90° flexion and mid prone position till suture removal i.e. 2 weeks and range of motion (ROM) exercises started. Post-operatively patients were reviewed on 1, 3, 6, 9, 12 months and then yearly. Functional assessments were done using Mayo Elbow Performance Score (MEPS).ResultsThe mean age of the patients were 34.33 years (16 years-50 years) and follow-up duration of median 22 months (minimum 12 months and maximum 50 months). Pre-operative the ROM of the patients were 0°-75° with median value of 25° which were significantly improved to 55°-135° with median value of 120° which was statistically significant with p-value of less than 0.01. Preoperative MEPS were 15-70 with median value of 45 which was improved to 85 to 100 with median value of 95 with p-value less than 0.01. Post-operatively 14 elbows (77.8%) has excellent and 4 elbows (22.2%) has good result. 5 (27.7%) elbow has mild instability and in 3 patients has hypertrophic scar over donor site.ConclusionIt's a very cost effective treatment as compared to total elbow arthroplasty. It provides superior functional outcome than other kind of salvageable procedure like arthrodesis and patient's satisfaction is very high after surgery as pain subsided and range of motion improved. Most of the patients returned to their previous occupation by 6 months after surgery.
| S-EPMC7394806 | biostudies-literature
Project description:Introduction: Revision surgery in the spine poses considerable challenges due to the presence of scar tissue and structural differences, necessitating careful surgical planning and precise techniques. In this technical note, we focus on lumbar unilateral biportal endoscopy (UBE) for single-level reoperations, outlining principles and methods for handling soft tissue in such cases. Materials and Methods: We reviewed our surgical approach for lumbar reoperations with UBE, emphasizing the importance of meticulous preoperative planning and bone-centered manipulation. Our technique involves utilizing biportal endoscopy for enhanced visualization and employing specific strategies for managing scar tissue, including the "pull-and-cut technique." We present two illustrative cases to demonstrate the application of our method. Results: The described approach yielded successful outcomes in both cases presented. Case 1 involved a posterior interlaminar approach for a recurrent disc at the L4-5 level, while Case 2 utilized a far lateral approach for recurrent disc herniation at the L4-5 level. Both surgeries were completed with relatively short operation time, minimal blood loss, and immediate improvement in symptoms postoperatively. Conclusion: Lumbar UBE offers a promising option for safe and effective reoperation in spinal surgery. Our technique, emphasizing bone-centered manipulation and specific strategies for scar tissue management, provides excellent visibility and enables precise tissue handling. Overall, UBE facilitates relatively simple and safe reoperations, contributing to improved patient outcomes in the challenging field of spinal surgery.
| S-EPMC11449562 | biostudies-literature
Project description:A long-term follow-up was made of 12 elbows operated upon between 1971 and 1986, with more than 20 years' follow-up, in nine males and three females, age at the time of surgery between 10 and 19 years . Eight right and four left elbows were involved, and there were three aetiological causes. Seven cases were sequelae of elbow fractures, of which five were supracondylar and two were of the olecranon. There were four cases of juvenile rheumatoid arthritis and one was post-osteomyelitis. The surgical technique involved a modification made by Vainio of MacAusland's technique (wider resection of the osseous ends and total covering of the bloody surfaces) [5, 9]. After extirpating the tissue blocking the joint, we proceeded to remodel the distal humerus in a wide V shape, the proximal end of the ulnar and, if necessary, the radial head. The proximal end of the ulna was sectioned transversely. All surgery was carried out sub-periosteally. Then, an interposition material was placed in one piece and sutured over the distal humerus and cut ends of the ulna and radius. The articular ends were brought together, and the capsule was closed using equidistant stitching, as is the skin. A small compression bandage was applied, and the arm was immobilised with a collar and cuff sling, with the forearm flexed to slightly less than a right angle. In ten cases, the interposition material was fascia lata grafts; in one case, skin graft and in one case, Gelfoam graft. Early rehabilitation began when post-operative pain allowed. Follow-up ranged from 25 to 32 years. Pre-surgical movement ranged between 90 degrees and 120 degrees of flexion and 30 degrees and 90 degrees of extension. Post-operative range varied between 90 degrees and 150 degrees of flexion. The five cases of full pre-operative ankylosis achieved between 90 degrees and 150 degrees of flexion and between 0 degrees and 70 degrees of extension. The total range of motion at the latest follow-up varied from 35 degrees to 150 degrees . Patients who were able to perform flexion of 120 degrees or more were considered to be excellent, those between 90 degrees and 119 degrees were graded good, from 60 degrees to 89 degrees fair and those 59 degrees or less poor. The ability to attain a hand to mouth position requires a mobility of 120 degrees . We obtained excellent results in two patients, good results in three, fair results in four and poor results in three. The fascia lata was used in 83% of cases, obtaining excellent to good results in five patients (41%). Elbow interposition arthroplasty has its indications in children and adolescents where arthrodesis or total joint replacement cannot be performed.
| S-EPMC2269022 | biostudies-other
Project description:The functioning and survival of hip resurfacing arthroplasty depends on correct positioning and alignment of the implant. Correct positioning of the femoral alignment wire with respect to the femoral neck is the key to avoiding complications. Although the surgeon must align the wire in two planes, we can only control one plane at a time without changing position or relying on the indications of an assistant. Independent placement of two parallel alignment wires, one for varus-valgus orientation and another for version orientation, will help to determine two planes, the valgus sagittal plane and the version coronal plane, at the intersection of which both the optimum point of entry into the femoral head and the orientation line of the femoral alignment wire can be established. The marks on the neck and head and Kirschner wires following these marks define the planes. This simple technique allows us to reduce surgery time, minimize errors, and speed up the learning curve. It can be used with any type of resurfacing arthroplasty.
| S-EPMC2744755 | biostudies-other
Project description:Chronic osteomyelitis is difficult to resolve and usually requires radical debridement, filling of dead space, and a well-vascularized tissue to cover the involved bone. In the tibia, this is frequently accomplished with free vascularized muscle transfer and success rates over 90% for cases of limited involvement but lower success for diffuse involvement. Elbow joints, with advanced arthritis but ineligible for total joint replacement, have been treated with interposition arthroplasty and varying degrees of success limited primarily by instability. A 46-year-old male presented with diffuse osteomyelitis of all three bones at the elbow joint and advanced articular destruction from septic arthritis. He had undergone more than ten previous surgeries without resolution of the osteomyelitis or restoration of elbow function over a 2-year period. Radical debridement followed by a latissimus dorsi free muscle flap interposed to the dead space and layered onto the bones as an interposition membrane was able to solve both of his problems. At 3 years postoperatively, there is no evidence of recurrent osteomyelitis, and the patient declares satisfaction with the daily functional performance of his elbow joint.
| S-EPMC2528967 | biostudies-other
Project description:ObjectiveTo report a bone hook reduction technique combined with lateral parapatellar arthrotomy for periprosthetic distal femoral fractures following total knee arthroplasty (TKA).MethodsFrom April 2012 to June 2018, a total of 31 knees who underwent this technique for the treatment of periprosthetic distal femoral fractures following TKA were retrospectively reviewed. Through a lateral parapatellar arthrotomy, the vastus lateralis fascia was dissected from the muscle belly to allow anteromedial mobilization of the muscles. With direct visualization of the posteriorly angulated distal fragment, a bone hook was placed on the anterior flange of the femoral component. The hook was then elevated to correct the posteriorly angulated and shortened distal fragment. The coronal and sagittal alignments of the distal segment with the femoral shaft were confirmed using fluoroscopic images, and internal fixation was performed using an anatomically pre-contoured lateral locked plate. Once the overall length and sagittal plane alignment were restored, the plate was inserted via the previous articular approach. The plate was centered on the femur using anteroposterior and lateral fluoroscopy and then fixed.ResultsA total of 28 patients underwent internal fixation using the bone hook reduction technique combined with lateral parapatellar arthrotomy for the treatment of periprosthetic distal femoral fractures following TKA. The average age at operation was 70.9 years (range, 62-83 years), and the average follow-up period was 17.5 months (range, 12-48.5 months). Fractures were classified as Su type I (13/28 [46.4%]), type II (11/28 [39.3%]), and type III (4/28 [14.3%]). Bone union was confirmed radiographically in all patients.ConclusionThe bone hook reduction technique is a simple and effective method to reduce the distal fragment in periprosthetic distal femoral fractures following TKA.
| S-EPMC9363775 | biostudies-literature
Project description:Open resection arthroplasty of the sternoclavicular (SC) joint has historically provided good long-term results in patients with symptomatic osteoarthritis of the SC joint. However, the procedure is rarely performed because of the risk of injury to vital mediastinal structures and concern regarding postoperative joint instability. Arthroscopic decompression of the SC joint has therefore emerged as a potential treatment option because of many recognized advantages including minimal tissue dissection, maintenance of joint stability, avoidance of posterior SC joint dissection, expeditious recovery, and improved cosmesis. There are, however, safety concerns given the proximity of neurovascular structures. In this article we demonstrate a technique for arthroscopic SC joint resection arthroplasty in a 26-year-old active man with bilateral, painful, idiopathic degenerative SC joint osteoarthritis. This case also highlights the pearls and pitfalls of arthroscopic resection arthroplasty for the SC joint. There were no perioperative complications. Four months postoperatively, the patient had returned to full activities, including weightlifting, without pain or evidence of SC joint instability. One year postoperatively, the patient showed substantial improvements in the American Shoulder and Elbow Surgeons score; Single Assessment Numeric Evaluation score; Quick Disabilities of the Arm, Shoulder and Hand score; and Short Form 12 Physical Component Summary score over preoperative baseline values.
| S-EPMC3986585 | biostudies-literature
Project description:Objective: The objective of this study was to introduce a surgical technique for the percutaneous decompression of cervical stenosis (CS) using a unilateral biportal endoscopic approach and characterize its early clinical and radiographic results. Materials and Methods: Nineteen consecutive patients with CS who needed surgical intervention were recruited. All enrolled patients underwent unilateral biportal endoscopic laminectomy (UBEL). All patients were followed postoperatively for >1 year. The preoperative and final follow-up evaluations included the Japanese Orthopedic Association (JOA) score for neurological assessment, visual analogue scale (VAS) for axial pain and C2-C7 Cobb angle for cervical sagittal alignment. The postoperative complications were analyzed. Results: Thirteen males and six females were included in the analysis. The mean follow-up period was 16.3 ± 2.6 months. The mean operative time was 82.6 ± 18.4 min. Postoperative MRI and CT revealed ideal neural decompression of the treated segments in all patients. Preoperative VAS and JOA scores improved significantly after the surgery, and cervical lordosis was preserved on the postoperative images. Conclusions: UBEL was an effective surgical method for CS, which may also minimize iatrogenic damage to the posterior tension band (PTB) and help to maximize the preservation of the cervical lordosis.
| S-EPMC9965142 | biostudies-literature
Project description:BackgroundThis article introduces a novel open synovectomy technique using an arthroscopy shaver blade to effectively remove intra-articular synovitis during revision surgery for infected primary total knee arthroplasty.Methods (techniques)Open synovectomy is performed using a 4.2-mm arthroscopy shaver blade, and the handpiece is connected to suction drainage. Suction is supplied through the central cylinder of the shaver blade to bring the debrided fragments of soft tissue into the window. Grossly inflamed, reddened, diseased synovium is debrided to reveal yellowish, healthy synovium. The inflamed tissues of the knee joint (suprapatellar pouch, medial and lateral gutters, and peripatellar area) are debrided. Then, with maintaining full flexion of the knee joint, a shaver equipped with a longer bar can be used to easily access the medial and lateral posterior compartments, which are generally difficult to access.ResultsDuring a mean of 13.5-month follow-up, there was no recurrent infection in either group; however, patients who underwent the novel technique improved significantly faster in terms of acute serological markers during the first period.ConclusionsThis technique yielded favorable outcomes compared with the conventional technique. In particular, it may facilitate the approach to the posterior joint space, which is difficult to access.
| S-EPMC8895592 | biostudies-literature