Journal of the American Academy of Orthopaedic Surgeons, The
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Preoperative Planning for Anatomic Total Shoulder Arthroplasty The success of total shoulder arthroplasty is dependent on both proper patient selection and restoration of the native anatomy. After proper patient selection, preoperative planning is essential to select implants that will allow the surgeon to properly restore soft-tissue tension and correct for deformity. Although it is possible to template implants with plain radiographs, these do not allow accurate measurements of the complex three-dimensional anatomy of the glenohumeral joint. CT can be used to further examine version of the glenoid and humerus, as well as humeral head subluxation. Three-dimensional reconstructions also allow for virtual implantation, resulting in a more reliable prediction of implant appearance. Commercial software is available that calculates parameters such as version; however, these have been shown to have variability when compared with measurements obtained by surgeons. Patient-specific instrumentation can also be obtained based on preoperative measurements; however, although it allowed for improved measurements when compared with two-dimensional imaging, there has been no difference in version error, inclination error, or positional offset of the glenoid implant when comparing patient-specific instrumentation with standard instrumentation. Intraoperative navigation can also be used to give real-time feedback on implant positioning; however, additional studies are needed to fully evaluate its benefit.
Journal of the American Academy of Orthopaedic Surgeons, The - - 2022
Survivorship of Anatomic Total Shoulder Arthroplasty Anatomic total shoulder arthroplasty provides pain relief and improved quality of life for patients suffering from glenohumeral arthritis. The 10-year survival rate for these implants has been most recently reported at 96%. As the number of shoulder arthroplasties per year increases, it is important to evaluate factors associated with failure. Patient-specific variables such as age, sex, medical comorbidities, a history of previous shoulder surgery, and rotator cuff integrity can influence implant survival. Both surgeon and hospital volume have been shown to affect perioperative outcomes. Implant design and glenoid pathoanatomy are important structural considerations because both have a causal relationship with survivorship. Modifiable factors, such as smoking, body mass index, and alcohol or opioid consumption, should be addressed preoperatively when possible. Modifiable factors that pertain to surgery are equally as important; it is the responsibility of the surgeon to be aware of the reported outcomes for varying implants and technique-related pearls and pitfalls. For those perioperative factors that are nonmodifiable, it is prudent to counsel patients accordingly because these individuals may be more likely to require an eventual revision procedure.
Journal of the American Academy of Orthopaedic Surgeons, The - - 2022
Saphenous Neuritis: A Poorly Understood Cause of Medial Knee Pain
Journal of the American Academy of Orthopaedic Surgeons, The - Tập 10 Số 2 - Trang 130-137 - 2002
Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Systematic Review
Introduction:
The purpose of this study was to evaluate the current literature on the use of functional knee braces after anterior cruciate ligament (ACL) reconstruction with respect to clinical and in vivo biomechanical data.
Methods:
A systematic search of both the PubMed and Embase databases was performed to identify all studies that reported clinical and/or in vivo biomechanical results of functional bracing versus nonbracing after ACL reconstruction. Extracted data included study design, surgical reconstruction techniques, postoperative rehabilitation protocols, objective outcomes, and subjective outcomes scores. The in vivo biomechanical data collected included kinematics, strength, function, and proprioception. Subjective clinical outcomes scores were collected when available. Quality appraisal analyses were performed using the Cochrane Collaboration tools for randomized and nonrandomized trials to aid in data interpretation.
Results:
Fifteen studies met the selection criteria (including 3 randomized trials [level II], 11 nonrandomized trials [level II], and 1 retrospective comparative study [level III]), with follow-up intervals ranging from 3 to 48 months. Most studies were designed to compare the effects of functional bracing versus nonbracing on subjective and objective results in patients who underwent previous primary ACL reconstruction. Functional bracing significantly improved kinematics of the knee joint and improved gait kinetics, although functional bracing may decrease quadriceps activation without affecting functional tests, range of motion, and proprioception. Four studies reported no differences in subjective outcomes scores with brace use; however, one study reported increased patient confidence with brace use, whereas another study reported decreased pain and quicker return to work when the brace was not used.
Conclusions:
The effectiveness of postoperative functional bracing following ACL reconstruction remains elusive. Some data suggest that functional bracing may have some benefit with regard to in vivo knee kinematics and may offer increased protection of the implanted graft after ACL reconstruction without sacrificing function, range of motion, or proprioception. However, limited evidence exists supporting the use of routine functional bracing to decrease the rate of reinjury after ACL reconstruction.
Journal of the American Academy of Orthopaedic Surgeons, The - Tập 25 Số 3 - Trang 239-249 - 2017
Tarsal Coalition and Painful Flatfoot
Journal of the American Academy of Orthopaedic Surgeons, The - Tập 6 Số 5 - Trang 274-281 - 1998
Surgical Techniques for Total Knee Arthroplasty: Measured Resection, Gap Balancing, and Hybrid Total knee arthroplasty (TKA) is effective in managing end-stage degenerative joint disease. Achieving favorable clinical outcomes is predicated on proper implant alignment, sizing, and rotation as well as adequate soft-tissue balancing. Modern TKA implants are designed to address the fundamental needs of attaining stability in both flexion and extension and of optimizing patellar tracking. Measured resection and gap balancing are the two different techniques used to implant the TKA components used today. Both techniques have been validated as durable and successful, and each has unique advantages and disadvantages. A hybrid technique has been developed that combines the benefits of measured resection and gap balancing and minimizes the limitations associated with both techniques. This hybrid approach has the potential for achieving improved TKA kinematics and refined surgical technique.
Journal of the American Academy of Orthopaedic Surgeons, The - Tập 25 Số 7 - Trang 499-508 - 2017
The Epidemiology of Primary and Revision Total Hip Arthroplasty in Teaching and Nonteaching Hospitals in the United States
Journal of the American Academy of Orthopaedic Surgeons, The - Tập 24 Số 6 - Trang 393-398 - 2016
Extensor Mechanism Failure Associated With Total Knee Arthroplasty: Prevention and Management
Journal of the American Academy of Orthopaedic Surgeons, The - Tập 11 Số 4 - Trang 238-247 - 2003
Anterior Iliopsoas Impingement and Tendinitis After Total Hip Arthroplasty
Journal of the American Academy of Orthopaedic Surgeons, The - Tập 17 Số 6 - Trang 337-344 - 2009
Surgical Treatment of Acetabular Fractures in Elderly Patients With Osteoporotic Bone
Journal of the American Academy of Orthopaedic Surgeons, The - Tập 7 Số 2 - Trang 128-141 - 1999
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