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Surgical Technology International XXV contains 41 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

 

Oct, 2014 - ISSN:1090-3941

 

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Orthopaedic Surgery

 

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Second-Generation Annealed Highly Crosslinked Polyethylene has Low Wear at Mean Seven Year Follow-up
James A. D’Antonio, MD, Orthopaedic Surgeon, Greater Pittsburgh Orthopaedics Association, Moon Township, PA, William N. Capello, MD, Professor of Orthopaedics, Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, J. Wesley Mesko, MD, Orthopaedic Surgeon, Michigan Orthopedic Center, Lansing, MI, Rama Ramakrishnan, MS, Corporate Engineer, Stryker Orthopaedics, Mahwah, NJ

PMID: 25433177

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Abstract

First-generation once annealed highly crosslinked polyethylene (HXLPE) has perfomed well for over 10 years but the presence of free radicals remain a concern. A second-generation sequentially annealed HXLPE was developed to further reduce wear, maintain mechanical strength, and enhance oxidative resistance. The primary objective of this study was to determine if a second generation HXLPE has low linear wear at mean seven years follow-up without evidence of osteolysis or bearing surface failure. In a prospective study, 118 cases have five year and 43 cases have seven year data. The linear head penetration rate was measured at six weeks, yearly through five years, and at seven-plus years. Radiographic evaluation found linear wear of 0.015mm/yr at mean seven years. No osteolysis has been found and no revisions for bearing surface failure have occurred. This second-generation annealed highly crosslinked polyethylene has a low wear at seven years’ follow-up with no osteolysis or other bearing surface related complications.

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Polymer Cable/Grip-Plate System with Locking Screws for Stable Fixation to Promote Healing of Trochanteric Osteotomies or Fractures in Revision Total Hip Arthroplasty
Keith R. Berend, MD, Surgeon Partner, Joint Implant Surgeons, Inc., New Albany, Ohio, Clinical Assistant Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, Attending Surgeon, Mount Carmel Health System, New Albany, Ohio, Jacob L. Willen, BS, Research Intern, Joint Implant Surgeons, Inc., New Albany, Ohio, Medical Student, The University of Tolado College of Medicine and, Life Sciences, Toledo, Ohio, Michael J. Morris, MD, Surgeon Partner, Joint Implant Surgeons, Inc., New Albany, Ohio, Attending Surgeon, Mount Carmel Health System, New Albany, Ohio, Joanne B. Adams, BFA, Research Director, Joint Implant Surgeons, Inc., New Albany, Ohio, Adolph V. Lombardi, Jr., MD, FACS, President, Joint Implant Surgeons, Inc., Clinical Assistant Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, Attending Surgeon, Mount Carmel Health System, New Albany, Ohio

PMID: 25398403

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Abstract

Multiple methods have been proposed to establish stable fixation to promote healing of trochanteric osteotomies or fractures in revision total hip arthroplasty (revTHA), from wiring techniques through cable-plate systems with or without supplemental locking screws. The purpose of this study is to report the clinical results of a single cable-plate system with locked screw fixation in revTHA. Between 2009 and 2012, 27 grip-plates (Supercable® System, Kinamed Inc., Camarillo, CA) were used in 26 patients in 27 revTHA procedures. Utilization was 12 1-hole (50 mm) grip-plates, 10 2-hole (135 mm) grip-plates, four 4-hole (190 mm) grip-plates, and one 6-hole (245 mm) grip-plate. There were 14 women and 12 men. Age averaged 63.2 years and BMI averaged 29.4 kg/m2. At average 2.5 year follow-up, grip-plate fixation was considered successful in 22 hips (81%) with five failures. Three failures consisted of 50 mm/short grip-plates used in one trochanteric slide, and two intraoperative trochanteric fractures during revTHA. The two additional failures were related to pre-revision trochanteric avulsion from bony necrosis of the proximal femur. An additional three grip-plates were removed electively for soft-tissue irritation and pain but with successful fixation and bony healing. Thus 70% of hips were free of reoperation related to the grip-plate. All other hips had successful fixation and the grip-plate was not symptomatic. In this study, the cable-grip system and isoelastic Supercables provided reliable fixation for adequate healing of difficult ETO and trochanteric fractures with an 81% rate of mechanical success with radiographic and clinical healing observed.

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Thrombosis Prevention in Lower Extremity Arthroplasty: Mobile Compression Device or Pharmacological Therapy
Clifford W. Colwell Jr., MD, Medical Director and Shiley Chair of Orthopaedic Research, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA

PMID: 25433153

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Abstract

Venous thromboembolic (VTE) events, either deep vein thromboses (DVT) or pulmonary emboli (PE), are important complications in patients undergoing knee or hip arthroplasty. Symptomatic VTE rates observed in total joint arthroplasty patients using the mobile compression device with home use capability were non-inferior to rates reported for pharmacological prophylaxis, including warfarin, enoxaparin, rivaroxaban, and dabigatran. Major bleeding in total hip arthroplasty was less using the mobile compression device than using low molecular weight heparin. A cost analysis demonstrated a cost savings based on decreased major bleeding. Use of a mobile compression device with or without aspirin for patients undergoing total joint arthroplasty provides a non-inferior risk for developing VTE compared with current pharmacological protocols.

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Bone Grafts as Carriers for Local Antibiotic Delivery for the Treatment and Prevention of Bone Infections
Fani Lalidou, BSc, MSc, Postgraduate Student in Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece, George Kolios, MD, PhD, Professor of Pharmacology, Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece, Anna Tavridou, PhD, Associate Professor of Pharmacology, Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece, Georgios I. Drosos, MD, PhD, Assistant Professor of Orthopaedics, Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece

PMID: 25433347

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Abstract

Osteomyelitis is a bone infection accompanied by inflammatory process, which can lead to destruction and bone necrosis. It is difficult to manage, and there are no commonly accepted guidelines. While most acute bone infections are usually successfully treated with intravenous antibiotics, chronic infections and infections in the presence of foreign materials usually require operative treatment with debridement, removal of metals, intravenous antibiotics, and very often local antibiotics. The aim of this study was to perform a systematic review of the existing literature concerning the use of bone grafts as carriers for local antibiotic delivery for the treatment and prevention of bone infections. According to the literature, antibiotic-loaded autologous bone grafts for the treatment of infected tibial nonunion is a good option (Grade-B recommendations). Although there are several studies concerning the use of antibiotic-loaded allogenic bone grafts in infected joint arthroplasty revisions, there is a lack of comparative studies (Grade-C recommendations). Studies concerning spinal fusion and spondylodiscitis are limited (Grade-I recommendations).

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Cement Extractor Device in Revision Prosthesis of the Humerus
Stefano Giannotti, MD, Specialist in Orthopaedics and Traumatology, Vanna Bottai, MD, Specialist in Orthopaedics and Traumatology, Giacomo Dell’Osso, MD, Specialist in Orthopaedics and, Traumatology, Giulia Bugelli, MD, Resident in Orthopaedics and Traumatology, Giulio Guido, MD, PhD, Ordinary Professor of Orthopaedics and, Traumatology, IInd Orthopaedic and Traumatologic Clinic, University of Pisa, Pisa, Italy

PMID: 25433154

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Abstract

In revision arthroplasty the surgeon is often faced with the problem of removal of residual cement in the medullary canal. Conventional manual cement removal by hand or power-driven instruments can be time-consuming, can require osteotomy, and can be associated with complications such as cortical perforation, fracture, or bone loss. Ultrasonic devices offer an alternative method of cement removal, but the potential for thermal injury exists, in particular for the humerus and the radial nerve. Considering these problems with the use of ultrasound, and whereas the old cement mantle may be left in place in the hip or knee but not in the shoulder, we tried this new mechanical cement extractor also in the humerus. We utilized this extractor in 5 cases, and we eliminated all residual resin in an accurate and complete way without bone loss and without iatrogenic fractures in all cases. We believe this system, which was designed for revisions of hip and knee surgery, is also suitable for the shoulder.

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An Open-label, Single-center, Retrospective Study of Cryopreserved Amniotic Membrane and Umbilical Cord Tissue as an Adjunct for Foot and Ankle Surgery
Meredith Warner, MD, MBA, Warner Orthopedics and Wellness, Baton Rouge, Louisiana, Orthopedic Surgeon, Woman’s Hospital, Baton Rouge General Hospital, Baton Rouge, Louisiana, Lukas Lasyone, BA, Medical Student, Tulane University Medical School, New Orleans, Louisiana

PMID: 25396324

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Abstract

The primary aim of this study was to compare preoperative assessments with postoperative outcomes from patients undergoing foot and ankle revisions and/or complex reconstructions with tendon and/or nerve involvement using cryopreserved human amniotic membrane and umbilical cord (cHAM/UC). We hypothesized complex foot and ankle surgery using amniotic membrane would be an effective treatment leading to reduced pain and improved functional outcomes. Fourteen patients (6 male and 8 female) underwent open foot and ankle surgery during the study period. All 14 patients included in this cohort reported improvement, namely, lessened pain intensity both on the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and the pain numeric rating scale (NRS), as well as improved functional status. The mean AOFAS score improved from 50 (range, 17–79) preoperatively to 85 (range, 67–100) postoperatively. The mean NRS score also improved from 8 (range, 4–10) preoperatively to 2 (range, 0–6) postoperatively with a mean percent change in pain NRS of 78% (range 17–100%). Both outcome-scoring systems showed statistically significant differences (p < .0001) when we compared the preoperative and postoperative results. All patients included in the cohort showed improvement in both outcome measures. Further study of long-term endpoints is warranted.

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Safety Analysis of Cryopreserved Amniotic Membrane/Umbilical Cord Tissue in Foot and Ankle Surgery:  A Consecutive Case Series of 124 Patients
Shyler L. DeMill, DO, Attending Physician, Orthopedics Northwest, Yakima, Washington, Jaymes D. Granata, MD, MBA, Attending Physician, Orthopedic Foot and Ankle Center, Westerville, Ohio, Jeffrey E. McAlister, DPM, AACFAS, Attending Physician, The CORE Institute, Sun City West, Arizona, Gregory C. Berlet, MD, Fellowship Director, Advanced Orthopedic Foot & Ankle Fellowship, Orthopedic Foot and Ankle Center, Westerville, Ohio, Christopher F. Hyer, DPM, MS, FACFAS, Fellowship Director, Advanced Foot & Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center, Westerville, Ohio

PMID: 25396325

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Abstract

Cryopreserved amnion tissues derived from amniotic membrane/umbilical cord (AM/UC) have been used extensively in ophthalmology for minimizing postoperative inflammation, pain, and adhesion formation following various surgical procedures. There is limited data in the current literature regarding the use of amnion tissue product in foot and ankle surgery. The purpose of this retrospective study is to report the short-term safety profile after in vivo application of cryopreserved AM/UC tissue use in foot and ankle surgery. A retrospective consecutive case series was performed for cases where amnion tissue was used with a minimum follow-up of 120 days between 2011 and 2012. The clinical outcomes of interest were postoperative infections, delayed or nonhealing wounds, adverse surgical site reactions, and repeat surgery for formal irrigation and debridement. One hundred twenty-four patients qualified for inclusion. Cryopreserved AM/UC tissue was introduced into the surgical wound and placed adjacent to the compromised and repaired tendons, most frequently in peroneal and Achilles tendon repairs. In this level IV consecutive case series cohort, there was an overall wound complication rate of 5.64%, with a re-operation rate of 1.6% (2/124). In each of these cases, patients had an irrigation and debridement with ultimate successful wound healing. The results of this study demonstrate that the use of amnion tissue in the foot and ankle setting is safe with a decreasing trend in overall complication rates compared with historically published norms.

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