Name: treatment of ankle osteoarthritis with total ankle replacement through a lateral transfibular approach
Uploaded: 2018-01-24T14:00:00.000+00:00
Duration: 9 min 1 s
Description: Watch this Scientific Journal Video about Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach at JoVE.com

The procedures are performed using the Zimmer Trabecular Metal Total Ankle prosthesis (Zimmer, Warsaw, IN).

All methods described have been approved by our institutional review board and the local ethics committee and they have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
1. Preoperative Radiographic Evaluation
<ol>
	<li>Perform weight bearing radiographs of the ankle and the foot with antero-posterior, lateral, and rearfoot alignment views (Saltzman&#39;s view30).</li>
	<li>Perform a conventional computed tomography (CT) of the ankle and request any other diagnostic exams (such as magnetic resonance), if necessary, to better clarify the diagnosis.</li>
	<li>Measure the following parameters on the preoperative weight-bearing radiographs.
	<ol>
		<li>Measure the anterior distal tibial angle (ADTA, normal value 83.0 &#177; 3.6 &#176;) on the lateral ankle view: measure the angle between the anatomic axis of the tibia and the line connecting the distal points on the anterior and posterior edge of the tibial articular surface (Figure 1)30,31.</li>
		<li>Measure the lateral distal tibial angle (LDTA, normal value 89.0 &#177; 3.0 &#176;) on the anteroposterior ankle view: measure the angle subtended between the anatomic axis of the tibia and the line connecting the distal points on the medial and lateral edge of the tibial articular surface (Figure 2)32,33,34.</li>
		<li>Measure the tibio-talar ratio (TT ratio, normal value 34.8 &#177; 3.8%): measure this parameter on the lateral ankle view; it is the ratio between the posterior longitudinal talar length (the length between the posterior talar edge and the intercept of the anatomical tibial axis) and the full longitudinal talar length (Figure 1)33,35,36.</li>
		<li>Measure the tibio-talar surface angle (normal value 89.0 &#177; 2.6 &#176;) on the anteroposterior ankle view: measure the angle between the anatomic axis of the tibia and the line connecting the proximal point on the medial and lateral talar articular surface (Figure 2)37.</li>
	</ol>
	</li>
	<li>Use the CT to assess the available bone stock and to evaluate the severity of the avascular necrosis of the talus, if present.</li>
</ol>
2. Surgical Technique17
NOTE: This procedure is performed under general or regional anesthesia (spinal anesthesia).
<ol>
	<li>Place the patient in the supine position with a rigid board under the leg to sustain the alignment stand. Position a thick pad under the ipsilateral hip. Do not use a tourniquet.</li>
	<li>Make a longitudinal incision with a scalpel over the lateral malleolus that curves under its tip toward the sinus tarsi (Figure 3). Dissect the fibula and the anterior side of the tibia subperiosteally with the scalpel and the periosteal elevator to obtain a complete view of the osteophytes and the joint.</li>
	<li>Release the posterior capsule of the tibia and the fibula using a periosteal elevator.</li>
	<li>Make an oblique lateral malleolus osteotomy with a sagittal saw blade: begin from the posterior edge of the fibula, 6-7 cm proximal to the joint line; end on the anterior side of the fibula, 2 cm proximal to the joint line. Rotate the fibular malleolus distally and use a 1.6 mm K-wire to fix it to the calcaneus.</li>
	<li>Remove the anterior osteophytes with the sagittal saw blade and a rongeur until the ankle can be easily placed in a neutral position. 
	NOTE: The medial gutter release can be performed later during the tibial preparation.</li>
	<li>Measure the medial/lateral talar width with the manufacturer&#39;s sizer, choosing the largest size possible while avoiding overhang.</li>
	<li>Place the leg in the alignment stand that is assembled at the beginning of the procedure.</li>
	<li>Internally rotate the foot and use the trans-calcaneal pin to fix it to the foot plate. Use the 4.0 mm pin to fix the talus to the footplate: put the pin as distal as possible in the talar neck, thus facilitating further correction of talar tilt.</li>
	<li>Check the tibial alignment with fluoroscopy using a bar that is parallel to the mechanical tibial axis. Use fluoroscopy with the following parameters: 55 kilovolts, 3 milliampere-seconds.</li>
	<li>Insert two 5.0 mm pins on the medial border of the tibia while an assistant pushes the tibia anteriorly if an anterior sagittal talar shifting is present. To increase the rigidity of the construct, an adjunctive carbon fiber bar can be placed in a vertical position.</li>
	<li>Verify the level of the desired joint line with the pointer located through the &#39;&#39;Position&#39;&#39; hole of the cutting guide of the selected size. Check the amount of bone resection with the pointer placed in the &#39;&#39;Talus&#39;&#39; and &#39;&#39;Tibia #1&#39;&#39; hole.</li>
	<li>Use the 4.0 mm drill through the pre-cutting guide to pre-drill the talus and the tibia surfaces. Assemble the bone burr to the pneumatic handpieces and put the contralateral talar trial of the selected size between the bone burr and the cutting guide to assess the medial depth of the bone cut. Then, use the bone burr to make the definitive bone cuts through the &#39;&#39;Talus&#39;&#39; and the &#39;&#39;Tibia #1&#39;&#39; holes of the guide. Use the &#39;&#39;Tibia #2&#39;&#39; hole to reach the whole tibial cut on the medial side and to release osteophytes of the medial gutter</li>
	<li>Position the rail drill guides. Utilize antero-posterior fluoroscopy to verify they are properly placed to avoid lateral overhang. Drill the rails and position the provisional implant, then choose the insert size.</li>
	<li>Insert the definitive implants using the talar and tibial inserter.</li>
	<li>Use fluoroscopy to check the positioning, and use two or three 3.5 mm lag screws to fix the fibula; alternatively, use a plate-fixation of the lateral malleolus, if the deformity requires a malleolar lengthening or shortening that does not leave sufficient contact for screw fixation.</li>
	<li>Check the stability of the syndesmosis with a bone hookapplied to the lateral malleolus. Gently pull the fibula laterally to assess any residual tibiofibular instability. If a lateral movement of the lateral malleolus is present, stabilize it with a syndesmosis screw fixation across four cortices. Test the ankle range of motion.</li>
	<li>Repair the anterior talofibular ligament with resorbable suture before routine wound-closure.</li>
</ol>
3. Postoperative Care
<ol>
	<li>Place the leg into a cast and forbid weight-bearing for four weeks. Then allow weight-bearing with a walker-boot for two weeks.</li>
	<li>Allow calf strengthening, proprioceptive training and stretching of the triceps surae six weeks after the surgery.</li>
</ol>
4. Clinical and Radiographic Follow-Up
<ol>
	<li>Radiologically and clinically evaluate patients at one, two, six, and twelve months after the procedure and, afterward, every twelve months. The follow-up protocol consists of function and pain assessment with SF-12, VAS pain score, and AOFAS ankle and hindfoot scores collected at each time-point.</li>
	<li>Perform radiographic examination: request weight-bearing radiographs of the ankle and of the foot with antero-posterior, lateral and Saltzman&#39;s view at each end-point.</li>
	<li>Measure the following parameters on the postoperative radiographs at each end-point.
	<ol>
		<li>Measure the alpha angle (&#945;-angle) on the antero-posterior ankle view: measure the angle formed laterally by the anatomical axis of the tibia and the articular surface of the tibial component (Figure 4)38.</li>
		<li>Measure the beta angle (&#946;-angle) on the lateral ankle view: measure the angle subtended anteriorly by the anatomical axis of the tibia and the articular surface of the tibial component (Figure 5)18,38.</li>
		<li>Measure the gamma angle (&#947;-angle) on the lateral ankle view: measure the angle between a line through the anterior and the posterior edge of the talar component and a line along the center of the talar neck (Figure 5)39.</li>
		<li>Measure the Tibio-talar ratio.</li>
		<li>Measure the Tibio-talar surface angle.</li>
	</ol>
	</li>
</ol>

Dr. Usuelli receives grants and personal fees from Zimmer. Dr. D'Ambrosi, Dr. Maccario, Dr. Manzi and Dr. Indino have nothing to disclose.

We reported the methods and protocol we use performing TAR with lateral transfibular approach. The absolute contraindications for TAR are talar avascular necrosis involving more than 50% of the bone-stock, acute or active infection with or without osteomyelitis, diabetic syndrome with polyneuropathy, high anesthesiologic risks, neuromuscular disorders, peripheral vascular disease, and neuroarthropathy (Charcot arthropathy of the midfoot or hindfoot)19,42. The rel...

The most frequent etiology of ankle osteoarthritis is the post-traumatic origin. In fact, it is often secondary to traumatic injuries that typically affect young patients1,2. Ankle osteoarthritis influences patients&#39; quality of life to the same degree as hip osteoarthritis and even more than knee osteoarthritis3. Ankle fusion has been considered the gold-standard for the treatment of ankle osteoarthritis, but some studies show that it confers augmented stress and increased risk of osteoarthritis of the adjacent joints4,5,6,7; furthermore, there still exist a number of complications associated with ankle fusion, such as equinus or talipes deformity and painful non-union8,9. With the evolution of surgical techniques and implant designs, total ankle replacement (TAR) has become an excellent alternative to ankle fusion for a surgeon with a proper learning-curve10,11,12.
TAR allows the preservation of ankle range of motion and protects from adjacent joint degeneration13. The anterior approach permits an optimal visualization of the coronal alignment; at the same time, this approach is inclined to wound-healing complications14,15. Recently, a novel TAR implant was designed to be performed via the lateral transfibular approach that results in an ideal visualization of the center of rotation and curved resections that allow for sparing bone cuts16; moreover, this approach permits the implantation of components perpendicular to the bone trabeculae, thus limiting the shear forces at the level of the bone-implant interface16. This prosthesis consists of a fixed-bearing implant; an alignment coordinate system guides the bone resections and facilitates addressing both coronal and sagittal deformities17. The early results of ankle arthroplasty using this TAR implant have been published 12,16,17,18. The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via the lateral approach.
Patient selection starts with a careful clinical examination and history. A medical history of inflammatory or vascular disease, neuropathy or neurologic disease and complicated diabetes may modify the indication. Poor soft tissue envelope of the ankle should be carefully evaluated because it may compromise the wound healing: skin and subcutaneous soft-tissue may already have been compromised from injury or previous surgery. The use of drugs that may influence healing must be considered. Muscle and tendon function, ankle and hindfoot alignment, and ankle range of motion should be evaluated: a detailed examination can indicate whether accessory procedures are needed at the time of surgery19.
We suggest always discussing the expectations of the patient concerning the outcomes of the procedure and the need for compliance with post-operative care. TAR is indicated for patients with an ankle joint disease due to post-traumatic, rheumatoid, or primary arthritis not responsive to conservative options that include physical therapy, activity modification, and non-steroidal anti-inflammatory drugs19. Also, lateral ankle instability may represent a cause of joint degeneration defined as ligamentous posttraumatic ankle osteoarthritis20. In addition, secondary osteoarthritis can be associated with systemic diseases: avascular necrosis of the talus, gout, hemophilia, post-infectious arthritis, and hereditary hemochromatosis21,22,23,24.
During the preoperative consultation, we routinely record the following clinical and functional scores: American Orthopaedic Foot &#38; Ankle Society (AOFAS) ankle and hindfoot score25,26,27, 12-Item Short Form Health Survey27,28, and Visual Analogue scale (VAS) pain score29.

<table><tbody><tr><td>Zimmer Total Ankle</td><td>Zimmer, Inc.</td><td>82-0175-162-00</td><td>Total Ankle Replacement</td></tr><tr><td>Calcaneus pin</td><td>Zimmer, Inc.</td><td>00-4501-040-00</td><td>Trans-calcaneal pin</td></tr><tr><td>4.0 mm Pin</td><td>Zimmer, Inc.</td><td>00-4501-040-04</td><td>Talar pin</td></tr><tr><td>5.0 mm Pin</td><td>Zimmer, Inc.</td><td>00-4501-040-05</td><td>Tibial pins</td></tr><tr><td>1.6 mm k-wire</td><td>Zimmer, Inc.</td><td>00-4501-040-01</td><td>1.6 mm Kirschner wire</td></tr><tr><td>Moonray BlueLIne Dual</td><td>SIMAD</td><td></td><td>Mobile C-arm</td></tr><tr><td>Pre-Cut Guide Drill</td><td>Zimmer, Inc.</td><td>00-4501-059-00</td><td>Precutting bone drill</td></tr><tr><td>Bur</td><td>Zimmer, Inc.</td><td>00-4501-076-00</td><td>Bone resection burr</td></tr><tr><td>Micro 100 Drill</td><td>Conmed Corporation</td><td>5053-009</td><td>Pneumatic handpieces</td></tr><tr><td>3.5 mm ULS screws</td><td>Zimmer, Inc.</td><td></td><td>Fibular fixation screws</td></tr><tr><td>Matlab version 2008</td><td>The MathWorks Inc.</td><td></td><td>Statistical software</td></tr></tbody></table>

treatment of ankle osteoarthritis with total ankle replacement through a lateral transfibular approach

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior approach. Recently, the lateral transfibular approach to the ankle has gained popularity since a new TAR implant was designed to be performed via this approach that results in an ideal visualization of the center of rotation of the ankle and curved resections that allow for sparing bone cuts. The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via lateral approach. We present our preoperative clinical and radiographic protocol. In addition, we describe our surgical technique with some technical tips. Finally, we report our follow-up schedule that includes the collection of clinical, functional, and radiographic data. The results of this procedure are encouraging: TAR through a lateral transfibular approach provides reliable pain relief and improvements in functional outcomes in patients with ankle osteoarthritis.

We collected the results of a consecutive series of 114 patients (114 ankles) who underwent TAR via lateral transfibular approach between May 2013 and July 2016. All operative procedures were carried out by the senior author.
Data were analyzed with a statistical software (see Table of Materials). The ANOVA and kappa tests were performed40,41. For k-scor...

Watch this Scientific Journal Video about Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach at JoVE.com

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

We present our preoperative, operative, and postoperative protocols for the treatment of osteoarthritis of the ankle with total ankle replacement via lateral transfibular approach.

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior ...

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11.7K Views.  Galeazzi Orthopedic Institute for Research and Care. We present our preoperative, operative, and postoperative protocols for the treatment of osteoarthritis of the ankle with total ankle replacement via lateral transfibular approach.

Video: Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in patients who were not appropriate for tendon transfer reconstructions. Traditional surgical options for these patients were limited and functional results were sub-optimal and at times catastrophic. The use of reverse shoulder arthroplasty has been found to effectively restore these patients function and relieve symptoms associated with their disease. The procedure can be done through two approaches, the deltopectoral or the superolateral. Complication rates associated with the use of the prosthesis have ranged from 8-60% with more recent reports trending lower as experienced is gained. Salvage options for a failed reverse shoulder prosthesis are limited and often have significant associated disability. Indications for the use of this prosthesis continue to be evaluated including its use for revision arthroplasty, proximal humeral fracture and tumor. Careful patient selection is essential because of the significant risks associated with the procedure.

Reverse total shoulder arthroplasty is indicated for the treatment of conditions that cannot be treated with conventional arthroplasty or other procedures. These primarily include degenerative and incapacitating conditions with irreparable rotator cuff and loss of the normal biomechanical coupling of the shoulder.

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in ...

Medicine

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several studies have focused their attention on mesenchymal stem cells derived from adipose tissue. Adipose-derived stem cells (ADSCs) exhibit morphological characteristics and properties similar to other mesenchymal cells, and are able to differentiate into several cellular lines. Moreover, these cells are also widely available in the subcutaneous tissue, representing 10 - 30% of the normal body weight, with a concentration of 5,000 cells per gram of tissue.
In the presented technique, the first step involves harvesting ADSCs from the abdomen and a process of microfracture and purification; next, the surgical procedure is performed entirely arthroscopically, with less soft tissue dissection, better joint visualization, and a faster recovery compared with standard open procedures. Arthroscopy is characterized by a first phase in which the lesion is identified, isolated, and prepared with microperforations; the second step, performed dry, involves injection of adipose tissue at the level of the lesion.
Between January 2016 and September 2016, four patients underwent arthroscopic treatment of osteochondral lesion of the talus with microfractured and purified adipose tissue. All patients reported clinical improvement six months after surgery with no reported complications. Functional scores at the latest follow-up are encouraging and confirm that the technique provides reliable pain relief and improvements in patients with osteochondral lesion of the talus.

The aim of this study is to report a protocol for the arthroscopic treatment of osteochondral lesions of the talus using microfractured and purified adipose-derived stem cells.

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several ...

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient.
In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.

C-arm-free oblique lumbar interbody fusion at the L5-S1 level (OLIF51) and simultaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This technique does not expose the surgeon or operating staff to radiation hazards.

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 ...

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed reality were used to perform complex revision hip arthroplasty in January 2019. The use of mixed reality allowed for a very good visualization of the structures and resulted in precise implant fixation. According to the authors' knowledge, this is the first described case report of the combined use of these two innovations. The diagnosis preceding the qualification for the procedure was the loosening of the left hip's acetabular component. Mixed reality headset and holograms prepared by engineers were used during the surgery. The operation was successful, and it was followed by early verticalization and patient rehabilitation. The team sees opportunities for technology development in joint arthroplasty, trauma, and orthopedic oncology.

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors&#39; knowledge, this is the first report of such procedure described in the literature.

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed ...

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

Surgeons considering transitioning to an anterior-based approach for THA are concerned about the learning curve and the reported marginal clinical benefit. Accordingly, the first cohort of THAs, which were implanted by a single surgeon using the anterior-based muscle-sparing approach (ABMS), was analyzed. The goal of the study was to test 1) whether patient-reported outcomes improved and 2) whether the complication rate decreased with the number of THAs performed. A retrospective cohort study on the first 30 primary THA cases (27 patients) of one surgeon (January 2021-April 2021) using the ABMS approach was conducted. These 30 THAs were compared to 30 primary THA cases (30 patients) done immediately prior to the transition by the same surgeon (September 2020-December 2020) using the posterior approach (PA). The Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score (HOOS Junior), and Forgotten Joint Score (FJS) obtained 6 weeks and 6 months after surgery were compared. In addition, three consecutive groups based on equal numbers of THAs were compared for the incidence of complications and surgery time. At 6 weeks after THA, the OHS was 6 points higher after the ABMS approach (p = 0.0408), and the OHS was comparable at 6 months. The HOOS Junior and FJS were similar at 6 weeks and 6 months after surgery.&#160;In the first 10 THAs using the ABMS approach, one patient had a greater trochanter fracture, and one patient had an intraoperative proximal femur fracture. No further immediate interoperative or postoperative complications occurred. Surgery time significantly reduced with the number of THAs performed. Transitioning from the PA to the ABMS approach is associated with a learning curve, which is limited to the first 20 cases. The effect of improved clinical outcomes is apparent within the early postoperative period. After 6 months, THA patients do well regardless of the approach.

The anterior-based muscle-sparing approach for total hip arthroplasty (THA) is associated with a learning curve. However, the improved clinical outcome in the early post-operative phase makes the consideration to transition worthwhile.

Surgeons considering transitioning to an anterior-based approach for THA are concerned about the learning curve and the reported marginal clinical ...

An Effective Surgical Strategy for Anteromedial Osteoarthritis of the Knee with Simultaneous Popliteal Cysts Drainage

Unicompartmental knee arthroplasty (UKA) is an established treatment option for anteromedial osteoarthritis, and popliteal cysts are a common finding in the knee among patients with chronic osteoarthritis pain. The two are so closely related that popliteal cysts are commonly discovered during the unicompartmental knee arthroplasty preoperative examination. However, only a few reports exist on the management and outcome of popliteal cysts in the patients receiving UKA for knee osteoarthritis (OA) and popliteal cysts. As such, it is crucial to evaluate different treatment strategies and their management of popliteal cysts. In this paper, we evaluate a surgical strategy for patients with knee anteromedial osteoarthritis and symptomatic popliteal cysts. These patients were treated with UKA and internal drainage of the popliteal cyst. The results shown here, spanning 1-year post-operation follow-up, demonstrated that UKA and internal drainage is an effective surgical protocol for treating anteromedial osteoarthritis with symptomatic popliteal cysts.

Popliteal cysts are frequently found during the pre-operative examination of patients with osteoarthritis being prepared for the unicompartmental knee arthroplasty. These symptomatic cysts usually require treatment. To do this, a unicompartmental knee arthroplasty was performed with internal drainage of the popliteal cyst under the same anesthetic.

Unicompartmental knee arthroplasty (UKA) is an established treatment option for anteromedial osteoarthritis, and popliteal cysts are a common finding in ...

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis (AMOA). The key to UKA is the flexion-extension gap balance, which is closely related to postoperative complications such as bearing dislocation, bearing wear, and arthritis progression. The traditional gap balance assessment is performed by indirectly sensing the tension of the medial collateral ligament by a gap gauge. It relies on the surgeon's feel and experience, which is imprecise and difficult for beginners. To accurately assess the flexion-extension gap balance of UKA, we developed a wireless sensor combination consisting of a metal base, a pressure sensor, and a cushion block. After osteotomy, the insertion of a wireless sensor combination allows the real-time measurement of intra-articular pressure. It accurately quantifies the flexion-extension gap balance parameters to guide further femur grinding and tibia osteotomy, to improve the accuracy of gap balance. We conducted an in vitro experiment with the wireless sensor combination. the results showed that there was a difference of 11.3 N after applying the traditional method of flexion-extension gap balance performed by an experienced expert.

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

This protocol presents a cadaveric study of a wireless sensor used in medial unicompartmental knee arthroplasty. The protocol includes the installation of an angle measuring device, standardized Oxford unicompartmental knee arthroplasty osteotomy, preliminary assessment of flexion-extension balance, and application of the sensor to measure flexion-extension gap pressure.

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis (AMOA). The key to UKA is the ...

Arthroscopic Repair of Medial Meniscus Posterior Root Tear with Adjustable Titanium Plate Fixation

Medial meniscus injury is one of the most prevalent knee disorders, with posterior root tears occurring in approximately 10% to 21% of affected individuals. A posterior root tear disrupts the meniscus's continuous annular structure, compromising its ability to absorb pressure and protect the knee's articular cartilage. If left untreated, this can result in increased stress on the cartilage, leading to conditions such as varus deformity and accelerated joint degeneration. Partial removal (resection) of the medial meniscus further exacerbates these issues, often leading to quicker joint deterioration. Repairing medial meniscus posterior root tears (MMPRTs) plays a crucial role in restoring the meniscus's structural integrity and improving knee biomechanics. Studies have shown that compared to partial medial meniscectomy or conservative treatments, repairing MMPRTs enhances clinical outcomes and significantly delays the onset of arthritis. This article details a surgical procedure that uses a single-suture, double-loop, adjustable titanium plate fixation technique under arthroscopy for effective MMPRT repair.

This article describes a surgical approach to repairing a medial meniscus posterior root tear (MMPRT) using a single-suture, double-loop, adjustable titanium plate internal fixation under arthroscopy.

Medial meniscus injury is one of the most prevalent knee disorders, with posterior root tears occurring in approximately 10% to 21% of affected ...

Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion

Interbody fusion of the lumbar spine is a standard procedure for symptomatic degenerative lumbar spine disease if conservative treatment fails. Surgical decompression and fusion of the segment can be achieved using several different techniques. Over the last decades, minimally invasive techniques, such as lateral interbody fusion (LLIF), have been developed to reduce tissue damage and complications and allow quicker patient recovery. With growing popularity, indications for LLIF have expanded to treat spinal deformities and foraminal/central stenosis. Mechanically, it allows for an unsurpassed fixation through the left-to-right apophyseal ring placement of the cage. LLIF utilizes a minimally disruptive retroperitoneal corridor and includes both trans-psoas and pre-psoas approaches. For the pre-psoas approach, the risk of damage from manipulation of the intramuscular lumbar plexus is reduced compared to a trans-psoas approach. However, increased risks of major vascular, ureteral, bowel injury and sympathetic plexus damage are reported.
This article aims to provide a detailed and comprehensive guide on stand-alone lateral trans-psoas interbody fusion, including its indications, surgical procedure, potential complications, and outcomes based on a decade of experience from a single center.

Interbody fusion of the lumbar spine can be achieved surgically using different techniques. Minimally invasive techniques, including lateral interbody fusion, have been developed within recent decades to reduce rates of complications and allow for quicker patient recovery. We provide insight into stand-alone lateral trans-psoas interbody fusion, highlighting potential complications and pitfalls.

Interbody fusion of the lumbar spine is a standard procedure for symptomatic degenerative lumbar spine disease if conservative treatment fails. Surgical ...

Management of Failed Latarjet and Off-tract Hill-Sachs Lesion: Arthroscopy-assisted Remplissage and Open Eden-Hybinette Procedure

This case report describes a 49-year-old former semi-professional judo player with recurrent right shoulder instability following his first dislocation in 2006. He underwent two unsuccessful arthroscopic Bankart repairs due to improper anchor positioning. In March 2020, an open Latarjet procedure was performed to address his ongoing instability, but he suffered another dislocation in January 2023 after a fall. Physical examination revealed a full range of motion, normal rotator cuff strength, and a positive apprehension test. X-rays showed a broken coracoid bone block, screw displacement, and a significant Hill-Sachs lesion. CT confirmed resorption of the previous coracoid graft and an off-track Hill-Sachs lesion. The patient underwent revision surgery, combining an arthroscopic-assisted Remplissage with an Eden-Hybinette procedure. One year postoperatively, the patient reported improved outcomes. Managing recurrent shoulder instability after failed surgeries is challenging. While the Latarjet procedure has a 10% recurrence rate, revision options such as distal tibial allograft and Eden-Hybinette procedures offer promising results. This case emphasizes the importance of combined surgical approaches and individualized treatment plans, particularly for patients with significant humeral bone loss, to enhance stability and reduce recurrent instability.

Here, we describe a modified technique for arthroscopy-assisted Remplissage and open Eden-Hybinette procedure for patients with failed Latarjet and off-tract Hill-Sachs lesions.

This case report describes a 49-year-old former semi-professional judo player with recurrent right shoulder instability following his first dislocation in ...

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

Summary

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Chapters in this video

Reverse Total Shoulder Arthroplasty

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

An Effective Surgical Strategy for Anteromedial Osteoarthritis of the Knee with Simultaneous Popliteal Cysts Drainage

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

Arthroscopic Repair of Medial Meniscus Posterior Root Tear with Adjustable Titanium Plate Fixation

Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion

Management of Failed Latarjet and Off-tract Hill-Sachs Lesion: Arthroscopy-assisted Remplissage and Open Eden-Hybinette Procedure