A Technical Tip to Avert Meniscal Rotation and Dislocation in a Mobile Bearing Unicompartmental Knee Arthroplasty

The Oxford (Oxford® partial knee; Biomet) mobile bearing medial unicondylar knee replacement (OUKR) is a preferred choice by surgeons due to minimal blood loss, reduced pain, and better range of motion. Commonly observed complications include aseptic loosening, polyethylene wear, bearing dislocation, and periprosthetic fractures. A bearing dislocation can be prevented by ensuring that there is correct tracking of bearing during the trial reduction as well as no loss of entrapment. We present a case report in a 50-year-old patient undergoing bilateral OUKR wherein it was observed that the meniscal bearing upon the flexion of the knee joint had the tendency to dislocate. Upon revising the vertical tibial recut according to the anterior superior iliac spine, the meniscus was found to have a normal excursion. Mobile bearing dislocation is a unique complication of mobile bearing OUKR. Surgical technique is of paramount importance in ensuring a successful OUKR. The vertical tibial cut is made to accommodate the vertical wall of the tibial component. Meniscal displacement is quite a common complication and can occur due to multiple causes. Inaccurate vertical tibial cut may be one such reason leading to tibial dislocation.

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Patellar Clunk Syndrome with Polyethylene Wear and Medial Synovial Hypertrophy after Mobile Bearing Total Knee Arthroplasty: A Case Report

Soonchunhyang Medical Science ◽

10.15746/sms.11.028 ◽

2011 ◽

Vol 17 (2) ◽

pp. 131-133

Author(s):

Soo Jae Yim ◽

Mun Suk Jang ◽

Joon Hee Yoon ◽

Sang Hyok Lee ◽

Hee kyung Kang

Keyword(s):

Total Knee Arthroplasty ◽

Case Report ◽

Knee Arthroplasty ◽

Polyethylene Wear ◽

Mobile Bearing ◽

Synovial Hypertrophy ◽

Total Knee

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Revision Total Wrist Arthroplasty Due to Polyethylene Wear, Metallosis-Induced Carpal Tunnel Syndrome, Distal Ulnar Impingement, and Fourth Carpometacarpal Joint Pain: Case Report and Pitfalls to Avoid

Hand ◽

10.1177/1558944718810863 ◽

2018 ◽

Vol 15 (1) ◽

pp. NP1-NP6

Author(s):

Fiesky A. Nunez ◽

Lauren Wright ◽

Scott E. Kilpatrick ◽

William H. Seitz

Keyword(s):

Case Report ◽

Surgical Technique ◽

Carpal Tunnel ◽

Polyethylene Wear ◽

Carpal Tunnel Release ◽

Carpometacarpal Joint ◽

Distal Ulna ◽

Total Wrist Arthroplasty ◽

Patient Reported ◽

Wrist Arthroplasty

Background: Total wrist arthroplasty (TWA) is indicated to alleviate pain secondary to arthritis while preserving wrist motion. Despite vigilant measures, TWAs are susceptible to complications. The current case illustrates an array of preventable complications which are addressed through operative technique in a revision setting. Case presentation: The patient was a 72-year-old man who presented with chronic pain at the fourth carpometacarpal joint (CMCJ) and distal radioulnar joint with paresthesias in the median nerve distribution. Surgery was undertaken to address the following complications secondary to a previous TWA: impingement of the native distal ulna on the prosthesis, carpal tunnel due to metallosis and polyethylene synovitis, loose carpal component, and prominent screw at the fourth CMCJ. Surgical correction included open carpal tunnel release with extensive flexor tenosynovectomy, distal ulna resection and implant arthroplasty with shortening, revision of carpal component with bone grafting, and shortening of the ulnar screw to avoid crossing the fourth CMCJ. Within 6 months of the procedure, the patient reported resolution of neuropathic symptoms and pain-free motion of the wrist. Discussion: Preventable complications associated with TWA are individually highlighted. In addition, we compare and contrast our approach and surgical technique to current reported literature. Overall, we provide education and guidance to avoid possible TWA pitfalls. Conclusion: With this case report, we hope to increase TWA knowledge with emphasis on the requirements of judicious patient selection, preoperative planning, meticulous surgical technique, and complication awareness for subsequent optimization of wrist function, stability, and durability.

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Hand-assisted laparoscopic nephrectomy in morbidly obese patients

Perspectives in Surgery ◽

10.33699/pis.2020.99.6.271-276 ◽

2020 ◽

Vol 99 (6) ◽

pp. 271-276

Keyword(s):

Body Weight ◽

Surgical Technique ◽

Blood Loss ◽

Hospital Stay ◽

Kidney Cancer ◽

The Body ◽

Laparoscopic Nephrectomy ◽

Morbidly Obese ◽

Obese Patients ◽

Morbid Obese

Introduction: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. Methods: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were analyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. Results: The patient age was 38−67 years; the cohort included 2 females and 5 males, the body weight was 117−155 kg and the BMI was 40.3−501 kg/m2. Surgery time was 73−98 minutes, blood loss was 20−450 ml, and hospital stay was 5−7 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48–110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

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Flapless esthetic crown lengthening: surgical technique and stability of gingival margin. Case report

10.26226/morressier.5ac383212afeeb00097a46d6 ◽

2018 ◽

Author(s):

Aušra Levickienė

Keyword(s):

Case Report ◽

Surgical Technique ◽

Gingival Margin ◽

Crown Lengthening

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An Alternative Approach Using Circummandibular Wiring for Treatment of Dentoalveolar Fractures in Children: A Case Report

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387521990283 ◽

2021 ◽

pp. 194338752199028

Author(s):

José Henrique Santana Quinto ◽

Andressa Bolognesi Bachesk ◽

Lucas Costa Nogueira ◽

Liogi Iwaki Filho

Keyword(s):

Case Report ◽

Surgical Technique ◽

Bone Fracture ◽

Closed Reduction ◽

Alternative Methods ◽

Alveolar Process ◽

Fractures In Children ◽

Alternative Approach ◽

Open Treatment ◽

Segmental Fractures

The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage and structure affected. For alveolar process fractures, closed reduction and semi-rigid dental splinting for 4 to 6 weeks is generally satisfactory. However, some cases, such as severe segmental fractures, require open treatment to ensure adequate reduction and stabilization of the displaced alveolar segment, which is usually achieved by titanium miniplates and screws. Nevertheless, there are situations where this type of fixation is not possible, requiring alternative methods. Therefore, this article describes a surgical technique performed by open reduction, associating semi-rigid dental splint and circummandibular wiring in pediatric patient diagnosed with dentoalveolar fracture through clinical examination (with bone fracture displacement) and tomography. The technique promoted a good prognostic to the patient, proving to be a viable alternative for treating dentoalveolar fractures.

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Shallow Water Diving-Associated Alveolar Hemorrhage in an Active Duty Sailor: A Case Report

Military Medicine ◽

10.1093/milmed/usab046 ◽

2021 ◽

Author(s):

Brannon L Inman ◽

Rachel E Bridwell ◽

Amber Cibrario ◽

Sarah Goss ◽

Joshua J Oliver

Keyword(s):

Case Report ◽

Lung Injury ◽

Active Duty ◽

Service Members ◽

Breath Hold ◽

Common Complication ◽

Special Operations ◽

Increased Risk ◽

History Of ◽

And Function

ABSTRACT Breath-hold diving is a common practice as a part of military dive training. An association between prior lung injury and a propensity for lung barotrauma may have the potential to impact mission readiness for combat divers, Pararescue, Combat Controllers, Army Engineer divers, and various units in Naval Special Warfare and Special Operations. Barotrauma is a common complication of diving, typically occurring at depths greater than 30 m (98.4 ft). Individuals with abnormal lung anatomy or function may be at increased risk of barotrauma at shallower depths than those with healthy lungs, rendering these service members unfit for certain missions. We describe the case of a 25-year-old male, with a remote history of polytrauma and resultant pulmonary pleural adhesions, whose dive training was complicated by lung barotrauma at shallow depths. In missions or training utilizing breath-hold diving, the association with secondary alterations in lung or thoracic anatomy and function may limit which service members can safely participate.

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Bearing dislocation of mobile bearing unicompartmental knee arthroplasty in East Asian countries: a systematic review with meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02190-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiaowei Sun ◽

Pei Liu ◽

Feifan Lu ◽

Weiguo Wang ◽

Wanshou Guo ◽

...

Keyword(s):

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Subgroup Analysis ◽

Meta Analysis ◽

East Asian ◽

Onset Time ◽

Mobile Bearing ◽

Dislocation Rate ◽

Asian Countries ◽

Bearing Dislocation

Abstract Background Bearing dislocation is a common postoperative complication of mobile-bearing unicompartmental knee arthroplasty, and East Asian patients tend to be at higher risk. However, whether this high dislocation rate is common in all East Asian populations remains unclear. This meta-analysis was performed to explore this issue and describe various features of dislocation in East Asians, including the onset time, dislocation direction, and re-dislocation rate. Methods The literature was searched in PubMed, Embase, Ovid, and Cochrane Library up to May 2020. Studies were scrutinized by two independent authors, and the bearing dislocation rate, onset time, direction, and re-dislocation rate were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven case series from Korea, China, and Japan were included. The pooled analysis showed that the total dislocation rate was 2.37%, while the subgroup analysis showed that the dislocation rate in Korea and other countries was 4.50% and 0.74%, respectively (P < 0.01). Another subgroup analysis of the onset time showed a significant difference before and after the first 5 years postoperatively (P < 0.01). Anterior and posterior dislocations were more frequent than medial and lateral dislocations (P < 0.01). The average re-dislocation rate was 32.45%, which was approximately seven times higher than the primary dislocation rate (P < 0.01). Conclusion Our meta-analysis demonstrated that Korea had a higher bearing dislocation rate among East Asian countries, especially in the first 5 years after primary UKA. Anterior and posterior dislocations were common. The most important finding is that the re-dislocation rate can be much higher than the initial dislocation rate.

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