Bipolar hip arthroplasty in geriatric patients using a conjoined tendon-preserving posterior approach

Abstract Background In bipolar hemiarthroplasty (BHA), it is important to preserve soft tissue to reduce the risk of postoperative dislocation. While a variety of surgical approaches have been reported recently, extra care is needed with muscle- and tendon-preserving approaches in geriatric patients due to the fragility of their soft tissue. We investigated the usefulness of BHA using a conjoined tendon-preserving posterior (CPP) approach, which only dissects the external obturator muscle, in geriatric patients. Methods This retrospective study included 40 femoral neck fracture patients (10 men, 30 women) aged ≥ 80 years who underwent BHA using the CPP approach. The average age of the subjects was 85.8 years (80–94 years). We examined operation time, bleeding, preservation of short external rotator muscles, complications, and stem alignment and subsidence from postoperative radiographs. Results Although, gemellus inferior muscle injury was detected in 4 patients (10%), hip joint stability was very excellent in all cases. There was no intraoperative fracture and postoperative dislocation. On postoperative radiographs, all femoral stems were in a neutral position. There was no stem subsidence in all the patients. Conclusions BHA using the CPP approach was not associated with postoperative dislocation and appeared to be useful even in geriatric patients with soft tissue fragility.

Download Full-text

Bipolar hip arthroplasty in geriatric patients using a conjoined tendon-preserving posterior approach

10.21203/rs.2.12100/v1 ◽

2019 ◽

Author(s):

Tomonori Tetsunaga ◽

Tomoko Tetsunaga ◽

Kazuki Yamada ◽

Takayuki Furumatsu ◽

Tomoaki Sanki ◽

...

Keyword(s):

Soft Tissue ◽

Geriatric Patients ◽

Operation Time ◽

Surgical Approaches ◽

Neutral Position ◽

Bipolar Hemiarthroplasty ◽

Joint Stability ◽

Short External Rotator ◽

Postoperative Dislocation ◽

Conjoined Tendon

Abstract Background In bipolar hemiarthroplasty (BHA), it is important to preserve soft tissue to reduce the risk of postoperative dislocation. While a variety of surgical approaches have been reported recently with this in mind, extra care is needed with muscle- and tendon-preserving approaches in geriatric patients due to the fragility of their soft tissue. We investigated the usefulness of BHA using a conjoined tendon-preserving posterior (CPP) approach, which only dissects the external obturator muscle, in geriatric patients. Methods This retrospective study included 40 femoral neck fracture patients (10 men, 30 women) aged ≥80 years who underwent BHA using the CPP approach. The average age of the subjects was 85.8 years (80 - 94 years). We examined operation time, bleeding, preservation of short external rotator muscles, complications, and stem alignment and subsidence from postoperative radiographs. Results Although, gemellus inferior muscle injury was detected in 4 patients (10%), hip joint stability was very excellent in all cases. There was no intraoperative fracture and postoperative dislocation. On postoperative radiographs, all femoral stems were in a neutral position. There was no stem subsidence in all the patients. Conclusions BHA using the CPP approach was not associated with postoperative dislocation and appeared to be useful even in geriatric patients with soft tissue fragility.

Download Full-text

Conjoined tendon preserving posterior approach in hemiarthroplasty for femoral neck fractures: A prospective multicenter clinical study of 322 patients

Journal of Orthopaedic Surgery ◽

10.1177/23094990211063963 ◽

2021 ◽

Vol 29 (3) ◽

pp. 230949902110639

Author(s):

Takuya Nakamura ◽

Toru Yamakawa ◽

Junji Hori ◽

Hisataka Goto ◽

Akihiko Nakagawa ◽

...

Keyword(s):

Adverse Event ◽

Femoral Neck ◽

Adverse Events ◽

Hip Joint ◽

Posterior Approach ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Joint Movement ◽

Postoperative Dislocation ◽

Conjoined Tendon

Purpose The posterior approach is widely used in femoral hemiarthroplasty. The major problem with this approach is the high risk of postoperative dislocation. A modified posterior approach, the conjoined tendon preserving posterior approach (CPP), was developed to reduce postoperative dislocations. The objective of this multicenter study was to evaluate the efficacy and safety of hemiarthroplasty performed using the CPP approach for femoral neck fractures. Methods A total of 322 patients with femoral neck fracture, from 10 facilities, were prospectively studied. Bipolar hemiarthroplasty using the CPP approach was performed, using the same type of implants. Hip joint movement was not restricted following surgery, regardless of a patient’s cognitive status. Final follow-up was performed 9.1 ± 1.5 months after surgery. Results Hemiarthroplasty was undertaken in 320 patients using the CPP approach. The mean age, operative time, and intraoperative blood loss were 83.3 ± 7.4 years, 70.0 ± 22.7 min, and 134.8 ± 107.9 mL, respectively. No postoperative dislocations were observed during the study period. Intraoperative adverse events related to the hip joint included femoral fractures in five patients (1.6%) and trochanteric fractures in four patients (1.3%). Postoperative hip joint adverse events included a periprosthetic fracture in one patient (0.3%), deep infection in two patients (0.6%), and stem subsidence in one patient (0.3%). Postoperative deaths occurred in 23 patients (7.2%). One patient (0.3%) had a severe non-hip adverse event unrelated to surgery that prevented independent living, while five patients (1.6%) had a moderate non-hip adverse event that required treatment. Conclusion The CPP approach prevented postoperative dislocation following femoral hemiarthroplasty in elderly patients, with no CPP-associated specific adverse events.

Download Full-text

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Journal of Personalized Medicine ◽

10.3390/jpm11070662 ◽

2021 ◽

Vol 11 (7) ◽

pp. 662

Author(s):

Kim Huber ◽

Bernhard Christen ◽

Sarah Calliess ◽

Tilman Calliess

Keyword(s):

Soft Tissue ◽

Retrospective Analysis ◽

Patient Specific ◽

Kinematic Alignment ◽

Postoperative Phase ◽

Robotic Assistance ◽

Component Position ◽

Joint Stability ◽

Robotic Assisted ◽

Primary Tkas

Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase.

Download Full-text

770 CONSIDERABLE EFFECT OF UPPER MEDIASTINAL LYMPHADENECTOMY UNDER LAPAROSCOPIC ASSISTED SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

Diseases of the Esophagus ◽

10.1093/dote/doab052.770 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Xiaojin Wang ◽

Xiangfeng Gan ◽

Qingdong Cao

Keyword(s):

Perioperative Complications ◽

Membrane Damage ◽

Operation Time ◽

Perioperative Outcomes ◽

Surgical Approaches ◽

Mediastinal Lymphadenectomy ◽

Invasive Esophagectomy ◽

Anastomotic Strictures ◽

Left Neck ◽

The Right

Abstract Conventional minimally invasive esophagectomy requires transthoracic surgery, which could increase the risk of many perioperative complications. Mediastinoscopy-assisted transhiatal esophagectomy has been proposed for years, but the traditional methods have shortcomings, such as unclear vision, especially during the dissection of upper mediastinal lymph nodes. We proposed a novel approach of upper mediastinal lymphadenectomy with mediastinoscopy through a left-neck incision, and investigated the effect of lymphadenectomy and other perioperative outcomes. Methods This approach for upper mediastinal lymphadenectomy includes three parts. (I) Lymphadenectomy along the left recurrent laryngeal nerve (RLN) could be accomplished during esophagectomy under mediastinoscopy. (II) At the level of the lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, instruments are used to access the right RLN. Lymphadenectomy of up to 2 cm could be accomplished at the upper edge of the RSA. (III) Between the trachea and esophagus, the left and right main bronchi are exposed along the trailing edge of the trachea down to the carina, and lymphadenectomy can be performed here. Results This lymphadenectomy had been completed successfully on 117 patients, and 1 was converted to thoracotomy due to intraoperative tracheal membrane damage. The average operation time was 181.4 ± 43.2 minutes, bleeding volume was 106.4 ± 87.9 mL. The number of dissected LNs of upper mediastinal, the left RLN, the right RLN and the subcarinal was 11.2 ± 6.3, 5.1 ± 2.8, 3.2 ± 1.3 and 3.8 ± 2.1 respectively. 10 cases of (8.5%) anastomotic fistula were resolved with proper drainage and nutritional support. There were 25 cases (21.2%) of anastomotic strictures, 10 cases (8.5%) of pleural effusion, 20 cases (16.9%) of hoarseness. The incidence of hoarseness was 2.5% in three months postoperation. Conclusion These results showed that the lymphadenectomy through the left neck approach was not inferior than other surgical approaches in the amount of upper mediastinal LNs resection and perioperative outcome. Further research is needed to discover its impact on the long-term prognosis of ESCC patients.

Download Full-text

Combined versus Single Perforator Propeller Flaps for Reconstruction of Large Soft Tissue Defects: A Retrospective Clinical Study

Journal of Personalized Medicine ◽

10.3390/jpm12010041 ◽

2022 ◽

Vol 12 (1) ◽

pp. 41

Author(s):

Amir K. Bigdeli ◽

Oliver Didzun ◽

Benjamin Thomas ◽

Leila Harhaus ◽

Emre Gazyakan ◽

...

Keyword(s):

Soft Tissue ◽

Significant Risk ◽

Operation Time ◽

Soft Tissue Defects ◽

Reliable Technique ◽

Propeller Flap ◽

Major Complications ◽

Additional Surgery ◽

Retrospective Clinical Study ◽

Tissue Defects

Sufficient wound closure of large soft tissue defects remains a challenge for reconstructive surgeons. We aimed to investigate whether combined perforator propeller flaps (PPFs) are suitable to expand reconstructive options. Patients undergoing PPF reconstruction surgery between 2008 and 2021 were screened and evaluated retrospectively. Of 86 identified patients, 69 patients received one perforator propeller flap, while 17 patients underwent combined PPF reconstruction with multiple flaps. We chose major complications as our primary outcome and defined those as complications that required additional surgery. Postoperatively, 27 patients (31.4%) suffered major complications. The propeller flap size, the type of intervention as well as the operation time were not associated with a higher risk of major complications. A defect size larger than 100 cm2, however, was identified as a significant risk factor for major complications among single PPFs but not among combined PPFs (OR: 2.82, 95% CI: 1.01−8.36; p = 0.05 vs. OR: 0.30, 95% CI: 0.02−3.37; p = 0.32). In conclusion, combined PPFs proved to be a reliable technique and should be preferred over single PPFs in the reconstruction of large soft tissue defects at the trunk and proximal lower extremity.

Download Full-text

Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3023-0 ◽

2019 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Weikun Meng ◽

Zhong Huang ◽

Haoyang Wang ◽

Duan Wang ◽

Zeyu Luo ◽

...

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Length Of Hospital Stay ◽

Operation Time ◽

Short Term ◽

Incision Length ◽

Total Hip ◽

Hip Function

Abstract Background The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH). Methods Patients with bilateral late-stage ONFH were prospectively recruited from our department from March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within approaches. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA approaches within 12-month postoperatively. Results Four male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded shorter incision length (7.62 vs. 11.12 cm), longer operation time (103.25 vs. 66.50 min), more blood loss (1108.50 vs. 843.50 ml), deficient abduction angle of the acetabular cup (38.75° vs. 44.50°), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25) at 12-month postoperatively. Soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both approaches. Conclusion The SuperPath may be a minimally invasive technique but the present study shows less favorable short-term outcomes than PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches. Trial registration information The trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4993) on July 04, 2019. The first participant was enrolled on March 13, 2017.

Download Full-text

Video-Assisted Thoracoscopic Dissection Of The Brachial Plexus:Cadaveric Study And Illustrative Case

Operative Neurosurgery ◽

10.1227/01.neu.0000204657.56274.86 ◽

2006 ◽

Vol 58 (suppl_4) ◽

pp. ONS-287-ONS-291 ◽

Cited By ~ 1

Author(s):

Chad J. Morgan ◽

Jefferson Lyons ◽

Benjamin C. Ling ◽

P. Colby Maher ◽

Robert J. Bohinski ◽

...

Keyword(s):

Soft Tissue ◽

Brachial Plexus ◽

Thoracoscopic Surgery ◽

Surgical Approaches ◽

Illustrative Case ◽

Lower Trunk ◽

Video Assisted ◽

First Rib ◽

Soft Tissue Dissection ◽

Tissue Dissection

Abstract Objective: Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus. Methods: VATS was used in cadaveric dissections to study the anatomic details of the brachial plexus at the thoracic apex. After placement of standard thoracoscopic ports, the thoracic apex was systematically dissected. The limitations of the VATS approach were defined before and after removal of the first rib. The technique was applied in a 22-year-old man with neurofibromatosis who presented with a large neurofibroma of the left T1 nerve root. Results: The cadaveric study demonstrated that VATS allowed for a direct cephalad approach to the inferior brachial plexus. The C8 and T1 nerve roots as well as the lower trunk of the brachial plexus were safely identified and dissected. Removal of the first rib provided exposure of the entire lower trunk and proximal divisions. After the fundamental steps to the dissection were identified, the patient underwent a successful gross total resection of a left T1 neurofibroma with VATS. Conclusion: VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.

Download Full-text

Pattern of Injuries and Treatment Given to Victims of Rana Plaza Tragedy in a Level II Armed Forces Medical Facility in Bangladesh

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2016.82 ◽

2016 ◽

Vol 11 (1) ◽

pp. 21-24

Author(s):

Shafiul Alam ◽

Rabiul Alam ◽

Manirul Islam ◽

Amin Salek

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Armed Forces ◽

Military Hospital ◽

Surgical Approaches ◽

Rescue Operation ◽

Cross Sectional ◽

Building Collapse ◽

Industrial Disaster

AbstractBackgroundRana Plaza building collapse is the worst industrial disaster of Bangladesh so far. The 9-storied structure collapsed suddenly on April 24, 2013, with more than 4000 people inside. Bangladesh Armed Forces played a key role in the massive rescue operations.MethodsWe conducted a cross-sectional study with 423 victims who were treated at a Combined Military Hospital to review the pattern of injuries and management provided.ResultsMiddle-aged (35±12.75 years) females (68.32%) were the majority of the victims. Among the injured, 42.35% had soft tissue injury, 22.55% had abrasions, 18.79% had fractures, 3.75% had facial injuries, and 2.5% each had head and abdominal injuries. We treated the injured with various surgical approaches, such as soft tissue debridement (38.84%), fasciotomy (18.79%), amputation (3.75%), and other procedures. We had to refer 8.27% of the patients to different advanced centers. The mortality rate was 5.91%, including 1 volunteer rescuer.ConclusionPattern of injuries and modalities of management needed in an industrial disaster is a valuable experience which can be utilized in preparing to face disasters in the future and beyond. Death of a voluntary rescuer once again warrants the necessity of using a helmet and safety gear during any rescue operation. (Disaster Med Public Health Preparedness. 2017;11:21–24)

Download Full-text

Applying a Hybrid Experimental-Computational Technique to Study Elbow Joint Ligamentous Stabilizers

Journal of Biomechanical Engineering ◽

10.1115/1.4039674 ◽

2018 ◽

Vol 140 (6) ◽

Author(s):

Danial Sharifi Kia ◽

Ryan Willing

Keyword(s):

Soft Tissue ◽

Elbow Joint ◽

Computational Technique ◽

Joint Stability ◽

Collateral Ligament ◽

Principle Of Superposition ◽

Flexion Extension ◽

Joint Biomechanics ◽

The Stability

Much of our understanding of the role of elbow ligaments to overall joint biomechanics has been developed through in vitro cadaver studies using joint motion simulators. The principle of superposition can be used to indirectly compute the force contributions of ligaments during prescribed motions. Previous studies have analyzed the contribution of different soft tissue structures to the stability of human elbow joints, but have limitations in evaluating the loads sustained by those tissues. This paper introduces a unique, hybrid experimental-computational technique for measuring and simulating the biomechanical contributions of ligaments to elbow joint kinematics and stability. in vitro testing of cadaveric joints is enhanced by the incorporation of fully parametric virtual ligaments, which are used in place of the native joint stabilizers to characterize the contribution of elbow ligaments during simple flexion–extension (FE) motions using the principle of superposition. Our results support previously reported findings that the anterior medial collateral ligament (AMCL) and the radial collateral ligament (RCL) are the primary soft tissue stabilizers for the elbow joint. Tuned virtual ligaments employed in this study were able to restore the kinematics and laxity of elbows to within 2 deg of native joint behavior. The hybrid framework presented in this study demonstrates promising capabilities in measuring the biomechanical contribution of ligamentous structures to joint stability.

Download Full-text