The AAA-Triple A total ankle arthroplastyRon Woering
Total Ankle Arthroplasty has become a viable option for selected patient with an end-stage ankle osteoarthritis. This presentation presents the product details of the AAA Triple-A ankle arthroplasty
The AAA-Triple A total ankle arthroplastyRon Woering
Total Ankle Arthroplasty has become a viable option for selected patient with an end-stage ankle osteoarthritis. This presentation presents the product details of the AAA Triple-A ankle arthroplasty
In this article, we present the general principle of management Periprosthetic fracture after arthroplasty according to the "Unified” or “Comprehensive” classification system. We especially review the current concepts of periprosthetic hip and knee fractures.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
In this article, we present the general principle of management Periprosthetic fracture after arthroplasty according to the "Unified” or “Comprehensive” classification system. We especially review the current concepts of periprosthetic hip and knee fractures.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
High tibial osteotomy (HTO) is a common and widely accepted procedure in orthopaedic surgery. In the literature, we find descriptions of the technique dating back to the 50s, with Jackson (Jackson, 1958). However, it was not until the 70s, with the publications of Conventry (Coventry, 1969 and 1973) and Insall (Insall, 1975), that proximal tibial osteotomy became common practice as a treatment option for medial compartment osteoarthritis of the knee usually associated to varus deformity. At that time, closing wedge osteotomies were performed, despite the greater technical difficulty and risks involved, as there were no fixation materials available that could enable opening wedge osteotomy. Only after the development of medial wedge plate fixation that opening wedge osteotomy became applicable (Puddu, 2004).
The goals of HTO are:
1. To reduce knee pain by transferring weight-bearing loads to the relatively unaffected compartment;
2. To increase the life span of the knee joint, by slowing or stopping the destruction of the medial joint compartment. This could delay the need of a joint replacement.
Discuss the prevalence of degenerative Knee Osteoarthritis (OA). Understand and discuss different approaches to treat Knee OA. Discuss the Indications, Priority and Clinical outcomes of Knee Replacement
Principle of Deformity Correction in lower Limb Kaushal Kafle
A brief summary about the priniciple of deformity correction in paediatrics and adults with the effects of deformity, etiology, physiological deformity, clinical and radiological assessment, measurements of various lines and angles, various terminologies, preoperative templating, acute and gradual correction , osteotomy principle and techniques, methods of fixation and stabilization.
Basics of patellofemoral instability for postgraduates. Gives brief introduction about patellofemoral joint anatomy, causes, examintaion and treatment for patellofemoral instability
Proximal fibular osteotomy - What is the evidence?Dr Saseendar MD
Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?Dr Saseendar MD
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
Brief discussion regarding management of physiotherapy, pharmacotherapy, orthosis, principles of orthopedic surgical managements, addressing problems at hip, knee and ankle, soft tissue release procedures, osteotomies, timing of surgery, complications, prognosis, hip at risk signs, birthday syndrome, role of botulinum toxin, upper extremity involvement, contracture release.
Conformis Patient Specific Custom Total Knee ReplacementMoby Parsons
This is a comprehensive review of the benefits of customized patient specific total knees. Conformis is the only company to currently offer this unique value-added innovation in knee replacement.
1. Total Ankle Replacement
Selene G. Parekh, MD, MBA
Associate Professor of Surgery
Partner, North Carolina Orthopaedic Clinic
Department of Orthopaedic Surgery
Adjunct Faculty Fuqua Business School
Duke University
Durham, NC
919.471.9622
http://seleneparekhmd.com
Twitter: @seleneparekhmd
2. Why a Total Ankle
Arthroplasty?
Severe painful post-traumatic osteoarthritis
3. Comparison of Health-Related
Quality of Life Between Patients with
End-Stage Ankle & Hip Arthrosis
JBJS Mar 2008; 90:499-505
• End stage ankle arthritis is as
severe, if not worse, than end
stage hip disease.
4. Why a Total Ankle
Arthroplasty?
• The Need for Other Surgical Options:
» Debilitating pain
» Patients with large bone loss
» Subtalar and/or midtarsal arthrosis
» Bilateral involvement
• Other Advantages:
» Provides pain relief
» Preserves joint motion & stability
15. TAR: What Went Wrong?
• 1st generation problems
• Did not respect
• Anatomy
• Kinematics
• Alignment
• Stability
16. TAR: What Went Wrong?
• 1st generation problems
• Excessive bone resections
• Changed in level of the ankle axis
• Constrained design
• Poor cement fixation in fatty bone marrow
• Multi-axial design relied on ligaments
17. TAR: What Went Wrong?
MAYO prosthesis (1974)
IRVINE arthroplasty
18. TAR: What Went Wrong?
• High incidence of complications
» Delayed wound healing
» Fibular impingement
» Loosening (radiologic and clinical)
» Malleolar fractures
19. TAR: What Went Wrong?
Conaxial ankle
replacement medial
malleolar fracture
Ankle is in Varus and Tibial
Component is Loose
20. What Went Wrong?
Constrained
•Treated the ankle as a hinge joint - transfer
stresses to bone-cement interface
»TPR
»ICLH
»Conaxial
»Mayo Clinic (1976)
ICLH
arthroplasty
23. Questions Outstanding
• Should the bearing be fixed or mobile?
• Fixed Bearings
• Track record in knee and hip
• One sided wear
• More difficult exchange
• Mobile bearings
• Good congruency Easier ligament tensioning
• Incidence of medial joint pain secondary to tight
tensioning
• Subluxation induced wear concerning
28. FDA approved TAA
Salto-Talaris with cement
S.T.A.R. without cement
INBONE with cement
Zimmer with cement
Prophecy without cement
Infinity without cement
Hintegra
Agility with cement
Eclipse with cement
Mobility
Exactech
Integra
29. Salto Total Ankle
• Next Generation……..
• Instrumentation to
Find “Sweet Spot” in
Fixed Bearing
Prosthesis
30. Salto Data
• FB better than MB
• 98% survivorship @ 3.5 yrs
• 85% survivorship @ 7-11 yrs
• Significant improvement in gait
• Survivorship lower in low volume centers
52. Selection of Implant
• Under 40yo
• Mobile bearing – STAR, Salto, Hintegra
• ? Zimmer
• Over 40yo
• Mobile bearing
• Fixed – Salto
• ? Zimmer
• Over 300lb (136kg), revision, big deformity
• Intramedullary device – InBone
53. Indications for TAA
•Optimal Patient
• Less excessive
demands
» Rheumatoid arthritic
patients
» Post-traumatic arthritis
• Older
• Multiple joint arthrosis
to slow them down
54. Indications for TAR
• Relative indication:
» Youthful, active individuals
• Contraindications:
» Talar AVN, Charcot Joint, neurologically
compromised foot, chronic infection
55. Outcomes
• TAR better than AA walking upstairs, downstairs, uphill
• TAR high rate of satisfaction & biomechanics of the gait
similar to a healthy ankle
• Bilateral gait mechanics
• Altered in fusion patients
• Relatively recovered TAR patients
• Gait patterns in 3component, mobile-bearing TAR more
closely resembled normal gait compared to fusion
56. Outcomes
• TAR & fusion significant improvements in various
parameters of gait
• Neither group functioned as well as normal control
subjects
• Fusion relieves pain and improves overall function
• Persistent alterations in gait
• TAR - improvements in pain and gait up to 2 years
57. Conclusions
• Both ankle design and technique dictate
what works to obtain a good result
• Expanding capability of ankle
replacements
• Offer opportunity to do ankle replacements
in all patients, regardless of deformity or
previous surgery