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Technique Spotlight: Lateral Ulnar Collateral Ligament Repair

Introduction Injuries to the lateral ulnar collateral ligament (LUCL) of the elbow can be caused by simple elbow dislocations as well as complex trauma, or unfortunately, from iatrogenic injury. Simple elbow dislocations can often be treated successfully with bracing and rehabilitation. However, failure of the LUCL to heal can lead to varus and posterolateral rotatory instability (PLRI) of the elbow. Simple activities of daily living, such…

Traumatic Elbow Ligamentous Injury

Introduction The elbow is the second most commonly dislocated joint in the human body after the shoulder joint. This is likely to be due to the relatively small surface area of the joint, the short working length of stabilizing structures, and the large moment arms on either side of the articulation that magnify the forces applied to the limb. Stability of the elbow comes from the…

Technique Spotlight: Total Elbow Arthroplasty for Distal Humerus Fracture

Introduction Articular fractures of the distal humerus are treated most successfully with operative intervention in order to restore function. Despite advances in plating constructs, these fractures can be difficult to fix and failures can result in a high reoperation rate. Therefore in unreconstructable distal humerus fractures, total elbow arthroplasty (TEA) has arisen as a viable treatment option. Indications Unreconstructable distal humeral fractures—those fractures in which open…

Technique Spotlight: Principle-Based Internal Fixation of Distal Humerus Fractures

Indications Open reduction and internal fixation (ORIF) is recommended for the majority of medically stable patients with displaced distal humerus fractures. In selected cases, nonsurgical management or total elbow arthroplasty (TEA) may be preferred. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Adult Distal Humerus Fractures

Introduction While rare, fractures of the distal humerus are complex and have always created unique challenges for orthopedic surgeons. Until the second half of the 20th century, most of these fractures could not be reliably fixed and therefore were treated nonoperatively. Complications including nonunion, malunion, neurovascular injury, and joint stiffness were common. Subsequently with nonoperative management, patients often could not return to employment and the psychosocial…

Evolving technology in unicompartmental knee arthroplasty

Introduction The evolution of the basic technical principles of unicompartmental arthroplasty design and implantation are discussed in Chapters 1 , 3 , 6 and 7 . These should endure for years to come. Innovative technological advances, however, will appear, evolve, and find their place in the years to come. This final chapter will discuss current evolving technologies such as robotic component positioning, patient-specific instruments and prosthetic…

Revision of failed unicompartmental knee arthroplasty

One of the principal advantages of unicompartmental knee arthroplasty (UKA) is its conservative nature. Ideally, after a UKA, any future revision can be carried out with the use of primary total knee arthroplasty (TKA) components and the result can be comparable to a primary arthroplasty. Initial experience from the 1980s indicated that this might not be the case. As experience with primary UKA was gained, however,…

Unicompartmental knee arthroplasty in outliers

Although the “classic” indication for unicompartmental knee arthroplasty (UKA) is isolated end-stage osteoarthritis of the medial or lateral compartment in the elderly patient with an intact anterior cruciate ligament (ACL), other potential indications exist. These “outliers” include selected patients with ACL deficiency. Some patients with the diagnosis of osteonecrosis, as well as middle-aged patients, may be candidates for UKA. Octogenarians are often excluded as candidates, but…

Lateral compartment arthroplasty

Indications The indications for lateral unicompartmental knee arthroplasty (UKA) are similar to those for medial UKA. The incidence of its need, however, is much less than that for medial replacement. In most experienced UKA practices, lateral arthroplasty comprises about 10% of UKAs. The patient is more likely to be female and will present with a valgus knee alignment along with lateral knee pain and radiographic changes…

Mobile-bearing unicompartmental knee arthroplasty: Rationale and surgical technique

The rationale for a mobile-bearing articulation Mobile-bearing unicompartmental components were introduced in an attempt to increase the longevity of the prosthesis by maximizing the articular contact area, thereby reducing stress on the polyethylene and minimizing wear. They might also reduce the rate of aseptic loosening in a conforming articulation. Stress across an articulation is related to the difference between the radius of curvature of the two…

Surgical technique of medial fixed-bearing unicompartmental knee arthroplasty

Intraoperative confirmation of patient candidacy Even if a unicompartmental knee arthroplasty (UKA) is planned for a patient based on preoperative radiographs and physical examination, the surgeon must confirm at arthrotomy that the patient is an appropriate candidate. Both cruciate ligaments should be intact, although a deficient anterior cruciate ligament (ACL) is occasionally acceptable for fixed-bearing UKA if certain criteria are fulfilled (see Chapter 9 ). Secondly,…

Reasons for and modes of failure of unicompartmental knee arthroplasty

Reasons for failure of unicompartmental knee arthroplasty (UKA) include improper patient selection, poor prosthetic design, improper surgical technique, and pain of unknown origin. Modes of failure include prosthetic loosening and wear, secondary degeneration of an unresurfaced compartment, instability, and stress fracture of the tibia through peripherally placed guide pins. Improper patient selection The “classic” and updated guidelines for appropriate patient selection are given in Chapter 2…

Prosthetic design considerations

Unicompartmental components have been available for over 50 years, beginning with designs such as the Polycentric Knee, and the Marmor Knee prostheses. , Many of these early designs were also advocated for bicompartmental arthroplasty, but their success was hindered by the fact that instrumentation was poor and they did not provide for resurfacing of the patellofemoral compartment. As time passed, one-piece bicompartmental components became available on…

Acetabular distraction technique for chronic pelvic discontinuity

Background Acetabular bone loss with an associated chronic pelvic discontinuity presents an extremely challenging problem in the setting of revision total hip arthroplasty (THA). A chronic pelvic discontinuity should be thought of as a chronic fibrous non-union and may exhibit an inability to heal, thus adding an additional layer of complexity to this clinical entity. When planning for biologic fixation, clinical success is predicated on the…

Jumbo cup and modular porous metal augments for chronic pelvic discontinuity

Background Chronic pelvic discontinuity, separation of the superior ilium from the inferior ischiopubic segment through the acetabulum with loss of host bone, is one of the most challenging issues to manage with respect to acetabular revision surgery. It is estimated that chronic pelvic discontinuity is the cause of up to 5% of revision total hip arthroplasty (THA) procedures. Construct survivorship is a function of the degree…

Custom 3D-printed acetabular component for chronic pelvic discontinuity

Background Chronic pelvic discontinuity (CPD) is the separation of the ilium superiorly from the inferior pelvis, i.e., the ischiopubic segment. While CPD most frequently stems from a chronic non-united pelvic stress fracture via deficient bone in revision total hip arthroplasty (THA), an acetabular fracture that has not healed or an acute acetabular fracture in the setting of THA may also result in a CPD. Revision surgeries…

Custom triflange acetabular component for chronic pelvic discontinuity

Background Several treatment options exist for the management of massive acetabular bone loss encountered during acetabular component revision. These include column plating in conjunction with porous metal shells, structural allografts, impaction grafting, distraction technique with jumbo porous metal acetabular components with or without porous metal augments, acetabular reconstruction cages, cup-cage constructs, and custom triflange acetabular components (CTACs). However, in the setting of massive bone loss with…