JAAOS

JAAOS, Volume 7, No. 5


Aseptic complications after total knee arthroplasty.

Aseptic complications after total knee arthroplasty are occurring less frequently than they did one or two decades ago. This is related in part to technical advancements, design improvements, and changes in perioperative management. Extensor mechanism dysfunction is the most frequent complication and the most commonly cited reason for secondary surgery after total knee arthroplasty. Mechanical wear, tibiofemoral instability, periprosthetic fracture, thromboembolic disease, compromised wound healing, neurovascular problems, and stiffness are less common, but nevertheless troublesome, sources of dysfunction after total knee arthroplasty. Complications compromise outcomes, and the most effective way of dealing with complications is prevention.

    • Keywords:
    • Arthroplasty

    • Replacement

    • Knee|Fractures

    • Spontaneous|Humans|Knee Prosthesis|Patella|Postoperative Complications|Prosthesis Design|Prosthesis Failure|Risk Factors|Tendon Injuries

    • Subspecialty:
    • Adult Reconstruction

Biceps tendon disorders in athletes.

It has been proposed that the long head of the biceps functions as a humeral head depressor and stabilizer. In addition, in many overhead sports, the biceps helps to accelerate and decelerate the arm. With improper training or fatigue, inordinate stresses can be placed on the biceps as it attempts to compensate for other muscles. This can lead to attrition and failure, either within the tendon substance or at its origin. Bicipital problems in athletes usually occur in conjunction with other types of shoulder disorders, such as rotator cuff impingement and glenohumeral instability, making determination of the role and degree of biceps involvement difficult. Conditions affecting the biceps tendon in athletes can be generally classified as degeneration, instability, and disorders of the origin. Because of the close association of biceps lesions with other abnormalities, a thorough evaluation of the shoulder with a suspected biceps disorder is essential. Treatment of bicipital problems in athletes must often be accompanied by treatment of associated shoulder conditions.

    • Keywords:
    • Athletic Injuries|Humans|Joint Instability|Rotator Cuff|Shoulder|Shoulder Impingement Syndrome|Shoulder Joint|Tendon Injuries|Tendons

    • Subspecialty:
    • Sports Medicine

    • Shoulder and Elbow

Cervical spine injuries in football players.

Cervical spine injuries have been estimated to occur in 10% to 15% of football players, most commonly in linemen, defensive ends, and linebackers. The overwhelming majority of such injuries are self-limited, and full recovery can be expected. However, the presenting symptoms of serious cervical spine injuries may closely resemble those of minor injuries. The orthopaedic surgeon frequently must make a judgment, on the field or later in the office, about the advisability of returning the athlete to the game. These decisions can have an enormous impact on the player and his family. Most severe cervical spine injuries share the common mechanism of application of an axial load to the straightened spine. Avoiding techniques that employ head-down "spear" tackling and wearing properly fitted equipment markedly reduce the risk of serious injury.

    • Keywords:
    • Brachial Plexus|Cervical Vertebrae|First Aid|Football|Humans|Intervertebral Disk Displacement|Male|Quadriplegia|Spinal Fractures|Spinal Nerve Roots|Sprains and Strains

    • Subspecialty:
    • Trauma

    • Sports Medicine

    • Spine

Loading of healing bone, fibrous tissue, and muscle: implications for orthopaedic practice.

One of the most important concepts in orthopaedics in this century is the understanding that loading accelerates healing of bone, fibrous tissue, and skeletal muscle. Basic scientific and clinical investigations have shown that these tissues respond to certain patterns of loading by increasing matrix synthesis and in many instances by changing the composition, organization, and mechanical properties of their matrices. Although new approaches to facilitate bone and fibrous tissue healing have shown promise (e.g., the use of cytokines, cell transplants, and gene therapy), none has been proved to offer beneficial effects comparable to those produced by loading of healing tissues. For these reasons, patients with musculoskeletal injuries and those who have recently undergone surgery are now being treated with controlled physical activity that loads their healing tissues. Evaluation of new approaches to the promotion of healing of bone, fibrous tissue, and muscle should include consideration of the effects of loading on tissue repair and remodeling.

    • Keywords:
    • Animals|Bone and Bones|Exercise Therapy|Fracture Healing|Humans|Ligaments|Muscle

    • Skeletal|Tendon Injuries|Weight-Bearing|Wound Healing

    • Subspecialty:
    • General Orthopaedics

    • Basic Science

Pelvic osteotomies for the treatment of hip dysplasia in children and young adults.

Persistent acetabular dysplasia is a well-known cause of premature hip osteoarthritis. In the dysplastic hip, point loading occurs at the edge of the steep, shallow acetabulum. Pelvic osteotomies reduce this load by increasing the contact area, relaxing the capsule and muscles about the hip, improving the moment arm of the hip, and normalizing the forces of weight bearing. The orthopaedic surgeon can choose from among a variety of pelvic osteotomies (e.g., redirectional, reshaping, and salvage) for the purpose of restoring normal anatomy and biomechanical forces across the hip joint. Treatment of residual dysplasia is based on the patient's age and the presence or absence of congruent hip reduction. A Salter or Pemberton procedure is generally appropriate for a child between the ages of 2 and 10. A triple innominate osteotomy can be considered for the older child or adolescent in whom the triradiate cartilage remains open. After triradiate closure, the Ganz periacetabular osteotomy can be considered in addition to the triple innominate osteotomy.

    • Keywords:
    • Adolescent|Adult|Child|Child

    • Preschool|Female|Hip|Hip Dislocation

    • Congenital|Hip Joint|Humans|Infant|Male|Osteoarthritis

    • Hip|Osteotomy|Pelvic Bones

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

Use of bone-graft substitutes in distal radius fractures.

The development of bone-graft substitutes potentially provides the benefits of bone grafting without the risks of autograft harvest. During the past few years, the US Food and Drug Administration has approved several different types of products. These vary considerably in composition, structural strength, osteoinductive and osteoconductive potential, and mechanisms and rates at which they are resorbed or remodeled. The products now approved for orthopaedic applications in the United States include those based on naturally occurring materials (e.g., demineralized human bone matrix, bovine collagen mineral composites, and processed coralline hydroxyapatite) as well as synthetic materials (e.g., calcium sulfate pellets, bioactive glass, and calcium phosphate cement). Materials in development include variations on available products and a new generation of biologically active materials employing growth factors. Rigorous comparison of the products is difficult, as there are no universally accepted preclinical assays and comparable clinical studies. Despite the limitations of the data now available, controlled studies and anecdotal reports suggest that use of bone-graft substitutes may result in improved treatment outcomes for patients with fractures of the distal radius.

    • Keywords:
    • Animals|Biocompatible Materials|Bone Cements|Bone Remodeling|Bone Substitutes|Bone Transplantation|Cattle|Ceramics|Glass|Humans|Hydroxyapatites|Osseointegration|Radius Fractures|Transplantation

    • Autologous|Transplantation

    • Homologous|Treatment Outcome

    • Subspecialty:
    • Trauma

    • Hand and Wrist

    • Basic Science

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