Modular Taper Junctions

Modular Taper Junctions

Illustration created for the article Evaluation and Treatment of Painful Total Hip Arthroplasties with Modular Metal Taper Junctions by R. Michael Meneghini, MD; Nadim J. Hallab, PhD; Joshua J. Jacobs, MD. Orthopedics May 2012, Volume 35, Number 5.

Modern primary total hip arthroplasty femoral components have emerged to include modular necks. Subsequently, the additional taper junction provides another interface as a potential source for mechanically assisted crevice corrosion, which is a complex process involving fretting and crevice corrosion. Furthermore, it is becoming evident that an adverse local tissue reaction may result in some patients due to the mechanically assisted crevice corrosion. This article details the clinical, radiographic, and laboratory evaluation of patients with these components who present with persistent pain. The relevant surgical strategies and techniques to address this pathology in symptomatic patients are addressed.

Failed Total Shoulder Arthroplasty

Failed Total Shoulder Arthroplasty

This illustration was commissioned for Arthroscopically Assisted Conversion of Total Shoulder Arthroplasty to Hemiarthroplasty With Glenoid Bone Grafting by Surena Namdari, MD, MSc; and David Glaser, MD for publication in ORTHOPEDICS October 2011 issue (ORTHOPEDICS November 2011;34(11):862).

Aseptic loosening of the glenoid component after total shoulder arthroplasty presents a considerable treatment challenge in the setting of substantial glenoid bone loss.  Glenoid component explantation and bone grafting of defects has become a common methods of recreating bone stock in hopes of preventing later fractures, maintaining joint kinematics, and allowing for later glenoid reimplantation if necessary.  While this has been traditionally accomplished via open techniques, we describe an arthroscopic-assisted method of glenoid explantation and bone grafting for cases of aseptic glenoid loosening with contained bone defects.

Patellar Instability

Patellar Instability

According to Dr. Hu Xu of the Department of Orthopedics, Xijing Hospital, proximal soft-tissue realignment is the main surgical intervention for recurrent patellar instability. In recent years, all-inside arthroscopic procedures or mini-open surgeries comes to replace traditional operations which have more associated morbidity and poor cosmetic results. In this article (ORTHOPEDICS July 2011;34(7):524), Xu and his colleagues report a very simple and all-inside arthroscopic technique for the operative treatment of recurrent patellar instability. Using two epidural needles in several steps and no accessory portals required, the medial patellar retinaculum is imbricated to the desired tension. The combination of lateral release and medial retinacular placation obviously improves the patellar tracking compared with pre-operation.

The Modified Lapidus Procedure

The Modified Lapidus Procedure

This illustration shows a technique described by Romain Gérard, MD, Richard Stern, MD, and Mathieu Assal, MD from the Orthopaedic Surgery Service, University Hospital of Geneva, Switzerland for the March 2008 issue of Orthopedics. This technique is valuable for providing a powerful and durable correction of metatarsus primus varus and hallux valgus, and careful attention to the details should help in achieving a successful outcome while avoiding complications.

 

“Hands Free” Femoral Retraction

“Hands Free” Femoral Retraction

The illustration posted in this example was created for the April 2013 issue of Orthopaedics feature and peer-reviewed article, Technical Trick: Simple, No-Hands Retraction for Lateral Approach to the Proximal Femur.

A simple technique is described that allows the orthopaedic surgeon to perform no-hands retraction during the lateral approach to the proximal femur during fixation of an intertrochanteric fracture with a sliding hip screw. All instruments remain sterile and within 6 inches of the surgical wound. Use of this technique is particularly useful in the event that a surgeon is operating with only one surgical assistant who may not be able to provide adequate assistance with retraction while concurrently preparing surgical instruments.

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