OKOJ, Volume 9, No. 10

Modified Sliding Trochanteric Osteotomy for Complex Hip Arthroplasty: Surgical Technique and Clinical Outcomes

The modified sliding trochanteric osteotomy preserves vastus lateralis continuity with the osteotomized greater trochanter and the abductors. This technique also preserves the posterior capsule and external rotators in order to reduce the risk of dislocations. In this paper, we describe the surgical technique and present the clinical and radiographic results of 113 patients who underwent modified sliding trochanteric osteotomy for hip arthroplasty. Follow-up ranged from 24 to 118 months. Ninety-seven osteotomies (85.8%) healed with bony union, 12 (10.6%) had fibrous union, and 4 (3.5%) had nonunion. No correlation was found between union rate and previous greater trochanter osteotomy, osteotomy width, osteotomy fragmentation, or the type of femoral component. Nine patients (7.9%) developed a new abductor lurch. Patients with union of the greater trochanter had a 4.1% incidence of a lurch, and patients with either fibrous union or nonunion had a 31.3% incidence of a lurch. Five patients (4.4%) experienced postoperative hip dislocation. The benefits of modified sliding trochanteric osteotomy have been well described, and this study provides evidence of an acceptably low complication rate.

    • Keywords:
    • total hip arthroplasty

    • THA

    • revision total hip arthroplasty

    • revision THA

    • total hip replacement

    • revision total hip replacement

    • modified trochanteric slide osteotomy

    • sliding trochanteric osteotomy

    • Subspecialty:
    • Adult Reconstruction

Arthroscopic Treatment for Impingement Lesions of the Foot and Ankle

Anterior ankle impingement is a common source of chronic pain in athletes, and is generally caused by the development of bone spurs at the anterior tibiotalar joint, resulting in a loss of motion. Anterolateral impingement by soft tissue is another common source of chronic ankle pain. Arthroscopic treatment of ankle impingement has been shown to provide consistent improvement in function, pain, and in clinical outcome scores for most patients. Long-term follow-up has shown 92% to 95% good-to-excellent results in patients without joint space narrowing on radiographs. In athletes, it has been reported that 80% have been able to return to sports at the same level of performance. Following arthroscopic surgery, osteophytes may recur and most patients will not obtain a full range of dorsiflexion; however, most do obtain symptomatic relief that allows return to function.

    • Keywords:
    • anterolateral soft-tissue impingement

    • anterior ankle impingement

    • anterior tibiotalar spurs

    • anterior ankle pian

    • tibiotalar osteophytes

    • anterior bony ankle impingement

    • Subspecialty:
    • Foot and Ankle

HOT TOPIC: Perioperative Pain Management in Anticoagulated Patients

The use of regional anesthesia for the perioperative management of surgically induced pain has expanded exponentially over the past 2 decades. Concomitant to that increase has been an increasing awareness of the implications of using neuraxial and peripheral nerve block techniques in individuals receiving chronic or acute anticoagulation therapy, largely to minimize the deleterious risks of venous thromboembolism. This paper reviews the current state of knowledge concerning the respective guidelines and position statements promulgated by the American Society of Regional Anesthesia, American College of Chest Physicians, and the American Academy of Orthopaedic Surgeons in conjunction with broad statements on patient management issued by the Surgical Care Improvement Project and the Joint Commission on the Accreditation of Health Care Organizations. Each of these respective entities has addressed the issue of anticoagulation in perioperative patients, emphasizing the safest approaches to managing them based upon best practices and peer-refereed literature. We describe current knowledge regarding the management of patients undergoing major orthopaedic surgery under regional anesthesia.

    • Keywords:
    • neuraxial blockade

    • perioperative analgesia

    • epidural anesthesia

    • spinal anesthesia

    • peripheral nerveblock

    • epidural regional anesthesia

    • total hip replacement

    • total knee replacement

    • knee arthroscopy

    • hip fracture surgery

    • venous thromboembolism

    • VTE prophylaxis

    • thromboprohylaxis

    • pulmonary embolism

    • antocoagulant

    • anticoagulation

    • antithrombotic therapy

    • thrombolytic therapy

    • unfractionated heparin

    • UFH

    • low-molecular-weight heparin

    • LMWH

    • warfarin

    • antiplatelet medication

    • herbal medicine

    • thrombin inhibitors

    • Factor Xa inhibitors

    • Subspecialty:
    • Pain Management

The Ponseti Technique for Treating Clubfoot

Over the past decade, the treatment of clubfoot has evolved from extensive soft-tissue releases to less invasive approaches. The most popular minimally invasive approach is the Ponseti method, which not only results in excellent correction but has fewer complications compared with traditional surgical treatment. To achieve success with the Ponseti method, attention to detail is critical and the protocol has to be followed precisely by both the orthopaedic surgeon and the parents. The goal of this review is to emphasize the details of the Ponseti method for treating isolated clubfoot as well as to point out common pearls and pitfalls with the application of this method. Indications and technique for performing the tenotomy of the Achilles tendon, the importance of foot abduction bracing to prevent relapse, and the management of clubfoot relapse will also be emphasized.

    • Keywords:
    • club foot

    • congenital clubfoot

    • congenital talipes equinovarus

    • club foot deformity

    • clubfoot deformity

    • idiopathic clubfoot

    • recurrent clubfoot

    • isolated clubfoot

    • nonisolated clubfoot

    • serial casting

    • Achilles tenotomy

    • Subspecialty:
    • Pediatric Orthopaedics

Diagnosis and Arthroscopic Management of Posterior Shoulder Instability

Posterior shoulder instability is a condition increasingly diagnosed in young, active patients. Because of the need for its accurate diagnosis, it is important to understand the symptoms of posterior shoulder instability and the types of sports and other activities that raise the risk of its occurrence. Physical examination plays a key role in the diagnosis of posterior shoulder instability, and several specific, provocative tests can be performed to identify its presence. Patients in whom the nonsurgical management of posterior shoulder instability fails may be candidates for surgical intervention, with arthroscopic techniques providing good results when used under the appropriate indications.

    • Keywords:
    • posterior shoulder instability

    • recurrent posterior shoulder instability

    • glenohumeral instability

    • shoulder instability

    • shoulder dislocation

    • shoulder subluxation

    • multidirectional instability

    • arthroscopy

    • Subspecialty:
    • Shoulder and Elbow