OKOJ, Volume 9, No. 12

Hip resurfacing is an alternative to total hip replacement that at medium-term follow-up has had high rates of clinical success and prosthesis survival when done by experienced surgeons in appropriately selected patients. Traditional selection criteria for hip resurfacing suggest that it is most successful in active men younger than 55 years, most of whom have a diagnosis of osteoarthritic hip pain. Recent reports have suggested that high survivorships of resurfaced hips can also be achieved in wider settings, such as those of active older patients and those with osteonecrosis or developmental dysplasia of the hip. Advantages of hip resurfacing as compared with total hip arthroplasty include improved load transfer to the proximal femur, a greater range of motion of the hip joint, and more natural gait mechanics of walking. Some sources also suggest that because the proximal femoral bone is retained, conversion of a failed resurfaced hip is less demanding than revision of a total hip arthroplasty. Despite these advantages, hip resurfacing is a technically demanding procedure that requires extensive training and has a well-documented learning curve. To assist the progress along this learning curve for orthopaedic surgeons unfamiliar with hip resurfacing, this article outlines the indications for and contraindications to hip resurfacing, and offers surgical tips and techniques that can help improve the outcome of this procedure.

Hip dysplasia in the skeletally mature patient can lead to symptomatic instability, most often as a result of anterolateral acetabular insufficiency. Recent studies have shown that symptomatic acetabular dysplasia can predictably be corrected surgically with the Bernese (Ganz) periacetabular osteotomy. This paper describes the protocol for radiographic evaluation of the patient with symptomatic primary acetabular dysplasia and provides a step-by-step description and video presentation of the surgical technique.

Although partial fasciectomy remains the standard treatment for Dupuytren contracture, especially for patients with severe or recurrent disease, the potential for a high complication rate and a lengthy recovery following this procedure has fueled interest in alternative treatments. Needle aponeurotomy and collagenase injection are two minimally invasive procedures for Dupuytren contracture that have gained recent popularity. Each allows rapid recovery and lower risk of complications compared with fasciectomy. Minimally invasive treatment is an attractive alternative for patients who feel that lower risk and relative ease of recovery more than offset the likelihood of earlier recurrence. Collagenase injection is technically easier, but is limited with respect to both the number of areas that can be treated simultaneously and how closely multiple treatments may be scheduled. Needle aponeurotomy has a longer technical learning curve, but is less expensive and has more flexibility in treating multiple areas and bilateral disease.

Soft-tissue sarcomas are estimated to represent approximately 1% of all malignant tumors, and liposarcoma is the most common of the soft-tissue sarcomas. The median age range of patients ranges from 40 to 60 years, with males more commonly affected than females. Treatment is often multidisciplinary, with wide surgical resection and adjuvant radiation therapy as the mainstays of treatment. The use of chemotherapy for liposarcoma depends on tumor size, grade, histologic type, and the presence of metastases. A tumor size exceeding 5 cm, local invasion, metastases, and positive surgical margins have been shown to be negative prognostic factors in patients with liposarcoma.

Computer-assisted spinal navigation technologies couple anatomic information with real-time visual feedback to assist surgeons in the operating room in treating disorders of the spine. Since their inception, systems for computer-assisted spinal navigation have been adapted to multiple imaging modalities. The efficacy of these systems has been shown to be at least comparable to that of conventional techniques for spinal surgery in terms of the accuracy of placement of prosthetic hardware in the spine, sizes of the incisions for the treatment of spinal disorders, and speed of the relevant procedures. In surgical procedures involving complex anatomy, computer-assisted spinal navigation can be an invaluable tool. Modern systems for computer-assisted spinal navigation are available from most major medical device manufacturers, and are being adopted in many tertiary care centers and medical practices specializing in treatment of the spine. This article reviews the basic concepts and components of spinal navigation technology and the literature relating to its efficacy. It also describes the utilization of spinal navigation technologies at two institutions and describes illustrative situations in which surgeons and patients have benefited from the use of this still-recent technology.