OKOJ, Volume 9, No. 3

Orthopaedic Biomaterials: Part IV. Ceramics

Advances in biomaterials have been central to improvements in orthopaedic implants in all fields of orthopaedics. For the clinician, patient care decisions are most enhanced by key principles and facts, as opposed to technical details. In the final part of this series, we review the basic principles of ceramics, including common materials, commercial implant applications, and modern manufacturing processes. Emphasis is given to clinical relevance for patient care decisions.

    • Keywords:
    • metal oxides

    • alumina

    • zirconia

    • manufacturing

    • hot isostatic pressing

    • tribology

    • bearing surfaces

    • ceramic-on-ceramic

    • alumina-on-alumina

    • stripe wear

    • total hip arthroplasty

    • squeak

    • titanium nitride

    • calcium phosphates

    • hydroxyapatite

    • beta tricalcium phosphate

    • TCP

    • bone graft substitute

    • pyrolytic carbon

    • silicon nitride

    • ceramic coatings

    • Subspecialty:
    • Basic Science

    • Adult Reconstruction

Managing Pain Associated With Total Knee Arthroplasty

Management of postoperative pain is an important concern for the patient undergoing total knee arthroplasty and for the orthopaedic surgeon. Continuous femoral nerve block has proven to be superior not only for controlling the pain associated with total knee arthroplasty but for producing a better surgical outcome. A pioneering study of continuous femoral nerve block in the late 1990s, later followed by other research investigations, demonstrated unequivocally that this modality of pain management supersedes intravenous morphine sulphate administered via patient-controlled analgesia and is equivalent to epidural analgesia. Continuous femoral nerve block, however, produces fewer undesirable side effects and complications than both morphine sulphate via patient-controlled analgesia and epidural analgesia. This discussion focuses on the use of continuous femoral nerve block and single-injection subgluteal sciatic nerve block, reviews the method of continuous femoral nerve block in perspective, outlines pharmaceutical considerations, and analyzes financial ramifications for the anesthesiologist. Tips for controlling postoperative pain after total knee arthroplasty are provided for the orthopaedic surgeon and the patient.

    • Keywords:
    • pain management

    • pain control

    • continuous peripheral nerve blockade

    • continuous femoral nerve block

    • single-injection subgluteal sciatic nerve block

    • total knee arthroplasty

    • Subspecialty:
    • Knee

    • Pain Management

Return to Play: Shoulder Dislocations, Clavicle Fractures, and Acromioclavicular Separations

Shoulder dislocations, clavicle fractures, and acromioclavicular separations are common athletic injuries that may result in time lost from sports participation. Nonsurgical treatment remains appropriate for some of these injuries. Surgical treatment may also be warranted, and recommended surgical techniques continue to evolve and be refined. With either form of treatment, the timing of return to sports participation is important in avoiding recurrence of injury and promoting a high level of performance. In this article, we discuss and review the various methods of treatment of these common shoulder injuries, as well as the implications for return to play in the athletic patient population.

    • Keywords:
    • clavicle fracture

    • clavicular fractures

    • collarbone fracture

    • broken collarbone

    • shoulder trauma

    • intramedullary fixation

    • plate fixation

    • AC joint injury

    • shoulder separation

    • shoulder dislocation

    • AC separation

    • AC joint disruption

    • acromioclavicular disruption

    • anterior shoulder instability

    • shoulder laxity

    • recurrent dislocation

    • traumatic dislocation

    • Bankart lesion

    • dislocated shoulder

    • multidirectional instability

    • posterior instability

    • Subspecialty:
    • Shoulder and Elbow

ACL Technique: Two-Incision Bone-Patellar Tendon-Bone Autograft

Surgical techniques for anterior cruciate ligament reconstruction have evolved over time. Currently, most orthopaedic surgeons perform this reconstruction with arthroscopic assistance, using patellar tendons or hamstring tendons as graft sources. This article describes the two-incision bone–patellar tendon-bone autograft technique and its advantages. This method affords the surgeon complete latitude in placing the femoral tunnel in any desired position of the lateral wall of the notch, thus avoiding the need to place the femoral drill hole in a position dictated by the tibial tunnel position or the degree of knee flexion. Another significant advantage of this technique is that it allows relatively uncomplicated revision of failed single-incision ACL reconstruction, because the new tunnel is created from outside, within solid bone. Finally, the two-incision bone–patellar tendon-bone autograft technique significantly decreases the likelihood of posterior femoral tunnel blowout.

    • Keywords:
    • anterior cruciate ligament reconstruction

    • two-incision bone–patellar tendon-bone autograft

    • three-strand hamstring graft

    • four-strand hamstring graft

    • patellar tendon autograft

    • hamstring tendon autograft

    • Subspecialty:
    • Sports Medicine

HOT TOPIC: Arthroscopic PCL Repair With Repair of Meniscal Root Avulsion

In this video presentation, Drs. Taylor and Peterson perform arthroscopic PCL and meniscal root repair on a 16-year-old female gymnast who presented following a hyperextension injury during a tumbling pass.

    • Keywords:
    • PCL tear

    • posterior cruciate ligament tear

    • arthroscopy

    • meniscal injury

    • meniscal tear

    • meniscal root avulsion

    • sports medicine

    • Subspecialty:
    • Sports Medicine