OKOJ, Volume 9, No. 7

Cup-Cage Constructs for Acetabular Revisions With Pelvic Discontinuity

Pelvic discontinuity associated with bone loss is a complex challenge in acetabular revision surgery. Reconstruction with an anti-protrusion cage and highly porous cementless cup construct, more briefly known as the cup-cage technique, is a relatively new approach to addressing this challenge. A review was done of 32 consecutive acetabular revision reconstructions in 30 patients with pelvic discontinuity and bone loss treated with the cup-cage technique. The average follow-up of these patients was 44 months (range, 24 to 75 months). Failure was defined as more than 5 mm migration of the acetabular cup component of the revision construct. In 29 of the 32 revisions (90.6%), there was no clinical or radiographic evidence of loosening of the acetabular cup component. The patients’ Harris hip scores improved significantly (P <0.001), from 46.6 ± 10.4 at baseline to 78.7 ± 10.4 (mean ± SD) at the time of the last follow-up visit. In three revisions (9.4%), the cup-cage construct had migrated at 1 year after surgery. Complications included 2 dislocations of the femoral head, 1 infection, and 1 partial palsy of the peroneal nerve. Treatment of pelvic discontinuity with a cup-cage construct is a reliable option for restoring pelvic mechanical stability in the short-term after revision total hip arthroplasty.

    • Keywords:
    • revision total hip arthroplasty

    • revision THA

    • revision total hip replacement

    • revision THR

    • acetabular defects

    • acetabular cages

    • pelvic discontinuity

    • acetabular bone loss

    • anti-protrusion cage

    • anti-protrusio cage

    • acetabular reconstruction

    • Subspecialty:
    • Adult Reconstruction

Occult and Subtle Injuries of the Pediatric Elbow: Pearls and Pitfalls

Unfamiliarity with many pediatric elbow injuries makes their proper definition difficult for those who do not routinely encounter them. This article is intended to facilitate identification of the more elusive fractures and injuries of the elbow in children, to outline the workup for their diagnosis, and to guide their management. It is especially intended to be helpful to the practicing orthopaedic surgeon without specialty training in pediatrics, and to resident physicians encountering small children in the emergency and clinical settings.

    • Keywords:
    • elbow fractures

    • elbow injuries

    • supracondylar fracture of the humerus

    • medial epicondyle fracture

    • elbow dislocation

    • capitellar fracture

    • nusemaid elbow

    • lateral epicondyle fracture

    • apophyseal fracture of the olecranon

    • transphyseal fractures of the humerus

    • medial condyle fracture

    • proximal ulna fracture

    • Subspecialty:
    • Pediatric Orthopaedics

Articular Cartilage Injuries of the Glenohumeral Joint: Diagnosis, Imaging, and Management

Injuries to the articular cartilage of the glenohumeral joint represent a challenge to the orthopaedic surgeon from diagnosis to management. The etiologies of such injuries are numerous, and despite exhaustive physical examination and modern imaging techniques, their diagnosis remains difficult and they are often incidental findings made in the course of treating a concomitant injury. Following their diagnosis, the options for treating injuries to the glenohumeral cartilage are multiple, ranging from conservative treatment to surgery. Their management must be tailored to the type of lesion and the individual patient in terms of the patient's age, activity level, and expectations. Although arthroplasty has produced good results in the treatment of advanced glenohumeral osteoarthritis in elderly patients, its clinical outcomes are less predictable in the younger and more active population, and the risk of such complications as the early loosening of implants is higher in this population. New technologies and mini-invasive surgical techniques have recently provided alternative treatments for this younger patient population. Additionally, the literature has described many restorative and reconstructive techniques for lesions of the glenohumeral cartilage, in all of which the goal is to delay the need for arthroplasty. This article describes the challenges associated with the diagnosis and management of injuries to the glenohumeral articular cartilage, and emphasizes techniques for preserving the shoulder joint in young patients with active demands on this joint.

    • Keywords:
    • ostoechondritis dissecans

    • osteonecrosis

    • Hill-Sachs lesion

    • instability

    • glenolabral articular disruption

    • GLAD

    • chondrolysis

    • infection

    • labral repair

    • rotator cuff tear

    • Outerbridge classification

    • ICRS classification

    • arthroscopic lavage

    • débridement

    • osteochondral autologous transfer system

    • OATS

    • autologous chondrocyte implantation

    • ACI

    • microfracture

    • mosaicplasty

    • osteochondral allograft reconstruction

    • joint resurfacing

    • resurfacing arthroplasty

    • hemiarthroplasty

    • total shoulder arthroplasty

    • comprehensive arthroscopic management

    • CAM procedure

    • bilogic resurfacing

    • interposition arthroplasty

    • Subspecialty:
    • Sports Medicine

HOT TOPIC: Knee Dislocation: Controversies and Future Directions

Knee dislocations are ligamentous disruptions that result in loss of continuity of the tibiofemoral articulation. Most knee dislocations are the result of high-energy trauma, and involve tears of both the anterior cruciate ligament and the posterior cruciate ligament, with variable collateral ligament damage. The diagnosis of these injuries has changed considerably, as it has been recognized that most patients present with the knee spontaneously reduced. Successful outcome with these challenging injuries requires combining complex knee reconstruction techniques from sports medicine with a firm understanding of the management of high-energy soft-tissue injuries from trauma. This article will review relevant anatomy and diagnostic criteria for knee dislocations, in addition to reviewing several management options for this complex injury.

    • Keywords:
    • multiligament-injured knee

    • multiligamentous knee dislocation

    • anterior cruciate ligament injury

    • ACL injury

    • posterior cruciate ligament injury

    • PCL injury

    • medial collateral ligament injury

    • MCL injury

    • lateral collateral ligament injury

    • LCL injury

    • double-bundle PCL reconstruction

    • tibial inlay PCL reconstruction

    • single-bundle transtibial tunnel PCL reconstruction

    • PLC reconstruction

    • PMC reconstruction

    • CT angiography

    • external fixation

    • Subspecialty:
    • Trauma