Abstract:
BACKGROUND:Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA. QUESTIONS/PURPOSES:We compared the effectiveness of patient-specific positioning guides to manual instrumentation with intramedullary femoral and extramedullary tibial guides in restoring the mechanical axis of the extremity and achieving neutral coronal alignment of the femoral and tibial components. METHODS:We retrospectively reviewed 569 TKAs performed with patient-specific positioning guides and 155 with manual instrumentation by two surgeons using postoperative long-leg radiographs. For all patients, we assessed the zone in which the overall mechanical axis passed through the knee, and for one surgeon's cases (105 patient-specific positioning guide, 55 manual instrumentation), we also measured the hip-knee-ankle angle and the individual component angles with respect to their mechanical axes. RESULTS:The overall mechanical axis passed through the central third of the knee more often with patient-specific positioning guides (88%) than with manual instrumentation (78%). The overall mean hip-knee-ankle angle for patient-specific positioning guides (180.6°) was similar to manual instrumentation (181.1°), but there were fewer ± 3° hip-knee-ankle angle outliers with patient-specific positioning guides (9%) than with manual instrumentation (22%). The overall mean tibial (89.9° versus 90.4°) and femoral (90.7° versus 91.3°) component angles were closer to neutral with patient-specific positioning guides than with manual instrumentation, but the rate of ± 2° outliers was similar for both the tibia (10% versus 7%) and femur (22% versus 18%). CONCLUSIONS:Patient-specific positioning guides can assist in achieving a neutral mechanical axis with reduction in outliers.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Ng VY,DeClaire JH,Berend KR,Gulick BC,Lombardi AV Jrdoi
10.1007/s11999-011-1996-6subject
Has Abstractpub_date
2012-01-01 00:00:00pages
99-107issue
1eissn
0009-921Xissn
1528-1132journal_volume
470pub_type
杂志文章abstract::Accurate diagnosis of the degree of malignancy of individual chondrosarcomas is a difficult problem for the orthopedist. To determine whether certain biochemical and metabolic parameters might provide a useful supplement to roentgenologic and histologic evaluations, 19 human chondrosarcomas were analyzed for DNA and c...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-08-01 00:00:00
abstract::Three patients were treated for pathologic fractures of the thoracolumbar spine causing progressive neurologic deficit. An anterior decompression with partial removal of the diseased vertebra was performed with improvement of neurologic function in each patient. Active tumor was not found, but necrotic bone with colla...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
abstract::Patellar tendinosis is characterized by longstanding localized and activity-related pain, swelling and tenderness on palpation, and characteristic features on magnetic resonance imaging and ultrasonography and during surgical excision. Histologic examination of tendinosis tissues shows disrupted collagen matrix, incre...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200207000-00022
更新日期:2002-07-01 00:00:00
abstract:BACKGROUND:The choice of surgical approach for THA remains controversial. Some studies suggest that the direct anterior approach (DAA) leads to less muscle damage than the miniposterior approach (MPA), but there is little high-quality evidence indicating whether this accelerates recovery, or whether this approach-which...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11999.0000000000000112
更新日期:2018-02-01 00:00:00
abstract::Thirty infected total knee arthroplasties were investigated in 29 patients over an average interval of 42 months. Eleven infections began in the immediate perioperative period. Six developed from postoperative wound-healing problems. The remainder were late infections. Staphylococcus was found in 16 infections, gram-n...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-10-01 00:00:00
abstract:BACKGROUND:Major disadvantages of antibiotic bone cements include limited drug release and reduced strength resulting from the addition of high doses of antibiotics. Bacterial cellulose, a three-dimensional hydrophilic mesh, may retain antibiotics and release them gradually. We hypothesized that the addition of cellulo...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1626-8
更新日期:2011-02-01 00:00:00
abstract::Retrospective review of 30 patients with nonunion of the humeral shaft treated from 1984-1999 revealed nine patients with an initial fracture pattern which to our knowledge was not described previously. Humeral fractures originated at the junction of the proximal and middle thirds of the diaphysis as an hemitransverse...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:2004-07-01 00:00:00
abstract::Using a testing apparatus that allows axial loading and displacement in the sagittal, axial, and coronal planes, 6 ankles were tested under experimental conditions intended to model the Lauge-Hansen pronation external rotation injury. All specimens were rotated through a continuous range of sagittal motion with the an...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199607000-00043
更新日期:1996-07-01 00:00:00
abstract::A Replantation Team was instituted in Vienna 3 years ago. This team is the oldest in Europe. One hundred and eighty-one complete and incomplete amputated parts of 118 patients were replanted during this period. A survival rate of 86% and a useful functional result ("integrated parts") in 78% of the cases was obtained....
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-06-01 00:00:00
abstract:BACKGROUND:Developmental hip disorders (DHDs), eg, developmental dysplasia of the hip, slipped capitis femoris epiphysis, and femoroacetabular impingement, can be considered morphology variants of the normal hip. The femoroacetabular morphology of DHD is believed to induce osteoarthritis (OA) through local cumulative m...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-012-2511-4
更新日期:2012-12-01 00:00:00
abstract::Removal of cement from the femoral canal during total hip revision arthroplasty continues to be very challenging. The technique is described using multiple 9-mm perforations placed at least 5 cm apart on the anterior surface of the femoral shaft. The tip of the revision stem should be at least 5 cm distal to the most ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-04-01 00:00:00
abstract:UNLABELLED:Total knee replacement effectively relieves arthritis pain but improvement in physical function varies. A clearer understanding of the patient attributes associated with differing levels of functional gain after TKR is critical to surgical decision making. We reviewed 8050 primary, unilateral TKR patients en...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0428-8
更新日期:2008-11-01 00:00:00
abstract::This biographical sketch on Themistocles Gluck corresponds to the historic text, The Classic: Report on the positive results obtained by the modern surgical experiment regarding the suture and replacement of defects of superior tissue, as well as the utilization of re-absorbable and living tamponade in surgery (1891),...
journal_title:Clinical orthopaedics and related research
pub_type: 传,历史文章
doi:10.1007/s11999-011-1836-8
更新日期:2011-06-01 00:00:00
abstract::Mineralization processes in the body are controlled by physicochemical and cellular regulation of hydroxyapatite (HA) nucleators and inhibitors. The chemical mechanism of action of HA inhibitors has been studied in vitro using solution pH-stat techniques or Types I and II collagen gel diffusion systems. Three biologic...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1989-10-01 00:00:00
abstract::A simple but efficient way to secure the biceps tendon after it has been detached at its upper end by either trauma, attrition or surgical interference is the use of the keyhole in the upper humerus. A tied or rolled knot of tendon inserted into a keyhole shaped opening in the bicipital groove permits firm attachment ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1975-10-01 00:00:00
abstract::Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works wel...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-009-0930-7
更新日期:2009-10-01 00:00:00
abstract::Osteopetrosis is a metabolic bone disease characterized by a systemic increase in skeletal mass. It results from a defect in the production or function of osteoclasts and is inherited in nine genetically distinct osteopetrotic animal mutations and man. Studies of these mutations have revealed that osteopetrosis is a c...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1993-09-01 00:00:00
abstract::Narrow lumbar spinal canal or lumbar spinal stenosis is a not uncommon problem. Thirty-two patients with this disorder have been treated surgically at the Ochsner Medical Center between 1963 and 1973. The best method of diagnosis is a careful history and second is roentgenographic evidence, particularly the myelogram....
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1976-01-01 00:00:00
abstract::The efficacy of treatment of overuse patellofemoral pain with an elastic knee sleeve with a silicone patellar ring was compared with a simple elastic sleeve and with no treatment in a prospective study of 395 army recruits. During 14 weeks of basic training, 84 knees were diagnosed as having overuse patellofemoral pai...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1993-08-01 00:00:00
abstract::Clinical failures of all-polyethylene tibial components in total knee arthroplasty generally have been failures of design, not materials. The current study was designed to compare a modern congruent all-polyethylene tibial component with a metal-backed tibial component with the same articular design and geometry. All ...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003086-200011000-00015
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:Lisfranc (tarsometatarsal joint) injuries are relatively rare, accounting for less than 1% of all fractures, and as many as 20% of subtle Lisfranc injuries are missed at the initial patient presentation. An undiagnosed Lisfranc injury can have devastating consequences to the patient. Therefore, any factor th...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-016-5131-6
更新日期:2017-05-01 00:00:00
abstract::Gout commonly occurs as an acute arthritis. In a 64-year-old man, gout was associated with a proliferative hemosiderin-laden synovitis. The association of recurrent atraumatic hemarthrosis seems not to have been reported in the literature on gout. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:Postoperative varus alignment has been associated with lower IKS scores and increased failure rates. Appropriate positioning of TKA components therefore is a key concern of surgeons. However, obtaining neutral alignment can be challenging in patients with substantial preoperative varus deformity and it is un...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-011-1988-6
更新日期:2011-12-01 00:00:00
abstract::This report describes a laboratory model designed to illustrate a newer concept for the control of plasma calcium concentrations. This postulate suggests that plasma calcium levels are the result of a balance or imbalance in opposing calcium ion fluxes between plasma and bone fluid compartments existing around osteocy...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-01-01 00:00:00
abstract::The purpose of this study was to compare the success rate of bony fusion and the clinical results of rigid instrumentation, nonrigid instrumentation, and no instrumentation for a single level lesion for degenerative lumbar spondylolisthesis. Thirty-three patients with degenerative spondylolisthesis of L4 who had under...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1999-11-01 00:00:00
abstract::Six patients with systemic lupus erythematosus and avascular necrosis of the femoral head were treated by total hip arthroplasty (THA). The primary indication for surgery was persistent hip pain despite conservative therapy. Postoperatively, pain was relieved with corresponding improvement in range of motion in all si...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-11-01 00:00:00
abstract::The anatomic abnormalities and the effects of serial release of soft tissue are described in seven stillborn fetal clubfeet. The essential anatomic abnormality is a dislocation of the talocalcaneonavicular joint, with dysplastic changes in the talus and less severe changes in the adjacent bones. By gradually releasing...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-04-01 00:00:00
abstract::The primary indication for arthroplasty of the hip is the elimination of pain and the restoration of function. This paper addresses the progression of developments leading to the present satisfactory attainment of this goal. Having achieved this goal, patients and surgeons have come to expect far more than the necessi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1985-11-01 00:00:00
abstract::The success of a total hip arthroplasty (THA) is dependent on many more parameters than simply the prosthesis used. This study has demonstrated that a randomized controlled clinical trial of 250 patients comparing two types of hip prostheses (cemented versus cementless) with virtually complete follow-up examination is...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-01-01 00:00:00
abstract::The introduction of alumina ceramic combined with the self-locking principle by surface increase has many followers. There is no manufacturing company in the world that does not produce self-locking hip prostheses with ceramic components. Despite increased interim results with conventional prostheses by improved cemen...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-09-01 00:00:00