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We describe the primary total hip arthroplasty procedure in this award-winning Home Study Program.
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We studied the P.F.C. Sigma rotating-platform total knee arthroplasties to assess implant size variations in men versus women and size variation in bilateral knees. Sixty-four percent of women more frequently had a tibial tray one size smaller with respect to the femur and 63.5% of men had the same-sized femur and tibia. Bilateral knees were the same size in both sides 97% of the time in women, and 90% in men.
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We describe experience with 2000 cruciate-retaining Sigma RP total knee arthroplasties performed between September 2000 to January 2006. All procedures were performed with a midvastus arthrotomy, medioposterior release, and posterior condylar clean-out technique. This implant design uses a congruent polyethylene bearing to diminish contact stress while allowing rotation between the polyethylene bearing surface and tibial tray. Of the 2000 knees, 1596 had follow-up data at one year. Seven hundred-twenty-seven had an average flexion of 123 degrees, 692 had an average Knee Society Score of 94, and 672 had an average function score of 86.
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The authors compared the restoration of leg length in two cohort protocols. In the 2001 cohort, tapered stems were exclusively used, giving priority to fit and fill of the medullary canal. In the 2004 cohort, porous-tapered stems, or an S-ROM modular stem (DePuy Orthopaedics Inc., Warsaw, Ind) when needed, were used based on preoperative templating to restore the center of femoral head rotation.
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The S-ROM hip stem also prepares a previously distorted anatomy by milling through cortical bone that can occlude the femoral medullar canals and recreate proper femoral anteversion and reduces the risk of intraoperative or postoperative periprosthetic fracture due to the flexible titanium-slotted stem. The S-ROM femoral stem is recommended for challenging total hip reconstructions.
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By Kathleen Misovic
Conventional radiography techniques require continuing costs, recurring film retrieval and increasing storage needs. Orthopaedic practices considering the conversion to digital imaging for radiography will benefit from the physician-sided guidelines presented in Scientific Exibit SE059. Researchers found that Computed Radiography (CR) allows better image capture technology for multi-specialty orthopaedic practice groups because it is more versatile, and results in fewer templating errors caused by the magnification parameters of the Digital Radiography (DR) image.
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Impaction grafting is a useful method to restore bone stock in contained tibial or femoral defects during primary and revision total knee arthroplasty. The authors describe a method to restore both contained and uncontained defects in deficient femoral and tibial condyles to reestablish the joint line without massive structural allograft.
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As surgeons learn to perform minimally invasive hip arthroplasty procedures, the various techniques will evolve and one or two approaches may eventually become the standard. Currently, most of these procedures are reserved for the nonmorbidly obese patients; however, as techniques are perfected and surgeons gain experience, this patient population may eventually be served.
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The charts of 1869 patients were reviewed for the occurrence of deep venous thrombosis (DVT) and pulmonary embolism after total hip or knee arthroplasty. Prophylaxis consisted of 3 (group 1; n=1235) or 6 (group 2; n=634) weeks low-dose warfarin, pneumatic compression boots worn by patients in the hospital, mobilization on the first postoperative day, and a clinical surveillance protocol. Venous ultrasound or ventilation/perfusion lung scintigraphy (V/Q) was performed only if patients became symptomatic. patients. Twenty-three (1.8%) patients were positive for DVT. Ventilation/perfusion lung scintigraphy was performed on 25 patients, and 5 (0.4%) patients were positive for pulmonary embolism. In group 2, 117 patients were evaluated for DVT, and 19 (3%) patients had positive results determined by ultrasound. Twenty-five patients were evaluated with V/Q and only 1 (0.16%) patient was positive for pulmonary embolism. No patient developed a fatal pulmonary embolism or postphlebitic syndrome. This prophylaxis protocol is an efficient and cost-effective method for the prevention of significant events after surgery.
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The goal of this study was to determine if obesity is a risk factor for total joint arthroplasty. This was a retrospective review of 130 patients treated with either primary total hip arthroplasty or primary total knee arthroplasty during a two-year period (154 consecutive arthroplasties). The patients were placed in the nonobese or obese group. Obesity was defined as 20% above ideal weight for height, based on life insurance tables. There were 51 in the nonobese groups and 103 in the obese group. Charts were reviewed for a number of factors associated with postoperative complications. Operative time, intravenous fluids administered, and total blood loss were found to be slightly higher in the obese group. Only the difference in operative time proved statistically significant, however. The hospitalization time, number of days with a fever, number of transfusions, preoperative and postoperative hemoglobin levels, and days requiring intramuscular narcotics were very similar between the two groups. There were 0.29 minor complications per nonobese patient, but only 0.22 per obese patient. Major complications were encountered 0.22 times per nonobese patient and 0.10 times per obese patient. The patient is not necessarily at a higher risk for peroperative complications in total joint arthroplasty. The longevity of the implant in the obese patient was not determined in this perioperative study.
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We studied results at two to five years with a Mobile-Bearing system that includes a cobalt-chrome tibial tray and femoral component with a polyethylene cruciate-retaining tibial component insert that allows rotation around a central axis. In comparison with the Fixed-Bearing knee equivalent, this Mobile-Bearing knee has demonstrated at least equivalent results in terms of survivorship, function and patient satisfaction in the short and mid-term.
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We performed a retrospective cohort analysis of 150 patients with unilateral TKA vs 150 patients with simultaneous bilateral TKA. Our study demonstrated that age, body mass index, and a preexisting pulmonary disorder resulted in increased complications.
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We studied the medial protrusio technique for acetabular fixation in revision total hip arthroplasty and found this technique can be a valuable option in addressing acetabular cup failure.
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We compared the Minimal Incision Total Hip (MITH) technique to a standard incision technique and assessed patients regarding satisfaction and cosmesis. The smaller incision group had a significantly higher incidence of scar edges sinking or curling into the scar and more patients with the longer standard incision had optimal cosmesis scores than those with the smaller incisions.
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The purpose of this study is to optimise the design of the femoral cam-tibial post articulation through finite element analysis and suggest various design parameters that would optimise femoral rollback.
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We describe a case of recurrent instability secondary to femoral stem dissociation from the proximal metaphyseal sleeve and resultant traumatic retroversion of the neck.
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We studied kneeling after total knee replacement and describe a medial midline incision used by the senior author that avoids the highest stress points that occur when patients are in this position after surgery.
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We studied how posterior condylar offset and cleanout of the posterior condylar space can impact range of motion after total knee arthroplasty.
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We describe a method to improve surgical cup placement during total hip arthroplasty that utilizes a level-type measuring device.
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Presented at the AAOS annual meeting 2003 in New Orleans.

Rotating platform knees showed greater mean range of motion at 12 weeks and further at 52 weeks as compared to a fixed-bearing knee implant. Early ROM might reduce the cost of postoperative rehabilitation.
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We presented our experience with total hip arthroplasty performed through a minimal incision.
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We described the simple and reproducible surgical technique of proximal tibial exposure.
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We describe the bilateral primary total knee arthroplasty procedure in this award-winning Home Study Program.
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We describe a surgical technique change that significantly decreased the rate of postoperative dislocation.
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Presented at the AAOS annual meeting 2001 in San Francisco and published in the Journal of Bone and Joint Surgery Supplement in 2001.

This exhibit demonstrated the technique of capsulotomy, exposure and repair. Incidence of hip dislocation decreased from 2.8% to 0.6% in patients with this new surgical suturing technique. Prevention of hip dislocation remains the surgeon’s priority and can be addressed by surgical technique and implant selection.
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A temporary articulating, antibiotic-impregnated cement spacer for use during stage one of a two-stage revision for an infected total knee replacement has been developed by Dr. Goldstein. This technique has been successfully utilized in patients since 1999 and has now become our standard treatment method.

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Presented at the AAOS annual meeting 2001 in San Francisco and published in the Journal of Bone and Joint Surgery Supplement in 2001.
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Published in Orthopedics in July 2001.

The charts of 1869 patients were reviewed for the occurrence of DVT and PE after total hip or knee arthroplasty. Prophylaxis for such events included; low dose warfarin, pneumatic compression boots, mobilization on the first post-operative day, and a clinical surveillance protocol initiated. Routine venous ultrasound or perfusion scan was not performed. These tests were only performed if patients became symptomatic.

One hundred and seventeen patients were evaluated for DVT and 19 (3%) had positive results determined by U/S. Twenty–five patients were evaluated with V/Q scan, and only one patient (0.16%) was positive for PE.

No patient developed a fatal pulmonary embolism or post-phlebitic syndrome. It is concluded that this prophylaxis protocol is an effective method for prevention of significant events after surgery. It is also cost-effective because routine screening is not necessary.
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