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PubMed1988

Osteosarcoma.

Osteosarcoma is the most common bone tumor of children and adolescents. The peak incidence of the disease is in the 15 to 19 year age group. The disease is more commonly seen in males than females. While several factors, including exposure to radiation, genetic disorders such as retinoblastoma, and high rate of bone growth, have been associated with osteosarcoma, in most cases no definite etiology can be established. Osteosarcoma usually originates in the metaphyseal region of long bones and extends through the cortex, causing varying degrees of bone destruction and expansion of periosteum. The radiographic appearance caused by this process is often referred to as "sun burst" sign. Positive diagnosis of osteosarcoma is made by histopathology. The histopathological classification of osteosarcoma can also predict the degree of aggressive behavior of this tumor and thus has prognostic significance. Surgery, including amputation or limb-salvage procedure, is the mainstay of treatment of osteosarcoma. It is now unequivocally established that adjuvant chemotherapy will prolong the survival of patients with this disease. Chemotherapy agents often used include platinum derivates, methotrexate, vincristine, cyclophosphamide, adriamycin, actinomycin D, bleomycin and DTIC. Depending on surgical decision, these agents can be used prior to or after the operation. Immediate fitting with prosthesis and provision of appropriate medical and psychological support in the care of these patients is essential.

Adolescent↗
PubMed2000

The effect of intramedullary bone plug on femoral stem migration of hydroxyapatite-coated hip arthroplasty.

This study investigated the effect of intramedullary corticocancellous bone plug on the fixation and stability of hydroxyapatite-coated femoral stems in total hip arthroplasty (THA). Intramedullary corticocancellous bone plug was used in 30 patients with hydroxyapatite-coated femoral stems (group A) and a consecutive series of 30 patients with hypdroxyapatite-coated stems without bone plug served as the control group (group B). Patients underwent clinical and radiographic follow-up for at least 2 years. The addition of corticocancellous bone plug to the hydroxyapatite-coated stem significantly improved clinical and radiographic results. The mean Harris Hip Score at 3 and 6 months postoperatively was 92 and 94 in group A, and 84 and 87 points in group B (P<.004 and P<.001, respectively). There was no significant difference between groups at 1 year postoperatively and thereafter. The predominant cause for the difference was the thigh pain score, which was reduced at both 3 and 6 months in group A compared to group B (P<.01 and P<.05, respectively). There also were statistical differences between the two groups regarding radiographic signs. The evidence of endosteal bone formation in group A patients was superior at 3 and 6 months (P<.001 and P<.01, respectively). The appearance of a radiolucent line was significant in group B patients at 3 and 6 months (P<.001). Femoral stem migration of 3 mm was noted in three group B patients versus no group A patients (P<.05). These short-term clinical and radiographic results suggest corticocancellous bone plug can provide early pain relief and durable implant fixation, but long-term follow-up should be considered.

Aged↗
PubMed2001

Rotational alignment of the tibial component in total knee arthroplasty.

This study compares two different methods of aligning the tibial component in a total knee arthroplasty, one by aligning the component with the border between the medial one third and lateral two thirds of the tibial tubercle and the other by allowing the component to seek its own position as the knee is taken through a range of motion. The first technique emphasizes the need to maintain an appropriate quadriceps angle for optimum patellar tracking and the second method optimizes femorotibial kinematics. The two methods suggest different positions for the tibial component, with the tibial component internally rotated an average of 5.6 mm from the border between the medial one third and lateral two thirds of the tibial tubercle when allowed to seek its own rotation. Surgeons must be aware of the choices they are making when selecting a method of aligning the tibial component. The prosthesis used in this study had a relatively high level of rotational constraint. The situation is somewhat different in a less constrained design.

Arthroplasty, Replacement, Knee↗
PubMed2002

Fixed- versus mobile-bearing total knee arthroplasty: technical issues and surgical tips.

Mobile-bearing knee arthroplasties have been used clinically for 25 years. The success of this technology depends on strict adherence to the principles of flexion-extension gap technique. The use of the fixed femoral landmarks for the rotational positioning of the femoral component (measured resection technique) is not acceptable if bearing dislocation is to be avoided. The principles of flexion-extension gap balancing, as well as the surgical technique, are reviewed in this article.

Arthroplasty, Replacement, Knee↗
PubMed2002

Alternate surgical approaches in mobile-bearing total knee arthroplasty.

Surgical approaches in nonconstrained mobile-bearing total knee arthroplasty (TKA) should provide the best access for specific deformity correction. Alternatives to the standard medial approach include the medial midvastus and subvastus approaches, and the direct lateral approach, with or without tibial tubercle osteotomy or proximal "rectus snip." The direct lateral approach is a recommended alternative for fixed valgus knees, especially if there is lateral patellar subluxation and significant rotational deformity. The subvastus and midvastus medial approaches preserve quadriceps integrity and patella stability, and are recommended for severely unstable knees in nonobese, non-fixed valgus, and medial unicompartmental knee replacements.

Arthroplasty, Replacement, Knee↗
PubMed2002

A fencepost solution.

Explore the source record for details and available documents.

Arthroplasty, Replacement, Knee↗