Faculty Bibliography

The purpose of this prospective study was to determine the clinical outcomes of patients who had total hip arthroplasties with a zirconia (Zr) - Hylamer pairing. Fifty-eight consecutive cemented total hip arthroplasties with a Hylamer cup and 22.25 mm Zr head were examined for component wear and failure. The SF-36 and Mayo hip score were used to evaluate patient outcome. Regression and Kaplan Meier survival analyses were used to determine outcome. The mean Mayo postoperative score was 94 points. The median post-operative SF-36 score was 84 points. The mean rate of wear was 0.097 +/- 0.02 mm/year, with no evidence of loosening or significant osteolysis at a minimum follow-up of 5 years. Kaplan-Meier survival analysis was 98% at 3-year follow-up and 94% at 5-year follow-up. This study has confounded previous reports relating to Zirconia-Hylamer counter-surface components.

BACKGROUND:Procedures utilized to address the flatfoot in this study included medializing calcaneal osteotomy, posterior tibial tendon reconstruction with flexor digitorum longus tendon transfer, and in patients with more severe deformity, lateral column lengthening. We evaluated patients age 50 and less at the time of surgery, who underwent surgical reconstruction for Stage 2 posterior tibial tendon dysfunction. Pre- and postoperative activity levels were evaluated to assess the effect of surgical reconstruction in the younger patient. MATERIALS AND METHOD/METHODS:Thirty-four feet in 30 patients (11 male, 19 female) with an average age of 41.2 (range, 17 to 50) years had surgery between 1997 and 2004. All feet were examined at an average followup of 44.5 (range, 24 to 65) months and were evaluated with the American-Orthopaedic-Foot and Ankle Society (AOFAS) Hindfoot-Score and SF-36 score. RESULTS:The average preoperative AOFAS-Score was 53.1 +/- 14.5 points and 83.2 +/- 12.2 points at final postoperative followup. The mean improvement was 29.5. The difference between the preoperative and postoperative AOFAS score was significant (p < 0.0001) using a two-tailed t-test. The difference in the AOFAS pain and alignment subscales was also significant (p < 0.0001). The function subscale improvement was also significant (p = 0.018). The mean physical function component of the postoperative SF-36 score was 79.2. A correlation was found between the SF-36 physical component score and the post operative AOFAS score (r(2) = 0.754). CONCLUSION/CONCLUSIONS:While some lateral discomfort or pain occurred in patients with or without a lateral column lengthening, the posterior tibial tendon reconstruction utilizing medial calcaneal displacement osteotomy with flexor digitorum longus transfer and a lateral column lengthening with more deformity was successful in the higher-functioning, younger patients.

Traumatic injuries of the hip and pelvis are common in child athletes and typically require minimal treatment. However, the presentation of such injuries can at times be clinically indistinguishable from the onset of a benign or malignant neoplastic process. In these circumstances, the orthopedic surgeon relies on modern diagnostic tools including imaging-predominantly magnetic resonance imaging (MRI) and computed tomography-and pathology studies. This article presents the cases of 2 adolescent boys with traumatic injuries to the hip, in which the threat of neoplasm could not be ruled out by in both initial imaging studies. In one case, biopsy could not conclusively rule out malignancy. In both cases, serial MRIs to monitor changes in lesion size proved valuable in determining treatment approach. The authors recommend a diagnostic algorithm to approach the differentiation of iliac hematoma from neoplasm and address the issue of waiting time in the diagnostic process. Early-and if necessary repeated-biopsy to rule out these conditions is advised, as conclusive pathologic findings are the only evidence that can rule out Ewing's sarcoma or an aneurysmal bone cyst. Given the morbidity of these conditions, the authors advocate this course of action to minimize distress to the patient and family members. Careful observation in combination with radiographic findings can yield a successful diagnosis, but the orthopedic surgeon must carefully weigh the increased risk of tumor growth against the need for biopsy.

Persistent recalcitrant dorsolateral foot pain after ankle sprain cannot always be explained by known anatomic nerve pathways. To determine whether an impingement of a lateral branch of the deep peroneal nerve might be responsible for atypical pain, we conducted a cadaveric anatomic study to identify the anatomy and course of the nerve. Furthermore, using this information, we conducted a clinical study to determine if targeted treatment to a lateral branch of the deep peroneal nerve would resolve these symptoms. We dissected 22 cadaveric feet to identify a large lateral branch of the deep peroneal nerve. This nerve arborized into five main branches. We identified two areas of compression in the lateral branch of the deep peroneal nerve. We also performed a prospective clinical study including 11 consecutive patients with a 1-year minimum followup. Pain and clinical findings corresponded to the anatomic compression sites in all 11 patients. All patients responded to a local anesthetic injection or surgical release of the lateral branch of the deep peroneal nerve. We identified a previously unreported complex course of the lateral branch of the deep peroneal nerve that correlated with clinical impingement syndrome and responded to specifically targeted treatment.

Cycling is an increasingly popular recreational and competitive activity, and cycling-related injuries are becoming more common. Many common cycling injuries of the lower extremity are preventable. These include knee pain, patellar quadriceps tendinitis, iliotibial band syndrome, hip pain, medial tibial stress syndrome, stress fracture, compartment syndrome, numbness of the foot, and metatarsalgia. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, ice, a reduction in training intensity, orthotics, night splints, and physical therapy. Injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training.

Metatarsalgia is one of the most common forefoot pain presentations seen in orthopedics. Surgical management has often been suboptimal with more than 20 surgical methods reported, differing in indication, technique, fixation, and postoperative mobilization.The literature has not yet recorded a definitive surgical solution to this problem. Outcome parameters including patient satisfaction, pedobarographic, and radiologic measurements have indicated the relative success of the different surgical techniques and their adverse outcome trends.The current authors present their experience with the Weil, chevron, and oblique sliding diaphyseal techniques in the context of their indications, techniques, and outcomes, and review their success in the literature

Adult flat foot deformity, resulting from posterior tibial tendon (PTT) insufficiency has been treated traditionally with a combination of bony and soft tissue procedures with variable outcomes. Many techniques advocate repair of the spring ligament to optimize outcome. In cases of long standing PTT deficiency, however, the spring ligament may be significantly attenuated; compromising potential repair as a useful surgical strategy.The current authors describe a simple technique that uses the distal stump of the PTT to reconstruct and augment the spring ligament fibrocartilage complex. The advantage of this technique is the use of existing autogenous tissue to provide reconstruction of the attenuated spring ligament. The construct provides a broad proximal support; preventing midtarsal pronation and abduction by its Y shaped configuration without donor site morbidity

Repair of the Achilles tendon ruptures is becoming a more accepted means of treatment over casting. However, wound problems are still a problematic complication. Minimally invasive Achilles tendon repair using the Achillon® device is presented and discussed as a treatment method that combines the benefits of surgical repair with less wound complications caused by a smaller surgical approach. Cadaveric studies have shown this repair to be stronger than the traditional modified Krackow suture technique