Introduction: With increasing numbers of knee arthroplasty procedures being performed, revision total knee arthroplasty (TKA) remains a challenge to orthopedic surgeons. The use of robotics in primary joint arthroplasty is also increasing due to better technology and surgeon familiarity. Robotic arms have the ability to execute bone cuts within 1 mm of a preoperative plan, can measure soft tissue gap tension, and can plan femoral and tibial augments and rotation. The use of robotic arm assistance for revision TKA, however, has not been documented in the literature. Case Report: We present a case describing a novel technique in which the Mako robot (Stryker, Ft. Lauderdale, FL) was utilized for revision of a failed primary TKA secondary to aseptic loosening. The patient is a 68-year-old Caucasian male who underwent right revision TKA with robotic assistance. Stryker Triathlon TS implants were utilized with the use of both femoral and tibial cones and medial and lateral posterior femoral augments. He had satisfactory component alignment based on postoperative radiographs, and excellent clinical outcomes 6 months postoperatively. Conclusion: The use of robotic arm assistance in revision TKA for failed primary TKA is a novel technique and resulted in excellent operative outcomes in this case. Further study should be done to confirm its use in revision TKA. Keywords: Total knee arthroplasty, robotic, revision, total knee arthroplasty.
Case Type C pelvic ring fractures account for only 0.34% of all pelvic fractures (Zhang, 2012 [1]). Anterior and posterior pelvic fixation is necessary in these injuries and can be accomplished using a variety of techniques. This study presents a case of bilateral vertical shear sacroiliac joint dislocations with an associated hip dislocation and pubic rami fractures that was treated with bilateral triangular osteosynthesis and INFIX. Conclusion This is the first reported case of bilateral vertical shear sacroiliac joint dislocation treated with triangular osteosynthesis. Anterior pelvic fixation with INFIX and posterior fixation with lumbopelvic and percutaneous sacroiliac screws resulted in excellent radiographic and clinical outcomes.
The goal of this study was to examine the effects of systemic morphine on the pattern and morphology of gasping breathing during respiratory autoresuscitation from transient anoxia. We hypothesized that systemic morphine levels sufficient to cause significant depression of eupnea, would also cause depression of gasping breathing. Respiratory and cardiovascular variables were studied in twenty spontaneously breathing, pentobarbital-anaesthetized adult male rats. Sham (saline) injections caused no significant change in resting respiratory or cardiovascular variables (n=10). Morphine, on the other hand, caused significant depression of eupneic breathing, with ventilation and peak inspiratory flow decreased by ~30 to 60%, depending on the background condition (n=10). In contrast, morphine did not affect depress gasping breathing. Duration of primary apnea, time to restore eupnea, the number and amplitude of gasping breaths, average and maximum peak flows and volume of gasping breaths were not significantly different post-injection in either condition. Blood pressures were all significantly lower following morphine injection at key time points in the process of autoresuscitation. Lastly, rate of successful recovery from anoxia was 80% in the morphine group (8/10) compared to 100% (10/10) in the sham group, post-injection. We conclude that the mechanisms and/or anatomic correlates underlying generation of gasping rhythm are distinct from those underlying eupnea, allowing gasping to remain robust to systemic morphine levels causing significant depression of eupnea. Morphine nevertheless decreases likelihood of recovery from transient anoxia, possibly as a result of decreased tissue perfusion pressures at critical time points during the process of respiratory autoresuscitation.
Triangular osteosynthesis is a technique used to stabilize posterior pelvic ring injuries. Conventional triangular fixation can be problematic for several reasons, including the need for advanced skill sets to place instrumentation, difficulty with pelvic reduction and placing the connecting construct, and prominent instrumentation. The purpose of this study is 2-fold: (1) to describe in detail a technique for lumbopelvic fixation using implants that are easy to connect, allow distraction for complex lumbosacral displacements, and are placed in a location minimizing soft tissue prominence and (2) to present our initial case series using this technique. We present a retrospective review of 18 consecutively treated patients with this technique. Inclusion criteria were patients with complete disruption through the sacrum or sacroiliac joint from blunt trauma (OTA/AO type C injuries). Outcomes included pelvic reduction/malreduction, wound healing, and complications. Fourteen patients underwent unilateral fixation (81%), and 4 patients underwent bilateral fixation (19%). All patients (18 of the 18) had a well-reduced pelvis after fixation. No patient (0%) required a return trip to the operating room for loss of reduction/malreduction, wound breakdown, or implant failure. This study presents an updated technique for a lowprofile triangular osteosynthesis construct with straightforward application for unstable posterior pelvic ring injuries. This technique does not require rod bending, results in a consistently more recessed iliac screw and connecting rod, and can be used in a wide variety of unstable posterior pelvic ring injuries, including comminuted sacral fractures, L5/ S1 facet fractures, and vertical shear injuries.
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