The percutaneous procedure described here is a reliable technique to perform a distal transverse osteotomy of the fifth metatarsal to correct a painful varus fifth-toe deformity with prominence of the fifth metatarsal head. The clinical results are comparable with those reported with traditional open techniques, with the advantages of a minimally invasive surgical procedure, substantially shorter operating time, and a reduced risk of complications.
A minimally invasive surgical technique (MIS) is any procedure that could be less invasive than open surgery used for the same purpose. Though MIS often involves small incisions or percutaneous approaches, its main goal is to achieve good therapeutic results with the least damage to functional anatomic structures. Minimal invasiveness in orthopaedic forefoot surgery, including first ray and lesser toes, with its growth over the last two decade, showed many advantages and good outcomes with the aim to obtain fewer complications due to a contained approach, shorter surgical time and
Dislocation is one of the most common complications of total hip arthroplasty (THA). To the authors' knowledge, late recurrent dislocation of a THA with a ceramic-on-ceramic coupling secondary to fatigue fracture of the ceramic liner has never been described. A 76-year-old woman with right hip osteoarthritis underwent cementless modular THA with a ceramic-on-ceramic coupling. Approximately 10 years postoperatively, she experienced right hip pain with no trauma, which resolved in 14 days. Family members reported that the patient had shown a progressive cognitive and muscular decline in the previous months. Six months later, the patient was admitted for THA dislocation, which was immediately reduced. Computed tomography revealed that the right acetabular component had a retroversion of 4° and an inclination angle of 45°. An orthopedic brace was applied, but dislocation recurred 2 days after discharge. A 3-dimensional CT reconstruction showed a fracture of the ceramic liner in the posterolateral region. The patient underwent revision surgery, and the ceramic liner breakage was confirmed. After removal of the acetabular components, a cemented polyethylene cup was implanted. The stability of the stem was verified. The existing modular neck was replaced with a chromium-cobalt neck, and a new ceramic head was applied. At 7-month follow-up, the patient had good functional recovery with no hip instability. Fatigue failure of a ceramic liner should be considered as responsible for late dislocation after ceramic-on-ceramic THA. As part of the diagnostic strategy, 3-dimensional CT reconstruction should be used to evaluate ceramic liner breakage.
Intraoperative patellar position (eversion, lateralization, or in situ) influences the ligamentous balancing in knee flexion and thereby the correct positioning of the femoral component during total knee arthroplasty. The correct ligament balancing is crucial when, as in our experience, prostheses with medial pivot design are used. It was shown that the flexion gap in the normal knee is not rectangular and that the lateral compartment is significantly slacker than the medial. Therefore, to obtain a correct kinematics of a medial pivot anatomical prosthesis, it is essential to recreate an anatomical flexion gap slacker in the lateral compartment. We conducted a prospective study on a consecutive series of 87 total knee prostheses. The objective of this study is to evaluate the femoral external rotation angle in each patient with everted patella as well as with pure subluxated patella. The purpose of this study is to offer guidance about the optimal femoral rotation angle to achieve best outcomes of a knee replacement. The evaluation was done using an instrument developed by Medacta International (Switzerland) with our direct collaboration (Tensor, Medacta, Switzerland) and standardizing the basic conditions of each patient (knee 90 degrees flexed, medial transquadricipital surgical access, lateral displacement of the patella, tourniquet inflated at 250 mm Hg, spinal anesthesia). Each group was subdivided into subgroups according to gender, preoperative varus or valgus deformity, and patellar height. Our study advises against evaluating the flexion gap with everted patella due to high risk of underestimation of the lateral compartment laxity (differences up to + 3 degrees with pure subluxated patella compared with everted patella).
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