The latest and greatest in Orthopedics!
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1 The latest and greatest in Orthopedics!
2 Disclosures: None
3 Objectives: "The most important changes in contemporary orthopedics" Locking plates for fractures Advanced bearing surfaces for hip and knee replacements The reverse shoulder replacement Kyphoplasty for compression fractures Tranexmic acid to control intraoperative bleeding Technologies that hold promise for the future
4 What s New? The reverse total shoulder Volar locking plates for wrist fractures Direct anterior surgical approach for total hip replacements Alternative bearing surfaces in hip replacements Tranexamic acid to control bleeding in joint replacement Kyphoplasty for vertebral compression fractures Viscosupplementation injections for knee arthitis Platelet rich plasma (PRP) injetions Stem cell injections Metal allergies affecting outcomes of total joint replacement Indications for joint replacements in morbidly obese patients
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8 #1: The Glenoid is Small and Shallow
9 #2: The deltoid force vector is essentially vertical when the Arm is at the side
10 #3: The deltoid inserts on the lateral humerus
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17 Subacromial Space Impingement
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20 Shoulder Impingement
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26 Surgical Rx: Shoulder Replacement
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31 Colles Fracture
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41 Anterior approach hip replacement
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44 (slide with data on advantages of anterior approach)
45 Alternative bearing surfaces in total joint replacement
46 Traditional metal ball and polyethylene socket liner
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48 Traditional vs. New Poly
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50 Metal on Metal
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52 Trace metal elevation compared to normal people Chromium in blood: 28 fold increase Chromium in urine : 146 fold increase (Jacobs, 1996)
53 Ceramic Head Fracture
54 Ceramic on Ceramic
55 Ceramic Head Fracture
56 Ceramic on New Poly
57 Tranexamic Acid
58 (slide on history of tranexamic acid)
59 (slide showing data on decreased bleeding, transfusion rates, etc)
60 Kyphoplasty for vertebral compression fractures
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63 Braces
64 Kyphoplasty
65 Kyphoplasty
66 Viscosupplementation Injections
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73 Viscosupplementation Injections
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78 Platelet Rich Plasma Therapy (PRP)
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80 Platelet Rich Plasma Therapy (PRP)
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83 (slide(s) summarizing results of studies on PRP here)
84 Stem Cell Therapy
85 What needs to happen Injected stem cells must understand to differentiate into chondrocytes
86 What needs to happen Injected stem cells must understand to differentiate into chondrocytes The cells must be able to see where the are of cartilage loss is
87 What needs to happen Injected stem cells must understand to differentiate into chondrocytes The cells must be able to see where the are of cartilage loss is
88
89 What needs to happen Injected stem cells must understand to differentiate into chondrocytes The cells must be able to see where the are of cartilage loss is The cells must then swim to the defect and attach to the exposed surface of bone
90 What needs to happen Injected stem cells must understand to differentiate into chondrocytes The cells must be able to see where the are of cartilage loss is The cells must then swim to the defect and attach to the exposed surface of bone The cells need to turn on their synthesis of matrix, and, when when the surface layer is flush with the surrounding cartilage surface, turn it off
91 Allergies to metal affecting outcomes of total joint replacement
92 Cobalt Chrome alloy
93 * 19% of population allergic to Ni *
94 Dxed: Metal Allergy Positive skin patch test
95 The Nickel Free Total Knee
96 Oxinium and.001% Ni Titanium (.01%Ni)
97 Metal Allergies Do they exist? Where were they 10 years ago? Why does lowering (not eliminating) the allergen seem to work? Do the low levels of allergen desensitize pts? What is the best test to use to make the Dx?
98 Total joints in obese patients
99 Literature: Don t operate! High chance of intra-op complications High chance of post-op complications Poor results (WOMAC, Lyscholm, others) Joints won t last
100
101 Literature: Don t operate! High chance of intra-op complications High chance of post-op complications DVT, infection, wound healing problems, malposition of components, pneumonia, aspiration, other Poor results (WOMAC, Lyscholm, others) Joints won t last
102 Literature: Don t operate! High chance of intra-op complications High chance of post-op complications Poor results (WOMAC, Lyscholm, others) - rise from chair without using arms - climb stairs without banister - walk more than three blocks Joints won t last
103 Literature: Don t operate! High chance of intra-op complications High chance of post-op complications Poor results (WOMAC, Lyscholm, others) Joints won t last
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