Clinical topics

Positioning of the acetabular component

Acetabular cup positioning—a patient-specific approach

Let us take a close look at the multi-factorial considerations in accurate acetabular cup placement during total hip arthroplasty (THA). This is a challenging aspect of the procedure as it requires knowledge and visualization of anatomy and component position in three dimensions, amongst other things. Understanding each patient’s unique kinematics and structure, screening for spinal and/or other comorbidities, and careful pre-operative planning all play an important part in providing a personalized procedure and positive outcome for patients. 

Published in newsletter 04/2019

Gap balancing versus measured resection in TKA

Evidence for/against the techniques, and comparison

Which is the better technique to deliver superior patient outcomes? Will the soft tissue tensioning method of gap balancing deliver accurate femoral component rotation in TKA? Or is measured resection the superior technique to achieve this? We look at the pros and cons of both approaches, weigh the evidence, and determine whether there is a best path through this debate.

What do two practicing surgeons think about the question of gap balancing versus measured resection? We spoke to Philipp von Roth from the Charité – Universitätsmedizin Berlin (DE), and Matthew Abdel from the Mayo Clinic in Rochester, Minnesota (US). They share their perspectives and make some educated guesses about the future.

Published in newsletter 03/2018

Limb-length discrepancy in THA

Prevention, Management, and Dysplasia Patients

A recognized and common complication of total hip arthroplasty (THA) is limb-length discrepancy (LLD). (Incidentally, this problem is the number one reason for litigation against orthopedic surgeons in the US). But there are actions surgeons can undertake to minimize leg-length issues, with prevention being at the top of the list.

Through patient evaluation/education, preoperative templating, and intraoperative assessments, strategies can be employed to lessen the risk of LLD. This three-part article series looks at the prevention and management of LLD after THA and gives special consideration to the challenges associated with the dysplastic hip.

Published in newsletter 10/2017

Taper corrosion

risks, tools for diagnosis and surgical strategies

The last thirty years have seen many advances in the field of orthopedic medicine. The introduction of a modular taper joint for use in hip arthroplasty was embraced by surgeons for its intraoperative flexibility. However, it's been discovered that the modular taper is prone to corrosion and linked to problems such as pain, instability, pseudotumors, poor outcomes, increased revision rates, and higher rates of mortality.

Compounding the problem is the fact that researchers have not yet been able to reproduce the problem experimentally, which makes it a challenge to systematically understand the roles of contributing factors. This three-part article series on taper corrosion provides some background, looks at criteria to guide a diagnosis, as well as some points to consider when surgical intervention is under discussion.

Published in newsletter 12/2016

The Asian knee

special surgical considerations

Increasing evidence of race-related anatomical differences is adding a level of complexity when performing total knee replacement (TKR) on Asian patients. Many of the current prosthetic options are developed using Caucasian anatomical data, which could be leading to a less-than-ideal fit and poor device performance.

In this three part article series we examine cultural demands and expectations for TKR, and some of the documented anatomical differences and surgical considerations that are unique to the Asian-Pacific region.

Published in newsletter 12/2015

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