MIS Techniques in Orthopedics (eBook)

Preface 6
Table of contents 7
Contributors 10
Section I The Shoulder and Elbow 15
1 Mini-Incision Bankart Repair for Shoulder Instability 16
Anatomy and Biomechanics 16
Clinical Features 17
Patient History 17
Physical Examination 18
Radiographic Features 23
Treatment 24
Nonoperative Treatment 24
Operative Treatment 24
References 31
2 Mini-Open Rotator Cuff Repair 34
Surgical Technique 36
Postoperative Protocol/Rehabilitation 41
Results 42
Summary 43
References 43
3 Mini-Incision Fixation of Proximal Humeral Four-Part Fractures 45
Historical Perspective 46
Anatomic Considerations 47
Indications for Percutaneous Pinning 47
Patient Evaluation 48
Surgical Procedure 49
Patient Positioning 49
Percutaneous Reduction 50
Instrumentation 52
Postoperative Management 54
Results 54
Complications 55
Conclusion 56
References 56
4 Minimally Invasive Approach for Shoulder Arthroplasty 58
Techniques 58
Surgical Approaches 59
Concealed Axillary Approach 59
Mini-Incision Approach 60
Four-Part Proximal Humerus Fractures: 64
Avascular Necrosis 70
Glenohumeral Arthritis 72
Glenoid Exposure in Total Shoulder Arthroplasty 76
Postoperative Care 77
Conclusion 82
References 82
5 Mini-Incision Medial Collateral Ligament Reconstruction of the Elbow 84
Biomechanics and Anatomy 84
History and Physical Examination 86
Imaging 89
Surgical Technique: The Docking Procedure 91
Postoperative Mangement 99
Results 100
Summary 100
References 100
6 Mini-Incision Distal Biceps Tendon Repair 103
Etiology 103
History and Physical Examination 104
Surgical Indication 105
Technique 106
Rehabilitation 111
Complications 111
Summary 112
References 112
Section II The Hip 114
7 A Technique for the Anterolateral Approach to MIS Total Hip Replacement 115
Surgical Technique 115
Exposure 116
Preparation of the Acetabulum 123
Preparation of the Femur 125
Conclusion 132
8 The Anterior Approach for Total Hip Replacement: Background and Operative Technique 133
Surgical Technique 136
References 152
9 Posterolateral Minimal Incision for Total Hip Replacement: Techniqueand Early Results 153
Surgical Technique 153
Patient Positioning and Landmarks 154
Patient Exposure 156
Postoperative Protocol 169
Summary 169
References 170
10 Minimally Invasive Total Hip Arthroplasty Using the Two-Incision Approach 171
Surgical Technique 171
Summary 190
References 191
11 Minimally Invasive Metal-on-Metal Resurfacing Arthroplasty of the Hip 192
Indications 192
Surgical Technique: Anterolateral Approach 193
Placement of Incision 193
Deep Exposure 194
Exposing the Acetabulum 196
Femoral Resurfacing 197
Postoperative Care 199
Discussion 200
References 201
Section III The Knee: Unicondylar Knee Arthroplasty 202
12 Minimally Invasive Surgery for Unicondylar Knee Arthroplasty: The Bone-Sparing Technique 203
Patient Selection 205
Surgical Technique 206
Diagnostic Arthroscopy 207
Exposure with Posterior Femoral Condyle Resection 207
Distraction with Tibial Inlay Preparation and Resection 209
Femoral Preparation and Resection 211
Femoral-Tibial Alignment 212
Trial Reduction and Local Anesthetic Injection 212
Component Insertion and Final Preparation 212
Avoiding Complications 215
Results 216
Author’s Experience 216
Minimum 10-Year Results of Other Resurfacing UKA Designs 216
Minimally Invasive UKA Program 216
Conclusion 219
References 220
13 Minimally Invasive Surgery for Unicondylar Knee Arthroplasty: The Intramedullary Technique 224
Preoperative Planning 224
Surgical Technique (Intramedullary Approach) 227
Results 237
Conclusions 238
References 238
14 Minimally Invasive Surgery for Unicondylar Knee Arthroplasty: The Extramedullary Tensor Technique 240
The Tensor 241
Minimally Invasive Surgery 241
The Implant 242
Measure First, Cut Second 242
How Much Correction? 244
Surgical Technique 245
Surgical Steps 248
Incision 248
Removal of the Anterior Boss of the Tibia 249
Alignment Correction 249
Distal Femoral Cut 252
Tibial Cuts 254
Flexion and Extension Gaps 255
Anterior Femoral Marking 257
Femoral Finishing Guide Sizing and Positioning 258
Tibial Sizing and Finishing 260
Trial and Cementing 262
Conclusion 262
References 265
15 Minimally Invasive Surgery for Unicondylar Knee Arthroplasty: The Extramedullary Technique 267
General Principles 267
Approach 268
Tibial Preparation 268
Femoral Preparation 271
Finishing the Femur 271
Finishing the Tibia 275
Trial Reduction 275
Final Components 277
Summary 278
References 278
16 Minimally Invasive Surgery for Arthroplasty with the UniSpacer 280
MIS Arthroplasty with the UniSpacer 280
Preoperative Evaluation 281
Surgical Technique 283
Surgical Preparation 283
Arthroplasty 283
Arthrotomy 285
Osteophyte Resection and Anteromedial Meniscectomy 287
Chondroplasty 288
Tweenplasty 289
Sizing 290
Sizing the Implant 290
Insertion Technique 291
Fluoroscopy 292
Final Implantation and Closure 294
References 294
17 Minimally Invasive Technique for Insertion of a Unicompartmental Knee Arthroplasty 295
Prosthesis Design 295
Indications 295
Introduction of the Phase 3 Oxford Unicompartmental Knee Arthroplasty 296
Operative Technique 297
Templating the Preoperative Radiographs 297
Positioning the Patient 297
Incision and Debridement of Osteophytes 297
Making the Tibial Plateau Bone Cuts 300
Creating Femoral Drill Holes 301
Femoral Condyle Preparation: Posterior Facet Saw Cut and Initial Milling 303
Balancing the Flexion and Extension Gaps 303
Final Bony Preparation: Prevention of Impingement and Cutting the Keel Slot 305
Trial Reduction 307
Cementing Components and Final Reduction 307
Wound Closure 308
Postoperative Recovery 308
Summary 308
References 309
Section IV The Knee: Total Knee Arthroplasty 310
18 Minimal Incision Total Knee Arthroplasty with a Limited Medial Parapatellar Arthrotomy 311
Technique 312
Soft Tissue Releases 318
Postoperative Management 319
Clinical Observations 319
References 322
19 Minimally Invasive Total Knee Replacement with the Quadriceps-Sparing Subvastus Approach 323
Surgery 324
Closure 330
Complications 331
References 331
20 Mini-Midvastus Total Knee Arthroplasty 332
Standard Midvastus Approach 332
Mini-Midvastus Approach 334
Preoperative Assessment 335
Instrumentation 335
Surgical Technique 336
Positioning 336
Exposure 337
Femoral Preparation 337
Tibial Preparation 340
Final Preparation 342
Component Insertion 342
Closure 343
Results 344
Conclusion 345
References 345
21 Minimally Invasive Lateral Approach to Total Knee Arthroplasty 347
Special Unique Methods 348
Specific Details of the Lateral Approach Procedure 348
Results 353
Discussion 354
Technical Summary Highlights of the Lateral Approach 355
References 355
22 Minimally Invasive Total Knee Arthroplasty Using the Quadriceps-Sparing Approach 357
Preoperative Evaluation 358
Surgical Approach 358
Postoperative Management 370
Results 370
Conclusions 371
References 372
Section V Computer Navigation 373
23 Computer-Guided Total Hip Arthroplasty 374
Acetabular Component Navigation 377
Computed Tomography for Acetabular Navigation 378
Postoperative Assessment Using CT Computer Analysis 381
Clinical Experience with CT Navigation 382
Fluoroscopic Computer Assisted Navigation 383
Technique of Acetabular Navigation 384
Discussion 391
References 395
24 Computer-Guided Total Knee Arthroscopy 397
Classifications for Robotics and Computer-Assisted Surgery Systems 397
Active Robotic System 398
Semiactive Robotic System 402
Passive Robotic System 404
Information System 406
3D Based Information System 407
2.5D Based Information System 407
Image-Free Information System 408
Cross-Referencing Between Robotic System and Information System 409
References 410
Index 415

"Section III The Knee: Unicondylar Knee Arthroplasty (p. 190-191)

12 Minimally Invasive Surgery for Unicondylar Knee Arthroplasty: The Bone-Sparing Technique

John A. Repicci and Jodi F. Hartman

When considering treatment options for osteoarthritis of the knee, the pathology and progression of the disease must be considered. Past studies examining osteoarthritis of the knee have demonstrated that the disease is slow, progressive, and typically limited to the medial tibiofemoral compartment.1–4 Moreover, the erosion of cartilage in the medial compartment is almost always limited to the anterior half of the medial tibial plateau and the corresponding contact area on the distal portion of the medial femoral condylar.4 Anteromedial osteoarthritis was coined by White et al. to describe this distinct clinicopathological condition.

The ensuing anatomic defect, namely, loss of articular cartilage in the extension gap with no corresponding loss of articular cartilage in the ?exion gap, results in a 6-mm to 8-mm disparity between the extension and ?exion gaps. For this reason, medial osteoarthritis also may be considered an extension gap disease (Figure 12.1). The joint surface asymmetry also accounts for the varus alignment and lateral tibial thrust commonly associated with medial unicompartmental osteoarthritis.

At this stage in the disease process, the medial meniscus is either partially torn or completely compromised and tension is compromised in the anterior cruciate (ACL) and medial collateral (MCL) ligaments.5 To compensate for the varus deformity, a sclerotic layer of bone, or medial tibial buttress is formed. As varus angulation increases, the medial tibial buttress hypertrophies to resist the increasing varus stresses. Although this may appear to be a rather inef?cient solution, this layer of sclerotic bone allows the medial compartment to withstand joint loading and to support weight, permitting continued ambulation for 10 to 19 years after initiation of the disease.

Eventually, however, patients experience weight-bearing pain as a result of the plastic deformation of bone at the articular surface, instability because of ligamentous laxity, and mechanical symptoms due to meniscal damage.5 The clinical presentation of this early, unicompartmental form of osteoarthritis must be differentiated from that of patients with more advanced forms of the disease. The pain associated with the tricompartmental form of the disease often is so debilitating that activities of daily living are severely restricted, independence is lost, and ambulatory aids, such as crutches, a walker, or wheelchair, are required. For these patients, total knee arthroplasty (TKA) is the most appropriate surgical option to relieve pain and to restore some degree of independence."