Does the triceps-on approach affect alignment in total elbow arthroplasty? A cadaveric study

2018 ◽  
Vol 11 (5) ◽  
pp. 372-377
Author(s):  
Andrew King ◽  
Jonathan P Evans ◽  
Simon J Booker ◽  
James CS Beazley ◽  
Robin JS Jones ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
External Rotation ◽  
Total Elbow Arthroplasty ◽  
Anatomical Landmarks ◽  
Transepicondylar Axis ◽  
Elbow Arthroplasty ◽  
Humeral Component ◽  
Significant Difference ◽  
Flexion Extension ◽  
Centre Of Rotation

Background The triceps-on approach for total elbow arthroplasty has gained popularity due to the theoretical benefit of preserving the extensor mechanism. However, there is concern that the exposure may be reduced in comparison to a triceps-off approach and may affect the implant alignment achieved. Method Total elbow arthroplasties were implanted in 18 randomised, paired cadaveric elbows using the triceps-on or triceps-off approach. The bones were dissected out and the position of the implants measured relative to anatomical landmarks. The flexion/extension and varus/valgus angles, and the distance of centre of rotation from the anatomic centre of rotation in the sagittal plane for both components were obtained as well as the humeral component rotation relative to the transepicondylar axis. Results All humeral components were positioned in external rotation and all ulna components were placed in flexion. Seven components were positioned greater than 5° away from the ideal in one measurement, with no significant difference between the two approach groups. Discussion This unique study showed no significant difference in the alignment of the implants between the two approaches. These results support the theory that the triceps-on approach does not result in larger alignment errors in component positioning when performing total elbow arthroplasty.

The Use of Surface-Based Registration to Facilitate Total Elbow Arthroplasty in the Absence of Key Anatomical Landmarks

2008 ◽  
Author(s):  
Colin P. McDonald ◽  
Graham J. King ◽  
Terry M. Peters ◽  
James A. Johnson
Keyword(s):  
Bone Architecture ◽  
Total Elbow Arthroplasty ◽  
Anatomical Landmarks ◽  
Visual Estimation ◽  
Accurate Identification ◽  
Elbow Arthroplasty ◽  
Flexion Extension

Successful placement of elbow arthroplasty components is dependent on the accurate identification of the flexion-extension (FE) axis, generally defined by the geometric centers of the capitellum and trochlea [1,2]. Brownhill et al. [3] showed that a visual estimation of the FE axis, a technique described by Morrey and Hotchkiss [1], can result in significant errors, even with preserved bone architecture.

The Effects of Femoral Fixed Body Coordinate System Definition on Knee Kinematic Description

2008 ◽  
Vol 130 (2) ◽  
Author(s):  
Nathaniel M. Lenz ◽  
Amitkumar Mane ◽  
Lorin P. Maletsky ◽  
Nicholas A. Morton
Keyword(s):  
Sagittal Plane ◽  
External Rotation ◽  
Frontal Plane ◽  
Helical Axis ◽  
Anatomical Landmarks ◽  
Knee Kinematic ◽  
Coordinate Systems ◽  
Knee Simulator ◽  
Flexion Extension ◽  
Anterior Posterior

Understanding the differences in knee kinematic descriptions is important for comparing data from different laboratories and observing small but important changes within a set of knees. The purpose of this study was to identify how differences in fixed body femoral coordinate systems affect the described tibiofemoral and patellofemoral kinematics for cadaveric knee studies with no hip present. Different methods for describing kinematics were evaluated on a set of seven cadaveric knees during walking in a dynamic knee simulator. Three anatomical landmark coordinate systems, a partial helical axis, and an experimental setup-based system were examined. The results showed that flexion-extension was insensitive to differences in the kinematic systems tested, internal-external rotation was similar for most femoral coordinate systems although there were changes in absolute position, varus-valgus was the most sensitive to variations in flexion axis direction, and anterior-posterior motion was most sensitive to femoral origin location. Femoral coordinate systems that define the sagittal plane using anatomical landmarks and locate the flexion axis perpendicular to the femur’s mechanical axis in the frontal plane were typically similar and described kinematics most consistently.

Image-Based Navigation Improves the Accuracy and Reproducibility of Humeral Component Positioning in Total Elbow Arthroplasty

2009 ◽  
Author(s):  
Colin P. McDonald ◽  
James A. Johnson ◽  
Terry M. Peters ◽  
Graham J. W. King
Keyword(s):  
Visual Cues ◽  
Surgical Techniques ◽  
Total Elbow Arthroplasty ◽  
Implant Design ◽  
Computer Assisted ◽  
Elbow Arthroplasty ◽  
Humeral Component ◽  
Flexion Extension ◽  
Computer Assisted Orthopaedic Surgery ◽  
Alignment Errors

Total elbow arthroplasty (TEA) is commonly employed for cases of humeral bone loss. Success of the procedure depends on both the surgical technique and implant design. Current surgical techniques in TEA generally employ visual cues for estimating the flexion-extension (FE) axis. However, it has been shown that this approach can result in alignment errors upwards of 10° [1]. Computer-assisted orthopaedic surgery (CAOS) employed at the hip and knee has led to an improvement in the accuracy and reproducibility of the procedure, with implant alignment errors approaching 2–3 degrees [2]. TEA may well benefit from the accuracy of CAOS.

scholarly journals Design and Characterization of a Novel Knee Articulation Mechanism

2016 ◽  
Vol 21 (3) ◽  
pp. 611-622 ◽  
Author(s):  
M. Olinski ◽  
A. Gronowicz ◽  
A. Handke ◽  
M. Ceccarelli
Keyword(s):  
Sagittal Plane ◽  
Preliminary Design ◽  
Human Knee ◽  
Knee Rehabilitation ◽  
Flexion Extension ◽  
Adjustable Mechanism ◽  
Centre Of Rotation ◽  
Three Degree Of Freedom ◽  
Supporting Device

Abstract The paper is focused on designing a novel controllable and adjustable mechanism for reproducing human knee joint’s complex motion by taking into account the flexion/extension movement in the sagittal plane, in combination with roll and slide. Main requirements for a knee rehabilitation supporting device are specified by researching the knee’s anatomy and already existing mechanisms. A three degree of freedom (3 DOF) system (four-bar like linkage with controlled variable lengths of rockers) is synthesised to perform the reference path of instantaneous centre of rotation (ICR). Finally, a preliminary design of the adaptive mechanism is elaborated and a numerical model is built in Adams. Numerical results are derived from simulations that are presented to evaluate the accuracy of the reproduced movement and the mechanism’s capabilities.

scholarly journals Clinical outcomes and complications following primary total elbow arthroplasty using the Latitude prosthesis

2018 ◽  
Vol 11 (5) ◽  
pp. 359-371 ◽  
Author(s):  
David Cinats ◽  
Aaron J Bois ◽  
Kevin A Hildebrand
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Total Elbow Arthroplasty ◽  
Published Data ◽  
Mayo Elbow Performance Score ◽  
Elbow Arthroplasty ◽  
Radiographic Outcomes ◽  
Flexion Extension ◽  
Functional Outcome Measures

Background The Latitude total elbow arthroplasty (TEA) is an implant with limited published data on its performance and outcomes. The aim of this study was to report the short-term outcomes of the Latitude TEA as well as to describe the radiographic outcomes and complications. Methods The Latitude was implanted in 20 patients (23 elbows) in a linked configuration. Patients were recalled to clinic for the assessment of their range-of-motion and compared to preoperative values. Administration of functional outcome measures was also performed. Results Mean follow-up was 4.7 years (range, 1 to 7.5 years) with four elbows requiring revision. The flexion–extension arc improved from 86.6 to 101.3 (range, 76 to 126) postoperatively (p = 0.04). The average Disabilities of the Arm, Shoulder, and Hand score was 28.1 (range, 5.8 to 50.4) and the average Mayo Elbow Performance Score was 89.6 (range, 76 to 100), with 83% of elbows scoring in the good or excellent range. Radiolucencies were detected in 60% of patients and 31% of these lucencies progressed in size at the time of follow-up. Conclusions The Latitude prosthesis provides patients with favorable clinical outcomes with improvements in their range-of-motion and a complication rate comparable to other elbow arthroplasty implants.

scholarly journals Total Elbow Arthroplasty Gives Good Functional Outcome in Distal Humerus Fracture with Pre-existing Chronic Elbow Dislocation

2018 ◽  
Vol 24 (1) ◽  
pp. 60-65
Author(s):  
Chan Hing Shing ◽  
Ho Sheung Tung
Keyword(s):  
Internal Fixation ◽  
Elbow Dislocation ◽  
Distal Humerus ◽  
Total Elbow Arthroplasty ◽  
Humerus Fracture ◽  
Distal Humerus Fracture ◽  
Elbow Arthroplasty ◽  
Flexion Extension ◽  
Long Stem ◽  
Chronic Elbow Dislocation

Distal humerus fracture with concomitant chronic elbow dislocation is difficult to manage by open reduction and internal fixation, while total elbow arthroplasty (TEA) is an effective treatment for acute fracture or failed internal fixation of distal humerus fracture in elderly patients with osteoporosis. We present a case of an 86-year-old woman who suffered from acute distal humerus fracture in the presence of chronic elbow deformity from elbow dislocation since childhood at the age of 10 years. This was treated with TEA using Coonrad/Morrey prosthesis with long stem and long flange humerus components and cerclage wiring of humeral condyle. Postoperatively, elbow mobilization was started early within a hinged elbow brace. There was no operative complication. At the last follow-up 22 months after surgery, there was no pain and good elbow motion (20–130° flexion–extension arc, full supination and pronation to neutral) was obtained. The Mayo Elbow Performance Score was 100. There was incorporation of the bone graft at the anterior flange with no radiographic loosening of the prosthesis. This case shows that TEA can yield a gratifying clinical result and efficiently resolves two problems with one solution.

scholarly journals COMPARISON OF INTRA-ARTICULAR METHYLPREDNISOLONE AND KETOROLAC INJECTIONS IN IMPROVING RANGE OF MOTION FOR DIFFERENT SHOULDER JOINT DISORDERS

2021 ◽  
Vol 71 (3) ◽  
pp. 819-22
Author(s):  
Sumeera Matee ◽  
Wasif Anwar ◽  
Sami Wahid ◽  
Saeed Bin Ayaz ◽  
Rana Shahid ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Joint ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Military Hospital ◽  
Prednisolone Acetate ◽  
Methyl Prednisolone ◽  
Shoulder Range Of Motion ◽  
Significant Difference ◽  
Flexion Extension

Objective: To compare the efficacy of intra-articular injection of methyl prednisolone with ketorolac for improvement in range of motion in various shoulder joint disorders. Study Design: Quasi-experimental study. Place and Duration of Study: Departments of Internal and Rehabilitation Medicine, Combined Military Hospital Mangla, from Nov 2018 to May 2019. Methodology: Through non-probability consecutive sampling, patients with shoulder disorders were enrolled in the study and divided into two groups. Group A received intra articular corticosteroid injection and group B received intra-articular Ketorolac injection. Outcome was measured in terms of improvement in shoulder range of motion. Results: A total of 60 patients were selected, 40 (66.7%) male and 20 (33.3%) female. 30 (50%) patients had adhesive capsulitis, 24 (40%) had rotator cuff syndrome and 6 (10%) had impingement syndrome. 24 patients received methyl prednisolone acetate injection while 36 received ketorolac injection. There was no significant difference in the mean gain in flexion, extension, abduction, internal or external rotation between both groups (p=0.224, p=0.261, p=0.884, p=0.238, and p=0.584 respectively). Conclusion: There was no significant difference in efficacy of corticosteroid and ketorolac when injected intra-articularly in shoulder joint disorders.

scholarly journals A three dimensional multiplane kinematic model for bilateral hind limb gait analysis in cats

2018 ◽  
Author(s):  
Nathan P. Brown ◽  
Gina E. Bertocci ◽  
Kimberly A. Cheffer ◽  
Dena R. Howland
Keyword(s):  
Gait Analysis ◽  
Hind Limb ◽  
Sagittal Plane ◽  
External Rotation ◽  
Kinematic Model ◽  
Three Dimensional ◽  
Joint Angles ◽  
Plane Model ◽  
Flexion Extension ◽  
Joint Flexion

AbstractBackground: Kinematic gait analysis is an important noninvasive technique used for quantitative evaluation and description of locomotion and other movements in healthy and injured populations. Three dimensional (3D) kinematic analysis offers additional outcome measures including internal-external rotation not characterized using sagittal plane analysis techniques.Methods: The objectives of this study were to 1) develop and evaluate a 3D hind limb multiplane kinematic model for gait analysis in cats using joint coordinate systems, 2) implement and compare two 3D stifle (knee) prediction techniques, and 3) compare flexion-extension determined using the multiplane model to a sagittal plane model. Walking gait was recorded in 3 female adult cats (age = 2.9 years, weight = 3.5 ± 0.2 kg). Kinematic outcomes included flexion-extension, internal-external rotation, and abduction-adduction of the hip, stifle, and tarsal (ankle) joints.Results: Each multiplane stifle prediction technique yielded similar findings. Joint angles determined using markers placed on skin above bony landmarks in vivo were similar to joint angles determined using a feline hind limb skeleton in which markers were placed directly on landmarks ex vivo. Differences in hip, stifle, and tarsal joint flexion-extension were demonstrated when comparing the multiplane model to the sagittal plane model.Conclusions: This multiplane cat kinematic model can predict joint rotational kinematics as a tool that can quantify frontal, transverse, and sagittal plane motion. This model has multiple advantages given its ability to characterize joint internal-external rotation and abduction-adduction. A further, important benefit is greater accuracy in representing joint flexion-extension movements.

Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Nonweightbearing CT

2018 ◽  
Vol 39 (12) ◽  
pp. 1487-1496 ◽  
Author(s):  
Arne Burssens ◽  
Hannes Vermue ◽  
Alexej Barg ◽  
Nicola Krähenbühl ◽  
Jan Victor ◽  
...  
Keyword(s):  
External Rotation ◽  
Imaging Techniques ◽  
Ankle Injuries ◽  
Control Group ◽  
3D Analysis ◽  
Anatomical Landmarks ◽  
Distal Fibula ◽  
Fracture Group ◽  
Significant Difference ◽  
The Mean

Background: Diagnosis and operative treatment of syndesmotic ankle injuries remain challenging due to the limitations of 2-dimensional imaging. The aim of this study was therefore to develop a reproducible method to quantify the displacement of a syndesmotic lesion based on 3-dimensional computed imaging techniques. Methods: Eighteen patients with a unilateral syndesmotic lesion were included. Bilateral imaging was performed with weightbearing cone-beam computed tomography (CT) in case of a high ankle sprain (n = 12) and by nonweightbearing CT in case of a fracture-associated syndesmotic lesion (n = 6). The healthy ankle was used as a template after being mirrored and superimposed on the contralateral ankle. The following anatomical landmarks of the distal fibula were computed: the most lateral aspect of the lateral malleolus and the anterior and posterior tubercle. The change in position of these landmarks relative to the stationary, healthy fibula was used to quantify the syndesmotic lesion. A control group of 7 studies was used. Results: The main clinical relevant findings demonstrated a statistically significant difference between the mean mediolateral diastasis of both the sprained (mean [SD], 1.6 [1.0] mm) and the fracture group (mean [SD], 1.7 [0.6] mm) compared to the control group ( P < .001). The mean external rotation was statistically different when comparing the sprained (mean [SD], 4.7 [2.7] degrees) and the fracture group (mean [SD], 7.0 [7.1] degrees) to the control group ( P < .05). Conclusion: This study evaluated an effective method for quantifying a unilateral syndesmotic lesion of the ankle. Applications in clinical practice could improve diagnostic accuracy and potentially aid in preoperative planning by determining which correction needs to be achieved to have the fibula correctly reduced in the syndesmosis. Level of Evidence: Level III, retrospective comparative study.

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