Replacement Arthroplasty: Seyler TM

Mont MA, Seyler TM. · No affiliation provided · Clin Orthop Relat Res. · Pubmed #19263181 No free full text.

This publication has no abstract.

Mont MA, McGrath MS, Bonutti PM, Ulrich SD, Marker DR, Seyler TM, Suda AJ. · Rubin Institute for Advanced Orthopaedics, Baltimore, MD 21215, USA. · Expert Rev Med Devices. · Pubmed #19298164 No free full text.

Abstract: A number of patients have anatomic or physiologic variations that may adversely affect the performance of a primary total hip arthroplasty. Various technologies have been utilized in an attempt to improve the outcomes for these patients; however, some of these potential solutions are controversial. The authors examined the complete body of literature for scientific evidence regarding the use of these new technologies. The anatomic and physiologic anomalies that were studied include extra-articular deformities, developmental dysplasia, Perthes disease, Type C femoral bone, acetabular bone deficiency, femoral rotational abnormalities, variations that increase the risk of hip dislocation, sickle cell anemia, and extremely small or large bone sizes. This article presents the current scientific evidence and imparts an unbiased view of the use of various technologies to provide individualized solutions for patients who have anatomic or physiologic variations.

McGrath MS, Suda AJ, Bonutti PM, Zywiel MG, Marker DR, Seyler TM, Mont MA. · Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · Expert Rev Med Devices. · Pubmed #19105782 No free full text.

Abstract: Primary total knee arthroplasties have high success rates, but certain patient anatomic or other variations may adversely affect the performance or the clinical outcomes of these procedures. Various technologies and techniques have been developed in attempts to overcome these challenges. However, there is controversy concerning whether these innovations are beneficial. This article assessed the scientific evidence regarding the use of these technologies to address various anatomic variations by examining the complete body of literature. The anatomic variations that were examined included extra-articular deformities, bone deficiencies, ligamentous instability, post-patellectomy knees, patella baja, variations in bone size and high-flexion knees. Recommendations for each circumstance were presented based upon the available scientific evidence.

Seyler TM, Smith BP, Marker DR, Ma J, Shen J, Smith TL, Mont MA, Kolaski K, Koman LA. · Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA. · J Bone Joint Surg Am. · Pubmed #18984726 No free full text.

This publication has no abstract.

Sikes CV, Lai LP, Schreiber M, Mont MA, Jinnah RH, Seyler TM. · Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA. · J Arthroplasty. · Pubmed #18922375 No free full text.

Abstract: One of the most common complications after total hip arthroplasty is instability. This study reviewed the recent literature concerning the indications, contraindications, and results of recent studies using both constrained liners and large femoral heads to treat instability after total hip arthroplasty. We also report on the results of a series of 41 patients (52 hips) considered being at high risk for dislocation who were treated with large-diameter metal-on-metal bearings and who were compared with a matched group of hips treated with standard-size metal-on-polyethylene bearings. The large-diameter femoral head group had no dislocations at a minimum follow-up of 24 months, whereas the standard-size group had 2 dislocations. We support the use of large femoral heads to treat instability in a wide variety of patients because of the increased stability, decreased wear of modern metal-on-metal designs, increased range of motion, and variety of revision options.

Delanois RE, McGrath MS, Ulrich SD, Marker DR, Seyler TM, Bonutti PM, Mont MA. · Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · Orthop Clin North Am. · Pubmed #18602566 No free full text.

Abstract: Many procedures have been used to treat advanced isolated patellofemoral arthritis, with varying results. Patellofemoral arthroplasty (PFA) is a bone-conserving procedure that has shown short-term success but has relatively high revision rates. Total knee arthroplasty (TKA) has been recommended for treatment of this disease in patients who are older than 60 years of age. Recent literature indicates that PFA is most successful in patients who have isolated patellofemoral arthritis secondary to trochlear dysplasia or patellar fracture and in patients who are younger than 60 years; TKA is recommended for older patients who have primary or idiopathic isolated patellofemoral arthritis.

Akbar M, Mont MA, Heisel C, Marker DR, Ulrich SD, Seyler TM. · Stiftung Orthopädische Universitätsklinik, Heidelberg. · Orthopade. · Pubmed #18542917 No free full text.

Abstract: Osteonecrosis of the femoral head is a disease of the young patient which eventually destroys the hip joint. In the early stage of the disease, treatment options are aimed at preserving the femoral head. Unfortunately, many patients present with late-stage disease (Ficat III and IV).In late-stage disease the treatment of choice is total hip arthroplasty. The high failure rate of total hip arthroplasty in young patients with osteonecrosis of the femoral head, however, made it an unfavourable treatment option. The results of hemiresurfacing (femoral resurfacing) in this patient population have been very disappointing due to high revision rates and insufficient pain relief. More recently, promising short- and mid-term results were reported with the use of total resurfacing with a survivorship of 90-93% after 3.4-10 years. Our own results in 60 patients show an overall survivorship of 92% after a mean follow-up of 4.8 years (1.6-6.5 years). Total hip resurfacing is a valuable treatment option for late-stage osteonecrosis based on recent study results.

Stiehl JB, Ulrich SD, Seyler TM, Bonutti PM, Marker DR, Mont MA. · Orthopaedic Surgeon, Orthopedic Hospital of Wisconsin, 575 W River Woods Parkway, Milwaukee, WI 53212, USA. · Expert Rev Med Devices. · Pubmed #18331183 No free full text.

Abstract: This review provides an overview of the use of bone morphogenetic proteins to enhance bone healing and bone graft incorporation in difficult defects created from failed total hip arthroplasties, osteonecrosis of the femoral head and trauma. Multiple publications have demonstrated that bone morphogenetic proteins are osteoinductive in preclinical trials (i.e., animal models); however, there is controversy and limited understanding of the use of this technology in orthopedic surgical practice. The question remains as to whether they are useful in difficult fractures, nonunions and large defects created from failed total hip arthroplasty or femoral head osteonecrosis. There might be a small risk for infection by the process of introducing foreign materials in a clinical situation, but this has not yet been realized to date. In addition, these materials offer an advantage in large defects where there is not enough transplantable material available from the host. We believe that the use of these materials will become more widespread with newer carriers, minimally invasive applications and diminished commercial costs.

Ulrich SD, Bonutti PM, Seyler TM, Marker DR, Jones LC, Mont MA. · Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · Expert Rev Med Devices. · Pubmed #18035952 No free full text.

Abstract: Minimally invasive surgeries, as well as computer-assisted surgery for total hip replacement have gained popularity over recent years. This article provides an overview of state-of-the-art minimally invasive surgery (MIS) and computer-assisted surgery for total hip arthroplasty. A comprehensive review of the literature for scientific evidence supporting the use of these technologies was undertaken. This review evaluates whether commonly asked questions concerning these topics have been addressed. Controversy remains as to whether there are significant benefits of MIS or computer-assisted surgery for total hip arthroplasty. Fortunately, most studies report similar outcomes for both technologies. Minimally invasive techniques have been developed that do not significantly increase operative time or immediate postoperative complications. Computer-assisted navigation has shown improved radiographic alignment for total hip arthroplasty and may allow MIS to be performed more optimally. The authors believe that both of these technologies are likely to have a place in the future for hip arthroplasty with expectations of increased successful outcomes with these techniques while lowering complications and costs. Long-term outcomes of both techniques will need to be investigated.

Seyler TM, Marker DR, Bhave A, Plate JF, Marulanda GA, Bonutti PM, Delanois RE, Mont MA. · Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, MD 21215, USA. · J Bone Joint Surg Am. · Pubmed #17908871 No free full text.

This publication has no abstract.

Ulrich SD, Mont MA, Bonutti PM, Seyler TM, Marker DR, Jones LC. · Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · Expert Rev Med Devices. · Pubmed #17605685 No free full text.

Abstract: This review provides an overview of the field of minimally invasive surgery and computer-assisted surgery for total knee arthroplasty. The authors have examined the complete body of literature for scientific evidence supporting the use of these new technologies and how the literature specifically supports commonly asked questions. There is controversy concerning the benefits of minimally invasive surgery and computer-assisted surgery for total knee arthroplasty. However, in most studies the results are similar for minimally invasive surgery compared to standard approaches. Computer-assisted navigation has been found in some studies to improve radiographic alignment of total knee arthroplasty. The authors believe that there is evidence for both technologies to be at least equivalent in terms of results, as well as expectations of increased success with the techniques. Both technologies have led manufacturers to invest more effort into newer prosthetic instrumentations and designs to facilitate these techniques.

Seyler TM, Cui Q, Mihalko WM, Mont MA, Saleh KJ. · Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, Maryland, USA. · Instr Course Lect. · Pubmed #17472309 No free full text.

Abstract: Osteonecrosis of the femoral head is a devastating disease for which many patients will eventually require total hip arthroplasty. Standard total hip arthroplasties have historically had poor results in patients with osteonecrosis. More recently, reports have shown excellent results with second- and third-generation designs that incorporate advances in bearing technology. However, there are still certain subpopulations of patients (those with sickle cell disease, those with systemic lupus erythematosus, and those who have undergone renal transplantation) that have less than optimal results. Other hip arthroplasty alternatives include bipolar hemiarthroplasty, limited femoral resurfacing, and metal-on-metal resurfacing. Bipolar hemiarthroplasty historically and currently has consistently poor results in most studies and should be avoided in patients with osteonecrosis. In multiple reports, limited femoral arthroplasty has demonstrated reasonable midterm and long-term outcomes as a temporizing procedure, with results being less predictable than for standard total hip arthroplasty. Recently, ceramic-on-ceramic and metal-on-metal resurfacing hip arthroplasty has emerged as a viable option that has been used to treat patients with osteonecrosis of the femoral head, and several studies have shown promising short-term outcomes. Overall, however, recent studies have shown more optimal outcomes with hip arthroplasty than resurfacing hip arthroplasty, which makes standard hip replacements, as well as other arthroplasty alternatives, more attractive for young patients with this disease.

Leadbetter WB, Seyler TM, Ragland PS, Mont MA. · Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · J Bone Joint Surg Am. · Pubmed #17142442 No free full text.

This publication has no abstract.

Seyler TM, Etienne G, Plate JF, Fisher P, Mont MA. · Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland, USA. · Surg Technol Int. · Pubmed #17029179 No free full text.

Abstract: The use of large-diameter femoral heads in total hip arthroplasty appears to reduce the risk for dislocation, and potentially improve articular wear. Moreover, large-diameter total hip femoral heads have been determined to increase range of motion. The purpose of this study was to report our experiences with this new device. In our patient cohort, many patients have done extremely well in the short-term with this new device, and it seems these patients function better than those with a standard total hip arthroplasty. The patients who experience less pain are able to return to full activities postoperatively. The preliminary results of this study are encouraging, and large femoral head prosthesis appears to be a great choice for orthopaedic surgeons in primary total hip arthroplasty.

Mont MA, Ragland PS, Etienne G, Seyler TM, Schmalzried TP. · Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, MD 21215, USA. · J Am Acad Orthop Surg. · Pubmed #16885477 No free full text.

Abstract: Hip resurfacing arthroplasty is a type of hip replacement that involves capping the femoral head and preserving bone of the proximal femur. Metal-on-metal surface replacements have been manufactured since the early 1990s. Recent studies indicate excellent clinical results with low failure rates at 1- to 5-year follow-up. Although these early results are encouraging, resurfacing devices must be used with caution because less is known about their long-term safety and efficacy. The best candidates for resurfacing are patients younger than age 60 years with good bone stock. The surgical approach is similar to that for standard total hip replacements, but with slightly more dissection because the femoral head must be preserved and displaced to visualize the acetabulum. To reduce complications, resurfacing arthroplasty should be performed by surgeons who have received training specifically in this technique.

Seyler TM, Mont MA, Ragland PS, Kachwala MM, Delanois RE. · Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Baltimore, Maryland 21215, USA. · Sports Med. · Pubmed #16796395 No free full text.

Abstract: Lower extremity total joint arthroplasties are among the most successful operations in orthopaedics. Presently, it appears that some patients wish to not only have general functions restored, but also desire the opportunity to return or continue on a high level of activity. This review summarises the literature concerning athletic activity, and tennis in particular, in relation to lower extremity total joint arthroplasties. Orthopaedic surgeons frequently recommend participation in low-impact sports such as swimming, walking, bicycling, bowling and golf. The patient's return to these recreational activities appears to be without problems. In contrast, there has been a general consensus from surgeons to avoid high-impact sports such as tennis and jogging after total joint arthroplasty, but there have been numerous studies that reported functional results being compatible with these activity levels. Conflicts emerge with some studies that describe lower survival rates for hip and knee arthroplasty in patients participating in high-impact sports. Most of these studies report that participation in sporting activities following total joint arthroplasty refers to increased polyethylene wear and debris, which could eventually result in implant failure. With recent advances in implant technology and surgical technique, the survival rates for modern prosthetic designs and patients with these high demands are promising. Various studies assessing the association between clinical outcome and participation in tennis did not demonstrate a harmful effect on implant survival rates. Although the majority of these studies do not reflect a true representation of the average patient undergoing total joint arthroplasty, more surgeons are confronted with the patients' desire to continue with sports activity. To optimise results, patients who demand higher levels of activity must be carefully selected, and must have the motivation and drive to optimise their results. In general, all patients should be encouraged to remain physically active to improve general health, maintain good bone quality, and improve implant fixation. There is still a need for prospective, randomised controlled studies concerning high activity and its impact on total joint arthroplasty.

McGrath MS, Marker DR, Seyler TM, Ulrich SD, Mont MA. · Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA. · Clin Orthop Relat Res. · Pubmed #18797977 No free full text.

Abstract: Conversion of a failed surface hip replacement to a conventional total hip arthroplasty is reportedly a straightforward procedure with excellent results. We compared perioperative parameters, complications, and clinical as well as radiographic outcomes of 39 hemi and total hip resurfacing conversions with conventional THAs. The hips were matched by diagnosis, gender, age, body mass index, preoperative Harris hip score, and followup time to a cohort of primary conventional THAs performed during the same time period by the same surgeon. The mean operative time was longer (by 19 minutes) for the conversions, but other perioperative parameters were similar. At a mean followup of 45 months (range, 24-63 months), the mean Harris hip scores were similar in the two groups (92 points versus 94 points for the conversion and conventional hips, respectively). Thirty-eight of 39 stems were well-aligned and appeared osseointegrated. When a resurfaced hip fails, conversion to conventional THA has similar early clinical and radiographic outcomes to primary conventional THA. Level of Evidence: Level III, therapeutic (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Ulrich SD, Bhave A, Marker DR, Seyler TM, Mont MA. · Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA. · Clin Orthop Relat Res. · Pubmed #18062047 No free full text.

Abstract: Patient dissatisfaction after total knee arthroplasty (TKA) is often linked to complications resulting from comorbidities, radiographic loosening, and poor prosthetic alignment. However, some patients report functional problems without obvious cause. We asked if focused physical therapeutic techniques influenced the clinical outcome in these patients. We identified functional problems in 56 patients after TKA and described outcomes following focused physical therapy modalities. Assessments included detailed physical examination, videotape analyses, electromyograms, nerve conduction studies, foot pressure studies, and isokinetic strength measurements in selected patients. Identified abnormalities were knee flexion contracture, quadriceps muscle weakness, knee flexion deficit, limb length difference, foot and ankle malalignment, and peroneal nerve entrapment. Focused treatment protocols for each of the six abnormalities included knee braces, shoe lifts, orthoses, electrical stimulation, peroneal nerve releases, and intramuscular botulinum toxin injections. Fifty-three patients (95%) had Knee Society scores greater than 80 points at final minimum followup of 24 months (mean, 43 months; range, 24-73 months). Patient satisfaction was a mean of 9.1 out of 10 possible points. Our results suggest focused physical therapy may help patients with difficult functional problems after TKA. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Seyler TM, Bonutti PM, Ulrich SD, Fatscher T, Marker DR, Mont MA. · Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA. · J Arthroplasty. · Pubmed #17919588 No free full text.

Abstract: Minimally invasive knee surgery can be accomplished through several exposures used in standard total knee arthroplasty. These exposures include the medial parapatellar, subvastus, and midvastus approaches. The authors describe a new minimally invasive direct lateral approach in an attempt to minimize soft tissue damage and preserve quadriceps muscle function in 35 patients (35 knees). There were 23 women and 12 men with a mean age of 65 years. At a mean follow-up of 3.8 years, the mean Knee Society objective and functional scores improved to 94 and 92 points, respectively. The assessment of quadriceps muscle strength, anterior knee pain, and patient satisfaction was promising. However, the downside of this pilot cohort was that using instruments and implants that have not been customized for this approach led to a considerable rate of early complications that may limit the potential of this new approach. Thus, further refinements are needed to increase clinical success and allow this technique for general use.

Mont MA, Seyler TM, Ulrich SD, Beaule PE, Boyd HS, Grecula MJ, Goldberg VM, Kennedy WR, Marker DR, Schmalzried TP, Sparling EA, Vail TP, Amstutz HC. · The Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA. · Clin Orthop Relat Res. · Pubmed #17891034 No free full text.

Abstract: Recently, improved metal-on-metal bearing technology has led to the reemergence of resurfacing as a reasonable option for total hip arthroplasty. During the course of a prospective multicenter FDA-IDE evaluation of metal-on-metal total hip resurfacings, we modified our indications and emphasized surgical technique where the femoral surface area was small due to femoral cysts and small component size. We assessed the influence of these changes on complication rates in the first cohort of 292 patients and the second of 724, and then compared these outcomes in the second cohort with historical reports of resurfacing. We had a minimum followup of 24 months (mean, 33 months; range, 24-60 months). After changes were made in the indications and technique, the overall complication rate decreased from 13.4% to 2.1% with the femoral neck fracture rate reduced from 7.2% to 0.8%. The outcomes of the second cohort compare with modern-day resurfacing devices and appear superior to historical results. The data suggest patients should be carefully selected and technique optimized to reduce complications. Long-term followup is required to see if these promising results will be maintained.

Mont MA, Seyler TM, Ragland PS, Starr R, Erhart J, Bhave A. · Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA. · J Arthroplasty. · Pubmed #17197316 No free full text.

Abstract: Patients with standard total hip arthroplasties may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips. In comparison, patients after resurfacing total hip arthroplasty appear to have a near-normal gait. The authors evaluated temporal-spatial parameters, hip kinematics, and kinetics in hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral standard total hip arthroplasties. Patients with resurfacing walked faster (average 1.26 m/s) and were comparable with normals. There were no significant differences in hip abductor and extensor moments of patients with resurfacing compared with patients in the standard hip arthroplasty group. This study showed more normal hip kinematics and functionality in resurfacing hip arthroplasty, which may be due to the large femoral head.

Seyler TM, Jinnah RH, Koman LA, Marker DR, Mont MA, Ulrich SD, Bhave A. · Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA. · J Surg Orthop Adv. · Pubmed #19138496 No free full text.

Abstract: The development of knee flexion contractures following total knee arthroplasty is detrimental to a patient's functional capabilities. Despite using aggressive rehabilitative modalities postoperatively, some knee arthroplasty patients do not respond and continue to experience muscle spasms. Botulinum toxin type A has been used as a temporary neuromuscular transmitter blocker to treat muscle spasms in patients with neurological disorders, and it has been utilized as a treatment method for clubfoot. The purpose of this study was to evaluate botulinum toxin type A as a new treatment modality for patients with flexion contractures following total knee arthroplasty that were recalcitrant to standard treatment methods. By 2 years following injections, 9 out of 11 knees achieved extension within 10; of neutral position, and 8 of the 11 maintained this improved range of motion by a mean follow-up of 36 months. There were two failures in patients who had a revision knee arthroplasty, suggesting that this treatment is more effective in patients following primary cases. Based on these results, botulinum toxin type A should be considered as a potential treatment modality, especially in difficult-to-treat cases of knee flexion contracture that are recalcitrant to standard therapy.

Bonutti PM, Dethmers D, Ulrich SD, Seyler TM, Mont MA. · Bonutti Clinic, Effingham, IL, USA. · Clin Orthop Relat Res. · Pubmed #18815850 No free full text.

Abstract: Computer-navigated and minimally invasive TKAs are emerging technologies that have distinct strengths and weaknesses. We compared duration of surgery, length of hospitalization, Knee Society scores, radiographic alignments, and complications in two unselected groups of 81 consecutive knees that underwent TKA using either a minimally invasive approach or computer navigation. The two groups were operated on by two different surgeons over differing timeframes. The mean surgical time was longer in the navigated group by 63 minutes. The Knee Society scores and lengths of hospitalization of the two groups were similar. The postoperative component alignments of the two groups were similar; the mean femoral valgus and tibial varus angles of the navigation group changed from 96 degrees and 88 degrees preoperatively to 95 degrees and 89 degrees postoperatively, respectively, and in the minimally invasive group, the mean femoral valgus angles and tibial varus angles changed from 97 degrees and 88 degrees preoperatively to 95 degrees and 89 degrees postoperatively, respectively. There were 11 major and three minor complications in the navigation group, including one revision, two femoral shaft fractures, four reoperations for knee stiffness, and four instances of bleeding from tracker sites. We believe the higher incidence of complications in addition to the longer operative time in the navigated group may outweigh any potential radiographic benefits. LEVEL OF EVIDENCE: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Kolisek FR, Seyler TM, Ulrich SD, Marker DR, Jessup NM, Mont MA. · Joint Replacement Center at St. Francis Hospital, OrthoIndy, Indianapolis, Indiana, USA. · Surg Technol Int. · Pubmed #18802911 No free full text.

Abstract: This study directly compared a minimally invasive dual-incision muscle-sparing surgical technique with a standard posterolateral approach in total hip arthroplasty to assess for early complications, clinical success, and alignment. Total hip arthroplasties using a minimally invasive, muscle-sparing, dual-incision approach were performed on 21 hips (20 patients). This cohort was compared to a contemporaneously performed group of 21 hips (20 patients) using a standard posterolateral approach. Five complications were reported for the dual-incision group versus one complication for the posterolateral group. Postoperative radiographic alignment of the prosthesis was closer to optimal for the posterolateral group. The dual-incision group had longer operating times and a significant increase in complications. The authors have discontinued the use of this technique based on the results of this study.

Mont MA, Marker DR, Seyler TM, Jones LC, Kolisek FR, Hungerford DS. · Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA. · J Arthroplasty. · Pubmed #18722307 No free full text.

Abstract: Many patients will attempt high-impact loading activities after total knee arthroplasty. This study analyzed the clinical and radiographic results of these high-demand sports patients. A total of 31 patients (33 knees) were identified who participated in high-impact sports on average 4 times per week (range, 1-7 times per week) for a mean of 3.5 hours per week (range, 1 to 10 hours), including jogging, downhill skiing, singles tennis, racquetball, squash, and basketball. At 4 years mean follow-up (range, 2-9 years), 32 of 33 knees had successful clinical and radiographic outcomes. Overall satisfaction was a mean of 9.1 points on a scale of 0 to 10 points. These results indicate that some patients will participate in high-impact sports and enjoy excellent clinical outcomes at a minimum 4 years after surgery.