John J. Bauer, MD, FACS - Malleable Penile Prosthesis

Hip Disarticulation Specialist Tony van der Waarde | Award Prosthetics

Shoulder and Elbow Coding - UW Faculty Web Server

Background and purpose The methods of reconstruction for proximal femur bone tumors that are used most often include modular prosthetic replacement and allograft-prosthesis composite reconstruction. In modular prostheses, the abductors are detached from the insertion and then reinserted into the implant, and the iliopsoas is detached and left free. In the allograft-prosthesis composite, the detached tendons are fixated to the graft. We assessed whether the latter procedure provides functional advantages regarding gait. Patients and methods We studied 2 groups of 10 patients, each with prosthetic reconstruction of the proximal femur either with modular prosthetic replacement or with allograft-prosthesis composite. Functional performance was analyzed by gait analysis 2.5-10 years after surgery. At that time, all the patients had good function according to the Musculoskeletal Society score. Results Walking speed was reduced in all patients, and especially in patients with modular prosthetic replacement. Different hip extension patterns during late stance were found in the 2 groups. Surface EMG showed a typical prolonged muscle co-contraction pattern during gait, which was more evident in modular prosthetic patients. Interpretation Although both procedures provided good functional outcome in the long-term follow-up, gait analysis revealed mechanical changes during gait that were probably related to the muscle reinsertion procedure. Direct fixation of the muscles to the bone graft appeared to result in a more efficient muscular recovery.

L0112 Cranial cervical orthosis, congenital torticollis type, with or without sof..

Robotic Leg Control with EMG Decoding in an Amputee …

seen after removal of uncemented component without biological ingrowth on surface
II Extensive metaphyseal cancellous bone loss / intact diaphysis
- often seen after removal of cemented prosthesis
IIIA Metaphysis severely damaged / > 4cm diaphyseal bone for distal fixation
- grossly loose femoral component
- first generation cementing techniques
IIIB Metaphysis severely damaged /
- cemented with cement restrictor
- uncemented with substantial distal osteolysis
IV Extensive metaphyseal and diaphyseal bone loss / isthmus non supportive
I Segmental
- proximal (partial or complete)
- intercalary
- greater trochanter
II Cavitary
- cancellous
- cortical
- ectasia (dilatation)
III Combined segmental and cavity
IV Malalignment
- rotational
- angular
V Femoral Stenosis
VI Femoral Discontinuity
Type I Segmental deficiencies Peripheral - superior / anterior / posterior Central - medial wall absent
Type II Cavitary deficiencies
Peripheral - superior / anterior / posterior
Central - medial wall intact
Type III Combined deficiencies
Type IV Pelvic discontinuity Separation of anterior and posterior columns
Type V Arthrodesis
Based on ability of the remaining host bone - to provide initial stability to a hemispherical cementless acetabular component - until ingrowth occurs Undistorted rim
- anterior and posterior columns intact
- no superior migration

- may have some contained deformities
- ishium, teardrop and Kohlers line intact Distorted but intact rim
- can support a hemispherical cementless implant
Some distortion, minimal superior migration
- at least 50% good support by host bone
- anterior and posterior columns intact
- no substantial osteolysis of ischium or teardrop 2A - superomedial migration but superior rim intact 2B - - remainder is still supportive - replace with allograft for bone stock 2C - medial migration to Kohlers, but wall intact - rim is supportive - manage as for protrusio Non supportive rim
- columns not supportive, superior migration> 3 cm

- require structural allograft for support
4 radiographic criteria
1. Superior migration of the hip centre
- indicates damage to anterior and posterior columns
- supero-medial indicates greater damage to anterior column
- supero-lateral indicates greater damage to posterior column
2. Ischial osteolysis
- bone loss inferior posterior column
3. Teardrop osteolysis
- inferior anterior column and medial wall
4. Position of the implant relative to Kohler’s line
- deficiency of anterior column 3A - > 40% host bone contact - 3B - - > 50% rim missing

Evaluation of Robotic Prosthesis Control during Ambulation

AB - Nine fresh-frozen normal human cadaveric long fingers were used to corn pare the kinematics of the proximal interphalangeal joint (PIP) before and after a resurfacing metal-polyethylene prosthetic replacement (Avanta prosthesis, San Diego, CA) using the magnetic Isotrak system (Polhemus Navigational Systems, Colchester, VT). The kinematics of the PIP joint after replacement were similar to that of the normal joint. The maximum angular displacement was 5°for lateral deviation and 9°for rotation during the passive flexion and extension motion. The center of rotation after implant insertion was nearly identical to the center of rotation of the normal joint. This anatomically designed Pip prosthesis has potential to restore normal motion to the finger PIP joint while resisting physiologic out-of-plane forces such as pinch and grasp. (C) 2000 by the American Society for Surgery of the Hand.

The Schedule for Rating Disabilities - Military Disability


Total Hip Arthroplasty 27130 M16.10 | eORIF

Increased PF strain - oversized or anterior femoral component - oversized patella component - patella baja Non-Operative Indications - extensor mechanism intact - patella component stable Treatment - immobilse for 6 weeks then progressive ROM Operative Indications - loose component or ruptured extensor mechanism Treatment A. Patella ORIF if component stable B. Removal component if unstable + Patella ORIF Cemented patella - Uncemented higher - 0.6% - 11.1% Metal backed designs Uncemented Fracture / AVN of patella Excessive bone removal A. Remove and leave B. Revision - need > 10 mm bone left C. Patellectomy Clunk with knee extension - as patella exits groove at 30-45° extension Complain of symptoms when rising from chair or climbing stairs Fibrous nodule at junction of posterioraspect of patella and quadricep tendon - with flexion enters trochlear groove and gets trapped as go back into extension - usually due to entrapment at superior flange of femur - inflammation and a synovial proliferation Increased incidence in PS knees Newer designs - deeper patella groove - more posterior femoral box Can visualise nodule on ultrasound Arthroscopic debridement Dajani et al J Arthroplasty 2010 - good result in 15 knees 0.17-2.5% Usually post operative, insidious and due to a vascular insult Lateral release - devascularises tendon Closed MUA of knee Osteotomy of tibial tuberosity Revision TKR Prevention with surgical technique is imperative Debilitating extensor lag - can be about 50o - operation improves this to about 20o Can predispose to knee dislocation / post jump 1. Primary repair with autograft / allograft reinforcement - staples, wire reinforcement - hamstring reconstruction (leave attached distally) - achilles tendon allograft - Lars ligament reinforcement Usually left with extensor lag 2. Chronic rupture / failed repair Must deal with patella baja - combine repair with proximalization of tibial tuberosity 3. Revise to constrained prosthesis if required - PS component - loss of mechanical advantage of quads - extensor lag - anterior translation of femur on tibia once the PCL stretches