Medial Elbow Pain Syndrome: Current Treatment Strategies.

Medial elbow pain is a common presentation that can be a challenge to appropriately treat for the orthopedic surgeon. Causes include medial epicondylitis, ulnar neuritis, ulnar collateral ligament injury, flexor pronator strain, or snapping medial triceps. A good outcome is typically achieved with adequate treatment of tendon degeneration at the common flexor tendon origin. Mainstay treatment is nonoperative modalities such as stretching, rest, activity modification, therapy, and injections. If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted. Surgical treatments are dictated based on the severity of the pathology, involvement of soft tissues, and concomitant pathology. Medial elbow complaints can be multifactorial and require a broad differential diagnosis. [Orthopedics. 2023;46(2):e81-e88.].

The internal joint stabilizer for chronic elbow dislocation: a surgical technique.

The main goal of treatment for chronically unreduced elbow dislocations is to restore a stable, concentric joint and regain a satisfactory arc of motion. Due to the conflicting goals of restoring elbow stability and regaining a good arc of motion, the treatment of chronic elbow dislocation remains a challenge for even the experienced orthopedic surgeon. The standard treatment of these dislocations consists of open reduction, V-Y muscleplasty of the triceps, and temporary arthrodesis or cast immobilization. However, prolonged postoperative immobilization may result in elbow stiffness, which significantly limits the functional outcome. We present our surgical technique with a focus on restoring stable reduction such that early motion can be instituted and complications of prolonged immobilization can be avoided. From position to wound closure, surgical steps are presented in detail, with pearls for practice and a discussion on chronic elbow dislocation. The internal joint stabilizer is a safe and effective implant that complements the management of chronic elbow dislocations. This reproducible surgical technique allows for stability and early mobility while having the added benefit of circumventing complications associated with prolonged immobilization and hinged external fixation. Understanding the surgical indications, as well as the nuances of the surgical technique utilizing the internal joint stabilizer, is critical in order to improve patient outcomes and avoid complications.

Precision of robotic guided instrumentation for acetabular component positioning.

Robotic computerized instrumentation that guides bone preparation and cup implantation in total hip arthroplasty was studied. In 38 patients (43 hips) intraoperative cup inclination and anteversion were validated by postoperative CT scans. Planned inclination was 39.9°±0.8° and with robotic instrumentation was 38. 0°±1.6° with no outliers of 5°; on the postoperative CT scan there were 5 outliers (12%). Planned anteversion was 21.2°±2.4° and intraoperatively was 20.7°±2.4° with no outlier of 5°; on the CT there were 7 outliers (16%). The center of rotation (COR) was superior by a mean 0.9±4.2 mm and medial by 2.7±2.9 mm. This robotic instrumentation achieved precision of inclination in 88%, anteversion in 84% and COR in 81.5%.

Predictability of Acetabular Component Angular Change with Postural Shift from Standing to Sitting Position.

BACKGROUND: The angles of the acetabular component of a total hip replacement change with body postural changes, and this change can affect stability and wear. We sought to correlate the intraoperative angles of inclination and anteversion of the cup with the changes in these angles when patients moved from standing to sitting and determine if these changes were predictable. METHODS: Eighty-five patients (eighty-five hips) had sagittal (lateral) spinopelvic radiographs made while they were standing and while they were sitting before and after undergoing total hip replacement. The spinosacral tilt and the pelvic tilt were measured on these radiographs. The angles of acetabular inclination and anteversion achieved at surgery changed during sitting. Each patient was classified according to the stiffness of the spine/pelvis as measured by the change in posterior sacral or pelvic tilt between the standing and sitting positions. The magnitude of change of the sagittal cup position (termed ante-inclination) was correlated to the stiffness classification of the pelvis. An experimental phantom model reproduced possible combinations of intraoperative inclination and anteversion and correlated them to sagittal ante-inclination according to pelvic tilt. RESULTS: The pelves with normal stiffness tilted posteriorly 20° to 35° with the postural change from standing to sitting. Ante-inclination of the acetabular cup averaged 29.6° ± 8.4° (95% confidence interval [CI] = 13.1° to 46°) with standing and 54.6° ± 10.2° (95% CI = 44.4° to 64.8°) with sitting. The stiff pelves had a mean of 4° less tilt than those with normal stiffness and 13° less than the hypermobile pelves with the postoperative sitting position. The phantom model showed ante-inclination could be predicted by measuring the preoperative degrees of change in sacral/pelvic tilt from standing to sitting. CONCLUSIONS: Ante-inclination during sitting results in a more vertical acetabular cup, which can result in hip instability, especially drop-out dislocation, and edge-loading wear. Patients with supine coronal cup inclination of ≥50° and anteversion of ≥25° and those with a hypermobile pelvis are at risk. It is the pelvic spatial position during postural change that creates the postoperative consequences of the surgical cup placement.