Fully endoscopic lumbar spinal surgery: Is it time to change?

Spinal surgery is becoming safer and progressively less invasive with advances in optical and instrument technology. The amount of decompression achievable with endoscopic approaches is now comparable to open approaches with the advantage of much less tissue trauma. This review aims at examining the status of endoscopic approaches in lumbar decompressive surgery.

Fully endoscopic cervical spine surgery: What does the future hold?

Fully endoscopic cervical spine surgery is an emerging novel approach to address cervical spinal pathology. Techniques, both anterior and posterior have been adapted to address various cervical pathologies. The primary goal of these procedures like other open techniques is to surgically decompress the canal centrally and/or along the foramen. The narrative review aims to provide the reader an overview of the rapidly advancing field of endoscopic cervical spinal surgery and evaluate whether these newer approaches could potentially reduce the cost and the risk associated with instrumented cervical fusion.

Early failure with the Journey-Deuce bicompartmental knee arthroplasty.

The aim of this study was to evaluate the early functional outcome and survivorship of a bicompartmental knee arthroplasty implant (Journey-Deuce) in a cohort of patients with combined medial and patellofemoral degenerative osteoarthritis. Fifteen patients with a mean age of 57 years were followed up prospectively and evaluated with clinical examination, Oxford knee score and radiology imaging. Poor pain scores, concerns about the tibial fixation, early aseptic loosening of the tibial component and a revision rate of 60 % at a minimum follow-up of 54 months are reported. Implantation of this prosthesis was stopped at our institution well before the first revision due to an unfavourable early clinical response. This was further endorsed by an unacceptable revision rate. The outcome of the Journey-Deuce bicompartmental knee replacement was considerably worse than the published outcome of total knee replacement.

The use of rivaroxaban for chemical thromboprophylaxis following total knee replacement.

BACKGROUND: Pulmonary embolism is a leading cause of fatality in elective orthopaedics. Recently introduced oral thromboprophylaxis (rivaroxaban) has a logistic advantage but has also raised early concerns amongst arthroplasty surgeons AIM: The aim of this study was to evaluate the impact of rivaroxaban as a chemical thromboprophylaxis following knee arthroplasty in reference to radiologically diagnosed PE and return to theatre following wound complication. METHOD: Following the introduction of new NICE guidelines in our institute 266 consecutive TKR receiving rivaroxaban were studied prospectively and compared with retrospectively collected consecutive 596 TKR prior to adoption of the guidelines. Both of these groups were studied for radiologically diagnosed symptomatic VTE episodes within 90days and return to theatre following wound complication. RESULTS: A total of 862 cases were studied, out of which 596 were in the retrospective control group and 266 were in the prospective rivaroxaban group. Both the groups had a female predominance with a mean age at the time of surgery as 68 and 69 in control and prospective cohort respectively. There were 24 radiologically diagnosed symptomatic PE and one DVT in the control group whereas, the rivaroxaban prospective group had 2 PE and 2 DVT cases. The return to theatre following wound complication was 2 and 7 in control and prospective group respectively. CONCLUSION: Following the introduction of rivaroxaban the number of symptomatic radiologically confirmed PE events declined (p=0.0084) but the return to theatre rate due to wound complications increased (p=0.0049). LEVEL OF EVIDENCE: III.

Aseptic loosening of the patellar component at the cement-implant interface.

We present four cases of aseptic loosening at the implant-cement interface following patellar resurfacing. All patients initially had good results, but then presented with onset of a new anterior knee pain. The radiographs including flexed lateral and skyline view of the knee were normal in all the cases. After carefully ruling out infection, aseptic loosening at the cement-implant interface was diagnosed on further investigation. Aseptic loosening of the patellar button at the implant-cement interface can be difficult to diagnose with standard knee radiographs. During flexed lateral radiograph of the knee and the skyline view radiograph of the patellofemoral joint, the patella is compressed on the femur and thereby reducing the loose patellar button. This phenomenon has not been previously described. Patients presenting with new onset of knee pain after an initial good results following patellar resurfacing require further investigation to exclude loosening at the cement-implant interface as plain radiographs can be misleading.