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Yadin Levy

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Papers by Yadin Levy

Practical implications of the lumbar spine and its function on total hip arthroplasty

Journal of spine surgery, Dec 1, 2016

Correct component placement is of significant importance to ensure optimal outcomes in total hip ... more Correct component placement is of significant importance to ensure optimal outcomes in total hip arthroplasty (THA). Traditionally, the Lewinnek plane has been referenced as an adequate "safe zone", formed between the anterior superior iliac spines and public tubercles to optimize acetabular orientation. However, recent evidence shows that the positioning of this plane may vary due to the biomechanical relationship between the lumbar spine and hip. Therefore, the plane acquired intraoperatively may not accurately recreate the actual functional plane and acetabular orientation encountered outside of the intraoperative environment. This review summarizes the hip-spine relationship and its implications on THA.

Thrombosis rates using aspirin and a compression device as multimodal prophylaxis for lower limb arthroplasty in a screened population

Journal of clinical orthopaedics and trauma, Mar 1, 2020

Background: Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)... more Background: Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)), is a common complication in patients undergoing total joint arthroplasty (TJA). Recently, aspirin was recommended by the American Academy of Orthopaedic Surgeons (AAOS) as VTE prophylaxis following TJA. This study investigates VTE rates in TJA patients using as thromboprophylaxis. Methods: DVT was screened for in 396 consecutive total hip or knee arthroplasty procedures. Patients were treated with early mobilisation, calf compression device and 300 mg aspirin for 5 days and then 100 mg aspirin for 5 weeks. All patients received lower-limb duplex ultrasonography prior to discharge. Patients were clinically evaluated at 6 weeks post-op documenting any VTE. Results: 51 TJA's (12.87%) were complicated by VTE: one proximal, 47 distal DVT and 3 PE. No fatal PE occurred. Only four DVT were symptomatic. Of 159 THA, 2 (1.25%) had VTE: one distal DVT and one PE. Of 237 TKA, 49 (20.67%) had VTE: 1 proximal, 46 distal DVT and 2 PE. Patients with a history of diabetes and those receiving TKA were at higher risk of DVT. Conclusion: Multimodal VTE prophylaxis demonstrated a low rate of proximal DVT, PE and bleeding complications. The rate of asymptomatic DVT was high, but most were distal and unlikely to be clinically significant. Patients with diabetes and those receiving TKA could be at higher risk of asymptomatic DVT, and may benefit from closer clinical assessment. These findings suggest aspirin is safe and efficacious when used in combination with mechanical compressors and early mobilisation. However, our findings require further validation, particularly with larger, prospective comparative studies.

Surgical approaches and bearing surfaces

© 2017 by the American Academy of Orthopaedic Surgeons. The many surgical approaches to the hip c... more © 2017 by the American Academy of Orthopaedic Surgeons. The many surgical approaches to the hip continue to evolve and progress has been made over the past 10 years. Perioperative patient management has helped optimize outcomes. Advances in component design have led to the generation of improved bearing surfaces, which has led to increased wear resistance and decreased rates of osteolysis

Increase in Benign Squeaking Rate at Five-Year Follow-Up: Results of a Large Diameter Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty

Journal of Arthroplasty, Apr 1, 2018

Background: Squeaking is an ongoing complication with a variable incidence of 0.5%-20.7%. The mec... more Background: Squeaking is an ongoing complication with a variable incidence of 0.5%-20.7%. The mechanism of squeaking has not been understood completely and is most likely multifactorial in nature. Previously, we have reported on a squeaking rate of 7.3% at 2 years. Our current results show a substantial increase in the squeaking incidence from 7.3% to 17.4% with the DeltaMotion articulation at the 5-year follow-up. Methods: Two hundred six total hip arthroplasties with a large ceramic-on-ceramic bearing were performed on 195 patients by 2 senior authors. The minimum duration of follow-up was 5 years (range 5-6.2). Results: The mean Harris Hip Score remained stable at 91.7 at 5 years compared to 92 after 2 years. However, we observed an increase in the squeaking rate from 7.3% after 2 years to 17.4% after 5 years. As in previous studies, we did not find significant differences between the silent and squeaking group in relation to age, height, weight, and femoral head diameter. In contrast, others reported no significant differences regarding range of motion and gender between the silent and the squeaking hip group at 2 years of follow-up, whereas at 5 years, the squeaking group showed a significantly higher combined range of motion and a higher relative risk of squeaking in women compared to the silent group. Conclusion: While large diameter ceramic bearings may produce squeaking, especially in female patients, our mid-term clinical results of a large ceramic-on-ceramic bearing in total hip arthroplasty are encouraging. Nevertheless, long-term follow-up is recommended.

Long term followup of fresh osteochondral allografting of the femoral condyle

Osteoarthritis and Cartilage, Apr 1, 2012

Complications of Ceramic-on-Ceramic Bearings: Fracture, Stripe Wear, and Squeaking

Springer eBooks, 2017

Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional m... more Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional metal-on-polyethylene (MoP) bearings in order to decrease bearing surface wear and hopefully increase implant longevity. Overall, CoC bearings have the lowest rate of wear among all bearing [1] surfaces and are not associated with complications such as osteolysis and tissue necrosis linked with MoP and metal-on-metal (MoM) articulations, respectively. Despite ceramics’ superior tribological properties, their use has been associated with other complications such as fracture, edge loading, and squeaking. Edge loading and benign squeaking have little clinical significance, while pathological squeaking and fractures are rare. Despite the low rate of clinical complications seen, these factors deter surgeons from routinely using ceramic bearings in total hip arthroplasty (THA). This chapter further expands on these complications.

Simultaneous Bilateral Femoral Osteonecrosis in Gaucher Disease

Life

Gaucher disease (GD) is one of the most common lysosomal storage disorders. Bone complications ar... more Gaucher disease (GD) is one of the most common lysosomal storage disorders. Bone complications are the most critical irreversible consequence of GD. Osteonecrosis (ON) of the femoral head inevitably leads to osteoarthritis and may be managed by hip arthroplasty. The introduction and worldwide use of therapeutic agents (specifically enzyme replacement therapies (ERT)) lowered the prevalence of osteonecrosis events per patient. We present the cases of two female patients who sustained simultaneous bilateral femoral head osteonecrosis after receiving ERT for long periods while exposed to concomitant risk factors related to femoral head ON. Both patients suffered severe pain and deterioration of their daily activity capabilities, and thus, were offered bilateral hip arthroplasty. Surgery was performed in both hip joints during the same procedure. The current report highlights several key aspects of femoral head ON in young patients with GD.

AN IN VITRO BIOMECHANICAL COMPARISON OF ACHILLES TENDON REPAIR : Modified Triple Kessler Versus Krackow Suture Technique

Complications of Ceramic-on-Ceramic Bearings: Fracture, Stripe Wear, and Squeaking

Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional m... more Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional metal-on-polyethylene (MoP) bearings in order to decrease bearing surface wear and hopefully increase implant longevity. Overall, CoC bearings have the lowest rate of wear among all bearing [1] surfaces and are not associated with complications such as osteolysis and tissue necrosis linked with MoP and metal-on-metal (MoM) articulations, respectively. Despite ceramics’ superior tribological properties, their use has been associated with other complications such as fracture, edge loading, and squeaking. Edge loading and benign squeaking have little clinical significance, while pathological squeaking and fractures are rare. Despite the low rate of clinical complications seen, these factors deter surgeons from routinely using ceramic bearings in total hip arthroplasty (THA). This chapter further expands on these complications.

Biomechanics of the Non-Operated Knee Before and Two Months After Total Knee Arthroplasty 1

Eytan M. Debbi, Benjamin Bernfeld, Arielle G. Fisher, Moshe Salai, Aviram Gold, Aharon Menachem, ... more Eytan M. Debbi, Benjamin Bernfeld, Arielle G. Fisher, Moshe Salai, Aviram Gold, Aharon Menachem, Nadav Shaha, Yadin D. Levy Alon Wolf Biorobotics and Biomechanics Lab, Faculty of Mechanical Engineering, Technion Israel Institute of Technology, Israel; Department of Orthopedic Surgery, Carmel Medical Center, Israel; Division of Orthopedics, Sourasky Medical Center,Israel; email: edebbi@technion.ac.il, web: brml.technion.ac.il

Thrombosis rates using aspirin and a compression device as multimodal prophylaxis for lower limb arthroplasty in a screened population

Journal of Clinical Orthopaedics and Trauma, 2018

Background: Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)... more Background: Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)), is a common complication in patients undergoing total joint arthroplasty (TJA). Recently, aspirin was recommended by the American Academy of Orthopaedic Surgeons (AAOS) as VTE prophylaxis following TJA. This study investigates VTE rates in TJA patients using as thromboprophylaxis. Methods: DVT was screened for in 396 consecutive total hip or knee arthroplasty procedures. Patients were treated with early mobilisation, calf compression device and 300 mg aspirin for 5 days and then 100 mg aspirin for 5 weeks. All patients received lower-limb duplex ultrasonography prior to discharge. Patients were clinically evaluated at 6 weeks post-op documenting any VTE. Results: 51 TJA's (12.87%) were complicated by VTE: one proximal, 47 distal DVT and 3 PE. No fatal PE occurred. Only four DVT were symptomatic. Of 159 THA, 2 (1.25%) had VTE: one distal DVT and one PE. Of 237 TKA, 49 (20.67%) had VTE: 1 proximal, 46 distal DVT and 2 PE. Patients with a history of diabetes and those receiving TKA were at higher risk of DVT. Conclusion: Multimodal VTE prophylaxis demonstrated a low rate of proximal DVT, PE and bleeding complications. The rate of asymptomatic DVT was high, but most were distal and unlikely to be clinically significant. Patients with diabetes and those receiving TKA could be at higher risk of asymptomatic DVT, and may benefit from closer clinical assessment. These findings suggest aspirin is safe and efficacious when used in combination with mechanical compressors and early mobilisation. However, our findings require further validation, particularly with larger, prospective comparative studies.

Increase in Benign Squeaking Rate at Five-Year Follow-Up: Results of a Large Diameter Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty

The Journal of Arthroplasty, 2018

Background: Squeaking is an ongoing complication with a variable incidence of 0.5%-20.7%. The mec... more Background: Squeaking is an ongoing complication with a variable incidence of 0.5%-20.7%. The mechanism of squeaking has not been understood completely and is most likely multifactorial in nature. Previously, we have reported on a squeaking rate of 7.3% at 2 years. Our current results show a substantial increase in the squeaking incidence from 7.3% to 17.4% with the DeltaMotion articulation at the 5-year follow-up. Methods: Two hundred six total hip arthroplasties with a large ceramic-on-ceramic bearing were performed on 195 patients by 2 senior authors. The minimum duration of follow-up was 5 years (range 5-6.2). Results: The mean Harris Hip Score remained stable at 91.7 at 5 years compared to 92 after 2 years. However, we observed an increase in the squeaking rate from 7.3% after 2 years to 17.4% after 5 years. As in previous studies, we did not find significant differences between the silent and squeaking group in relation to age, height, weight, and femoral head diameter. In contrast, others reported no significant differences regarding range of motion and gender between the silent and the squeaking hip group at 2 years of follow-up, whereas at 5 years, the squeaking group showed a significantly higher combined range of motion and a higher relative risk of squeaking in women compared to the silent group. Conclusion: While large diameter ceramic bearings may produce squeaking, especially in female patients, our mid-term clinical results of a large ceramic-on-ceramic bearing in total hip arthroplasty are encouraging. Nevertheless, long-term follow-up is recommended.

Accuracy of leg length and femoral offset restoration after total hip arthroplasty with the utilisation of an intraoperative calibration gauge

HIP International, 2019

Background: Offset and leg length (LL) restoration are critical for the achievement of a stable, ... more Background: Offset and leg length (LL) restoration are critical for the achievement of a stable, well-functioning hip following total hip arthroplasty (THA). Several techniques are described in the literature, including a hip calibration gauge. We question whether meticulous preoperative planning of a specific surgical technique in combination with the utilisation of a calibration gauge can provide an accurate offset and LL restoration. Methods: Retrospective review of 101 unilateral THAs via a posterior approach by a single surgeon. Preoperative radiographic LL and offset were radiographically calculated. Intraoperatively prior to hip dislocation a calibration gauge was used to measure LL and offset with a pin inserted into the iliac crest acting as a static referencing point. All had pelvis x-ray performed 6 weeks postoperatively. A literature review was conducted to establish average postoperative LL/offset values for statistical comparison. Results: The average absolute postoper...

Complications of Ceramic-on-Ceramic Bearings: Fracture, Stripe Wear, and Squeaking

Complications after Primary Total Hip Arthroplasty, 2017

Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional m... more Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional metal-on-polyethylene (MoP) bearings in order to decrease bearing surface wear and hopefully increase implant longevity. Overall, CoC bearings have the lowest rate of wear among all bearing [1] surfaces and are not associated with complications such as osteolysis and tissue necrosis linked with MoP and metal-on-metal (MoM) articulations, respectively. Despite ceramics’ superior tribological properties, their use has been associated with other complications such as fracture, edge loading, and squeaking. Edge loading and benign squeaking have little clinical significance, while pathological squeaking and fractures are rare. Despite the low rate of clinical complications seen, these factors deter surgeons from routinely using ceramic bearings in total hip arthroplasty (THA). This chapter further expands on these complications.

Practical implications of the lumbar spine and its function on total hip arthroplasty

Journal of spine surgery (Hong Kong), 2016

Correct component placement is of significant importance to ensure optimal outcomes in total hip ... more Correct component placement is of significant importance to ensure optimal outcomes in total hip arthroplasty (THA). Traditionally, the Lewinnek plane has been referenced as an adequate "safe zone", formed between the anterior superior iliac spines and public tubercles to optimize acetabular orientation. However, recent evidence shows that the positioning of this plane may vary due to the biomechanical relationship between the lumbar spine and hip. Therefore, the plane acquired intraoperatively may not accurately recreate the actual functional plane and acetabular orientation encountered outside of the intraoperative environment. This review summarizes the hip-spine relationship and its implications on THA.

The accuracy of bony resection from patient-specific guides during total knee arthroplasty

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 4, 2016

In patient-specifically instrumented (PSI) total knee arthroplasty, the correlation between the p... more In patient-specifically instrumented (PSI) total knee arthroplasty, the correlation between the pre-operative surgical plan, accuracy of the cutting block, and intra-operative resection size is unclear. The aim of this study was to evaluate the ability to accurately execute the PSI surgical plan and to add to the merging information with respect to this technology with the hypothesis that the PSI blocks would demonstrate good accuracy with regard to the bony thickness of the resections. One hundred and thirty TKAs using PSI (MRI/long-leg radiographs) were retrospectively analysed. All surgeries were conducted via similar surgical approach and technique, with resection performed after guide placement and alignment assessment. The bony cut thicknesses of the medial (MTP) and lateral tibial plateau (LTP), distal medial (DM), distal lateral (DL), posterior medial (PM) and posterior lateral (PL) femur were measured with a vernier calliper. The measured resection thickness was subtracted ...

Glenoid Rim Anatomy: Risk for Glenoid Vault Perforation During Labral Repair

Orthopaedic Journal of Sports Medicine, 2014

Background: Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor... more Background: Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor devices arthroscopically can be challenging, and anchor malpositioning can complicate surgical outcomes. Purpose: To determine the safe insertion range and optimal insertion angle of glenoid labral anchors at various positions on the glenoid rim and to establish surgical guidelines that minimize risk of anchor perforation. Study Design: Descriptive laboratory study. Methods: Three-dimensional computed tomography scans of 30 normal cadaveric specimens were obtained. A virtual model of a generic labral anchor was inserted into the rim of the glenoid at the clockface positions represented by 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00, and 10:30. At each position, the safe insertion range was the maximal range measured, and the optimal insertion angle was identified as the angle between the bisector of the safe insertion range and the glenoid face. Results: Progressing in the clockwise direc...

Long term followup of fresh osteochondral allografting of the femoral condyle

Osteoarthritis and Cartilage, 2012

14-Year Median Follow-Up Using the Press-Fit Condylar Sigma Design for Total Knee Arthroplasty

The Journal of Arthroplasty, 2013

Median 14-year follow-up (mean 11.8 years) of a cemented primary posterior cruciate-retaining tot... more Median 14-year follow-up (mean 11.8 years) of a cemented primary posterior cruciate-retaining total knee arthroplasty (TKA) utilizing the Press-Fit Condylar (PFC) Sigma design was evaluated in 77 patients (79 TKA). Follow-up assessment included implant survivorship, x-rays, Knee Society rating system, and clinical evaluation. Radiographic analysis demonstrated minor non-progressive osteolysis in 40% (10/25) knees. Two revisions, one for instability at 4 years and one for polyethylene wear at 10 years were performed. Survivorship of the PFC Sigma knee implant was 97% using revision for any reason and 100% using aseptic loosening as endpoints. The PFC Sigma had excellent survivorship at 14 years, the longest clinical followup reported.

Surgical approaches and bearing surfaces

© 2017 by the American Academy of Orthopaedic Surgeons. The many surgical approaches to the hip c... more © 2017 by the American Academy of Orthopaedic Surgeons. The many surgical approaches to the hip continue to evolve and progress has been made over the past 10 years. Perioperative patient management has helped optimize outcomes. Advances in component design have led to the generation of improved bearing surfaces, which has led to increased wear resistance and decreased rates of osteolysis

Practical implications of the lumbar spine and its function on total hip arthroplasty

Journal of spine surgery, Dec 1, 2016

Correct component placement is of significant importance to ensure optimal outcomes in total hip ... more Correct component placement is of significant importance to ensure optimal outcomes in total hip arthroplasty (THA). Traditionally, the Lewinnek plane has been referenced as an adequate "safe zone", formed between the anterior superior iliac spines and public tubercles to optimize acetabular orientation. However, recent evidence shows that the positioning of this plane may vary due to the biomechanical relationship between the lumbar spine and hip. Therefore, the plane acquired intraoperatively may not accurately recreate the actual functional plane and acetabular orientation encountered outside of the intraoperative environment. This review summarizes the hip-spine relationship and its implications on THA.

Thrombosis rates using aspirin and a compression device as multimodal prophylaxis for lower limb arthroplasty in a screened population

Journal of clinical orthopaedics and trauma, Mar 1, 2020

Background: Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)... more Background: Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)), is a common complication in patients undergoing total joint arthroplasty (TJA). Recently, aspirin was recommended by the American Academy of Orthopaedic Surgeons (AAOS) as VTE prophylaxis following TJA. This study investigates VTE rates in TJA patients using as thromboprophylaxis. Methods: DVT was screened for in 396 consecutive total hip or knee arthroplasty procedures. Patients were treated with early mobilisation, calf compression device and 300 mg aspirin for 5 days and then 100 mg aspirin for 5 weeks. All patients received lower-limb duplex ultrasonography prior to discharge. Patients were clinically evaluated at 6 weeks post-op documenting any VTE. Results: 51 TJA's (12.87%) were complicated by VTE: one proximal, 47 distal DVT and 3 PE. No fatal PE occurred. Only four DVT were symptomatic. Of 159 THA, 2 (1.25%) had VTE: one distal DVT and one PE. Of 237 TKA, 49 (20.67%) had VTE: 1 proximal, 46 distal DVT and 2 PE. Patients with a history of diabetes and those receiving TKA were at higher risk of DVT. Conclusion: Multimodal VTE prophylaxis demonstrated a low rate of proximal DVT, PE and bleeding complications. The rate of asymptomatic DVT was high, but most were distal and unlikely to be clinically significant. Patients with diabetes and those receiving TKA could be at higher risk of asymptomatic DVT, and may benefit from closer clinical assessment. These findings suggest aspirin is safe and efficacious when used in combination with mechanical compressors and early mobilisation. However, our findings require further validation, particularly with larger, prospective comparative studies.

Surgical approaches and bearing surfaces

© 2017 by the American Academy of Orthopaedic Surgeons. The many surgical approaches to the hip c... more © 2017 by the American Academy of Orthopaedic Surgeons. The many surgical approaches to the hip continue to evolve and progress has been made over the past 10 years. Perioperative patient management has helped optimize outcomes. Advances in component design have led to the generation of improved bearing surfaces, which has led to increased wear resistance and decreased rates of osteolysis

Increase in Benign Squeaking Rate at Five-Year Follow-Up: Results of a Large Diameter Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty

Journal of Arthroplasty, Apr 1, 2018

Background: Squeaking is an ongoing complication with a variable incidence of 0.5%-20.7%. The mec... more Background: Squeaking is an ongoing complication with a variable incidence of 0.5%-20.7%. The mechanism of squeaking has not been understood completely and is most likely multifactorial in nature. Previously, we have reported on a squeaking rate of 7.3% at 2 years. Our current results show a substantial increase in the squeaking incidence from 7.3% to 17.4% with the DeltaMotion articulation at the 5-year follow-up. Methods: Two hundred six total hip arthroplasties with a large ceramic-on-ceramic bearing were performed on 195 patients by 2 senior authors. The minimum duration of follow-up was 5 years (range 5-6.2). Results: The mean Harris Hip Score remained stable at 91.7 at 5 years compared to 92 after 2 years. However, we observed an increase in the squeaking rate from 7.3% after 2 years to 17.4% after 5 years. As in previous studies, we did not find significant differences between the silent and squeaking group in relation to age, height, weight, and femoral head diameter. In contrast, others reported no significant differences regarding range of motion and gender between the silent and the squeaking hip group at 2 years of follow-up, whereas at 5 years, the squeaking group showed a significantly higher combined range of motion and a higher relative risk of squeaking in women compared to the silent group. Conclusion: While large diameter ceramic bearings may produce squeaking, especially in female patients, our mid-term clinical results of a large ceramic-on-ceramic bearing in total hip arthroplasty are encouraging. Nevertheless, long-term follow-up is recommended.

Long term followup of fresh osteochondral allografting of the femoral condyle

Osteoarthritis and Cartilage, Apr 1, 2012

Complications of Ceramic-on-Ceramic Bearings: Fracture, Stripe Wear, and Squeaking

Springer eBooks, 2017

Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional m... more Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional metal-on-polyethylene (MoP) bearings in order to decrease bearing surface wear and hopefully increase implant longevity. Overall, CoC bearings have the lowest rate of wear among all bearing [1] surfaces and are not associated with complications such as osteolysis and tissue necrosis linked with MoP and metal-on-metal (MoM) articulations, respectively. Despite ceramics’ superior tribological properties, their use has been associated with other complications such as fracture, edge loading, and squeaking. Edge loading and benign squeaking have little clinical significance, while pathological squeaking and fractures are rare. Despite the low rate of clinical complications seen, these factors deter surgeons from routinely using ceramic bearings in total hip arthroplasty (THA). This chapter further expands on these complications.

Simultaneous Bilateral Femoral Osteonecrosis in Gaucher Disease

Life

Gaucher disease (GD) is one of the most common lysosomal storage disorders. Bone complications ar... more Gaucher disease (GD) is one of the most common lysosomal storage disorders. Bone complications are the most critical irreversible consequence of GD. Osteonecrosis (ON) of the femoral head inevitably leads to osteoarthritis and may be managed by hip arthroplasty. The introduction and worldwide use of therapeutic agents (specifically enzyme replacement therapies (ERT)) lowered the prevalence of osteonecrosis events per patient. We present the cases of two female patients who sustained simultaneous bilateral femoral head osteonecrosis after receiving ERT for long periods while exposed to concomitant risk factors related to femoral head ON. Both patients suffered severe pain and deterioration of their daily activity capabilities, and thus, were offered bilateral hip arthroplasty. Surgery was performed in both hip joints during the same procedure. The current report highlights several key aspects of femoral head ON in young patients with GD.

AN IN VITRO BIOMECHANICAL COMPARISON OF ACHILLES TENDON REPAIR : Modified Triple Kessler Versus Krackow Suture Technique

Complications of Ceramic-on-Ceramic Bearings: Fracture, Stripe Wear, and Squeaking

Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional m... more Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional metal-on-polyethylene (MoP) bearings in order to decrease bearing surface wear and hopefully increase implant longevity. Overall, CoC bearings have the lowest rate of wear among all bearing [1] surfaces and are not associated with complications such as osteolysis and tissue necrosis linked with MoP and metal-on-metal (MoM) articulations, respectively. Despite ceramics’ superior tribological properties, their use has been associated with other complications such as fracture, edge loading, and squeaking. Edge loading and benign squeaking have little clinical significance, while pathological squeaking and fractures are rare. Despite the low rate of clinical complications seen, these factors deter surgeons from routinely using ceramic bearings in total hip arthroplasty (THA). This chapter further expands on these complications.

Biomechanics of the Non-Operated Knee Before and Two Months After Total Knee Arthroplasty 1

Eytan M. Debbi, Benjamin Bernfeld, Arielle G. Fisher, Moshe Salai, Aviram Gold, Aharon Menachem, ... more Eytan M. Debbi, Benjamin Bernfeld, Arielle G. Fisher, Moshe Salai, Aviram Gold, Aharon Menachem, Nadav Shaha, Yadin D. Levy Alon Wolf Biorobotics and Biomechanics Lab, Faculty of Mechanical Engineering, Technion Israel Institute of Technology, Israel; Department of Orthopedic Surgery, Carmel Medical Center, Israel; Division of Orthopedics, Sourasky Medical Center,Israel; email: edebbi@technion.ac.il, web: brml.technion.ac.il

Thrombosis rates using aspirin and a compression device as multimodal prophylaxis for lower limb arthroplasty in a screened population

Journal of Clinical Orthopaedics and Trauma, 2018

Background: Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)... more Background: Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)), is a common complication in patients undergoing total joint arthroplasty (TJA). Recently, aspirin was recommended by the American Academy of Orthopaedic Surgeons (AAOS) as VTE prophylaxis following TJA. This study investigates VTE rates in TJA patients using as thromboprophylaxis. Methods: DVT was screened for in 396 consecutive total hip or knee arthroplasty procedures. Patients were treated with early mobilisation, calf compression device and 300 mg aspirin for 5 days and then 100 mg aspirin for 5 weeks. All patients received lower-limb duplex ultrasonography prior to discharge. Patients were clinically evaluated at 6 weeks post-op documenting any VTE. Results: 51 TJA's (12.87%) were complicated by VTE: one proximal, 47 distal DVT and 3 PE. No fatal PE occurred. Only four DVT were symptomatic. Of 159 THA, 2 (1.25%) had VTE: one distal DVT and one PE. Of 237 TKA, 49 (20.67%) had VTE: 1 proximal, 46 distal DVT and 2 PE. Patients with a history of diabetes and those receiving TKA were at higher risk of DVT. Conclusion: Multimodal VTE prophylaxis demonstrated a low rate of proximal DVT, PE and bleeding complications. The rate of asymptomatic DVT was high, but most were distal and unlikely to be clinically significant. Patients with diabetes and those receiving TKA could be at higher risk of asymptomatic DVT, and may benefit from closer clinical assessment. These findings suggest aspirin is safe and efficacious when used in combination with mechanical compressors and early mobilisation. However, our findings require further validation, particularly with larger, prospective comparative studies.

Increase in Benign Squeaking Rate at Five-Year Follow-Up: Results of a Large Diameter Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty

The Journal of Arthroplasty, 2018

Background: Squeaking is an ongoing complication with a variable incidence of 0.5%-20.7%. The mec... more Background: Squeaking is an ongoing complication with a variable incidence of 0.5%-20.7%. The mechanism of squeaking has not been understood completely and is most likely multifactorial in nature. Previously, we have reported on a squeaking rate of 7.3% at 2 years. Our current results show a substantial increase in the squeaking incidence from 7.3% to 17.4% with the DeltaMotion articulation at the 5-year follow-up. Methods: Two hundred six total hip arthroplasties with a large ceramic-on-ceramic bearing were performed on 195 patients by 2 senior authors. The minimum duration of follow-up was 5 years (range 5-6.2). Results: The mean Harris Hip Score remained stable at 91.7 at 5 years compared to 92 after 2 years. However, we observed an increase in the squeaking rate from 7.3% after 2 years to 17.4% after 5 years. As in previous studies, we did not find significant differences between the silent and squeaking group in relation to age, height, weight, and femoral head diameter. In contrast, others reported no significant differences regarding range of motion and gender between the silent and the squeaking hip group at 2 years of follow-up, whereas at 5 years, the squeaking group showed a significantly higher combined range of motion and a higher relative risk of squeaking in women compared to the silent group. Conclusion: While large diameter ceramic bearings may produce squeaking, especially in female patients, our mid-term clinical results of a large ceramic-on-ceramic bearing in total hip arthroplasty are encouraging. Nevertheless, long-term follow-up is recommended.

Accuracy of leg length and femoral offset restoration after total hip arthroplasty with the utilisation of an intraoperative calibration gauge

HIP International, 2019

Background: Offset and leg length (LL) restoration are critical for the achievement of a stable, ... more Background: Offset and leg length (LL) restoration are critical for the achievement of a stable, well-functioning hip following total hip arthroplasty (THA). Several techniques are described in the literature, including a hip calibration gauge. We question whether meticulous preoperative planning of a specific surgical technique in combination with the utilisation of a calibration gauge can provide an accurate offset and LL restoration. Methods: Retrospective review of 101 unilateral THAs via a posterior approach by a single surgeon. Preoperative radiographic LL and offset were radiographically calculated. Intraoperatively prior to hip dislocation a calibration gauge was used to measure LL and offset with a pin inserted into the iliac crest acting as a static referencing point. All had pelvis x-ray performed 6 weeks postoperatively. A literature review was conducted to establish average postoperative LL/offset values for statistical comparison. Results: The average absolute postoper...

Complications of Ceramic-on-Ceramic Bearings: Fracture, Stripe Wear, and Squeaking

Complications after Primary Total Hip Arthroplasty, 2017

Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional m... more Ceramic-on-ceramic (CoC) articulations were developed as an alternative bearing to conventional metal-on-polyethylene (MoP) bearings in order to decrease bearing surface wear and hopefully increase implant longevity. Overall, CoC bearings have the lowest rate of wear among all bearing [1] surfaces and are not associated with complications such as osteolysis and tissue necrosis linked with MoP and metal-on-metal (MoM) articulations, respectively. Despite ceramics’ superior tribological properties, their use has been associated with other complications such as fracture, edge loading, and squeaking. Edge loading and benign squeaking have little clinical significance, while pathological squeaking and fractures are rare. Despite the low rate of clinical complications seen, these factors deter surgeons from routinely using ceramic bearings in total hip arthroplasty (THA). This chapter further expands on these complications.

Practical implications of the lumbar spine and its function on total hip arthroplasty

Journal of spine surgery (Hong Kong), 2016

Correct component placement is of significant importance to ensure optimal outcomes in total hip ... more Correct component placement is of significant importance to ensure optimal outcomes in total hip arthroplasty (THA). Traditionally, the Lewinnek plane has been referenced as an adequate "safe zone", formed between the anterior superior iliac spines and public tubercles to optimize acetabular orientation. However, recent evidence shows that the positioning of this plane may vary due to the biomechanical relationship between the lumbar spine and hip. Therefore, the plane acquired intraoperatively may not accurately recreate the actual functional plane and acetabular orientation encountered outside of the intraoperative environment. This review summarizes the hip-spine relationship and its implications on THA.

The accuracy of bony resection from patient-specific guides during total knee arthroplasty

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 4, 2016

In patient-specifically instrumented (PSI) total knee arthroplasty, the correlation between the p... more In patient-specifically instrumented (PSI) total knee arthroplasty, the correlation between the pre-operative surgical plan, accuracy of the cutting block, and intra-operative resection size is unclear. The aim of this study was to evaluate the ability to accurately execute the PSI surgical plan and to add to the merging information with respect to this technology with the hypothesis that the PSI blocks would demonstrate good accuracy with regard to the bony thickness of the resections. One hundred and thirty TKAs using PSI (MRI/long-leg radiographs) were retrospectively analysed. All surgeries were conducted via similar surgical approach and technique, with resection performed after guide placement and alignment assessment. The bony cut thicknesses of the medial (MTP) and lateral tibial plateau (LTP), distal medial (DM), distal lateral (DL), posterior medial (PM) and posterior lateral (PL) femur were measured with a vernier calliper. The measured resection thickness was subtracted ...

Glenoid Rim Anatomy: Risk for Glenoid Vault Perforation During Labral Repair

Orthopaedic Journal of Sports Medicine, 2014

Background: Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor... more Background: Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor devices arthroscopically can be challenging, and anchor malpositioning can complicate surgical outcomes. Purpose: To determine the safe insertion range and optimal insertion angle of glenoid labral anchors at various positions on the glenoid rim and to establish surgical guidelines that minimize risk of anchor perforation. Study Design: Descriptive laboratory study. Methods: Three-dimensional computed tomography scans of 30 normal cadaveric specimens were obtained. A virtual model of a generic labral anchor was inserted into the rim of the glenoid at the clockface positions represented by 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00, and 10:30. At each position, the safe insertion range was the maximal range measured, and the optimal insertion angle was identified as the angle between the bisector of the safe insertion range and the glenoid face. Results: Progressing in the clockwise direc...

Long term followup of fresh osteochondral allografting of the femoral condyle

Osteoarthritis and Cartilage, 2012

14-Year Median Follow-Up Using the Press-Fit Condylar Sigma Design for Total Knee Arthroplasty

The Journal of Arthroplasty, 2013

Median 14-year follow-up (mean 11.8 years) of a cemented primary posterior cruciate-retaining tot... more Median 14-year follow-up (mean 11.8 years) of a cemented primary posterior cruciate-retaining total knee arthroplasty (TKA) utilizing the Press-Fit Condylar (PFC) Sigma design was evaluated in 77 patients (79 TKA). Follow-up assessment included implant survivorship, x-rays, Knee Society rating system, and clinical evaluation. Radiographic analysis demonstrated minor non-progressive osteolysis in 40% (10/25) knees. Two revisions, one for instability at 4 years and one for polyethylene wear at 10 years were performed. Survivorship of the PFC Sigma knee implant was 97% using revision for any reason and 100% using aseptic loosening as endpoints. The PFC Sigma had excellent survivorship at 14 years, the longest clinical followup reported.

Surgical approaches and bearing surfaces

© 2017 by the American Academy of Orthopaedic Surgeons. The many surgical approaches to the hip c... more © 2017 by the American Academy of Orthopaedic Surgeons. The many surgical approaches to the hip continue to evolve and progress has been made over the past 10 years. Perioperative patient management has helped optimize outcomes. Advances in component design have led to the generation of improved bearing surfaces, which has led to increased wear resistance and decreased rates of osteolysis