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Great Neck, NY, United States

Ellis S.,The Hospital for Special Surgery | DeOrio J.K.,Duke University
Operative Techniques in Orthopaedics | Year: 2010

Total ankle replacement represents an alternative to arthrodesis in the setting of advanced ankle arthrosis. The INBONE total ankle system is a Food and Drug Administration-approved, nonmobile-bearing implant with intramedullary modular stems that afford additional fixation in both the tibia and talus. Although approved for use only with cement, it is used universally without cement. A sophisticated leg assembly and intramedullary guidance system greatly increase the accuracy of implant position. Increased polyethylene thickness with a saddle geometry spreads out stresses across the ankle joint while maintaining stability. Although formal clinical data have not been published, the implant shows promise and may be well suited not only for standard primary total ankle replacement, but also in the setting of instability, moderate deformity, or failure of previous arthroplasty. As always, patients should be alerted to the potential complications with total ankle replacement. The purpose of this article is to describe the surgical technique for implanting the INBONE total ankle. © 2010 Elsevier Inc.

El-Amin S.F.,University of Illinois at Springfield | El-Amin S.F.,Southern Illinois University Carbondale | Hogan M.V.,University of Virginia | Allen A.A.,The Hospital for Special Surgery | And 4 more authors.
Foot and Ankle Clinics | Year: 2010

Tissue engineering is an area of rapid growth. Tissue engineering in orthopedic surgery involves the use of growth factors, mesenchymal stem cells, and scaffolds, individually or in combination, toward the growth and restoration of various musculoskeletal tissues, such as ligaments, tendons, muscles, nerves, and bone. These advances are constantly evolving in foot and ankle surgery as well. Bone morphogenetic proteins (BMPs) have played an integral role in the advancement of tissue engineering strategies across multiple orthopedic subspecialities and have proved to play a role in the development of bone and musculoskeletal tissues. BMPs have recently been applied in several areas of foot and ankle surgery, including acute fracture augmentation, nonunions, and arthrodesis, with promising results. This article reviews the key aspects of clinical translation of strategies in tissue engineering as well as current applications and results of BMP use in tibia, foot, and ankle surgery. Future applications of BMP and novel materials in foot and ankle surgery are also reviewed. © 2010.

The Hospital For Special Surgery | Date: 2010-02-24

External fixation devices and methods of use are provided. A device for external fixation of a joint includes a first pin block for connection to a first skeletal element and a second pin block for connection to a second skeletal element. The device includes a connection assembly that is releasably attached to at least one of the pin blocks. The device is locked in an original position when the connection assembly is attached to both of the pin blocks, and is unlocked when the connection assembly is detached from at least one of the pin blocks.

The Hospital For Special Surgery | Date: 2010-02-24

Expanding cannula and retractor devices and methods of use are provided. An expanding cannula and retractor device includes a first tube, a second tube positioned within the first tube, and an expandable continuous membrane connecting distal portions of the first and second tubes. The membrane can expand into an annulus based on the movement of the second tube relative to the first tube in order to contact tissue and maintain the position of the device.

Goldring S.R.,The Hospital for Special Surgery
Therapeutic Advances in Musculoskeletal Disease | Year: 2012

The articular cartilage and the subchondral bone form a biocomposite that is uniquely adapted to the transfer of loads across the diarthrodial joint. During the evolution of the osteoarthritic process biomechanical and biological processes result in alterations in the composition, structure and functional properties of these tissues. Given the intimate contact between the cartilage and bone, alterations of either tissue will modulate the properties and function of the other joint component. The changes in periarticular bone tend to occur very early in the development of OA. Although chondrocytes also have the capacity to modulate their functional state in response to loading, the capacity of these cells to repair and modify their surrounding extracellular matrix is relatively limited in comparison to the adjacent subchondral bone. This differential adaptive capacity likely underlies the more rapid appearance of detectable skeletal changes in OA in comparison to the articular cartilage. The OA changes in periarticular bone include increases in subchondral cortical bone thickness, gradual decreases in subchondral trabeular bone mass, formation of marginal joint osteophytes, development of bone cysts and advancement of the zone of calcified cartilage between the articular cartilage and subchondral bone. The expansion of the zone of calcified cartilage contributes to overall thinning of the articular cartilage. The mechanisms involved in this process include the release of soluble mediators from chondrocytes in the deep zones of the articular cartilage and/or the influences of microcracks that have initiated focal remodeling in the calcified cartilage and subchondral bone in an attempt to repair the microdamage. There is the need for further studies to define the pathophysiological mechanisms involved in the interaction between subchondral bone and articular cartilage and for applying this information to the development of therapeutic interventions to improve the outcomes in patients with OA. © The Author(s), 2012.

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