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Richard S Laskin

Publications and source records attributed to Richard S Laskin.

At least 19 recordsLinked to original sources
PubMed2006

Mini-incision: occasionally desirable, rarely necessary in opposition.

Using a mini mid vastus limited incision for primary total knee arthroplasty, the authors noted the ability to decrease postoperative pain while speeding up the rate of recovery of motion and of return of function. By specific flexion and extension of the knee, the surgical window could be mobilized to visualize the articular surfaces at various stages during the surgery. Radiographic evaluation revealed that component position and limb alignment were excellent despite the use of the more limited incision.

Arthroplasty, Replacement, Knee↗
PubMed2006

What would you do? Case challenges in knee surgery.

Six cases representing a variety of orthopedic issues were presented to a panel of senior surgeons. These included the following: (1) developmental patella baja with degenerative arthritis, (2) high valgus knee with attenuated medial collateral ligament, (3) degenerative arthritis with near-ankylosis, (4) depressed tibial plateau fracture with degenerative arthritis, (5) degenerative arthritis with laterally dislocating patella, and (6) degenerative arthritis with distal femoral malunion.

Aged↗
PubMed2006

VenaFlow plus Lovenox vs VenaFlow plus aspirin for thromboembolic disease prophylaxis in total knee arthroplasty.

Two hundred seventy-five patients undergoing unilateral total knee arthroplasty were prospectively randomized to receive spinal epidural anesthesia (SEA), a VenaFlow calf compression device, and enoxaparin (group A) or SEA, VenaFlow, and aspirin (group B). Aspirin was started on the day of surgery, whereas enoxaparin was started 48 hours after surgery. Anticoagulants were continued for 4 weeks after surgery. All patients had an in-hospital ultrasound screening test on postoperative days 3 to 5 and a second follow-up ultrasound 4 to 6 weeks after surgery. The overall deep venous thrombosis rates in groups A and B were 14.1% and 17.8% (P = not significant), respectively. When used in combination with pneumatic compression devices and SEA, enoxaparin was not superior to aspirin in preventing deep venous thrombosis after total knee arthroplasty.

Adult↗
PubMed2006

Computer-assisted navigation in TKA: where we are and where we are going.

When compared to standard intramedullary and extramedullary referencing systems, computer-assisted navigation systems have been shown in multiple randomized studies to increase the accuracy of bone resections in total knee arthroplasty. Accuracy to within 1 degrees in the coronal plane resections can routinely be obtained. Recent modifications of the software programs address the problem of proper soft tissue balance. Newer techniques of bone morphing have obviated the use of preoperative imaging in most cases. Despite these advances, the systems remain somewhat cumbersome to use and costly to acquire. As these limitations are addressed, computer-assisted navigation may become a valuable part of the knee surgeon's armamentarium, especially for the patient with a deformed femur or tibia in whom conventional navigation instruments are difficult to use accurately.

Arthroplasty, Replacement, Knee↗
PubMed2005

Choosing your implant: cemented, tricompartmental, and posterior stabilized.

Cemented, posterior-stabilized, tricompartmental implants have yielded excellent relief of pain and are applicable to almost all clinical situations. The complications and revision rates after routine patellar resurfacing are less than those seen without such resurfacing. Cine fluoroscopic studies have shown that they restore a more normal kinematic pattern than do posterior cruciate ligament-retaining implants and have a low rate of radiographic and/or clinical loosening when followed up through 15 years after surgery. Latest posterior stabilized designs can allow a higher degree of flexion than seen in any other combination of implant designs. It is for all these reasons that the author feels that this method of performing a knee arthroplasty is the gold standard.

Arthroplasty, Replacement, Knee↗
PubMed2005

What would you do? Case challenges in knee surgery.

These knee arthroplasty cases were presented to a panel of surgeon and they represent classic clinical problems: (1) indications for unicompartmental arthroplasty; (2) total knee arthroplasty after a high tibial osteotomy complicated by infection and extensor mechanism rupture; (3) neuropathic arthropathy; (4) posttraumatic osteoarthritis with extraarticular deformity; (5) degenerative arthritis in the young patient; (6) osteoarthritis with a valgus deformity, fixed flexion contracture, degenerative scoliosis, and leg length discrepancy.

Adult↗
PubMed2005

Total knee replacement using the Genesis II prosthesis: a 5-year follow up study of the first 100 consecutive cases.

One hundred consecutive patients with osteoarthritis undergoing knee replacement using a prosthesis with asymmetrical posterior condyles and an asymmetrical tibial base plate (Genesis II) were followed for a minimum of 5 years after surgery. Mean flexion was 118 degrees. Seventy nine percent of the patients could ascend and descend stairs in a reciprocal manner. A lateral retinacular release was required in only three patients. Post-operative patellar tracking was excellent as determined by both patellar displacement and patellar tilt. There was excellent flexion space stability using this prosthesis configuration without having to resort to external rotation of the femoral component. Tibial coverage was obtainable in >95% of the knees due to the asymmetric configuration of the base plate. Kaplan Meir Survivorship was 98% at 5 years.

Aged↗
PubMed2005

Minimally invasive total knee arthroplasty: the results justify its use.

UNLABELLED: A mini-midvastus capsular incision was used in a feasibility study of 100 patients having primary total knee arthroplasty. Patients with marked limitation of motion were excluded from the study. Patients were followed up for a minimum of 2 years after surgery. The exposure yielded excellent results clinically and radiographically with restoration of stability and motion. The length of the skin incision varied from 8 to 15 cm with a mean of 10.5 cm. Using the limited exposure did not result in implant malpositioning. The surgical approach was not applicable in patients with a BMI > 40 or in those patients with a severe fixed valgus deformity. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

The use of standard posterior stabilized implants in revision total knee arthroplasty.

UNLABELLED: In primary knee replacement, posterior-stabilized prostheses often are used but we wondered if by balancing the flexion and extension spaces satisfactory coronal and AP stability could be achieved without a more constrained implant. We retrospectively reviewed 61 patients who had a unilateral revision knee replacement 58 of whom had a posterior stabilized implant. The initial indication for the revision had been coronal instability in 42% and a loose tibial component in 44%. All patients were followed up for at least 4 years after the revision operation. Fifty two of 58 patients have fewer than 5 mm of anteroposterior instability. Fifty three of 58 patients had 0 degrees to 5 degrees of coronal instability. Patients who had either coronal or anteroposterior instability had evidence of instability usually by the 1-year followup. It did not progress in severity during the subsequent 3 years. In many patients satisfactory stability can be achieved in revision TKA with a posterior constrained implant and without implants with greater constraint. LEVEL OF EVIDENCE: Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2004

Stiffness after total knee arthroplasty.

Limitation of motion after knee arthroplasty can be the result of a multiplicity of factors. Among these are malpositioning of the components, especially in the sagittal plane; oversizing at the patellofemoral or tibiofemoral joint spaces; retaining posterior osteophytes; and persisting with a tight posterior cruciate ligament. Postoperatively, problems with physical therapy likewise can cause limitation of both extension and flexion. Specific patient factors also may affect the range of motion after surgery. Although most patients achieve a postoperative flexion that is highly correlated to that which was present preoperatively, factors such as pain, obesity, and deformities of adjacent joints may limit such motion.

Arthroplasty, Replacement, Knee↗
PubMed2004

The use of a personal digital assistant in orthopaedic surgical practice.

The personal data assistant is a powerful tool enabling data acquisition, analysis, and scheduling. The Palm and Windows Pocket PC Operating Systems are available in various personal data assistants that combine bright screens, ease of use, and compactness. Data that are acquired can be imported into standardized spreadsheets for statistical analysis. Report generation using these data can simplify record keeping, facilitate later research, and decrease secretarial typing time. The use of a forms manager, such as Pendragon Forms, enables rapid creation of personal data assistant forms that interface with numerous computer database programs. We currently use theses programs for data acquisition when patients are seen in the office, in the operating room, and when returning for followup.

Computers, Handheld↗
PubMed2004

Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study.

Total knee replacement traditionally has been done through an anterior incision approximately 18 cm long, using a capsular incision that separates the interval between the rectus femoris and vastus medialis musculature. Although giving excellent exposure, this incision also disrupts the suprapatellar pouch and may lead to adhesions and difficulty with rapidly regaining flexion. It is hypothesized that, by using a more minimally invasive incision, there will be a more rapid return of flexion and the patient will require fewer narcotic medications postoperatively. This retrospective review compared 32 total knee replacements done through a minimally invasive mini-midvastus approach with 26 total knee replacements done through the standard medial parapatellar approach. Preoperative Knee Society scores and postoperative functional outcomes were compared. Postoperative flexion was measured daily during hospitalization and at a 6-week and 3-month followup. Pain was assessed by a visual analog scale and the amount of pain medication used during hospitalization. Implant position was measured. The MIS group had an average skin incision length of 12.8 cm. Passive flexion on a daily basis was significantly higher in the MIS group compared with the standard group. At 6 weeks postoperatively, the change in Knee Score was statistically higher in the MIS group and the average visual analog pain score and the total amount of pain medication was lower. The radiographic alignment and position of all the components was normal in all patients in both groups. The limited disruption of the extensor mechanism results in more rapid restoration of the quadriceps muscle control.

Aged↗
PubMed2004

Minimally invasive total knee replacement using a mini-mid vastus incision technique and results.

This study was performed to determine whether differences existed between primary knee replacement performed through a standard medial parapatellar approach, and those performed through a minimally invasive mini-mid vastus approach. It was a prospective study compared with a retrospective evaluation of a matched cohort. In this study, the Genesis(tm) II and its MIS instrumentation were used. Patients with the mini-mid vastus MIS incision (MMV MIS) required less pain medication post-operatively, regained their flexion more rapidly, and attained their functional milestones at an earlier point than those with the traditional median parapatellar long incision. Despite the smaller incision, component placement was radiographically excellent in all cases. Optimal performance of the surgery required the use of special instrumentation, modified so as to be used in smaller incisions.

Arthroplasty, Replacement, Knee↗
PubMed2003

Instrumentation pitfalls: you just can't go on autopilot!

Instrumentation for total knee arthroplasty is crucial for proper positioning and orientation of the components. Instruments, however, must be used properly if the surgeon is to accomplish the goals. The entrance point for intramedullary guides for both the femur and tibia should not be arbitrarily chosen but picked after evaluation of the intersection of the anatomic axes of the respective bones with their articular surfaces. Saw blades must be held on cutting blocks, and the blocks themselves affixed to bones with sufficient pins to assure stability. If an extramedullary tibial alignment guide is chosen, its distal position should be in the center of the ankle plafond, not in the mid-malleolar point. In the lateral plane, it should parallel the shaft of the fibula. Femoral component rotation cannot always be judged from the posterior condylar tangent line. There may be difficulties of deformity with bone and cartilage loss, especially in valgus knees. Surgeons need to be mindful of the epicondylar axis and the midtrochlear of the anteroposterior axis of Whiteside.

Arthroplasty, Replacement, Knee↗