Designed for Wear Reduction • Improved Function • Optimal Kinematics4 VOLUME 25 2005 THERE IS A DIFFERENCE The Iowa Orthopaedic Journal DEPUY ROTATING PLATFORM KNEE 1 REDUCED WEAR BY 94% Polyethylene wear has been associated with osteolysis in the knee.2,3 * The rotating platform knee, used with GVF JOURNAL ORTHOPAEDIC THE IOWA polyethylene, reduced wear by 94% when compared to a fixed bearing knee. Results based on knee simulation testing. Available only from DePuy Orthopaedics. Trusted Innovation. 1 ASTM Symposium on Cross-linked Thermally Treated Ultra High Molecular Weight Polyethylene for Joint Replacements (data on file). Miami Beach, Florida Nov. 5 and 6, 2002. 2 Lewis, Peter; Cecil H. Rorabeck, Robert B. Bourne and Peter Devane. “Posteromedial Tibial Polyethylene Failure in Total Knee Replacements.” CORR Feb. 1994: 11-17. 3 Cadambi, Ajai, Gerard A. Engh, Kimberly A. Dwyer and Tuyethoa N. Vinh. “Osteolysis of the Distal Femur After Total Knee Arthroplasty.” The Journal of Arthroplasty Dec. 1994: 579-594. * GVF - Gamma Vacuum Foil IMPORTANT • The presence of osteomyelitis, pyrogenic infection or other overt infection of the These include: This Essential Product Information sheet does not include all of the information nec- knee joint; essary for selection and use of a device. Please see full labeling for all necessary infor- • Patients with loss of musculature or neuromuscular compromise leading to loss of •Vascular deficiency at the bone site; mation. function in the involved limb or in whom the requirements for its use would affect •Inadequate bone stock to assure both a firm press fit and close apposition of the cut recommended rehabilitation procedures. bone surfaces to the prosthesis; • Patients with severe osteoporosis or other metabolic bone diseases of the knee. • The inability to make bone cuts so as to assure both correct component position and INDICATIONS intimate apposition of bone and prosthetic surfaces; The LCS® Complete – P.F.C. Sigma RP Mobile Bearing Total Knee System is indicated • Patients with any of the following conditions: • Lesions of the supporting bone structures (e.g. aneurysmal or simple bone cysts, •Inadequate bone quality (e.g. severe osteoporosis) and lack of stability of the for cemented use in cases of osteoarthritis and rheumatoid arthritis. The rotating plat- implanted components. form prosthesis and modular revision components are indicated for revision of failed giant cell tumor or any malignant tumor), • Systemic and metabolic disorders leading to progressive deterioration of solid bone 25th Anniversary Edition knee prostheses. In the presence of any of the above conditions the components should be fixed with support, cement. The porous coated Keeled and Non Keeled M.B.T. (Mobile Bearing Tibial) Tray config- • The presence of severe instability secondary to advanced loss of osteochondral urations of the LCS Total Knee System are indicated for noncemented use in skeletally structure or the absence of collateral ligament integrity, fixed deformities greater than WARNINGS AND PRECAUTIONS mature individuals undergoing primary surgery for reconstructing knees damaged as 60° of flexion, 45° of genu varus or valgus, a result of noninflammatory degenerative joint disease (NIDJD) or either of its com- Components labeled for “Cemented Use Only” are to be implanted only with bone VOLUME 25, 2005 Published by the Residents and Faculty of the Department of Orthopaedics, The University of Iowa •Known drug or alcohol addiction, cement. The following conditions tend to adversely affect knee replacement implants: posite diagnoses of osteoarthritis and post-traumatic arthritis pathologies. The • Skeletally immature individuals and the presence of allergic reaction to implant met- Rotating Platform device configuration is indicated for use in knees whose anterior and excessive patient weight, high levels of patient activity, likelihood of falls, poor bone als or polyethylene are also contraindications for the noncemented, porous coated, stock, metabolic disorders, disabilities of other joints. posterior cruciate ligaments are absent or are in such condition as to justify their sac- M.B.T. and LCS Complete – P.F.C. Sigma RP Mobile Bearing device configurations, rifice. The P.F.C. Sigma RP Curved bearings when used with the P.F.C. Sigma Cruciate and for the cemented use of all device configurations of the LCS Complete – P.F.C. Editors: Kirk D. Clifford, M.D., and Anthony V. Mollano, M.D. Retaining Femoral Component can be used in posterior cruciate ligament retaining pro- Sigma RP Mobile Bearing Total Knee System. ADVERSE EVENTS cedures. The following are the most frequent adverse events after knee arthroplasty: change in position of the components, loosening, bending, cracking, fracture, deformation or CONTRAINDICATIONS FOR USE WITHOUT CEMENT CONTRAINDICATIONS wear of one or more of the components, infection, tissue reaction to implant materi- Noncemented use of the Porous Coated Keeled or Non-Keeled M.B.T. Tray device con- als or wear debris; pain, dislocation, subluxation, flexion contracture, decreased range The use of the LCS Complete – P.F.C. Sigma RP Mobile Bearing Total Knee System is figurations is contraindicated in patients with sufficient loss in quantity or quality of contraindicated in: of motion, lengthening or shortening of leg caused by improper positioning, looseness bone stock (as determined on x-ray) such that successful noncemented fixation is or wear of components; fractures of the femur or tibia. unlikely. Additional contraindications may become apparent at the time of surgery. THE IOWA ORTHOPAEDIC JOURNAL 2005 ● Volume 25 ISSN 1541-5457 EDITORS Kirk D. Clifford, M.D. Anthony V. Mollano, M.D. STAFF ADVISERS Joseph A. Buckwalter, M.D. Jose A. Morcuende, M.D. Editors’ Note .................................................................................................................................................................................................... i Editors Emeriti ............................................................................................................................................................................................... ii Dedication—Lawrence D. Dorr, M.D. .................................................................................................................................................... iii 2005 Graduating Orthopaedic Residents and Fellows ..................................................................................................................... vi New Orthopaedic Faculty............................................................................................................................................................................ x 2004-2005 Schedule of Lectureships and Conferences ................................................................................................................ xi Bonfiglio Award and Iowa Orthopaedic Society Award ................................................................................................................... xii UNIVERSITY OF IOWA ORTHOPAEDIC RESIDENCY RESEARCH PROGRAM Orthopaedic Residency Research Program Update Charles L. Saltzman, M.D. .................................................................................................................................................................... xiii Impact of Iowa Orthopaedic Resident Research Projects from 25 Years Ago Joseph A. Buckwalter, M.D. ................................................................................................................................................................... xiv A Look Back at Alumni Research Projects George Brown, M.D. ............................................................................................................................................................................... xv Jack Lindstrom, M.D. ............................................................................................................................................................................. xvi Sterling Laaveg, M.D. .......................................................................................................................................................................... xviii TRIBUTE TO DR. IGNACIO PONSETI Speeches at 90th Birthday for Ignacio V. Ponseti Joseph A. Buckwalter, M.D. ................................................................................................................................................................... xix Stuart L. Weinstein, M.D. ...................................................................................................................................................................... xx Ignacio V. Ponseti, M.D. ...................................................................................................................................................................... xxiv ARTHROPLASTY Development of Imageless Computer Navigation for Acetabular Component Position in Total Hip Replacement Lawrence D. Dorr, M.D.; Yuji Hishiki, R.N.; Zhinian Wan, M.D.; Deanne Newton, PA-C; Andrew Yun, M.D. .............................. 1 The Clinical Performance of Metal-on-Metal as an Articulation Surface in Total Hip Replacement William T. Long, M.D. ............................................................................................................................................................... 10 Does Smoking Affect Implant Survivorship in Total Hip Arthroplasty?