2020 innovations in orthopedic surgery and traumatology

Xavier Libouton*, Nathalie Pireau*, Robin Evrard*, Emmanuel Thienpont*, Daniel Morcillo, Loic Thoreau, Maïte Van Cauter, Vincent Druez, Jean-Emile Dubuc, Maxime Bonnelance, Nadia Irda, Ludovic Kaminski, Simon Vandergugten, Alin Sirbu, Karim Tribak, Dan Pu Published in the journal : February 2021 Category : Chirurgie orthopédique et traumatologie

Summary :

Four themes were emphasized in the year 2020, including new perspectives in knee arthroplasty surgery, contribution of 3D metal printing in developing implants for sarcoma surgery, usefulness of lateralization of the rotation center in reverse prosthetic shoulder surgery, and, lastly, contribution of microsurgery in bone defects. Nevertheless, 20% of patients still experience an unsatisfactory outcome following knee arthroplasty. Advances in tribology and implant fixation have rendered it possible to deviate from a purely mechanical approach and develop new resurfacing strategies that respect the patient's native anatomy. These advances are aimed at a kinematic alignment that is capable of recreating the natural joint movement with its ligament balance. This has resulted in developing personalized implants and ultra-precise positioning techniques, which are assisted by navigation and robot.

In oncological surgery, certain tumor resections are associated with difficult reconstructions, especially within the pelvis, as these resections are accompanied by a high rate of complications and mechanical failures. Metal 3D printing technology has rendered it possible to design porous titanium implants, which basically mirror the substance loss. Their stable fixation can already been anticipated at the design stage, thereby facilitating the reconstruction process and offering lasting mechanical perspectives. The performance of a reverse shoulder arthroplasty, which is indicated in osteoarthritis associated with a cuff tear, results in a medialization of the glenohumeral rotation center. This medialization results in a conflict with the scapula and progressive loosening of joint replacement. Metallic augmentation or bone grafting techniques enable lateralization of the rotation center, thereby preventing these complications.

Finally, when facing vast bone-tissue defects with a significant functional impact, the use of autologous vascularized grafts of different types represents a surgical solution that is still constantly evolving, including the recent contribution of super microsurgery.

Key Words

Custom knee arthroplasty, robotics, CT planning, kinematic knee alignment, 3D printing, pelvic sarcoma surgery, reverse shoulder prosthesis, allograft reconstruction, vascular grafts, supermicrosurgery