https://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.png00TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-11-13 18:59:112018-11-13 18:59:11Dr. Lederman and colleagues present a study comparing new techniques for rotator cuff repair!
Title: Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation
Patrick Denard MD, Patric Raiss MD, Reuben Gobezie MD, T. Bradley Edwards MD, Evan S. Lederman MD
Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings.
Full article link below.
Journal of Shoulder and Elbow Surgery E-pub February 6, 2018
https://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.png00TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-11-11 20:57:282018-11-13 20:58:44Dr. Evan Lederman and colleagues review how bone reacts to shoulder replacements and propose a classification system for critical review of implant/bone interaction
Title: Healing and functional outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty
Reuben Gobezie MD, Patrick Denard MD, Yousef Shishani MD, Anthony Romeo MD, Evan S. Lederman MD
The purpose of this study was to evaluate functional outcome and healing of a subscapularis peel with a stem-based repair after total shoulder arthroplasty (TSA). The hypothesis was that the repair would lead to subscapularis healing in the majority of cases.
https://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.png00TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-11-10 00:10:062018-11-14 00:17:37Dr. Lederman and colleagues discuss the outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty
Title: Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty
Anthony A. Romeo MD, Robert J Thorness MD, Shelby A Sumner MPH, Reuben Gobezie MD, Evan S Lederman MD, Patrick J Denard MD
Short-stem press-fit humeral components have recently been developed in an effort to preserve bone in total shoulder arthroplasty (TSA), but few studies have reported outcomes of these devices. The purpose of this study was to evaluate the short-term clinical outcomes of an anatomic short-stem humeral component in TSA. We hypothesized that the implant would lead to significant functional improvement with low rates of radiographic loosening.
https://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.png00TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-11-01 22:37:492018-11-13 22:44:24Dr. Lederman and colleagues discuss the outcome and safety of a short stem shoulder replacement
Title: Humeral cemented revision: Techniques for safe extraction
Samuel HarmsenMD, Evan S. Lederman MD
Removing a well-fixed humeral component in revision shoulder arthroplasty can present a difficult challenge. Intraoperative complications including iatrogenic fracture, humeral perforation, segmental bone loss, nerve and soft tissue injury can occur. These complications can occur with both cemented and press-fitted stems and can lead to increased morbidity and decreased functional outcomes. Complete removal of the cement mantle and cement restrictor, when necessary, can present even further challenges. Several extraction techniques have been described that can help minimize complications and enable safe, complete component extraction.
*This is based on a lecture by Dr. Lederman at the 2017 Current Concepts in Shoulder Arthroplasty Conference in Las Vegas, NV.
https://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.png00TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-11-01 21:33:412018-11-13 21:41:01Dr. Lederman and Dr. Harmsen discuss the challenges and techniques for revision shoulder replacement.*
Title: In vitro susceptibility of Propionibacterium acnes to simulated intrawound vancomycin concentrations
Luke Hosack MD MS, Derek Overstreet PhD, Evan S Lederman, MD
There is convincing evidence supporting the prophylactic use of intrawound vancomycin powder in spinal fusion surgery and mounting evidence in the arthroplasty literature suggesting that it can reduce surgical site infections. As a result, a number of shoulder arthroplasty surgeons have adopted this practice, despite a paucity of evidence and the presence of a pathogen that is, for the most part, unique to this area of the body—Propionibacterium acnes. The purpose of this study was to evaluate the efficacy of vancomycin against planktonic P. acnes in vitro, using time-dependent concentrations one would expect in vivo after intra-articular application.
https://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.png00TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-10-13 21:59:002018-11-13 22:09:01Dr Lederman, Dr Hosack and colleagues from the University of Arizona College of Medicine Phoenix discuss the potential for Vancomycin Powder to prevent infection in shoulder replacement.
Dr. Josh C. Vella, TOCA Hand and Upper Extremity Surgeon, is honored to carry the distinction of becoming an international lecturer at the 5th Annual World Congress in Orthopedics-2018 in Milan, Italy.
He was one of a few distinguished international lecturers who discussed various new treatment options with the theme of this years conference “Breaking Barriers in Orthopedic Research”.
Photo: Dr. Josh C. Vella (center), Dr Michael Boland (right) of The Hand Institute, University of Auckland, New Zealand and Dr Scott Fried (left) in collaboration with Thomas Jefferson University Hand Center in Philadelphia.
TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-08-05 20:49:062018-10-30 15:39:38Dr. Josh Vella - 5th Annual World Congress in Orthopedics-2018
Dr. Padley returned to the Dominican Republic in April with the Cincinnati Reds for the annual opening of their Dominican complex. The trip included evaluations of 40+ Dominican athletes hoping to advance their way up the Cincinnati Reds baseball system. This marks the beginning of the baseball season for the Dominican teams. Most major league baseball teams have affiliates in the Dominican in search of that next great player! Dr. Padley is an orthopedic consultant and provider to the Cincinnati Reds for major league baseball spring training and throughout the year for their minor league and rookie league teams. In additional to this health care relationship, he is also a consultant to Japanese professional baseball for the Saitama Seibu Lions. With his expertise in hip disorders and injuries, Ballet Arizona benefits from his service as a consultant. He was a team physician for the WNBA’s Phoenix Mercury for four years including the 2014 championship season. Dr. Padley proudly serves as the team physician for Benedictine University in Mesa as well as Millennium and Verrado High Schools in Goodyear.
TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-05-11 14:44:552018-10-30 15:39:38Dr. Padley has a long tradition of providing care for sports teams.
Title: The Evolution of the Superior Capsular Reconstruction Technique
Alan M. Hirahara, MD, FRCSC; Evan S. Lederman, MD; Wyatt J. Andersen, ATC; and Kyle Yamashiro, PT, DPT, CSCS
Irreparable, massive rotator cuff tears can result in unacceptable functional deficits in patients. When the supraspinatus tears and retracts medially, the superior capsule is also disrupted, and superior constraint is lost. With no superior restraint to the humerus, the humeral head migrates superiorly, causing a decrease in the acromial-humeral distance. [1-4]
Biomechanical analysis has shown that a defect in the superior capsule results in a minimum 200% greater glenohumeral superior translation and subacromial peak contact pressure compared with an intact capsule.  The malposition of the humeral head leads to functional abnormalities and pseudoparalysis.
Numerous proposed treatments for massive rotator cuff tears – including debridement and tenotomy, tendon transfers, and reverse total shoulder arthroplasty – have yielded mixed results and high complication rates. [5-12] In particular, reverse shoulder arthroplasty can result in humeral or glenoid fractures, persistent anterior or posterior instabilities, loosening of the glenoid or humeral cemented components, dislocations, and infection. [5-7]
The superior capsular reconstruction (SCR) was described by Hanada et al  in 1993 and by Mihata et al  in 2013 as an alternative procedure to increase function and decrease pain by restoring the restraint mechanisms in the shoulder. Using a graft to recreate the superior capsule, the humeral head is centered in the glenoid, allowing the larger muscles (ie, deltoid, latissimus dorsi, and pectoralis major) to function appropriately. Mihata et al [3,4] have found that the SCR reduces glenohumeral superior translation and subacromial contact force.
TOCA Webmasterhttps://tocamd.com/wp-content/uploads/2018/06/logo-toca-blue-300x171.pngTOCA Webmaster2018-05-02 16:15:042018-10-30 15:39:38Congratulations to Dr. Evan Lederman for his recent publication!
Your Life Arizona talks with orthopedic surgeon Dr. Tom Carter and NUsurface Meniscus Implant recipient Robert Nowlan about a clinical trial for knee pain after meniscus surgery. For more information on the trial, please call (844) 680-8951.
Have you had surgery to repair a torn meniscus but are still living with knee pain? Have you been told that you’re too young for knee replacement surgery and thought you were out of options? If you answered yes to these questions, you may be a candidate for the NUsurface Meniscus Implant – a medial meniscus replacement to treat persistent knee pain caused by injured or deteriorating meniscus cartilage.
The implant, which is made of medical grade plastic and inserted in to the knee through a small incision, has been used in Europe since 2008 and Israel since 2011. A clinical trial called SUN (Safety Using NUsurface®) is taking place at TOCA (The Orthopedic Clinic Association) to determine the effectiveness of the NUsurface Meniscus Implant for individuals with knee pain. More information about this study can be foundhere.
While it’s not meant to take the place of a total knee replacement, the NUsurface Meniscus Implant can serve as an opportunity to treat knee pain and keep you active until knee replacement surgery, if needed, is a viable option. The unique materials and composite structure are designed to mimic the function of a natural meniscus and redistribute loads transmitted across the knee joint. To date, the implant has given nearly 100 patients a second chance at a pain-free, active life.
About the Procedure
The meniscus implant is inserted into the knee through a small incision, and patients are allowed to go home the same day or the day after the operation. After surgery, they undergo a six-week rehabilitation program and a physician will explain recommended activities during this period.
Who is Eligible?
If you’re interested in the NUsurface Meniscus Implant, ask yourself the following questions to determine if you might be eligible to participate in this clinical trial:
Have you had a previous medial partial meniscectomy that was performed at least six months ago?
Do you have persistent knee pain?
Has your physician recommended non-surgical therapies to deal with the pain?
Are you between the ages of 30 and 75?
Please note patients who are candidates for partial or total knee arthroplasty are not eligible.
How Can I Find Out if I Qualify?
Visit sun-trial.com, call (844) 680-8951 or contact the dedicated TOCA Team at 602-277-6211