FEBRUARY 2009 VOLUME XXXVIII NUMBER 2 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

28	Acute Sciatic Nerve Palsy as a Delayed Complication of Low-Molecular-Weight Heparin Prophylaxis After Total Hip Arthroplasty Burak Beksaç, MD, Alejandro González Della Valle, MD, and Eduardo A. Salvati, MD Dr. Beksaç is Research Fellow, Hospital for Special Surgery, New York, New York, and Weill Medical College of Cornell University, New York, New York. Abstract not available. Introduction provided instead. Sciatic nerve palsy is a recognized complication of total hip arthroplasty (THA).1,2 The low incidence of this complication ranges from 0% to 3.7%.1 Delayed-onset acute sciatic nerve palsy due to hematoma is rare. With recent increased use of potent anticoagulants for thromboprophylaxis, the incidence of sciatic palsy secondary to local hematoma has increased.3 In this article, we report the case of a patient who underwent primary THA and, over a few hours on postoperative day 3 (POD3), developed complete sciatic nerve palsy due to local bleeding secondary to low-molecular-weight heparin (LMWH) prophylaxis. Our patient was informed that the data concerning his case would be submitted for publication. Am J Orthop. 2009;38(2):E28-E30.
31	Post–Total-Knee-Arthroplasty Popliteal Artery Intimal Tear Repaired With Endoluminal Balloon Angioplasty J. Andrew Sedrick, BS, Jane Ho, BA, DO, John A. Stern, MD, Alan T. McDaniel, MD, and Craig R. Mahoney, MD Mr. Sedrick is with Des Moines University, Des Moines, Iowa. Abstract not available. Introduction provided instead. Arterial vascular injury after total knee arthroplasty (TKA) is rare; its rate of occurrence is 0.03% to 0.17%.1,2 Post-TKA arterial occlusion can be caused by thrombosis, fascial obstruction, plaque embolization, or direct trauma to the vessel.3,4 Optimal treatment options for popliteal artery occlusion are primary repair of the vessel and saphenous vein bypass.5 In this article, we report a case of post-TKA popliteal artery occlusion with suspected intimal flap disruption treated endovascularly with percutaneous transluminal angioplasty (PTA). We obtained the patient’s written informed consent to document her case for publication. Am J Orthop. 2009;38(2):E31-E33.
34	Severe Chondrolysis of the Glenohumeral Joint After Shoulder Thermal Capsulorrhaphy Benjamin R. Coobs, BS, and Robert F. LaPrade, MD, PhD Mr. Coobs is Medical Student, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota. Abstract not available. Introduction provided instead. Over the past decade, thermal capsulorrhaphy procedures have had relatively few complications.1-3 More recently, reports of glenohumeral chondrolysis after arthroscopy and thermal shrinkage procedures have raised concerns.4-6 In this article, we present the cases of 2 young patients who presented to our institution for evaluation of devastating glenohumeral chondrolysis after shoulder arthroscopy procedures. We obtained informed consent to describe these patients’ cases in this article, and each patient was given the opportunity to review our manuscript before submission. Am J Orthop. 2009;38(2):E34-E37.
38	Delayed Radial Nerve Laceration by the Sharp Blade of a Medially Inserted Kirschner-Wire Pin: A Rare Complication of Supracondylar Humerus Fracture Mohammad Javad Fatemi, MD, Mohammadali Habibi, MD, Aydin H. Pooli, MD, and Maryam Jafari Mansoori, MD Dr. Fatemi is Associate Professor of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran. Abstract not available. Introduction provided instead. Supracondylar humerus fracture is one of the most common fractures in children and the most common pediatric elbow fracture. It usually occurs during a fall onto an outstretched hand1 and is associated with considerable morbidity, including neurovascular complications, malunion, myositis ossificans, and compartment syndrome.1-3 The most common complication is nerve damage, which in some cases causes paralysis. Primary nerve injuries occur in up to 20% of displaced supracondylar fractures.2,4 Secondary nerve injuries are usually caused by stretching, laceration, or entrapment of the nerve between the ends of the fracture.2 In most cases of supracondylar humerus fractures, the treatment of choice is closed reduction and percutaneous pinning.5-7 After 3 to 4 weeks of immobilization, the pins should be removed. During Kirschner-wire (K-wire) pin placement, there is a risk for nerve damage, particularly ulnar nerve damage during insertion of a medial pin.5-9 The literature includes many reports of ulnar nerve damage during medial pinning, but radial nerve laceration by a medially inserted pin that crosses the anterolateral cortex of the humerus is rare. In this article, we report the case of a patient who, 8 years after being treated for a supracondylar humerus fracture, presented with radial nerve palsy caused by repeated trauma from the sharp blade of a medially inserted K-wire pin. We have obtained the patient’s guardian’s informed, written consent to publish the case report. Am J Orthop. 2009;38(2):E38-E40.
41	Erosive Inflammatory Pseudotumor of the Odontoid Process in Association With Forestier’s Disease (Diffuse Idiopathic Skeletal Hyperostosis) Alireza Mirzasadeghi, MD, MPH, Sabarul Afian Mokhtar, MD, MS (Ortho), Baharuddin Azmi, MD, MS (Ortho), Norhazla Mohamed Haflah, MD, MS (Ortho), and Mohamad Abdul Razak, MD, MS (Ortho) Dr. Mirzasadeghi is Resident of Orthopaedics, Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia. Abstract not available. Introduction provided instead. Inflammatory pseudotumor, first described in 1954,1 was initially considered any lesion that simulated a neoplastic condition at clinical, macroscopic, and microscopic levels but that was thought to have an inflammatory and/or reactive pathogenesis. In recent literature, inflammatory pseudotumor is mostly considered a mass lesion characterized microscopically by a proliferation of a spindle-cell component against a heavy inflammatory infiltrate of mixed composition but usually with a predominance of mature lymphocyte and plasma cells.2 The World Health Organization accepts the term inflammatory myofibroblastic tumor, but, given the heterogeneity of these soft-tissue tumors, other terms, based on original body sites, are still applied.3 This naming convention reflects the complexity and variable histologic characteristics and behavior of the entity. Pseudotumors are important at least because of their ability to mimic malignant tumors, either clinically or radiologically.4-6 Inflammatory pseudotumors can develop in many sites but is most commonly reported in the lung, orbit, gastrointestinal tract, and kidney.4,7 The spinal column is an extremely rare site for pseudotumors; to our knowledge, only 16 cases have been reported,4,8-20 the last in 2005.4 Four cases in the periodontoid area were reported.21 The lesion was associated with diffuse idiopathic skeletal hyperostosis (DISH) in only 1 case, reported by Jun and colleagues.19 To the authors’ knowledge, atlantoaxial dislocation resulting from periodontoid pseudotumor in association with Forestier’s disease has not been previously reported. DISH was first described in 1950 by Forestier and Rotés-Querol21 as senile ankylosing hyperostosis of the spine, but soon it was discovered that this disorder is not limited to “senile” age groups and is not limited to the “spine,” ie, there are many cases of the disorder among younger age groups and/or those with extraspinal manifestation. However, this condition, now also known as Forestier’s disease, has a marked predilection for the axial skeleton, particularly the thoracic and lumbar spine. Although DISH is considered a benign rheumatologic disorder, it can be associated with a variety of complications ranging from pain and stiffness to different neurologic disturbances and even dysphagia.19,22 Am J Orthop. 2009;38(2):E41-E44.
45	Osteoporotic Insufficiency Fractures of the Pelvis Simulating a Malignancy in an Elderly Man Aditya V. Maheshwari, MD, PGDPHA, Melissa M. Kounine, MD, Manuela Soaita, MD, Deepak Kumar, MPT, and J. David Pitcher, Jr., MD Dr. Maheshwari is Clinical Fellow, Division of Musculoskeletal Oncology, Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, Florida. Abstract not available. Introduction provided instead. Insufficiency fracture is a common initial presentation of osteoporosis. Fractures of the distal radius are the most common, followed by fractures of the hip, vertebral body, and proximal humerus.1 Insufficiency fractures of the pelvis are rare, often unrecognized, and reported mostly in females.2,3 In their review of the literature, Weber and colleagues3 found that only 17 (7.4%) of 231 insufficiency fractures of the sacrum occurred in males. Although widely regarded as a disease of women, osteoporosis causes significant unrecognized morbidity and mortality in men.4 The absolute number of men presenting with osteoporotic fractures is rising because of an increase in the elderly population plus an age-related increased incidence of fractures.4 Awareness of this entity, particularly in males, should prevent its being confused with malignant disease, should prevent unnecessary extensive workup, and will allow appropriate management and patient reassurance. In this article, we report the case of an elderly man who had multiple pelvic metachronous insufficiency fractures with worrisome radiologic features simulating a malignancy. The patient provided written informed consent for us to submit his case data for publication. Am J Orthop. 2009;38(2):E45-E48.

66	EDITORIAL—Orthopedic Surgery and Integrative Medicine—Strange Bedfellows Peter D. McCann, MD Dr. McCann is Editor-in-Chief of this journal and Chair, Department of Orthopaedic Surgery at Beth Israel Medical Center, New York, New York. Abstract not available. Am J Orthop. 2009;38(2):66,71.
67	Vertical Humeral Osteotomy for Revision of Well-Fixed Humeral Components: Case Report and Operative Technique Geoffrey S. Van Thiel, MD, MBA, Dana Piasecki, MD, and Gregory Nicholson, MD Dr. Van Thiel is Resident, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois. The increase in the number of shoulder arthroplasties has also created a paradoxical increase in the number of revision procedures. These revision surgeries can be complicated by well-fixed humeral components that require removal. In this article, we report a representative revision arthroplasty that involved a novel technique, vertical humeral osteotomy, which allowed for safe and effective humeral stem extraction with no need for distal windows, no proximal bone loss, and no need for a long-stemmed prosthesis. Am J Orthop. 2009;38(2):67-71.
72	Fat Embolism and Respiratory Distress Associated With Cemented Femoral Arthroplasty Paul S. Issack, MD, PhD, Margaret H. Lauerman, BS, David L. Helfet, MD, Thomas P. Sculco, MD, and Joseph M. Lane, MD Dr. Issack is Fellow, Orthopaedic Trauma, Adult Reconstructive Surgery, and Metabolic Bone Diseases, Hospital for Special Surgery, New York, New York. Embolization of fat and marrow contents results from increased intramedullary pressure generated during insertion of an intramedullary implant such as a total hip prosthesis or an intramedullary nail. Embolization is accentuated when the implants are inserted using cemented techniques. These embolic events, observed by transesophageal echocardiography, correlate with hemodynamic changes suggesting pulmonary embolism. The ability of patients to tolerate these cardiopulmonary changes depends on both baseline pulmonary function and quantity of embolic debris delivered to the pulmonary vasculature during the operation. Patients with good pulmonary function can tolerate the embolic load associated with implantation of a cemented implant and will demonstrate little cardiopulmonary compromise. Patients with poor pulmonary reserve may be unable to withstand the showering of debris resulting from this procedure and are at risk for hypoxia, cardiopulmonary dysfunction, and possibly death. Measures to remove marrow contents and reduce intramedullary pressure during cemented femoral arthroplasty or to switch to an uncemented technique may minimize the cardiopulmonary risk incurred by this group of patients. Am J Orthop. 2009;38(2):72-76.
77	The Effects of Obesity Surgery on Bone Metabolism: What Orthopedic Surgeons Need to Know Angela Wang, MD, and Amy Powell, MD Dr. Wang is Associate Professor, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah. Morbid obesity affects approximately 9 million Americans. Obesity is associated with a reduced risk of osteoporosis, whereas weight loss decreases bone density. Obesity surgery has profound effects on bone, which are well described in the gastrointestinal literature; yet, there are virtually no reports in the orthopedic literature. The Roux-en-Y procedure is the leading bariatric operation performed in the United States. In this surgery, the primary sites for calcium absorption are bypassed. Patients become calcium- and Vitamin D-deficient, and the body then up-regulates parathyroid hormone, causing increased production of Vitamin D and increased calcium resorption from bone. Gastric banding utilizes a restrictive band and has not been shown to produce the same bone loss as the Roux-en-Y procedure, nor has there been evidence of secondary hyperparathyroidism. It is important for orthopedists to be aware of the types of obesity surgery and their sequelae on bone, as this may impact bone density, fracture risk, and fracture healing. Am J Orthop. 2009;38(2):77-79.
83	Pathologic Femoral Neck Fractures in Children M. Wade Shrader, MD, Joseph H. Schwab, MD, William J. Shaughnessy, MD, and David J. Jacofsky, MD Dr. Shrader is Orthopedic Resident, Department of Orthopedics, Mayo Clinic, Rochester, Minnesota. Pathologic fractures in children occur in a variety of malignant and benign pathologic processes. Pediatric pathologic femoral neck fractures are particularly rare. Until now, all reported cases have been isolated cases, small series, or cases reported in series of adult pathologic hip fractures. The present article is the first report of a relatively large series of pathologic femoral neck fractures in a pediatric population. We identified pathologic femoral neck fractures, including 2 basicervical fractures, in 15 children (9 boys, 6 girls) ranging in age from 18 months to 15 years (mean age, 9 years) and treated between 1960 and 2000. The pathologic diagnoses were fibrous dysplasia (5 children), unicameral bone cyst (2), Ewing’s sarcoma (2), osteomyelitis (2), leukemia (1), rhabdomyosarcoma (1), osteogenesis imperfecta (1), and osteopetrosis (1). Treatment methods, including time to reduction and fixation, were reviewed in detail. One patient was lost to follow-up. All others were followed until union; mean long-term follow-up was 7 years (range, 1-16 years). All patients ultimately went on to union. Mean time to union was 19 weeks (range, 5-46 weeks). However, 2 patients died before 2 years. There was a 40% complication rate, with limb-length discrepancy being the most common (4 children). No patient developed avascular necrosis. Pathologic femoral neck fractures are rare in children. Pediatric patients who present with a pathologic hip fracture are at significant risk for complications. Physicians and family should be alerted to the prolonged course involved in treating these fractures to union. Am J Orthop. 2009;38(2):83-86.
88	Bilateral Displaced Femoral Neck Fractures After Myoclonic Seizure Treated With Bilateral Total Hip Arthroplasties Paul C. Pappademos, MD, and William G. Hamilton, MD Dr. Pappademos is Fellow, Anderson Orthopaedic Research Institute, Alexandria, Virginia. Abstract not available. Am J Orthop. 2009;38(2)::88-89.
90	One-Bone Forearm Reconstruction Procedure as Salvage Operation After Severe Upper Extremity Trauma: A Case Report Sokratis E. Varitimidis, MD, Aaron I. Venouziou, MD, Zoe H. Dailiana, MD, and Konstantinos N. Malizos, MD Dr. Varitimidis is Assistant Professor, Department of Orthopaedics, University of Thessalia School of Medicine, Larissa, Greece. An industrial worker in his early 20s sustained a severe injury to the right dominant upper extremity: fracture, inversion, and complete devascularization of the ulna; transection of the median nerve, the radial artery, and almost all flexor tendons of the hand and fingers; loss of all extensor muscles; and transection of the biceps and brachialis muscles at the elbow. Treatment consisted of conversion to one-bone forearm, immediate reconstruction of the biceps and brachialis muscles and of all flexor tendons of the hand, repair of the radial artery and median nerve and late tendon transfer for extension of the wrist and fingers. Two and a half years after injury, the patient had full flexion and extension of the elbow, full extension but limited flexion of the wrist, and full flexion and extension of the fingers. Am J Orthop. 2009;38(2):90-92.
94	Arthroscopic Aspiration and Labral Repair for Treatment of Spinoglenoid Notch Cysts Robert Z. Tashjian, MD, and Robert T. Burks, MD Dr. Tashjian is Assistant Professor, Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah. Spinoglenoid notch cysts are a relatively uncommon cause of shoulder pain and weakness, are often associated with labral tears, and commonly result in compression of the suprascapular nerve. Open and arthroscopic treatments have been described. In an attempt to limit potential suprascapular nerve injury during arthroscopic excision, we have used a technique of arthroscopic cyst aspiration followed by labral repair. Routine glenohumeral arthroscopy is performed in preparation for superior labral repair. A 17-gauge spinal needle is then inserted 1 cm lateral to the posterior portal directed just lateral to the labrum in the region of the cyst (usually posterior-superior quadrant of glenoid). The cyst material is aspirated (commonly 5-15 mL), and the labral tear is repaired without violating the glenohumeral capsule. For all 4 patients described in this report, magnetic resonance imaging showed complete cyst resolution at a minimum of 6 months after surgery. Cyst aspiration followed by labral repair limits the potential for nerve injury while increasing the likelihood of complete cyst resolution during arthroscopic treatment of spinoglenoid notch cysts. Am J Orthop. 2009;38(2):94-96.

2	Introduction: Robotic Arm—Assisted Unicompartmental Knee Arthroplasty Jess H. Lonner, MD Dr. Lonner is Director, Knee Replacement Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania, and Director, Philadelphia Center for Minimally Invasive Knee Surgery, Philadelphia, Pennsylvania. Abstract not available. Am J Orthop. 2009;38(2 suppl):2.
3	Indications for Unicompartmental Knee Arthroplasty and Rationale for Robotic Arm–Assisted Technology Jess H. Lonner, MD Dr. Lonner is Director, Knee Replacement Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania, and Director, Philadelphia Center for Minimally Invasive Knee Surgery, Philadelphia, Pennsylvania. Unicompartmental knee arthroplasty (UKA) is an effective surgical treatment for focal arthritis when appropriate selection criteria are followed. Although results can be optimized with careful patient selection and use of a sound implant design, two of the most important determinants of UKA performance and durability are how well the bone is prepared and components aligned. Study results have shown that component malalignment by as little as 2° may predispose to implant failure after UKA. Conventional cutting guides have been relatively inaccurate in determining alignment and preparing the bone surfaces for unicompartmental implants. Computer navigation has improved component alignment to an extent, but outliers still exist. The introduction of robotics capitalizes on the virtues of computer navigation but couples the planning and mapping of navigation with robotic techniques for bone preparation. Robotic technology is fostering substantially improved precision and component alignment in UKA, even when using minimally invasive soft-tissue approaches. Am J Orthop. 2009;38(2 suppl):3-6.
7	Integrating Robotic Technology Into the Operating Room Thomas M. Coon, MD Dr. Coon is Founder and Director, Orthopedic Surgical Institute, Red Bluff, California. Integration of any highly complex technology into the operating room is challenging but can be accomplished with dedicated engineers, trained surgical team members, a streamlined surgical setup, and efficient surgical technique. Early results suggest a short learning curve and excellent radiographic outcomes (2.5 times improvement in tibial alignment, lower SD). The robotic arm is a valuable tool in modern orthopedics. Am J Orthop. 2009;38(2 suppl):7-9.
10	Robotic Arm—Assisted Unicompartmental Knee Arthroplasty: Preoperative Planning and Surgical Technique Martin Roche, MD, Padhraig F. O’Loughlin, MD, Daniel Kendoff, MD, PhD, Volker Musahl, MD, and Andrew D. Pearle, MD Dr. Roche is the Chief Attending Orthopaedic Surgeon, Department of Orthopaedic Surgery, Holy Cross Hospital, Fort Lauderdale, Florida. The goals of computer-assisted surgery (CAS) are to be patient-specific, minimally invasive, and quantitative. CAS can involve preoperative imaging and planning, intraoperative execution, and postoperative evaluation. Ideally, these components are integrated such that sophisticated diagnostic technologies are used to inform a patient-specific surgical plan. A recently developed CAS/robotic system has the potential to improve alignment in and results of unicompartmental knee arthroplasty. This new robot is “semiactive”; that is, the surgeon retains ultimate control of the procedure while benefiting from robotic guidance within target zones and boundaries. Surgeons who use the robotic arm–assisted technique described in this article can prepare and then precisely execute a patient-specific computed-tomography–based operative plan. The surgical field is predefined, and the active constraints used by the robotic arm eliminate inadvertent deviation outside this field, thus minimizing iatrogenic morbidity and maximizing bone preservation. In this article, we detail the preoperative planning and intraoperative technique for robotic arm—assisted unicompartmental knee arthroplasty. Am J Orthop. 2009;38(2 suppl):10-15.
16	Perioperative Management of Unicompartmental Knee Arthroplasty Using the MAKO Robotic Arm System (MAKOplasty) Andrew D. Pearle, MD, Daniel Kendoff, MD, PhD, Volker Stueber, MS, Volker Musahl, MD, and John A. Repicci, MD Dr. Pearle is Assistant Attending Orthopaedic Surgeon, Orthopaedic Department, Hospital for Special Surgery, New York, New York. Unicompartmental knee arthroplasty (UKA) is a popular treatment for unicompartmental knee arthritis. Indications for UKA include mechanical axis of less than 10° varus and less than 5° valgus, intact anterior cruciate ligament (ACL), and absence of femorotibial subluxation. Appropriately selected patients can expect UKA to last at least 10 years. UKA failures are not common and involve technical errors that are thought to be corrected with use of newly developed robotic technology. The surgeon using this technology may be able to arrive at a set target, enhance surgical precision, and avoid outliers. Whether improved precision will result in improved long-term clinical outcome remains a subject of research. In this article, we describe the perioperative management of patients who undergo UKA whether with conventional techniques or robotic arm assistance. We also describe the distinct aspects of preoperative, intraoperative, and postoperative pain management and of intraoperative anesthesia and blood management. Am J Orthop. 2009;38(2 suppl):16-19.
20	Outcomes of Robotic Arm—Assisted Unicompartmental Knee Arthroplasty Raj K. Sinha, MD, PhD Dr. Sinha is President, S.T.A.R. Orthopaedics, and Medical Director, Bone and Joint Institute, La Quinta, California. Early outcomes of unicompartmental knee arthroplasty performed with a robotically assisted navigation system have been favorable. The surgical technique enhances accuracy of bone preparation and component positioning. Technical errors of the system have been minimal. The surgeon’s learning curve is not adversely affected. Early patient outcomes are excellent and complications minimal. Further follow-up and study will help to determine whether these early outcomes are sustained over time. Am J Orthop. 2009;38(2 suppl):20-22.
23	Haptic Robotics Enable a Systems Approach to Design of a Minimally Invasive Modular Knee Arthroplasty Scott A. Banks, PhD Dr. Banks is Assistant Professor, Department of Mechanical and Aerospace Engineering and Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida. Novel arthroplasty tools present opportunities for exploring new implant designs, and such is the case for surgeon-guided or haptic robotic technology. These systems allow surgeons to sculpt bone precisely with or without direct visualization of the surgical site. It is in this context that we explored a novel system of implant components for modular knee arthroplasty intended to maximize the benefits of the robotic tools. In this article, we present the constraints, data, and decisions made to produce a version of a system of implant components for robot-assisted modular knee arthroplasty of the cruciate-intact knee. Am J Orthop. 2009;38(2 suppl):23-27.
28	Modular Bicompartmental Knee Arthroplasty With Robotic Arm Assistance Jess H. Lonner, MD Dr. Lonner is Director, Knee Replacement Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania, and Director, Philadelphia Center for Minimally Invasive Knee Surgery, Philadelphia, Pennsylvania. Modular bicompartmental arthroplasty is an emerging knee-resurfacing approach that provides a conservative alternative to total knee arthroplasty. Isolated bicompartmental arthritis involving the medial or lateral and patellofemoral compartments, but with no significant deformity or bone deficiency, preserved motion, and intact cruciate ligaments, can be effectively managed with this treatment method. For the many young and active patients with isolated bicompartmental arthritis, given the potential durability of the procedure and the prosthesis, it is appropriate to use an approach that is more conservative than total knee arthroplasty. Robotic arm assistance for modular bicompartmental arthroplasty optimizes component position and alignment, which may improve system performance and long-term durability. In addition, a percentage of patients who undergo isolated unicompartmental or patellofemoral arthroplasty may later develop progressive arthritis in an unresurfaced compartment. Their cases may be effectively managed with a staged modular approach to resurfacing the degenerating compartment, but additional study is needed. Am J Orthop. 2009;38(2 suppl):28-31.
32	Technology and Cost-Effectiveness in Knee Arthroplasty: Computer Navigation and Robotics Michael L. Swank, MD, Martha Alkire, CNP, Michael Conditt, PhD, and Jess H. Lonner, MD Dr. Swank is Director, Joint Replacement Program, Jewish Hospital, Cincinnati, Ohio, and President, Cincinnati Orthopaedic Research Institute, Cincinnati, Ohio.. Our aim in this article is to describe the impact that navigation technology has had on the market share of a community hospital and, specifically, to determine whether a high-volume surgeon using these technologies actually costs the hospital more than other surgeons at the same hospital and more than national means. In addition, we develop a comparable cost-effectiveness model for robotic technology in unicompartmental knee arthroplasty to demonstrate the potential cost-effectiveness at the same hospital. Am J Orthop. 2009;38(2 suppl):32-36.

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