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Biomedical subjects

A Cracchiolo

Publications and source records attributed to A Cracchiolo.

At least 19 recordsLinked to original sources
PubMed1992

A method for measuring foot pressures using a high resolution, computerized insole sensor: the effect of heel wedges on plantar pressure distribution and center of force.

A new, high resolution, pressure-sensitive insole was tested and found to provide reproducible measurements of static and dynamic plantar pressures inside the shoe of normal test subjects under certain conditions. However, calibration between separate sensors was poor and the sensor pads showed significant wear with use. This system was also used to investigate the effect of heel wedges on plantar foot pressure to determine whether this system was sensitive enough to detect the effect of a gross shoe modification on plantar foot pressure. Medial heel wedges decreased plantar pressures under the first and second metatarsals as well as under the first toe, and shifted the center of force laterally in all portions of the foot. Lateral heel wedges decreased pressures under the third, fourth, and fifth metatarsals, increased pressures under the first and second metatarsals, and shifted the center of force medially in all portions of the foot. Our evaluations indicate that it is possible to measure static and dynamic plantar foot pressures within shoes and to study the possible effect of shoe modifications on plantar pressures in controlled gait trials.

Adult↗
PubMed1992

Stability of an ankle arthrodesis fixed by cancellous-bone screws compared with that fixed by an external fixator. A biomechanical study.

Twenty-three fresh-frozen human specimens were subjected to ankle arthrodesis and fixation with two cancellous-bone screws. The specimens were then subjected to four newton-meters of manually applied tibial torque, plantar flexion-dorsiflexion moment, and medial-lateral bending moment; relative rotation between the tibia and the talus was recorded for each mode of testing. A Calandruccio triangular compression device was then applied to threaded pins penetrating the tibia and talus, the screws were removed, and the test sequence was repeated. Tibiotalar motions recorded with both systems of fixation were markedly affected by the quality of the bone. When less than 2 degrees of total tibiotalar rotation was recorded in response to four newton-meters of manually applied internal-external tibial torque, all specimens demonstrated less torsional rotation with the screw fixation than with the external fixator. The mean rotations produced by medial-lateral bending moment were equivalent for both systems of fixation. When torsional rotations with the use of screw fixation were greater than 2 degrees, all specimens demonstrated more torsional rotation with the screws than with the external fixator, and all but one specimen had more medial-lateral rotation with the screws than with the fixator. For applied plantar flexion-dorsiflexion moment, twenty-two of the twenty-three specimens demonstrated more rotation with the Calandruccio fixator than with the screws; this was due in part to motion permitted at the hinge points of the frame itself.

Aged↗
PubMed1992

Uncemented total hip arthroplasty in rheumatoid arthritis diseases. A two- to six-year follow-up study.

Forty primary uncemented total hip arthroplasties (THAs) were performed in 34 patients with an average age of 41.2 years (range, 21-78 years). Four hips had one component placed with cement: three femoral, one acetabular. Diagnoses included rheumatoid arthritis (30 hips), juvenile rheumatoid arthritis (seven hips), and systemic lupus erythematosus (three hips). The follow-up period averaged 3.7 years (range, two to six years). Thirty-five percent of the patients were using corticosteroids before hip replacement and throughout the follow-up period, whereas 44% of the patients had been using steroids in the past. Additionally, 79% of the patients were taking some form of antiinflammatory medications at follow-up examination. Clinical evaluation based on a ten-point rating scale indicated significant improvements from preoperative to the most recent follow-up examination for pain (from 3.1 to 9.0), walking (4.0-7.3), function (3.5-6.0), and activity (3.0-4.9). None of the hips required revision surgery, and none are pending. There was no evidence of roentgenographic failure; however, 43% of femoral and 12.8% of acetabular components showed some minor radiolucencies with sclerotic lines. None of these involved 100% of the bone-prosthesis interface. Femoral component subsidence occurred in two hips, and acetabular component migration occurred in one hip. Complications included three (8.1%) intraoperative femoral fractures, of which two required internal fixation. One patient had postoperative, culture negative, wound drainage. No deep sepsis occurred. These findings suggest that uncemented THA may be successful in the rheumatoid patient. Pain relief, walking, function, and activity levels are similar to those seen in cemented replacements with this length of follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1992

Arthroplasty of the first metatarsophalangeal joint with a double-stem silicone implant. Results in patients who have degenerative joint disease failure of previous operations, or rheumatoid arthritis.

Sixty-six patients who had a total of eighty-six double-stem silicone implants in the first metatarsophalangeal joint were followed prospectively for an average of 5.8 years (range, two to fifteen years). There were two groups of patients: thirty-four patients (thirty-seven implants) who had degenerative joint disease (including those who had hallux rigidus or in whom a previous operation on a bunion had failed) and thirty-two patients (forty-nine implants) who had rheumatoid arthritis. The implants were used only if the patient was a candidate for an excisional arthroplasty or an arthrodesis; they were not used in patients who wished to maintain or adopt very active use of the foot (such as in running, jogging, and tennis) or to wear very high heels. Twenty-eight (82 per cent) of the thirty-four patients in the first group were completely satisfied and three (9 per cent) were somewhat satisfied. However, three patients (9 per cent), all of whom had had a failed bunionectomy, were dissatisfied; the ages of these three patients were less than the average age of all patients in the first group. Radiographs showed a fracture in three implants, but the patients had a good clinical result and an additional operation was not warranted. Twenty-seven (84 per cent) of the thirty-two patients in the second group were completely satisfied, four (13 per cent) were somewhat satisfied, and one (3 per cent) was dissatisfied. Radiographs showed a fracture in five implants. Four of the implants caused no symptoms, and the result was good; the fifth one was fragmented and was removed because of symptoms. Radiographs showed radiolucent areas around the implant and hypertrophic changes in many patients. There was no evidence of synovitis, such as that caused by silicone, either clinically or radiographically. We found that the double-stem silicone implant was effective in reconstructing the first metatarsophalangeal joint but emphasize our belief that it should be used only in carefully selected patients.

Adult↗
PubMed1992

Ilizarov ankle arthrodesis.

Six consecutive patients, four with failed infected ankle fusions and two with posttraumatic degenerative ankle arthritis, were treated by monofocal compression arthrodesis using the Ilizarov external fixator. The average age was 48 years (range, 33-74 years). The average preoperative duration after failed infected ankle fusion was 18 months and for posttraumatic arthritis after fracture, 23 months. Infected failed pseudarthroses had significant fixed valgus deformity of the foot, bilateral draining sinuses, and near complete destruction and loss of the talus. Compression was dynamically applied during treatment. Custom foot plates were secured to the frame, and weight bearing as tolerated was allowed throughout the treatment period. Tibiocalcaneal fusion was obtained in three of four infected failed ankle fusions at an average of seven months (range, five to nine months). There was no evidence of infection at follow-up evaluation in these patients. One patient did not tolerate the frame and developed a fibroarthrosis. One patient sustained a refracture of the fusion at six months. Successful tibiocalcaneal fusion was obtained with reapplication of the frame and a Pappineau graft. Two primary ankle fusions healed with tibial talar fusion at an average of 3.5 months. Overall follow-up time averaged 26 months (range, 19-30 months). Six wires broke, requiring simple replacement. Four of these six were 1.5-mm wires. The Ilizarov frame may have several advantages in primary ankle arthrodesis and in the salvage of infected failed ankle fusions.

Adult↗
PubMed1992

Arthrodesis of the ankle in patients who have rheumatoid arthritis.

We reviewed thirty-two arthrodeses of the ankle in twenty-six patients who had rheumatoid arthritis. In seventeen patients (eighteen ankles), a compression arthrodesis was done and external fixation was used. In eight patients (twelve ankles), we used internal fixation with 6.5-millimeter cancellous-bone screws. In the remaining patient, an arthrodesis with external fixation was done in one ankle and internal fixation was used in the other ankle; data for the appropriate ankle are included in each group. The patients were followed for an average of thirty-three months. The two groups were comparable with respect to age, sex, preoperative medications, and severity of disease. The average time to fusion was nineteen weeks in the compression arthrodesis group and seventeen weeks in the internal fixation group. Of the nineteen ankles that had a compression arthrodesis, four failed to fuse; all of the failures were associated with infection. Infection developed in two additional patients, there was malposition of the fusion in three patients, and neurapraxia developed in three patients. Of the thirteen ankles that had internal fixation, three ankles failed to fuse; one of the failures was associated with infection. Infection developed in one additional ankle. In two patients, the ankle fused in excessive valgus. Comparison of the two groups revealed comparable rates of fusion: fusion occurred in fifteen of the nineteen ankles in the group that had compression arthrodesis and in ten of the thirteen ankles in the group that had internal fixation. The method of arthrodesis did not affect the time to fusion or the rate of complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Total knee arthroplasty using the total condylar III knee prosthesis.

Twenty-seven total knee arthroplasties (TKAs) were performed in 24 patients using the total condylar III knee prosthesis (TCP III) and were evaluated clinically and radiographically with a mean follow-up period of 4 years. Eighteen were revision TKAs, and nine were primary knee arthroplasties. Evaluations were made using the Hospital for Special Surgery (HSS) knee scale as well as the Knee Society radiographic evaluation method. Clinical results for all knees were 11% (3 of 27) excellent, 70% (19 of 27) good, 15% (4 of 27) fair, and 4% (1 of 27) poor. The one poor rating resulted from an intraoperative vascular injury. The results showed no statistical difference between revision and primary TKA. After operation, pain relief, range of motion, walking, function, and activity level improved in both the primary and revision patients. Radiolucencies 2 mm or greater in width were found in 6 of the 27 tibial components, in none of the 27 femoral components, and in 1 of the 19 patellar components. Only two tibial implants showed progressive radiolucencies. No correlation was found between the radiographic position of the implants and the clinical results. The authors conclude that the TCP III is a satisfactory choice for TKA in selected knees in which there is significant instability and in which intramedullary fixation is required.

Adult↗
PubMed1991

[Arthrodesis technique in post-traumatic foot disorders].

Surgical arthrodesis procedures are effective in stabilizing painful joints in the foot. Joints most suitable for arthrodesis are: the hallux joints, midfoot, and hindfoot joints. The use of internal fixation is recommended whenever possible to ensure a successful fusion. However, surgical technique is most important as is the final position of the fused joints.

Adult↗
PubMed1991

Periprosthetic chronic inflammation characterized through the measurement of superoxide anion production by synovial-derived macrophages.

Periprosthetic macrophages were isolated from the synovium of primary and revision arthroplasty patients. Inflammatory activity was determined by the level of superoxide (O2-) production de novo and in response to phorbol myristate acetate (PMA) stimulation. Nonstimulated primary arthroplasty-derived macrophages produced 2.54 +/- 2.04 pmoles of O2-/minute/10(5) cells. When identical reaction tubes were stimulated with PMA, O2- levels increased to 5.76 +/- 3.77 pmol of O2-/minute/10(5) cells. Nonstimulated revision arthroplasty-derived macrophages produced 3.26 +/- 2.02 pmol of O2-/minute/10(5) cells during this ten-minute time period. When identical reaction tubes were stimulated with PMA, O2- levels increased to 3.98 +/- 2.52 pmol of O2-/minute/10(5) cells. The difference in the ratio of O2- production in response to stimulation between primary and revision groups was statistically significant. The observation of a chronic moderate level of activation and the lack of responsiveness to a potent stimulator suggests that macrophage inflammatory activity is down-regulated in periprosthetic synovium.

Adult↗
PubMed1991

Total knee arthroplasty in patients after patellectomy.

Twenty-six total knee arthroplasties (TKAs) were evaluated in 22 patients who had had a patellectomy. Fourteen knees (12 patients) had a primary TKA, and 12 patients had a revision TKA. Two patients in the revision group, whose prostheses failed, were from the primary TKA group. The mean follow-up time was 8.5 years in the primary TKA group and 7.6 years in the revision TKA group. A group of 14 control knees with patellae was randomly generated but matched for prosthesis, diagnosis, surgeon, age, and time of surgery. This group was similarly evaluated with an average follow-up time of 6.9 years. The primary TKA group had seven knees that were rated as good or excellent, two as fair, and three as poor. The control group had a significantly higher average rating than the primary TKA group. In this group, there were 12 good or excellent knees, three fair, and none poor. Postoperative pain, flexion contracture, extension lag, and range of motion all contributed significant information to the final score, whereas other variables (walking, function, strength, and instability) did not contribute any additional information. Although higher overall scores may have been expected if the patients had patellae, the results during the follow-up examination were satisfactory and justified TKA in these patients. In general, however, patients without patellae may be at a higher risk for failure of the prosthesis, as seen in five patients having primary TKA and another ten patients with failed TKA requiring revision.

Adult↗
PubMed1991

Shoulder arthroplasty for rheumatoid arthritis.

Forty-two Designed After Natural Anatomy (DANA) total shoulder arthroplasties (Howmedica, Rutherford, New Jersey) were performed in 34 rheumatoid patients. Thirty shoulders in 23 patients were followed for a minimum of two years. Twelve of the 30 shoulders (40%) had significant rotator cuff tears. The average rating for pain improved from 3 points preoperatively to 8 points postoperatively for the overall group, and the average rating for function improved from 3 points preoperatively to 6 points postoperatively. Range of motion (ROM) improved substantially in patients treated with a regular glenoid component. Four patients were treated with hooded glenoid components designed to improve stability for shoulders in which the rotator cuff was deficient. In the rotator-cuff-deficient patients, pain and function improved; however, ROM was unchanged. Complications, including one acromial fracture and two loose glenoid components, required revision surgery.

Aged↗
PubMed1991

Total knee arthroplasty in rheumatoid arthritis. A comparison of the polycentric and total condylar prostheses.

From 1971 to 1985, 393 total knee arthroplasties (TKAs) were performed in patients for rheumatoid arthritis. Of these, 112 used polycentric prostheses and 131 used total condylar prostheses. One hundred seven of the patients with polycentric prostheses and 102 of the patients with total condylar prostheses were followed for a minimum of two years (average, 61 and 55 months, respectively). At the time of the latest examination, nine knees with polycentric prostheses required revision surgery: six for tibial component loosening and instability and three for patellofemoral pain. Five knees with total condylar prostheses required revision: one for chronic instability, one for a late posttraumatic patellar fracture, and three for late hematogenous infections. The total condylar prostheses with patellar resurfacing had better scores for pain (8.5 points) than the polycentric prosthesis without patellofemoral resurfacing (7.0 points). The total condylar prosthesis appeared more durable in terms of fixation, with no evidence of aseptic loosening of femoral or tibial components noted in this series thus far.

Arthritis, Rheumatoid↗
PubMed1991

Long-term follow-up of cemented total hip arthroplasty in rheumatoid arthritis.

Seventy-five primary cemented total hip arthroplasties (THAs) were performed in 53 patients with rheumatoid arthritis and juvenile rheumatoid arthritis. All patients were followed for an average of 7.4 years, unless their prosthetic hips failed before that time. Clinical evaluation was based on a 10-point maximum rating scale, and ratings for pain, walking, function, and activity improved from preoperative values to the most recent follow-up examination. Revision THA was performed for aseptic acetabular loosening in four hips, and femoral loosening in one hip. Sepsis occurred in another four hips. Complications of wound healing occurred in 14 hips. Roentgenographic evidence of loosening was seen in six acetabular components, in three femoral components, and in the femoral and acetabular component of one hip; none of these hips have as yet required revision THA. The Kaplan-Meier survivorship analysis revealed a 93% survival probability at seven years, which fell to 77% at 12 years in these patients. A trend was that younger, larger patients had increased failure and component loosening rates. Cemented primary THA has been a satisfactory operation in the rheumatoid patient. The relatively high rate of wound healing problems and sepsis may be due to the systemic immune nature of rheumatoid arthritis; however, 25% of these prosthetic hips either failed or are at risk for future failure. Thus, improved techniques are still necessary to increase the long-term success of THA in the rheumatoid patient.

Adolescent↗
PubMed1990

The use of the powered metaphyseal stapler for reconstructive procedures in the adult foot.

We have evaluated the Powered Metaphyseal Stapler in various procedures in the adult foot to determine the effectiveness of this form of internal fixation. Thirty-five patients had 40 operations (five bilateral). In all but one case there was both clinical and radiographic evidence of a solid bony union. Backing out of the staples has been a minor problem that has required staple removal in three patients. The Powered Metaphyseal Stapler appears to offer a most satisfactory option for internal fixation in the foot, when used in metaphyseal or cancellous bone, as either primary or adjuvant fixation.

Adult↗
PubMed1990

Total hip replacement for patients who have ankylosing spondylitis. The importance of the formation of heterotopic bone and of the durability of fixation of cemented components.

Fifty-three total hip replacements were performed in thirty-one patients who had ankylosing spondylitis. After an average period of follow-up of 6.3 years, cemented conventional hip prostheses proved to be very durable in this young population (average age, forty-three years). Only one primary conventional hip prosthesis was revised for aseptic loosening, seventeen years after implantation. Clinically important heterotopic bone (Classes III and IV of Brooker et al.) developed in 11 per cent of the patients, all of whom had had a previous operation on the hip, postoperative infection, or complete ankylosis preoperatively. If a patient has clinically important heterotopic bone after one operation on the hip, and an arthroplasty of the contralateral hip or reoperation on the same hip is to be done, prophylactic treatment should be considered for prevention of formation of heterotopic bone.

Adolescent↗
PubMed1990

Arthrodesis of the ankle with cancellous-bone screws and fibular strut graft. Biomechanical analysis.

The stability of an arthrodesis with two cancellous-bone screws across the ankle joint was evaluated in eighteen ankles from fresh-frozen cadavera. Tibiotalar motion was recorded in response to the following loading modes: medial-lateral moment, plantar flexion-dorsiflexion moment, and internal-external tibial torque. The series of loading tests was performed with two cancellous-bone screws through the tibia into the talus and a lateral fibular strut graft fixed with a proximal and a distal screw. The tests were repeated after the strut graft was removed, and again after it had been reapplied. The amount of motion at the site of the arthrodesis was greatest with tibial torque and was least with medial-lateral bending; this was true for specimens with or without a fibular strut graft. Removal of the strut graft allowed increased tibiotalar motion for all modes of loading; increases in motion were far greater for specimens of poor bone quality.

Aged↗
PubMed1990

Hindfoot arthrodesis in adults utilizing a dowel graft technique.

Surgical fusion may be indicated to stabilize deformed or painful hindfoot joints. Although more commonly performed in children or adolescents, it is the salvage procedure available for adults. Twenty-six patients (30 feet; 20 women, six men) followed for an average of 44.1 months after hindfoot arthrodesis were investigated in a prospective study. Most (20 patients, 24 feet) had inflammatory arthritis, usually rheumatoid, two had previous fractures, and four patients had other diagnoses. All had fusions done using a dowel graft technique. Twenty-four patients (92%) were completely satisfied with the operation, one had mild reservations, and the one dissatisfied patient was a technical failure. All joints were fused utilizing clinical and roentgenographic evaluation. A detailed roentgenographic assessment indicated that the talometatarsal angle was the most effective measurement to assess the clinical deformity. Anteroposterior weight-bearing roentgenograms of the ankle were also important in evaluating these patients preoperatively and postoperatively. Postoperatively, only nine ankles appeared normal roentgenographically, while the others worsened, and four required ankle arthrodesis.

Adult↗