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Biomedical subjects

A E Inglis

Publications and source records attributed to A E Inglis.

At least 37 records · Page 2Linked to original sources
PubMed1989

Total shoulder arthroplasty in rheumatoid arthritis.

Twenty-nine Neer-type total shoulder arthroplasties were performed in 26 patients with rheumatoid arthritis. The average age was 55.5 years and the average follow-up period was 37 months. On a 100-point scoring system, the average preoperative score of 25 improved to 71 after surgery. The most significant improvement was noted in pain relief. Radiographs demonstrated nonprogressive radiolucent lines in 86% of the glenoid components and 31% of the humeral components. Surgical problems included bone loss of the glenoid, acromioclavicular joint arthritis, and rotator cuff tears, in 7 of 29 shoulders. Follow-up study demonstrated poorer results for patients with rotator cuff tears. However, significant pain relief was achieved in 93% of our patients, despite limited functional improvements.

Adult↗
PubMed1989

Total knee arthroplasty in patients with psoriasis.

Patients with progressive psoriasis have an increased infection rate when having total joint arthroplasty. Therefore, maximum precautions should be taken in the perioperative period as well as with long-term follow-up care to prevent joint sepsis in these patients. In particular, skin care should be meticulous. Special attention should be given to use of a topical corticosteroid or other dermatologic treatment when total joint arthroplasty is considered.

Anti-Bacterial Agents↗
PubMed1989

Total elbow arthroplasty for complete ankylosis of the elbow.

Sixteen patients who received nineteen semiconstrained total elbow replacements for complete ankylosis of the elbow were followed for an average of five and three-quarters years (range, two to twelve years). The average preoperative elbow score was 23 points and the average postoperative score was 84 points. Postoperatively, the average flexion was 115 degrees; extension, 35 degrees; and pronation and supination, 95 degrees. There were fifteen excellent or good results. There was one failure due to a deep infection, but after removal of the prosthesis a satisfactory fascial arthroplasty was achieved in this elbow. Function was improved in all patients, and all patients had relief of the preoperative pain. For the arthroplasty to succeed, the patient must have a good understanding of the procedure and must be willing and able to comply with the postoperative rehabilitation program. The use of a semiconstrained, often custom-fit, implant is necessary. The Bryan-Morrey posteromedial approach to the elbow is recommended for the procedure, since this approach allows early institution of range-of-motion exercises.

Adolescent↗
PubMed1989

The effect of alignment of the implant on fractures of the patella after condylar total knee arthroplasty.

The results in thirty-six knees that had a fracture of the patella after a total condylar arthroplasty were reviewed, and were analyzed according to the type of fracture and the alignment of the implant and the limb. Most of the fractures occurred two years or less after the initial operation. Fourteen knees were rated fair or poor and twenty-two, good or excellent. None of the thirty-six implants had been aligned in the neutral range. In sixteen knees, the alignment had a minor variation from the neutral range--that is, the knees were in minor malalignment. In general, these knees had the least severe fractures and the best over-all results. All had a good or excellent result except one, which was revised because of a loose patellar component. That knee was rated as fair at the latest follow-up. There was a major discrepancy in the alignment of twenty implants. These knees had more severe fractures and less satisfactory results than those in the other group. In two of these knees, the fracture was treated non-operatively; one had a good and the other, a poor result. Twelve of the remaining knees, which were treated surgically, were rated as fair or worse. Two knees that had revision of three components and restoration of alignment to the neutral range had an excellent result. The results of this study indicate that the alignment and fit of a component are important in determining the severity of a fracture of the patella after condylar total knee replacement and the long-term results after treatment of the fracture.

Adult↗
PubMed1989

Salvage of non-union of supracondylar fracture of the humerus by total elbow arthroplasty.

Fourteen patients in whom open reduction and internal fixation could not be achieved satisfactorily had a total elbow arthroplasty for non-union of a supracondylar humeral fracture. All patients had an established non-union, and ten had had from one to four previous attempts at internal fixation. The average age at the time of operation was sixty-five years. The average duration of follow-up was five years, with a minimum of two years. The average preoperative elbow score was 17 points, with both pain and functional disability present. The average postoperative score was 84 points; there were eight good or excellent results and three failures. The latter three patients had an additional operation: one each for dislocation, loosening of the humeral component, and deep infection. Salvage of supracondylar non-union by means of a total elbow arthroplasty is a technically demanding procedure. Strict indications for selection of patients must be followed. A semiconstrained implant is recommended, with preservation of the epicondyles and their muscular attachments in order to achieve balance of the soft tissues.

Adult↗
PubMed1988

Total ankle arthroplasty. A procedural review.

Total ankle arthroplasty is a demanding surgical procedure, but the advantages of maintaining motion in the tibiotalar joint in the patient with systemic arthritis are known. Although the technology of ankle implant arthroplasty is still evolving, current results in properly selected patients approach the results of other leg implants.

Ankle Joint↗
PubMed1988

Preliminary results of total wrist arthroplasty in rheumatoid arthritis using the Trispherical total wrist arthroplasty.

Thirty-two patients underwent 38 arthroplasties for advanced rheumatoid arthritis and marked soft tissue losses. Seven wrists required repair or transfer of at least one tendon for rebalancing. All patients were improved by the implants. Thirty-four of the 38 patients were improved beyond the functional level of a painless wrist arthrodesis. Overall, there were 23 excellent, 10 good, 3 fair, and 2 poor results. The average wrist score was 90.3 points, and the average arc of motion was 38 degrees. There were three cases of migration of the third metacarpal stem and nine cases of lucency about the stems, three of which were progressive or greater than 1 mm. There were no deep infections. There was one reoperation for persistent pain and one for component loosening. There were no cases of implant failure. These results indicate that this total wrist arthroplasty is a safe, reproducible procedure for radiographic class III and IV rheumatoid disease and should be considered a first line of therapy for that group.

Adult↗
PubMed1988

An analysis of factors affecting the long-term results of total shoulder arthroplasty in inflammatory arthritis.

The authors studied 36 patients undergoing 50 total shoulder arthroplasties for inflammatory arthritis with an average follow-up period of 5 years (range, 2-9 years). There were 7 men and 29 women. Twenty-nine patients (38 shoulders) had rheumatoid arthritis, 6 patients (11 shoulders) had systemic lupus erythematosus, and 1 patient (1 shoulder) had psoriatic arthritis. Twenty-four of the procedures were performed on the dominant hand. Twenty-one patients (32 shoulders) were receiving steroids, chemotherapeutic agents, or Gold therapy at the time of arthroplasty. Using the Hospital for Special Surgery scoring system, 22 shoulders had excellent, 18 good, 1 fair, and 9 poor results. Forty-eight of 50 shoulders had satisfactory pain relief. The average shoulder score was 85 points (range, 50-100 points). There were no reoperations, infections, or persistent nerve palsies and no symptomatically loose prostheses, although there were three cases of glenoid component shift. Eighteen glenoid components and 4 humeral components had radiolucent lines and in two cases metaphyseal bone atrophy was noted about the proximal humerus with firm cement fixation and bone hypertrophy about the stem tip. Total shoulder arthroplasty provides a predictable reconstructive alternative for patients with inflammatory arthritis. Overall functional results are related to the biologic condition and motivation of the patient, the status of the rotator cuff, and prosthesis alignment.

Adult↗
PubMed1988

Total ankle arthroplasty in rheumatoid arthritis: a long-term follow-up study.

Patients with rheumatoid arthritis who had undergone total ankle arthroplasty and had a minimum of 2 yr follow-up were studied. Of the original 21 patients 17 were available for review. Twenty-three ankle replacements with an average follow-up of 5.6 yr were studied. On follow-up 2 ankles were rated excellent, 13 were rated good, 4 were rated fair, and 4 were rated poor. Thus, 83% were satisfactory on follow-up. Radiographic analysis revealed migration and settling of the talar component in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 tibial components with tilting in 12 of these components. The postoperative position of the implant did not correlate with the development of radiolucencies or migration of the implant.

Adult↗
PubMed1988

Patellar fracture type and prognosis in condylar total knee arthroplasty.

Fractures of the patella occurred following implantation of 36 condylar total knee arthroplasties in 35 patients. The end results were evaluated in relation to fracture type after an average 4.5-year follow-up period. The follow-up observations included a physical examination, quantitative knee score, and roentgenographic evaluations of extremity alignment and implant position. Twenty-two of the 36 knees had a good or excellent knee score and 14 had a fair or worse score at the time of the latest follow-up evaluation. The satisfactory knees had an average arc of motion of 100 degrees, while the unsatisfactory knees had an average arc of motion of 80 degrees. Fourteen fractures through the mid-body or superior pole of the patella not involving the implant, cement, or quadriceps mechanism (Type I) and two nondisplaced fractures through the inferior pole of the patella (Type IIIB) were managed nonoperatively, with all knees rating either a good or excellent score. Fractures of the patella disrupting the quadriceps mechanism or implant/bone/cement composite (Type II) were managed operatively in the six knees. Fractures of the inferior pole of the patella with disruption of the patellar ligament (Type IIIA) were managed operatively in seven of eight knees (one patient refused surgery). Lateral fracture-dislocations were managed operatively in all six knees. Six of the knees operated upon had a good or better score, and nine knees were rated as poor or failed. Those fractures alignment and implant position were seen had the more severe patellar fractures and poorest outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

One-stage bilateral total hip arthroplasty. A prospective study of perioperative morbidity.

Controversy exists over the safety of performing one-stage bilateral total hip arthroplasty. A prospective protocol was established in 35 patients to evaluate the perioperative morbidity of one-stage bilateral arthroplasty as compared with unilateral controls. Although there was no increase in the frequency of respiratory morbidity in bilateral procedures, respiratory depression is common with both procedures. The authors believe this is consistent with varying degrees of the adult respiratory distress syndrome and that the term fat embolism syndrome is misleading and should be abandoned.

Adult↗
PubMed1987

Total hip arthroplasty in rheumatoid arthritis. A long-term follow-up study.

This study was undertaken to assess the clinical and radiographic results of total hip arthroplasty in rheumatoid arthritis patients with a minimum of 10 years of follow-up evaluation. Eighty-three hips in 51 of the original 104 patients were available for follow-up study an average of 12.1 years following surgery. The average age of the patients at the time of surgery was 39.9 years (range, 14-72 years). Fourteen hips were revised, 11 for mechanical loosening and 3 for late infection. The overall revision rate is 16.7%; the revision rate for mechanical loosening was 13.3%. According to Merle D'Aubigne-Postel hip rating scores in the 69 hips that did not require revision, 19 hips were excellent (28%), 37 were good (54%), 11 were fair (15%), and 2 were poor (3%). Therefore, 67 of 83 hips (80.7%) were satisfactory on follow-up study. Radiographic evidence of loosening in nonrevised hips was found in 11 acetabular and 2 femoral components.

Adolescent↗
PubMed1987

Results of total elbow arthroplasty as a salvage procedure for failed elbow reconstructive operations.

Total elbow arthroplasty (TEA) was used as a salvage procedure following failed open reduction and internation fixation, failed triaxial arthroplasties, and septic and aseptic loosening of implant arthroplasty. A minimally constrained bicondylar implant with a block to disarticulation was substituted for the reconstruction of 20 revision TEAs. Custom-designed implant TEA was substituted in cases with substantial bony or soft tissue loss. Revision of the polyethylene-bearing component, coupled with the addition of a yolk-type locking mechanism, was implanted when only the bearing system of a well-fixed implant had failed. TEA can be performed successfully with satisfactory durability as a revision procedure. Revision of failed open reduction internal fixation or a failed bearing system was highly successful. Revision of previously infected elbows in a single-stage procedure was unsuccessful in two of three cases and has been abandoned in favor of a staged procedure. A revision of loose TEA was successful in only three of five cases. Further investigations are necessary to improve the function durability of TEA.

Arthroplasty↗
PubMed1987

Knee arthrodesis following total knee arthroplasty in rheumatoid arthritis.

Twenty-seven knees in 23 patients, all with seropositive rheumatoid arthritis and failed total knee arthroplasty, were treated by arthrodesis. Twenty of the 27 knees were solidly fused. A fusion aligned in 7 degrees +/- 5 degrees of valgus and knee flexion from zero to 30 degrees was associated with the highest rate of arthrodesis, the lowest rate of progression of disease in other joints, and the highest functional scores. Stable fixation using either internal or external fixation gave the most predictable rate of arthrodesis. Persistent sepsis and bone stock losses were associated with failure of arthrodesis, even under the best circumstances. All of the 20 successfully arthrodesed knees were completely functional.

Arthritis, Infectious↗
PubMed1986

A critical analysis of alignment factors influencing functional results following trispherical total wrist arthroplasty.

In a study of the impact of selected patient factors and alignment variables on functional results of total wrist arthroplasty, functional score and range of motion were found to be improved and incidence of component shift and progressive radiolucent lines decreased by proper positioning of the implant center of rotation and restoration of carpal height. Angulation of the implant stems was secondary in importance to the other positioning variables with respect to overall function and durability. A neutral alignment range for this implant arthroplasty was proposed. Within this neutral range, functional score averaged 94 points and range of motion averaged 68 degrees. There were no reoperations, component shifting, or progressive radiolucent lines, and all wrists rated an excellent score.

Arthritis, Rheumatoid↗
PubMed1986

A critical analysis of mechanical factors correlated with bone remodeling following total elbow arthroplasty.

Thirty elbows were critically reviewed for quantitative evidence of bone remodeling, with demonstrable bone remodeling noted in more than one half of the ulnae and humerii. Bone remodeling was analyzed statistically with independent variables of age, sex, handedness, diagnosis, implant design considerations, and implant alignment. Only implant design and alignment had a statistically significant impact on bone remodeling. Periarticular (zone 1) bone loss was statistically significantly correlated with a high percentage of diaphyseal medullary canal occupied by prosthesis, the presence of assymetric stem cortical contact, and lack of metaphyseal (zone 1) load transfer. Diaphyseal bone hypertrophy (zone 4) was statistically significantly correlated with a high percentage of diaphyseal medullary canal occupied by prosthesis (zone 4) and assymetric stem tip-to-cortical wall contact. Periarticular bone hypertrophy and diaphyseal bone atrophy did not occur. Fractures through the humeral condyles occurred in three elbows undergoing bone atrophy, but no implant loosening or failure could be correlated with bone remodeling. Bone remodeling does occur in a high percentage of stemmed elbow implants but to date has not been a factor in clinical failure.

Atrophy↗