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Biomedical subjects

A E Inglis

Publications and source records attributed to A E Inglis.

At least 55 records · Page 3Linked to original sources
PubMed1986

Total elbow arthroplasty in the face of significant bone stock or soft tissue losses. Preliminary results of custom-fit arthroplasty.

There is a class of patients with severe bone stock or soft tissue losses who remain an unsolved problem in elbow reconstruction. The authors report the results of 16 such patients who underwent 16 total elbow replacements. Follow-up averaged 4.0 years (range, 2.0-9.6 years). Fourteen patients had previous surgery on their elbows and three had been previously infected. Fourteen of the 16 patients had a good or excellent result, and overall elbow scores averaged 90 (range, 53-100). There were three reoperations and one case of nonprogressive circumferential lucent lines about a humeral component with clinical symptoms. There were no other cases of clinical or radiographic implant loosening and no implant fractures. The preliminary results of this study indicate that custom-fit total elbow arthroplasty offers acceptable functional results in a devastated elbow when normal methods of reconstruction are not suitable.

Elbow Joint↗
PubMed1985

Giant cell reparative granuloma in the hand: report of three cases and review of the literature.

Occurrence of giant cell reparative granuloma (GCRG) outside the jaw, skull, or facial bones is unusual. Three recent cases of GCRG occurring in the hand are presented. This lesion appears on radiographs as a lucent, expansile defect in bone, similar in appearance to enchondroma, giant cell tumor of bone, aneurysmal bone cyst, or brown tumor of hyperparathyroidism. Histologically, GCRG is characterized by spindle-shaped, fibroblastic stoma with scattered, small, angulated giant cells and areas of osteoid formation around foci of hemorrhage. Establishing the pathologic diagnosis is frequently difficult. Misdiagnosis occurred in approximately half of the reported cases and in one of our cases. The typical clinical presentation is that of localized pain and swelling. GCRG is not a neoplastic disorder; however, it recurred locally in a third of the reported cases. Recommended treatment for GCRG is thorough removal of the diseased tissues and grafting of autologous bone.

Adolescent↗
PubMed1985

Total knee arthroplasty in hemophilia.

Twenty-four total knee arthroplasties were performed in fourteen disabled patients with hemophilia. The average age of the patients at operation was thirty-five years. Twenty-one of the implants that were used were total condylar prostheses. Using The Hospital for Special Surgery knee-rating system after two to nine years of follow-up, the result in fifteen knees was rated as excellent; in six, as good; and in one, as fair. Two patients had a poor result that was attributable to late infection. Pain and function were markedly improved, and the average gain in range of motion was 23 degrees. Postoperative complications, in addition to the infections, included one subcutaneous hematoma, one hemolytic anemia, and one instance of inhibition to Factor VIII. The technical problems in treatment were formidable. Total knee arthroplasty in a hemophiliac can be successful, but it should be performed only with strict hematological supervision. The surgeon should be prepared to treat many potential postoperative complications.

Adult↗
PubMed1984

Glutaraldehyde-preserved pericardial allografts for pericardial closure.

Repeat cardiac surgery is significantly more difficult than the original surgery. Pericardial closure to limit adhesion formation between the heart and mediastinal structures and thus reduce the increased difficulty of reoperation has been considered. To investigate the feasibility of effecting loose pericardial closure with homologous pericardial grafts, glutaraldehyde-preserved pericardial allografts were implanted in 10 mongrel dogs. After a mean period of 6.7 months (range 6 to 8 months) the grafts were studied grossly and histologically. Adhesion formation was minimal and the adhesions were easily dissectible. The allografts evoked no significant inflammatory response. No infections resulted from graft placement. It is concluded that glutaraldehyde-preserved pericardial allografts may be useful to effect pericardial closure and deserve further investigation in this regard.

Animals↗
PubMed1984

Total ankle replacement in rheumatoid arthritis.

The indications for total ankle-replacement arthroplasty are controversial. Some preliminary experience with its use in patients with rheumatoid arthritis has been disappointing. However, in our fifteen single-axis arthroplasties, fourteen of the Mayo and one of the Buchholz type, after an average follow-up of thirty-nine months seven ankles were rated excellent and eight, good. The relief of pain was gratifying in all of the patients, only four patients having residual slight pain with starting activity. The average gain in the range of motion was 9 degrees. No patient had loosening that required reoperation, although radiolucent lines were seen in eleven ankles. Thirteen of the fifteen ankles had moderate to severe arthritic changes in the talonavicular, subtalar, or other intertarsal joints.

Adult↗
PubMed1983

Total knee arthroplasty in juvenile arthritis.

Sixteen patients with 29 knee arthroplasties due to juvenile arthritis were studied. Eight patients had been wheelchair-bound and were nonambulatory due to hip and knee involvement. Surgery was indicated for correction of deformity, decreased range of motion, and relief of pain. The average preoperative disability score was 40.3, and postoperative score was 79.9. Thirteen of the 16 patients also required bilateral hip replacement arthroplasty. The average hospital stay for bilateral knee arthroplasty under one anesthesia was 45.3 days. The average followup was 36 months with a range of 24 months to 7 years. The overall results were excellent in 13 knees, good in 11, fair in 3, and poor in 2. Ambulation improved in all but 2 of the knees. Of the 2 failures, 1 was due to deep infection and the other to severity of disease and poor cooperation of the patient, who remains wheelchair-bound.

Adolescent↗
PubMed1982

Surgical treatment of lesions of the long head of the biceps.

A follow-up study was carried out on 20 patients with a Hitchcock type of biceps tenodesis performed during the past seven years at the Hospital for Special Surgery. Thirteen cases were diagnosed as biceps tendinitis and seven as biceps instability. At follow-up, there was a 30% failure rate; the failures were related to misdiagnosing biceps instability, not identifying an impingement syndrome, or glenohumeral instability. Those patients who were relieved of symptoms had in addition to biceps tenodesis, an excision of a portion of the coracoacromial ligament. In four of the six failures, the coracoacromial ligament was not released. Two patients had a fixed dislocation of the biceps tendon noted preoperatively by arthrography and confirmed at surgery, and were successfully treated by biceps tenodesis. Two other patients who had unsuccessful biceps tenodesis and coracoacromial ligament excision were subsequently shown to have humeral head impingement with the coracoid process. Coracoid osteotomy relieved their pain. The role of the biceps tendon in the production of shoulder pain is difficult to assess and is easily overestimated, The biceps tendon inflammation may be a secondary manifestation of an impingement syndrome and unless treated as such, surgery will not be successful. Conversely, biceps lesions secondary to disorders of the bicipital groove can be treated by tenodesis. Instability of the biceps tendon can be difficult to evaluate preoperatively. Arthrography was noted to be diagnostic in dislocation of the biceps tendon.

Adolescent↗
PubMed1982

The structure of the posterolateral aspect of the knee.

The lateral structures of the knee can be divided into three distinct layers. The deepest layer, the lateral part of the capsule, divides into two laminae just posterior to the overlying iliotibial tract. These laminae encompass three ligaments: the lateral collateral, the fabellofibular, and the arcuate ligaments. Three major anatomical variations are seen: reinforcement of the capsule by the arcuate ligament alone (13 per cent), by the fabellofibular ligament alone (20 per cent), and by both ligaments (67 per cent). One can predict which variation will be seen in a given patient from the information provided by a radiograph and by physical examination.

Humans↗
PubMed1982

Methylmethacrylate stabilization for enhancement of posterior cervical arthrodesis in rheumatoid arthritis.

Stainless-steel wire, titanium mesh, and perforated titanium sheets and methylmethacrylate were used in conjunction with autogenous iliac-bone grafts to provide immediate stability in difficult or long posterior cervical fusions in eleven patients with rheumatoid arthritis, who were followed for three to 12.5 years. Two surgical techniques, using methylmethacrylate and metal supplementation of a traditional posterior cervical arthrodesis, are described. One technique includes the occiput, while the other consists of a long posterior fusion that excludes the occiput. In ten of the eleven patients, permanent radiographic stability was maintained as well as a significant reduction of pain and resolution of neural dysfunction. In the eleventh patient a cervical subluxation developed at the distal end of the rigidly fused segment, and eventually the patient died. Four patients who were seen early in the series had wound dehiscences, two of which were infected. Subsequently the methacrylate-metal composite was reduced in volume, and this problem did not recur. In summary, this technique has provided immediate internal splinting and avoided bulky external-fixation devices. It was most useful in fusions of the occiput to the upper part of the cervical spine, in long posterior cervical arthrodesis, and for the repair of pseudarthroses when traditional arthrodesis techniques had failed.

Adult↗
PubMed1982

Revision surgery following a failed total elbow arthroplasty.

The need for revision surgery following total elbow arthroplasty can be minimized if certain principles are observed. These include careful preoperative assessment for diaphyseal bone size, the presence of anatomic resources for arthroplasty, the possible need for future adjacent joint arthroplasties, meticulous surgical detail during the arthroplasty, and prompt diagnosis and correction of postoperative problems. Many of the problems following total elbow arthroplasty can be surgically corrected by replacing the high-density polyethylene bearing. Other problems are amenable to arthrodesis of the joint. Although the complication rate and need for revision surgery have diminished with improved implant design and improved surgical technology, it is helpful both to the patient and to the surgeon to discuss the potential problems and the risk versus gain ratio with the patient so that a clear understanding of the reconstruction is understood by everyone.

Elbow Joint↗
PubMed1981

Surgical repair of ruptures of the tendo Achillis.

Clinical data on 163 ruptures of the Achilles tendon demonstrated that recreational activity was a common cause. The technique of surgical repair includes local tendon graft, repair of deep fascia, and an angulated incision that relieves local tissue tension, prevents serious wound complications and provides satisfactory functional results. Measurements of power potential, a velocity-dependent parameter, rather than peak strength, provide a better indication of the true functional result after repair of Achilles tendon ruptures. The isokinetic torque developed in the triceps surae subsequent to surgical repair is 85% of that on the normal side. The peak strength after operation is 101% of the opposite side. Rather than chronic tendonitis or ischemia, uncontrolled power in a suboptimally conditioned musculotendinous unit may cause spontaneous ruptures.

Achilles Tendon↗
PubMed1980

Perforation of the femoral shaft during total hip replacement.

Perforation of the femoral shaft by the prosthetic stem as a complication of total hip replacement is not well described in the literature. We studied twelve patients with this complication in order to define the predisposing factors, optimum management, and long-term outcome. Each patient was found to have one or more of the following factors: female sex, osteoporosis, previous fracture, or previous surgery. Once the complication was recognized, management consisted of protected weight-bearing for six weeks. All but two of the patients were asymptomatic after an average follow-up of five years. Judging from the long-term roetgenographic follow-up, penetration of the femoral shaft does not appear to seriously compromise the fixation of the femoral component.

Aged↗
PubMed1980

Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis.

Thirty-five total hip arthroplasties done in twenty-five patients with protrusio acetabuli secondary to rheumatoid arthritis were reviewed. There was an average follow-up of 4.3 years, with a range of three to seven years. The results were rated as excellent or good in 66 per cent, fair in 26 per cent, and poor in 8 per cent. Although 100 per cent demonstrated cementbone interface demarcation around the acetabular component, only 10 per cent showed progression of the line of demarcation to two millimeters and one had acetabular loosening with migration. Eight per cent showed femoral loosening or subsidence; 8 per cent, calcar resorption; and 6 per cent, a receding cortex with cystic changes. Twenty-three per cent had nonunion of the greater torchanter after trochanteric osteotomy. Type-III cement-bone interface demarcation was present around the acetabular component was positioned one centimeter superiorly or medially beyond the anatomical position, as estimated by the method described. In thirteen hips in which the acetabular component was positioned within five millimeters of the anatomical position, no Type-III demarcation was present. Better fixation and position of the acetabular component is achieved by the use of a bone graft or a special titanium perforated-sheet mesh, or both, or by an acetabular shell. The use of three wires improved trochanteric fixation.

Arthritis, Rheumatoid↗
PubMed1980

Total elbow replacement.

Thirty-one patients who underwent thirty-six total elbow replacements between 1974 and 1977 were followed for a minimum of two years with an average of 3.7 years. A scoring system was used to quantitate results. Patients with rheumatoid arthritis and functional disability primarily related to pain benefited most from the operation. Patients with post-traumatic arthritis and disability secondary to loss of motion benefited least. The over-all complication rate was 53 per cent and the reoperation rate was 22 percent. However, only one-fourth of the complications adversely affected the final outcome. Total elbow replacement can give good results in carefully selected patients.

Adolescent↗
PubMed1979

GUEPAR knee arthroplasty results and late complications.

One hundred eight GUEPAR knee arthroplasties have been studied with a follow-up of one year on 41; 2 years on 22 and 3 years on 45 knees. Overall results were 17% excellent, 44% good, 10% fair and 29% poor. Excellent results were comparatively fewer in rheumatoid arthritis. There was a deterioration in the quality of results of arthroplasty with longer follow-up. The incidence of deep infection was 11%. There was a significant correlation between early wound drainage and deep infection. More than half of the infected knees have not required intervenition as yet. One knee was revised and 3 had attempted arthrodesis with one successful fusion. Two patients died with septicemia. Axle migration occurred in 8 knees and femoral stem breakage in 2 knees. Loosening was found in 27% of the knees with progressive reduction in quality of the arthroplasty. Incomplete cementing predisposed to loosening. Patellar symptoms were present in 28% of the knees. Patellar subluxation and dislocation occurred in 49% of the knees. More than half of these were symptomatic. With normal patellofemoral alignment, pain was more common in the osteoarthritic knee. Use of a patellar implant with GUEPAR knee prostesis should be restricted to severely disabled patients with major fixed deformities. Mechanical failure can be minimized by proper positioning of the implant, correct alignment of the extensor mechanism and adequate cement around the entire stem.

Adolescent↗