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Biomedical subjects

A W Heywood

Publications and source records attributed to A W Heywood.

At least 19 recordsLinked to original sources
PubMed1994

The A1 pulley in rheumatoid flexor tenosynovectomy. To retain or divide?

We report a detailed comparative evaluation of flexor tenosynovectomy in 55 fingers in which the A1 pulley was divided and 45 fingers in which the A1 pulley was retained. The metacarpophalangeal joint subluxed volarly in 49% when the A1 pulley was divided, compared to 11% when the pulley was preserved. Bowstringing occurred in 7% and only when the A1 pulley was divided. Ulnar deviation was 7 degrees worse when the pulley was divided. Active range of movement was limited in both groups. It was 11 degrees less when the A1 pulley was divided.

Adult↗
PubMed1990

Patterns of failure in the original Besser bipolar prosthesis.

Fourteen original Besser endoprostheses inserted in young patients with osteonecrosis of the femoral head were reviewed. Two cups dislocated early and 1 other required replacement due to acetabular degeneration. Component disassembly occurred in 4 hips, which had exhibited persistently vertical cups. Their stems revealed notching medially and the cups showed gross erosion and failure. The remaining 5 hips were mobile and pain free, but in 3 of these the cups exhibited a persistently vertical orientation and, as such, are predisposed to failure. Only one article reporting early good results using this prosthesis has been published. The failure rate of 50% in this series is disappointing.

Adult↗
PubMed1989

Radiological loosening after cemented hip replacement for juvenile chronic arthritis.

We reviewed the results of 14 total hip replacements in patients with juvenile chronic arthritis. The mean age at operation was 16 years (range 12 to 22 years); follow-up was from four to 11 years (mean 8.5 years). Postoperatively pain relief was sustained in all but one hip, while movement generally remained significantly restricted. No hip has as yet required a revision operation, although eight hips (57%) show radiological changes suggestive of impending failure. All patients had severe polyarticular involvement with associated restriction of locomotor activity. Potential causes contributing to loosening such as continuing diaphyseal bone growth and increased immunocompetence in adolescence are discussed.

Adolescent↗
PubMed1988

Cervical spine instability in rheumatoid arthritis.

We present a study of 30 fusion operations in 26 rheumatoid arthritics with cervical spine instability. Atlanto-axial instability was present in 15, of whom 12 were fused; three had cord involvement and all made a partial or complete recovery following fusion. Cranial settling necessitated cranio-cervical fusion in four patients; all fused, and one with myelopathy was relieved. Subaxial instability required fusion in seven cases; two postoperative deaths followed the only two anterior interbody fusions. Posterior fusion was successful in the other five, with remission of neurological compromise in the three with myelopathy and one with radiculopathy. We conclude that neurological compromise in an unstable but mobile rheumatoid cervical spine can usually be brought to remission by immobilisation alone, so decompressive procedures are unnecessary in the first instance.

Arthritis, Rheumatoid↗
PubMed1988

Internal fixation for occipito-cervical fusion.

We describe a method of internal fixation for occipito-cervical fusion utilising a standard "small fragment" T-plate bent and fixed to the skull with three screws. The lower end of the plate is screwed and wired firmly to the spine of the axis. Of 14 patients so treated, 12 fused, one died and one failed to unite to the skull. Of eight with cord signs, seven remitted or improved and one died.

Arthritis, Rheumatoid↗
PubMed1986

Rheumatoid arthritis of the thoracic and lumbar spine.

We report seven cases of patients with seropositive rheumatoid arthritis in whom involvement of the thoracic and lumbar vertebrae occurred. Histological corroboration is presented in four. Pathological lesions comprised various combinations of paravertebral joint erosions, erosive discitis, anteroposterior and rotatory instability, major lumbar nerve root compression, and vertebral collapse. Specific radiological features are presented, enabling a distinction to be made between pure degenerative spondylosis and rheumatoid spondylitis. We submit that subcervical rheumatoid spondylitis is commoner than is generally believed, though less common than rheumatoid involvement of the cervical spine.

Aged↗
PubMed1985

A clinical evaluation of isoxicam in the treatment of osteo-arthritis.

Thirteen patients with osteo-arthritis entered a 12-month open-label assessment of the efficacy and safety of a single morning dose of isoxicam 200 mg. Pain scale scores were significantly reduced and this was accompanied by improvement in most of the symptoms. No patients suffered adverse reactions considered to be definitely related to the use of isoxicam and only 3 patients reported adverse reactions (mild weight gain, stomatitis, constipation) probably related to treatment. Isoxicam 200 mg once a day was effective and well tolerated in the long-term symptomatic treatment of osteo-arthritis.

Aged↗
PubMed1985

Hip replacement arthroplasty in rheumatoid arthritis.

Numerous factors conspire to make hip replacement arthroplasty for rheumatoid arthritis different from the same operation in osteo-arthritis. Patients are frequently younger, arousing fears that the patient will outlive the prosthesis. However this factor is more than counterbalanced by the constraints imposed by the disease in other joints: polyarticular involvement usually protects the hip arthroplasty from weight-bearing stress thus prolonging its life. Protrusio acetabuli, uncommon in osteo-arthritis is the commonest presentation in rheumatoid arthritis because of the concentric cartilage degradation which erodes the acetabulum medially and proximally. In arthroplasty for protrusio, a plea is made for grafting of the floor of the acetabulum with solid bone derived usually from the femoral head. This offers a stronger and more physiological support for the acetabular component than synthetic devices. The hip is often only one of the many joints requiring arthroplasty to maintain locomotor function in severe cases of rheumatoid and the results of multiple operations are usually very gratifying. However, any form of surgery may be contra-indicated in a patient enfeebled by prolonged immobilisation from involvement of multiple joints. Late infection of cemented prosthesis is commoner in rheumatoid than in osteo-arthritis: such patients need antibiotic cover during transient bacteraemia from any cause such as dental extraction, trivial infections etc.

Acetabulum↗
PubMed1980

Total replacement of the rheumatoid knee: a review of currently available prostheses and a follow-up of 50 operations.

Total replacement of the knee has become an essential part of the overall management of rheumatoid arthritis. This paper reviews briefly the various forms of arthroplasty currently available, touching on some design features and associated problems. A study has been made of 50 knees in which one prosthetic design (the ICLH) has been used. The follow-up period varied between 2 and 7 years. Analysis of pain, walking ability and anatomical integrity before and after operation revealed an incidence of 82% good or fair results. Four patients (8%) developed septic complications, a higher incidence than that associated with total hip replacement. The factors associated with this increased incidence include steroid medication, previous surgery, general debility, and the thin soft-tissue cover of the knee.

Adult↗
PubMed1980

Arthroplasty with a solid bone graft for protrusio acetabuli.

A high percentage of hips in patients with rheumatoid arthritis presenting for total joint replacement have protrusio deformity with extremely thin medial acetabular walls. Biomechanical principles suggest that, to prevent inward migration of the acetabular component, the prosthesis should be positioned laterally near the acetabular rim. To reinforce the medial wall, the femoral head is fashioned into a solid graft which is anchored against the medial wall as a plug, minimising the amount of cement used and making the use of wire mesh and restraining rings about the acetabulum unnecessary. A series of nine operations on seven patients is presented. Serial radiographs, tomograms and scintigrams taken after operation suggest satisfactory incorporation of the grafts, and no complications have been encountered in a follow-up period ranging from three months to two years.

Acetabulum↗
PubMed1979

The pathogenesis of the rheumatoid swan neck deformity.

Disappointment with the late results of intrinsic release for the rheumatoid "intrinsic-plus" hand has led to a re-appraisal of the role of intrinsic muscle contracture in the pathogenesis of the rheumatoid swan neck deformity. In cadaveric fingers, a properly placed suture typing the lateral band to the middle slip insertion causes a swan neck deformity. It is suggested that the usual "intrinsic-plus" hand and the fixed swan neck deformity of rheumatoid arthritis is caused by adhesions between the extensor tendons on the dorsum of the proximal interphalangeal joint, rather than by intrinsic muscle contracture and/or metacarpo-phalangeal dislocation.

Arthritis, Rheumatoid↗