Search PubMed⌕ Search

Biomedical subjects

Adolph V Lombardi

Publications and source records attributed to Adolph V Lombardi.

At least 19 recordsLinked to original sources
PubMed2006

Intramedullary total femoral replacement for salvage of the compromised femur associated with hip and knee arthroplasty.

Severely compromised femora because of prosthetic loosening, osteolysis, or periprosthetic fracture around total hip and knee arthroplasties are increasing. Two approaches that create an intramedullary total femoral (IMTF) replacement are reported. Twenty-three IMTF replacements in 22 patients were performed at 2 institutions. Seven revision total knee arthroplasties with a stemmed component were linked to a well-fixed hip stem with a custom intramedullary sleeve. Sixteen IMTF replacements involved revision of both hip and knee arthroplasties which were connected via an intercalary segment with morse taper junctions. Follow-up averaged 36 months. Complications included 2 dislocations, 2 deep infections, and 2 knee revisions for tibial loosening. Advantages over conventional total femoral replacement or ORIF include less dissection, maintenance of soft tissue attachments, and immediate component stability to allow for early mobilization.

Aged↗
PubMed2006

The shattered femur: radical solution options.

The field of total joint arthroplasty has undergone a tremendous evolution over the past 5 decades. With increased arthroplasty use, indications expanding to younger patients, and increased life span, coupled with the limited longevity demonstrated by all arthroplasty devices to date, many patients have undergone at least one revision procedure. Therefore, reconstructive orthopedic surgeons may sometimes face the so-called shattered femur, defined as a femur that is not reconstructible with conventional methods. The clinical scenarios for which total femoral arthroplasty is indicated and a recommended surgical technique are reviewed.

Adult↗
PubMed2006

Constrained liners in revision: total hip arthroplasty an overuse syndrome: in opposition.

Use of constrained liners in revision total hip arthroplasty is frequently a necessary evil. Concomitant with the increasing complexity of the operative intervention is the deterioration of periarticular soft-tissue envelope integrity, causing increased risk of dislocation. Risk factors can be categorized as impingement independent or impingement related. Impingement-independent risk factors include those related to compromised soft-tissue tension, patient-specific issues, and surgical approach. Impingement-related risk factors include head-to-neck size and geometry, acetabular liner geometry, and surgical technique. Indications for constraint include recurrent hip instability after arthroplasty, intraoperative multidirectional hip instability, neuromuscular diseases that impair hip dynamics, neurologic diseases that impair the patient's ability to restrict activities, and proximal muscle weakness with or without deficiency of the protective muscular. Newer designs featuring large heads, improved range of motion, and reduced impingement hold the promise of improved results.

Acetabulum↗
PubMed2006

Tapered titanium porous plasma-sprayed femoral component in patients aged 40 years and younger.

Total hip arthroplasty (THA) in patients aged 40 years and younger requires decades of increased activity demands. Between 1987 and 2000, 249 primary THAs in patients 40 years of age or younger were performed with the Mallory-Head component. The average age at THA was 34.7 years (range, 20-40 years). Follow-up averaged 91 months with 125 hips having minimum 5-year follow-up and 51 THAs having a minimum of 10 years. Four stems failed the 98.2% overall survivorship. Two stems were revised for loosening for a 99.2% (95% confidence interval, 96.4%-99.8%) survivorship with aseptic loosening as the end-point at 18 years. In young patients, this tapered titanium, proximally porous plasma-sprayed femoral component provides outstanding long-term fixation and function with significant pain relief into the second decade. Overall stem survivorship is 98.2% at up to 18 years.

Adult↗
PubMed2006

A constrained device with increased range of motion prevents early dislocation.

Constrained components can treat or prevent instability after total hip arthroplasty. Some previous designs have shown a high rate of early dislocation. These early dislocations appear to be secondary to component impingement and levering out of the femoral head. We report the early rate of dislocation in 81 consecutive patients undergoing constrained total hip arthroplasty using a novel constrained device that allows substantially more range of motion and a higher lever out strength. One hip redislocated at 6 months followup, for a success rate of 98.8%. The success rate was 93% for patients for whom a constrained device was placed during revision for recurrent instability. This device allows a higher range of motion before prosthetic impingement and maintains a higher levering out strength when impingement occurs. These changes should provide long lasting hip stability in these difficult cases.

Adult↗
PubMed2006

Total knee arthroplasty in patients with greater than 20 degrees flexion contracture.

Fixed flexion contracture can present a technical challenge in total knee arthroplasty. Various techniques of addressing these deformities have been described including additional bony resection, ligamentous releases, and the use of increasing constraint. We retrospectively reviewed the clinical outcomes of 40 patients (52 knees) with fixed flexion contracture greater than or equal to 20 degrees treated with revision TKA and a stepwise algorithmic approach to treating the contracture. A cruciate-retaining device was used in 31 knees, a posterior stabilized design was used in 14, a posterior stabilized constrained device was used in five knees, and a rotating hinged design in was used in two knees. Full correction was achieved intraoperatively. Ninety-four percent of knees had less than 10 degrees residual contracture at an average followup of 37 months. We revised one case of postoperative instability in the posterior stabilized group and we had one infection in the cruciate-retaining group. No other revisions were performed. The stepwise algorithmic approach to treating fixed flexion deformity presented in this study in primary total knee arthroplasty is safe and effective.

Adult↗
PubMed2006

Rapid recovery protocols and minimally invasive surgery help achieve high knee flexion.

Although the primary goal of total knee arthroplasty is to relieve pain, the attainment of high flexion has emerged as an important secondary goal. Clinical pathways are evolving and focus on rapid recovery. The entire perioperative process for the patient and family, including office and hospital procedures, has been streamlined and patients are advised from the initial evaluation they will be able to quickly return to activities of daily living. Currently, patients are out of bed within hours of surgery, engaging in activities that require a substantial range of motion in the treated knee. They are frequently discharged directly to home within 24 to 48 hours. We retrospectively reviewed two groups of patients undergoing primary total knee arthroplasty whose perioperative management differed only by surgical approach, namely, standard versus less invasive. Refined perioperative protocols in combination with a less invasive, mini-arthrotomy approach using special instrumentation resulted in earlier discharge to home, higher range of motion and improved clinical and pain scores.

Adult↗
PubMed2006

Multimodal venous thromboembolic disease prevention for patients undergoing primary or revision total joint arthroplasty: the role of aspirin.

Venous thromboembolic disease (VTD), which consists primarily of deep venous thrombosis (DVT) and pulmonary embolism (PE), is of significant concern to orthopedic surgeons who perform total hip and total knee arthroplasties. DVT and PE can be prevented in multiple ways; each method or combination of methods has its benefits and drawbacks. Seemingly, the more efficacious a medication or method for preventing VTD, the higher the associated risk for adverse events such as bleeding and wound complications. For each patient, then, the balance or homeostasis between significant clotting event and bleeding must be determined. Examining this balance and understanding the benefits and risks associated with each medication or intervention may allow surgeons to make educated decisions about prophylaxis for their patients. Furthermore, risk stratification and multimodal management may prove to be the safest and most effective way to manage VTD prevention.

Arthroplasty, Replacement, Hip↗
PubMed2006

Posterior cruciate ligament-retaining, posterior stabilized, and varus/valgus posterior stabilized constrained articulations in total knee arthroplasty.

The degree of constraint required to achieve immediate and long-term stability in total knee arthroplasty (TKA) is frequently debated, with most authors favoring the least degree of constraint possible. There are generally three surgical biases in TKA involving the posterior cruciate ligament (PCL): surgeons who always retain the PCL, those who always sacrifice it, and those who decide to retain or sacrifice the PCL based on pathology. Surgeons who retain the PCL argue that it is one of the strongest ligaments about the knee and affords inherent stability to the TKA, whereas the proponents of PCL sacrifice argue that the PCL is compromised as a result of the degenerative process. With the pathologic approach, the diseased state of the knee at the time of arthroplasty dictates whether the PCL is retained or sacrificed. In patients without significant varus or valgus malalignment and without significant flexion, contracture may be addressed by retaining the PCL, whereas the PCL should be removed in patients with these deformities. Certain disease processes are more amendable to PCL sacrifice, such as end-stage degenerative joint disease secondary to rheumatoid arthritis, previous patellectomy, previous high tibial osteotomy or distal femoral osteotomy, and posttraumatic arthritis with disruption of the PCL. The degree of constraint of the articulation in TKA should be dictated by the degree of disease and associated deformity. A pathologic approach is rational and has clinically based evidence of success. Surgeons should have the option of modifying the degree of constraint at the time of surgical intervention. Currently, many TKA implant systems offer such flexibility.

Arthroplasty, Replacement, Knee↗
PubMed2006

Manipulation with prolonged epidural analgesia for treatment of TKA complicated by arthrofibrosis.

Inability to achieve adequate range of motion (ROM) after total knee arthroplasty (TKA) represents a frustrating complication for both patient and surgeon. Manipulation under anesthesia is indicated in TKA having less than 90 degrees ROM after six weeks, with no progression or regression in ROM. A modified technique has evolved for patients with chronic regional pain syndrome (CRPS) symptoms or persistent stiffness after standard manipulation. A retrospective review was conducted to determine the efficacy of the modified technique, which uses epidural anesthesia continued for postoperative analgesia, hospital stay of one to three days, continuous passive motion (CPM) for two to three days, and daily physical therapy (PT). Between 1997 and 2003, 5714 TKAs were performed in 4106 patients. Manipulation using a standard technique was performed on 334 (5.8%) knees in 273 patients. Manipulation using a modified technique was performed on 65 (1%) knees in 60 patients. Age averaged 58 years and body mass index (BMI) averaged 34.39. Follow up averaged 18.4 months. ROM improved significantly from 71 degrees to 102 degrees (p < 0.0001). Knee Society pain, function, and total clinical scores all improved significantly (all p < 0.0001). Successful results were observed in 48 (74%) knees. Four (6%) additional knees achieved a successful result after a subsequent manipulation. Nine (14%) knees required component revision for treatment of persistent arthrofibrosis, which included one full revision, five polyethylene exchanges, and three revisions of femoral component and polyethylene. Two significant complications occurred: one subdural hematoma and one death due to pulmonary embolism. Although not without complications, manipulation under epidural anesthesia represents a viable option for treatment of persistent stiffness after TKA; 80% of these difficult cases achieved successful results.

Anesthesia, Epidural↗
PubMed2006

A simple and accurate method for determining leg length in primary total hip arthroplasty.

Reconstruction of appropriate leg length is an important part of soft-tissue balance in total hip arthroplasty (THA). Leg length discrepancy (LLD) is one of the more common reasons for litigation after otherwise successful THA. The purpose of the study reported here was to analyze the accuracy of using preoperative templating and intraoperative referencing of the well leg to determine postoperative leg length in unilateral primary THA. Seven-hundred primary THAs performed at an institution by 3 surgeons were randomly selected from a computerized database. Cases with significant bilateral disease, congenital dysplasia, acute fracture, or previous surgery or without complete preoperative and postoperative radiographs were excluded. Three reviewers used a standardized method to measure preoperative and postoperative LLD. Included in the review were 410 THAs. Mean postoperative LLD was 3.9 mm lengthening (SD, 7.5 mm). In 20 THAs (4.9%), lengthening was more than 15 mm. Lengthening was more than 20 mm (maximum, 22 mm) in 4 THAs (1%). Of the 20 THAs with LLD of more than 15 mm, 14 involved hips that were longer preoperatively. Thirteen of these hips were reconstructed to within 10 mm of preoperative LLD. Only 2 patients with radiographic LLD of more than 15 mm perceived LLD. There were no differences in gender, height, weight, or body mass index. This method of preoperative templating and referencing the well leg intraoperatively is an inexpensive, reliable, and accurate method for determining leg length in primary THA and has few significant radiographic or clinical outliers.

Arthroplasty, Replacement, Hip↗
PubMed2005

Severe symptomatic heterotopic ossification and dislocation: a complication after two-incision minimally invasive total hip arthroplasty.

Minimally invasive total hip arthroplasty (THA) continues to be surrounded by controversy. Some proponents argue that they are able to achieve reduced soft tissue trauma, blood loss, postoperative pain, and hospitalization time as well as a more cosmetically pleasing surgical scar. Types of complications similar to those of a more open exposure are now being reported with these techniques. One such complication is the development of severe symptomatic heterotopic ossification requiring treatment. This case report profiles a patient who required removal of Brooker stage III heterotopic ossification after a 2-incision minimally invasive total hip THA. This is the first report of this complication after 2-incision THA.

Arthroplasty, Replacement, Hip↗
PubMed2005

The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures.

Constrained acetabular components can treat or prevent instability after total hip arthroplasty (THA). We examine long-term results of 755 consecutive constrained THA in 720 patients (1986-1993; 62 primary, 59 conversion, 565 revision, 60 reimplantation, and 9 total femur). Eighty-three patients (88 THAs) were lost before 10-year follow-up, leaving 639 patients (667 THAs) available for study. Dislocation occurred in 117 hips (17.5%), in 37 (28.9%) of 128 constrained for recurrent dislocation, and 46 (28.2%) of 163 with dislocation history. Other reoperations were for aseptic loosening (51, 7.6% acetabular; 28, 4.2% stem; 16, 2.4% combined), infection (40, 6.0%), periprosthetic fracture (19, 2.8%), stem breakage (2, 0.3%), cup malposition (1, 0.1%), dissociated insert (1, 0.1%), dissociated femoral head (1, 0.1%), and impingement of 1 broken (0.1%) and 4 (0.6%) dissociated constraining rings. Although constrained acetabular components prevented recurrent dislocation in 71.1%, they should be used cautiously, with a 42.1% long-term failure rate observed in this series. Dislocation was common despite constraint with previous history as a significant risk.

Acetabulum↗
PubMed2005

Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity.

UNLABELLED: There has been increasing use of and expanding indications for unicompartmental knee arthroplasty using minimally invasive techniques. We sought to define contraindications by examining failures. We retrospectively reviewed the early results of a consecutive series of minimally invasive medial unicompartmental knee arthroplasty using two implant designs. Seventy-nine consecutive unicompartmental knee arthroplasty cases (48 instrumented and 31 noninstrumented) with minimum 2-year followup were reviewed. Patients with radiographic involvement with or without pain referable to the lateral compartment or to the patellofemoral joint were not considered candidates. Failure was defined as revision or pending revision. The average followup was 40.2 months. There were 16 failures (six tibial loosening, three plateau fracture, four persistent medial pain, one progressive arthritis, and two sepsis). Age, gender, disease severity and implant design did not predict failure. Body mass index greater than 32 did predict failure and was associated with a reduction in survivorship by log-rank and Wilcoxon analyses. These results show reliable success if obesity is considered a contraindication and technical errors resulting in fracture are eliminated. Better defining the ideal candidate for unicompartmental knee arthroplasty, with obesity remaining a contraindication, will make this a more predictable and reliable procedure. LEVEL OF EVIDENCE: Prognostic study, Level IV-2 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

Metal-on-metal total hip arthroplasty with large heads may prevent early dislocation.

UNLABELLED: Postoperative dislocation is one of the major causes of morbidity and failure of total hip arthroplasty. We reviewed 327 patients (377 hips) retrospectively with varying diagnoses and indications but all of whom received large-diameter metal-on-metal prostheses. Two surgical approaches were used: the anterolateral abductor splitting (342 procedures) and a mini-incision posterior approach (35 procedures). Average age at time of surgery was 55.9 years and average followup was 4.0 months. There were 346 (91.8%) primary procedures, 15 (4.0%) conversion procedures, and 16 (4.2%) revisions or reimplantations. The most common preoperative diagnoses included osteoarthritis (250 hips; 66.3%) and avascular necrosis (46 hips; 12.2%). There were 62 (16.4%) patients with high-risk diagnoses for dislocation. The status in terms of postoperative dislocation was known for all patients. During the short followup period, there were no dislocations. Use of large-diameter femoral heads and metal-on-metal articulations decreases the risk of dislocations, making their use a viable choice for primary and revision procedures. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

Isolated liner exchange using the anterolateral approach is associated with a low risk of dislocation.

UNLABELLED: Authors of reports on the outcome of isolated liner exchange for osteolysis and wear have reported high dislocation rates. Twenty-six patients (27 hips) with a minimum of 2 years of followup had isolated liner exchange for wear and osteolysis done using the abductor splitting anterolateral approach. The mean followup was 41 months. The average age at time of surgery was 51 years. Preoperative Harris hip scores averaged 70, and increased to 82 at the most recent followup. We observed improvements in pain and functional scores. The average operating time was 82 minutes, and the average blood loss was 255 mL. Only three (12%) patients required transfusion. No components were rerevised for aseptic loosening, and one patient (one hip) had a dislocation (3.7%). Isolated liner exchange for osteolysis and wear done using the anterolateral approach has a lower risk of dislocation than previously reported and provides substantial improvements in pain, function, and Harris hip score. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗