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Biomedical subjects

B F Morrey

Publications and source records attributed to B F Morrey.

At least 181 records · Page 10Linked to original sources
PubMed1989

Long-term results of various treatment options for infected total knee arthroplasty.

Of 73 infected total knee arthroplasties treated from 1973 through 1984, the outcome of various management options revealed that solid arthrodesis was obtained in 70%. Fifteen percent of those with a solid fusion had residual pain or even recurrence of infection. Aggressive debridement was successful in eight of ten (80%). Long-term follow-up results show reimplantations were successful in eight of 15 (53%) but were functionally successful in only five of 15 (33%). A treatment plan based on functional considerations follows. For acute infections a very aggressive initial debridement followed by primary closure over an antibiotic-soaked pack is carried out. The prosthesis is left in place if at all possible and if the bone-cement interface has not demonstrated loosening. The knee is debrided every two or three days until negative cultures are obtained. Antibiotic beads are then inserted, with reexploration at three weeks with new cultures. Parenteral antibiotics are given for a three-week period initially. If two successive surgical debridements fail to reveal a positive culture, the knee is closed and rehabilitation is begun. For chronic infections, the recommendations of Wilde and Ruth are followed, employing antibiotic-impregnated beads and spacers with staged debridements similar to the method described above. Finally, an accurate definition of the true value of any of these options is predicated on long-term follow-up studies, since options that seemed promising as an initial procedure have proved disappointing as more experienced and longer follow-up study is obtained.

Anti-Bacterial Agents↗
PubMed1989

Size of the femoral head and acetabular revision in total hip-replacement arthroplasty.

Fifty-nine revisions that were done for aseptic acetabular loosening after 6,128 total hip arthroplasties for degenerative arthritis or traumatic arthritis were studied. These revisions were in forty-four (approximately 1 per cent) of 4,576 hips that had a twenty-two-millimeter femoral-head component, in two of 520 that had a twenty-eight-millimeter femoral-head component, and in thirteen (approximately 2.5 per cent) of 487 that had a thirty-two-millimeter femoral-head component. Therefore, the thirty-two-millimeter femoral component was associated with the highest rate of acetabular revision (p less than 0.001). The dimensions of the acetabular wall were thinner in the hips that had the thirty-two-millimeter component than in those that had the twenty-two-millimeter component (p less than 0.05). Multivariate analysis demonstrated a significantly increased risk of acetabular loosening in men and in patients who were less than sixty years old.

Acetabulum↗
PubMed1988

Vertebral fractures without neurological deficit. A long-term follow-up study.

Twenty-five patients, who did not have osteoporosis and who were between the ages of seventeen and sixty years, were treated for one or more stable compression fractures of a vertebra with compaction of less than 50 per cent and without an associated neurological deficit. The patients were followed for a minimum of nine years. Associated vertebral fractures (12 per cent) were identified during the first three months after the injury, but no deformity progressed after three months. Radiographic changes of degenerative disc disease were evident in eight patients, but the changes did not correlate with symptoms or with level of activity. With one exception, all patients functioned as well as uninjured subjects of comparable age. Patients who have a compression fracture of a vertebra should have serial radiographs made for at least three months to ensure that all fractured vertebrae are identified and to document any progression of deformity.

Adolescent↗
PubMed1988

Fracture of the porous-coated metal tray of a biologically fixed knee prosthesis. Report of a case.

It has been assumed that, when properly implanted, a biologically fixed device is less prone to loosening and probably to fatigue failure as well. This case demonstrates that many of the known risk factors of loosening or fatigue fracture of cemented tibial replacement devices must be considered when using devices designed for biologic fixation. Age, weight, axial alignment, and bone substrate have been identified as probable contributing factors to failure in the case reported here. Manufacturing technique and changes in material properties associated with porous coating should also be carefully tested for factors predisposing the components to fatigue failure.

Adult↗
PubMed1988

Force transmission through the radial head.

A technique has been developed to study the transmission of axial force across the radiohumeral joint during simulated active motion of the elbow. Variations in the line of action and in the amount of muscle load, as well as in rotation of the forearm during flexion and extension of the elbow, were assessed. Consistent patterns of force transmission were demonstrated in the three specimens that were studied. The greatest force transmission occurred between zero and 30 degrees of flexion, and it consistently decreased with increased flexion. Force transmission was consistently greater in magnitude when the forearm was in pronation than when it was in supination. The varus-valgus pivot point with the elbow extended was established to closely approximate the line of action of the brachial muscle, which crosses near the center of the lateral portion of the trochlea.

Aged↗
PubMed1988

Strength function after elbow arthroplasty.

A prospective study of elbow strength after total elbow joint arthroplasty was conducted in 27 patients (31 procedures). In this overall group, flexion strength improved 92%, pronation, 63%, and supination, 69%. Grip strength improved 35%, but there was no mean improvement in extension strength among these patients. After 27 procedures for rheumatoid arthritis, the average strength improvement of all five functions was 71% compared to a 25% improvement in four patients with nonrheumatoid involvement. Placement of the prosthetic axis of rotation proximal or anterior to the normal axis was associated with consistently poorer strength. The sample was too small to distinguish performance among prosthetic types, but the triceps-sparing approach showed consistently better strength in extension (averaging 20%) than did the other exposures.

Arthritis↗
PubMed1987

Electromyographic analysis of muscles across the elbow joint.

An electromyographic (EMG) technique was developed to study simultaneously the eight major elbow muscles in five normal subjects. Recordings of EMG activity in elbow muscles were obtained while the elbow joint was subjected to resisted flexion, extension, abduction, and adduction functions. The results indicate that activity in the major elbow muscles is determined by the size of the resultant flexion and extension moments created about the elbow joint, but not by varus and valgus moments. These results support the hypothesis that determination of muscle force about a joint depends on joint constraint, namely, the degree of freedom, the resultant joint forces and moments due to externally applied load, and also the function of the muscle, i.e., the line of action of the muscle that crosses the joint. The data may be used to further refine the calculation of muscle force distribution across the elbow joint.

Adolescent↗
PubMed1987

Rheumatoid pseudocyst (geode) of the femoral neck without apparent joint involvement.

Typically, rheumatoid cysts are associated with obvious joint involvement and are located in the subchondral portion of the adjacent joint. Giant pseudocysts (geodes) are uncommon and are characteristically associated with extensive joint destruction. The patient described in this report had a giant pseudocyst of the femoral neck but no joint involvement. To the best of my knowledge, this is the first report of such a manifestation of a giant pseudocyst. As such, it posed a somewhat difficult diagnostic problem.

Aged↗
PubMed1987

Osteochondral fractures of the talus. A long-term follow-up.

Sixty-eight patients with 71 osteochondral fractures of the talus were evaluated an average of 7.5 years after the onset of symptoms to determine which factors influenced the final result. It was found that the type of fracture was the most important; delay in treatment also affected the result adversely. A scheme of treatment for each type of fracture is proposed.

Adolescent↗
PubMed1987

Results of treatment of fracture-dislocations of the elbow.

Twenty-four patients with ulnohumeral dislocation associated with radial head fracture were studied two to 35 years after injury. On the basis of an objective functional grading score that included elements of pain, motion, strength, and stability, results were excellent in three (12%), good in 15 (62%), and fair in six (25%). The best results were obtained in patients with Mason Type 2 injuries treated by closed reduction without fracture excision and with early complete radial head excision for a Type 3 fracture. Late instability was not observed in any of the 24 patients. Prolonged immobilization (greater than four weeks) was associated with poor results. Ectopic ossification occurred in only one patient who had surgical treatment at eight days after injury; the grading score was only fair. These observations demonstrate that the injury should be treated with early reduction of the ulnohumeral joint and treatment of the radial head fracture according to its type. Immobilization for more than four weeks should be avoided. The prognosis is better than what has been thought previously.

Adolescent↗
PubMed1987

Complications and mortality associated with bilateral or unilateral total knee arthroplasty.

The incidence of complications, the need for secondary surgical procedures, and the mortality rate associated with bilateral replacement of the knee performed simultaneously, performed during the same hospitalization, or performed during separate hospitalizations were compared with those after unilateral replacement of the knee. The incidence of complications after 290 simultaneous bilateral procedures was 9.3 per cent, which compares favorably both with the incidence of 7.0 per cent after 228 bilateral procedures that were done during the same hospitalization and incidence of the 12.0 per cent after 234 bilateral procedures that were performed during separate hospitalizations. The incidence for each of these groups compares favorably with the incidence of complications of 11.0 per cent after 501 unilateral procedures. The incidence of reoperation was 2.4, 4.8, 8.5, and 5.6 per cent, respectively, in the four groups, and the incidence of mortality was 5.5, 0.9, 3.8, and 7.0 per cent. None of these differences were statistically significant. These data indicate that the incidence of morbidity and mortality that is associated with simultaneous bilateral total knee arthroplasty is no greater than when the procedure is performed during the same hospitalization or separate hospitalizations.

Costs and Cost Analysis↗
PubMed1987

Revision total elbow arthroplasty.

Over a ten-year period, thirty-three consecutive revision total elbow arthroplasties were performed at our institution. These were assessed at a minimum of three years after the revision, with an average length of follow-up of sixty-one months. Eighteen (55 per cent) of the elbows had a good result and fifteen (45 per cent) had a poor result. The poor results were due to infection in three elbows, loosening of the prosthesis in six, inadequate motion in two, continued pain in two, and prosthetic failure in two. Additional surgical revision with another implant was done in the fifteen elbows that initially had a poor result. Eventually the result was good in twenty-four elbows. The three elbows that became infected after surgical revision had a resection arthroplasty and all were rated as having a fair result. The data from this study indicated that reimplantation is a viable option for the revision of a failed total elbow arthroplasty, although more than one revision may be required. They also suggested that young patients who have post-traumatic arthritis should not undergo a total joint replacement, and that revision procedures should be performed in settings that can offer several surgical options and by surgeons who have had experience with these options. Alternatives to reimplantation as a revision procedure should be considered in selected patients.

Arthritis, Rheumatoid↗
PubMed1987

Isometric elbow strength in normal individuals.

Isometric elbow strength was measured with torque cell dynamometers in a group of 104 normal subjects. Their mean age was 43 years (range, 21-79 years). Test functions included elbow flexion and extension, forearm pronation and supination, and grip. In general, the men were twice as strong as the women, and the dominant extremities were 6% stronger than the nondominant. The mean extension strength was 61% of that of flexion, and pronation was 86% of supination.

Adult↗
PubMed1987

The optimum position of arthrodesis of the ankle. A gait study of the knee and ankle.

UNLABELLED: Findings from biomechanical analyses of gait were used to estimate the optimum position of arthrodesis of the ankle. Nineteen patients who were followed for an average of 10.4 years (range, four to seventeen years) were studied. By including the knee in the analysis as well as studying the effects on gait of different ground conditions, objective data for the weight-bearing extremities in the transverse, sagittal, and coronal planes were generated. Genu recurvatum was shown to be associated with a plantar-flexion position of fusion of the ankle. Laxity of the medial collateral ligament of the knee was noted in twelve patients (63 per cent). Among these patients, in three (16 per cent) the laxity was graded as moderate to severe, possibly due to external rotation of the extremity during gait to avoid rolling over the rigid plantar-flexed ankle. The patterns of gait showed that a valgus position of the arthrodesis is more advantageous and provides more normal gait, particularly on uneven ground. To attain more normal function of the knee and improve performance on rough ground, the optimum position of arthrodesis of the ankle appears to be neutral flexion, slight (zero to 5 degrees) valgus angulation, and approximately 5 to 10 degrees of external rotation. Posterior displacement of the talus under the tibia tends to produce a more normal pattern of gait and decreases the stress at the knee. CLINICAL RELEVANCE: This study has shown the ideal position of fusion of the ankle to be neutral flexion, slight (zero to 5 degrees) valgus angulation of the hind part of the foot, and 5 to 10 degrees of external rotation. This position allows the greatest compensatory motion at the foot and places the least strain on the knee.

Adult↗
PubMed1987

Delayed open reduction and fixation of ankle fractures.

Because of clinical circumstances in the period from 1970-1980, 26 consecutive ankle fractures were treated by delayed (14-31 days after injury) open reduction and internal fixation. Follow-up examination (two to 12 years) was obtained in 25 patients. Based on clinical performance index, outcome was judged satisfactory in 17 patients (68%). Seventeen (68%) had an anatomic reduction, and 15 (88%) of these 17 had a satisfactory result. Compared to a group of 26 similar patients treated within 24 hours after injury, the major effect of delay was an adverse influence on the probability of achieving an anatomic reduction (p less than 0.08). When anatomic reduction was obtained, the performance index in the delayed-treatment group (78.8) was comparable to that in the immediate-treatment group (78.4%). Thus, when immediate fixation is not possible, delayed reduction and fixation of displaced ankle fractures is a reasonable option in some instances and can be seriously considered by the surgeon. Displaced fractures should not be left in a malreduced position because this provides virtually no opportunity for a satisfactory result.

Adolescent↗
PubMed1987

Condylar total knee arthroplasty after failed proximal tibial osteotomy.

Data were collected retrospectively on thirty-five patients who had a failed osteotomy of the proximal part of the tibia for unicompartmental osteoarthrosis of the knee that was treated with a cruciate condylar, total condylar, kinematic condylar, or cemented porous-coated anatomical total knee prosthesis. The patients were evaluated clinically and roentgenographically before and after the arthroplasty. The minimum period of follow-up was twenty-nine months (mean, forty-four months). On the basis of the knee-rating scale of The Hospital for Special Surgery, 89 per cent of the patients had either an excellent or a good result after the arthroplasty. No result was a failure. One patient had loosening of the patellar component, but no other loosening was identified. The results of total knee arthroplasty after osteotomy of the proximal part of the tibia were found to be comparable with the results after arthroplasty in knees that had not had a prior osteotomy. The intraoperative and postoperative rates of complications were not higher, and no untoward technical difficulties were encountered at surgery. These data support the clinical impression that an osteotomy of the proximal part of the tibia does not "burn any bridges" insofar as a future successful arthroplasty is concerned.

Adult↗
PubMed1986

Management of infected total knee arthroplasty.

A retrospective study of the Mayo Clinic experience with the management of 61 infected total knee arthroplasties treated between 1970 and 1980 revealed rheumatoid arthritis as an underlying diagnosis in 47%. Previous operations had been performed in 58%. Arthrodesis was the most frequently utilized salvage technique and was successful in 83%. Reimplantation of a new prosthesis was successful in 63%. Debridement alone was successful in six knees when performed early for acute infections.

Adult↗