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Biomedical subjects

B F Morrey

Publications and source records attributed to B F Morrey.

At least 73 records · Page 4Linked to original sources
PubMed1998

Total knee arthroplasty in patients who have pigmented villonodular synovitis.

We reviewed the results of all eighteen total knee arthroplasties that had been performed at the Mayo Clinic between 1974 and 1992 for the treatment of pigmented villonodular synovitis. The diagnosis had been confirmed histologically in all patients. Fourteen patients had diffuse disease, which was active in eleven and inactive in three, and four had focal disease. In addition to the arthroplasty, the eleven patients who had active diffuse disease were managed with a complete synovectomy and the four patients who had focal disease had a partial synovectomy. The three remaining patients had a history of diffuse pigmented villonodular synovitis but had no evidence of disease at the time of the arthroplasty, so a synovectomy was not performed. At an average of 9.9 years (range, 3.6 to 20.1 years) after the arthroplasty, fourteen of the eighteen total knee prostheses were well fixed and functioning satisfactorily. The average knee score was 89 points (range, 80 to 99 points) and the average functional score was 77 points (range, 20 to 100 points) for these fourteen patients. The four failures were in patients who had active diffuse disease at the time of the arthroplasty. Three of the failures were due to aseptic loosening, and one was due to recurrence of the disease. Sixteen patients had no evidence of recurrence when they were last seen, at an average of 10.3 years (range, 3.6 to 20.1 years) after the arthroplasty. The two patients who had a recurrence were among the eleven who had active diffuse disease. In one of these patients, the recurrence was diagnosed at the time of a revision arthroplasty performed because of aseptic loosening. The other patient had two recurrences, necessitating an above-the-knee amputation.

Adult↗
PubMed1998

Infection after total elbow arthroplasty.

The purpose of this study was to review our experience with the treatment of twenty-five infections (in twenty-five patients) after total elbow arthroplasty and to examine indications for salvage of the prosthesis compared with those for resection arthroplasty. The patients were divided into three groups on the basis of treatment. Group I comprised fourteen patients who were managed with multiple, extensive irrigation and debridement procedures with retention of the original components. The primary indication for retention of the prosthesis was evidence that it was well fixed as determined both radiographically and intraoperatively. Group II comprised six patients who had removal of the prosthesis and debridement followed by immediate or staged reimplantation. Group III comprised five patients who were managed with resection arthroplasty. The infection was successfully eradicated in seven of the fourteen elbows that had salvage of the prosthesis with irrigation and debridement. The results were strongly dependent on the causative organism; attempts at debridement failed in the four elbows that were infected with Staphylococcus epidermidis compared with three of the ten that were infected with another organism. Four of the six patients in Group II had successful reimplantation of a prosthesis; in three, the infection had been caused by an organism other than Staphylococcus epidermidis. Only one of the three patients who had a Staphylococcus epidermidis infection had a successful reimplantation. None of the five patients who had a resection arthroplasty had signs of infection at the latest follow-up examination. We concluded that salvage of the prosthesis with extensive irrigation and debridement in the presence of an infection about the elbow can be reasonably successful if the infecting organism is not Staphylococcus epidermidis and if the components are well fixed. When removal of the components is warranted, staged reimplantation can also be highly successful when the infecting organism is not Staphylococcus epidermidis. However, the repeated operations necessary to retain a prosthesis and the high rates of complications seen with this approach--and the relatively good rates of satisfaction obtained with resection arthroplasty--suggest that resection arthroplasty remains the procedure of choice in medically frail patients or in patients for whom function of the elbow is less of a concern.

Adult↗
PubMed1998

Total elbow arthroplasty in patients who have juvenile rheumatoid arthritis.

Patients who have juvenile rheumatoid arthritis often are seen at a very young age because of severe stiffness and pain in several joints. While total elbow replacement may be indicated in these patients, this procedure is difficult to perform because of contracture of the soft tissues and the extremely small bones and intramedullary cavities in these patients. As there is little information in the literature regarding this procedure, we attempted to learn about the long-term results by evaluating nineteen patients (twenty-four elbows) with juvenile rheumatoid arthritis who had been managed with total elbow arthroplasty. At an average of 7.4 years (range, two to fourteen years) after the operation, there was an improvement in the average Mayo elbow performance score from 31 points (range, 5 to 55 points) preoperatively to 90 points (range, 55 to 100 points). Twenty-two (96 per cent) of the twenty-three elbows available at the most recent follow-up evaluation caused little or no pain, but the improvement in the range of motion was not as reliable. The average arc of flexion improved from only 63 degrees preoperatively to 90 degrees postoperatively; the average postoperative arc of flexion began at 35 degrees, with additional flexion to 125 degrees. Examination of the four elbows that had been ankylosed before the procedure revealed an average arc of 73 degrees after the operation, and evaluation of the twenty ipsilateral wrists that were not limited by disease revealed that pronation and supination had been maintained. The average functional score improved from 9 points (range, 0 to 25 points) preoperatively to 23 points (range, 15 to 25 points) postoperatively (p < 0.001). The function of eighteen elbows (78 per cent) did not adversely affect the ability to perform activities of daily living. There were thirteen complications, including one perioperative death, that affected twelve of the twenty-four elbows. Seven of the nine early complications, including a fracture of the olecranon, subluxation of the prosthesis, stiffness of the elbow, and problems with wound-healing, led to an additional operative procedure but did not adversely affect the long-term outcome after appropriate diagnosis and treatment. Late complications (aseptic loosening, instability, and worn bushings) led to three poor results. None of the eighteen semiconstrained prostheses had radiographic evidence of loosening at the most recent follow-up evaluation. Of the twenty-three elbows that had been followed for at least two years, twelve (52 per cent) had an excellent result, eight (35 per cent) had a good result, and three (13 per cent) had a poor result.

Activities of Daily Living↗
PubMed1998

Treatment of infection with débridement and retention of the components following hip arthroplasty.

Forty-two patients (forty-two hips) who had an infection following a hip arthroplasty were managed with open débridement, retention of the prosthetic components, and antibiotic therapy. After a mean duration of follow-up of 6.3 years (range, 0.14 to twenty-two years), only six patients (14 per cent) -- four of nineteen who had had an early postoperative infection and two of four who had had an acute hematogenous infection -- had been managed successfully. Of the remaining thirty-six patients, three (7 per cent of the entire group) were being managed with chronic suppression with oral administration of antibiotics and thirty-three (79 per cent of the entire group) had had a failure of treatment. All nineteen patients who had a late chronic infection were deemed to have had a failure of treatment. Débridement had been performed at a mean of six days (range, two to fourteen days) after the onset of symptoms in the patients who had been managed successfully and at a mean of twenty-three days (range, three to ninety-three days) in those for whom treatment had failed. Débridement with retention of the prosthesis is a potentially successful treatment for early postoperative infection or acute hematogenous infection, provided that it is performed in the first two weeks after the onset of symptoms and that the prosthesis previously had been functioning well. In our experience, this procedure has not been successful when it has been performed more than two weeks after the onset of symptoms. Retention of the prosthesis should not be attempted in patients who have a chronic infection at the site of a hip arthroplasty as this approach universally fails.

Adult↗
PubMed1998

The Coonrad-Morrey total elbow arthroplasty in patients who have rheumatoid arthritis. A ten to fifteen-year follow-up study.

Sixty-nine patients (seventy-eight elbows) who had rheumatoid arthritis were managed with a Coonrad-Morrey total elbow arthroplasty between 1981 and 1986. At the time of the present review, forty-one patients (forty-six elbows) were alive and had been followed for at least ten years after the procedure (Group 1). The remaining twenty-eight patients (thirty-two elbows) had died or had had a revision less than ten years after the procedure or had been followed for less than ten years (Group 2). The patients in Group 1 had a younger mean age at the time of the procedure, but all other preoperative parameters were similar for both groups. At the latest follow-up evaluation, 97 per cent of the elbows (forty-five of the forty-six in Group 1 and thirty-one of the thirty-two in Group 2) were not painful or were only mildly painful. The mean arc of flexion-extension was 28 to 131 degrees; this represents an increase of 13 degrees (15 degrees in Group 1 and 7 degrees in Group 2) compared with the preoperative value. The mean arc of pronation was 68 degrees, and the mean arc of supination was 62 degrees; this represents an increase of 21 degrees. The results for seventy-four of the seventy-eight elbows (all forty-six in Group 1 and twenty-eight of the thirty-two in Group 2) were considered satisfactory by the patients. One patient thought that the status of the elbow was unchanged compared with preoperatively, and three thought that it was worse. Seventy-six of the seventy-eight elbows had long-term radiographic evaluation; the two remaining elbows were excluded because a resection arthroplasty had been performed. There were two loose ulnar components; one was associated with an infection, and the other had been causing no symptoms at the time of the patient's death. In addition, both components were radiographically loose in an elbow that had had a revision without cement after a previous total elbow arthroplasty. Five bushings (7 per cent) were completely worn, and six (8 per cent) were partially worn. Complications occurred in eleven elbows (14 per cent) and were serious, necessitating reoperation, in ten (13 per cent). Delayed complications included three avulsions of the triceps, two deep infections, two ulnar fractures, and one fracture of an ulnar component. In addition, two elbows were revised because of aseptic loosening. No patient had persistent ulnar neuritis or serious skin complications. At the latest clinical follow-up evaluation, according to the Mayo elbow performance score, forty-three of the seventy-eight elbows had an excellent result; twenty-six, a good result; seven, a fair result; and two (both in Group 2), a poor result. The rate of survival of the prosthesis was 92.4 per cent, with 86 per cent good or excellent and 14 per cent fair or poor results.

Activities of Daily Living↗
PubMed1998

Superior-inferior stability of the shoulder: role of the coracohumeral ligament and the rotator interval capsule.

OBJECTIVE: To study the superior-inferior stabilizing functions of the coracohumeral ligament (CHL) and the rotator interval capsule (RIC) with use of a material testing machine. MATERIAL AND METHODS: The axial translations of the humerus with the superior-inferior translation force of 30 N applied were recorded under the following joint capsule conditions: (1) intact, (2) vented, (3) the CHL sectioned, and (4) the RIC incised in six cadaver shoulders. The order of sectioning was changed for conditions 3 and 4 in six other cadaver shoulders. RESULTS: With the arm in internal and neutral rotations, venting the capsule significantly increased the superior-inferior translation, which was unaffected by further sectioning of the CHL and the RIC. With the arm in external rotation, only the CHL contributed significantly to inferior stability, whereas both this ligament and the RIC contributed to superior stability to a lesser degree. CONCLUSION: The CHL is a stabilizer in superior inferior directions with the arm in external rotation, and the intra-articular pressure that is maintained by the intact RIC is a stabilizer in superior-inferior directions with the arm in internal and neutral rotations. These findings may provide a scientific background to support closure of the interval space to stabilize the shoulder and may explain part of the superior instability observed in shoulders with rotator cuff tears.

Aged↗
PubMed1998

Biomechanical evaluation of the elbow following radial head fracture. Comparison of open reduction and internal fixation vs. excision, silastic replacement, and non-operative management.

Thirty-six fractures of the radial head were evaluated following treatment with four different techniques: open reduction and internal fixation (ORIF), excision, silastic replacement, and non-operative management. Clinical assessment included calculation of the Clinical Performance Index based on parameters for motion, stability, pain, and daily function, as well as radiographic evaluation for fracture type (Mason) and the development of degenerative changes. Further assessment included isometric strength measurements for elbow flexion, extension, pronation, supination, and grip. Range of motion and strength measurements were similar, except for grip strength, which was significantly better for ORIF patients compared to excision or silastic replacement groups. Patients with ORIF had the best clinical scores with minimal radiographic changes. When possible, ORIF of displaced radial head fractures appears to provide the best functional result.

Adult↗
PubMed1998

Tennis elbow.

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Adult↗
PubMed1998

Can specialists reduce costs? The case of referrals to orthopaedic surgeons.

This study investigates whether timely referral to specialists, in this case orthopaedic surgeons, potentially can reduce the costs of a health care episode. Five musculoskeletal diagnoses were chosen, and the diagnostic and treatment history of approximately 2500 persons with these five diagnoses was traced to determine when in the course of their treatment episode they were referred from nonorthopaedist to orthopaedist care and how much their episode of care cost. It was found that the average episodic costs for those who were referred earlier in the episode of care was lower than for those referred later. The implication is that there are likely to be numerous identifiable health conditions that should be flagged for early referral to specialists to reduce costs. It also questions the validity of the presumption that specialist care is necessarily more expensive.

Cost Savings↗
PubMed1998

The column procedure: a limited lateral approach for extrinsic contracture of the elbow.

Thirty-eight elbows (thirty-seven patients) with an extrinsic contracture were treated operatively with a limited lateral approach to the anterior and posterior aspects of the capsule. Because the procedure elevates muscles from the anterior and posterior aspects of the lateral supracondylar osseous ridge, we called it the column procedure. The mean preoperative arc of flexion was 49 degrees (from 52 to 101 degrees). At a mean of forty-three months (range, twenty-four to seventy-four months) postoperatively, the mean arc of flexion was 94 degrees (from 27 to 121 degrees). The mean total gain in the arc of flexion-extension was 45 degrees; thirty-four elbows (89 percent) had an improved range of motion at the latest follow-up examination. Overall, thirty-one elbows (82 percent) had a satisfactory result. Greater improvement was obtained in elbows that had had severe stiffness (a total arc of 31 to 60 degrees) or very severe stiffness (a total arc of 30 degrees or less) or that had had a combined flexion and extension contracture. A complication occurred in four elbows (11 percent). A hematoma developed in two elbows and impaired the final outcome in one of them. Two elbows had transient ulnar paresthesia, which resolved spontaneously. The arc of flexion obtained at the time of the operation was lost in ten elbows (26 percent) after an initial period of improvement; at the latest follow-up evaluation, four of these elbows had a mean decrease in the arc of flexion of 24 degrees compared with preoperatively. The column procedure is associated with a low rate of complications and is safe and effective for the treatment of a limitation in flexion or extension resulting from an extrinsic contracture of the elbow.

Adolescent↗
PubMed1997

Maintaining a hip registry for 25 years. Mayo Clinic experience.

A computerized database was established for all total joint replacements done at the authors' institution. To date the registry contains information on more than 56,000 arthroplasties of which more than 30,000 involve the hip. The registry was designed to determine the effectiveness of total hip arthroplasty as a function of implant design, surgical technique, and patient selection. Furthermore, by maintaining and updating the patient record, data regarding success or anticipated failure could be communicated to the patient. Finally, this resource would provide reliable information that could be communicated to the orthopedic community. Patients are routinely evaluated at 1, 2, and 5 years postoperatively and at 5-year intervals thereafter by examination or letter or telephone questionnaire. Followup of patients at each interval is approximately 95%. Patients are more likely to respond by questionnaire (rather than be seen in person) if they are older, if a longer time has elapsed since surgery, or if they live a long distance from the clinic. Data are collected by five full time employees including computer and statistical support specifically assigned to the project. The annual joint registry budget is in excess of $400,000. Unfortunately, the future of this endeavor is challenged by the needs to: (1) show cost effectiveness of the activity; (2) update and validate outcomes instruments used as input into the database; and (3) maintain satisfactory followup rates in a medical economic environment that often discourages patient return visits or local assessment.

Adult↗
PubMed1997

Acute repair and delayed reconstruction for lateral ankle instability: twenty-year follow-up study.

OBJECTIVES: To determine long-term results of patients who underwent primary ligament repair and delayed reconstruction for lateral ligament instability. DESIGN: Retrospective. SETTING: Outpatient clinic. PATIENTS/PARTICIPANTS: Patients who had undergone acute repair or delayed reconstruction at this institution between 1958 and 1977, excluding patients who were deceased or who could not be located. INTERVENTION: Forty-eight patients (fifty-three ankles) underwent twenty-two primary ligament repairs and thirty-one delayed reconstruction operations. MAIN OUTCOME MEASUREMENTS: Clinical results graded with clinical scale and radiologic results based on stress radiographs and plain film radiographs. RESULTS: At an average of twenty years after operation (range 12 to 33 years), patients were satisfied with forty-nine ankles, satisfied with reservations with two ankles, and dissatisfied with two ankles. Clinical results after repair were excellent in twenty ankles, good in one, fair in none, and poor in one. After reconstruction, the results were excellent in twenty-one ankles, good in six, fair in one, and poor in three. In the primary repair group, the mean talar tilt with stress testing improved from 20.7 +/- 10.7 degrees before operation to 2.8 +/- 3.0 degrees after operation. In the reconstruction group, the mean talar tilt improved from 20.7 +/- 8.4 degrees before operation to 2.8 +/- 3.5 degrees after operation. CONCLUSIONS: Clinical and radiologic results were similar in the repair and reconstruction groups. The majority of severe (Grade III) ankle sprains may be treated nonoperatively, but if residual instability occurs, late reconstruction should achieve satisfactory results.

Acute Disease↗
PubMed1997

Arthroscopic synovectomy of the elbow for rheumatoid arthritis. A prospective study.

The short-term assessment of 14 arthroscopic synovectomies of the elbow in 11 patients with rheumatoid arthritis showed that 93% achieved a short-term rating of excellent or good on the Mayo Elbow Performance Score. At the most recent assessment at an average of 42 months, however, only 57% maintained excellent or good results; four had required total elbow replacement. Although rehabilitation is facilitated by an arthroscopic procedure the results deteriorate more rapidly than after open synovectomy. This may be due to the limitations of the arthroscopic technique and is consistent with experience of the similar procedure in the knee. Recognition of the short-term gain and the potential for serious nerve injury should be considered when offering arthroscopic synovectomy.

Arthritis, Rheumatoid↗
PubMed1997

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.

We retrospectively reviewed the results of primary total elbow arthroplasty for the treatment of an acute fracture of the distal aspect of the humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two years) at the time of the injury. The patients were managed between November 1982 and October 1992. The presence of rheumatoid arthritis in nine patients (ten elbows) influenced the choice of treatment. The mean interval between the injury and the total elbow arthroplasty was seven days (range, one to twenty-five days). The mean duration of postoperative hospitalization was seven days (range, four to thirteen days). The mean duration of follow-up was 3.3 years (range, three months to 10.5 years). All patients were followed for a minimum of two years or until the time of death; the duration of follow-up was less than two years for three patients who died. None of the patients were lost to follow-up. Twenty implants were intact at the latest follow-up examination. One patient had a revision total elbow arthroplasty twenty months after the index procedure because of a fracture of the ulnar component sustained in a fall on the outstretched arm. On the basis of the Mayo elbow performance score, fifteen elbows had an excellent result and five had a good result; there were inadequate data for one elbow. There were no fair or poor results. The mean arc of flexion was 25 to 130 degrees. There was no evidence of loosening on the radiographs. Postoperative complications included fracture of the ulnar component in one patient, ulnar neurapraxia in three, and reflex sympathetic dystrophy in one. The results suggest that total elbow arthroplasty can be an alternative form of treatment of a severely comminuted fracture of the distal aspect of the humerus in older patients even in the presence of rheumatoid arthritis. This procedure is not an alternative to osteosynthesis in younger patients.

Accidental Falls↗