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Biomedical subjects

B F Morrey

Publications and source records attributed to B F Morrey.

At least 91 records · Page 5Linked to original sources
PubMed1997

Semiconstrained total elbow replacement for the treatment of post-traumatic osteoarthrosis.

Forty-one consecutive patients were managed for post-traumatic osteoarthrosis or dysfunction of the elbow with use of a non-customized semiconstrained Coonrad-Morrey total elbow prosthesis. The average age at the time of the operation was fifty-seven years (range, thirty-two to eighty-two years). The patients were followed for an average of five years and eight months (range, two to twelve years). Radiographs were made at least two years postoperatively (average, five years and one month; range, two to twelve years) for thirty-nine of the forty-one patients. According to the Mayo elbow performance score, sixteen patients (39 per cent) had an excellent result, eighteen (44 per cent) had a good result, five (12 per cent) had a fair result, and two (5 per cent) had a poor result. Thirty-six (95 per cent) of the thirty-eight patients who had a functioning implant at the time of follow-up considered the outcome to be satisfactory. Preoperatively, thirty-seven patients (90 per cent) had moderate or severe pain; postoperatively, thirty (73 per cent) had no or only mild discomfort. Motion improved from an average arc of flexion of 40 to 118 degrees preoperatively to an average arc of flexion of 27 to 131 degrees postoperatively. All thirty-eight functioning implants rendered the elbow stable. Eleven patients (27 per cent) had a major complication. Nine of them (22 per cent of the series) needed an additional operation. There was no aseptic loosening, and most of the complications were primarily due to so-called mechanical failure. The ulnar component fractured in five patients (12 per cent), and the polyethylene bushings wore out in two (5 per cent). These complications were attributed principally to the performance of strenuous physical labor, such as lifting more than ten kilograms on a regular basis, against the advice of the surgeon; excessive preoperative deformity of the joint; or an unstable traumatic injury. Two patients (5 per cent) had an infection. Semiconstrained joint replacement of the elbow can be a reliable form of treatment, and frequently is the only viable option, for the difficult problems encountered with post-traumatic destruction of a joint. Restoration of function, relief of pain, and patient satisfaction can be achieved even when a patient is less than sixty years old if that patient has low demands and a low level of activity. However, the mechanical failures underscore the fact that this procedure is relatively contraindicated in patients who anticipate strenuous physical activity or who are not expected to comply with the postoperative protocol. This observation reflects the tendency for increased and excessive use of a previously functionless joint, after it has been rendered stable and pain-free, to lead to mechanical failure.

Adult↗
PubMed1997

Effect of the elevated-rim acetabular liner on loosening after total hip arthroplasty.

Elevated-rim acetabular liners recently were shown to be associated with improved stability of total hip prostheses in a large clinical series. However, the effect of this design on loosening remains unknown. To address this question, we reviewed the results of 5167 primary and revision total hip arthroplasties that had been performed at our institution from September 1, 1985, through December 31, 1991; 2469 of the acetabular components had an elevated-rim liner (10 degrees of elevation), and 2698 had a standard liner. Five-year follow-up data were available for 1237 hips (174 that had an elevated-rim acetabular liner and 1063 that had a standard acetabular liner). The cumulative probability of revision because of loosening of the implant was estimated as a function of time since the operation with use of the Kaplan-Meier survivorship method. The five-year probability of survival of the acetabular component was 98.8 per cent (95 per cent confidence interval, 97.9 to 99.6 per cent) for the prostheses that had an elevated-rim liner and 98.3 per cent (95 per cent confidence interval, 97.7 to 99.0 per cent) for those that had a standard liner (p = 0.87). The effect of the elevated-rim acetabular liner on the probability of revision because of loosening of the acetabular or the femoral component was analyzed for several subgroups: components inserted with cement, components inserted without cement, primary total hip arthroplasties, revision total hip arthroplasties, male patients, and female patients. With the numbers available, no significant differences were found in the probability of survival of the acetabular or the femoral component in any of the subgroups. Theoretical considerations suggest that the geometric design of the elevated-rim acetabular liner may have biomechanical characteristics that predispose the implant to early loosening. However, our initial review of the results of total hip arthroplasties after a mean follow-up period of five years (range, 0.25 to ten years) failed to demonstrate any difference in the cumulative probability of revision because of loosening of the implant. Continued surveillance is warranted and ongoing.

Acetabulum↗
PubMed1997

The extraosseous and intraosseous arterial anatomy of the adult elbow.

UNLABELLED: We investigated the extraosseous and intraosseous arterial anatomy of the human adult elbow. Twenty-two fresh adult cadaveric upper extremities were studied with a technique of combined India-ink and latex injection followed by chemical débridement. The intraosseous vascularity of twelve extremities was then evaluated with a rapid Spalteholz clearing technique. Our findings demonstrated consistent patterns of extraosseous and intraosseous vascular anatomy, which were organized into three vascular arcades: medial, lateral, and posterior. The medial arcade was formed by the superior and inferior ulnar collateral arteries and the posterior ulnar recurrent artery. The lateral arcade was formed by the radial and middle collateral, radial recurrent, and interosseous recurrent arteries. The posterior arcade was formed by the medial and lateral arcades and the middle collateral artery. The intraosseous circulation of the elbow, which was segmental in organization, appeared to be dependent on the local blood supply. The capitellum and the lateral aspect of the trochlea were supplied by posterior perforating vessels arising from the radial recurrent, radial collateral, and interosseous recurrent arteries. The medial aspect of the trochlea was supplied by a circumferential vascular ring originating from the inferior ulnar collateral artery. Watershed areas were apparent between the blood supplies to the medial and lateral aspects of the distal end of the humerus. The olecranon was richly supplied by vessels coursing along its medial aspect from the posterior ulnar recurrent artery and along its lateral aspect from the interosseous recurrent artery. The radial head had a dual extraosseous blood supply from a single branch of the radial recurrent artery, which supplied the head directly, and from additional vessels from both the radial and the interosseous recurrent artery, which penetrated the capsular insertion at the neck of the radius. CLINICAL RELEVANCE: Our findings demonstrate that arterial contributions to the intraosseous circulation of the elbow are more specific than previously appreciated. The intraosseous circulation of the elbow is derived mainly from perforating vessels that arise from neighboring extraosseous arteries. These perforating arteries may be damaged by trauma or by extensile dissection during reconstruction of the elbow. An understanding of the extraosseous and intraosseous circulation of the elbow may help to avoid iatrogenic injury to the intraosseous circulation.

Adult↗
PubMed1997

Total elbow arthroplasty: revision with use of a non-custom semiconstrained prosthesis.

The results of revision elbow arthroplasty with use of the semiconstrained Mayo-modified Coonrad implant in forty-one patients were reviewed retrospectively. The average duration of follow-up was six years (range, two to thirteen years). At the time of the latest follow-up evaluation, thirty-eight patients were able to perform activities of daily living, one had a stiff elbow because of heterotopic ossification, one had weakness secondary to an injury of the radial nerve, and one had an unstable elbow after removal of the prosthesis because of recurrent aseptic loosening. Fourteen patients sustained either a fracture or a perforation of the cortex at the time of removal of the primary implant. Three of these patients had an injury of the radial nerve; the injury was due to extravasation of the cement from a cortical defect in two of them and was sustained during removal of the cement in one. Eight patients had an intraoperative or postoperative complication that necessitated additional operative intervention. Postoperatively, twenty-two patients had complete relief of pain and sixteen had mild discomfort. Three patients remained disabled: one, because of pain secondary to loosening of the component; one, because of a pre-existing nerve injury; and one, because of the residual effects of an intraoperative injury of the radial nerve. The average Mayo elbow performance score was 87 +/- 16 points at the latest follow-up evaluation, compared with 44 +/- 17 points preoperatively (p < 0.0001). Revision elbow arthroplasty restored function to the patients who had had a failed prosthesis without infection.

Adult↗
PubMed1997

Difficult complications after hip joint replacement. Dislocation.

Dislocation after hip replacement occurs at an overall incidence of 2% to 3% and has significant cost and morbidity implications. Statistically increased incidence is observed in females and in the elderly, and after reoperation procedures. Specific causes include cup malrotation, trochanteric migration, and decreased femoral offset. Head size, leg length, and postoperative mobilization have not proven to be causative factors, but the posterior exposure statistically and consistently is associated with increased instability. Extended acetabular walls do lessen the incidence of dislocation in the primary but even more significantly in the revision procedure. Early (< 3 months) dislocations successfully are treated by 4 to 8 weeks of immobilization in 60% to 70% of instances. The most successful reoperations are those in which the specific cause of the dislocation has been defined. The success rate is approximately 80% for cup reorientation and trochanteric advancement. Nonspecific or ill defined causes are managed successfully by surgical intervention in only approximately 50% of cases. With extensive soft tissue compromise, limited experience with certain salvage options include the bipolar implant with a reported success rate of approximately 80%. Captive articular designs also seem to be successful in approximately 70% of instances but with relatively short term followup and lingering concerns regarding the long term integrity of the fixation.

Arthroplasty, Replacement, Hip↗
PubMed1996

A differential scanning calorimetry study of retrieved orthopedic implants made of ultrahigh molecular weight polyethylene.

Differential scanning calorimetry (DSC) was used to examine thermal and thermooxidative properties of ultrahigh molecular weight polyethylene (UHMW-PE) of five acetabular components of failed orthopedic implants retrieved at revision of total hip arthoplasty. The results were compared with controls (unimplanted acetabular cups, a 20-year-old slab of UHMW-PE, and raw material). Profiles of exothermic peaks indicated increased levels of oxidation in all retrieved cups. In three retrieved cups, DSC revealed an additional peak of endotherm that was not seen in control samples. The additional endotherm peaks were not artifacts due to oxidation during scanning, heat buildup during cutting of the samples, or the sterilization method after retrieval. The additional peak was associated with the bulk of the polymer that was extracted with hexane. It varied in relative area, depending on its original location of the sample in a cup, implicating local variability in the extent of changes in material property. The distribution of the changes suggests that, during implantation, tissue exposure and friction affected the level of oxidation and degree of crystallinity in the UHMW-PE to a greater degree than did loading alone. Overall results showed that DSC may be a useful tool in evaluating changes in the properties of UHMW-PE orthopedic components in vivo.

Acetabulum↗
PubMed1996

Total joint arthroplasty in orthotopic liver transplant recipients.

Eight total hip and two total knee arthroplasties were performed from 1986 to 1991 in eight patients who had orthotopic liver transplantation. The indications for joint arthroplasty were avascular necrosis of the femoral head in five hips, pathologic femoral neck fracture caused by osteopenia in three hips, avascular necrosis of femoral and tibial condyles in one knee, and posttraumatic arthritis in one knee. Six patients (75%) had significant osteopenia. The mean interval between liver transplantation surgery and hip or knee joint arthroplasty was 2 years (8-48 months). The patients who had hip arthroplasty were followed for a mean of 4.85 years (2-8 years), and those who had a knee arthroplasty after a hip arthroplasty, for a mean of 3.5 years (2-5 years) after the knee arthroplasty. In the patients who had hip arthroplasty, the mean Harris hip score was improved from 34 to 82 points. In the two patients who had a knee arthroplasty, the mean score was improved to 100 points both for pain and function of the knee and for overall function from mean preoperative knee scores of 49 and 25 points, respectively. Radiographs did not reveal any loosening of the components. None of the patients required reoperation and there were no serious postoperative complications.

Adult↗
PubMed1996

Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties.

Questionnaires are commonly used in orthopaedic outcome studies. This study sought to determine if responses to a simple standardized questionnaire correlated with responses obtained during a physician interview in evaluation of clinical outcome following hip and knee arthroplasty. One hundred sixty-two patients with 201 hip and knee arthroplasties were asked to fill out a questionnaire prior to returning for routine follow-up evaluation. There was a highly significant correlation (P < .0001, r = .74) between scores calculated from patient responses on the questionnaire and those calculated from responses recorded during the subsequent physician visit. There was no significant difference between patient and physician clinical hip scores, but physicians gave significantly higher knee scores than patients for both long- ( > 4.5 years, P < .05) and short-term ( < or = 4.5 years, P < .0001) follow-up periods; however, 97% of patient responses were within one grade of physician-recorded answers to the same questions. Eight and one-half percent of scores differed in overall evaluation from good-excellent to fair-poor categories. This study both validates and defines more clearly the limitations of questionnaires for follow-up evaluation of clinical results following total hip and knee arthroplasty.

Aged↗
PubMed1996

Long term outcome and survivorship analysis of primary total knee arthroplasty in patients with diabetes mellitus.

Sixty-eight consecutive primary total knee arthroplasties in 51 patients with diabetes mellitus were assessed for long term outcome and risk factors. The mean followup was 8 years. There was a higher complication rate compared with that of a matched control group. Wound complications occurred in 4 knees, deep infection in 1, periprosthetic fractures in 3, and definite aseptic loosening in 5. Urinary tract infections occurred in 4 patients. Radiolucencies of more than 1 mm were observed in 38% of arthroplasties. At last followup, the Hospital for Special Surgery knee score was 77 +/- 12 points, which is worse than the 86 +/- 10 points of the control subjects. Only 74% of the patients had a satisfactory clinical result. Survivorship analysis showed a 91% probability of implant survival at 10 years, which was not significantly different from that of the control subjects. Previous surgery and increased weight were the only risk factors associated with implant failure.

Diabetes Mellitus, Type 2↗
PubMed1996

The elevated-rim acetabular liner in total hip arthroplasty: relationship to postoperative dislocation.

Although an acetabular component with an elevated rim is thought to improve the postoperative stability of a total hip prosthesis, the actual clinical value has not yet been demonstrated. To address this question, we reviewed the results of 5167 total hip arthroplasties that had been performed at our institution from April 1, 1985, through December 31, 1991. The prostheses included 2469 acetabular components with an elevated-rim liner (10 degrees of elevation) and 2698 with a standard liner. The cumulative probability of dislocation was estimated as a function of time since the operation with use of the Kaplan-Meier survivorship method. Forty-eight of the 2469 hips that had the elevated-rim acetabular liner dislocated within two years, compared with 101 of the 2698 hips that had the standard acetabular liner. The two-year probability of dislocation was 2.19 per cent for the hips with the elevated-rim liner and 3.85 per cent for those with the standard liner (p = 0.001). A similar trend was seen at five years; however, because of a smaller sample the difference was not significant. Increased stability at two years was also demonstrated for the hips with the elevated-rim liner when the hips were analyzed according to the operative approach, the mode of fixation, the sex of the patient, and the type of total hip arthroplasty (primary or revision). Although these data demonstrate improved stability after total hip arthroplasty when an elevated liner is used, particularly in hips that are at greater risk for dislocation of the prosthesis, the long-term effect of this elevated liner on wear and loosening remains unknown but is of considerable concern. The elevated liner deserves additional study to clarify its effect on wear and loosening.

Adult↗
PubMed1996

Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors.

Thirty-two postoperative peroneal-nerve palsies in thirty patients were documented in a retrospective review of 10,361 consecutive total knee arthroplasties performed at one institution from 1979 through 1992. The mean age of the thirty patients was sixty-five years (range, twenty-eight to seventy-eight years). Four of these patients had had a previous proximal tibial osteotomy and five had had a previous lumbar laminectomy. Ten knees (ten patients) had preoperative valgus alignment of 12 degrees or more. A control group of 100 patients who had had total knee arthroplasty during the same period was computer-matched to the patients by age, sex, and operating surgeon. Comparison of this control group with the thirty patients showed that epidural anesthesia for postoperative control of pain (p < 0.03), previous laminectomy (p < 0.04), and preoperative valgus deformity (p < 0.0001) were significantly associated with peroneal nerve palsy. The relative risk for patients who had had a previous proximal tibial osteotomy was doubled, but this was not significant (p < 0.4). To determine risk factors associated with anesthesia better, a subgroup of 4388 total knee arthroplasties performed during a five-year period (1988 through 1992) was also studied. In this sample, twenty-five peroneal-nerve palsies were documented. Eighteen occurred after epidural anesthesia (p < 0.03); five, after general anesthesia; and two, after spinal anesthesia. An important finding of this study is the high frequency of delayed presentation of peroneal nerve palsy. We believe that epidural anesthesia for postoperative control of pain leads to decreased proprioception and sensation postoperatively. It is postulated that positioning of the limb in this unprotected state may be a factor in the late development of palsy. The concept of the so-called double-crush phenomenon may partially explain the palsy seen in the patients who had had a lumbar laminectomy and asymptomatic peripheral neuropathy.

Adult↗
PubMed1996

Effect of feedback on resource use and morbidity in hip and knee arthroplasty in an integrated group practice setting.

OBJECTIVE: To assess the effect of a structured program of feedback about resource utilization and morbidity on resource consumption and complications in an orthopedic surgical practice. DESIGN: We prospectively analyzed use and outcomes before and after an intervention (departmental data presentation). MATERIAL AND METHODS: Feedback on resource utilization and morbidity for 2,820 patients who underwent a primary total hip or knee arthroplasty for a diagnosis of osteoarthritis between Jan. 1, 1990, and Dec. 31, 1992, was provided to members of the orthopedic department of an academic medical center. Data were adjusted for severity of disease. RESULTS: On reassessment 18 months after the beginning of the feedback program, total charges and length of hospital stay for hip or knee arthroplasty were significantly reduced. Interpractitioner variability was also reduced but not significantly. The feedback process was instrumental in identifying a specific complication--pulmonary embolism after bilateral total knee replacement--which was significantly reduced by addition of warfarin prophylaxis. CONCLUSION: The intervention was successful in reducing resource use (length of hospital stay) and complications (pulmonary embolism). In addition, total charges for hip and knee arthroplasty declined significantly at a time when medical center charges overall were increasing. Efforts to maintain continuous improvement will primarily focus on the development of critical pathways.

Critical Pathways↗
PubMed1995

Tensile properties of the supraspinatus tendon.

The tensile properties of the supraspinatus tendon were investigated in 11 shoulders from fresh cadavers. The tendon was divided into three longitudinal strips: anterior, middle, and posterior. Each specimen was mounted on a materials testing machine, with four fluorescent markers placed on both surfaces of the tendon strip. The positions of these markers were recorded during the test by two synchronized video cameras. Load-deformation and strain curves were determined, and the stress-strain curve, strength, and modulus of elasticity were calculated. The posterior strip was thinner in cross section than the others (p = 0.0355). The ultimate load and ultimate stress were significantly greater in the anterior strip (16.5 +/- 7.1 MPa) than in the middle (6.0 +/- 2.6 MPa) and posterior (4.1 +/- 1.3 MPa) strips (p < 0.0001). The modulus of elasticity also was significantly greater in the anterior strip (p < 0.0001), but there was no significant difference between the superficial and deep surfaces. It is concluded that the anterior portion of the supraspinatus tendon is mechanically stronger than the other portions, and it seems to perform the main functional role of the tendon.

Aged↗
PubMed1995

Loose-hinge total elbow arthroplasty. An experimental study of the effects of implant alignment on three-dimensional elbow kinematics.

A previous study suggested that the kinematics of a loose-hinge total elbow arthroplasty (TEA) are those of a truly semiconstrained joint. This study addresses the effects of malposition of the implant. The three-dimensional elbow kinematics during simulated active motion were studied in six cadaver specimens using an electromagnetic tracking device. In addition to simulated active elbow flexion, flexion arcs were obtained under an elbow varus or valgus moment, to calculate the structural varus-valgus laxities. The results after four different Coondrad-Morrey TEA positions of implantation were compared with those of the intact elbow. The flexion-extension amplitudes were not significantly decreased after TEA implantation, except with external rotation of the ulnar component, which resulted in a loss of extension. In the intact elbow and after TEA implantation in any position, the mean varus-valgus deviations throughout elbow flexion were in a narrower range than the structural limits imposed by the ligaments (intact elbow) or the TEA hinge design. With internal malrotation of the humeral component over 10 degrees, however, the valgus structural limit was reached and, conversely, the varus limit with external rotation over 10 degrees. The clinical improvement observed with the semiconstrained TEA is derived from the benefits of the less constrained articulation. The proximodistal changes of TEA implantation have no consequence on the kinematic pattern. Rotational malpositioning of either humeral or ulnar component should be avoided, the first because it changes the kinematic pattern toward the structural limits of the implant and, therefore, may lead to excessive stresses at the bone-cement-implant interfaces and to early loosening, and the latter because it causes loss of extension.

Biomechanical Phenomena↗
PubMed1995

Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow.

We performed a retrospective review of the long-term results of operative treatment of medial epicondylitis in thirty elbows (twenty-six patients). Sixteen elbows had concomitant ulnar neuropathy. All of the patients had tenderness over the medial epicondyle. The most sensitive provocative maneuver was resisted pronation of the forearm (a positive result for twenty-eight elbows), followed by resisted flexion of the wrist (a positive result for twelve elbows). The operative findings included an inflammatory focus in seventeen elbows and focal ulnar-nerve compression in nine. Débridement of the origin of the flexor-pronator tendon mass, with decompression or transposition of the ulnar nerve when indicated, was associated with an 87 per cent rate (twenty-six elbows) of good or excellent results at an average of seven years (range, two to fifteen years) after the operation. Twenty-four of the twenty-five elbows that had no or mild associated ulnar neuropathy (type-IA or IB medial epicondylitis) had a good or excellent result, while two of the five elbows that had moderate or severe associated ulnar neuropathy (type-II medial epicondylitis) had a good or excellent result. This difference was significant (p = 0.009). Nine patients (nine elbows) needed more than six months before maximum improvement was obtained.

Arm Injuries↗
PubMed1995

Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty.

At a minimum of one year after operation, we studied 64 patients with 86 total hip arthroplasties (THA) by standard anteroposterior hip and pelvic radiographs and measurement of range of motion and of isometric abduction strength. The femoral offset correlated positively with the range of abduction (p = 0.046). Abduction strength correlated positively with both femoral offset (p = 0.0001) and the length of the abductor lever arm (p = 0.005). Using multiple regression, abduction strength correlated with height (p = 0.017), gender (p = 0.0005), range of flexion (p = 0.047) and the abductor lever arm (p = 0.060). Our findings suggest that greater femoral offset after THA allows both an increased range of abduction and greater abductor strength.

Adult↗