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Biomedical subjects

David J Jacofsky

Publications and source records attributed to David J Jacofsky.

25 records · Page 2Linked to original sources
PubMed2004

Rotating platform knees did not improve patellar tracking: a prospective, randomized study of 240 primary total knee arthroplasties.

Renewed interest in mobile-bearing total knee replacement designs has been generated by the concept of self alignment and the suggestion that those designs can accommodate small mismatches in the rotational position of the tibial and femoral components. Self alignment might improve patellar tracking, decrease the prevalence of lateral retinacular release and postoperative patellar tilt or subluxation, improve knee flexion, and improve patellofemoral function during daily activities such as stair climbing. This prospective randomized study of 240 patients used a single posterior-stabilized femoral component and included three groups of 80 patients: an all-polyethylene group, a modular metal-backed group, and a rotating platform tibia group. The prevalence of lateral retinacular release was 3.8% in each group. The prevalence of patellar tilt was 5% (all-polyethylene group), 7% (modular metal-backed group), and 11% (rotating platform group). Preoperative motion was not significantly different and both the 3-month flexion (112 degrees , 110 degrees , and 108 degrees ) and 1-year flexion (116 degrees , 117 degrees , and 115 degrees ) were not significantly different among the all-polyethylene, modular metal-backed, and rotating platform groups, respectively. Preoperative stair climbing scores were not significantly different and both the 3-month (38, 41, and 35 points) and 1-year (44, 46, and 42 points) scores were not significantly different. In this prospective randomized study, the rotating platform knee design did not decrease the prevalence of lateral retinacular release or patellar tilt or subluxation and did not increase knee flexion or improve stair climbing ability at 3 months or at 1 year postoperatively when compared with a posterior-stabilized, fixed-bearing knee.

Adult↗
PubMed2003

Use of erythropoietin in two-stage reimplantation total hip arthroplasty.

This study was done to quantify the effect of epoetin alfa on the transfusion requirements of patients having two-stage reimplantation for infected total hip arthroplasties. This prospective study included 30 consecutive patients treated with a two-stage reimplantation procedure during a 2-year period at one institution. Each patient received a standard dose of epoetin alpha (40,000 units) subcutaneous in the interval between resection and reimplantation. Transfusions were administered only when warranted by clinical symptoms and were not governed by predetermined hemoglobin levels. When compared with a control group of similar patients, the hemoglobin levels before reimplantation were significantly higher (14.0 g/dL versus 11.8 g/dL) and the median allogeneic blood requirements were significantly lower (0 units/patient [range, 0-6] versus 4.3 units per patient [range, 0-9]). Epoetin alfa used in the interval between the resection and reimplantation stage significantly increased the hemoglobin levels and decreased the rate of transfusion for patients having two-stage reimplantation total hip arthroplasty.

Aged↗
PubMed2003

Advances and challenges in the surgical treatment of metastatic bone disease.

There are numerous challenges facing the orthopaedic surgeon who treats metastatic bone disease in the twenty-first century. The orthopaedic surgeon must be familiar with the indications for surgical intervention, the available implants for fixation of a given anatomic lesion, the appropriateness of fixation versus resection and replacement, and the viability of newer, less invasive treatment options for a given lesion. Determination of the best surgical candidates still is controversial, especially in the arena of prophylactic treatment. Recent advances have made fixation with intramedullary devices and standard plates simpler and more rigid. The advent and improvement of megaprostheses has made complex joint reconstructions more durable. Advances in interventional radiology such as radiofrequency ablation and percutaneous vertebroplasty and acetabuloplasty with polymethylmethacrylate (PMMA) continue to be promising options for future treatment. Better methods are necessary to evaluate the status of the patients preoperatively and postoperatively, to classify functional improvement after surgical treatment, and to determine the impact of treatment on the quality of life.

Acetabulum↗
PubMed2003

Treatment of supracondylar femur nonunions with open reduction and internal fixation.

We reviewed a consecutive series of 22 adults with 22 supracondylar femoral nonunions treated with open reduction and internal fixation (ORIF) to determine the results and complications associated with the procedure. Twenty-one of 22 nonunions (95%) healed. Knee Society pain scores improved from 18 to 88 (P < 0.001). Mean Knee Society functional scores improved from 4 to 55 (P < 0.001). Mean range of motion at follow-up was 1 degree to 96 degrees. ORIF and bone grafting of properly selected patients with nonunions of the distal femur resulted in high rate of union with few associated complications. All patients had improvement in pain scores and the great majority had improvements in functional scores.

Femoral Fractures↗
PubMedDate not supplied

Innovations in musculoskeletal oncologic surgery over the year 2000.

It is clear that recent advances in related fields including modern imaging, medical chemotherapy, and advances in materials and bioengineering has enhanced the opportunity for limb sparing surgery. This technique should be considered as a surgical option for these patients, when not at the expense of sound oncological procedure. Significant improvements have been noted over the later part of the 20th Century, and in recent years, advances in molecular oncology have resulted in an explosion of knowledge of the biology of cancer which will result in continued progress in this challenging area.

Adult↗