Tapered stems in cemented primary total hip replacement.
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Arthroplasty, Replacement, Hip↗
Biomedical subjects
Donald S Garbuz
Publications and source records attributed to Donald S Garbuz.
Computer-assisted femoral head resurfacing.
Femoral head resurfacing is re-emerging as a surgical option for younger patients who are not yet candidates for total hip replacement. However, this procedure is more difficult than total hip replacement, and the mechanical jigs typically used to align the implant produce significant variability in implant placement and take a significant amount of time to position properly. We propose that a computer-assisted surgical (CAS) technique could reduce implant variability with little or no increase in operative time. We describe a new CAS technique for this procedure and demonstrate in a cadaver study of five paired femurs that the CAS technique in the hands of a novice surgeon markedly reduced the varus/valgus variability of the implant relative to the pre-operative plan (2 degrees standard deviation for CAS versus 5 degrees for a mechanical jig operated by an expert surgeon). We also show that the mechanical jig resulted in significantly retroverted implant placement. There was no significant difference in operative time between the two techniques.
Arthroplasty, Replacement, Hip↗
Evaluation of pain in patients with apparently solidly fixed total hip arthroplasty components.
The cause of pain in a patient with an apparently solidly fixed total hip arthroplasty can be difficult to elucidate. A detailed history, careful examination, and plain radiographs provide the most useful information, especially in excluding causes not primarily related to the hip. Determining whether the pain is related to the implant, to soft tissue, or to bone can require laboratory tests, radiographic and fluoroscopic imaging, and contrast arthrography and local anesthetic injections. Particularly when pain is caused by occult infection, erythrocyte sedimentation rate, C-reactive protein level, hip aspiration, advanced radiologic imaging, and nuclear medicine scans can help determine the diagnosis.
Arthroplasty, Replacement, Hip↗
Classification systems in orthopaedics.
Classification systems help orthopaedic surgeons characterize a problem, suggest a potential prognosis, and offer guidance in determining the optimal treatment method for a particular condition. Classification systems also play a key role in the reporting of clinical and epidemiologic data, allowing uniform comparison and documentation of like conditions. A useful classification system is reliable and valid. Although the measurement of validity is often difficult and sometimes impractical, reliability-as summarized by intraobserver and interobserver reliability-is easy to measure and should serve as a minimum standard for validation. Reliability is measured by the kappa value, which distinguishes true agreement of various observations from agreement due to chance alone. Some commonly used classifications of musculoskeletal conditions have not proved to be reliable when critically evaluated.
Classification↗