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Biomedical subjects

F S Haddad

Publications and source records attributed to F S Haddad.

At least 37 records · Page 2Linked to original sources
PubMed2000

Total knee arthroplasty after high tibial osteotomy: a medium-term review.

A total of 50 consecutive knee arthroplasties in 42 patients who had undergone previous high tibial osteotomies have been reviewed with a minimum follow-up of 5 years and compared with 50 age-matched and sex-matched primary total knee arthroplasties. There were no significant preoperative differences between the 2 groups. Surgery in the osteotomy group took on average 23 minutes longer (P < .02), and there was a decrease of 80 flexion postoperatively but without an associated difference in knee scores. Patellar subluxation was also seen more frequently (P < .05). There was no difference in the revision rate at an average follow-up of > 6.2 years. Although there are significant technical difficulties and subtle clinical differences, the overall outcome remains good to excellent in most cases.

Aged↗
PubMed2000

Circumferential allograft replacement of the proximal femur. A critical analysis.

The use of proximal femoral structural allografts in revision hip arthroplasty remains controversial. The current study constitutes the mean 8.8 years followup (range, 3-12.5 years) of a consecutive series of 55 proximal femoral allografts in 51 patients. In 46 patients the implant was cemented into the allograft and the distal femur, and the host proximal femur was resected at the time of reconstruction in all but seven patients. Five patients underwent revision surgery for acetabular failure, and six additional patients underwent revision surgery for failure of the proximal femoral allograft. Three patients underwent successful revision surgery and had additional proximal femoral allografts. Failure was caused by graft fracture in one patient, by deep infection in two patients, and by junctional nonunion in three patients. Junctional nonunion was seen in five patients (9%), two of whom were treated successfully with bone grafting and bone grafting and plating, respectively. Instability was observed in six patients (11%). Trochanteric nonunion was seen in 22 patients (43%) and trochanteric escape was seen in 14 patients (27%). The mean Harris hip score improved from 39 to 79 points. Resorption involving the full thickness of the allograft in at least one zone was seen in seven patients. This progressed rapidly and silently within the first 3 years but has yet to lead to the failure of any of the reconstructions. Infection was ruled out in every case. Allograft resorption was seen in seven patients and may be related to a combination of factors. It is most likely that this is an immunologic problem of slow rejection, but it is possible that the distal cement fixation led to stress shielding and resorption attributable to mechanical disuse. The possible protective role of retaining the bivalved host bone as a vascularized onlay autograft remains to be clarified. Although these results justify the continued use of structural allografts for selected patients, continued followup is warranted.

Adult↗
PubMed2000

Orthopaedic manifestations of mucolipidosis III: an illustrative case.

The musculoskeletal manifestations of mucolipidosis III include short stature, claw hands, carpal tunnel syndrome, and limited joint mobility. This article presents a series of complex orthopaedic problems, including avascular necrosis of the talus, encountered in one such patient whose presentation had initially given the impression of a mild form of the disease.

Bone Diseases↗
PubMed2000

CT evaluation of periacetabular osteotomies.

We have previously described a simple and reproducible three-dimensional technique of CT for the measurement of the cover of the femoral head in acetabular dysplasia in adults. We now describe the application of this technique in ten patients with symptomatic dysplasia to assess the degree and direction of dysplasia and to measure the cover obtained at acetabular osteotomy. The indices obtained gave a useful indication of the degree and direction of the dysplasia and confirmed which components had been used most efficiently to achieve cover. The information is easily presented in graphical form and gives a clearer indication of the cover obtained than the indices derived from plain radiographs.

Acetabulum↗
PubMed2000

Two-stage uncemented revision hip arthroplasty for infection.

We treated 50 consecutive patients with infected total hip arthroplasties according to a standard protocol. Previous surgery to eradicate the infection had been attempted in 13 patients and discharging sinuses were present in 20. Aspiration arthrography was routinely carried out before our interventions. The first stage was a meticulous removal of all foreign and potentially infected material. Samples were taken for culture and a thorough lavage carried out. Antibiotic-loaded beads were placed in the femoral shaft and an antibiotic-loaded cement ball in the acetabulum. At the second stage an uncemented arthroplasty was introduced. Bone allograft was used in 18 patients. The interval between procedures was usually three weeks, but this was extended if the wound was slow to heal or there was extensive bony destruction. Appropriate antibiotics were given for three months. At a mean follow-up of 5.8 years the rate of reinfection was 8% (4 patients). Two of these patients have had another, successful, two-stage revision. At this medium-term review, a satisfactory clinical and radiological outcome was obtained in all except two patients.

Adult↗
PubMed2000

Structural proximal femoral allografts for failed total hip replacements: a minimum review of five years.

There are few medium- and long-term data on the outcome of the use of proximal femoral structural allografts in revision hip arthroplasty. This is a study of a consecutive series of 40 proximal femoral allografts performed for failed total hip replacements using the same technique with a minimum follow-up of five years (mean 8.8 years; range 5 to 11.5 years). In all cases the stem was cemented into both the allograft and the host femur. The proximal femur of the host was resected in 37 cases. There were four early revisions (10%), two for infection, one for nonunion of the allograft-host junction, and one for allograft resorption noted at the time of revision of a failed acetabular reconstruction. Junctional nonunion was seen in three patients (8%), two of whom were managed successfully by bone grafting, and bone grafting and plating respectively. Instability was observed in four (10%). Trochanteric nonunion was seen in 18 patients (46%) and trochanteric escape in ten of these (27%). The mean Harris hip score improved from 39 to 79. Severe resorption involving the full thickness of the allograft was seen in seven patients (17.5%). This progressed rapidly and silently, but has yet to cause failure of any of the reconstructions. Profound resorption of the allograft may be related to a combination of factors, including a slow form of immune rejection, stress shielding and resorption due to mechanical disuse with solid cemented distal fixation, and the absence of any masking or protective effect which may be provided by the retention of the bivalved host bone as a vascularised onlay autograft. Although continued surveillance is warranted, the very good medium-term clinical results justify the continued use of structural allografts for failed total hip replacements with severe loss of proximal femoral bone.

Adult↗
PubMed2000

The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement.

The PROSTALAC functional spacer is made of antibiotic-loaded acrylic cement but has a small metal-on-polythene articular surface. We have used it as an interim spacer in two-stage exchange arthroplasty for infected total knee replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the knee and a reasonable range of movement. It also helps to maintain the soft-tissue planes, which facilitates the second-stage procedure. We reviewed 45 consecutive patients, treated over a period of nine years. The mean follow-up was for 48 months (20 to 112). At final review, there was no evidence of infection in 41 patients (91%); only one had a recurrent infection with the same organism. There was improvement in the Hospital for Special Surgery knee score between stages and at final review. The range of movement was maintained between stages. Complications were primarily related to the extensor mechanism and stability of the knee between stages. Both of these problems decreased with refinement of the design of the implant. The rate of cure of the infection in our patients was similar to that using other methods. Movement of the knee does not appear to hinder control of infection.

Adult↗
PubMed2000

Femoral bone loss in total hip arthroplasty: classification and preoperative planning.

A single comprehensive classification system that can adequately describe all types of bone loss associated with hip arthroplasty should become a standard for reporting purposes. There is a need for a critical appraisal of the classification systems currently in use and, through a consensus, for development of a system that will permit comparison between the reported results of different techniques. Although no one classification system is ideal, the one proposed by the AAOS Committee on the Hip is the most comprehensive and the most consistently used. It addresses not only revision total hip arthroplasty but also primary hip replacement. It also addresses other conditions related to problems with the bone stock, such as those resulting from a previous hip arthrodesis on the acetabular side and femoral stenosis and malalignment on the femoral side. The only drawback to this classification system is its complexity; however, the problem of acetabular and femoral bone loss is of sufficient complexity and variety that a simple classification system, although ideal, cannot be comprehensive. Regardless of the absence of a common language and a comprehensive classification system that is applicable to all types of reconstructions, it is clear that femoral bone loss is a problem that will continue to challenge orthopaedic surgeons. It is only by careful and methodical analysis of patients who have femoral bone loss and by meticulous attention being paid to detail in preoperative evaluation and investigation, surgical planning, and the recording of outcomes that we will be able to improve our treatment of this difficult problem.

Arthroplasty, Replacement, Hip↗