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Biomedical subjects

G A Hunter

Publications and source records attributed to G A Hunter.

At least 55 records · Page 3Linked to original sources
PubMed1982

Mania operativa: an uncommon, unrecognized cause of limb amputation.

Mania operativa is an obsession with pain and disability and the seeking of relief from this pain by repeated surgical procedures. The authors report eight patients in whom a minor injury was followed by multiple operations, culminating in amputation of the upper or lower limb, at increasingly higher levels, in an unsuccessful attempt to relieve the patient's pain. They believe these patients had mania operativa. There are many varieties of psychogenic pain, which present the surgeon with a problem in both diagnosis and management. The authors discuss identifiable factors in the patient, the surgeon and society. By calling attention to this condition, they hope to avoid unnecessary multiple surgical procedures on such patients.

Adult↗
PubMed1982

A radiographic analysis of 166 Charnley-Müller total hip arthroplasties.

A review of 166 total hip arthroplasties, with follow-up from six months to 11 years, showed a 73% incidence of femoral "looseness," 22% incidence of progressive femoral "loosening" and 95% incidence of acetabular "looseness" for all radiolucent line sizes. Part of the reason for the high incidence of femoral "looseness" may be explained by the rigorous criteria in the authors' definition of "looseness." However, femoral "looseness" remains high at 47% and 36% incidences at the cement-bone and cement-stem interfaces, respectively, for radiolucent lines greater than 1 mm. Only one trochanteric osteotomy was performed and it is suggested that omission of trochanteric osteotomy results in inadequate cement filling of the femoral stem, as well as a lack of proper placement of the stem, contributing to the high incidence of femoral "looseness." Larger and more tapered stems, with routine trochanteric osteotomy, together with the use of low viscosity cement under pressure, should be investigated to reduce the incidence of femoral "loosening" and necessity for revision. The Harris Hip rating was found to have good correlation with the radiologic findings of loose and nonloose femoral stems.

Bone Cements↗
PubMed1982

Failure in total knee arthroplasty: mechanisms, revisions, and results.

Of 700 prosthetic knees inserted during the period from 1969 to 1978, 94 failed; 19 of the failures occurred due to infection. Other obvious mechanisms of failure were wear debris sy novitis, ligament rupture, and patellar dislocation. The majority of prosthetic loosenings occurred on the tibial side. There were five mechanical factors of such loosening: tilt and sink; compression; torsion; toggle; and a combination of these factors. Excluding those who died or were lost to follow-up, the results of revision were 37% good or excellent; 60% fair or poor; and 3% failure. To some extent the results were prosthesis dependent; the semiconstrained prosthesis had a good result in 48%, unlinked hinges a good result in 24%, and a true hinge a good result in 21%. The results in infected cases were poor; of five prosthetic revisions, only one was good. Fusion was found difficult to achieve; of 11 attempts, only six obtained solid fusion. Four amputations were performed, all for infection in hinged knee replacements.

Aged↗
PubMed1982

Total hip revision arthroplasty: does sepsis influence the results?

The results of revision total hip arthroplasty, with or without sepsis, are compared in a review of the recent literature. In 661 total hip revisions without sepsis, there is an overall 54% excellent/good/satisfactory rate and a 12% infection rate. Of 1063 total hip revisions in the presence of or after sepsis, there is an overall success rate of 73% and a 17% reinfection rate. Comparison of the two groups is difficult due to the different criteria used to diagnose infection, the variable use of parenteral antibiotics and cement impregnated with antibiotics, the frequently short follow-up periods, and the definition of success by different rating s stems. Aside from infection, before advising revision surgery or excision arthroplasty, consideration should be given to the individual patient, the hip to be revised, and the technical skills available. Follow-up should be monitored yearly by an independent examination of the patient, not by chart review or telephone questionnaire. Standardized rating methods should be used, together with strict criteria for the diagnosis of infection. Only in this way will results from different centers be comparable.

Bacterial Infections↗
PubMed1981

Fractures in lower limbs with prior amputation. A study of ninety cases.

Eighty-five lower-limb amputees with ninety subsequent fractures of the residual limb were studied retrospectively. Most of the fractures were managed by non-operative methods, with the exception of unstable intertrochanteric fractures and displaced fractures of the femoral neck. Indications for operative and non-operative treatment in below-the-knee and above-the-knee amputees are outlined. No indication was found for reamputation through the fracture site. Before fracture, all amputees used a prosthesis. After healing of the fracture, 97 per cent of the patients with amputation below the knee and 82 per cent of those with amputation above the knee resumed use of a prosthesis.

Adolescent↗
PubMed1981

Revision of total knee replacement.

In the London and Toronto areas between 1969 and 1978, 597 patients had 661 cemented knee replacements. Eighty-nine (13.5%) prostheses failed; 73 of them were revised. Nineteen (2.9%) failed primarily because of infection. The revised replacements were examined and rated using a modification of the British rating system. The overall results of revision were excellent or good in 30% and fair or poor in 52%. Fusion was attempted in two patients after revision. In 16 patients with failed replacements that were not revised, fusion was attempted in 9; 4 of the 16 patients had amputation. The results of failure in knee replacement surgery are similar to those of hip replacement, but are helped considerably by lower patient expectation.

Aged↗
PubMed1981

Unicompartmental knee replacement.

The results of unicompartmental knee replacement in a series of 83 knees were reviewed for the period of 1970 to 1978; 30.1 percent achieved good or excellent results; 48.2 percent fair or poor results; 21.7 percent were failures. The vast majority of failures and poor results were due to technical errors. Only 9.6 percent of the nonoperated contralateral compartments required further surgery.

Aged↗
PubMed1981

Fracture of the ipsilateral femur in patients wih total hip replacement.

The records of all patients who had had a total hip replacement complicated to a fracture of the ipsilateral femur in the intraoperative or postoperative period were collected from six London and Toronto teaching hospitals. Thirty-five patients (thirty-seven fractures) were studied to determine the effects of the fracture on the total hip replacement. The results of the total hip replacement ultimately were rated as satisfactory in fourteen patients (40 per cent) and unsatisfactory in twenty-one patients (60 per cent). Our study suggests that fractures proximal to the tip of the prosthetic stem that occur postoperatively should be treated conservatively if the prosthesis is intact. If subsequent symptomatic loosening develops, a revision can be done after the fracture has healed. Intraoperative fractures that occur proximal to the tip of the prosthesis and all fractures occurring at or distal to the tip should be stabilized surgically. The best results were obtained using a long-stem prosthesis supplemented with internal fixation of the fracture. If rigid fixation is not achieved at surgery, postoperative immobilization is required. Fractures entirely distal to the tip of the prosthesis do not result in prosthetic loosening and may be treated in a routine fashion if care is taken to avoid unnecessary areas of stress concentration.

Adult↗
PubMed1980

The below-elbow myo-electric prosthesis. A comparison of the Otto Bock myo-electric prosthesis with the hook and functional hand.

The place of the myo-electric prosthesis in below-elbow amputees has been reviewed. Forty-three patients were seen and all possessed both a myo-electric prosthesis and a standard artificial limb. Nearly half the patients used the newer device almost all the time at work and many of these wore it for the majority of their waking hours. Its use at work was mainly related to the patient's type of job and here in turn there was concern about damaging the device. It is suggested that acceptance would be further increased if greater attention were paid to the durability of the arm and its glove. Criteria for prescription and future developments are discussed.

Adult↗
PubMed1980

Should we abandon primary prosthetic replacement for fresh displaced fractures of the neck of the femur?

The complications and results of 100 patients with a displaced femoral neck fracture, treated by primary prosthetic arthroplasty between 1972 and 1977, demonstrate a high morbidity from the surgical procedure. The six-month mortality was 20%. Good results were obtained in only 28% of the patients. In view of the reported incidence of deep-wound infection, dislocation and high mortality at six months, arguments are presented for and against the routine use of cemented hemiarthroplasty. Further consideration should now be given to alternative procedures, such as the muscle-pedicle graft. Total hip replacement may be indicated in some patients in whom accurate reduction of a displaced femoral neck fracture is impossible.

Femoral Neck Fractures↗
PubMed1979

Dislocation requiring revision in total hip arthroplasty.

In a study of 141 hip revisions seventeen were found to be due to recurrent dislocation. Thirteen cases occurred immediately postoperatively and four more than two years following surgery. In the early cases component malposition was found to be the commonest cause of dislocation. Revision resulted in only 40% acceptable results.

Hip Dislocation↗
PubMed1979

The results of revision of total hip arthroplasty.

The results of 140 total hip revision procedures for "non-septic" loosening, dislocation, and fracture of the femoral stem or shaft have been personally reviewed and rated by the Harris method. The minimum follow-up period was six months: thirty-three (24 per cent) showed excellent or good results, seventy-two (51 per cent) showed fair or poor results. Subsequent excision arthroplasty was performed in thirty-one patients. The infection rate for these revision procedures was very high, suggesting that many were already infected at the time of revision, and that every "loose" hip must be assumed to be infected until proved otherwise. The mortality rate of 3 per cent was surprisingly low after more than one major surgical procedure in these elderly patients.

Aged↗
PubMed1979

The results of reinsertion of a total hip prosthesis after sepsis.

Sixty-five total hip arthroplastics were reinserted after sepsis around the hip, positive cultures being obtained from fifty-six. Although 65 per cent of patients still have their implant in position, only sixteen of sixty-five (25 per cent) show an excellent or good result on a Harris rating. Twenty-three of sixty-five (35 per cent) subsequently required an excision arthroplasty. The indications and contraindications for this procedure are given.

Aged↗
PubMed1979

Iatrogenic femoral nerve injuries.

Eighteen cases of iatrogenic femoral nerve injury are described. In two patients the damage was incurred as a result of an intra-abdominal operation. In three others the nerve was injured at the level of the inguinal ligament. In the majority femoral nerve palsy followed surgery to the hip joint and was attributable to a lesion-in-continuity. Only one of the patients in the series made a full recovery, but because only severe cases were included these disappointing results by no means represent the expected outcome. To avoid this serious and distressing complication of surgery, the surgeon must be familiar with the anatomic features of the region and must take care to avoid compression of the femoral nerve by retractors and its overstretching during operations on the the hip joint.

Adolescent↗
PubMed1978

Ipsilateral fracture of the femur and tibia.

The hospital records of 222 cases of ipsilateral fractures of the femur and tibia were reviewed, and patients were grouped according to the type of fracture and the method of treatment. Thirty-five per cent of patients required late operation for delayed union or non-union, osteomyelitis, refracture and malunion, regardless of the treatment group. A disturbing factor was the 30% incidence of osteomyelitis in patients treated by fixation of both fractures, almost three times the incidence when only one fracture was fixed. A 30% incidence of delayed union or non-union occurred in patients managed conservatively. Of sixty-three patients personally examined, the worst results found were those following conservative management of both fractures. More use of rigid external fixation and of cast bracing is recommended in the management of the fractured tibia, combined with internal fixation of the femoral fracture. Examination of the knee suggested that, with ipsilateral fractures, disruption of ligaments is a common occurrence and should always be suspected.

Adolescent↗