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Biomedical subjects

G R Scuderi

Publications and source records attributed to G R Scuderi.

At least 19 recordsLinked to original sources
PubMed1996

Management of the chronic irreducible patellar dislocation in total knee arthroplasty.

Neglected dislocation of the patella with gonarthrosis, genu valgum, flexion, and external rotation deformity is rarely encountered. Experience with five total knee arthroplasties in three patients with chronic patellar dislocation and gonarthrosis is reported. All knees had a modified proximal patellar realignment and arthroplasty with a constrained prosthesis. Preoperative Hospital for Special Surgery knee scores averaged 55. Average follow-up period was 40 months. At latest follow-up examination, the average Hospital for Special Surgery knee score was 83, the Knee Society knee score was 95, and the functional score averaged 50. There was one complication: a full-thickness lateral skin necrosis requiring flap coverage. The patellar score was zero in all knees. Four knees had mild quadriceps weakness. Three knees rated as excellent and two as good on both The Hospital for Special Surgery and Knee Society rating systems. Radiographic analysis revealed no radiolucent lines or osteolysis. The patellas were centralized in the trochlear groove in all patients. Patellar height averaged 14 mm (range, 12-17 mm). In conclusion, satisfactory results were obtained by restoring axial alignment with a constrained implant and realigning the patella with an extensive proximal realignment.

Aged↗
PubMed1996

Rotational landmarks and sizing of the distal femur in total knee arthroplasty.

In 100 knees undergoing a total replacement, the angles between the tangent line of the posterior condylar surfaces, the anteroposterior axis as described by Whiteside, the transepicondylar line, and the trochlear line were measured. Also measured were the sulcus angle, the transepicondylar width, the height of the condyles, and the thickness of the various cuts. Radiologic measurements made were: the mechanical angle, the hip center-femoral shaft angle, the transcondylar angle, and the tibial plateau-tibial shaft angle. The mean values of these measurements were calculated, and comparisons were made according to gender and the mechanical axis using the Student's t test. Correlations between the various measurements were calculated. The transepicondylar axis was found to be a reliable landmark to properly rotate the femoral component, and was easier to locate at surgery than the anteroposterior axis. In trochlear dysplasia and in some valgus knees, relying on the anteroposterior axis can induce an excessive external rotation of the femoral component, and the opposite can happen in some varus knees. The anterior extent of the condyles is highly variable in arthritic knees, and cannot be used to orient the prosthesis. The ratio between the transepicondylar width and the height of the condyles is constant, but some narrow femora could require narrower implants to avoid medial-lateral overhang of the femoral component.

Adult↗
PubMed1996

2-stage reimplantation for infected total knee replacement.

Between 1977 and 1983, 64 infected total knee replacements in 60 patients were treated with a 2-stage protocol for reimplantation. The clinical results and survivorship were determined at an average followup of 7.5 years (range, 2-17 years). Surgical protocol included removal of the prosthesis and all cement with thorough debridement of bone and soft tissues. This was followed by 6 weeks of parenteral antibiotics and then reimplantation of a new prosthesis. At followup, 6 knees (9%) had become reinfected, but only 2 with the same organism. Four knees had been revised: 3 for aseptic loosening and 1 for a periprosthetic femur fracture. Two other knees were impending failures due to aseptic loosening. The average Hospital for Special Surgery knee score was 78 points with 18 excellent, 28 good, 13 fair, and 5 poor results. Seventy-eight percent of patients were satisfied with the overall result of their reimplanted prosthesis and 95% think that they made the right decision in undergoing total knee arthroplasty. The 10-year predicted survivorship of 2-stage reimplantation is 77.4%. Two-stage reimplantation with a 6-week course of parenteral antibiotics is an effective means to eradicate deep infection and to provide a functional knee. The long term functional results and overall survivorship are comparable with the results of revision of aseptic failed total knee arthroplasty.

Adult↗
PubMed1996

Proximal tibial osteotomy. A subjective outcome study.

We performed a retrospective study of the results of proximal tibial osteotomy in thirty-four men (thirty-seven knees) who had had unicompartmental osteoarthrosis of the knee. The average age of the patients at the time of the procedure was forty-nine years (range, twenty-eight to sixty years). The functional results were evaluated according to the system of Tegner and Lysholm, in which the level of participation in work and sports activities is graded on a scale from 0 points (complete disability) to 10 points (the ability to participate in competitive sports at the elite professional level). The average functional score was 5.4 points (range, 2 to 8 points) preoperatively and 4.8 points (range, 1 to 8 points) postoperatively. Postoperatively, many of the patients were able to participate in activities, such as running and jumping, that can lead to damage of the components of a total knee arthroplasty. Twenty-eight (82 per cent) of the thirty-four patients stated that the results had met their expectations and that they would have the operation again given the same situation.

Adult↗
PubMed1995

The posterior stabilized total knee prosthesis. Assessment of polyethylene damage and osteolysis after a ten-year-minimum follow-up.

The long-term results of use of the posterior stabilized total knee prosthesis were evaluated with regard to clinical performance, survival of the implant, polyethylene wear, osteolysis, and loosening. One hundred and twenty patients had 165 primary total knee arthroplasties, with insertion of a posterior stabilized total knee prosthesis with a metal-backed tibial component with cement, between March 1981 and March 1983. Thirty-seven patients (fifty-three knees) subsequently died, five patients (six knees) were lost to follow-up, three patients (three knees) refused evaluation, and one patient (two knees) was excluded because of severe medical debilitation. Thus, seventy-four patients (101 knees) were available for analysis. The mean age of the patients at the time of the operation was sixty-four years (range, twenty-two to eighty-one years). The mean duration of follow-up was ten years and eight months (range, ten years to eleven years and ten months). Preoperatively, the mean arc of motion was 94 degrees (range, 65 to 130 degrees), compared with 110 degrees (range, 90 to 145 degrees) at the latest follow-up examination. The mean knee score, according to the rating system of The Hospital for Special Surgery, was 51 points (range, 18 to 73 points) preoperatively, compared with 85 points (range, 0 to 100 points) at the latest follow-up examination. When the four knees that had a revision are excluded, the mean knee score, according to the rating system of the Knee Society, was 92 points (range, 67 to 100 points) and the mean functional score was 71 points (range, 0 to 100 points) at the latest follow-up examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Treatment of nonunions about the knee utilizing custom total knee arthroplasty with press-fit intramedullary stems.

Juxta-articular nonunion about the knee is infrequent but may be a troublesome problem, especially if it is about a total knee arthroplasty or associated with an arthritic joint. This technique of total knee arthroplasty with an uncemented press-fit intramedullary rod and bone grafting achieved union in all nine nonunions about the knee. Radiographic review indicated all nonunions to be healed by an average of 2 months, with none taking longer than 6 months to heal. The average postoperative Hospital for Special Surgery knee score was 78 (range, 50-91), with 4 excellent, 4 good, and 1 poor result. This study demonstrated that this is a successful salvage procedure for juxta-articular nonunions in the face of either arthritis in the adjacent joint, severe articular incongruency, or an ipsilateral total knee arthroplasty.

Bone Transplantation↗
PubMed1992

Rehabilitation of patellofemoral joint disorders.

Patellofemoral dysfunction may be one of the most common and troublesome maladies to affect a patient. The correct identification of the underlying causes is paramount. Once identified, an effective rehabilitation program should be implemented. The program should include stretching and strengthening as well as several other therapeutic modalities. The most successful rehabilitation program is designed to address the specific needs of the patient.

Femur↗
PubMed1992

Surgical treatment for patellar instability.

The initial therapy for patellofemoral pain remains conservative. Once this treatment plan fails and examination has clearly identified the cause of the patellofemoral dysfunction, surgical treatment is considered. No single procedure corrects all patellofemoral problems, and the patient's age, the causative factor, the condition of the articular surface, and the level of activity should be considered. Surgical options include lateral retinacular release, proximal realignment, distal realignment, and proximal and distal realignment.

Humans↗
PubMed1992

Total knee arthroplasty. Current clinical perspectives.

Cemented total knee arthroplasty (TKA) has evolved to be the gold standard to which other means of fixation should be compared. Though controversy still exists regarding retention or sacrifice of the posterior cruciate ligament, clinical experience and survivorship analysis supports the use of the posterior stabilized prosthesis. Improvements in implant design, surgical technique, bone preparation, and cement technique have made TKA a more predictable procedure. With these advances, infection presently appears to be the main cause of failure in cemented TKA.

Cementation↗
PubMed1990

Knee surgery.

Explore the source record for details and available documents.

Humans↗
PubMed1990

Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/or lateral retinacular release in total knee arthroplasty.

A prospective study ascertained the effect of lateral retinacular release and/or excision of the infrapatellar fat pad on patellar vascularity after total knee arthroplasty. Fifty patients (70 knees) had postoperative technetium bone scans, which revealed a higher incidence of vascular compromise of the patella after lateral release than without lateral release. Excision of the infrapatellar fat pad, commonly performed to enhance exposure and simplify access to the proximal tibia, did not compromise patellar vascularity.

Adipose Tissue↗
PubMed1990

Cemented total knee arthroplasty for gonarthrosis in patients 55 years old or younger.

The results of 68 cemented total knee arthroplasties (TKAs) in 50 patients with gonarthrosis who were 55 years old or younger at the time of surgery were reviewed. These patients were operated on between 1979 and 1987 and were followed for an average of 6.2 years. The average age of the patients was 50 years. Patients were evaluated by the Hospital for Special Surgery knee score. The average preoperative score was 53, and the average follow-up score was 90. Overall, 55 TKAs were rated as excellent and 13 as good. Using the knee rating score advocated by the Knee Society, the average postoperative score was 92 for pain and 84 for function. There were four successful reoperations for patellar component loosening, all in metal-backed patellae. The femoral and tibial components in these patients were intact, and at the follow-up period, two knees were rated as excellent and two as good. Detailed roentgenographic evaluation demonstrated that 20% of tibial components had radiolucencies in at least one zone on the anteroposterior roentgenogram and in 11% on the lateral roentgenogram. Femoral radiolucencies occurred in only 2% of knees. Patellar radiolucencies in one or more zones occurred in 20% of knees that had not had patellar revision. No complete or progressive radiolucencies at the bone-cement interface were noted for any component, and no components were considered to be roentgenographically loose. Cemented TKAs can achieve excellent long-term results in patients younger than 55 years old with gonarthrosis of the knee. These results compare with those obtained in published reports on older age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Pneumatic sequential-compression boots compared with aspirin prophylaxis of deep-vein thrombosis after total knee arthroplasty.

This prospective, randomized study was undertaken to compare the effectiveness of pneumatic sequential-compression boots with that of aspirin in preventing deep-vein thrombosis after total knee arthroplasty. Patients were randomly assigned to one of two prophylactic regimens: compression boots or aspirin. One hundred and nineteen patients completed the study. Seventy-two patients had unilateral arthroplasty and forty-seven, one-stage bilateral arthroplasty. In the unilateral group, the incidence of deep-vein thrombosis was 22 per cent for the patients who used compression boots compared with 47 per cent for those who received aspirin (p less than 0.03). In the bilateral group, the incidence of deep-vein thrombosis was 48 per cent for the patients who used compression boots compared with 68 per cent for those who received aspirin (p less than 0.20). The results confirm the effectiveness of compression boots in the treatment of patients who have had unilateral total knee arthroplasty. Despite the use of compression boots, however, patients who had bilateral arthroplasty were at greater risk for the development of deep-vein thrombosis.

Aged↗
PubMed1989

Patellar fractures in total knee arthroplasty.

The incidence of patellar fractures following total knee arthroplasty varies from 3% to 21%. This problem has been attributed to avascular necrosis of the patella secondary to the surgical approach, including medial arthrotomy and lateral release, patellar bone resection, thermal necrosis, and anatomic variation. Management of these patellar fractures may be conservative or surgical.

Bone Wires↗
PubMed1989

Mechanisms of failure of the femoral and tibial components in total knee arthroplasty.

From 1974 to 1986, 1430 cemented primary total knee arthroplasties were available for analysis. These included 224 total condylar prostheses with a polyethylene tibial component, 289 posterior stabilized prostheses with a polyethylene tibial component, and 917 posterior stabilized prostheses with a metal-backed tibial component. There were 12 failures in the total condylar series including three infections (one early and two late), five loose tibial components, two loose femoral and tibial components, and two unstable arthroplasties. The posterior stabilized prosthesis with the polyethylene tibia demonstrated six failures including two loose tibial components, two loose femoral components, and one supracondylar femur fracture. The posterior stabilized prosthesis with the metal-backed tibial component was associated with seven failures including six infections (three early and three late) and one femoral loosening. No metal-backed tibial components have been revised for loosening. The overall failure rate in this series was 1.7% for all prostheses. The incidence of tibial loosening was 0.53% with an average time to failure of 4.7 years. The incidence of femoral loosening was 0.35% with an average time to failure of 2.0 years. Tibial loosening was related to error in technique: postoperative varus tibiofemoral alignment, varus tibial component position, and excessive tibial resection. The overall infection rate was 0.63% for all total knee arthroplasties, and all were secondary to gram-positive organisms. Presently, the posterior stabilized prosthesis with a metal-backed tibia is the authors' implant of choice. Technical error and infection are the major causes of failure.

Aged↗
PubMed1989

Survivorship of cemented knee replacements.

The survivorship method of analysis has been used to compare the failure rate and overall success of 1,430 cemented primary total knee arthroplasties performed at The Hospital for Special Surgery over a 15-year period. There were 224 total condylar prostheses with a polyethylene tibia, 289 of the posterior stabilised type with an all polyethylene tibia, and 917 posterior stabilised with a metal-backed tibial component. There were 12 failures in the total condylar series, giving an average annual failure rate of 0.65% and a 15-year success rate of 90.56%. The posterior stabilised prosthesis with a polyethylene tibia showed an average annual failure rate of 0.27% and a 10-year success rate of 97.34%, and this prosthesis with a metal-backed tibial component gave an annual failure rate of 0.19% and a seven-year success rate of 98.75%. The overall survival rate was not influenced by sex or age, diagnosis or the percentage of ideal body weight. No metal-backed tibial components have yet needed revision for loosening. It seems that infection will be the major cause of failure.

Adult↗