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Biomedical subjects

G R Scuderi

Publications and source records attributed to G R Scuderi.

At least 37 records · Page 2Linked to original sources
PubMed1998

Total knee arthroplasty in patients who were obese with 10 years followup.

The 10-year results of primary total knee arthroplasty in patients who were obese were evaluated. In a 2-year period, 120 patients had 165 primary, posterior stabilized, cemented total knee replacements with metal backed tibial components. After exclusions, 56 patients (73 knees) were available for study. Twenty-two patients (32 knees) were classified as obese, and 34 patients (41 knees) were classified as nonobese. At 10 years followup, patients who were obese had lower Knee Society function scores than had the patients who were nonobese (mostly attributable to more difficulty with stair climbing). Patients who were obese had poorer patellar scores at 10 years. Bilaterality was more common in patients who were obese and preoperative knee scores were lower. Minor nonprogressive radiolucent lines were seen more commonly in the patients who were obese. Overall, however, 10-year Hospital for Special Surgery scores and Knee Society scores for patients who were obese were comparable with scores for patients who were nonobese and given lower preoperative Hospital for Special Surgery scores, improvement in knee score was greater. Revision rates in patients who were obese were not higher than in patients who were nonobese at 10 years followup. More study is needed of the subgroup of patients who were morbidly obese.

Aged↗
PubMed1998

Is the routine examination of surgical specimens worthwhile in primary total knee arthroplasty?

Two thousand two hundred eighty-nine consecutive primary total knee arthroplasties performed between 1993 and 1996 were reviewed retrospectively to assess the utility and cost effectiveness of the routine examination of surgical specimens. In those cases where a discrepancy was seen between the clinical and pathologic diagnoses, the records were reviewed carefully and those patients were contacted to determine whether their subsequent treatment was altered as a result of the pathologic findings. In 10 cases there was a potentially important discrepancy between the clinical and pathologic diagnoses. In none of those 10 cases was the subsequent treatment of the patient altered as a result of the pathologic findings. This study suggests a reexamination of regulations that mandate the routine pathologic review of surgical specimens from primary total knee arthroplasties.

Adult↗
PubMed1998

Patellar component resection in revision and reimplantation total knee arthroplasty.

Between 1979 and 1995, 34 knees in 31 patients had a revision or reimplantation total knee arthroplasty in which the patellar component could not be reinserted. The patellar bone stock in each of those cases was compromised markedly and precluded adequate prosthetic fixation. The mean followup after the revision operation was 3.5 years (range, 2-14 years). The Knee Society knee score improved from a mean of 59 points preoperatively to a mean of 75 points postoperatively. The function score improved from a mean of 46 points preoperatively to a mean of 69 points postoperatively. Complications occurred in five patients: one patient sustained a patellar fracture that required no additional treatment; one experienced intermittent episodes of patellar subluxation; one had a recurvatum deformity develop and was treated with a brace; one had persistent knee stiffness and had four manipulations; and one patient had an extensor lag of 30 degrees develop. Twenty-six patients were satisfied with the results of their revision operations and five were dissatisfied. Ten patients had persistent knee symptoms referable to the patellofemoral articulation: mild pain in three; moderate pain in six; and severe pain in one. This study suggests that resection of the patellar component during revision or reimplantation total knee arthroplasty may be a reasonable approach for patients with markedly compromised patellar bone stock; however, mild or moderate anterior knee pain can be expected to persist in as much as 1/3 of these patients.

Arthralgia↗
PubMed1997

Arthroscopic treatment of the degenerative knee in older athletes.

The role of arthroscopy in the management of degenerative knee arthritis in the older athlete remains controversial. This patient population desires symptomatic improvement to maintain active lifestyles. For advanced tricompartmental osteoarthritis, total knee arthroplasty provides the most predictable results. For active patients with unicompartmental disease, osteotomy can provide symptomatic improvement and delay the time to total knee arthroplasty. Substantial morbidity is associated with both of these procedures. Arthroscopic management of degenerative arthritis is an attractive alternative to osteotomy or total knee arthroplasty if predictable improvement and durable results can be achieved. Arthroscopic lavage success rates are quite variable and decline rapidly over time. It is mainly a palliative procedure with limited long-term success. Success rates for arthroscopic partial meniscectomy and arthroscopic débridement vary between 50% and 75% depending on many factors, including the age of the patient, degree of arthritis, activity level of the patient, limb alignment, and extent of follow-up. Lavage is probably an important aspect of this procedure. Abrasion arthroplasty and the Pridie procedure do not appear to offer any additional benefit to arthroscopic débridement alone. In fact, studies comparing arthroscopic abrasion with arthroscopic débridement have shown that débridement alone gives better long-term results than débridement combined with abrasion. Several studies have shown that some patients become significantly worse following abrasion arthroplasty. Clearly, arthroscopic débridement is the preferred procedure to abrasion arthroplasty. The arthroscope is useful in the treatment of degenerative arthritis of the knee. It has low morbidity and does not preclude future reconstructive procedures. Although long-term success is difficult to predict, certain patient variables are associated with a better outcome: normal limb alignment, history of mechanical symptoms, minimal radiographic signs of degeneration, and short duration of symptoms. Long-term randomized prospective studies are needed to define the role of arthroscopy further in the older athlete with degenerative knee arthritis.

Adult↗
PubMed1997

The efficacy of arthroscopy following total knee replacement.

We evaluated the utility and safety of arthroscopy for diagnosing and treating symptoms in problematic total knee replacements. From 1988 to 1995, 40 arthroscopies were performed on 38 patients with an average age of 68.4 years. The average onset of symptoms post knee replacement was 33.7 months (range 1 month to 15 years), and the average duration of symptoms prior to arthroscopy was 15.6 months (range 1 month to 5 years). Presenting symptoms included pain in 73%, catching or soft tissue impingement in 35%, and stiffness in 20% of patients. Our protocol involves 24 hours of perioperative, intravenous antibiotics, and two or three routine arthroscopic portals. There were no arthroscopy-related complications or infections. Arthroscopy successfully diagnosed the etiology of the patient's symptoms in all but one case (97.5%). Operative diagnoses included impinging soft tissue under the patella consistent with the "clunk" syndrome (43%), impinging hypertrophic synovitis elsewhere in the knee (15%), impinging PCL stump (10%), prosthesis loosening or wear (10%), and arthrofibrosis (20%). Arthroscopic treatment consisted of removal of impinging tissue or loose body as indicated. Additionally, eight of the patients had a manipulation under anesthesia with an average improvement in flexion of 26.3 degrees postoperatively. At an average follow-up of 19.9 months, 27.5% of knees had developed recurrent symptoms. Two of these patients had repeat arthroscopy for recurrent impinging hypertrophic synovitis. The rates of successfully relieving symptoms without recurrence according to operative diagnosis were 82% for "clunks," 60% for other impinging synovium or soft tissue, and 63% for arthrofibrosis. Three patients underwent total knee revisions. Knees were rated at follow-up using the Knee Society rating system with patients divided according to functional category. The average Knee Society knee scores and function scores respectively were 93 and 92 for group A patients, 91 and 88 for group B patients, and 81 and 76 for group C patients. Arthroscopy successfully identified all cases of soft tissue impingement and prosthetic loosening or wear, and successfully treated 73% of patients without recurrence. There were no arthroscopy associated complications or infections. Thus, arthroscopy is a safe, effective tool for managing certain problematic knee replacements, especially "clunks," and may help to avoid revision or arthrotomy in some cases.

Aged↗
PubMed1997

Arthroscopic treatment of popliteus tendon dysfunction following total knee arthroplasty.

Following total knee arthoplasty, the popliteus tendon may cause a "snap" when it rolls over a retained lateral femoral condylar osteophyte or when it subluxates over the posterior condyle of the femoral component. When this condition is painful and fails to respond to conservative treatment, arthroscopic release of the popliteus tendon has been beneficial.

Aged↗
PubMed1997

Total knee replacement in young, active patients. Long-term follow-up and functional outcome.

We reviewed our experience with total knee arthroplasties performed between 1977 and 1992 in patients who were fifty-five years old or less to determine the appropriate management for younger patients who have severe osteoarthrosis. One hundred and fourteen knee replacements were performed in eighty-eight patients who were an average of fifty-one years old (range, twenty-two to fifty-five years old). All of the operations were performed by one of the two senior ones of us (J. N. I. or W. N. S.) with the use of cementing techniques. A posterior stabilized, posterior cruciate-substituting design was used for all but one replacement, for which a semiconstrained total condylar prosthesis was used. Six knees (four patients) were lost to follow-up. Follow-up data for the remaining 108 knees (eighty-four patients) were used to perform the survivorship analysis. One hundred and three unrevised knees (eighty patients) were available for clinical evaluation with the scoring systems of The Hospital for Special Surgery and the Knee Society at an average of eight years (range, three to eighteen years) postoperatively; thirty-six knees were followed for more than ten years. In addition, the activity levels of the patients were assessed with the activity score of Tegner and Lysholm. Radiographs were examined for evidence of loosening of the component. At the latest follow-up examination, the average knee score according to the system of The Hospital for Special Surgery had improved from 55 points preoperatively to 92 points. According to the system of the Knee Society, the average knee score was 94 points and the average functional score was 89 points. The result for all 103 knees was good or excellent according to the knee scores of The Hospital for Special Surgery and the Knee Society. Ninety-seven knees (94 per cent) had good or excellent function according to the functional score of the Knee Society. The average activity score of Tegner and, Lysholm improved from 1.3 points (range, 0 to 4 points) preoperatively to 3.5 points (range, 1 to 6 points) at the latest follow-up examination. All but two patients had improvement in the activity score postoperatively, and nineteen (24 per cent) of the eighty patients had an activity score of at least 5 points, indicating regular participation in activities such as tennis, skiing, bicycling, or strenuous farm or construction work. Nine (9 per cent) of the 103 knees had non-progressive tibial radiolucent lines. Two patients had a revision because of late infection, and one patient had revision of a well fixed tibial component because of wear of the polyethylene. In addition, three patellar components were revised for loosening, and one spacer was exchanged to treat instability. With failure defined as revision of either the femoral or the tibial component, the over-all rate of survival was 94 per cent at eighteen years. When the three patellar revisions were included in the failures, the survival rate was 90 per cent at eighteen years. When the exchange of the spacer was also included in the failures, the survival rate was 87 per cent at eighteen years. We consider arthroplasty with cementing of a posterior stabilized total knee prosthesis to be effective operative treatment with durable results for osteoarthrosis in younger patients when other, less invasive measures have failed. Within the average eight-year follow-up interval of this study, polyethylene wear, osteolysis, and loosening of the conforming posterior cruciate-substituting prosthesis were not major problems for these younger, active patients, although it is possible that this observation could change with an even longer duration of follow-up.

Adult↗
PubMed1997

Survivorship of cemented total knee arthroplasty.

The survivorship method of analysis was used to compare the failure rate and overall success of 2629 cemented primary total knee arthroplasties during a 22-year period by the senior surgeon. There were 215 Total Condylar prostheses with a polyethylene tibia, 265 of the Posterior Stabilized type with an all polyethylene tibia, 2036 Posterior Stabilized with a metal backed tibial component, 49 Posterior Stabilized with modular augmented components, and 64 with the Constrained Condylar system. Failure was considered revision or planned revision. The Total Condylar series had an average annual failure rate of 0.46% and a 21-year success rate of 90.77%. The Posterior Stabilized prosthesis with an all polyethylene tibia had an average annual rate of failure of 0.38% and a 16-year success rate of 94.10%, and this prosthesis with a metal backed tibial component had an annual failure rate of 0.14% and a 14-year success rate of 98.10%. The Posterior Stabilized series with modular components had an average annual rate of failure of 0.59% and a 10-year success rate of 93.63%. The Constrained Condylar knee series had an average annual failure rate of 0.26% and a 7-year success rate of 98.12%. This review represents a retrospective analysis of consecutive series of cemented, total knee arthroplasties, whose annual failure and success rates were done during differing time spans. The overall success rate was not influenced by gender, age, diagnosis, or percentage of ideal body weight. Failure was considered revision or planned revision. The best and worse case scenarios were calculated for each series. Long term results of cemented, total knee arthroplasty with a relatively conforming articular surface has been shown to be a reliable procedure with excellent survivorship.

Adolescent↗
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↗