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H E Figgie

Publications and source records attributed to H E Figgie.

At least 19 recordsLinked to original sources
PubMed1992

Custom total shoulder arthroplasty in inflammatory arthritis. Preliminary results.

Twenty-three patients with inflammatory arthritis and rotator cuff deficiency have undergone 27 custom-fit total shoulder arthroplasties. The design used included a short-stem humeral component and a metal-backed glenoid component with an offset keel. The glenoid component was custom-fit to provide maximum coverage of the glenoid surface. The average age of the patients at the time of surgery was 55 years (range, 20-75 years). All patients had inflammatory arthritis, 16 were on steroids, and all had some degree of rotator cuff involvement ranging from small to complete tears. The average length of follow-up study was 5 years (range, 3-7 years). The average preoperative shoulder score was 36 points (range, 15-50 points) with an average pain score of 7 (of 30) points. Postoperatively, the shoulder score improved to 85 points with a pain score of 28 points. Twenty-one shoulders scored a good to excellent result. Two patients required reoperation, both for recurrent rotator cuff tears, one of which occurred after a fall. Radiographic analysis revealed no incidence of humeral radiolucency and six cases of glenoid radiolucency. Only two of these were progressive and both were associated with irreparable rotator cuff tears. Thus, in the early follow-up, this design of glenoid has decreased the incidence of glenoid radiolucency in this difficult patient population.

Adult↗
PubMed1992

Distal femoral replacement with allograft/prosthetic reconstruction for treatment of supracondylar fractures in patients with total knee arthroplasty.

Large-segment distal femoral allografts were used in conjunction with non-linked total knee prostheses to reconstruct bone deficits following supracondylar fracture of the femur in seven patients with previous total knee arthroplasties. Three patients with multiple medical problems died of unrelated causes prior to a minimum 2 year follow-up. Indications for surgery were previously failed attempts at osteosynthesis and significant fracture comminution, osteopenia, and intercondylar extension or femoral component loosening. Specifics of the surgical technique included subperiosteal excision of the involved distal femur with retention of a soft tissue sleeve containing the collateral ligaments and reconstruction with a large-segment allograft and a stemmed, semiconstrained total knee prosthesis. Cement fixation using pressurized technique with intramedullary plugging of the tibial and femoral canal was routinely used to secure the prosthesis/allograft construct to the host bone. Postoperative complications included one dislocation, which was successfully treated closed, and one popliteal artery injury, which was successfully repaired. There were no postoperative infections. Two patients, however, had some degree of persistent instability, warranting bracing at the time of last follow-up. Using the Knee Society rating system, the average knee score for these patients was 71, and the average pain score and function score were 33 and 49, respectively. Range of motion averaged 96 degrees. All of the femoral components were well fixed at last follow-up. Results of this study indicate that large-segment distal femoral allografts used in conjunction with nonlinked knee prostheses can be an acceptable method of treatment of these difficult reconstructive problems.

Aged↗
PubMed1992

Use of an antibiotic impregnated polymethyl methacrylate intramedullary spacer for complicated revision total hip arthroplasty.

Revision total hip arthroplasty is frequently necessary in the presence of significant proximal femoral bone loss, periprosthetic fracture, or infection. In these situations, optimal reconstruction may sometimes warrant the use of special implants, including bone grafts. The emergent presentation of these cases or unexpected findings at the time of surgery can preclude the use of these treatment options. In cases of periprosthetic sepsis, delayed reimplantation may be the most successful approach to eradicate infection. In seven of these complicated revision total hip arthroplasties, the authors used an antibiotic-impregnated intramedullary polymethyl methacrylate spacer with delayed prosthetic reimplantation to allow for the use of these methods. Benefits of this technique include uncompromised radiographic evaluation of the proximal femur for design of a custom implant, if needed, stabilization of the proximal femur facilitating early mobilization of the patient in the case of periprosthetic fracture, and local delivery of antibiotics to the wound in the case of infection. The author's ability to reconstruct these total hip arthroplasties complicated by bone deficiency, fracture, and sepsis, was significantly improved with this use of this technique.

Adult↗
PubMed1991

The elbow.

Explore the source record for details and available documents.

Adult↗
PubMed1991

"Hybrid" total knee arthroplasty with the Miller-Galante prosthesis. A prospective clinical and roentgenographic evaluation.

Twenty-nine "hybrid" Miller-Galante total knee arthroplasties, in 22 patients, were evaluated prospectively and according to the clinical and roentgenographic guidelines of The Knee Society. Selection of this technique, incorporating an uncemented, porous-ingrowth femoral component and a cemented tibial component, was based on patient age, medical condition, activity level, and intraoperative assessment of bone quality and ligament competency. The average age of the patients at the time of surgery was 71 years. The average preoperative Knee Society Knee Score was 32; average pain score was 14; and the average function score, 47. After an average follow-up interval of 28 months postsurgery (minimum, 24 months), the average Knee Society Knee Score was 93; the average pain score, 47; and the average function score, 79. Range of motion averaged 110 degrees. Only one knee, with persistent pain of obscure origin, rated an unsuccessful result. No arthroplasties were revised for any reason. Twenty-three knees had fluoroscopically guided roentgenograms to assess the bone-prosthesis and bone-cement interfaces. No significant or progressive radiolucencies were noted under any of the components. No apparent adverse bone remodeling was associated with the uncemented femoral component. The fluoroscopically guided roentgenograms were significantly more sensitive in detecting interface radiolucencies than plain ones. Clinical and roentgenographic evidence of component loosening were absent in all patients. Results of this study suggest that the hybrid fixation technique can reliably provide satisfactory pain relief and restoration of function in properly selected patients. Potential advantages of an uncemented femoral component include decreased operative time, reduction of polyethylene wear from cement debris, and avoidance of a possible adverse biologic response to polymethylmethacrylate.

Aged↗
PubMed1990

Trispherical total wrist arthroplasty in rheumatoid arthritis.

Thirty-four patients, with 35 trispherical total wrist arthroplasties for treatment of rheumatoid arthritis, were evaluated at an average follow-up of 9 years (range, 5 to 11 years). The average preoperative score was 25 points inasmuch as all patients had severe pain and loss of function. The average postoperative score improved to 87 points since 30 wrists were free of pain. Twenty-eight wrists rated as a good-to-excellent result. The average arc of flexion and extension improved from 35 to 50 degrees. There were no deep infections or dislocations. Two wrists required revision, one for loosening and one for persistent pain, both requiring removal of the implant and arthrodesis. Postoperative tendon attrition occurred in six wrists, all of which had preoperative tendon ruptures necessitating tendon transfer. Radiographs showed radiolucencies in seven wrists, including seven around the metacarpal stem and one around the radial stem. The optimum results were achieved in those patients with intact extensor tendons before operation.

Adult↗
PubMed1990

The results of treatment of supracondylar fracture above total knee arthroplasty.

This study analyzes the results of treatment of 22 patients with 24 supracondylar femur fractures above a total knee arthroplasty. Ten knees were treated by closed methods utilizing traction and then a cast, 10 knees with immediate open reduction and internal fixation, 2 knees with a custom total knee integrated with a distal femoral allograft, 1 knee with external fixation, and 1 knee with primary arthrodesis. Nine fractures treated by closed means and 5 fractures treated by open reduction and internal fixation healed primarily. Two of the 5 surgical failures healed after replating and bone graft. The 3 failures of surgical therapy were salvaged utilizing custom total knee arthroplasty, 2 of which required integration with a distal femoral allograft. One knee treated with external fixation developed a deep infection necessitating implant removal and arthrodesis. Twelve of the 14 femoral fractures that united primarily healed with the femoral component in varus with respect to the long axis of the anatomic femur. Nine of these 12 implants developed progressive radiolucent lines at the tibial component. Three of these knees have required implant revision due to progressive loosening of the tibial and/or femoral components. The results of this evaluation indicate that fractures above a well-fixed total knee arthroplasty are difficult to manage. If anatomical alignment cannot be achieved by simple closed techniques, then primary open reduction and internal fixation should be considered. However, because of the complexity of the problem, the surgeon should be prepared to perform a primary arthrodesis or revision using custom components with or without a distal femoral allograft.

Adult↗
PubMed1990

Results of reconstruction for failed total elbow arthroplasty.

Failure of total elbow arthroplasty leads to difficult and complicated surgical reconstruction. This study evaluates the results of reconstruction after implant removal with respect to pain, motion, and functional ability. Between 1978 and 1985, 11 patients required implant removal. Indications for removal were infection for seven, implant fracture for three, and recurrent dislocation for one. The original diagnosis was rheumatoid arthritis in six elbows and traumatic arthritis in five. The average length of the follow-up period was 5.5 years after implant removal (minimum, two years). Treatment consisted of implant removal and soft-tissue arthroplasty combined with external fixation in ten patients, and attempted arthrodesis with external fixation in one. There were four good, one fair, two poor, and four failed results. Satisfactory results were obtained in seven of the eight elbows in which an anatomic arthroplasty was achieved. This consisted of containment of the ulna by the humeral epicondylar remnants. All eight elbows were pain-free with an average arc of motion of 85 degrees (range, 55 degrees to 120 degrees). They had excellent elbow flexion power; however, triceps strength was often compromised. In the three elbows in which anatomic arthroplasty could not be achieved, one was flail, one was later converted to an arthrodesis with a customized plate, and the third required an immediate arthrodesis. All three were rated as failures. Fractures occurred in five of the 11 elbows. One occurred preoperatively, three occurred intraoperatively, and one occurred postoperatively. All healed satisfactorily during the course of immobilization. The importance of an anatomic arthroplasty when removing a total arthroplasty cannot be overemphasized. Retaining the epicondylar segments is important because satisfactory results were obtained in patients in whom entrapment of the olecranon within the epicondylar ridges was obtained. Such patients can achieve a satisfactory soft-tissue arthroplasty without the use of an interpositional material. When the epicondylar ridges were not retained and there was marked instability, the patients did not achieve satisfactory results.

Adult↗
PubMed1989

Technical considerations in total knee surgery. Management of patella problems.

Patellofemoral symptoms are now the most common cause of aseptic knee revision; however, the majority of patello-femoral problems are self-limited and may be managed symptomatically and nonoperatively. A trial of anti-inflammatory medications, stretching exercises, and appropriate bracing is always indicated. Patellofemoral symptoms are usually related to mechanical malalignment of all three components of the total knee arthroplasty. Attention to the fundamental principles of total knee arthroplasty, including restoration of the bony mechanical alignment, soft tissue stability, and maintenance of the anatomic joint line, prevents many of the problems. Meticulous preoperative planning and anatomic placement of the component parts are important for a satisfactory long-term outcome. Present research is directed to providing kinematic analysis of the patellofemoral tracking mechanism and to minimizing patellofemoral contact stresses with appropriate new designs.

Biomechanical Phenomena↗
PubMed1989

Total elbow arthroplasty for complete ankylosis of the elbow.

Sixteen patients who received nineteen semiconstrained total elbow replacements for complete ankylosis of the elbow were followed for an average of five and three-quarters years (range, two to twelve years). The average preoperative elbow score was 23 points and the average postoperative score was 84 points. Postoperatively, the average flexion was 115 degrees; extension, 35 degrees; and pronation and supination, 95 degrees. There were fifteen excellent or good results. There was one failure due to a deep infection, but after removal of the prosthesis a satisfactory fascial arthroplasty was achieved in this elbow. Function was improved in all patients, and all patients had relief of the preoperative pain. For the arthroplasty to succeed, the patient must have a good understanding of the procedure and must be willing and able to comply with the postoperative rehabilitation program. The use of a semiconstrained, often custom-fit, implant is necessary. The Bryan-Morrey posteromedial approach to the elbow is recommended for the procedure, since this approach allows early institution of range-of-motion exercises.

Adolescent↗
PubMed1989

The effect of alignment of the implant on fractures of the patella after condylar total knee arthroplasty.

The results in thirty-six knees that had a fracture of the patella after a total condylar arthroplasty were reviewed, and were analyzed according to the type of fracture and the alignment of the implant and the limb. Most of the fractures occurred two years or less after the initial operation. Fourteen knees were rated fair or poor and twenty-two, good or excellent. None of the thirty-six implants had been aligned in the neutral range. In sixteen knees, the alignment had a minor variation from the neutral range--that is, the knees were in minor malalignment. In general, these knees had the least severe fractures and the best over-all results. All had a good or excellent result except one, which was revised because of a loose patellar component. That knee was rated as fair at the latest follow-up. There was a major discrepancy in the alignment of twenty implants. These knees had more severe fractures and less satisfactory results than those in the other group. In two of these knees, the fracture was treated non-operatively; one had a good and the other, a poor result. Twelve of the remaining knees, which were treated surgically, were rated as fair or worse. Two knees that had revision of three components and restoration of alignment to the neutral range had an excellent result. The results of this study indicate that the alignment and fit of a component are important in determining the severity of a fracture of the patella after condylar total knee replacement and the long-term results after treatment of the fracture.

Adult↗
PubMed1989

Salvage of non-union of supracondylar fracture of the humerus by total elbow arthroplasty.

Fourteen patients in whom open reduction and internal fixation could not be achieved satisfactorily had a total elbow arthroplasty for non-union of a supracondylar humeral fracture. All patients had an established non-union, and ten had had from one to four previous attempts at internal fixation. The average age at the time of operation was sixty-five years. The average duration of follow-up was five years, with a minimum of two years. The average preoperative elbow score was 17 points, with both pain and functional disability present. The average postoperative score was 84 points; there were eight good or excellent results and three failures. The latter three patients had an additional operation: one each for dislocation, loosening of the humeral component, and deep infection. Salvage of supracondylar non-union by means of a total elbow arthroplasty is a technically demanding procedure. Strict indications for selection of patients must be followed. A semiconstrained implant is recommended, with preservation of the epicondyles and their muscular attachments in order to achieve balance of the soft tissues.

Adult↗
PubMed1989

Total knee arthroplasty for the treatment of chronic hemophilic arthropathy.

Total knee arthroplasty (TKA) for hemophilic (factor VIII deficiency) arthropathy is a complex and demanding procedure with a high complication rate. However, the long-term benefits have not previously been reported. This study reviews 19 TKAs performed for hemophilic arthropathy that were followed for a minimum of 5.5 years and an average of 9.5 years. At present, 13 knees have good or excellent results, and six knees rate as poor or failures. Those patients with excellent results have maintained good pain relief and function. Four of the six failures were among the first seven arthroplasties performed, when only 80% factor VIII coverage was used during the perioperative period. Since the use of 100% factor VIII coverage was instituted, the failure rate has declined. Ten of the 19 knees suffered complications, including one deep infection, six superficial skin necroses, three nerve palsies, seven postoperative bleedings, and one transfusion reaction. Six of the seven knees operated on under 80% factor VIII coverage had complications. Once 100% factor VIII coverage was instituted, the only complications included one skin necrosis and three postoperative bleedings. The roentgenographic failure rate has remained high with progressive roentgenographic lucencies in 13 of 19 tibial components, associated with component shift in three knees. While these roentgenographic findings have not necessarily correlated with clinical results, they are disturbing and may portend future failures. However, pain relief and improved function are maintained at longer follow-up times. The best results were obtained under 100% factor VIII coverage using a posterior stabilized prosthesis and patellar resurfacing.

Adult↗
PubMed1988

Total ankle arthroplasty. A procedural review.

Total ankle arthroplasty is a demanding surgical procedure, but the advantages of maintaining motion in the tibiotalar joint in the patient with systemic arthritis are known. Although the technology of ankle implant arthroplasty is still evolving, current results in properly selected patients approach the results of other leg implants.

Ankle Joint↗
PubMed1988

Preliminary results of total wrist arthroplasty in rheumatoid arthritis using the Trispherical total wrist arthroplasty.

Thirty-two patients underwent 38 arthroplasties for advanced rheumatoid arthritis and marked soft tissue losses. Seven wrists required repair or transfer of at least one tendon for rebalancing. All patients were improved by the implants. Thirty-four of the 38 patients were improved beyond the functional level of a painless wrist arthrodesis. Overall, there were 23 excellent, 10 good, 3 fair, and 2 poor results. The average wrist score was 90.3 points, and the average arc of motion was 38 degrees. There were three cases of migration of the third metacarpal stem and nine cases of lucency about the stems, three of which were progressive or greater than 1 mm. There were no deep infections. There was one reoperation for persistent pain and one for component loosening. There were no cases of implant failure. These results indicate that this total wrist arthroplasty is a safe, reproducible procedure for radiographic class III and IV rheumatoid disease and should be considered a first line of therapy for that group.

Adult↗
PubMed1988

An analysis of factors affecting the long-term results of total shoulder arthroplasty in inflammatory arthritis.

The authors studied 36 patients undergoing 50 total shoulder arthroplasties for inflammatory arthritis with an average follow-up period of 5 years (range, 2-9 years). There were 7 men and 29 women. Twenty-nine patients (38 shoulders) had rheumatoid arthritis, 6 patients (11 shoulders) had systemic lupus erythematosus, and 1 patient (1 shoulder) had psoriatic arthritis. Twenty-four of the procedures were performed on the dominant hand. Twenty-one patients (32 shoulders) were receiving steroids, chemotherapeutic agents, or Gold therapy at the time of arthroplasty. Using the Hospital for Special Surgery scoring system, 22 shoulders had excellent, 18 good, 1 fair, and 9 poor results. Forty-eight of 50 shoulders had satisfactory pain relief. The average shoulder score was 85 points (range, 50-100 points). There were no reoperations, infections, or persistent nerve palsies and no symptomatically loose prostheses, although there were three cases of glenoid component shift. Eighteen glenoid components and 4 humeral components had radiolucent lines and in two cases metaphyseal bone atrophy was noted about the proximal humerus with firm cement fixation and bone hypertrophy about the stem tip. Total shoulder arthroplasty provides a predictable reconstructive alternative for patients with inflammatory arthritis. Overall functional results are related to the biologic condition and motivation of the patient, the status of the rotator cuff, and prosthesis alignment.

Adult↗
PubMed1988

Total ankle arthroplasty in rheumatoid arthritis: a long-term follow-up study.

Patients with rheumatoid arthritis who had undergone total ankle arthroplasty and had a minimum of 2 yr follow-up were studied. Of the original 21 patients 17 were available for review. Twenty-three ankle replacements with an average follow-up of 5.6 yr were studied. On follow-up 2 ankles were rated excellent, 13 were rated good, 4 were rated fair, and 4 were rated poor. Thus, 83% were satisfactory on follow-up. Radiographic analysis revealed migration and settling of the talar component in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 tibial components with tilting in 12 of these components. The postoperative position of the implant did not correlate with the development of radiolucencies or migration of the implant.

Adult↗