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Biomedical subjects

Henry D Clarke

Publications and source records attributed to Henry D Clarke.

At least 19 recordsLinked to original sources
PubMed2006

The influence of femoral component design in the elimination of patellar clunk in posterior-stabilized total knee arthroplasty.

Patellar clunk occurs after posterior-stabilized total knee arthroplasty and is believed to be a design-related complication. This study was undertaken to define the incidence of patellar clunk with an optimized third-generation, posterior-stabilized prosthesis. One hundred ninety three patients with 238 knees were evaluated at a minimum of 2 years after primary total knee arthroplasty with a cemented, NexGen Legacy Posterior-Stabilized prosthesis (Zimmer, Warsaw, Ind). The mean follow-up was 48 months (range, 24-72 months). No patient manifested symptoms of patellar clunk or underwent surgery for any patello-femoral problem. These results support prior evidence that femoral component design is the primary cause of patellar clunk and that modifications incorporated into this third-generation, posterior-stabilized prosthesis has eliminated the problem.

Adult↗
PubMed2006

A third-generation, posterior-stabilized knee prosthesis: early results after follow-up of 2 to 6 years.

Two hundred seventy-nine primary total knee arthroplasties were performed with a modular, cemented, third-generation, posterior-stabilized prosthesis. At mean follow-up of 48 months (range, 24-72 months), the outcomes of 238 knees (85%) were evaluated with the Knee Society's Knee and Functional Scoring Systems and Roentgenographic Scoring System. The mean preoperative Knee Society Knee Score was 48 points compared with 96 points at latest follow-up. There were no cases of patellar clunk, symptomatic patellar maltracking, or posterior dislocation. There was no radiographic evidence of loosening or osteolysis, and no revisions were performed or recommended for loosening, osteolysis, instability, or polyethylene wear. Three patients developed late infections. These early results support the ongoing use of this design; however, long-term studies will be required.

Adult↗
PubMed2006

Use of multi-detector computed tomography for the detection of periprosthetic osteolysis in total knee arthroplasty.

This study determined the accuracy of plain radiography in detecting osteolytic lesions around total knee prostheses compared to multi-detector computed tomography (CT). Thirty-one patients diagnosed with periprosthetic osteolysis by multi-detector CT after total knee arthroplasty (TKA) were studied. Computed tomography for each patient was retrospectively reviewed in a blinded fashion. The plain radiographs for each patient that had been obtained prior to CT were reviewed in the same manner. The results of the CT were compared with the results of the radiographs. The number, size, and location of the lesions were compared. The multi-detector CT detected 48 lesions in 31 knees: 40 tibial lesions, 4 femoral lesions, and 4 patellar lesions. Radiographic diagnosis was made in 6 of the 40 tibial lesions, 2 of the 4 femoral lesions, and 0 of the 4 patellar lesions. Plain radiographs are inadequate for evaluating periprosthetic osteolysis in TKA with only 8 (17%) of 48 lesions detected by multi-detector CT visible on the standard radiographs. Multi-detector CT provides the surgeon with a diagnostic and preoperative planning tool when osteolysis is suspected.

Aged↗
PubMed2006

The painful total knee arthroplasty: diagnosis and management.

The results of TKA during the past two decades have been reliable and favorable. While success rates are high, some patients experience pain and impaired function. This clinical scenario can be frustrating to both the patient and the surgeon who is accustomed to good outcomes. A systematic evaluation of the patient and arthroplasty can lead to a definitive diagnosis of the cause of the patient's symptoms. Problems can be caused by a broad spectrum of possible etiologies. It is helpful to divide the differential diagnosis into two broad categories: extra-articular and intra-articular etiologies. When trying to establish the diagnosis, it is important to approach the task in a systematic fashion. Evaluation must begin with a thorough history and physical examination. Laboratory tests and imaging studies can provide additional evidence supporting a particular diagnosis. Once the etiology has been established, symptomatic relief may be achieved with appropriate treatment including revision TKA. However, revision TKA that is performed for unexplained pain is associated with a low probability of success.

Algorithms↗
PubMed2005

Clinical results in valgus total knee arthroplasty with the "pie crust" technique of lateral soft tissue releases.

Numerous methods for creating symmetric flexion and extension gaps during knee arthroplasty in valgus knees have been proposed, and no consensus exists about the optimal technique. The "pie crust" technique for lateral soft tissue releases has been used extensively, yet few clinical results have been published. In this study, the clinical outcomes of 24 consecutive knees in 24 patients in whom this method was used in conjunction with a cemented posterior-stabilized prosthesis were evaluated. At a mean of 54 months' (range 24-69 months) follow-up, the knees were performing well with a mean Knee Society score of 97 (range 87-100) and mean range of motion of 121 degrees (range 100 degrees -145 degrees). Importantly, there were no clinical failures or cases of postoperative instability and no cases of radiographic loosening or wear.

Adult↗
PubMed2005

Minimal-incision total knee arthroplasty: the early clinical experience.

UNLABELLED: Minimal-incision total knee arthroplasty can be considered part of the continuum from traditional extensile exposures to the quadriceps-sparing approach. We did this study to identify preoperative variables that predict which patients are amenable to a mini-incision and mini-arthrotomy technique, and to compare early outcomes in these patients versus patients in whom a standard approach was required. A consecutive series of 118 primary total knee arthroplasties were evaluated. In each case, the incision and arthrotomy were kept as small as possible, while still allowing proper implantation of the prosthesis. Group 1 consisted of 69 patients (58%) with skin incisions smaller than 14 cm and limited medial parapatellar arthrotomies. Group 2 consisted of 49 patients (42%) with incisions greater than or equal to 14 cm and standard medial parapatellar arthrotomies. Patients in Group 1 averaged one size smaller femoral and tibial components, had narrower femurs, required fewer transfusions and had better postoperative flexion. There were no differences between the groups in length of hospital stay, ambulatory ability, stair-climbing, tourniquet time, radiographic alignment, or complications. Based on these results, the ideal patient for a minimal incision total knee arthroplasty and limited arthrotomy seems to be a thin woman with a low body mass index, a narrow femur, and good preoperative range of motion. LEVEL OF EVIDENCE: Prognostic study, Level III-1 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

Surgical treatment of the middle-aged patient with arthritic knees.

Arthritic knee disease is increasingly more common in the active aging population. The pathology seen in this patient group can run a spectrum of localized degenerative change through tricompartmental arthritis. Nonsurgical options to treat early symptoms are well known and often are effective. When nonsurgical management has failed, surgical intervention often is warranted. Arthroscopic debridement is considered in select patients with mechanical symptoms. Osteotomy continues to have a role in the treatment of young, active patients and may be particularly appropriate in combination with articular cartilage procedures. Unicompartmental and total knee arthroplasty are reliable treatments for patients with advanced stages of degenerative arthritis.

Anterior Cruciate Ligament↗
PubMed2004

Anatomic risk of peroneal nerve injury with the "pie crust" technique for valgus release in total knee arthroplasty.

Peroneal nerve damage can occur during total knee arthroplasty because of indirect or direct injury. The potential for direct laceration injury exists when performing the "pie crust" lateral soft-tissue release in a valgus knee. To assess this risk, the axial, magnetic resonance images of 60 adult knees were evaluated. The distance from the peroneal nerve to the tibia was measured at the level of the standard tibial resection. At this level, the lateral gastrocnemius muscle is interposed between the capsule and the nerve. The mean nerve to bone distance was 1.49 cm (0.91-2.18 cm). These results suggest that the peroneal nerve is adequately protected at the posterolateral corner of the knee but that the "pie crust" release should be performed carefully.

Adult↗
PubMed2004

Cemented posterior stabilized total knee arthroplasty.

In the development of modern cemented total knee arthroplasty, the posterior stabilized knee prosthesis was designed to substitute for the function of the posterior cruciate ligament. Implant designs include the Insall Burstein posterior stabilized knee and the Legacy posterior stabilized knee. The primary feature of these prostheses is the femoral cam and tibial spine mechanism, which prevents posterior tibial subluxation and enhances knee kinematics. Another important feature is the relatively conforming round on round articular geometry that mitigates edge loading and reduces polyethylene damage. In concert, these features have produced a lineage of implants with unsurpassed clinical results, predictable kinematics and durability, which have been reproducible and well documented.

Arthroplasty, Replacement, Knee↗
PubMed2004

Polyethylene post failure in posterior stabilized total knee arthroplasty.

Posterior-stabilized (PS) prostheses have been used extensively in total knee arthroplasty (TKA), with excellent long-term results. The key feature of these prostheses is the femoral cam and tibial post mechanism that limits posterior displacement and produces femoral rollback. Although articular-surface polyethylene wear of the tibial component has not been a significant clinical problem, tibial post wear has been reported. In distinction to chronic post wear, little information exists about catastrophic post failure. We present the case of a 56-year-old woman who presented 63 months after TKA with a PS prosthesis with acute fracture of the polyethylene post. The evaluation and treatment of this patient, including the previously unreported use of computed tomography arthrography to diagnose this rare problem, is reviewed.

Arthroplasty, Replacement, Knee↗
PubMed2004

Factors affecting postoperative range of motion after total knee arthroplasty.

One hundred thirty five patients with osteoarthritis who underwent total knee arthroplasty (TKA) were evaluated to determine whether specific pre- and postoperative variables were correlated with the postoperative range of motion. Age, sex, pre- and postoperative range of motion, pre- and postoperative Knee Society scores, intraoperative patellar thickness before and after resurfacing, pre- and postoperative radiographic patellar height (as determined by the Insall-Salvati and Blackburn-Peel ratios), and preoperative radiographic alignment were recorded for each patient. Regression analysis was performed to identify whether any variables were correlated with the postoperative range of motion or Knee Society scores. The only variable that was significantly correlated with postoperative range of motion was the preoperative range of motion. This study suggests that among the variables evaluated, the preoperative range of motion was the only significant predictor of postoperative range of motion.

Adult↗
PubMed2004

The role of osteotomy 2003: defining the niche.

Although the use of traditional high tibial osteotomy in the unicompartmental osteoarthritic knee has declined due to high failure rates at 10 years, results that are generally poorer than total and unicompartmental arthroplasty, and difficulties with conversion to TKR, a potential role for osteotomy still exists. As long-term data becomes available to support or refute the renewed enthusiasm in the more modern techniques and applications, the indications for osteotomies about the knee will become better defined.

Arthroplasty, Replacement, Knee↗
PubMed2003

The role of debridement: through small portals.

Arthroscopic debridement represents one option for treatment of the patient with degenerative arthritis of the knee. Numerous procedures, including joint lavage, removal of loose bodies, partial meniscectomy, and techniques to stimulate cartilage repair may be included under this topic. Understanding surgical indications and clinical results requires differentiation of these individual components where possible. Furthermore, it is important to note that degenerative changes present along a spectrum of involvement. However, despite patient heterogeneity, selective application of conservative debridement, partial meniscectomy and removal of mechanical irritants will result in improved midterm follow-up results in approximately two thirds of patients. Patient expectations are crucial, and the temporizing nature of the procedure must be understood.

Arthroscopy↗
PubMed2003

Stiffness and ankylosis in primary total knee arthroplasty.

To do a successful total knee arthroplasty (TKA), adequate exposure of the tibial plateau and distal femur is required. Difficulty with exposure often is encountered in the patient with a stiff or ankylosed knee. This can lead to complications including component malpositioning and extensor mechanism problems, such as patellar tendon rupture. In these cases where the knee has limited motion preoperatively, knowledge of advanced techniques for soft tissue treatment, and for optimizing exposure are required. Numerous such techniques have been described, including the quadriceps snip, V-Y quadriceps turndown, tibial tubercle osteotomy, and femoral peel. A systematic review of these techniques, including indications and results, based published reports and our experiences, is presented.

Arthroplasty, Replacement, Knee↗
PubMed2003

Routine patellar resurfacing: a viable option.

The literature on routine patellar resurfacing documents that the rate of anterior knee pain after TKA is the same whether the patella is resurfaced or unresurfaced. The complication rate is different in these groups. In patients in whom the native patella is left, the rate of reoperation is approximately 10%. However, when correct surgical technique is used, the rate of patellar complications after routine resurfacing is negligible. Although design modifications have helped reduce patellar complications, the surgeon is the most important variable. As long as good technique is used, routine patellar resurfacing has been proven to produce the best results in TKA.

Arthroplasty, Replacement, Knee↗
PubMed2003

Tibial tubercle osteotomy.

During primary and revision TKA, difficulties with exposure may be due to poor motion, obesity, and patellar baja. To gain accurate component positioning and avoid catastrophic complications with the extensor mechanism, a stepwise approach to optimizing the exposure should be used. In cases where the standard medial parapatellar arthrotomy is inadequate, a quadriceps snip is helpful. Occasionally, exposure will still be limited and in these cases, a tibial tubercle osteotomy can be used following the quadriceps snip. The tubercle osteotomy consistently heals postoperatively and results in less extensor lag than the V-Y quadricepsplasty. To minimize postoperative complications, strict attention to the operative technique should be maintained.

Algorithms↗