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Biomedical subjects

I M Pinder

Publications and source records attributed to I M Pinder.

28 records · Page 2Linked to original sources
PubMed1993

The incidence of fatal pulmonary embolism after knee replacement with no prophylactic anticoagulation.

We made a prospective study of the incidence of fatal pulmonary embolism in patients after total knee replacement with no prophylactic anticoagulation. There were 499 consecutive patients having 527 knee replacements. They all wore anti-thromboembolic stockings and were mobilised 48 hours after surgery. No patient was lost to follow-up. One patient died of pulmonary embolism 22 days after operation. There were no other deaths within three months of operation. The incidence of fatal pulmonary embolism was 0.19% (95% confidence interval: 0 to 0.6%). Fatal pulmonary embolism is rare after total knee replacement without prophylactic anticoagulation and the routine anticoagulation of these patients is of doubtful value.

Adolescent↗
PubMed1992

External fixation of lower limb fractures in children.

Thirty-four tibial and femoral shaft fractures in 32 children between the ages of 3 and 15 years were treated by external fixation over a 5-year period. The indications were fractures occurring in association with other major injuries and failure of conservative treatment to maintain satisfactory reduction. There was one case of delayed union and one early refracture. The overall pin track infection rate was 6%, but the rate for the tibial pins (2.1%) was much lower than for the femoral pins (10.3%). Union was achieved at an average of 11.7 weeks in the femoral fractures and 10.0 weeks in the tibial fractures. The use of external fixation is recommended for childhood femoral and tibial fractures, particularly in children with multiple injuries.

Adolescent↗
PubMed1992

Polyethylene wear in uncemented knee replacements.

Isolated wear of the polyethylene tibial component led to failure in five of a series of 108 uncemented porous-coated knee replacements. The clinical features included pain, effusion and instability with progressive varus deformity. In all cases there was extensive wear on the medial side of the polyethylene surface of the prosthesis. The mechanism of such wear is complex, being due in part to the unconstrained nature of the joint and the incongruity of its surfaces. Other design characteristics may have contributed.

Adult↗
PubMed1991

Ankle arthrodesis in rheumatoid arthritis. 30 cases followed for 5 years.

We have reviewed the results of 30 ankle arthrodeses performed on 26 patients with rheumatoid arthritis. This procedure was associated with a high morbidity, with wound breakdown and infection occurring in 12 cases. Eighteen ankles had fused, six had pain-free fibrous union, and six required further surgery for nonunion. Clinical evaluation, at an average follow-up of 5 years, was based on a modified ankle-grading system with good or excellent results in 14, fair results in nine, and poor in two. Only 4 patients had some residual pain in the ankle, and so, despite the high complication rate, arthrodesis is an effective method of treating the painful, rheumatoid ankle.

Adult↗
PubMed1991

Survivorship analysis of the uncemented porous-coated anatomic knee replacement.

Ninety-six patients who had a total of 108 replacements with an uncemented porous-coated anatomic knee prosthesis were followed for an average of sixty-four months (range, thirty-nine to ninety-three months). At the time of the most recent follow-up, twenty-one implants (19 per cent) had failed, all due to problems with the tibial component. A patellar component was not used, and no noteworthy patellar problems were encountered after the operation. There were no infections about the prostheses, and no femoral implant was revised. The most common cause of failure was collapse of the anteromedial part of the tibial plateau, which occurred in fourteen knees. The prosthesis loosened without collapse of bone in two knees, and five knees were revised because of gross wear of the polyethylene. When the time of failure was defined as the point at which revision of the prosthesis was recommended, the cumulative rate of survival was 84 per cent (95 per cent confidence interval, +/- 7 per cent) at five years and 77 +/- 10 per cent at six years. When the time of failure was defined as the point at which the knee replacement was actually done, the five-year rate of survival was the same. No significant differences were demonstrated between groups that were stratified by age, sex, weight, or primary diagnosis. We therefore do not recommend the use of an uncemented porous-coated anatomic knee replacement of the design that was evaluated in this study.

Adult↗
PubMed1989

Nonresurfaced patella in total knee arthroplasty.

Problems attributable to the patellofemoral joint are still the major cause of disability in contemporary knee arthroplasty. Patellar resurfacing does lead to further complications, such as loosening, wear, and malalignment. Two studies have been performed specifically to review experience with the nonresurfaced patella in total knee arthroplasty. The first study determined that patellofemoral symptoms occurred in 8% of the total group and the majority of these were due to patellar malalignment. The postoperative skyline views at 60 degrees and 90 degrees of flexion obtained routinely identified dynamic patellar maltracking responsible for anterior knee pain. The second study addressed long-term durability of the nonresurfaced patella. The tracking of the patella was maintained with only small shifts of patella position and the tendency to stabilize with time. Stress-induced bone remodelling, particularly of the lateral facet, occurred in 85% of patellae. No preoperative or postoperative radiologic variable was associated with anterior knee pain. The authors strongly recommend that accurate patellofemoral tracking be obtained at the time of knee arthroplasty by staged procedures, with removal of peripheral osteophytes, then proximal iliotibial tract release followed by lateral debulking to a marked degree to obtain neutral tracking. Only then will intracapsular lateral release be performed. The results presented support the use of the nonresurfaced patella, and patellar malalignment remains a major source of disability attributable to the patellofemoral joint following total knee arthroplasty.

Arthroplasty↗
PubMed1989

Outcome from multiple joint replacement surgery to the lower limbs.

All patients who had three or more major joints (hips or knees) replaced were identified from operation records at one hospital and reviewed to assess outcome. Forty-three were found to suffer from rheumatoid arthritis, four from osteoarthritis and three from psoriatic arthritis. Eight patients had died an average of 2.6 years (range 1-7 years) after their last operation and this was higher than expected, even for RA. Average follow-up in the 36 surviving RA sufferers was 1.8 years, with a minimum of 6 months since last operation. Range of joint movement, pain relief, satisfaction, mobility, disability and social outcomes were assessed and are reported. Patients were satisfied with outcome because of pain relief and functional improvement. No patient required permanent in-patient care, although they still represented a very disabled group with mean HAQ score of 2.75.

Aged↗
PubMed1982

Detection of sacroiliac injury by bone scanning in fractures of the pelvis and its clinical significance.

Fifteen patients with stable pelvic fractures were investigated by technetium bone scanning of the pelvis and subsequently reviewed to study their recovery from this injury. Eleven of these patients had a significantly raised uptake of isotope over the ipsilateral sacroiliac joint suggesting a bone injury in this region, probably as a result of micro-avulsion fractures. All patients, with one exception, made a full recovery from their fractures within 4 months. We conclude from this that the region of the sacroiliac joint is frequently injured in isolated fractures of the pubic rami, but in the short term this has a good prognosis.

Adolescent↗