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Biomedical subjects

J A Rand

Publications and source records attributed to J A Rand.

At least 55 records · Page 3Linked to original sources
PubMed1993

Revision of failed unicompartmental total knee arthroplasty.

Forty-eight revision total knee arthroplasties (TKAs) for failed unicompartmental total knee prostheses were evaluated at 5.4 +/- 2.5 years after revision. The most frequent mode of failure of the original arthroplasty was loosening. All revisions used a condylar-type prosthesis. Fifty percent of the knees had bone defects that were filled with cement. Good or excellent results were achieved in 81% of the knees. One knee had a complete radiolucent line adjacent to the tibia at last evaluation. The surgical complication rate was 13%. Predictable salvage of the failed unicompartmental TKA can be achieved by revision arthroplasty.

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PubMed1993

Subcapital femoral neck fracture following open reduction and internal fixation of an intertrochanteric hip fracture using a sliding screw and side plate.

This case report illustrates a subcapital femoral neck fracture following application of a compression screw and side plate to treat an intertrochanteric hip fracture. This is an uncommon complication in the management of intertrochanteric hip fractures. The authors describe steps in this surgical technique that minimize the possibility of this complication.

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PubMed1993

Results of meniscectomy in the knee with anterior cruciate ligament deficiency.

Sixty-three knees in 62 patients with insufficiency of the anterior cruciate ligament (ACL) were treated by arthroscopic partial or total meniscectomy without ligament reconstruction. The implications of this sequence of treatment with this combination of pathologies was documented. At 4.5 years after meniscectomy, 84% of the knees were subjectively improved and 10% were subjectively worse. Sixty-eight percent of the patients had persistent knee pain and 52% had episodes of giving way. Roentgenographic evidence of osteoarthrosis was present in 65% of 34 knees at 4.4 years after operation. Additional surgery was required in 24% of the knees. Meniscectomy without a stabilization procedure should be performed only infrequently in knees with deficient ACL.

Acute Disease↗
PubMed1992

Simplified enrollment for autologous transfusion: automatic referral of presurgical patients for assessment for autologous blood collections.

We implemented a pilot program at our institution for automatic referral of patients for presurgical assessment for preoperative and intraoperative collection of autologous blood. Although patients and clinicians support the use of autologous transfusion, often a request for collection of autologous blood is not initiated. During 11 months, 269 patients (82%) of three orthopedic surgeons entered the program, and 218 underwent operation and were dismissed from the hospital. A total of 940 units of autologous blood (675 preoperatively and 265 intraoperatively) was collected from these 218 patients, and 84% of the units were transfused. Throughout hospitalization, 86% of the patients received only autologous blood, whereas 14% received various proportions of homologous and autologous blood. In contrast, only 26% of a concomitant control group of 220 consecutive orthopedic surgical patients not participating in the automatic-referral program received only autologous blood. Thus, the automatic-referral program increased the percentage of elective orthopedic surgical patients who received only autologous blood from 26% to 86% (P less than 0.001). This study also showed that the same amount of blood was used for autologous transfusions as was routinely used for homologous transfusions in similar cases. The automatic-referral system was convenient for physicians and patients and offered the benefits of reduction of transfusion-associated risks and amelioration of patient anxieties.

Blood Transfusion, Autologous↗
PubMed1991

Role of arthroscopy in osteoarthritis of the knee.

We compared arthroscopic partial menisectomy with limited debridement versus arthroscopic abrasion arthroplasty in patients with osteoarthritis. Group I consisted of 131 knees in 131 patients treated by partial meniscectomy and debridement of loose articular cartilage or removal of loose bodies. All patients had grade 3 or 4 chondromalacia in the affected compartment. The patients were followed for a mean of 3 +/- 1 years. Group II consisted of 28 knees in 28 patients treated by debridement with abrasion arthroplasty of exposed bone. The mean age of this group of patients was 63 years and they were followed for a mean of 3.8 years. The Group I patients noted 80% improvement by 1 year but this fell to 67% by 5 years after meniscectomy. Overall, 104 were improved, 16 unchanged, and 15 worse at the time of last evaluation compared to their preoperative status. In the Group II patients, 11 were improved, 8 unchanged, and 9 worse. Fifty percent of Group II subsequently underwent a total knee arthroplasty for salvage at a mean of 3 years following the abrasion procedure. Abrasion arthroplasty appears to offer little benefit over partial meniscectomy and debridement in the degenerative knee. Results of abrasion arthroplasty are unpredictable.

Arthroplasty↗
PubMed1991

Total knee arthroplasty: a population-based study.

Total knee arthroplasty (TKA) is being used increasingly for the management of chronic arthritis of the knee. In this report, we review the frequency of application of TKA in the population of Olmsted County, Minnesota, from 1971 through 1986. The utilization rate of TKA increased from 20.5 per 100,000 person-years for 1971 through 1974 to 60.8 per 100,000 for 1983 through 1986. Although rates were higher in women, they increased with advancing age in both sexes. Rates between the urban and rural populations of Olmsted County did not differ. The two most common underlying diseases that necessitated TKA were osteoarthritis and rheumatoid arthritis; they were the cause of more than 90% of all operations. By extrapolating the rates of TKA in Olmsted County to the total 1986 US population, we estimate a need for at least 143,000 TKAs annually at a direct cost of more than $2.3 billion each year.

Adult↗
PubMed1991

Revision total knee arthroplasty using the total condylar III prosthesis.

Implant selection for the severely damaged knee being treated by revision is difficult. Fixed or rotating hinges have provided mixed results with a high frequency of complication. An alternative to a hinge implant is the total condylar III prosthesis, which can substitute for a deficient collateral ligament. Between August 1980 and April 1987 total condylar III prostheses were used for revision of failed total knee arthroplasties (TKA) of 21 knees in 19 patients. In the same time interval, 649 TKA revisions were performed for a frequency of 3.2% using this prosthesis. The indications for using this prosthesis were bone loss in 10 knees, instability in 9 knees, supracondylar femur fracture in 1 knee, and implant malposition in one knee. At a 4-year follow-up evaluation the knee scores were excellent in 25%, good in 25%, fair in 25%, and poor in 25%. Complications occurred in 33% of the knees. The total condylar III prosthesis provided results similar to other constrained implants used for revision in patients with severe bone loss and ligamentous instability.

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PubMed1991

Bone deficiency in total knee arthroplasty. Use of metal wedge augmentation.

Twenty-eight knees in 25 patients with a metal wedge augmentation for tibial bone deficiency were reviewed at 2.3 +/- 0.6 years (range, 2-3.5) after surgery. A medial side wedge was used in 24 knees and a lateral side wedge in four. The preoperative bone defect size was 12 mm +/- 6 mm on the medial side and 8 mm +/- 2 mm on the lateral side. The knee scores improved from a preoperative mean of 53 +/- 12 to 89 +/- 8 at the last evaluation. There were 79% excellent and 21% good results. There were no complications or reoperations. Radiolucent lines beneath the metal wedge were present in 13 knees but none were progressive.

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PubMed1991

Cement or cementless fixation in total knee arthroplasty?

A prospectively studied group of 59 knees with cementless fixation were compared to a retrospectively studied but matched group of 59 knees with cement fixation using a Press Fit Condylar prosthesis. The only significant preoperative difference between the patient groups was mean age; the cemented group was on average nine years older than the cementless group (p less than 0.0001). At an average of 2.8 years after surgery, there were no significant differences in knee scores between the two groups. Radiolucent lines adjacent to the tibial component were similar in both groups. The complication rate of 20% in the cementless knees was higher than the 12% rate in the cemented knees; this was primarily related to polyethylene wear of metal-backed patellar components. Cement or cementless fixation of this prosthesis appears to provide equivalent early results.

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PubMed1991

Total knee arthroplasty in osteonecrosis.

Thirty-eight total knee arthroplasties in 36 patients were studied at 4 +/- 2 (mean, +/- SD) years follow-up evaluation. The Hospital for Special Surgery knee score improved from 59 +/- 9 (mean, +/- SD) before surgery to 83 +/- 11 (mean, +/- SD) (p less than 0.0001) at last evaluation. Good or excellent results were achieved in 87%. Implant survivorship at five years was predicted to be 85% using an endpoint of revision, or 68% using an end point of revision for moderate or severe pain. There was one failure for deep infection but no clinical or roentgenographic evidence of loosening.

Adult↗
PubMed1991

Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties.

From 1971 through 1987, 9200 total knee arthroplasties were performed at the Mayo Clinic. Actuarial analysis was used to estimate cumulative rates of survival. Use of a proportional-hazard, general linear model led to the identification of four independent variables that were associated with a significantly lower risk of failure: primary total knee arthroplasty, a diagnosis of rheumatoid arthritis, an age of sixty years or more, and use of a condylar prosthesis with a metal-backed tibial component. When all four of these favorable variables were present (without regard for radiographic changes and non-disabling symptoms), the probability of an implant being in situ was 97 per cent at both five and ten years.

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PubMed1991

Total knee arthroplasty for osteoarthrosis in patients who have Paget disease of bone at the knee.

Thirteen patients who had had sixteen total knee arthroplasties for pagetic gonarthrosis were followed for a mean of seven years (range, two to fifteen years). Involvement of the femur or tibia with Paget disease was associated with multiple technical difficulties at operation and with a final position in suboptimum varus or valgus alignment (ten limbs) or suboptimum alignment of the mechanical axis (nine limbs). The presence of bone with Paget disease did not affect the amount of blood lost during the operation, the postoperative course, or the rate of loosening of the prostheses. At the most recent evaluation, nine patients had no pain, three had mild pain, and one had moderate pain. The mean Knee Society pain score improved from 42 points preoperatively to 88 points and the mean functional score, from 33 to 86 points.

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PubMed1990

The value of indium 111 leukocyte scanning in the evaluation of painful or infected total knee arthroplasties.

Evaluation of painful total knee arthroplasties (TKAs) for infection can be difficult. Indium 111 (111In) leukocyte bone scanning provides a minimally invasive technique for evaluation of possible infection. Thirty-eight patients with a painful TKA who had surgical exploration after 111In leukocyte scanning were reviewed. The scan had an accuracy of 84%, a sensitivity of 83%, and a specificity of 85%. The 111In leukocyte scans must be interpreted in conjunction with the clinical evaluation of the patient because they are less accurate for study of TKAs than of total hip arthroplasties.

Adult↗
PubMed1990

Patellar resurfacing in total knee arthroplasty.

Technical errors in patellar resurfacing at the time of total knee arthroplasty (TKA) are responsible for many of the complications that affect the patellofemoral joint. Instability, patellar fracture, and wear of metal-backed patellar implants are significantly affected by errors of patellar resurfacing. A review of 50 TKAs using a condylar prosthesis and a standardized technique for patellar resurfacing was performed to evaluate the accuracy of the technique. The patients were evaluated at a mean of 2.5 years (range, two to five years) after surgery. The Hospital for Special Surgery Knee Score improved from a preoperative mean of 56 to 92 at the last evaluation. The Hospital for Special Surgery Knee Scores were excellent in 92% and good in 8%. The Knee Society Knee Score improved from a preoperative mean of 28 for pain and 49 for function to a last evaluation mean of 96 for pain and 85 for function. None of the patients had symptoms referable to the patellofemoral joint. There were no patellar fractures, dislocations, or instances of implant loosening of the patella. Roentgenograms revealed nine asymmetrically resurfaced patellae and five tilted patellae. There were no patellar subluxations. Patellar thickness was maintained at the preoperative level of 21 mm. Joint-line height was elevated 1 mm. The patellar height was decreased 2 mm from the preoperative height. Using a standard technique, satisfactory clinical results can be achieved, but minor errors in resurfacing and alignment will still occur.

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PubMed1990

Peroneal nerve palsy after total knee arthroplasty.

The prognosis for peroneal palsy after total knee arthroplasty (TKA) is poorly defined. Twenty-six postoperative peroneal palsies occurred after 8998 TKAs performed between 1972 and 1985. Eighteen patients had complete and eight had incomplete peroneal palsies. Twenty-three had both motor and sensory deficits, and three had only motor deficits. At an average of 5.1 years (range, one to 11 years) after arthroplasty, recovery was complete for 13 palsies and partial for 12. Complete recovery was more likely in those palsies that were incomplete initially. Patients with palsies that were initially partial had significantly higher knee scores than those with complete palsies, and patients whose eventual recovery was complete had significantly higher knee scores than those with incomplete recovery. This new prognostic information should be useful for surgeons who encounter this unfortunate yet persistent complication of TKA.

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PubMed1989

Abrasion arthroplasty as a salvage for failed upper tibial osteotomy.

Eight patients with persistent pain after upper tibial osteotomy and correction of malalignment were treated with abrasion arthroplasty of the affected compartment. At 34-month follow-up examination, only one patient had significant lasting benefit. Five of the patients required subsequent total knee arthroplasty for relief of their pain. One patient was symptomatically unchanged, and one was awaiting total knee arthroplasty. The authors conclude that abrasion arthroplasty is not a satisfactory salvage for a failed upper tibial osteotomy.

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