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Biomedical subjects

J B Meding

Publications and source records attributed to J B Meding.

51 records · Page 3Linked to original sources
PubMed1995

Comparative outcomes of total joint arthroplasty.

A prospective pre- and postoperative general health/quality-of-life factor comparison, using the Rand SF-36 Health Status Questionnaire (TyPE Specification, Quality Quest [Health Outcomes Institute, Minneapolis, MN]), was carried out on a consecutive series of patients with diagnosed osteoarthritis undergoing total hip and knee arthroplasty between March 1991 and March 1994. Study groups consisted of 85 total hip arthroplasty patients, 93 total knee arthroplasty patients, and 65 single-stage bilateral total knee arthroplasty patients, all treated at the same specialty hospital, under the care of three senior orthopaedic surgeons. The average patient age was 69 years. Significant improvements in quality-of-life measures including physical functioning, social functioning, role functioning/physical problem, role functioning/emotional problem, mental health, energy/fatigue, pain, and change in health were noted in all hip and knee arthroplasty patients 6 months, 1 year, and 2 years after surgery (P < .05). There appeared to be no significant differences in quality-of-life measures between hip and knee arthroplasty patients. Results therefore indicate that total hip and knee arthroplasty significantly improve the functional status and quality of life among patients suffering from osteoarthritis.

Activities of Daily Living↗
PubMed1995

Rush rod fixation of supracondylar fractures above total knee arthroplasties.

The authors report on 22 displaced supracondylar femur fractures and total knee arthroplasties treated with Rush rod (Berivon, Meridian, MI) fixation. The average age at the time of total knee arthroplasty was 67 years. Fractures occurred at an average of 5 years after surgery. In only five cases was notch in the anterior cortex noted. The follow-up period averaged 7 years. There were no nonunions. All knees healed between 3 and 4 months after surgery. Postoperative flexion averaged 108 degrees (preoperative average, 102 degrees). Only two knees demonstrated a flexion contracture before surgery (5 degrees-10 degrees), and both had flexion contractures after surgery as well (each 10 degrees). All other knees achieved full extension. The average alignment prior to fracture was 7 degrees of anatomic valgus. At the most recent follow-up evaluation this averaged 10 degrees with two knees in 15 degrees of valgus. The only complications noted were two intraoperative technical errors. No postoperative complications occurred. For supracondylar fractures above a total knee arthroplasty, the authors suggest closed reduction, Rush supracondylar rod fixation, early range of motion, and protected weight bearing until fracture healing. In all cases, an extensive surgical procedure was not required.

Aged↗
PubMed1995

Flat-on-flat, nonconstrained, compression molded polyethylene total knee replacement.

Flat-on-flat, posterior cruciate ligament-sparing total knee prostheses recently have shown problems of wear, loosening, and multiple design changes. Two thousand one Anatomical Graduated Components total knee arthroplasties with compression molded, nonmodular polyethylene tibial components were done between 1983 and 1991 at 3 institutions. All knees were evaluated clinically and radiographically every 2 to 3 years; 71 knees were seen in followup > 10 years. There were 8 failures secondary to revision (5 tibial failures; 2 secondary to metalosis from patellar polyethylene dissociation; and 3 femoral failures) resulting in a 98% survival rate at 10 years. The tibial design was flat-on-flat with a compression molded polyethylene that the authors believe is the primary reason for its success.

Adult↗
PubMed1995

The effect of heterotopic bone formation on prosthetic loosening after total hip replacement.

Seven hundred thirty-two total hip replacements performed from 1970 to 1980 were evaluated for the degree of heterotopic bone formation postoperatively and its effect on long-term mechanical loosening. There were 231 Charnley total hip replacements, of which 152 had no heterotopic bone formation, 58 had Grade 1 formation, and 21 had Grade 2 or 3 formation. Among the 123 Mueller total hip replacements, 98 had no heterotopic bone formation, 19 had Grade 1 formation, and 6 had Grade 2 or 3 formation. For the 378 T-28 total hip replacements, there were 305 with no heterotopic bone formation, 59 with Grade 1 formation, and 14 with Grade 2 or 3 formation. Survival analyses using the definition of failure as loosening, fracture, or revision of the acetabulum or femoral components were constructed. There was no correlation between mechanical loosening, fracture, or revision of the total hip replacement and any degree of heterotopic bone formation.

Arthritis, Rheumatoid↗
PubMed1994

Clinical and radiographic evaluation of long-stem femoral components following revision total hip arthroplasty.

Fifty-four consecutive, long-stem revision hip arthroplasties were performed in 53 patients. In order to evaluate periprosthetic femoral changes, all cases utilizing cement, requiring bone-grafts for prosthetic stability, or with a follow-up period of less than 2 years were omitted. Thus, 32 long-stem revision hip arthroplasties in 32 patients were reviewed. Twenty-three Porous Coated Anatomic (Howmedica, Rutherford, NJ) and nine Bi-Metric (Biomet, Warsaw, IN) stems were implanted, with an average follow-up period of 3.6 years (range, 2-6 years). Prosthetic canal fill averaged 94% proximally and 80% distally. Intraoperative complications included three femoral shaft fractures. Harris hip scores averaged 47.8 points, before surgery and 87.6 points at the final follow-up evaluation, with 81% of patients the pain-free. Only three cases of subsidence and one case of osteolysis were noted. By 1 year, proximal osteopenia (off-load) (P = .005), bony condensation about the porous surface (spot weld) (P = .01), and pedestal formation (P = .004) were observed. The presence of distal cortical hypertrophy, (P = .02) spot weld (P = .001), and pedestal formation (P = .05) correlated significantly with off-load. Pedestal formation and distal cortical hypertrophy were commonly found together (P = .001). Despite significant periprosthetic remodeling, adequate fixation and satisfactory early clinical scores were achieved in this setting. Contrary to similar reviews using extensive bone-grafts, acceptable pain-free clinical results were obtained with these components.

Female↗
PubMed1994

Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty.

From 1975 to 1983, 278 patients received 418 posterior cruciate ligament-retaining Total Condylar knee arthroplasties. Twenty-four patients were excluded, 15 for lack of followup data, 6 for infection during followup, and 3 for revision surgeries for previous infections. The 394 remaining knees were observed from 1 to 18 years (mean, 8.08 years). Kaplan-Meier and crude survival estimates at 12 years were 96.8% and 98.1%, respectively. Various survival analyses by other authors have yielded similar successful results.

Adult↗
PubMed1994

Polyethylene wear in uncemented acetabular components.

We measured polyethylene wear in 231 porous-coated uncemented acetabular cups. We divided the hips into two groups according to the fixation of the femoral component, by cementing (n = 97) or press-fit (n = 134). Follow-up was from three to five years. The patients in two sub-groups were matched for weight, diagnosis, sex, age and length of follow-up. The linear wear rate of cups articulated with uncemented femoral components (0.22 mm/year) was significantly higher than the wear rate (0.15 mm/year) of cups articulated within cemented femoral components (p < 0.05). These results can be compared with previously reported wear rates of 0.08 mm/year for cemented all-polyethylene cups and 0.11 mm/year for cemented metal-backed cups. The higher wear rates of uncemented arthroplasties could jeopardize the long-term results of this type of hip replacement.

Acetabulum↗
PubMed1994

Postoperative alignment of total knee replacement. Its effect on survival.

Four hundred twenty-one posterior cruciate condylar total knee arthroplasties were performed between 1975 and 1983. Anatomic alignment of the knee was recorded on follow-up evaluations from two months to 13 years postoperatively. Patients were stratified into a normal group that was 5 degrees to 8 degrees anatomic valgus, a varus group that was from 4 degrees anatomic valgus to any degree of varus, and a valgus group that was more than 9 degrees anatomic valgus. There were eight failures, five in the varus group and three in the normal group. There were no failures in the valgus group. Kaplan-Meier survival curves showed no significant difference between normal and valgus groups; however, there was a statistical difference between the valgus and varus and the normal and varus groups. A surgeon should align a total knee prosthesis in neutral or a slight amount of anatomic valgus to give the patient the best chance for long-term survival.

Aged↗
PubMed1993

Critical analysis of strut grafts in anterior spinal fusions.

Fifty patients undergoing anterior spinal decompression with partial or complete corpectomy and fusion with strut grafting were reviewed. The etiology of the spinal lesions included pathologic fracture (9 patients), trauma (22 patients), congenital/developmental lesions (6 patients), failed fusion (6 patients), and degenerative lesions (7 patients). Vertebral body reconstruction of the cervical, thoracic, or lumbar spine used iliac crest (20 cases), rib (12 cases), and fibular autografts (9 cases). Additionally, in 10 cases fibular allografts were used. There were four deaths, all secondary to systemic disease. Of the remaining 46 patients, 2 required revisions and all subsequently progressed to a solid anterior arthrodesis with an average follow-up of 30.4 months (range 12-62 months). Posterior spinal fusion was staged in 38 patients. Twenty of 29 patients with neurologic lesions improved after corpectomy. Eleven cases treated for a progressive, painful kyphosis averaged correction of 11.4 degrees (26%), which was maintained on long-term follow-up. Complications were primarily pulmonary and/or genitourinary. Others included a pseudarthrosis, an early fractured strut, and a late allograft infection. On the basis of this review, it appears that spinal arthrodesis with anterior decompression and strut grafting is an effective method of treating anterior compressive syndromes of the spine and painful progressive kyphoses.

Adolescent↗
PubMed1987

Bilateral simultaneous total knee arthroplasty.

One hundred thirty-two patients (264 knees) who had simultaneous bilateral total knee arthroplasty and 77 patients who had unilateral procedures were reviewed for statistical comparison of the two procedures with respect to pain, tibial and femoral radiolucency, and all other complications as well as average hospital stay and hospital costs. Both groups had posterior cruciate condylar total knee prostheses. There were no significant differences except for tibial radiolucency, which was significantly higher in the unilateral group. Bilateral total knee arthroplasty as a single procedure does not increase the risk of postoperative or follow-up complications and decreases the probability of complications such as phlebitis and pulmonary emboli, because only one operation is necessary. The average hospital cost and length of stay were lower in the simultaneous group (decreased by 20% and 46%, respectively), compared with twice that of the unilateral group.

Aged↗
PubMed1987

Total hip arthroplasty. Can the patient play sports again?

To analyze the effect of athletic involvement on total hip replacements, a questionnaire was sent to all of our total hip patients with at least a 3-year follow up. Patients were asked to list the type, degree, and frequency of sports participation before and after surgery, along with any problems they encountered upon returning to active sports. The patients who responded were then placed in one of two groups, participant or non-participant, for each sport we encountered, and were statistically compared with respect to clinical analysis. The population showed a significant decrease in all forms of activity after surgery, except bicycling; yet more returned to an active sport than did not. No correlation existed between involvement in a sport and the variables we tested. We concluded that intelligent participation in activities such as walking, golf, or bowling where no excess load was placed on the total hip, had no influence on the outcome of a total hip replacement.

Adult↗
PubMed1986

A comparison of osteonecrosis and osteoarthritis patients following total hip arthroplasty. A long-term follow-up study.

Between November 1969 and December 1983, 105 total hip arthroplasties were performed on 82 patients with a diagnosis of idiopathic osteonecrosis (ON). During the same period, 891 total hip surgeries were performed on 706 osteoarthritis (OA) patients. In order to statistically compare these two diseases, the records of each patient were examined for possible differences in bilaterality, sex, age, and acute postoperative complications including infections, pain, nonunions, and heterotopic bone (HB). Sixty-four ON hips and 615 OA hips (all with at least three years of follow-up data) were then evaluated for acetabular and femoral radiolucency, acetabular and femoral loosening, and pain. The same long-term complications were evaluated in some of these patients at five-, seven-, and ten-year follow-up periods. The ON patients were significantly younger than the OA patients (p less than .001). Bilateral involvement and male/female distributions were found to be similar. Except for HB, acute postoperative complications (zero to six months) were similar. Early HB surrounding one-third or more of the hip joint was statistically less in the ON patient population (p less than .001). No significant differences in long-term complications were found. However, a much higher death rate was found in ON patients (24%) as compared to OA patients (15%) (significant at p less than .07). This difference was not due to any postoperative complication or the hip arthroplasty itself, because both were the same in the two populations.

Adult↗
PubMed1986

Anterior displacement. Its effects on instability and radiolucency in total knee replacements.

One hundred sixty-nine posterior cruciate condylar knee arthroplasties were evaluated for investigation of the effect of anterior displacement on instability and interface radiolucency in total knee arthroplasty. All knees were followed for at least one year, and 37 knees were followed for at least three years. The status of the anterior cruciate ligament at surgery was first compared to the postoperative, six-month, one-year, and three-year anterior drawer sign. A correlation coefficient was computed to test for the existence of a relation between these two variables. A chi-square test for statistical significance was used to compare the overall anterior drawer results with time and the anterior drawer sign at each follow-up evaluation with pain and radiolucent zones between cement and bone. For further evaluation of the effect of anterior stability on radiolucent zones, the authors analyzed the records of all their posterior cruciate condylar total knee arthroplasties over a seven-year period (average follow-up period, 2.5 years). Anterior stability over time was independent of the status of the anterior cruciate at surgery, and the presence or absence of an anterior cruciate ligament at surgery did not affect anterior stability over time. Furthermore, cutting of the anterior cruciate did not change anterior stability over time. Anterior instability proved to be statistically less at six months than at surgery and did not become worse with time. Neither anterior instability nor the preoperative state of the anterior cruciate ligament affects pain and interface radiolucency between cement and bone.

Adult↗