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J C McCarthy

Publications and source records attributed to J C McCarthy.

At least 19 recordsLinked to original sources
PubMed2001

The watershed labral lesion: its relationship to early arthritis of the hip.

This study examined the hypothesis that labral lesions contribute to early degenerative hip disease. Between 1993 and 1999, 436 consecutive hip arthroscopies were performed by the senior author (J.C.M.). In addition, 54 acetabula were harvested from human adult cadavers and 10 hips underwent microangiography to determine labral blood supply. Of the 436 arthroscopic patients, 241 (55.3%) had a total of 261 labral tears, all located at the articular, not capsular, margin of the labrum. Stereomicroscopic examination of the 54 cadaver acetabula revealed a total of 52 labral lesions. Overall, there was no significant difference between the arthroscopic and cadaver populations in terms of the incidence of labral tears (P=.315). There was a high association between labral lesions and adjacent acetabular chondral damage. Arthroscopic and anatomic observations support the concept that labral disruption and degenerative joint disease frequently are part of a continuum of joint pathology.

Acetabulum↗
PubMed2001

The Otto E. Aufranc Award: The role of labral lesions to development of early degenerative hip disease.

The current authors examined the hypothesis that labral lesions contribute to early degenerative hip disease. Between 1993 and 1999, 436 consecutive hip arthroscopies were done by the senior author. In addition, 54 acetabula were harvested from human adult cadavers. Two hundred forty-one of the 436 (55.3%) patients who had arthroscopies had a 261 labral tears, all located at the articular, not capsular margin of the labrum. Stereomicroscopic examination of the 54 acetabula from cadavers revealed 52 labral lesions. Overall, there was no significant difference between the arthroscopic and cadaveric populations in terms of the incidence of labral tears. (Overall, 73% of patients with fraying or a tear of the labrum had chondral change. Arthroscopic and anatomic observations support the concept that labral disruption and degenerative joint disease are frequently part of a continuum of joint disease.

Acetabulum↗
PubMed2000

The difficult femur.

Explore the source record for details and available documents.

Arthroplasty, Replacement, Hip↗
PubMed1999

The outcome of trochanteric reattachment in revision total hip arthroplasty with a Cable Grip System: mean 6-year follow-up.

We have reviewed 251 hips that were revised by the senior authors with subsequent reattachment using the Dall-Miles Cable Grip System. Of these patients, 223 were available for follow-up. A trochanteric slide osteotomy was used for most cases (n = 170), and the remainder had conventional trochanteric osteotomy to facilitate surgical exposure. Follow-up period was 1 to 8 years. Forty-eight percent (n = 108) of the hips had a previous trochanteric osteotomy. Thirteen percent (n = 30) had a prior trochanteric nonunion. Of the 223 hips, 91% (n = 204) of the trochanters remained attached to the trochanteric bed when reapproximated by the cable grip system. The 2 multifilament cables were passed medially through drill holes in the lesser trochanter in 67% (n = 149) of cases. Of the hips, 16% (n = 35) had 2 cables passed through bone lateral to the prosthesis, and 17% (n = 39) had cables passed 1 medial and 1 lateral to the prosthesis. Cable breakage was noted in 10% (n = 23) of cases. Of those 23, 70% (n = 16) were stainless steel. Unraveling of the cable occurred in 18% (n = 41) of cases. There were 19 nonunions (9%). Of the 19 nonunions, 74% (n = 14) were stainless steel. The trochanter was reattached to bone in 9 hips, to cement in 4 hips, and to a proximal femoral allograft in 6 hips (P = .0001). Eight of the 19 hips (42%) had the cables placed lateral to the prosthesis (P = .0002). When bone-to-bone apposition was achieved at surgery, the nonunion rate was 4%. In this difficult group of revision procedures, the Dall-Miles Cable Grip has provided reliable trochanteric fixation. Factors associated with successful trochanteric healing include use of vitallium cables, use of a trochanteric slide osteotomy, cables passed medially through the lesser trochanter, cerclage rather than intramedullary placement, and bone-to-bone apposition.

Arthroplasty, Replacement, Hip↗
PubMed1997

Custom and modular components in primary total hip replacement.

Cementless custom implants attempted to enhance fit and fill of variable hip geometry. Fabrication of custom implants in referenced from a computed tomography scan, thus allowing three dimensional specifications of femoral anatomy. However, the aggregate charge of manufacturing the implant and obtaining the computed tomography scan is prohibitive in today's healthcare climate. Clinical studies have not shown that customized implants incrementally improve clinical success or implant longevity. Modular prostheses allow the surgeon intraoperative versatility, allowing adjustment of leg length, offset, neck length, anteversion, and fixation. This is particularly helpful in developmental dysplasia of the hip and posttraumatic arthritis. Other advantages of modularity include decreased implant inventory and the ability to remove the femoral head at revision surgery to improve exposure or change head size without component removal. Subsequent clinical experience has witnessed significant drawbacks associated with modularity. These include corrosion, especially with mixed metals, fretting, dissociation, implant fracture below the head and neck taper joint, and reduced range of motion. In addition, thin acetabular polyethylene contributes to higher were rates, earlier failure, local or distal debris particles, and osteolysis. Finally, the cost of modular implants is generally higher than a comparable monolithic prosthesis. In primary hip arthroplasty, use of custom or modular implants should be judicious. Modularity beyond the head and neck junction should be reserved for those cases where a comparable monolithic implant would not suffice.

Acetabulum↗
PubMed1996

Minimum four-year radiographic and clinical evaluation of results following femoral revision surgery with the S-ROM modular hip system.

Thirty-four patients were reviewed following revision modular cementless reconstruction for proximal femoral deficiency. One patient underwent a Girdlestone conversion for sepsis at 3 years postoperatively, leaving 33 patients with an average follow-up of 51 months (range 48 to 62 months). The average age at surgery was 60 years, and there were 17 right and 16 left hips. Patients were assessed clinically using the Merle d'Aubigné and Postel hip rating system. Radiographic assessment was performed on preoperative and postoperative films. Femoral assessment was performed using the Engh fixation stability score, Gruen zonal system for radiolucencies and observing for the presence or absence of osteolysis. The average pain score was 5.4/6 with 88% having slight or no pain. Only one patient (3%) had thigh pain. Radiographically, the average fixation stability score was 21.7 with features of bony ingrowth present in 97%, and one case with features of stable fibrous ingrowth. There was no evidence of osteolysis.

Adult↗
PubMed1995

The role of hip arthroscopy in the diagnosis and treatment of hip disease.

Injuries to the hip are commonly encountered by orthopedic surgeons and will, for the most part, respond well to conservative therapy. When a patient's hip pain has not responded to the appropriate treatment and radiographic measurements have not shown any specific pathology, arthroscopy of the hip can be a valuable diagnostic and therapeutic procedure. We retrospectively reviewed 94 consecutive patients who experienced refractory hip pain that persisted longer than 6 months (average: 2.1 years) and who had an average follow up of 2.5 years. Statistical analysis was performed using Fisher's Exact Test (P value) and Pearson (r value) correlation coefficient to compare preoperative symptomatology and physical examination findings with intraoperative pathology. Statistically significant results were obtained when comparing preoperative symptoms of a painful hip click and mechanical symptoms of locking with acetabular labral injuries (P = .000, r = .896) and loose bodies (P = .000, r = .896), respectively. Radiologic studies were nondiagnostic in 76% of patients in this series. Hip arthroscopy can be a valuable and viable procedure in the diagnosis and treatment of protracted or progressive hip pain lasting more than 6 months.

Adult↗
PubMed1995

The role of hip arthroscopy in the diagnosis and treatment of hip disease.

OBJECTIVE: To report the results of arthroscopy performed on adults with hip disease who did not respond to extended conservative treatment and to evaluate the relationship between clinical findings, radiologic tests and surgical abnormalities. DESIGN: A case study. SETTING: New England Baptist Hospital, Boston, Mass. PATIENTS: Fifty-nine patients (32 women, 27 men) with refractory hip pain, between the ages of 17 and 69 years, who were seen between January 1989 and January 1992. INTERVENTION: Hip arthroscopy. MAIN OUTCOME MEASURES: Cause of hip pain, results of physical examination and operative findings. RESULTS: In 26 patients the cause of hip pain was traumatic; in 21 the cause was idiopathic. On physical had pain on straight leg examination, 56% of patients reported painful clicking of the hip joint, 37% had pain on straight leg raising, 9% had decreased extension and 34% had had episodes of locking of the joint. Five percent had pain predominantly in the thigh, 41% reported at least one episode of "giving way" of the hip and 7% had snapping of the iliotibial band. At arthroscopy, 69% of patients had synovitis in the hip joint, 59% had a tear of the acetabular labrum, 39% had loose bodies, 32% had degenerative arthritis and 27% had a chondral defect. On statistical analysis, significant (p < 0.05) relationships were found between acetabular labral tears and preoperative complaints of clicking or giving way, between loose bodies and preoperative locking and between degeneration of the hip joint and thigh pain. CONCLUSION: Arthroscopy of the hip is a valuable diagnostic and therapeutic procedure for patients with hip pain refractory to conservative therapy.

Adolescent↗
PubMed1993

Hip disease in adults with Down syndrome.

The life expectancy of patients with Down syndrome has increased significantly in recent years. Hip abnormalities occur in children with this syndrome but little is known about their natural history in later life. In 65 adults with Down syndrome we found hip abnormalities in 28%, and this was statistically correlated with walking ability. A subgroup of 18 patients was followed by serial examination; this showed that hip instability occurred in adulthood and became worse with time. In some patients, hip instability started after skeletal maturity.

Adolescent↗
PubMed1993

Classification of femoral abnormalities in total hip arthroplasty.

Bony abnormalities of the femur can significantly complicate total hip arthroplasty both for the primary and revision operations. No standard nomenclature exists for the description of these femoral abnormalities. A classification system is presented to standardize nomenclature, assist in preoperative planning, and to assist in the reporting of these defects.

Bone Malalignment↗
PubMed1989

Anatomy of the proximal femur as seen with three-dimensional magnetic resonance imaging.

Magnetic resonance imaging (MRI) is being applied successfully to the study of the musculoskeletal system with notable recent advances, including the use of three-dimensional imaging techniques. The authors introduce three-dimensional MRI as a technique for examining proximal femoral anatomy and suggest its use as an improvement on current methods for prosthetic hip design. The proximal femurs of 14 cadavers were scanned using a three-dimensional FISP technique and the images were subsequently manipulated on a three-dimensional MRI image-processing workstation to produce rotated surface reconstructions and multiplanar reformatted images. The surface rotations showed that the marrow cavity contours closely follow the contours of the external cortex. Axially reformatted images allowed relative area measurements of the marrow cavity, quantifying the variability between subjects.

Aged↗
PubMed1984

Changes in long-bone structural properties during the first 8 weeks of plate implantation.

The midplate structural rigidities of metal- and plastic-plated intact canine femora were experimentally determined after initial plate application and 8 weeks after in vivo implantation. Composite beam theory significantly overestimated the bending rigidities of the metal-plated bones. The rigidities of the plastic-plated bones were nearly identical to that of the isolated bone, as composite beam theory predicted. Plating with either plate increased the intracortical porosity and caused the deposition of periosteal new bone, which was greater with plastic than with metal plates. The increased rigidities provided by the attachment of the metal plates and, hence, the degree of bone strain shielding were variable. Platings for 8 weeks which provided little strain shielding with either metal or plastic plates caused an increase in bone flexural rigidity (measured after plate removal) with respect to the contralateral control. Platings that provided increasing amounts of strain shielding caused a decreasing midplate bone rigidity (measured after plate removal) and increasing bone deposition at the outer screws. These findings suggest that the surgical implantation of any plate (metal or plastic) will provide a net stimulus to bone formation and consequently increased bone structural rigidity, even though intracortical porosity is increased. If the plate significantly reduces the normal loads borne by the bone, however, there is a net stimulus to remove bone, resulting in a loss of midplate structural rigidity within 8 weeks of implantation.

Animals↗
PubMed1983

Bony ingrowth fixation of the acetabular component in canine hip joint arthroplasty.

Five mature dogs were studied five to eight months after insertion of a newly designed acetabular component that eliminates the use of bone cement in total hip arthroplasty (THA). The component was hemispheric, with a layer of porous metal on its outside surface. It initially was fixed to the innominate bone by screws passed through projections from the edge of the metal substrate. When the dogs were killed five or eight months after implantation, all components were fixed rigidly to the bone. Bony ingrowth covered an average of 53% of the porous surface of the implant, penetrating three layers of balls.

Acetabulum↗