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Biomedical subjects

J Charnley

Publications and source records attributed to J Charnley.

At least 37 records · Page 2Linked to original sources

Pulmonary embolism and its prophylaxis following the Charnley total hip replacement.

The incidence of pulmonary emboli after a standardized technique of total hip replacement in a series of 7,959 hip arthroplasties operated on between 1962 and 1973 was 1.04% fatal and 7.89% non-fatal. 1,174 had no prophylaxis against embolism with a fatality rate of 2.3% and non-fatal embolism in 15.2%. Phenindione, intravenous heparin and dextran all reduced the complication rate to about 1% fatal and 8% non-fatal but none was statistically better than another. Statistically, plaquenil (hydroxychloroquine sulphate), was as good as any of the other methods used and had few complications. Analysis of the blood groups, pre and post-operative hemoglobin levels, major and revision surgery showed little relationship to the incidence of embolism. The most frequent time of onset of embolism (75%) occurred in the second and third postoperative weeks with only 10% in the first week.

Blood Transfusion↗

Fracture of femoral prostheses in total hip replacement. A clinical study.

The clinical features are presented of 17 fractured Charnley femoral prostheses occurring over a period of about ten years and arising from some 6,500 operations, with more than a 3 1/2 year follow-up. The patients especially at risk are males weighing over 170 lb (75.5 kg) and from these is an obvious need for a heavier design of prosthesis. Whereas the overall fracture rate is only 0.23 per cent, the rate for males over 196 lb (88 kg) is 6.0 per cent. It is believed that defective surgical technique, in failing to provide adequate support by cement to the concavity of the upper levels of the prosthesis is probably the main cause of fracture and reasonably good cement technique explains why the fracture rate is not higher in the present series. Indications for improving cement technique are outlined.

Adult↗

A radiological study of fractures of acrylic cement in relation to the stem of a femoral head prosthesis.

The incidence and prognostic significance of fractures of acrylic cement related to the stem of a femoral head prosthesis in total hip replacement are examined. These fractures are demonstrated when the cement has been rendered radio-opaque by the addition of barium sulphate. One and a half percent of the radiographs of 6,649 patients showed these fractures, which were sometimes associated with subsidence of the prosthesis. Fracture of the cement was usually evident at the six-month post-operative review, if it occurred at all. This radiological complication was devoid of symptoms in the majority of cases and tended to occur in patients with excellent functional recovery. In a minority of patients pain in the thigh during the first six months seemed likely to be explained by this fracture. Slight subsidence of the prosthesis in the cement bed appeared to result in a new and final position of stability. The prognosis was very good; only when separation of the fracture exceeded about 4 millimetres was the prognosis doubtful, in which case a chronic deep infection might be suspected. Possible mechanical and structural causes of fracture of the cement are discussed.

Aged↗

Rate of wear in total hip replacement.

The wear of high molecular weight polyethylene sockets was measured on radiographs, over a period of 9 to 10 years, in a group of patients whose ages averaged 73.3 years at the end of the period. The average rate of wear was 0.15 mm/year and 68 per cent of patients followed this pattern. Wear more than 2.5 mm in 10 years occurred in 15 per cent. There was a diminution in the rate of wear with the passage of time; in the second 5 years the rate of wear was approximately 40 per cent less than in the first 5 years. Body weight and physical activity did not appear to have any relationship to the final amount of wear. In a second series of very disabled subjects under 30 years of age (33 patients, 59 hips, followed only for an average of 38.4 months) the wear was rather more than in the previous series. Most remarkable was the performance of 4 patients, below the age of 50, who were considered completely normal for their age (category A); three of these wore less than the average for the main series.

Adolescent↗

Results of low friction arthroplasty in patients thirty years of age or younger.

The results of total hip replacement in 39 patients 30 years old or younger were evaluated including 67 Charnley low-friction arthroplasties and one McKee total hip arthroplasty. The average age was 25.9 years with an average follow-up of 39 months, the longest being 8 years, 3 months. The diagnoses included rheumatoid arthritis, ankylosing spondylitis, CDH, Still's disease, and a miscellaneous group. Over-all function did not improve as greatly as in the 9 to 10 year series, but this was due to a higher proportion of patients with severely disabling rheumatoid polyarthritis, hemiplegia, severe obesity, or cardiovascular disease. Wear did not seem to be any greater in this younger age group as compared to previous studies in older patients.

Adolescent↗