Search PubMed⌕ Search

Biomedical subjects

J Insall

Publications and source records attributed to J Insall.

At least 19 recordsLinked to original sources
PubMed1996

Randomized trial of epidural versus general anesthesia: outcomes after primary total knee replacement.

To compare the effects of epidural anesthesia and general anesthesia on early postoperative outcomes after unilateral primary total knee replacement, 262 patients were randomly assigned to receive either epidural or general anesthesia. All patients received a common rehabilitation protocol including a standardized assessment of progress. One hundred eighty-eight patients received a common thromboembolic prophylaxis protocol with postoperative aspirin, and had a standardized surveillance protocol to detect thromboembolic complications. Deep vein thrombosis was determined by venography on the operative limb, and pulmonary embolism was determined by comparison of preoperative and postoperative lung perfusion scans. The epidural anesthesia group reached all rehabilitative milestones earlier postoperatively than did the general anesthesia group, with a statistically significant earlier attainment of stair climbing. The incidence of deep vein thrombosis was 40% with epidural anesthesia, and 48% with general anesthesia. There were no clots proximal to the popliteal veins. The incidence of pulmonary embolism on lung scan was 12% with epidural anesthesia and 9% with general anesthesia. Epidural anesthesia is associated with more rapid achievement of postoperative in hospital rehabilitation goals after total knee replacement. A minor reduction in postoperative deep vein thrombosis rate was observed with epidural anesthesia, but this did not reach statistical significance. No difference in early postoperative pulmonary embolism was observed between the 2 types of anesthesia.

Aged↗
PubMed1993

Factors affecting deep vein thrombosis rate following total knee arthroplasty under epidural anesthesia.

A retrospective review was performed of 448 consecutive patients undergoing primary, unilateral, bicondylar, and cemented total knee arthroplasty under epidural anesthesia by three surgeons to determine factors contributing to deep vein thrombosis rate. All had venography on the fourth or fifth postoperative day and received aspirin and elastic stockings as their only thromboprophylaxis. The overall deep vein thrombosis rate was 41% (2% had proximal clots). The rate of deep vein thrombosis was not related to obesity, history of heart disease, hypertension, prior malignancy, smoking, diagnosis of osteoarthritis, duration of surgery, type of local anesthetic used, or the use of postoperative epidural analgesia. The rate of deep vein thrombosis varied significantly between surgeons: one surgeon had an overall deep vein thrombosis rate of 58% (proximal thrombi, 4%) whereas the other two surgeons had a deep vein thrombosis rate of 35% (proximal clot thrombi, 1%). A number of possible mechanisms to explain the variation in deep vein thrombosis rates between surgeons are provided.

Aged↗
PubMed1984

Failure of total condylar knee replacement. Correlation of radiographic, clinical, and surgical findings.

The authors reviewed 55 failed total condylar knee replacements, correlating the radiographic and surgical findings at removal or revision. Failure was due to infection in 20 cases, mechanical loosening in 18, instability without loosening in 10, malalignment without loosening in 4, a supracondylar fracture in 2, and unknown causes in 1. In infection with loosening or chronic infection, radiographs usually showed a wide, extensive radiolucent region at the cement-bone interface around one or more components without shifting, while in acute infection without loosening the radiographs were normal. In mechanical loosening, in addition to a similar lucent region, the prosthesis became tilted in 16 out of 18 cases. Most loosening involved tilting of the tibial component into the varus position with subsidence into the medial tibial plateau, collapse of the cancellous bone, and plastic deformation. Radiographs can be helpful in determining the reason for failure of a total knee replacement, which is important in planning surgery.

Adult↗
PubMed1982

Bone scanning for the evaluation of knee prosthesis.

Twenty-six knees were scanned after total replacement to evaluate the relationship between bone scan, pain, the presence of a radiolucent line at the bone-cement interface and loosening. A radiolucent line was often accompanied by an increased uptake over the affected condyle, but there was no significant relationship with pain or loosening.

Bone Cements↗
PubMed1981

Bone-block iliotibial-band transfer for anterior cruciate insufficiency.

The anterior distal part of the iliotibial trace with attached bone block from Gerdy's tubercle was used as an intra-articular graft fixed by a screw to the tibia to control anterior instability (otherwise known as anterior, anteromedial, or anterolateral laxity) in twenty-four knees which were followed for two to four years. Concomitant single-plane 2+ to 4+ medial instability was present in eleven knees and was treated in five of them by simple immobilization, by imbrication of the medial collateral ligament, or by the Vigliani procedure. At follow-up, stability was improved and the result was rated good or excellent in twenty-one (88 per cent) of the twenty-four knees. The operation is applicable to the majority of chronic laxities of the knee and, because no immobilization is necessary, the postoperative care is much simplified and the rehabilitation time is much shorter. The procedure is contraindicated where there is posterior or single-plane lateral laxity.

Adolescent↗
PubMed1980

Spontaneous osteonecrosis of the knee.

Spontaneous osteonecrosis was diagnosed in ninety knees in which a roentgenographically visible lesion had developed within six months after onset of symptoms. Scintimetry can be used to differentiate between osteonecrosis and other painful conditions of the knee. The prognosis of osteonecrosis is dependent on the size of the radiolucent lesion. In knees with a lesion that is larger than 2.3 square centimeters, osteoarthritis is likely to develop. For forty-two knees the patients were treated with analgesics, partial weight-bearing, and quadriceps exercises. Forty-eight knees were treated surgically. Indications for surgical treatment were persistent severe complaints in spite of conservative treatment and a large osteonecrotic lesion with collapse of the condyle resulting in a varus deformity. The best results were achieved with osteotomy together with arthrotomy, and by knee replacement arthroplasty. Arthrotomy and drilling alone were ineffective.

Adult↗
PubMed1980

Resurfacing of the patella.

The results of use of twenty-nine patellar resurfacing prostheses in twenty-eight patients were studied. The diagnosis was osteoarthritis in twenty-two knees, chondromalacia in five knees, and habitual dislocation with severe osteoarthritis in two. The follow-up time was from three to six years. A cemented chromium-cobalt prosthesis was used. Of the twenty-nine knees studied, two were rated excellent; fourteen, good; three, fair; and ten, poor. Failure was always due to unrelieved pain.

Adolescent↗
PubMed1980

A five to seven-year follow-up of unicondylar arthroplasty.

Thirty-two unicondylar knee replacements in thirty patients were done between 1972 and 1974. Ten patients were lost to follow-up because of death or other reasons. The remaining twenty-two knees (seventeen medial and five lateral compartments replaced) had a follow-up ranging from five to seven years, with an average of six years. Although the quality and result of these unicondylar arthroplasties were initially considered good, they have subsequently shown a marked deterioration. At the time of this report only one knee was rated as excellent; seven knees, as good; four knees, as fair; and ten knees, as poor. Seven knees (28 per cent) have been converted to a bicondylar prosthesis. The lateral replacements did much better than the medial replacements.

Aged↗
PubMed1979

The total condylar knee prosthesis. A report of two hundred and twenty cases.

The total condylar knee prosthesis is a non-hinged surface replacement which can be used for almost all knee deformities. This report discusses the first consecutive 220 arthroplasties in 183 patients. Follow-up time was three to five years. Before operation eighty-six knees had more than 10 degrees of fixed varus deformity and thirty-one knees had more than 10 degrees of fixed valgus deformity. All patients were assessed using The Hospital for Special Surgery scoring system. Of the total of 220 knees, 137 (62%) were rated excellent; sixty-one (28%), good; ten (4.5%), fair; and twelve (5.5%), poor. Of 139 osteoarthritic knees, 93% were rated excellent or good. Complications included three deep infections and four cases of posterior subluxation. The over-all reoperation rate was 3.6%.

Arthritis, Rheumatoid↗
PubMed1979

Proximal "tube" realignment of the patella for chondromalacia patellae.

In young people complaining of patellar pain there is often an anatomic basis (an increased quadriceps angle or a high-riding patella). Forty-eight knees with one or other of these abnormalities underwent proximal quadriceps realignment. The results were excellent or good in 94%. Shaving of chondromalacic cartilage was also done in 11 knees but did not seem to improve the results, and is not now recommended except for "blister" lesions. Extensor mechanism dysplasia is an etiologically correct name for the disorder and therefore preferable to "chondromalacia patellae."

Cartilage Diseases↗