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Biomedical subjects

J J Callaghan

Publications and source records attributed to J J Callaghan.

At least 37 records · Page 2Linked to original sources
PubMed2000

Cemented rotating-platform total knee replacement. A nine to twelve-year follow-up study.

BACKGROUND: Although the LCS (low contact stress) rotating-platform mobile-bearing knee replacement has been used extensively, there have been few intermediate or long-term clinical and radiographic follow-up studies evaluating the device. The purpose of this study was to report the nine to twelve-year results of a consecutive series of patients who had a primary total knee replacement performed with this device. METHODS: Between November 1985 and November 1988, the senior author (R. C. J.) performed 119 consecutive total knee arthroplasties in eighty-six patients with LCS rotating-platform femoral and tibial components and a Townley all-polyethylene dome patellar component. All components were fixed with cement. The average age of the patients at the time of the operation was seventy years (range, thirty-seven to eighty-eight years). Fifty-two patients (seventy-six knees) were female, and thirty-four patients (forty-three knees) were male. The patients were evaluated with clinical knee ratings and radiographic analysis nine to twelve years following the knee replacement. RESULTS: At the time of the nine to twelve-year follow-up, sixty-four patients (eighty-six knees) were alive, eighteen patients (twenty-eight knees) had died, and four patients (five knees) had been lost to follow-up. Of the 114 knees in the eighty-two patients for whom the final outcome was known, none required a reoperation and none had a dislocation of the mobile-bearing prosthesis. For the forty-five patients (sixty-six knees) who returned for final clinical and radiographic follow-up examinations at nine to twelve years, the average clinical and functional Knee Society ratings were 30 points (range, 2 to 70 points) and 44 points (range, 0 to 80 points) preoperatively and 90 points (range, 63 to 102 points) and 75 points (range, 30 to 100 points) at the final follow-up evaluation. The average Hospital for Special Surgery knee rating was 57 points (range, 28 to 80 points) preoperatively and 84 points (range, 59 to 97 points) at the final follow-up evaluation. The average active range of knee flexion was from 0 degrees (range, 0 to 10 degrees) to 102 degrees (range, 15 to 120 degrees) at the final follow-up evaluation. Seven of the sixty-six knees were painful anteriorly. There was no periprosthetic osteolysis and no evidence of loosening on follow-up radiographs. CONCLUSIONS: After nine to twelve years of follow-up, the cemented LCS rotating-platform knee replacement was found to be performing well, with durable clinical and radiographic results.

Adult↗
PubMed1999

Periprosthetic fractures of the acetabulum.

Periprosthetic acetabular fractures during and after total hip replacement occur infrequently. Intraoperative fractures have risen with the use of press fit cementless fixation techniques and postoperative fractures are increasing because of the long-term problems associated with osteolysis. This article outlines the classification and management of these fractures.

Acetabulum↗
PubMed1999

Acetabular fracture associated with cementless acetabular component insertion: a report of 13 cases.

Acetabular fracture during insertion of a cementless acetabular component occurred in 13 patients. The preoperative diagnosis was osteoarthritis in 6 patients, rheumatoid arthritis in 2 patients, avascular necrosis in 3 patients, hip fracture nonunion in 1 patient, and developmental dysplasia of the hip in 1 patient. Several different components were used; however, the acetabulum was underreamed by 1 to 3 mm in all cases. The acetabular fracture was identified in 9 of 13 cases intraoperatively. The fracture was identified on postoperative radiographs for the other 4 cases. Fractures were treated by a variety of means, including the addition of augmentation screws in or around the cup, use of autograft bone at the fracture site, modified postoperative weight-bearing status, and immobilization. In 2 cases, the socket needed to be revised after it progressively migrated and failed. One patient had cup migration, and another had a radiolucent line about the cup but was not symptomatic enough to require revision. In 3 of these 4 cases, the fracture was not identified intraoperatively. Underreaming of the acetabulum and use of an oversized acetabular component has been recommended to improve the initial stability of the acetabular component during total hip arthroplasty. Impaction of an oversized component requires bone to undergo plastic deformation if the cup is to be fully seated. Theoretically, this technique provides improved component stability with enhanced osseous ingrowth into the cup. The 13 cases reported in this study demonstrate that acetabular fracture is a complication that may occur in association with uncemented hip arthroplasty, particularly if oversized components are used. The importance of recognizing acetabular fractures intraoperatively and the need to institute appropriate treatment to ensure a stable acetabular component is emphasized. In patients with osteoporotic bone, line-to-line reaming with use of a cementless acetabular component or insertion of a cemented socket may be considered to avoid this significant complication.

Acetabulum↗
PubMed1999

The John Charnley Award. Practice surveillance: a practical method to assess outcome and to perform clinical research.

The senior author systematically began collecting preoperative and postoperative data on all the total hip arthroplasties he performed starting in July 1970. The data collected represent a 26-year experience using practice surveillance (preoperative and regular interval postoperative collection and analysis of outcomes) as a method to document the outcome of the total hip arthroplasty procedure and as a method to evaluate the need for changes in the procedure. As the senior author made few selected changes in the operative procedure during the followup period, the primary author has been able to evaluate the change in outcome based on these changes. The six studies reported in the current study show the durability of the long-term results of cemented total hip arthroplasty, the improvement in radiographic reproducibility obtained on the femoral side of the construct with improved cementing techniques, the deleterious effects of using cable to reattach the greater trochanter, the deleterious effects of changing femoral component design that included a change in surface finish, the improvement in acetabular fixation using cementless fixation, and the optimization of bearing surface wear using smaller diameter femoral heads. All of these findings have been incorporated into the primary surgeon's practice based on this practice surveillance. As shown, practice surveillance also has provided a tool for performing clinical research. Although practice surveillance of controlled cohorts never will supplant prospective randomized clinical trials in evidence based medicine, it should help each surgeon with his or her own practice and can be used as an important research tool to study the optimization of outcomes of a surgical procedure.

Adult↗
PubMed1999

One-stage revision surgery of the infected hip. A minimum 10-year followup study.

Between 1977 and 1983, 24 one-stage revision surgeries were performed for septic failure of a total hip arthroplasty in 24 patients by one surgeon. Twelve patients died and none were lost to followup at a minimum of 10 years after the procedure. Infection reoccurred around two hips (8.3%). If the selected criteria (patients without draining sinuses, without immunocompromise, and with adequate bone quality after debridement) and the standard approach (meticulous debridement, use of antibiotic-impregnated cement, and use of 3 to 6 months postoperative oral antibiotic therapy) used in this study are implemented, direct exchange of an infected total hip arthroplasty construct is a reasonable and cost-effective alternative for some patients with infection after total hip arthroplasty.

Adult↗
PubMed1999

An analysis of blood management in patients having a total hip or knee arthroplasty.

Three hundred and thirty orthopaedic surgeons in the United States participated in a study of transfusion requirements associated with total joint arthroplasty. A total of 9482 patients (3920 patients who had a total hip replacement and 5562 patients who had a total knee replacement) were evaluated prospectively from September 1996 through June 1997. Of those patients, 4409 (46 percent [57 percent of the patients who had a hip replacement and 39 percent of the patients who had a knee replacement]) had a blood transfusion. Two thousand eight hundred and ninety patients (66 percent) received autologous blood, and 1519 patients (34 percent) received allogenic blood. Ordered logistic regression analysis showed the most important predictors of the transfusion of allogenic blood to be a low baseline hemoglobin level and a lack of predonated autologous blood. Preoperative donation of autologous blood decreases the risk of transfusion of allogenic blood; however, inefficiencies in the procedures for obtaining autologous blood were identified. Sixty-one percent (5741) of the patients had predonated blood for autologous transfusion, but 4464 (45 percent) of the 9920 units of the predonated autologous blood were not used. Primary procedures and revision total knee arthroplasty were associated with the greatest number of wasted autologous units. Of the 5741 patients who had predonated blood, 503 (9 percent) needed a transfusion of allogenic blood. The frequency of allogenic blood transfusion varied with respect to the type of operative procedure (revision total hip arthroplasty and bilateral total knee arthroplasty were associated with the highest prevalence of such transfusions) and with a baseline hemoglobin level of 130 grams per liter or less. Transfusion of allogenic blood was also associated with infection (p < or = 0.001), fluid overload (p < or = 0.001), and increased duration of hospitalization (p < or = 0.01). These latter findings warrant further evaluation in controlled studies.

Aged↗
PubMed1999

The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up.

One hundred consecutive primary total hip arthroplasties performed with use of a porous-coated anatomic total hip prosthesis, fixed without cement, in ninety-one patients were followed prospectively for a minimum of ten years. At the time of the most recent follow-up, twenty patients (twenty-three hips) had died and seventy-one patients (seventy-seven hips) were living. The average age of the living patients was sixty-six years (range, thirty-two to ninety-two years), and their average Harris hip score was 84 points (range, 33 to 100 points). Twelve percent (nine) of the seventy-seven hips were found to be associated with pain in the thigh when the patients were specifically questioned by the examiner. Eleven hips were revised during the follow-up period. Only the acetabular component was revised in six hips, only the femoral component was revised in one hip, and both the femoral and the acetabular components were revised in four hips. Of the ten acetabular revisions, one was performed because of acute dissociation of the component and eight, because of a combination of polyethylene wear, osteolysis, and loosening; the tenth acetabular revision consisted of exchange of the liner and curettage and bone-grafting of the osteolytic area. Of the five femoral revisions, two were performed because of loosening and three, because of extensive osteolysis of the proximal aspect of the femur. Including the revised components, twelve acetabular components and five femoral components had radiographic evidence of aseptic loosening. Acetabular osteolysis occurred in seventeen hips. Femoral osteolysis occurred in thirty-nine hips: in the proximal aspect of thirty-one hips, in the distal aspect of four, and in both the proximal and the distal aspect of four. The durability of the femoral fixation documented in this study is especially encouraging in view of the fact that this was our initial experience with devices fixed without cement and that a so-called first-generation femoral component was used. However, the study also demonstrated that not all acetabular components fixed without cement function well over the long term and that specific design considerations (adequate initial fixation, congruency between the liner and the shell, an optimum shell-liner capturing mechanism, and a smaller femoral head) are warranted.

Aged↗
PubMed1999

The effects of surface roughness and polymethylmethacrylate precoating on the radiographic and clinical results of the Iowa hip prosthesis. A study of patients less than fifty years old.

BACKGROUND: The purpose of the present study was to compare the results associated with two different surface finishes (bead-blasted and grit-blasted) for Iowa femoral components used in total hip arthroplasties performed between January 1979 and June 1991 in patients who were less than fifty years old. METHODS: Between January 1979 and December 1985, thirty-six primary total hip replacements were performed in twenty-five patients with insertion of a bead-blasted Iowa femoral component (average surface roughness, 0.8 micrometer) with cement and insertion of a titanium-backed acetabular component (thirty-five hips) or non-metal-backed acetabular component (one hip) with cement. Between January 1986 and June 1991, forty-five primary total hip replacements were performed in thirty-seven patients with use of a precoated grit-blasted Iowa femoral component (average surface roughness, 2.1 micrometers) and a Harris-Galante-I porous ingrowth acetabular component (forty-one hips) or an Osteonics component (four hips). The only change in the design of the femoral component (other than the surface finish) between the two consecutive series was the addition of polymethylmethacrylate precoating to the proximal third of all forty-five grit-blasted stems and modularity of the femoral head of the last eight grit-blasted stems. RESULTS: No hip was lost to follow-up. The duration of radiographic follow-up of the hips treated with the bead-blasted component averaged 11.3 years (range, ten to sixteen years) postoperatively, whereas that of the hips treated with the precoated grit-blasted component averaged 8.2 years (range, five to eleven years). Two (6 percent) of the bead-blasted femoral components were revised because of aseptic loosening compared with eight (18 percent) of the precoated grit-blasted components. Four bead-blasted components (11 percent) were either radiographically loose or were revised because of loosening compared with eleven precoated grit-blasted components (24 percent). Kaplan-Meier survivorship curves evaluated with log-rank analysis revealed that the bead-blasted Iowa femoral components were revised because of aseptic loosening (p = 0.0184) and were radiographically loose (p = 0.0068) less often than the precoated grit-blasted Iowa femoral components. CONCLUSIONS: The findings of the present study have led the senior ones of us to resume using femoral components with a polished surface and fixed with cement.

Adolescent↗
PubMed1999

Unicompartmental knee replacement. A minimum 15 year followup study.

One hundred forty Marmor cemented unicompartmental knee replacements were inserted in 103 patients between 1975 and 1982. Fifty-two patients were women and 51 were men. One hundred twenty-five were medial compartment knee replacements and 15 were lateral knee replacements. At minimum 15 year followup 34 patients with 48 knee replacements were living; only four patients with four knee replacements were lost to followup. Average preoperative and final followup Hospital for Special Surgery knee scores were 57 and 82 points, respectively for the knees of living patients. Average preoperative and final followup Knee Society clinical and Knee Society functional scores were 31 and 42, and 85 and 71 points, respectively. For all knees, 10.2% (14 knees) were revised [4.4% (six knees) for tibial loosening, 5.1% (seven knees) for disease progression, and .7% (one knee) for pain]. For patients living 15 years, 12.5% (six knees) were revised [2.1% (one knee) for tibial loosening, and 10.4% (five knees) for disease progression]. Revision for failure of fixation of these unicompartmental replacements was comparable with that reported for fixed bearing total knee replacement. Disease progression (46%; 62 of 136 knees) and tibial subsidence with wear (10.4%; 15 of 136 knees, five of which required revision) were the major long term problems in this group of patients.

Activities of Daily Living↗
PubMed1999

Posterior cruciate ligament function following total knee arthroplasty: the effect of joint line elevation.

One of the most commonly cited reasons for retaining the posterior cruciate ligament (PCL) during total knee arthroplasty is to preserve femoral rollback and theoretically improve extensor mechanism efficiency (lengthening the moment arm). This study was undertaken to assess PCL function in this regard and to delineate the effects of joint line elevation that can be manipulated intraoperatively by the surgeon. The anterior movement of tibiofemoral contact following PCL resection at flexion angles 60 degrees demonstrated the beneficial effect of the PCL on extensor function. This anterior translation and the concomitant increases in quadriceps tendon load and patellofemoral contact pressures were consistently observed. This study demonstrated that small changes of the joint line position significantly influenced PCL strain and knee kinematics. In order to preserve the desired functions that would be lost with an overly lax PCL and to avoid the potential adverse effects of an overly tight PCL (posterior edge loading and increased tibiofemoral contact), the surgeon should make every effort to restore the preoperative joint line. If this is not possible, consideration should be given to posterior cruciate recession or use of a posterior cruciate substituting design.

Adult↗
PubMed1999

Subchondral metastasis: report of five cases.

Subchondral metastasis is a rare occurrence and poses a diagnostic dilemma as initial films may show a lytic lesion in the subchondral region often misinterpreted as being benign. We present five cases of subchondral metastasis as well as a review of the literature. In our cases, we present subchondral metastasis in the elbow, shoulder, and hip joints. All patients had pain over the affected joint and most presented with a lytic lesion in the subchondral bone. Three patients have died since presentation and two are doing well at last follow up visit. Subchondral metastasis is a rare entity, but it should be included in the differential of a lytic lesion in the subchondral bone.

Aged↗
PubMed1998

Prediction of long-term polyethylene wear in total hip arthroplasty, based on early wear measurements made using digital image analysis.

The capability to reliably predict long-term in vivo wear of polyethylene would be of great value for the early identification of problematic total hip designs. Formal quantitative estimates of long-term polyethylene wear were made from a series of 197 patients who had a total hip arthroplasty and who were followed for a minimum of 10 years; the estimates were based on the wear that was apparent radiographically at nominally 2 years after the operation. A newly developed digital image-analysis edge-detection procedure was applied to 1,237 archived follow-up radiographs. The edge-detection measurements were analyzed with a robust regression random-coefficients statistical formulation developed especially to address the distributions of wear rate observed across this population over time. Formal regression equations were reported, which can be used to estimate late-wear depth for a patient radiographed at a 2-year follow-up visit. Series wide, the correlation between predicted and observed wear depths was 0.73 at 4 years, with a correlation decline of approximately 0.03 per additional year.

Aged↗
PubMed1998

Hybrid total hip arthroplasty in patients under the age of fifty: a five- to ten-year follow-up.

In 37 patients, 45 total hip replacements were performed using contemporary cementing techniques, an uncemented Harris-Galante I acetabular component and a cemented precoated Iowa femoral component in patients under the age of 50 at the time of their surgery; 36 patients with 43 hybrid hips were living, 1 patient with 2 hybrid hips was decreased. No patients were lost to follow-up. At 5- to 10-year follow-up, eight hips were revised for aseptic loosening. No acetabular components, and eight femoral components (18%) were revised for aseptic loosening. When looking at radiographic results, including revision as well as those components that were probably or definitely loose on radiographs, 0 acetabular components and 11 femoral components (24%) were radiographically loose. These results demonstrate the excellent durability of the uncemented Harris-Galante acetabular component in the younger patient. However, the Iowa grit-blasted methyl methacrylate precoated femoral component had a magnitude increase in the prevalence of revision for aseptic femoral loosening when compared to the senior author's long-term Charnley results in this age group. The authors attribute the failure to the rough surface finish applied to the femoral component. However, the polymethyl methacrylate proximal precoating and the femoral component design may also contribute to the femoral failures.

Adult↗