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Biomedical subjects

J P Waddell

Publications and source records attributed to J P Waddell.

At least 19 recordsLinked to original sources
PubMed2001

Outcome of foot injuries in multiply injured patients.

In the past, foot injuries in patients with multiple trauma were thought to be of lesser importance than fractures of long bones. In one prospective study from the authors' institutions, however, multiple-trauma patients with foot injuries were shown to have a poorer functional outcome compared with matched controls. To address these concerns, this article has two parts. The first part is an overview of general principles in the treatment of foot injuries in polytrauma patients. The treatment of specific injuries is beyond the scope of this article, but an approach is highlighted that can be remembered when decisions are made regarding these severely injured patients. The second part reviews the findings from the authors' study, focusing on functional outcomes of multiple-trauma patients with foot injuries.

Calcaneus↗
PubMed2000

The effect of partial vs. full hydroxyapatite coating on periprosthetic bone quality around the canine madreporic femoral stem.

While hydroxyapatite coatings have been shown to enhance osseointegration of metal prostheses, the optimal extent of the coating over the femoral stem component remains unclear. In this study, we investigated the effect of the application of hydroxyapatite to the proximal half of the femoral stem vs. full hydroxyapatite coating on the madreporic-surfaced femoral stems in a canine model over time. Total hip arthroplasties were performed on 22 dogs. Fifteen had half-HA coated stems, and seven had fully HA coated stems. The dogs were followed for 3 weeks, 3 months, or 1 year postoperatively. Micromotion near the femoral component was assessed at three levels along the medial aspect of the stems. Percent bone apposition, trabecular strut width, connectivity index, and cortical porosity measurements were performed at five levels and in four quadrants about the femoral stems. Micromotion was greater adjacent to the half-coated stems at 3 weeks postoperatively only. There was a trend to decreased micromotion from proximal to distal in both stem types. Both designs fixed proximally and tended to load share laterally more than in the other three quadrants. Fully HA coated stems induced greater percent bone apposition, wider trabecular struts, and more connectivity compared to half-HA coated stems.

Animals↗
PubMed2000

The reliability and validity of the self-reported patient-specific index for total hip arthroplasty.

BACKGROUND: The Patient-Specific Index is unique in that it reflects how individual patients weigh concerns in rating the outcome of total hip arthroplasty. The Patient-Specific Index was originally administered by an interviewer, which is not always feasible and can be costly. The purposes of the present study were (1) to create a self-reported version of the Patient-Specific Index, (2) to determine the reliability of this new self-reported version, and (3) to determine the relationship between the scores on the new self-reported version and those on the original interviewer-administered version. METHODS: A self-reported version of the Patient-Specific Index was developed, and a pilot test was performed on ten patients. Patients who were scheduled for a total hip arthroplasty or who had recently had a total hip arthroplasty were eligible for the reliability and validity testing. A copy of the new self-reported Patient-Specific Index was mailed to the patients, and they completed it independently. The patients' ratings of the importance and severity of twenty-four concerns prior to total hip arthroplasty were added together to create a summary Patient-Specific Index score. To determine test-retest reliability, patients completed the self-reported Patient-Specific Index a second time, two weeks later. To determine criterion validity, participants also completed the interviewer-administered Patient-Specific Index. RESULTS: Fifty-five patients completed the study. The random-effects intraclass correlation test-retest coefficient was 0.79 (greater than 0.75 represents excellent reliability). The mean Patient-Specific Index scores on the self-reported version and on the interviewer-administered version were 173 and 165 points, respectively (Student t test, p = 0.45). The self-reported Patient-Specific Index was concordant with the interviewer-administered Patient-Specific Index (intraclass correlation coefficient, 0.78). CONCLUSIONS: We concluded that a self-reported version of the Patient-Specific Index, which focuses on the concerns of individuals, is reliable and has criterion validity compared with an interviewer-administered version.

Activities of Daily Living↗
PubMed2000

Acetabular blood flow during total hip arthroplasty.

OBJECTIVE: To determine the immediate effect of reaming and insertion of the acetabular component with and without cement on peri-acetabular blood flow during primary total hip arthroplasty (THA). DESIGN: A clinical experimental study. SETTING: A tertiary referral and teaching hospital in Toronto. PATIENTS: Sixteen patients (9 men, 7 women) ranging in age from 30 to 78 years and suffering from arthritis. INTERVENTION: Elective primary THA with a cemented (8 patients) and non-cemented (8 patients) acetabular component. All procedures were done by a single surgeon who used a posterior approach. MAIN OUTCOME MEASURE: Acetabular bone blood-flow measurements made with a laser Doppler flowmeter before reaming, after reaming and after insertion of the acetabular prosthesis. RESULTS: Acetabular blood flow after prosthesis insertion was decreased by 52% in the non-cemented group (p < 0.001) and 59% in the cemented group (p < 0.001) compared with baseline (pre-reaming) values. CONCLUSION: The significance of these changes in peri-acetabular bone blood flow during THA may relate to the extent of bony ingrowth, peri-prosthetic remodelling and ultimately the incidence of implant failure because of aseptic loosening.

Acetabulum↗
PubMed2000

Cementless acetabular revision arthroplasty.

OBJECTIVE: To evaluate the effects of clinical factors on outcome after acetabular revision with a cementless beaded cup. DESIGN: Retrospective case series. SETTING: Tertiary care referral centre. PATIENTS: Forty-one patients who underwent acetabular revision with a cementless cup were followed up for a mean of 3.4 years. INTERVENTIONS: Acetabular revision with a beaded cementless cup in all patients. A morcellized allograft was used in 10 patients. OUTCOME MEASURES: A modified Harris hip score (range of motion measurement omitted), the SF-36 health survey, and the Western Ontario McMaster (WOMAC) osteoarthritis index. Multivariate analysis was used to evaluate the effects of age, gender, morcellized allografting, time to revision from the previous operation, acetabular screw fixation and concurrent femoral revision on outcome. RESULTS: Gender accounted for a significant portion of the variation seen in the SF-36 physical component scores (r = 0.36, p = 0.02), with women tending to have worse results. Increasing age was associated with lower WOMAC index function scores (r = 0.36, p = 0.03), whereas concurrent femoral revision tended to have a positive effect on WOMAC index function (r = 0.39, p = 0.01). None of the potential clinical predictors had any significant effect on the SF-36 mental component scores, or WOMAC index pain and stiffness scores. CONCLUSIONS: In cementless acetabular revision arthroplasty, physical function, as measured by generic and limb-specific scales, may be affected by gender, age and the presence of a concurrent femoral revision. Time to revision from the previous operation, morcellized allografting and screw fixation of the acetabulum did not affect outcomes. This information may provide some prognostic value for patients' expectations.

Acetabulum↗
PubMed2000

Functional outcome after acetabular revision with roof reinforcement rings.

OBJECTIVE: To evaluate the role for potential predictors of functional outcome after acetabular arthroplasty and to assess the results of revision with the use of a roof reinforcement ring. DESIGN: A retrospective case series. SETTING: A tertiary-care referral centre. PATIENTS: Twenty-four patients (average age 72.7 years) who had undergone acetabular revision with a roof reinforcement ring were followed up for an average of 2.8 years. INTERVENTIONS: Revision acetabular arthroplasty was performed using either the Mueller or Burch Schneider roof reinforcement ring, bone grafting and a cemented polyethylene cup. OUTCOME MEASURES: A modified Harris hip score (range of motion omitted), the SF-36 health survey and the Western Ontario McMaster (WOMAC) osteoarthritis index measured outcome. Multivariate analysis was used to determine the effects of certain clinical factors (age, sex, time to revision from previous hip operation and number of previous revisions) on outcome. RESULTS: Patients reported disability both on hip-specific and general health measures. The time to revision from previous operation positively correlated with SF-36 mental component scores (p = 0.003), WOMAC function (p = 0.04) and WOMAC pain (p = 0.03). Age, gender and number of past revisions did not affect outcome. CONCLUSIONS: Patients who undergo acetabular revision with a roof ring will continue to have some disability in the first 3 years after the procedure. A greater time between the previous operation and the revision operation is associated with a better outcome. Patients' expectations of postoperative results should be realistic in the face of a challenging reconstructive procedure.

Acetabulum↗
PubMed2000

Blood flow changes to the proximal femur during total hip arthroplasty.

OBJECTIVE: To determine the changes in perfusion to the proximal femur that occur during cemented and uncemented total hip arthroplasty (THA). DESIGN: Case series. SETTING: A single tertiary-care centre. PATIENTS: Twenty-two consecutive patients. Those who had undergone previous hip surgery or received systemic corticosteroid therapy were excluded. INTERVENTION: Cemented (11 procedures) or uncemented (12 procedures) THA. MAIN OUTCOME MEASURE: Changes in blood flow at the level of the proximal femur, measured with laser Doppler flowmetry at 4 different times during THA. RESULTS: In both the cemented and the uncemented procedure overall proximal femoral blood flow was reduced (p = 0.002, p = 0.008, respectively). A greater reduction in overall proximal femoral perfusion was seen in the cemented group compared with the uncemented group (p = 0.004). This greater reduction in perfusion was seen primarily in the proximal femoral diaphysis (p = 0.004). CONCLUSION: The extensive canal preparation involved with the cemented procedure or the introduction of bone cement under pressure into the femoral canal may contribute to the greater reduction in perfusion to the proximal femur.

Adult↗
PubMed1999

Do foot injuries significantly affect the functional outcome of multiply injured patients?

OBJECTIVE: To assess the functional outcome of multiply injured trauma patients with foot injuries and to determine which outcome measures are most appropriate for this assessment. DESIGN: Prospective, matched pair analysis. SETTING: University-affiliated Level I trauma center with a prospectively entered trauma database. PATIENTS: Twenty-eight multiply injured patients with foot injuries were randomly identified in our prospective trauma database (Group 1). The patients in Group 1 were randomly matched in a blinded fashion to twenty-eight multiply injured patients without foot injuries who were selected from the entire group of patients in our trauma database (Group 2). The patients were matched by age, sex, length of follow-up, and Injury Severity Score. MAIN OUTCOME MEASURES: Three outcome tools were used: the Short Form 36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the modified Boston Children's Hospital Grading System. RESULTS: The outcome of multiply injured patients with foot injuries was significantly worse than that of patients without foot injuries when using any of the three outcome measures (SF-36, p = 0.008; WOMAC, p = 0.00007; modified Boston Children's score, p = 0.001). The outcome of patients with foot injuries was worse than that of those without foot injuries in five of the eight components of the SF-36 score (physical functioning, p = 0.0004; role physical, p = 0.01; bodily pain, p = 0.01; social functioning, p = 0.01; role emotional, p = 0.006). The outcome of patients with foot injuries was worse than that of patients without foot injuries in all three components of the WOMAC (pain score, p = 0.0004; stiffness score, p = 0.007; physical function score, p = 0.00006). For the patients with foot injuries, there was strong correlation across all three scales (SF-36 vs. WOMAC, r = 0.84; SF-36 vs. modified Boston Children's Hospital, r = 0.88; WOMAC vs. modified Boston Children's Hospital, r = 0.78). CONCLUSIONS: The SF-36, WOMAC, and modified Boston Children's Hospital Grading System are all useful in assessing the outcome of multiply injured patients with foot injuries. The outcome of these patients is poor when using any of these measures. Foot injuries cause significant disability to multiply injured patients. More attention should be given to these injuries, and more aggressive management should be considered to improve the outcome of this group of multiply injured patients.

Adolescent↗
PubMed1999

Ogilvie's syndrome after lower extremity arthroplasty.

OBJECTIVE: To alert surgeons who perform arthroplasty to the possibility of acute colonic pseudo-obstruction (Ogilvie's syndrome) after elective orthopedic procedures. To identify possible risk factors and emphasize the need for prompt recognition, careful monitoring and appropriate management so as to reduce morbidity and mortality. DESIGN: A case series. SETTING: A university-affiliated hospital that is a major referral centre for orthopedic surgery. PATIENTS: Four patients who had Ogilvie's syndrome after lower extremity arthroplasty. Of this group, 2 had primary hip arthroplasty, 1 had primary knee arthroplasty and 1 had revision hip arthroplasty. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: In all 4 patients Ogilvie's syndrome was recognized late and required surgical intervention. Two patients died as a result of postoperative complications. CONCLUSIONS: Our case series identified increasing age, immobility and patient-controlled narcotic analgesia as potential risk factors for Ogilvie's syndrome in the postoperative orthopedic patient. Prompt recognition and early consultation with frequent clinical and radiographic monitoring are necessary to avoid colonic perforation and its significant associated death rate.

Aged↗
PubMed1999

Greater trochanteric blood flow during total hip arthroplasty using a posterior approach.

The authors investigated the effect of a posterior surgical approach on the local femoral blood supply during primary total hip arthroplasty. Greater trochanteric blood flow measurements were made with a laser Doppler flowmeter at intervals during the performance of eight uncemented and nine cemented total hip arthroplasties. Complete detachment of the quadratus femoris was associated with a significant decrease in trochanteric blood flow in the uncemented and cemented groups. The lowest perfusion levels during the procedure were seen transiently with posterior dislocation of the femoral head, after which trochanteric perfusion was decreased by 66% in the uncemented group, and 61% in the cemented group compared with baseline values. Blood flow remained approximately half of baseline values after insertion of the femoral prosthesis in the uncemented and cemented groups. These changes in greater trochanteric blood flow may serve as a marker for reduction in proximal femoral blood flow during total hip arthroplasty, and subsequently relate to the extent of bony ingrowth, periprosthetic bone loss, and ultimately the incidence of implant failure caused by aseptic loosening.

Adult↗
PubMed1999

Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status.

OBJECTIVE: To evaluate the limb-specific outcome and general health status of patients with osteonecrosis of the femoral head treated with vascularized fibular grafting. DESIGN: A retrospective review. SETTING: A single tertiary care centre. PATIENTS: Fifty-five consecutive patients with osteonecrosis of the femoral head who underwent fibular grafting (8 bilaterally). INTERVENTION: Vascularized fibular grafting. OUTCOME MEASURES: Limb-specific scores (Harris Hip Score, St. Michael's Hospital Hip Score), general health status (Nottingham Health Profile, SF-36 health status survey) and radiographic outcome measures (Steinberg stage). RESULTS: Patients were young (mean age 34 years, range from 18 to 52 years) and 80% had advanced osteonecrosis (Steinberg stages IV and V). Fifty-nine hips were followed up for an average of 50 months (range from 24 to 117 months) after vascularized fibular grafting. Sixteen hips (27%) were converted to total hip arthroplasty (THA). To date, 73% of hips treated with vascularized fibular grafting have required no further surgery. Preoperative and postoperative Harris Hip Scores were 57.3 and 83.6 respectively (p < 0.001). As measured by patient-oriented health status questionnaires (SF-36, Nottingham Health Profile) and compared with population controls, patients had normal mental health scores and only slight decreases in physical component scores. CONCLUSIONS: Free vascularized fibular grafting for osteonecrosis of the femoral head provides satisfactory pain relief, functional improvement and general health status and halts the progression of symptomatic disease.

Adolescent↗