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Biomedical subjects

J R Lieberman

Publications and source records attributed to J R Lieberman.

At least 55 records · Page 3Linked to original sources
PubMed1995

Intraoperative complications during total hip arthroplasty.

Total hip replacement is one of the most common adult reconstructive procedures performed today. Even though training in total hip replacement has become fairly common in many orthopedic residency programs, complications can still occur during surgery. Preoperative planning and close attention to detail may prevent intraoperative problems. Awareness of the potential downfalls allows the surgeon to properly prepare for surgery, avoid intraoperative complications, and manage unavoidable problems when they do arise.

Acetabulum↗
PubMed1995

Complications of femoral and acetabular modularity.

The versatility of modular total hip arthroplasties have rapidly extended their applications. However, these new interfaces can lead to complications that were not observed with monolithic components. These problems have been noted with modular femoral and acetabular components and have been associated with the generation of particulate debris. This article reviews the authors' clinical observations and histologic, biomechanic, and spectophotometric evaluations of modular total hip arthroplasties. New data comparing both synovial fluid metal levels in well-fixed and loose monolithic and modular prosthetic hip implants are presented. In modular total hip components, synovial fluid cobalt levels correlated positively with patient weight and length of implantation. The generation of particulate debris in modular total hip components may induce periprosthetic osteolysis. Taper locks for femoral components and locking mechanisms for the polyethylene liner and metallic cup must be designed to avoid the production of particulate debris.

Acetabulum↗
PubMed1995

Single plane and biplane external fixators for knee arthrodesis.

Thirty-six knee arthrodeses performed using an external fixator with an average followup of 48 months were reviewed retrospectively. A single plane fixator was used in 19 cases and a biplane fixator in 17 cases. The reasons for fusion included an infected total knee arthroplasty (21 cases), aseptic loosening of a total knee arthroplasty (9 cases), posttraumatic osteoarthritis (3 cases), and a neuropathic joint, an infected unicondylar knee arthroplasty, and a tuberculous joint (1 case each). A fusion was obtained after the initial procedure in 22 patients (61%). With additional procedures, a fusion was obtained eventually in 27 patients (75%). The fusion rate decreased with an increasing number of prior knee procedures. Single and biplane external fixator designs had similar initial fusion rates (single 58%, biplane 65%). Complications included 14 nonunions (5 fused with additional procedures), 6 pin tract infections, 5 delayed unions, 1 stress fracture through a pin site, and 1 persistent infection resulting in an above-knee amputation. Despite biomechanical advances in external fixator design, knee arthrodesis remains difficult to achieve in patients who have had multiple previous procedures, a failed total knee arthroplasty, or an infected total knee arthroplasty with significant bone loss.

Adult↗
PubMed1995

Perioperative aspects of hip fracture. Guidelines for intervention that will impact prevalence and outcome.

The cost of treating osteoporosis-related diagnoses, over one half of which are hip fractures, is $5.2 billion per year. The incidence of hip fractures is rising, and it is the orthopedic surgeon who provides the definitive medical care to these patients. Factors associated with poor outcome in hip fractures include poor nutrition, impaired mental ability and mobility, age, male sex, and inadequate fluid resuscitation and medical stabilization prior to surgery. The energy requirements for fracturing the hip are low. Potential prophylactic interventions include fall prevention, hip protector devices, estrogen replacement therapy, and calcium and vitamin D supplementation.

Accidental Falls↗
PubMed1994

The prevalence of deep venous thrombosis after total hip arthroplasty with hypotensive epidural anesthesia.

A prospective, randomized trial was done to evaluate the prevalence of deep venous thrombosis following primary unilateral or bilateral total hip arthroplasty with use of hypotensive epidural anesthesia, external pneumatic-compression boots, and aspirin (Group I) and with use of hypotensive epidural anesthesia and aspirin (Group II). All operations were performed by two of us (E. A. S. and T. P. S.) through a posterolateral approach. Two hundred and thirty-one patients who were more than thirty-nine years old and who had a total of 250 primary total hip arthroplasties were included in the study. There were 113 patients (124 hips) in Group I and 118 patients (126 hips) in Group II. All patients had venography on the sixth, seventh, or eighth postoperative day. Group I had no proximal thrombi, seven distal thrombi (6 per cent), and one late pulmonary embolus (1 per cent). Group II had one proximal thrombus (popliteal) (1 per cent), eight distal thrombi (6 per cent), and one late pulmonary embolus (1 per cent). The difference was not significant (p = 0.65). However, a significant difference may have been noted if the study population had been larger. The combination of hypotensive epidural anesthesia and aspirin is effective prophylaxis against deep venous thrombosis in patients who have a primary total hip arthroplasty. The extremely low rate of deep venous thrombosis in the present study may be attributed to the use of hypotensive epidural anesthesia and the associated decrease in blood loss and transfusion requirements.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Inter- and intraobserver variation in staging patients with proven avascular necrosis of the hip.

Diagnosis and treatment of avascular necrosis of the hip has long been predicated on the evaluation of plain radiographs, though other modalities (such as magnetic resonance imaging) are being increasingly used to aid in this evaluation. The Ficat classification is commonly used to assess plain radiographs and to help determine what treatment is appropriate for a given patient. It also is used to help evaluate patient outcome after surgical or nonsurgical treatment. This study was designed to evaluate the adequacy of plain radiographs in the evaluation of avascular necrosis of the hip. The plain radiographs of 25 hips with avascular necrosis were analyzed on 3 occasions by 6 readers (450 total readings). A clinically significant difference in radiographic staging was defined as a Stage I or II reading of the radiographs of a given hip on 1 reading and a separate reading of the same radiographs as Stage III or IV. By this definition, interobserver variability for the first reading resulted in clinically significant differences in 10 (40%) of the 25 hips. Intraobserver variability resulted in clinically significant differences for 10 (40%) of the 25 hips as well. The most experienced readers in the study (a total joint specialist and a musculoskeletal radiologist) were consistent internally in their readings in 90% of cases, and had a clinically significant difference in only 1 case (1%); however, these same 2 readers disagreed with one another on the staging of 9 (36%) of 25 hips, with 4 (16%) of 25 hips having a clinically significant difference in readings.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1994

Polyethylene and metal debris generated by non-articulating surfaces of modular acetabular components.

We report a prospective study of the liner-metal interfaces of modular uncemented acetabular components as sources of debris. We collected the pseudomembrane from the screw-cup junction and the empty screw holes of the metal backing of 19 acetabula after an average implantation of 22 months. Associated osteolytic lesions were separately collected in two cases. The back surfaces of the liners and the screws were examined for damage, and some liners were scanned by electron microscopy. The tissues were studied histologically and by atomic absorption spectrophotometry to measure titanium content. The pseudomembrane from the screw-cup junction contained polyethylene debris in seven specimens and metal debris in ten. The material from empty screw holes was necrotic tissue or dense fibroconnective tissue with a proliferative histiocytic infiltrate and foreign-body giant-cell reaction. It contained polyethylene debris in 14 cases and metal in five. The two acetabular osteolytic lesions also showed a foreign-body giant-cell reaction to particulate debris. The average titanium levels in pseudomembranes from the screw-cup junction and the empty screw holes were 959 micrograms/g (48 to 11,900) and 74 micrograms/g (0.72 to 331) respectively. The tissue from the two lytic lesions showed average titanium levels of 139 and 147 micrograms/g respectively. The back surfaces of the PE liners showed surface deformation, burnishing, and embedded metal debris. All 30 retrieved screws demonstrated fretting at the base of the head and on the proximal shaft. Non-articular modular junctions create new interfaces for the generation of particulate debris, which may cause granulomatous reaction.

Acetabulum↗
PubMed1994

An analysis of the head-neck taper interface in retrieved hip prostheses.

The purpose of this study was to examine the mating surfaces of femoral heads and stems for evidence of corrosion, and to evaluate the quality of the taper lock of modular hip prostheses. Forty-eight implants with three different designs were evaluated. Group I (26 implants) had a cobalt alloy head and cobalt alloy stem. Group II (ten implants) had a cobalt alloy head and a titanium stem. Group III (12 implants) had a cobalt alloy head with a titanium stem that was coupled in the factory via a shrink fit. The implants were examined under light microscopy and scanning electron microscopy. In cases where the femoral head was still assembled to the stem, pull-off testing was performed using an MTS machine. The average failure load for the pull-off tests for each group of prostheses was as follows: Group I (nine implants) 3,003 N +/- 623 N; Group II (six implants) 4453 N +/- 570 N; and Group III (12 implants) 6859 N +/- 3525 N. The Group III implants required a significantly greater pull-off force than those in Group I (p = 0.002). There was no evidence of corrosion in Group I. In Group II, crevice corrosion was noted in one taper interface and there was fretting in two other tapers. No corrosion was noted in Group III. Improving the tolerances of the mating surfaces may be a key factor in preventing corrosion. This would not only increase the forces that are necessary to debond the matting surfaces, but also decrease corrosion by reducing micromotion and fluid at the taper interface.

Adult↗
PubMed1994

Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol.

Forty-four patients (46 hips) with infected total hip arthroplasties were evaluated. They were entered into a protocol that included resection arthroplasty, six weeks of intravenous antibiotics which obtained a minimum postpeak serum bactericidal titer of 1:8, and possible reimplantation. Thirty-two of 46 hips (70%) were reimplanted. At an average of 40 months (range, 24-74 months) after reimplantation, infection recurred in three hips (9%). In two of the three recurrent infections, 1:8 bactericidal titers were not attained. Both of these hips were infected with gram-negative organisms. Minimum postpeak serum bactericidal titers of 1:8 were attained in 28 of 32 hips that were reimplanted, and only one of these hips (4%) had a recurrent infection (p = 0.035). The presence of retained cement after resection arthroplasty (ten hips) was not associated with recurrent infection. Fourteen hips (12 patients were not reimplanted as a result of a combination of factors, including inadequate bone stock, poor soft-tissue quality, and antibiotic resistance of the infecting organism. The treatment of an infected total hip arthroplasty with resection arthroplasty, six weeks of intravenous antibiotics that attains a minimum postpeak serum bactericidal titer of 1:8, and reimplantation can be an effective and safe treatment.

Adult↗
PubMed1993

Increased platelet thromboxane A2/prostaglandin H2 receptors in patients with pregnancy induced hypertension.

Pregnancy induced hypertension (PIH) is associated with a variety of disturbances in the hemostatic system including alterations in platelet function, thrombocytopenia, and an increase in platelet turnover. The density of platelet Thromboxane A2 (TXA2)/Prostaglandin H2 (PGH2) receptors was determined in patients with PIH and normal pregnant women, using [125I]-PTA-OH, a TXA2/PGH2 receptor antagonist. The number of platelet TXA2/PGH2 receptors significantly increased (p < 0.008) from 1734 +/- 370 sites/platelet (n = 8) in normal pregnant women to 3703 +/- 846 sites/platelet (n = 9) in patients with severe PIH. The sensitivity of platelets to the TXA2 mimetic U46619 was significantly (p < 0.0005) increased in platelets obtained from severe PIH patients (EC50 = 150 +/- 10nM, n = 3) compared to controls (EC50 = 290 +/- 60 nM, n = 5). These results indicate that an increased number of TXA2/PGH2 receptors as well as increased sensitivity to TXA2/PGH2 mimetics occurs in PIH. Collectively, these results provide further support for the notion that TXA2 and its receptor may play an important role in the pathophysiology of PIH.

Blood Platelets↗
PubMed1993

Evaluation of painful hip arthroplasties. Are technetium bone scans necessary?

We reviewed the plain radiographs, bone scans and hip aspiration results of 54 patients with painful hip arthroplasties which had been explored surgically, to compare the results of the investigations with the operative findings. For acetabular loosening, the sensitivity and specificity of bone scanning were 87% and 95%, with an accuracy of 90%: for serial plain radiography sensitivity was 95%, specificity 100% and accuracy 97%. For femoral component loosening, bone scan sensitivity was 85%, specificity 100% and accuracy 89%: the sensitivity of plain radiography was 100%, with specificity 92% and accuracy 98%. Technetium bone scanning did not provide additional information with regard to loosening and is not necessary in the routine investigation of a painful hip arthroplasty. Serial pain radiography is the most effective method of detecting loosening, and bone scanning is useful only when radiography is inconclusive with regard to loosening or infection.

Adult↗
PubMed1993

Cement-within-cement revision hip arthroplasty.

We reviewed 19 revision hip arthroplasties in which the new femoral component had been recemented into the old, intact cement mantle. The mean time from the first operation to revision was 64 months and the average follow-up was 59 months. There were 7 excellent, 11 good, and one fair result. No femoral component had been revised for loosening and all the stems appeared radiographically stable. Complications included intraoperative perforation of the femur on two occasions and one dislocation. The use of the cement-within-cement technique requires that the old cement surface be dry and roughened to increase the surface area and that the cement be injected in the liquid phase to prevent lamination. The indications for this technique include a broken stem with an intact distal cement mantle, the removal of a femoral component for revision of a loose cup to improve exposure and/or increase offset, recurrent dislocation secondary to component malposition, and debonding of the femoral component within an intact cement mantle.

Adult↗
PubMed1993

Custom-designed femoral prostheses in total hip arthroplasty done with cement for severe dysplasia of the hip.

A custom-designed femoral prosthesis was implanted with cement and a standard acetabular component was used to treat nineteen severely dysplastic hips in fourteen consecutively managed patients. Components that had been custom-designed with the use of plain radiography were used because the anatomical reconstructive goals could not be achieved with commercially available implants. These goals were to match the offset of the femoral head and the length of the lower limb with those on the normal side for patients who had unilateral involvement and to provide an average (thirty to forty-millimeter) offset with equal limb lengths for patients who had bilateral involvement. A retrospective clinical and radiographic analysis was performed. The diagnoses included coxa vara (one hip), congenital dislocation (twelve hips), achondroplasia (three hips), and spondyloepiphyseal dysplasia (three hips). The mean age at the time of the reconstruction was forty-nine years (range, twenty-two to seventy-three years), and the mean duration of follow-up was fifty-seven months (range, twenty-seven to 108 months). In five hips, bone-grafting of the acetabulum was needed to obtain superolateral coverage. The clinical result was excellent in eighteen hips and good in one. No revisions have been performed to date. Two femoral components were possibly loose radiographically. One was associated with a definite loosening of the acetabular cup. In addition, one other cup was possibly loose. There was a 100 per cent rate of survival if only a revision procedure was considered as a failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Chopart amputation with percutaneous heel cord lengthening.

When amputation becomes necessary in a patient with peripheral vascular disease, it is important to preserve as much tissue as possible to preserve maximum function. This is especially important because the other extremity may have similar involvement in the future. With appropriate care, an amputation at the Chopart (calcaneocuboid-talonavicular) level can give a good functional result.

Achilles Tendon↗
PubMed1992

Metallic debris in femoral endosteolysis in failed cemented total hip arthroplasties.

A prospective study was undertaken to quantitate metallic and cement debris in 12 consecutive patients with femoral endosteolysis (FE) and aseptic loosening of a cemented total hip arthroplasty. The mean interval between primary and revision surgery was 9.6 years. The average time to onset of FE was 8.9 years. There were four stems each of cobalt-chromium (Co-Cr), stainless steel (SS), and titanium alloy. At revision, tissue was retrieved from FE, the femoral bone-cement pseudomembrane, and the joint pseudocapsule. Histology of these tissues was studied using light and polarized microscopy. Metal and barium levels were measured by atomic absorption spectrophotometry. A histiocytic reaction and particulate cement debris were seen in every case. Polyethylene wear debris was noted in 11 of 12 cases (92%), and metallic debris in four cases (33%). Detectable metal levels were found in the FE in all cases. Metal levels were on average 2.5 times higher in FE than in femoral pseudomembrane, and 4.2 times higher than in joint pseudocapsule. This difference was statistically significant for the Co-Cr and SS groups. Barium levels in areas of FE were on average 1.7 times and 42.4 times higher than in femoral pseudomembrane and joint pseudocapsule, respectively. The difference seen between the FE and the joint pseudocapsule tissue was significant for all three alloy groups. The authors' data demonstrated higher metal and barium levels in FE than in the other tissue sites. Polyethylene and cement debris were noted in nearly every case. Cement, polyethylene, and metallic particulate wear debris may contribute to the pathogenesis and progression of FE.

Adult↗
PubMed1991

Pseudoaneurysm of the dorsalis pedis artery after Lisfranc amputation.

Pseudoaneurysm formation is usually associated with laceration, fracture, or iatrogenic arterial injury. However, it may also develop as a result of blunt trauma. We report the case of a pseudoaneurysm of the dorsalis pedis artery after a Lisfranc amputation in an individual with diabetes mellitus, Charcot joint changes in the left forefoot, and atherosclerosis of the distal vessels.

Amputation, Surgical↗