Search PubMed⌕ Search

Biomedical subjects

James P Waddell

Publications and source records attributed to James P Waddell.

At least 19 recordsLinked to original sources
PubMed2006

Bone remodeling is different in metaphyseal and diaphyseal-fit uncemented hip stems.

Femoral component stability in uncemented total hip arthroplasties depends on periprosthetic bone remodeling. Stem design is an important factor influencing bone remodeling, however the design that promotes the most bone remodeling is unclear. We examined metaphyseal and diaphyseal-fit stems to determine the effect of stem design on bone remodeling and stability. Twenty-three patients who had total hip arthroplasties (28 hips) with metaphyseal-fit stems were matched with 27 patients (32 hips) who had uncemented total hip arthroplasties with diaphyseal-fit stems. We assessed preoperative radiographs for canal fill, canal shape, and bone quality. We then assessed postoperative radiographs for periprosthetic bone remodeling including spot welds, cortical hypertrophy, and pedestal formation. Patients were examined clinically using a modified Harris hip score. Patients with metaphyseal stems had increased cortical hypertrophy 1 year postoperatively. However, there was no functional difference 2 years postoperatively. Both stem designs resulted in bone remodeling by 2 years postoperatively with similar clinical results.

Adult↗
PubMed2006

Predictors of functional outcome two years following revision hip arthroplasty.

BACKGROUND: Little is known about factors that might predict functional outcome following revision hip arthroplasty. The purpose of this study was to identify predictors of pain and physical function at two years following revision total hip arthroplasty and to evaluate whether the time that the patient waited for the surgery and whether the patient had complications were significant predictors of outcome. METHODS: One hundred and twenty-six patients (126 hips) were entered prospectively into the study when their name was placed on the waiting list for surgery. Baseline measures included demographic factors, comorbidities, and the responses to the Short Form-36 (SF-36) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaires. Follow-up was carried out at six-month intervals while the patient was waiting for the surgery; within one week prior to the surgery; and at six, twelve, and twenty-four months after the surgery. Patient age and gender, the preoperative WOMAC pain and function scores, the physical and mental component scores of the SF-36, comorbidities, the number of revisions, bilateral joint replacement, and the severity of the revision were evaluated as possible predictors of ultimate pain and function as measured with the WOMAC instrument. RESULTS: The mean age of the patients was 68.6 years. Improvement in WOMAC pain and function scores plateaued at six months. The mean pain score (and standard deviation) improved from 9.4 +/- 4.1 points preoperatively to 3.9 +/- 3.9 points at six months postoperatively, and the mean function score improved from 35.4 +/- 14.1 to 19.1 +/- 13.2 points. Preoperative pain (p = 0.002) and comorbidity (p = 0.02) were significant predictors of pain at two years. There was a trend toward preoperative function predicting function at twenty-four months (p = 0.07). There was no significant deterioration in the WOMAC pain or function score while the patients waited for surgery. Twenty-eight patients had complications. When the time that the patient waited for the surgery and complications were added to the models, only complications were found to be predictive of outcome (p = 0.04 for pain and p = 0.05 for function). Four patients required repeat revision during the follow-up period. CONCLUSIONS: Patients with better preoperative pain scores and fewer comorbidities have better outcomes following revision total hip arthroplasty. Although the time that the patient waited for the revision was not predictive of the ultimate WOMAC pain and function scores, we believe that performing revision arthroplasty before the patient has substantial functional compromise potentially improves the outcome.

Adult↗
PubMed2006

Total hip arthroplasty following failure of free vascularized fibular graft.

BACKGROUND: Many treatments for osteonecrosis of the femoral head, including the use of a free vascularized fibular graft, have been advocated in an attempt to delay the need for hip arthroplasty. The purpose of this study was to document the clinical and radiographic results of total hip arthroplasty performed following failure of a free vascularized fibular grafting procedure. METHODS: Twenty total hip arthroplasties in eighteen patients who had previously undergone a free vascularized fibular grafting procedure for the treatment of osteonecrosis were retrospectively reviewed. A straight-stem femoral component was used in twelve hips, a tapered femoral component with removal of residual fibular graft was used in five hips, and a tapered stem without graft removal was used in three hips. The twelve hips with a straight-stem femoral component and previous vascularized fibular grafting were compared with thirty-six osteonecrotic hips in thirty other patients who had undergone total hip arthroplasty but had not had previous free vascularized fibular grafting. The radiographic outcomes with respect to initial femoral component alignment and subsequent migration and the clinical outcomes were compared. RESULTS: Analysis of the immediate postoperative radiographs demonstrated significantly improved alignment of the femoral component when a high-speed burr had been used to remove residual fibular graft (p = 0.001), although doing so did significantly increase both the intraoperative blood loss (p = 0.017) and the operative time (p = 0.0002). There was no significant difference in the amount of migration of either the acetabular or the femoral component between the control and study groups at the time of the most recent follow-up. When comparing patients with or without a previous free vascularized fibular graft, the mean postoperative scores at three years were significantly worse in patients who had undergone a previous free vascularized fibular graft (p = 0.03). One revision occurred in the study group at seventy-two months due to acetabular wear, and one revision occurred in the control group at 108 months due to aseptic loosening. CONCLUSIONS: This study raises concern that the outcome of total hip arthroplasty in patients who previously underwent a free vascularized fibular graft for the treatment of osteonecrosis of the femoral head may be worse than that in patients without previous free vascularized fibular grafting. The intraoperative use of a high-speed burr can improve the alignment of the femoral component by removing more of the residual graft. However, this technique does increase intraoperative blood loss and operative time. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Adult↗
PubMed2006

Flattery.

Explore the source record for details and available documents.

General Surgery↗
PubMed2005

Isolated acetabular revision after total hip arthroplasty: results at 5-9 years of follow-up.

The purpose of the study was to determine whether isolated revision of the acetabular component can be successfully performed without disturbing the femoral stem and to determine the fate of the unrevised femoral stem following revision. Fifty-seven hips in 55 patients underwent isolated acetabular revision without removal of the femoral component. Thirty-three hips with minimal acetabular deficiency required no bone grafting; the remaining 24 hips were treated by morselized or structural allograft in addition to a new acetabular component. Twenty-two of these 24 hips demonstrated incorporation of the bone graft. A mean follow-up of 5.8 (5-9) years, all femoral and acetabular components were judged to be stable and well fixed.

Acetabulum↗
PubMed2005

A comparison of plate versus staple-and-cast fixation in maintaining femoral tibial alignment after valgus tibial osteotomy.

PURPOSE: To compare 2 methods of fixation for maintenance of alignment during healing of valgus tibial osteotomies. METHODS: We performed a retrospective chart and radiographic review of valgus tibial osteotomy cases of staple fixation supplemented by a postoperative cast and of blade plate fixation for maintenance of femoral-tibial alignment during healing of the osteotomy. RESULTS: Both groups (staple-and-cast, n = 16; plate, n = 28) were similar in terms of age, preoperative alignment, extent of osteoarthritis and degree of intra-operative correction. Between-group differences in the maintenance of femoral-tibial alignment during healing were not significant. In both groups there was a strong correlation between degree of bone contact at the osteotomy site and maintenance of alignment (p < 0.005). In cases done with the plate, 90% of osteotomies with good or excellent bone contact maintained alignment during healing; with poor or fair bone contact, 75% had loss of alignment > 5 degrees during healing. There was a trend toward a greater incidence of delayed or non-union with plate fixation compared with staple fixation that did not reach statistical significance. All of these cases of delayed/non-union had loss of femoral-tibial alignment > 5 degrees during healing. CONCLUSION: As a result of this study, we have modified our surgical technique. We now use intra-operative fluoroscopy for optimization of bone contact, and we have reverted to the less invasive staple method for fixation of tibial osteotomies.

Adult↗
PubMed2004

The role of total hip replacement in intertrochanteric fractures of the femur.

Total hip replacement is rarely used in the treatment of acute intertrochanteric fractures of the femur. Pathologic fractures with involvement of the femoral head and/or periacetabular pelvis may represent one such indication; rheumatoid arthritis with or without radiographic involvement of the joint space or end-stage osteoarthritis with substantial hip symptoms before fracture may represent other indications. Total hip replacement is mainly reserved for the treatment of complications such as nonunion or avascular necrosis of the femoral head.

Adult↗
PubMed2003

Classifying failed hip arthroplasty: generalizability of reliability and validity.

Interrater reliability and validity of a radiographic severity classification was evaluated in 81 patients having revision hip arthroplasty. Severity was rated separately on the femoral and acetabular sides using a five-level scale ranging from no significant loss of bone stock to uncontained loss of bone stock and discontinuity. Three academic orthopaedic surgeons rated preoperative anteroposterior radiographs taken within 6 weeks of surgery. Interrater reliability was 0.54 (weighted kappa) with 57% agreement on the acetabular side and 0.56 with 52% agreement on the femoral side. Rater to intraoperative findings agreed 45% of the time and weighted kappa was 0.41 on the acetabular side and agreed 38% of the time with weighted kappa of 0.39 on the femoral side. When radiographic and intraoperative ratings disagreed, 30% of the time no bony defect was found on the acetabular side. Fifty-eight percent of femoral radiographic ratings were upgraded intraoperatively. These results differ from previously reported results of high reliability from one institution with trained raters. A reliable and valid severity classification that is generalizable to multiple raters from different institutions is required to stratify patients for intervention studies, and to aid preoperative planning. Training in the classification system may improve generalizability.

Adult↗