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Joanne B Adams

Publications and source records attributed to Joanne B Adams.

16 recordsLinked to original sources
PubMed2006

A constrained device with increased range of motion prevents early dislocation.

Constrained components can treat or prevent instability after total hip arthroplasty. Some previous designs have shown a high rate of early dislocation. These early dislocations appear to be secondary to component impingement and levering out of the femoral head. We report the early rate of dislocation in 81 consecutive patients undergoing constrained total hip arthroplasty using a novel constrained device that allows substantially more range of motion and a higher lever out strength. One hip redislocated at 6 months followup, for a success rate of 98.8%. The success rate was 93% for patients for whom a constrained device was placed during revision for recurrent instability. This device allows a higher range of motion before prosthetic impingement and maintains a higher levering out strength when impingement occurs. These changes should provide long lasting hip stability in these difficult cases.

Adult↗
PubMed2006

Total knee arthroplasty in patients with greater than 20 degrees flexion contracture.

Fixed flexion contracture can present a technical challenge in total knee arthroplasty. Various techniques of addressing these deformities have been described including additional bony resection, ligamentous releases, and the use of increasing constraint. We retrospectively reviewed the clinical outcomes of 40 patients (52 knees) with fixed flexion contracture greater than or equal to 20 degrees treated with revision TKA and a stepwise algorithmic approach to treating the contracture. A cruciate-retaining device was used in 31 knees, a posterior stabilized design was used in 14, a posterior stabilized constrained device was used in five knees, and a rotating hinged design in was used in two knees. Full correction was achieved intraoperatively. Ninety-four percent of knees had less than 10 degrees residual contracture at an average followup of 37 months. We revised one case of postoperative instability in the posterior stabilized group and we had one infection in the cruciate-retaining group. No other revisions were performed. The stepwise algorithmic approach to treating fixed flexion deformity presented in this study in primary total knee arthroplasty is safe and effective.

Adult↗
PubMed2006

Manipulation with prolonged epidural analgesia for treatment of TKA complicated by arthrofibrosis.

Inability to achieve adequate range of motion (ROM) after total knee arthroplasty (TKA) represents a frustrating complication for both patient and surgeon. Manipulation under anesthesia is indicated in TKA having less than 90 degrees ROM after six weeks, with no progression or regression in ROM. A modified technique has evolved for patients with chronic regional pain syndrome (CRPS) symptoms or persistent stiffness after standard manipulation. A retrospective review was conducted to determine the efficacy of the modified technique, which uses epidural anesthesia continued for postoperative analgesia, hospital stay of one to three days, continuous passive motion (CPM) for two to three days, and daily physical therapy (PT). Between 1997 and 2003, 5714 TKAs were performed in 4106 patients. Manipulation using a standard technique was performed on 334 (5.8%) knees in 273 patients. Manipulation using a modified technique was performed on 65 (1%) knees in 60 patients. Age averaged 58 years and body mass index (BMI) averaged 34.39. Follow up averaged 18.4 months. ROM improved significantly from 71 degrees to 102 degrees (p < 0.0001). Knee Society pain, function, and total clinical scores all improved significantly (all p < 0.0001). Successful results were observed in 48 (74%) knees. Four (6%) additional knees achieved a successful result after a subsequent manipulation. Nine (14%) knees required component revision for treatment of persistent arthrofibrosis, which included one full revision, five polyethylene exchanges, and three revisions of femoral component and polyethylene. Two significant complications occurred: one subdural hematoma and one death due to pulmonary embolism. Although not without complications, manipulation under epidural anesthesia represents a viable option for treatment of persistent stiffness after TKA; 80% of these difficult cases achieved successful results.

Anesthesia, Epidural↗
PubMed2006

A simple and accurate method for determining leg length in primary total hip arthroplasty.

Reconstruction of appropriate leg length is an important part of soft-tissue balance in total hip arthroplasty (THA). Leg length discrepancy (LLD) is one of the more common reasons for litigation after otherwise successful THA. The purpose of the study reported here was to analyze the accuracy of using preoperative templating and intraoperative referencing of the well leg to determine postoperative leg length in unilateral primary THA. Seven-hundred primary THAs performed at an institution by 3 surgeons were randomly selected from a computerized database. Cases with significant bilateral disease, congenital dysplasia, acute fracture, or previous surgery or without complete preoperative and postoperative radiographs were excluded. Three reviewers used a standardized method to measure preoperative and postoperative LLD. Included in the review were 410 THAs. Mean postoperative LLD was 3.9 mm lengthening (SD, 7.5 mm). In 20 THAs (4.9%), lengthening was more than 15 mm. Lengthening was more than 20 mm (maximum, 22 mm) in 4 THAs (1%). Of the 20 THAs with LLD of more than 15 mm, 14 involved hips that were longer preoperatively. Thirteen of these hips were reconstructed to within 10 mm of preoperative LLD. Only 2 patients with radiographic LLD of more than 15 mm perceived LLD. There were no differences in gender, height, weight, or body mass index. This method of preoperative templating and referencing the well leg intraoperatively is an inexpensive, reliable, and accurate method for determining leg length in primary THA and has few significant radiographic or clinical outliers.

Arthroplasty, Replacement, Hip↗
PubMed2005

The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures.

Constrained acetabular components can treat or prevent instability after total hip arthroplasty (THA). We examine long-term results of 755 consecutive constrained THA in 720 patients (1986-1993; 62 primary, 59 conversion, 565 revision, 60 reimplantation, and 9 total femur). Eighty-three patients (88 THAs) were lost before 10-year follow-up, leaving 639 patients (667 THAs) available for study. Dislocation occurred in 117 hips (17.5%), in 37 (28.9%) of 128 constrained for recurrent dislocation, and 46 (28.2%) of 163 with dislocation history. Other reoperations were for aseptic loosening (51, 7.6% acetabular; 28, 4.2% stem; 16, 2.4% combined), infection (40, 6.0%), periprosthetic fracture (19, 2.8%), stem breakage (2, 0.3%), cup malposition (1, 0.1%), dissociated insert (1, 0.1%), dissociated femoral head (1, 0.1%), and impingement of 1 broken (0.1%) and 4 (0.6%) dissociated constraining rings. Although constrained acetabular components prevented recurrent dislocation in 71.1%, they should be used cautiously, with a 42.1% long-term failure rate observed in this series. Dislocation was common despite constraint with previous history as a significant risk.

Acetabulum↗
PubMed2005

Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity.

UNLABELLED: There has been increasing use of and expanding indications for unicompartmental knee arthroplasty using minimally invasive techniques. We sought to define contraindications by examining failures. We retrospectively reviewed the early results of a consecutive series of minimally invasive medial unicompartmental knee arthroplasty using two implant designs. Seventy-nine consecutive unicompartmental knee arthroplasty cases (48 instrumented and 31 noninstrumented) with minimum 2-year followup were reviewed. Patients with radiographic involvement with or without pain referable to the lateral compartment or to the patellofemoral joint were not considered candidates. Failure was defined as revision or pending revision. The average followup was 40.2 months. There were 16 failures (six tibial loosening, three plateau fracture, four persistent medial pain, one progressive arthritis, and two sepsis). Age, gender, disease severity and implant design did not predict failure. Body mass index greater than 32 did predict failure and was associated with a reduction in survivorship by log-rank and Wilcoxon analyses. These results show reliable success if obesity is considered a contraindication and technical errors resulting in fracture are eliminated. Better defining the ideal candidate for unicompartmental knee arthroplasty, with obesity remaining a contraindication, will make this a more predictable and reliable procedure. LEVEL OF EVIDENCE: Prognostic study, Level IV-2 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2004

Cementless double-tapered total hip arthroplasty in patients 75 years of age and older.

Concerns exist with cementless total hip arthroplasty (THA) femoral fixation in the elderly patient population. This study reviews the outcomes of a tapered cementless femoral component in elderly patients 75 years of age and older. Forty-seven patients (49 hips) older than 74 years of age (average age, 79 years) underwent primary cementless THA with a double-tapered stem between 1996 and 2000. Radiographs and clinical data were reviewed. At a mean follow-up of 5 years, the mean postoperative Harris Hip Score was 84, with 87% having no or minimal pain; none had severe thigh pain. Two cases of stem subsidence and no progressive radiolucencies were seen. One well-fixed stem was revised for unexplained pain (2%). Survival with aseptic loosening as an end-point was 100%. Overall implant survival was 98% at an average of 5 years. No perioperative deaths or significant orthopedic complications were identified. Advanced age is not a contraindication for tapered cementless THA.

Aged↗
PubMed2004

Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: results at 2 to 16 years.

Initial stability is critical for fixation and survival of cementless total hip arthroplasty. Occasionally, a split of the calcar occurs intraoperatively. A review of 1,320 primary total hip arthroplasties with 2-year follow-up, performed between August 1985 and February 2001 using the Mallory-Head Porous tapered femoral component, revealed 58 hips in 55 patients with an intraoperative calcar fracture managed with single or multiple cerclage wires or cables and immediate full weight bearing. At 7.5 years average follow-up (range, 2-16 years), there were no revisions of the femoral component, radiographic failures, or patients with severe thigh pain, for a stem survival rate of 100%. Average Harris hip score improvement was 33.8 points. Fracture of the proximal femur occurs in approximately 4% of primary THAs using the Mallory-Head Porous femoral component. When managed intraoperatively with cerclage wire or cable, the mid- to long-term results appear unaffected with 100% femoral component survival at up to 16 years.

Adult↗
PubMed2004

Ileus following total hip or knee arthroplasty is associated with increased risk of deep venous thrombosis and pulmonary embolism.

Venous thromboembolic disease (VTD), deep venous thrombosis and pulmonary embolism, causes morbidity and mortality following total hip and total knee arthroplasties, while ileus complicates up to 4.0%. The clinical courses of 2,949 patients undergoing 3,364 consecutive primary and revision total hip and total knee arthroplasties, radical debridements, and reimplantations at one institution over a 2-year period were reviewed to examine the relationship between ileus and VTD. VTD prophylaxis consisted of aspirin and intermittent plantar pulse boots for all patients except those at high risk, who received parenteral chemical prophylaxis and boots. Ileus occurred in 62 patients (2.1%) and symptomatic DVT in 51 (1.7%). With ileus, the incidence of DVT was 8.1%: odds ratio 5.5 (P =.0036). Symptomatic pulmonary embolism occurred in 7 patients (0.24%); with ileus the incidence was 3.2%: odds ratio 19.6 (P =.0082). A significant increase was observed in rates of VTD with ileus. We recommend using parenteral chemical and mechanical prophylaxis in patients with ileus following total hip and total knee arthroplasties.

Arthroplasty, Replacement, Hip↗
PubMed2004

Total femoral arthroplasty for salvage of end-stage prosthetic disease.

The complications and outcomes in patients who had total femoral arthroplasty for salvage of a severely compromised femur were studied. The clinical scenarios included numerous revision total hip or knee arthroplasties, failed periprosthetic fractures, or recurrent infection treated with multiple radical debridement surgeries. Fifty-nine patients (average age, 73.7 years) were identified. At an average 4.8 years followup, adequate pain relief was achieved and Harris hip pain scores averaged 33.8 of 44 points, and knee pain scores averaged 42.8 of 50 points. Good function was achieved with 98% of patients able to ambulate and 43% using no assistive device or a cane only. There were 18 complications or subsequent surgeries. Infection and dislocation occurred in eight patients and seven patients, respectively. Total femoral arthroplasty for salvage of a severely compromised femur provides acceptable results even in the most difficult of cases.

Adult↗
PubMed2004

Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty.

The purpose of this study was to determine if an intraoperative intraarticular and soft-tissue injection of local anaesthetic, epinephrine, and morphine has a beneficial effect for total knee arthroplasty. A control group of 138 patients (181 knees) received no intraoperative injection. The study group of 171 patients (197 knees) received intraoperative injection of 0.25% bupivacaine with epinephrine and morphine with 2/3 injected into the soft tissues and 1/3 injected into the joint. Patients having bilateral simultaneous procedures received a divided dose. The pain treatment protocol otherwise was identical. Pain, sedation, rescue narcotic usage, narcotic reversal and blood loss were examined. Pain levels during the immediate postoperative period, blood loss, and bleeding indices were reduced with injection. Considerably more control patients required rescue doses of narcotics. Preemptive analgesia with soft tissue and intra-articular injection of long-acting local anesthetic with epinephrine and morphine provides better pain control in the immediate postoperative period, decreases blood loss, and decreases the need for rescue narcotics and reversal agents. This simple, inexpensive method provides an effective adjunct to a multimodal approach in improving the postoperative course of primary total knee arthroplasty.

Aged↗
PubMed2003

The relationship of lateral release and tourniquet deflation in total knee arthroplasty.

A total of 242 knees in 198 patients undergoing total knee arthroplasty were reviewed to evaluate the effect of tourniquet deflation on lateral release rates, possible variables associated with the need for lateral release, and adequacy of intraoperative evaluation on final radiographs. The need for lateral release was determined using the "no-thumbs" and "full contact" rules and visual evaluation. Lateral release was performed after tourniquet deflation. A total of 171 (71%) knees needed a lateral release before tourniquet deflation. After tourniquet deflation, only 53 (22%) required lateral release, representing a 69% reduction. Obesity was the only other significant factor in lateral release requirement. Based on the observations of this study, it is recommended that the need for lateral release be evaluated after tourniquet deflation. A 69% reduction in lateral release supports the hypothesis that tourniquet pressure has an effect on patellar tracking. Lateral release appears to be effective in restoring normal patellar tilt, and obesity increases its need.

Adult↗
PubMed2002

Pain management for joint arthroplasty: preemptive analgesia.

Scheduled preoperative and postoperative analgesia should be offered in a multimodal management model. By a combined drug synergy effect, the central nervous system, afferent pathways, and peripheral wound site are modified collectively. In an ongoing effort to improve perioperative pain management, we retrospectively compared the results of a previously reported pain management protocol with 2 more recent groups of patients managed with modified pain protocols. In the earlier control protocol, epidural anesthesia was discontinued on arrival to the postanesthesia care unit, and regularly scheduled oral opioids and intravenous hydromorphone for breakthrough pain were initiated. The first more recent group used epidural anesthesia, and the second group used spinal anesthesia. Both protocols featured the use of cyclooxygenase-2-inhibiting anti-inflammatory medication administered for 2 weeks preoperatively and continued for 10 days postoperatively and patient-controlled analgesia for 24 hours followed by scheduled oral opioids.

Aged↗
PubMed2002

Why a taper?

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Femur↗
PubMed2002

Stem modularity: rarely necessary in primary total hip arthroplasty.

A retrospective review of two consecutive series of cementless primary THA performed simultaneously from November 1987 to February 1994 within a single orthopedic practice by three surgeons was conducted. A series using non-modular Mallory-Head Porous (Biomet Inc, Warsaw, Ind) femoral components was compared to a series using modular Sivash Range of Motion (DePuy, Warsaw, Ind) femoral components to evaluate whether modularity of the femoral stem body is necessary in cementless primary THA. Clinically and radiographically, both components performed at comparable levels with equally satisfactory results. Both series demonstrated effective femoral fixation as evidenced by excellent Engh fixation scores. However, this study has shown the importance of circumferential proximal porous-coating to form an effective seal, preventing the propagation of particulate debris. Modular systems were associated with a higher degree of technical difficulty, operative time, and blood loss.

Arthroplasty, Replacement, Hip↗