Search PubMed⌕ Search

Biomedical subjects

Joel M Matta

Publications and source records attributed to Joel M Matta.

12 recordsLinked to original sources
PubMed2006

Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective.

The ilioinguinal surgical approach was found to be effective for treatment of 119 (about 33%) of the 373 acetabular fractures treated operatively by the author over a 10-year period. It is indicated for anterior wall, anterior column, associated anterior and posterior hemitransverse fractures, as well as certain both column and transverse fractures. The approach offers the advantages of a cosmetic incision, rapid recovery of muscle function, and minimal ectopic bone formation. Complications included 3% surgical wound infection, 2% iatrogenic nerve palsy, 1% significant ectopic bone, and 1% death from pulmonary embolus. Clinical results at a minimum of 1-year, and an average of 3-years' followup, were excellent in 37%, good in 47%, fair in 14%, and poor in 2%. Two patients later required total hip arthroplasty for posttraumatic arthritis.

Acetabulum↗
PubMed2005

Trans-sacral fixation for failed posterior fixation of the pelvic ring.

INTRODUCTION: In the treatment of certain pelvic ring pathologies (non-unions and failure of ilio-sacral screw fixation) trans-sacral fixation (i.e. fixation from iliac wing to the other traversing the body of S1) may be necessary. The purpose of our study was to describe our early experience and describe the surgical technique. MATERIALS AND METHODS: Seven cases of trans-sacral fixation were identified with a mean patient age of 49-years-old with four females and three males. The diagnosis at the time of trans-sacral fixation was failure of posterior ring fixation in four (three of which had vertical sacral fractures), mal-position of iliosacral (IS) screw in one, failure of fusion of sacroiliac (SI) joint in two. All these cases were augmented with a 4.5 mm reconstruction plate placed in tension posteriorly. RESULTS: At average follow up of 39 months (range 24-75), all patients achieved union. There were no neurological or vascular complications. Two patients required reoperations prior to union. Our current use for this technique is with a 8.0 mm screw (16 mm thread). CONCLUSIONS: Initial experience with trans-sacral fixation has proven to be very effective technique to solve the most difficult problems in posterior pelvic ring fixation. We reserve its use to the following indications: nonunion/malunion of the pelvic ring, and sacral fractures.

Aged↗
PubMed2005

Single-incision anterior approach for total hip arthroplasty on an orthopaedic table.

UNLABELLED: Dislocation remains the leading early complication of total hip arthroplasty; surgical approach and implant positioning have been recognized as factors influencing total hip arthroplasty stability. We describe a total hip arthroplasty technique done through a single, tissue sparing anterior approach that allows implantation of the femoral and acetabular components without detaching or sectioning any of the muscles and tendons around the hip joint. A series of 437 consecutive, unselected patients who had 494 primary total hip arthroplasty surgeries done through an anterior approach on an orthopaedic table from September 1996 to September 2004 was reviewed. There were 54 hybrid and 442 uncemented hips in the 437 patients (57 bilateral). The average patient age was 64 years. Radiographic analysis showed an average abduction angle of 42 degrees , with 96% in the range of 35 degrees to 50 degrees abduction. The average cup anteversion was 19 degrees with 93% within the target range of 10 degrees to 25 degrees . Postoperative leg length discrepancy averaged 3 +/- 2 mm (range, 0-26 mm). Three patients sustained dislocations for an overall dislocation rate of 0.61%, and no patients required revision surgery for recurrent dislocation. There were 17 operative complications, including one deep infection, three wound infections, one transient femoral nerve palsy, three greater trochanter fracture, two femoral shaft fractures four calcar fractures, and three ankle fractures. Operative time averaged 75 minutes (range 40-150 minutes), and the average blood loss was 350 mL (range, 100-1300 mL). The mean hospital stay was 3 days (range, 1-17 days). The anterior approach on the orthopaedic table is a minimally invasive technique applicable to all primary hip patients. This technique allows accurate and reproducible component positioning and leg-length restoration and does not increase the rate of hip dislocation. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

Surgical management of pelvic ring injuries.

Posterior pelvic ring injuries disrupt the weight-bearing function of the pelvis and cause deformity that results in pain and loss of function. The indications for reduction and fixation are the presence of instability and/or deformity. Surgical fixation of the pelvic ring is divided into anterior and posterior ring injuries. In many instances, reduction and fixation of the anterior pelvic ring is not needed after reduction and fixation of the posterior pelvic ring. Although techniques exist for both open and closed reductions, the main dfficulty remains achieving anatomic restoration of the pelvis. Whether posterior pelvic ring injuries are best treated using closed reduction and fixation or open reduction and fixation remains a controversial topic.

Fracture Fixation↗
PubMed2004

Hip arthrodesis: a procedure for the new millennium?

Advanced hip arthrosis in the young patient represents a difficult problem. Using currently available techniques, total hip arthroplasty (THA) in this patient population likely would result in multiple revision surgeries, usually at the expense of bone in the proximal femur and acetabulum. For noninflammatory, monoarticular hip arthritis, arthrodesis remains an excellent reconstruction option. Arthrodesis can provide pain relief and return to function in the majority of patients indicated for the procedure. Current techniques provide acceptable fusion rates. If possible, techniques that protect the abductor mechanism and limit deformity of the pelvis should be used. Patient education is an important part of the treatment process. The position of the limb is important to early satisfaction and durability of the fusion. Long-term difficulties after hip fusion are related to pain in contiguous joints. Conversion arthroplasty, if necessary, can result in favorable outcomes. Familiarity with the techniques and outcomes of hip arthrodesis are important for the hip surgeon to understand.

Adolescent↗
PubMed2004

The Levine anterior approach for total hip replacement as the treatment for an acute acetabular fracture.

The treatment of acetabular fractures in part relies on the selection of a specific surgical approach that allows for accurate reduction of fracture fragments. Moreover, these acetabular approaches were not developed for the insertion of a total hip replacement. Therefore, if a total hip arthroplasty is to be the treatment of an acute acetabular fracture, a single incision that permits reduction of the acetabular fracture fragments and ease of insertion of the arthroplasty components would be desirable. The Levine anterior approach provides both accesses to the anterior wall/column for reduction and fixation and to the femoral shaft for insertion of a total hip replacement. This paper describes that surgical technique and our initial clinical experience with this approach for acute acetabular fractures. A consecutive group of 10 patients with acetabular fractures, all involving the anterior wall/column with articular impaction (>50% of the acetabular roof) including 2 cases with an associated posterior hemitrans-verse component, were reviewed. After fracture reduction and fixation, a hybrid total hip replacement was implanted in all cases with an average acetabular component size of 56 mm (range 52-64). At a mean follow-up of 36 months (range 24-53), all fractures united, and all acetabular components remained fixed with no evidence of migration or loosening. There were 2 complications, a Brooker grade II heterotopic ossification and 1 postoperative anterior dislocation treated successfully with closed reduction and spica cast immobilization. The average Merle d'Aubigné hip score at latest follow-up was 16 (range 13-18). The Levine anterior approach is a reliable, safe, and efficient technique that permits early mobilization of patients with anterior wall/column acetabular fractures requiring a total hip replacement.

Acetabulum↗
PubMed2003

Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability.

BACKGROUND: A fracture classification system enables communication among surgeons and provides guidelines for treatment as well as some estimate of prognosis. Thus, the system should be anatomically meaningful and reliable. The purpose of this study was to assess the interobserver and intraobserver reliability of Letournel's acetabular fracture classification and the effect of computed tomography on its reliability. METHODS: Plain radiographs (anteroposterior and Judet views) and axial computed tomography scans were randomly chosen from an acetabular fracture database, with at least five cases of each fracture type and eight of the most common types. The study involved three groups of three orthopaedic surgeons: (1) surgeons who had studied under Letournel, (2) surgeons who specialized in acetabular fracture surgery, and (3) general trauma surgeons. Each observer read the radiographs twice, and at each session the fractures were classified first on the basis of the radiographs only and then in combination with the computed tomography scan. Observer agreement was then assessed with the unweighted kappa coefficient (kappa). We also calculated the frequency with which the observers agreed with the diagnosis made intraoperatively by the treating orthopaedic surgeon. RESULTS: The interobserver reliability without and with computed tomography during the first session was 0.70 and 0.74, respectively, for group 1, 0.71 and 0.69 for group 2, and 0.51 and 0.51 for group 3. The results of the second session were similar. When the two sessions were compared, intraobserver reliability without and with computed tomography was 0.80 and 0.83 for group 1, 0.80 and 0.80 for group 2, and 0.64 and 0.69 for group 3. The overall agreement of the radiographic observation with the fracture pattern observed at surgery was 74%. CONCLUSIONS: Letournel's acetabular classification with use of plain radiographs with or without supplemental computed tomography scans has substantial reliability (kappa > 0.7) when used by surgeons who have been taught how to interpret the images or by those who treat acetabular fractures on a regular basis. The value of computed tomography scans in the evaluation of acetabular fractures has been well established for the identification of loose bodies and articular impaction; however, they do not appear to be essential for the classification of acetabular fractures.

Acetabulum↗
PubMed2002

Bilateral THA.

Explore the source record for details and available documents.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Hip arthrodesis: current indications and techniques.

The management of young adults with severe osteoarthritis of the hip remains a problem because of the increased failure rates of total hip arthroplasty (THA) as well as the prospect of multiple revisions in this population. Although hip arthrodesis is not perceived favorably as an alternative by most orthopaedic surgeons or patients because of the presumption of less than optimal functional outcomes, it is a viable technique, especially for younger patients with a recent history of local infection and/or trauma. With current internal fixation techniques, a fusion rate >80% can be achieved with maximal preservation of bone stock. Proper patient selection and optimal arthrodesis position (flexion of 20 degrees to 30 degrees, adduction of 5 degrees, external rotation of 5 degrees to 10 degrees, and limb-length discrepancy <2 cm) are essential for a successful, long-term result. Back and ipsilateral knee pain are the most common complaints leading to secondary conversion of a hip fusion to a THA. Symptoms improve markedly after conversion. Survivorship of the conversion THA is comparable to that of a primary THA when the patient is older than 50 years of age and multiple surgical procedures have been avoided. However, the procedure can be technically challenging and has a high risk of postoperative complications.

Adolescent↗