Search PubMed⌕ Search

Biomedical subjects

K A Krackow

Publications and source records attributed to K A Krackow.

At least 37 records · Page 2Linked to original sources
PubMed1998

Total knee arthroplasty in patients receiving Workers' Compensation.

The poor outcomes in patients who have a low-back injury that was sustained while they were on the job have been well described in many studies. The purpose of the current study was to determine the influence of Workers' Compensation on the outcome of total knee arthroplasty in forty-two patients who had been managed between January 1980 and December 1993. There were thirty-two men and ten women, and the mean age at the time of the operation was forty-eight years (range, twenty-nine to sixty-eight years). These patients were directly matched with a group of forty-two patients who were not receiving compensation. The two groups were matched with regard to nine parameters: age, gender, obesity index, preoperative deformity in the coronal plane, preoperative level of symptoms, preoperative radiographic severity according to the criteria of Ahlbäck, method of fixation, number of previous procedures, and duration of follow-up. After a mean duration of follow-up of eighty months (range, forty-eight to 178 months), the patients who were receiving compensation had a mean Knee Society score of 64 points (range, 25 to 100 points). Twelve (29 per cent) of the patients in this group had an excellent or good clinical result, and thirty (71 per cent) had a fair or poor result or had had a revision. The patients who were not receiving compensation had a mean Knee Society score of 93 points (range, 57 to 100 points) after a similar duration of follow-up. Thirty-seven patients (88 per cent) in this group had an excellent or good clinical result, and five (12 per cent) had a fair or poor result or had had a revision; the difference between the two groups with regard to fair or poor results and revisions was significant (p < 0.01). With the numbers available, no significant differences could be detected between the two groups with regard to objective measurements of range of motion and stability or with regard to radiographic alignment, the presence of radiolucent lines, or the shedding of beads. On the basis of our findings, we believe that surgeons should be aware that Workers' Compensation is one of several variables that may have an untoward influence on the perceived outcome of total knee arthroplasty.

Adult↗
PubMed1998

Surface replacement hemiarthroplasty for the treatment of osteonecrosis of the femoral head.

We reviewed the results of thirty-three femoral resurfacing procedures in twenty-five patients who had stage-III or early stage-IV osteonecrosis of the femoral head according to the classification system of Ficat and Arlet. There were no perioperative complications. Thirty hip prostheses (91 percent) survived for a minimum of five years. At a mean of 10.5 years (range, four to fourteen years) postoperatively, sixteen (62 percent) of the twenty-six hips with stage-III disease had a good or excellent Harris hip score. Four of the seven hips with stage-IV disease did not have or need a total hip arthroplasty. Overall, twenty hips (61 percent) had a good or excellent result according to the scoring system of Harris, and thirteen (39 percent) had a fair or poor result and subsequently had or needed a total hip arthroplasty. The mean interval between the hemiarthroplasty and the total hip arthroplasty was sixty months (range, thirty-six to 136 months). These thirteen hips all had a successful clinical result (a Harris hip score of at least 80 points) at a mean of thirty months (range, twenty-four to seventy-two months) after the total hip arthroplasty. The results of the present study suggest that resurfacing of the femoral head can be a successful interim procedure for the management of patients who have Ficat and Arlet stage-III or early stage-IV disease with a large lesion that is not amenable to other treatment options except total hip arthroplasty.

Adult↗
PubMed1997

Intramedullary goniometer can improve alignment in knee arthroplasty surgery.

Fifty total knee arthroplasties were performed using an intraoperative intramedullary goniometer to measure the angle of the distal femoral cut. When deviations of 1 degree or more were found, angled cutting blocks ranging from 1 degree to 5 degrees were used to recut the distal femur. Revised femoral cuts were made it 25 knees (50%). Postoperative evaluation from weight-bearing long-standing anteroposterior radiographs revealed an average distal femoral angle deviation from preoperative planning of 0.64 degree (range, 0 degree-3 degrees). This was statistically significantly different from the value for a comparison group of 50 knees on which arthroplasties were performed without the intraoperative goniometer with an average femoral angle deviation of 1.44 degrees (range, 0 degree-4 degrees) (P < .05). In the control group, there were 7 knees (14%) that deviated by 3 degrees or more versus only 2 knees in the study group. The authors conclude that an intramedullary goniometer is fast, is simple to use, and leads to more accurate preparation of the distal femur in total knee arthroplasty.

Adult↗
PubMed1997

Total knee arthroplasty for corticosteroid associated avascular necrosis of the knee.

Despite their age, patients younger than 50 years who have collapse of their femoral condyles caused by steroid associated avascular necrosis have few options except total knee arthroplasty. There have been no specific reports of the results of total knee replacements for this disease. Between 1980 and 1993, 31 porous coated anatomic total knee replacements were performed in 21 patients younger than 50 years of age with avascular necrosis of the femoral condyles and tibial plateaus. There were 17 women and 4 men, with an average age of 36 years (range, 22-48 years). Seventeen of 21 patients had systemic lupus erythematosus, and all patients had a history of corticosteroid use. Patients underwent a complete clinical and radiographic evaluation at final followup that averaged 8.2 years (range, 2-16 years). Overall, there were 17 good and excellent results (55%). Eleven knees were revised for aseptic loosening (37%), and 3 additional knees (10%) ultimately were revised for deep sepsis. All 6 knees in patients with no diagnosis of systemic lupus erythematosus had excellent clinical results. There were only 11 of 25 successful outcomes (44%) in the patients with systemic lupus erythematosus. There were no differences in results when patients were stratified by degree of steroid use, cemented versus cementless fixation, or activity level.

Adult↗
PubMed1996

Cementless total knee arthroplasty in obese patients. A comparison with a matched control group.

The heaviest 45 patients (50 knees) who underwent cementless total knee arthroplasty were compared with a matched control group of 45 total knee arthroplasty patients (50 knees) with respect to clinical and radiographic data. Surgery was performed over a 10-year period (1980-1989) and follow-up evaluation averaged 7 years (range, 2-11 years). The control group consisted of nonobese patients matched to the obese group with respect to age, sex, diagnosis, preoperative deformity, and length of follow-up evaluation. Clinical evaluation was made using the Knee Society rating scale as well as an analysis of multiple other clinical parameters. Radiographically, each patient was evaluated with long-standing anteroposterior views, lateral and patellar views, and spot fluoroscopic views of the involved knee. This evaluation included an analysis of lucencies, bead shedding, and prosthetic alignment. The final average clinical score in the obese group was 88 points with four revisions, and that for the control group was 91 points with two revisions. There were no significant differences in the combined percentage of good and excellent results between the two groups. On the basis of the results of this study, it is believed that weight as a factor by itself should not compromise the early (7-year average follow-up period) results of total knee arthroplasty.

Adult↗
PubMed1996

Exploration of radiographically normal total knee replacements for unexplained pain.

Twenty-seven patients underwent exploration of their total knee replacements because of severe debilitating pain of an unknown cause. The group was further subdivided into (1) patients who had painful knees with range of motion greater than 80 degrees and (2) patients who had painful knees with decreased range of motion (< 80 degrees arc). At final followup, there were 11 excellent and good results (41%) with 16 fair or poor results (59%). For the 15 patients with decreased range of motion, 9 of 15 knees (60%) had good or excellent results. Range of motion arc improved from a preoperative 43 degrees average to a 81 degrees average. For the pain only group, there were only 2 excellent or good results (17%). Poor results were encountered in 6 of 7 patients (86%) in whom a cementless prosthesis was converted to a cemented prosthesis. If a problem was identified at surgery, only 3 of 12 knees (25%) had successful outcomes.

Adult↗
PubMed1996

Osteonecrosis of the talus: treatment by hindfoot fusion.

The results were reviewed for 11 ankles (10 patients) that had been treated with various hindfoot arthrodeses because of symptomatic osteonecrosis of the talus. Follow-up averaged 6.5 years (range, 2-15 years). A functional assessment using a modified Mazur grading system was performed both before surgery and at final follow-up. Data were also collected on the duration of the procedure, intraoperative findings, and the patient's assessment of postoperative cosmesis (excellent, good, fair, or poor). Radiographs were analyzed to determine the interval from the procedure until bony union. Nine of the 11 arthrodeses (82%) fused with the primary procedure and achieved excellent Mazur ratings (mean, 86 points; range, 81-90 points). The average interval until radiographic fusion was 7 months (range, 4-13 months). All eight patients (nine fusions) with successful fusions graded their cosmetic outcomes as excellent or good. The average length of the procedure was 148 minutes (range, 130-300 minutes), compared with an average of 92 minutes (range, 62-151 minutes) for ankle arthrodeses performed by the same surgeons in rheumatoid or osteoarthritic ankles (P < 0.001) and 102 minutes (range, 75-164 minutes) from a report in the literature. Two of the procedures were complicated by nonunions secondary to infections. In one patient, after treatment by debridement and intravenous antibiotics, reinfection and chronic osteomyelitis developed with a subsequent below-knee amputation. The other patient was treated successfully with debridement, antibiotics, and subsequent revision arthrodesis, which fused solidly at 9 months with an excellent result. We conclude that hindfoot arthrodeses for osteonecrosis can be technically demanding, but, despite having a long time to bony union, they can have an excellent clinical outcome.

Adult↗
PubMed1996

Corrective osteotomy for osteonecrosis of the femoral head.

We reviewed the long-term results of thirty-seven corrective osteotomies that had been performed for osteonecrosis of the femoral head that was stage II or III according to the classification of Ficat and Arlet. At a mean of 11.5 years (range, five to eighteen years) postoperatively, twenty-eight hips (76 per cent) had a good or excellent result according to the Harris hip-scoring system, and nine (24 per cent) had a fair or poor result and subsequently needed a total hip arthroplasty. Six of the nine failures were in the seventeen hips of patients who had received corticosteroids. Conversely, of the twenty hips of patients who had not received corticosteroids, seventeen (85 per cent) had a good or excellent result as determined by the Harris hip score at the latest follow-up evaluation. Five of the six hips that had had a combined necrotic angle of more than 200 degrees preoperatively had subsequent collapse of the femoral head. Of the thirty-one hips that had had a combined necrotic angle of less than 200 degrees preoperatively, twenty-seven (87 per cent) had a good or excellent clinical result. There were five complications. Three non-unions and one cutout of the compression screw were successfully treated, and these hips had an excellent clinical result at the time of the latest follow-up. The fifth complication was osteomyelitis and led to a poor result. The results of this study suggest that corrective intertrochanteric osteotomy is a successful treatment for Ficat and Arlet stage-II or III disease if the patient has a small or medium lesion (a combined necrotic angle of less than 200 degrees) and is not receiving continuous high doses of corticosteroids.

Adolescent↗
PubMed1996

The operative treatment of peroneal nerve palsy.

We retrospectively reviewed the results of operative decompression for peroneal nerve palsy in thirty-one patients who had been managed between 1980 and 1990. All patients had been managed non-operatively for at least two months after they had initially been seen. Intraoperatively, we found epineurial fibrosis and bands of fibrous tissue constricting the peroneal nerve at the level of the fibular head and at the proximal origin of the peroneus longus muscle. At a mean of thirty-six months (range, twelve to seventy-two months) postoperatively, thirty (97 per cent) of the thirty-one patients reported subjective and functional improvement and were able to discontinue the use of the ankle-foot orthosis. In contrast, only three of nine patients who had been managed non-operatively reported subjective and functional improvement (p < 0.01). Peroneal nerve palsy does not always resolve spontaneously; if it is left untreated, the loss of dorsiflexion of the ankle and persistent paresthesias can result in severe functional disability. Therefore, if non-operative measures do not lead to improvement within two months, we believe that operative decompression should be considered.

Adolescent↗
PubMed1995

Radiographic characterization of aseptically loosened cementless total knee replacement.

From January 1980 to December 1992, 655 cementless total knee arthroplasties with the PCA total knee system were done at the authors' institution. Thirty of these knees have been revised for aseptic loosening of either tibial or femoral components or both. Patients in the failed arthroplasty group were matched directly to a control group with well-functioning, stable and painless cementless total knee prostheses (Knee Society objective score, > 90 points). In this study, the authors analyzed any alignment differences between the 2 groups of knees. Special attention was given to the postoperative radiographs to evaluate for potential predictors of success versus failure. Multiple radiographic parameters were measured for each knee and included measures of frontal alignment, sagittal alignment, rotation, percent prosthetic coverage, and cortical thickness (denoted as the cortical-cancellous index). On univariate analysis, no individual radiographic parameter was significantly different in the failure group versus the control group. However, multivariate analysis indicated that certain combinations of abnormal parameters were significantly higher in the failed group than the control group. These parameters included measures of frontal and sagittal plane component alignment. The summated abnormal parameters per patient averaged 3.67 (range, 1-7) for the failure group and 1.80 (range, 0-7) for the control group.

Activities of Daily Living↗
PubMed1995

Revision and primary hip and knee arthroplasty. A cost analysis.

The cost of health care in the United States has been rising steadily during the past 10 years. Total joint arthroplasty, a commonly performed orthopaedic procedure, accounts for approximately $10 billion dollars per year. The objective of this study was to perform a clinician-oriented cost analysis of primary and revision hip and knee arthroplasty. Twenty-five consecutive cases each of total knee arthroplasty, total hip arthroplasty, revision total knee arthroplasty, and revision total hip arthroplasty were analyzed. The length of stay and number of minutes spent in the operating room were significantly higher for the patients with revision hip surgery than for the other groups. The total charges for the prosthesis in the 4 groups exceeded 40% of the total charges for the procedure. Primary hip and knee surgery had similar billed costs, and work for revision hip surgery has a significantly higher billed cost than physician's work. The implant selection process by an orthopaedic surgeon performing arthroplasty of the hip and knee needs to include economic aspects.

Costs and Cost Analysis↗
PubMed1995

Partial denervation for persistent neuroma pain after total knee arthroplasty.

Despite the high percentage of patients who are satisfied completely with the results of total knee arthroplasty, there is a small group who remain disabled because of persistent neuroma pain. Recently, a better understanding of the innervation of the skin and capsule around the human knee joint has provided a theoretical basis for denervation in this group of patients. Fifteen patients were identified who had persistent or worse knee pain for > 6 months after total knee arthroplasty. In each patient, component loosening, malalignment, knee instability, and infection had been excluded systematically as a source of pain. Pain was evaluated preoperatively with the Knee Society Functional Score Questionnaire and a visual analog scale. To be selected for surgery, each patient must have had a reduction by 5 points on the visual analogue scale for pain after undergoing selective nerve blocks. Postoperative assessment was done by a team that did not include the surgeon who did the denervation. The technique for selective knee denervation is described in detail. All 15 patients had at least 1 of the nerves to the knee selectively denervated (45 nerves in 15 patients). All patients reported subjective improvement in the immediate postoperative period. This improvement was maintained at a mean followup of 12 months (range, 6-16 months). Selective knee denervation is indicated in the management of intractable knee pain of neuroma origin after total knee arthroplasty.

Aged↗
PubMed1994

Total knee arthroplasty in diabetic patients. Comparison to a matched control group.

Between January 1980 and July 1989, 63 total knee arthroplasties were performed on 48 patients who had a clinical history of diabetes mellitus. Six patients died prior to completing the 2-year follow-up period and two patients (3 knees) were lost, leaving 53 knees in 40 patients available for review. The patients were considered as a total group, and were also divided into two subgroups: (1) insulin-dependent diabetes mellitus (IDDM) (9 knees) and (2) noninsulin-dependent diabetes mellitus (NIDDM) (44 knees). There were 10 men and 30 women in the series with an average age of 67. Patients were followed from 24 to 126 months (average, 54 months). The Porous Coated Anatomic total knee system (Howmedica, Rutherford, NJ) was used without cement in 30 knees and with cement in 23 knees. Diabetic patients were matched to a nondiabetic control group using a computer-generated selection process to match the following parameters: (1) age at surgery, (2) sex, (3) arthritic diagnosis, (4) length of follow-up period, (5) mode of fixation, and (6) preoperative deformity. Statistical analysis was performed using regression analysis and chi-square tests. In the diabetic group, there was an average clinical score of 85, with 43 knees (82%) rated excellent or good. Ten knees (18%) were rated fair, poor, or required revision (4 revisions, 7%). This was statistically different from the control group, which had an average clinical score of 92, with 51 knees (96%) rated excellent or good, 1 fair rating, and 1 revision (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

A new neck preserving total hip arthroplasty for the young patient.

A retrospective review of a femoral neck preserving custom total hip replacement was performed on seven young patients with disabling hip arthrosis. This design was created to provide greater rotational control to off-axis load and to provide greater proximal medial support to counteract varus bending forces. Eight hip arthroplasties, with a minimum follow up of 24 months, were reviewed and all had good and excellent clinical Harris scores. Presented is a treatment alternative to the standard total hip replacement.

Adult↗