Search PubMed⌕ Search

Biomedical subjects

K L Garvin

Publications and source records attributed to K L Garvin.

At least 37 records · Page 2Linked to original sources
PubMed1994

Fatal marrow embolization following a porous-coated bipolar hip endoprosthesis.

Fat embolization syndrome is a well-known complication associated with total hip arthroplasty. It is believed to be caused by high intramedullary pressures that occur during cement pressurization and femoral stem placement. Fat embolization syndrome has also been reported with intramedullary reaming and placement of an intramedullary alignment guide during total knee arthroplasty. To our knowledge, there have not been previous reports of fatal fat emboli as a result of uncemented hip arthroplasty. The purpose of this case report is to describe a fatality due to fat embolization following a noncemented bipolar arthroplasty.

Aged↗
PubMed1994

Polylactide/polyglycolide antibiotic implants in the treatment of osteomyelitis. A canine model.

Osteomyelitis with Staphylococcus aureus was established in the tibiae of twenty-six adult mongrel dogs. After confirmation of infection at four weeks, all animals had operative débridement and were then divided into three treatment groups. Group 1 (eight animals [sixteen tibiae]) was treated with parenteral administration of gentamicin (three milligrams per kilogram of body weight per day) every eight hours for four weeks. Group 2 (nine animals [nine tibiae]) was treated with a polymethylmethacrylate implant containing 100 milligrams of gentamicin that was placed in the tibia for six weeks. Group 3 (nine animals [nine tibiae]) was treated with a polylactide/polyglycolide implant containing 100 milligrams of gentamicin that was placed in the tibia for six weeks. All animals were killed at the end of treatment. At that time, specimens of tissue were obtained for quantitative culture as well as for antibiotic immunoassay. In the groups that had been treated with an implant, serum was obtained for the measurement of serum drug levels after débridement; after the implantation; four, seven, and twenty-one days postoperatively; and immediately before the animals were killed. The infection was eradicated in ten of the sixteen tibiae in Group 1, in eight of the nine tibiae in Group 2, and in all nine tibiae in Group 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Two-stage reimplantation of the infected hip.

To determine the diagnosis of patients with infection after total hip replacement may be very difficult, and successful reimplantation is even more challenging. Surgical debridement, removal of all foreign material, and the prosthesis followed by antibiotic therapy are essential for successful eradication of the infection. Reimplantation of the hip allows for functional recovery of the patient. The optimal time for reimplantation of the prosthesis and the role of antibiotic impregnated cement is less clear. A review of the literature strongly favors a two-stage reimplantation with local antibiotic delivery with successful results of approximately 93%.

Anti-Bacterial Agents↗
PubMed1994

Palacos gentamicin for the treatment of deep periprosthetic hip infections.

Between 1983 and 1986, 40 hip arthroplasties in 40 patients with documented deep infection were reimplanted using Palacos Gentamicin at The Hospital for Special Surgery. Palacos Gentamicin was added to the standard protocol, which included removal of the prosthesis, cement, if present, and a thorough debridement of infected and necrotic tissue, six weeks of intravenous antibiotics with a postpeak serum bactericidal titer of at least 1:8 against the infecting bacteria, followed by reimplantation of the hip. Sixteen of the patients also had the placement of gentamicin-impregnated beads at the time of prosthetic removal. All patients had a deep periprosthetic infection, 13 with Staphylococcus epidermidis, seven Staphylococcus aureus, four Streptococcus, three Enterococcus, three with gram-positive bacteria, four Escherichia coli, two Proteus, one Pseudomonas, and three anaerobic organisms. At an average follow-up period of five years (range, two to ten), two of the 40 hips (5%) developed recurrent infection. These cases recurred at one month in a patient immunocompromised by end-stage systemic lupus erythematosus (S. epidermidis) and at five months in a patient with severe titanium metallosis (S. aureus). No recurrence was noted in eight cases with gram-negative organisms or in three cases of mixed infections. No infection recurred after five months in the remaining patients before their death or last follow-up examination. Of the remaining 38 hips, 16 died of causes unrelated to the hip, leaving 21 with an average follow-up period of 7.5 years. Clinical results in these patients were 14 excellent, five good, two fair, and no poor results.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
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

Failure of a polyethylene total knee component presenting as a thigh mass. Report of a rare complication of total knee arthroplasty.

Early failure caused by wear of the polyethylene bearing surface of a metal-backed tibial platform or a metal-backed patellar component in a total knee prosthesis has been a recognized complication; patients with these problems initially have pain and instability. A patient who had a cystic mass in the distal thigh was evaluated, and osteolysis of the distal femur was detected. Polyethylene debris and reactive synovium were confirmed surgically and histologically, indicating a cause-effect relationship of polyethylene wear debris and failure of the total knee arthroplasty. Regular and long-term patient follow-up evaluation after total joint arthroplasty is essential for the detection of early evidence of occult polyethylene wear.

Aged↗
PubMed1993

Total hip arthroplasty in sickle cell hemoglobinopathy.

Twenty-two arthroplasties were performed in 14 patients with sickle cell hemoglobinopathy (SCH). There were 15 primary and seven revision procedures; none were lost to follow-up evaluation. In the primary arthroplasty group, there were two deaths in patients whose implants were functioning well. The remaining 13 hips had a mean follow-up period of 4.8 years. Failure occurred in five of these 13 hips (38%), four due to aseptic acetabular loosening and one due to sepsis. In the revision arthroplasty group, at a mean follow-up period of 5.3 years, failure occurred in three hips (43%), one due to acetabular loosening, one due to femoral loosening, and one due to sepsis. Perioperative complication rates were high in both groups. Femoral intramedullary sclerosis and bone altered by marrow hyperplasia were associated with intraoperative technical difficulties as well as problems with achieving long-term component fixation. Though total hip arthroplasty provides the most reliable measure of effective treatment in SCH, it carries a high risk of complications and failure.

Adolescent↗
PubMed1991

MR of the knee: the significance of high signal in the meniscus that does not clearly extend to the surface.

On MR images of the knee it is sometimes impossible to determine with confidence if a focus of high signal in the meniscus is confined to the substance of the meniscus or if it extends to involve the surface. This is a critical differentiation because the latter represents meniscal tears that can be found and treated at arthroscopy, whereas the former represents degeneration, tears, or perhaps normal variants that cannot be detected or treated arthroscopically. We make an equivocal diagnosis of a tear when it is difficult to decide if signal in a meniscus involves the meniscal surface. We studied MR scans of the knee in 142 consecutive patients for the presence of such equivocal tears. Their prevalence was 14% (20/142); 17 were in the posterior horn of the lateral meniscus and three were in the posterior horn of the medial meniscus. In 13 cases with arthroscopy/arthrotomy correlation, no tears were found. In one of the 20 patients in whom the meniscus was removed during arthroplasty, histologic examination of the meniscus showed separation of collagen bundles, which was caused by meniscal degeneration confined to the substance of the meniscus. These results suggest that a meniscal tear is unlikely when MR scans show a focus of high signal in a meniscus that does not unequivocally extend to involve the surface of the meniscus.

Adolescent↗
PubMed1991

Uncemented total hip arthroplasty. Prospective analysis of the tri-lock femoral component.

Fifty consecutive hip disease patients (56 hips) with total hip arthroplasties (THA) utilized the uncemented Tri-Lock femoral component. Forty-five patients (51 hips) were followed for an average of 46 months (range, 24-66). Forty-two patients (47 hips) were followed with clinical examination and roentgenographs, three (four hips) by telephone interview, four (four hips) were deceased, and one (one hip) was lost to follow-up evaluation. The diagnoses included osteoarthritis (30 hips), avascular necrosis (11 hips), juvenile rheumatoid arthritis (two hips), and degenerative joint disease secondary to childhood hip disorder (four hips). Of 47 hips, 34 were graded excellent, seven good, three fair, and three poor using the Harris hip score. The incidence of thigh pain was 19% at one year, but only 6% at final follow-up evaluation. Limp persisted in 19% of the patients. Of the three patients with four hips contacted by telephone, two had slight pain and two had no pain. The roentgenographic results found an alarming 38% incidence of varus shift of the components, relative to their preoperative position. The presence of a varus shift did not adversely affect the clinical results. Early experience with the Tri-Lock femoral component shows results comparable to those reported in the literature. The high incidence of femoral component shift, presumably because of geometry of the stem is of concern. Longer follow-up evaluation will be necessary to determine the fate of these uncemented THA operations.

Adolescent↗
PubMed1991

Long-term results of total hip arthroplasty in congenital dislocation and dysplasia of the hip. A follow-up note.

Twenty-three of twenty-nine hips that were previously reported on were studied at an average of fourteen years (range, eight to 16.5 years) after total hip arthroplasty with cement. The original arthroplasties had been performed between November 1971 and January 1976. In all hips, there was dislocation or severe dysplasia. In six hips, superolateral bone grafts were used to increase acetabular coverage. At the latest follow-up examination, seven hips were rated excellent; nine, good; and one, fair. There were six failures (26 per cent) that were revised: four hips (17 per cent) had a fractured Trapezoidal-28 stem, one had loose femoral and acetabular components, and one had loosening of only the acetabular component. Radiographic analysis of the remaining hips revealed that one had progressive acetabular radiolucencies. This patient had an excellent clinical result. Two-thirds of the failures were due to a fractured stem.

Adult↗
PubMed1991

Varus rotational femoral osteotomies in adults with hip dysplasia.

Fifty-six hips in 48 consecutive patients operated on for congenital dysplasia of the hip during the years 1971 through 1986 were evaluated for an average follow-up period of nine years (range, two-21 years). Twenty-three percent of the patients were treated with revision to total hip arthroplasty by the time of follow-up examination. The average time before revision was 8.6 years. All but three of the remaining hips were rated good or excellent (72%). These patients tended to have minimal or no preoperative degenerative joint disease. Complications included one subtrochanteric fracture, two cases of loss of fixation, and one superficial wound infection. The authors conclude that the operation provides predictable, high-quality results in those patients with minimal or no degenerative changes preoperatively. In those patients with mild or moderate degenerative changes, it may forestall the onset of severe symptoms by several years.

Adolescent↗
PubMed1989

Contralateral total hip arthroplasty or ipsilateral total knee arthroplasty in patients who have a long-standing fusion of the hip.

We studied the cases of twenty patients who had had an ipsilateral total knee arthroplasty or a contralateral total hip arthroplasty, or both, long after one hip had been fused in an acceptable position. Between 1972 and 1986, we performed twenty-one total joint arthroplasties (on thirteen hips and eight knees) and followed two additional patients (one hip and one knee) in whom the operation had been performed elsewhere. The average age of the patients at the time of arthroplasty was fifty-seven years (range, thirty-one to eighty-one years), and the average time from arthrodesis to arthroplasty was thirty-two years (range, eleven to fifty-four years). The results of eighteen of the twenty-three arthroplasties were evaluated at an average of seven years and nine months postoperatively. Four of the remaining five patients, who were followed for an average of eight years, died of a cause that was unrelated to the arthroplasty. After the hip arthroplasty, five hips were rated excellent; five, good; one, fair; and three, poor. Each hip that had a poor result was revised twice for mechanical loosening. Three hips for which the result was not considered poor had progressive radiolucency. After the knee arthroplasty, three knees were rated excellent; four, good; one, fair; and one, poor (because of infection). Seven knees were manipulated a total of fifteen times. Only one patient had progressive symptomatic radiolucency, nine years after the insertion of a posterior stabilized prosthesis. Clinically important ligamentous instability was not encountered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Role of gentamicin-impregnated cement in total joint arthroplasty.

Palacos-Gentamicin (PG) was used in 130 joint arthroplasties at The Hospital for Special Surgery. At an average follow-up of 2.5 years (range, 2 to 5), the overall recurrence rate of infection was 3.8 per cent. Only one (2.0 per cent) infection occurred where the bacteria were sensitive to PG and there were no infections in the two-stage reimplantation group. There have been no adverse effects from the gentamicin and the inferior intrusion properties of the PG have not been reflected in the clinical or radiographic results.

Bone Cements↗
PubMed1988

Fracture of the femoral component. Analysis of failure and long-term follow-up of revision.

Although fracture of the femoral component is an uncommon mode of mechanical failure, when it does occur, symptoms may be dramatic. In addition, it presents the surgeon with one of the more challenging problems in revision total hip arthroplasty surgery. This study reviews the problem of femoral stem fracture and evaluates the stem failures and long-term follow-up of the revision for femoral component fractures performed at The Hospital for Special Surgery.

Aged↗
PubMed1988

Coccidioidomycosis of the knee with a 26-year follow-up evaluation. A case report.

A case of coccidioidomycosis of the knee caused by the fungus Coccidioides immitis demonstrates the chronicity of this disease as well as the disability incurred. The patient was completely asymptomatic for 11 years after initial treatment but developed progressive joint destruction, disabling pain, and loss of function. The nature of fungal infections in bone and joint necessitates long-term follow-up evaluation, even with adequate surgical debridement and medical therapy.

Arthritis, Infectious↗
PubMed1987

The use of the vastus lateralis flap in patients with intractable infection after resection arthroplasty following the use of a hip implant.

Recurrent sepsis and breakdown of the tissues in the operative wound after resection arthroplasty is performed for a hip with an infection at the site of an implant present a formidable challenge. A review of the literature indicates that more than 25 per cent of patients had delayed healing, additional surgery, or persistent drainage after resection arthroplasty. Under these circumstances, muscle flaps may help provide definitive closure, cessation of drainage, and functional recovery of the extremity as well as a reduction in the length and cost of hospitalization. The successful use of a vastus lateralis flap in seven patients is described. The specific advantages are: the flap has a consistent reliably identified vascular pedicle which permits a wide arc of rotation; sufficient muscle volume enables large open wounds to be filled; the structural integrity of the muscle is not violated by previous operations; and no important functional deficit is attributable to the procedure.

Drainage↗