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Biomedical subjects

M A Mont

Publications and source records attributed to M A Mont.

At least 91 records · Page 5Linked to original sources
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↗
PubMed1994

Total knee arthroplasty after failed high tibial osteotomy.

Total knee arthroplasty performed after failed high tibial osteotomy is an important subgroup encompassing close to 10% of replacements performed and may be difficult in 20% to 40% of these patients. The problems in this group can be different from those encountered with primary of revision total knee arthroplasty. The authors present a review of the literature on this subject including assessments of variables affecting outcome. Preoperative clinical and radiographic factors to be considered are discussed and surgical technical factors are delineated.

Humans↗
PubMed1994

Total knee arthroplasty after failed high tibial osteotomy. A comparison with a matched group.

The results of 73 total knee arthroplasties in 67 patients after a high tibial osteotomy (HTO) were carefully reviewed at an average follow-up period of 73 months (range, 24-132 months). An extensive clinical as well as radiographic review was performed in an attempt to evaluate parameters that might portend more favorable or worse outcomes. Additional comparisons were made with two groups of 73 primary TKAs matched according to age, gender, diagnosis, prosthetic fixation, and length of follow-up period. The two comparison groups differed in that one (Group A) was additionally matched to deformity before TKA with a second comparison group (B) matched to pre-HTO deformity. On the basis of a 100-point knee rating scale, 36% of the study group patients had either a fair or poor result or required additional surgery. This was significantly greater than either comparison group (p < 0.01). Factors that prognosticated a worse outcome in the HTO patients (p < 0.01) included (1) workmen's compensation patient, (2) history of reflex sympathetic dystrophy after HTO, (3) early onset (less than one year) or no period of relief of pain after HTO, (4) multiple surgeries before HTO, and (5) an occupation as a laborer.

Adult↗
PubMed1994

Hypocalcemic-induced tetany that causes triceps and bilateral quadriceps tendon ruptures.

Traumatic ruptures of the triceps are very rare among tendon injuries. A unique case of hypocalcemic tetany that induced spontaneous triceps tendon avulsion with associated bilateral quadriceps tendon ruptures is reported. The current orthopaedic literature is reviewed, and a new application of an existing surgical treatment for repair of the major tendon ruptures is described.

Adult↗
PubMed1993

Avascular necrosis of the humeral head treated by core decompression. A retrospective review.

Thirty shoulders, in 20 patients, which had undergone core decompression for symptomatic avascular necrosis of the humeral head were reviewed 2 to 14 years later (average 5.6). Twenty-two showed good or excellent clinical results; the other eight shoulders had required arthroplasty. All 14 shoulders with stage I or II radiological changes (Ficat and Arlet 1980) at operation had good or excellent results. We advocate early core decompression for symptomatic avascular necrosis of the humeral head.

Adult↗
PubMed1993

Total hip replacement without cement for non-inflammatory osteoarthrosis in patients who are less than forty-five years old.

Forty-two patients (forty-four hips) who, at an age of less than forty-five years, had a total hip replacement without cement for the treatment of non-inflammatory osteoarthrosis, were followed for three to seven years (average, four and one-half years). At the latest follow-up evaluation, thirty-seven hips (84 per cent) had an excellent Harris rating; three (7 per cent), good; one (2 per cent), fair; and three (7 per cent), poor. The mean Harris hip score was 92 points, compared with 43 points before the operation. Two hips (5 per cent) had a revision due to complications. In another hip, there was a progressive radiolucent line around the femoral component, increased shedding of beads, and a low score for fixation and stability, according to the criteria of Engh et al. We concluded that total hip arthroplasty without cement, at least for the time-period studied, has a high rate of success for the management of patients less than forty-five years old who have non-inflammatory osteoarthrosis of the hip.

Adult↗
PubMed1993

Surgical decompression for peroneal nerve palsy after total knee arthroplasty.

Five patients were treated by operative exploration and decompression of the peroneal nerve for peroneal nerve palsy complicating total knee arthroplasty (TKA). All patients had failed to demonstrate improvement in the peroneal nerve function despite extended conservative care. The procedure was performed five to 45 months after the index TKA. Patients were evaluated and graded preoperatively and postoperatively using the Modified Nerve Palsy Scale of Weber, Daube, and Coventry. All patients demonstrated improved nerve function. Four of five patients had full peroneal nerve recovery. All patients were able to discontinue their ankle-foot orthoses. This is a rare complication of TKA, and when conservative nonoperative measures do not lead to sufficient improvement in nerve function, consideration may be given to operative decompression of the peroneal nerve.

Adult↗
PubMed1993

Limited femoral endoprosthesis for avascular necrosis of the femoral head.

The options for treatment of the young patient with late-stage avascular necrosis of the femoral head are limited. The authors performed a conservative type of femoral hemiarthroplasty on a select group of patients. They chose for the series only patients with Ficat stage III and IV avascular necrosis, particularly those who had an intact acetabulum and femoral-head involvement only. Of 19 procedures followed for an average of 36 months, there were 84% good and excellent results. The authors feel that this operative procedure may have a role in the treatment of this specific group of young patients.

Adult↗
PubMed1992

Postoperative radiographs as predictors of clinical outcome in unstable ankle fractures.

This study reviews a group of 80 consecutive displaced ankle fractures treated operatively and followed for an average of 3.2 years. Fractures included bone or combined bone and ligamentous injuries in which the initial talar displacement was greater than or equal to 2 mm. The immediate postoperative roentgenograms were examined for several features, which included widening of the syndesmosis, fibular length, talo-crural angle, talar tilt, presence and size of a posterior malleolar fracture, and an abnormality of the medial clear space. Patients were examined at follow-up per Cedell, and their clinical evaluations were correlated with the analysis of radiographic features and demographic data. Good to excellent results were seen in 80% of the cases. The radiographic factors most predictive of a poor outcome were abnormal medial clear space and the presence of a large (greater than 20%) posterior malleolar fracture (p less than 0.05). Fibular shortening, talar tilt, and syndesmotic widening suggested a poor result, but these findings were not statistically significant. Multiple (two or more) radiographic abnormalities correlated with a poor prognosis. Conversely, a perfect radiographic result did not guarantee an excellent clinical outcome. Older patients and those with a delay between injury and surgery greater than 7 days tended to have a poorer result.

Adolescent↗
PubMed1992

Hoop-stress fractures of the proximal femur during hip arthroplasty. Management and results in 19 cases.

Retrospective review of 730 consecutive primary uncemented and cemented total hip arthroplasties revealed 19 intra-operative hoop-stress fractures of the femoral neck. These were incomplete, linear, and minimally displaced. Management was by cerclage wiring (12), bone graft and cerclage (two), further impaction (two), and the use of cement (three), with no change from our standard postoperative management and rehabilitation. Eighteen patients had excellent or good results with an average Harris hip score of 93. Radiographically, all but one patient had Engh stability-fixation scores consistent with stable bone ingrowth. We conclude that hoop-stress fractures of the proximal femur, properly managed, do not detract from the results of total hip arthroplasty.

Baltimore↗
PubMed1990

Non-invasive low-intensity pulsed ultrasound accelerates bone healing in the rabbit.

The effect of ultrasound (US) on the rate of fibula osteotomy healing in 139 mature New Zealand white rabbits was assessed in this study. Bilateral midshaft fibular osteotomies were made using a 1-mm Gigli saw. US was noninvasively applied to one limb for 20 minutes daily, while the contralateral limb served as a control. A 2.5-cm PZT transducer was applied to both limbs, with the treated limb receiving a 200-microseconds burst of 1.5-MHz sine waves repeated at 1.0 kHz. The incident intensity was approximately 30 mW/cm2. Animals were killed at intervals between 14 and 28 days. Maximum strength increases (significant to p less than or equal to 0.01) ranged from 40 to 85% from postoperative day 14 to 23. On day 28, no significant difference in ultimate strength was noted. From day 17 through day 28, all US-treated fractures were as strong as intact bones (p less than or equal to 0.005). On the other hand, the ultimate strength of the control osteotomies attained intact values only by day 28. These results indicate that biomechanical healing is accelerated by a factor of nearly 1.7. This occurs with an overall acceleration of the healing curve in this fresh fracture model. If noninvasive low-intensity pulsed sine wave ultrasound can significantly accelerate bone repair in clinical application with an in-home treatment of 20 minutes daily, then US may be a useful adjunct for fracture care with a concomitant impact on patient morbidity.

Animals↗
PubMed1981

Pemphigus vulgaris and drug reactions.

A retrospective study of patients with pemphigus vulgaris, drug eruptions, psoriasis, and normal controls was undertaken in an attempt to determine whether a significant difference in drug exposure and/or drug allergy existed between the various groups. A statistically significant difference in drug exposure was found between pemphigus vulgaris and drug eruption patients, as compared with psoriatics and normal patients. Representative case reports and some possible mechanisms for the induction or exacerbation of pemphigus patients is described and discussed.

Aged↗
PubMedDate not supplied

The effects of ciprofloxacin on human chondrocytes in cell culture.

Ciprofloxacin is a highly potent antibacterial agent that is used extensively in bone and joint infections. Because of reports of potential chondro-toxicity in animals, the effects of this drug on cells derived from human cartilage were tested in liquid micromass and agarose gel cultures. An inhibition of cell proliferation as indicated by a decrease in [3H]-thymidine uptake and bromodeoxyuridine labeling at ciprofloxacin concentrations of 0.5 and 50 mg/l was found which corresponded to the therapeutic and toxic serum levels. There was no effect on proteoglycan synthesis as indicated by 35SO4 incorporation. Immunocytochemistry showed no changes in morphology or staining patterns for type-I procollagen, type-II collagen, keratan sulfate and unsulfated chondroitin. Because the amount of inhibition of DNA synthesis varied with different ciprofloxacin concentrations, this data suggests that this agent has a differential effect on newly differentiating cells and might be the basis for contraindication in pediatric patients.

Adult↗
PubMedDate not supplied

Isokinetic concentric versus eccentric training of shoulder rotators with functional evaluation of performance enhancement in elite tennis players.

Thirty elite tennis players were randomly assigned to three groups to evaluate shoulder isokinetic internal and external rotation training: an isokinetic concentric group, an isokinetic eccentric group, and a control group with no training. Subjects were tested before and after training both concentrically and eccentrically using an isokinetic dynamometer. Functional output before and after training was assessed by the average and peak velocity of six maximal serves. The effect of training on serve velocity endurance was also assessed. Statistically significant concentric and eccentric strength gains (11%) were obtained in both training groups when compared with controls (decreased total average strain of 2%) (P < 0.0004). Serve velocity increased by greater than 11% in both training groups, which was a significant increase from the average of 1% in the control group (P < 0.0001). In the endurance study, training group subjects displayed a tendency to maintain their serve velocity (loss of approximately 2%) greater than controls (loss of 6.4%) (P < 0.05). Isokinetic training led to increases in objective and functional output in elite tennis players. This training regimen may have significance in the final stages of the rehabilitation of injured shoulders as well as in improved performance and reduced injury risk.

Adolescent↗
PubMedDate not supplied

Upper extremity physical factors affecting tennis serve velocity.

Forty tournament-level tennis players with expert serve technique volunteered to have their serve evaluated to determine relationships between anthropometric data, extremity strength, and functional serve velocity. All players underwent a complete physical examination, a video taped serve analysis, a radar measurement of serve velocity, and a series of upper extremity strength measurements. Statistical analysis was performed to determine which factors were related to serve velocity. Statistically significant relationships were found between serve velocity and several flexibility measurements including increased dominant wrist flexion (P < 0.05), increased dominant shoulder flexion (P < 0.05), and increased dominant shoulder internal rotation at 0 degrees of abduction (P < 0.05). Several strength measurements were also related to serve velocity including elbow extension torque production (P < 0.01) and the ratios of internal to external rotational torque production for both low- and high-speed measurements (P < 0.01 concentrically and P < 0.05 eccentrically). These findings relate strength and flexibility to serve velocity, suggesting that it may be possible to increase a tennis player's serve velocity through specifically directed muscular strengthening or stretching regimens. However, prospective studies must be undertaken to demonstrate these possibilities.

Adolescent↗
PubMedDate not supplied

Tennis after total hip arthroplasty.

The purpose of this study was to characterize patients who play tennis after undergoing hip arthroplasty in terms of their functional abilities and degree of satisfaction. A questionnaire was sent to all United States Tennis Association member associations in a tri-state area to identify players who had undergone a hip arthroplasty. The study group had 50 men and 8 women with a mean age of 70 years (range, 47 to 89). Only 14% of the patients' surgeons approved this tennis activity, with 34% of the surgeons recommending only doubles. Three patients required revision surgery after a mean of 8 years. One year after arthroplasty, players played both singles and doubles approximately three times per week. All tennis players were extremely satisfied with their hip arthroplasties and their increased ability to participate in their favorite sport. Because this study was confined to association members, further studies are needed to assess the general effect of tennis on total hip arthroplasty. Until future studies are performed, the authors would recommend that physicians advise caution in tennis activities and to carefully follow their patients yearly to see if osteolysis is occurring prematurely.

Aged↗