Biomedical subjects
Publications and source records attributed to M B Coventry.
In a study of our experience with the first 119 geometric arthroplasties of the knee done at the Mayo Clinic, reported after a minimum follow-up period of two years, we noted that relief of pain was the primary goal in 84 per cent of the cases and this was achieved in the majority. The average total motion was relatively unchanged but it became more useful postoperatively.
Seventy-five knees in 56 patients were examined preoperatively and at two years after geometric total knee surgery. Thirty-three knees were in 28 patients with osteoarthritis. Fourty-two knees were in 28 patients with rheumatoid arthritis. Pain was significantly decreased and the use of aids was significantly decreased in both groups. The distance walked increased significantly for the osteoarthritic group but not for the rheumatoid group. Rheumatoid patients did not fare as well as osteoarthritic patients in distance walked and use of aids. Knees with osteoarthritis had more evidence of lucent lines and implant loosening than did the rheumatoid patients.
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The chronology of infections after total hip arthroplasty has been categorized and described. Occurring at various time intervals after operation, the three phases of the infected total hip arthroplasty are as follows: (1) the acute complications with either a fulminating infection or a hematoma with potential or actual infection; (2) low-grade, creeping infection that is recognized early and treated with antibiotics alone, treated by débridement, with components left in place, or treated by débridement with removal of the components; (3) reimplantation of components after a previous hip infection. The methods for treating each of these phases are presented together with rationale for such treatment.
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In a series of 3,204 consecutive total hip arthroplasties performed on 2,684 patients at the Mayo Clinic from March 1, 1969, through February 28, 1972, reoperation for a complication was necessary in 125 hips (3.9 per cent). The complications, in order of frequency, were infection, dislocation, trochanteric problems, ectopic bone, and loosening of the femoral prosthesis. There were less frequent complications that also required further surgery. Attention to specific technical details is the most important means of avoiding a complication that requires reoperation.
Total hip arthroplasty was done in thirty-three patients who had had previous surgical attempts at arthrodesis of the hip. The arthrodesis had failed in nineteen patients, and the other fourteen patients had fused hips with symptoms in the knee and lower back. Thirty-one of the patients had satisfactory functional ability after total hip arthroplasty after one to three and one-half years' follow-up. The two patients in whom the procedure failed had complicating infections.
Five patients with chronic and subacute unreduced fracture-dislocation of the hip were treated successfully by total hip arthroplasty. The regimen developed was as follows: The first stage, in general, consisted of removal of the head of the femur and reduction and internal fixation of the acetabular fragments. Surgery to the sciatic nerve, if necessary, was done at this time. This was followed by total hip arthroplasty in five to eight weeks as a second stage. If severe fracture of the acetabulum occurred with dislocation of the hip, and the hip could be reduced, total hip arthroplasty could be done in one stage, either soon after the injury or at a later time. Such a procedure restores almost normal function to a hip that otherwise may remain painful and stiff because of traumatic arthritis and disturbed anatomical relationships of the acetabulum to the femoral head, and may save the patient much time and suffering.
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