Biomedical subjects
Publications and source records attributed to M E Blazina.
A modular humeral hemiarthroplasty utilizing a prosthesis with a taper-lock design was performed on a 77-year-old woman with a diagnosis of rotator cuff arthropathy. Radiographic examination at 3 months after surgery revealed disarticulation of the modular head and neck from the humeral prosthetic stem. This is a case report of a disarticulated modular humeral hemiarthroplasty.
The CO2 laser is a precision surgical laser because of its high degree of absorption in soft tissue with limited lateral damage. The tissue, which absorbs the CO2 laser energy, and has a high water content, will be converted to vapor with a small residue of ash and a by-product of heat. The laser can only be effective if these by-products, i.e. vapors, heat, and carbon ash residue, are not injurious and are well tolerated by the joint. These by-products must be either reabsorbed by the synovium or remain as a nonviable substance in the joint. From April 1989 through April 1990, 40 patients underwent 43 operative arthroscopies of the knee using the Pfizer CO2 laser. All procedures were chondroplasties, synovectomies, and/or meniscectomies. All accessible CO2 carbon ash residue was removed from the joint after the procedures using an intraarticular shaver and hand rasp. Postoperatively there were no cases of hemorrhagic effusions, subcutaneous emphysema, or synovitis. Histologic examinations performed on 10 patients undergoing subsequent surgery showed no evidence of carbon ash residue or synovitis seen grossly or microscopically. The carbon ash residue is not noxious to the joint and is completely removed from the joint, presumably by the synovial response.
Incidental metastatic breast carcinoma was discovered by histologic examination in a total knee arthroplasty (TKA) patient. A 70-year-old woman was evaluated for increasing debilitating pain in the right knee. A radiograph demonstrated only degenerative changes. Degenerative changes were noted in the gross and microscopic examination of the knee specimen. The unsuspected focus of poorly differentiated adenocarcinoma was suggestive of mammary carcinoma. A mass in the right breast then was subsequently noted on reexamination. Mastectomy showed infiltrating adenocarcinoma with metastases to axillary lymph nodes, and diffuse involvement of the skeleton was demonstrated with a bone scan. This case emphasizes the importance of a meticulous history and a complete medical examination before surgery, detailed examinations of the excised knee and joint fragments by a pathologist after a TKA operation. Malignancy can be missed with only gross specimen evaluations and radiographs.
Sixty-eight consecutive unicompartment knee arthroplasties were reviewed. Seven patients were lost to follow-up evaluation, and the review group consisted of 55 patients with 61 medial compartment replacements. Follow-up periods averaged 51 months, with a range of 24 to 70 months. All of the knees had a Robert Brigham unicompartment arthroplasty. All patients were evaluated using The Knee Society Clinical Rating System. Overall results revealed that 70% (42 patients) rated excellent, 10% (seven patients) rated good, 10% (six patients) rated fair, and 10% (six patients) were failures. Preoperative scores in the pain, range of motion, and stability sections averaged 54 points of a maximum of 100. Postoperatively, the scores averaged 87 points. Postoperative roentgenographs were evaluated using The Knee Society Roentgenographic Evaluation and Scoring System. Roentgenographs revealed at least one radiolucent line in 16 femoral components and 15 tibial components, and nine in both. Four of the six failures in the series had lucent lines in both the femur and tibia. This procedure is recommended in active patients between the ages of 55 to 65 years with single compartment disease. Also, a unicompartment arthroplasty is recommended in more sedentary patients 65 years and older with single compartment disease.
Eighty-two patients, average age 29 years, were surgically treated (during the period from April 1981 to July 1983) for both acute (8%) and chronic (92%) knee ligament instabilities. An absorbable copolymer-carbon fiber ligament prosthesis was used as a tissue scaffold. Seventy-five percent had anterior cruciate ligament reconstructions, 6% had anterior cruciate and posterior cruciate ligament reconstructions, 6% had just posterior cruciate ligament reconstructions, and 9% had other combinations of anterior cruciate ligament, medical collateral ligament, and lateral collateral ligament reconstructions. Preoperative and postoperative evaluation, consisting of questionnaires, physical examinations, and isoskinetic testing, revealed significant improvements in categories of stability, pain, function, and strength persisting to the end of the study at 24 months. Arthroscopic examination and histologic studies of retrieved specimens demonstrated well-vascularized reconstructions with collagenous tissue ingrowth into the carbon-copolymer implants.
Prosthetic ligament device evaluation techniques involve the following: stating the goals of the use of the prosthesis; obtaining adequate postoperative assessment by using standard clinical measurements of joint stability and performance; obtaining the patient's own evaluation of the reconstructive process; and periodically insuring that there is retention of the initial benefits obtained throughout the recovery period.
In a retrospective study, 14,731 menisci were examined to determine the incidence of discoid medial and lateral menisci. Of 8040 medial menisci, ten (0.12%) were discoid. Of 6691 lateral menisci, 102 (1.5%) were discoid. Only 22 discoid medial menisci have been reported in the medical literature. The previously reported cases were analyzed as one series and compared with the present series of ten cases as another. The incidence rate of symptoms in patients older than 18 years of age was 62% in the present series and 65% in the other series. The male to female ratio was three to one in both series. In 38% of the patients in this series trauma preceded meniscal symptoms, as compared with 66% in the literature series. Radiographic abnormalities had been reported in two of the patients reported in the literature, but none were noticed in our series. In both series, all patients recovered following meniscectomy, with the exception of one patient in our series, who developed chondromalacia patella from an unrelated patellar abnormality.
Utilizing material from a registry of knee surgery, subsequent operations relating to meniscectomy were reviewed. The overall reoperation rate for the entire series was 30%; 6% of the patients eventually had at least the other meniscus removed. One out of ten had subsequent anterior stabilization with or without removal of the meniscus. Only 4% had an osteotomy, knee replacement or arthrodesis at a later date. Further and expanded studies may aid in further understanding the ultimate fate of meniscectomized knees. Longer follow-up examinations are required to evaluate the long term results following removal of the meniscus through the operative arthroscope.
The normal mechanics of patellar motion lead to an eventual age-dependent degeneration of the patellofemoral joint in the majority of persons. This review explores the relationships between normal patellar mechanics, patellofemoral joint disease, and findings of quadriceps femoris muscle-function studies. Implications of these relationships are then discussed with regard to the rehabilitation of all patients.
From an analysis of the clinical evaluation of 85 cases and subsequent revisionary procedures, patients for isolated patellofemoral joint replacements should be carefully selected. At the present time, the primary indications are distortion or severe degeneration of the femoral groove.
The incidence of a symptomatic retained posterior fragment of the medial meniscus in 2 different groups of patients with medial meniscectomy is compared. If the original surgery was done through one capsular incision, there was a 9.5% incidence of symptomatic retained posterior fragment as compared to 0.2% incidence if the original surgery was performed through 2 capsular incisions. For total excision of the meniscus medial meniscectomy should be performed through 2 capsular incisions.
A review of fifty-one cases of the modified Bristow procedure for recurrent anterior shoulder instability is presented. The results were favorable. The redislocation rate was 2% with few complications. The average limitation of motion was 11 degrees of external rotation. Athletic individuals with involvement of the dominant shoulder were not capable of returning to high performance levels of overhead sports activity (particularly throwing) after the operation.
An analysis was perfomed on 32 operative cases of Achilles tendon disease. Two patient classifications emerged. One group suffering an acute rupture of the Achilles tendon with no antecedent complaints, and the second group had a history of chronic pain, weakness and functional loss. This latter group could be further differentiated by the occurrence of tendon failure in 10 of 22 cases. Surgical exploration in the group with chronic complaints demonstrated a high incidence of diffuse reactive changes such as fibrinoid and myxomatous degeneration, fibroisis and metaplastic calcification. Degenerative disease of the Achilles tendon should be recognized and treated not as a simple injury but as a pathological lesion.
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