Search PubMed⌕ Search

Biomedical subjects

M H Huo

Publications and source records attributed to M H Huo.

At least 37 records · Page 2Linked to original sources
PubMed1993

Total hip arthroplasty in patients with diabetes mellitus.

Diabetes mellitus is a common disease. It affects multiple organ systems. Adverse effects of hyperglycemia on infection, fracture healing, and bone remodeling have been recently reported. This study was conducted to evaluate the clinical and radiographic results of 93 total hip arthroplasties in 78 consecutive patients with diabetes. All femoral components were cemented using contemporary cementing techniques. Prophylactic antibiotics were given in each case. The mean follow-up period was 4.1 years (range, 2-6.5 years). Ninety-six percent of the hips were rated excellent or good. Radiolucencies were observed in only 3.7% of the stems, while 22.2% of the cups showed radiolucencies. There was a 4% revision incidence. There was no postoperative infection in this series--a distinct improvement from previously reported series. However, complications remained high at 24.3%. The most frequent complication was urinary tract infection (14.2%). The most serious complication was myocardial infarction. The authors believe total hip arthroplasty can be safely performed in patients with diabetes, provided that adequate medical and follow-up evaluations are performed. The medium-term clinical and radiographic follow-up evaluations are not inferior to reported series in patients without diabetes.

Adult↗
PubMed1993

Evaluation of painful hip arthroplasties. Are technetium bone scans necessary?

We reviewed the plain radiographs, bone scans and hip aspiration results of 54 patients with painful hip arthroplasties which had been explored surgically, to compare the results of the investigations with the operative findings. For acetabular loosening, the sensitivity and specificity of bone scanning were 87% and 95%, with an accuracy of 90%: for serial plain radiography sensitivity was 95%, specificity 100% and accuracy 97%. For femoral component loosening, bone scan sensitivity was 85%, specificity 100% and accuracy 89%: the sensitivity of plain radiography was 100%, with specificity 92% and accuracy 98%. Technetium bone scanning did not provide additional information with regard to loosening and is not necessary in the routine investigation of a painful hip arthroplasty. Serial pain radiography is the most effective method of detecting loosening, and bone scanning is useful only when radiography is inconclusive with regard to loosening or infection.

Adult↗
PubMed1993

Custom-designed femoral prostheses in total hip arthroplasty done with cement for severe dysplasia of the hip.

A custom-designed femoral prosthesis was implanted with cement and a standard acetabular component was used to treat nineteen severely dysplastic hips in fourteen consecutively managed patients. Components that had been custom-designed with the use of plain radiography were used because the anatomical reconstructive goals could not be achieved with commercially available implants. These goals were to match the offset of the femoral head and the length of the lower limb with those on the normal side for patients who had unilateral involvement and to provide an average (thirty to forty-millimeter) offset with equal limb lengths for patients who had bilateral involvement. A retrospective clinical and radiographic analysis was performed. The diagnoses included coxa vara (one hip), congenital dislocation (twelve hips), achondroplasia (three hips), and spondyloepiphyseal dysplasia (three hips). The mean age at the time of the reconstruction was forty-nine years (range, twenty-two to seventy-three years), and the mean duration of follow-up was fifty-seven months (range, twenty-seven to 108 months). In five hips, bone-grafting of the acetabulum was needed to obtain superolateral coverage. The clinical result was excellent in eighteen hips and good in one. No revisions have been performed to date. Two femoral components were possibly loose radiographically. One was associated with a definite loosening of the acetabular cup. In addition, one other cup was possibly loose. There was a 100 per cent rate of survival if only a revision procedure was considered as a failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Metallic wear debris in acetabular osteolysis in a mechanically stable cementless total hip replacement: report of a case.

Wear debris has evolved as the primary etiology of mechanical loosening of cemented as well as uncemented total hip arthroplasty. Osteolysis results from particle formation, and this has been most commonly reported to be secondary to polyethylene wear debris. This article demonstrates that metallic particle debris will also result in significant osteolysis. The two sources in this case are cobalt-chromium (Co-Cr) particles from the acetabular component and titanium-alloy (Ti) particles from the Morse taper junction and the Ti-alloy femoral head. However, it is likely that polyethylene debris also contributed to the osteolysis, because a titanium head was used and we know this results in increased poly wear.

Adult↗
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↗
PubMed1993

The rationale for cemented total hip arthroplasty.

Long-term follow-up of early Charnley cemented THAs demonstrates excellent survival (Table 1). New techniques in cementing have improved the quality of the femoral cement fixation and have shown consistently good performance at 10-year follow-up. Noncemented designs have not yet demonstrated similar long-term results. Recent reports reveal osteolysis in noncemented prostheses, which is observed earlier than in cemented designs. This implies a greater role for polyethylene debris in the etiology of osteolysis. Polyethylene debris is produced not only at the articulation but also at the nonarticular metal-polyethylene interface in modular metal-backed acetabular components. This results in the production of additional plastic debris. Metal backing has not demonstrated any clinical improvement in the long-term performance of cemented acetabular components. Furthermore, it may be detrimental due to decreased polyethylene thickness, increased stress within the polyethylene, and an increased rate of polyethylene wear of both the articular and nonarticular surfaces. Multiple reports have demonstrated that titanium alloy is not an acceptable articulating surface because it has a poor resistance to abrasion. It can result in severe metallosis in the periarticular tissues, leading to progressive osteolysis and early failure of the arthroplasty. Caution is suggested in the widespread application of polymodular femoral components because the production of metallic debris may prove excessive. Cemented THA remains the gold standard by which other methods of fixation must be assessed. The enviable long-term results with early cementing techniques and the Charnley prosthesis will be difficult to match, even with developing technology.

Acetabulum↗
PubMed1992

Bone graft and total hip arthroplasty. A review.

The success of total hip arthroplasty has been well documented. Aseptic loosening remains the major long-term problem that can lead to significant bone loss and structural deficits. Bone graft has been used with increasing frequency to reconstruct these difficult cases. In this review, the authors detail the biology, biomechanics, and banking of bone grafts. A summary of currently available data on the clinical result of autograft and allograft in reconstructive hip surgery is presented.

Acetabulum↗
PubMed1992

Primary total hip arthroplasty in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease affecting primarily young women. Osteonecrosis of the femoral head produces significant morbidity in these patients. The clinical and radiographic results of 33 total hip arthroplasties (THA) in 25 patients were studied. The Hospital for Special Surgery hip rating was good or excellent in all surviving index primary hip arthroplasties at a median follow-up of 47 months. Overall survival probability was 94.6% at 5 years and 81.8% at 9 years using survivorship analysis. Perioperative morbidity was minimal. Total hip arthroplasty using contemporary techniques and current management protocols can provide reliable functional improvement in patients with osteonecrosis secondary to SLE.

Adult↗
PubMed1992

Titanium wear debris in failed cemented total hip arthroplasty. An analysis of 71 cases.

Seventy-one cemented total hip arthroplasties (THAs) were reviewed following removal of the all-titanium alloy femoral stem. Fifty-one hips were primary arthroplasties that failed due to aseptic loosening, 8 were previous revisions with aseptic loosening, and 12 were removed for infection. The average duration of service for the three groups was 4.5 years, 5.0 years, and 3.7 years, respectively. Femoral bone loss in aseptically loose, primary THA was graded as severe in 51%, moderate in 24%, and mild in 20%. Femoral endosteolysis was present in 94%, while acetabular osteolysis was seen in 6%. Histological evaluation of tissues from failed primary arthroplasties revealed polymethyl methacrylate debris in 75% of cases, polyethylene debris in 80%, metal debris in 75%, and chronic inflammatory cells in all cases. Metallic debris was not seen in the failed revision cases and in only 17% of the infected cases. Examination of retrieved femoral components revealed burnishing of the head in all cases, while 71% of stems with aseptic loosening were abraded from the cement. Metal levels from 12 cases averaged 2,111 mg/g of dry tissue (range, 60-11,823); synovial fluid levels from 8 other cases averaged 106 mg/l (range, 22-340). While it is not certain whether metallic particles are a primary cause of loosening or are generated secondarily, their presence seems to accelerate bone loss and loosening.

Adult↗
PubMed1992

Metallic debris in femoral endosteolysis in failed cemented total hip arthroplasties.

A prospective study was undertaken to quantitate metallic and cement debris in 12 consecutive patients with femoral endosteolysis (FE) and aseptic loosening of a cemented total hip arthroplasty. The mean interval between primary and revision surgery was 9.6 years. The average time to onset of FE was 8.9 years. There were four stems each of cobalt-chromium (Co-Cr), stainless steel (SS), and titanium alloy. At revision, tissue was retrieved from FE, the femoral bone-cement pseudomembrane, and the joint pseudocapsule. Histology of these tissues was studied using light and polarized microscopy. Metal and barium levels were measured by atomic absorption spectrophotometry. A histiocytic reaction and particulate cement debris were seen in every case. Polyethylene wear debris was noted in 11 of 12 cases (92%), and metallic debris in four cases (33%). Detectable metal levels were found in the FE in all cases. Metal levels were on average 2.5 times higher in FE than in femoral pseudomembrane, and 4.2 times higher than in joint pseudocapsule. This difference was statistically significant for the Co-Cr and SS groups. Barium levels in areas of FE were on average 1.7 times and 42.4 times higher than in femoral pseudomembrane and joint pseudocapsule, respectively. The difference seen between the FE and the joint pseudocapsule tissue was significant for all three alloy groups. The authors' data demonstrated higher metal and barium levels in FE than in the other tissue sites. Polyethylene and cement debris were noted in nearly every case. Cement, polyethylene, and metallic particulate wear debris may contribute to the pathogenesis and progression of FE.

Adult↗
PubMed1992

Intraoperative adjusted-dose heparin thromboembolic prophylaxis in primary total hip arthroplasty.

Intraoperative, fixed, intermittent, low-dose intravenous heparin prophylaxis has been reported to significantly reduce the incidence of thromboembolic disease from 24.3% to 8.3% after primary total hip arthroplasty (THA). This study examined the potential efficacy of adjusted-dose intraoperative heparin administration, keeping the activated clotting time at 30%-50% greater than normal. It was hypothesized that prolongation of clotting parameters in a uniform manner would further decrease the incidence of thromboembolic disease postoperatively. Sixty-one patients completed the protocol. The overall incidence of thromboembolic disease was 9.8%. Five patients had a positive postoperative venogram: four in the calf and one in the proximal deep thigh vein. One patient had a symptomatic nonfatal pulmonary embolus diagnosed by ventilation-perfusion scan. There were no complications related to heparin administration. This approach was therefore equally as effective as the fixed-dose regimen, and it further confirmed the efficacy and safety of an intraoperative heparin prophylaxis regimen. The extra efforts required to maintain a constant intraoperative level of anticoagulation did not prove advantageous over the simpler, fixed-dose regimen in reducing the incidence of thromboembolic disease after primary THA.

Adult↗
PubMed1992

Intraoperative heparin thromboembolic prophylaxis in primary total hip arthroplasty. A prospective, randomized, controlled, clinical trial.

Venous thromboembolic disease remains the most common and potentially fatal complication after total hip arthroplasty (THA). Proximal femoral deep vein thrombosis (DVT) is especially prone to propagate and embolize. The authors' hypothesis was that intraoperative intravenous heparin administration could reduce proximal DVT in THA. There were 286 patients who entered into a prospective, double-blind, randomized clinical trial at the authors' institution between June 1988 and May 1990. All patients had unilateral primary THA under hypotensive epidural anesthesia. The epidural catheter was placed at least 60 minutes before heparin administration. Intravenous heparin was given during surgery only. All patients received aspirin twice daily (650 mg/day) after surgery. Detection of DVT was by contrast venography on Postoperative Day 6 or 7. The study was divided into three phases. There was four groups: control (intraoperative saline), 30 minutes (1000 U heparin at beginning of surgery followed by 500 U every 30 minutes), continuous adjusted (1000 U or 1500 U initial bolus followed by continuous heparin infusion maintaining anticoagulation at 30%-50% elevation from baseline), and fixed dose (1000 U bolus before hip dislocation, and 500 U bolus before femoral canal preparation). Proximal femoral DVT was effectively reduced from 9.1% in the control group to 1.7% in the heparin groups (1.7% in 30 minute, 1.6% in continuous adjusted, 1.7% in fixed dose) (p less than 0.02). The overall DVT rate was also significantly reduced from 24.3% to 10% (p less than 0.01). No adverse effects from heparin administration were noted. Postoperative drainage, hematocrit levels on Postoperative Day 2 and at discharge, and transfusion requirements were not significantly different among the groups. The current recommended protocol is 1000 U bolus five minutes before hip dislocation, followed by 500 U bolus five minutes before femoral preparation. This, in conjunction with hypotensive epidural anesthesia and postoperative aspirin, is effective in reducing proximal DVT to less than 2% in primary THA.

Aged↗
PubMed1991

The influence of ibuprofen on fracture repair: biomechanical, biochemical, histologic, and histomorphometric parameters in rats.

Ibuprofen is a widely used cyclo-oxygenase inhibitor in clinical practice. It has been demonstrated by others to have an inhibitory effect on fracture repair in animals. In the present study, we were unable to demonstrate any significant alterations in fracture biomechanics as measured by torsion testing and fracture stage in mature Sprague-Dawley rats treated with 30 mg/kg/day oral dose of ibuprofen, starting 3 days following fracture, over a 12-week time interval. Fracture histology and serum osteocalcin levels were no different in treated animals than control animals. Furthermore, histomorphometric parameters of bone remodeling, including bone volume and bone formation rate in the intact tail vertebrae of these animals with unilateral femur fractures, were no different between treated and control animals.

Animals↗
PubMed1991

Wear debris in cemented total hip arthroplasty.

One of the most prevalent clinical problems in long-term follow up of total hip arthroplasty patients is loosening of prosthetic fixation. Factors contributing to mechanical failure of total hip reconstruction are complex and multiple. It has become increasingly apparent that wear debris from the prosthetic components may contribute significantly to this process. The authors summarize some of the current concepts concerning the detrimental effects of metallic debris in total hip arthroplasty.

Bone Cements↗
PubMed1990

Complications in primary total knee arthroplasty.

Total knee arthroplasty is one of the most popular and satisfying procedures in orthopaedic surgery. However, several perioperative and postoperative complications may follow total knee arthroplasty, leading to reconstruction failure. This article summarizes the issues of wound healing, infection, supracondylar fractures, thromboembolic disease, soft tissue balance, peroneal nerve palsy, and patellofemoral problems following primary total knee arthroplasty.

Femoral Fractures↗