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Biomedical subjects

M J Lemos

Publications and source records attributed to M J Lemos.

13 recordsLinked to original sources
PubMed2000

Athletic activity after total knee arthroplasty.

Americans are aging, elderly Americans are more active, and the prevalence of total knee arthroplasty is increasing. Indications for knee replacement include pain, deformity, and a desire to improve function. When patients have knee replacement operations, frequently they increase their activities. It is important for patients with knee replacements to understand the impact of athletic activity on the outcome of knee replacements. Orthopaedic surgeons should educate patients regarding athletic activity after total knee arthroplasty. Considerations and risk factors for athletic activity after knee replacements include athletic activity before surgery, preoperative rehabilitation, surgical reconstruction, implant failure or fracture, implant fixation or loosening, and joint bearing surface wear. Anatomic reconstruction and compulsive postoperative rehabilitation with restoration of muscular control are important for optimum function after total knee arthroplasty. In general, patients with knee replacements are encouraged to participate in low-impact, low-demand sports, and to avoid high-impact, high-demand sports.

Arthroplasty, Replacement, Knee↗
PubMed2000

Single Price/Case Price Purchasing in orthopaedic surgery: experience at the Lahey Clinic.

BACKGROUND: Hospital revenues for orthopaedic operations are not keeping pace with inflation or with rising hospital expenses. In an attempt to reduce the hospital cost of orthopaedic operations by reducing the cost of operating-room supplies, we developed a Single Price/Case Price Purchasing Program for implants used in total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty as well as for arthroscopic shavers and burrs, interference screws, and bone-suture anchors. METHODS: The Lahey Clinic asked orthopaedic vendors to supply all instruments, implants, and disposable items related to these selected products for one single price per unit or case. For example, a single price for total hip arthroplasty implants included instruments, acetabular cups, acetabular liners, acetabular screws, femoral stems, femoral heads, and stem centralizers, if required. The hospital implemented the Single Price/ Case Price Purchasing Program with a competitive-bid request for proposal. Surgeons evaluated the responses to the bidding process, and they made final decisions on product selection. RESULTS: The Single Price/Case Price Purchasing Program at the Lahey Clinic was successful in reducing the cost of orthopaedic implants and supplies. In the present article, we could not disclose the specific prices that we agreed to pay our vendors. The specific cost reductions were 32 percent for hip implants with a change of vendor, 23 percent for knee implants without a change of vendor, 25 percent for shoulder implants with a change of vendor, 45 percent for arthroscopic shavers and burrs without a change of vendor, 45 percent for interference screws without a change of vendor, and 23 percent for bone-suture anchors without a change of vendor. CONCLUSIONS: The Single Price/Case Price Purchasing Program at the Lahey Clinic allowed the hospital to reduce its cost of orthopaedic operations by lowering the cost of operating-room supplies. This cost reduction is important in a health-care economy in which hospital revenues per unit of service or care are decreasing.

Arthroplasty, Replacement↗
PubMed1995

Assessment of initial fixation of endoscopic interference femoral screws with divergent and parallel placement.

Divergence of the interference screw placement used for femoral fixation during endoscopically assisted reconstruction of the anterior cruciate ligament has been described. This study is a biomechanical evaluation in 12 pairs of fresh intact bovine knees of femoral interference screws placed divergently and parallel relative to the bone block and its tunnel. One knee of each pair had the interference screw placed in a parallel fashion and the other knee had a 15 degrees divergence from the bone plug. Paired specimens were used to provide an optimal comparison of biomechanical data of the two different screw placements. No statistically significant differences were seen between the two groups when looking at ultimate load, deformation, and stiffness. Mode of failure was of more concern: in 4 of 12 divergent constructs, bone plug pullout occurred compared with only 1 of 12 in the parallel construct. The pullout strength remains high even with divergence of up to 15 degrees between the bone plug and femoral interference screws placed endoscopically.

Animals↗
PubMed1993

Radiographic analysis of femoral interference screw placement during ACL reconstruction: endoscopic versus open technique.

Fifty patients with anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft performed by two techniques were evaluated roentgenographically to compare the position of the femoral interference screws. Group I consisted of 25 patients in whom the screw was placed using a distal lateral femoral incision (the two-incision technique). Group II patients underwent arthroscopically assisted intraarticular placement of the screw. These patients were then evaluated with anterior-posterior (AP) and lateral roentgenograms. We observed that the AP and lateral screw angles were significantly different with the two techniques. In addition, the endoscopic placement of the femoral screw had an associated divergence of the screw relative to the bone plug in nine of 25 patients compared with zero of 25 in the open group. In conclusion, radiographic differences do exist between femoral interference screws placed for fixation of an ACL graft using the open approach and those placed endoscopically. Although the clinical significance of these differences is not known, we raise the question of greater divergence in femoral interference screw placement with the newer intraarticular femoral interference screw placement techniques.

Anterior Cruciate Ligament↗
PubMed1992

Pulmonary embolism in total hip and knee arthroplasty. Risk factors in patients on warfarin prophylaxis and analysis of the prothrombin time as an indicator of warfarin's prophylactic effect.

This study was designed to identify those total arthroplasty patients at high risk for embolism even while on a proven warfarin prophylactic regimen and to identify the measure of anticoagulation that would be most efficacious in the prevention of pulmonary embolism (PE). A series of 2348 total arthroplasty patients had a preoperative perfusion scan and a postoperative ventilation/perfusion scan. All patients were placed on a low-dose warfarin protocol. Eighty-one patients were identified as having a PE by pulmonary arteriography (incidence of 3.4%). Of these, 89% were asymptomatic and no case was fatal. A control group of 159 patients without PE was used for comparison. Patients older than 65 years of age with a history of genitourinary infection were identified as being at higher risk of PE while on a proven warfarin prophylactic program. These patients may need additional prophylactic measures to reduce the risk of PE. In contrast, patients with a history of phlebitis, PE, obesity, or varicosities were not at excess risk for PE while on warfarin prophylaxis; therefore, no additional prophylactic measures are required. All prothrombin time profiles were within the prophylactic range. Therefore, the actual prothrombin time may not be the critical determinant of the level of anticoagulation or prophylaxis achieved.

Analysis of Variance↗
PubMedDate not supplied

Scalp lacerations resulting in hemorrhagic shock: case reports and recommended management.

Scalp lacerations may bleed profusely when not adequately controlled. Three cases of isolated scalp lacerations that resulted in hemorrhagic shock are reported. A technique for achieving hemostasis using scalp clips is presented. Rapid assessment and early hemostasis of scalp lacerations are advocated, especially in the patient with multiple injuries.

Accidents, Traffic↗
PubMedDate not supplied

Posterior spinal arthrodesis for atlantoaxial instability in Down syndrome.

Nine children with Down syndrome who had atlantoaxial instability underwent posterior spinal fusion. At follow-up, all patients had stabilization or improvement of their neurologic symptoms. Evaluation of the spine using flexion and lateral radiographs, as well as selective cineradiography, showed no instability over the fused area or adjacent motion segments. Stable fibrous union with no clinical significance was noted in three of the nine patients. We recommend posterior spinal fusion in situ with external immobilization as the safest and most effective means of surgical stabilization in the patient with Down syndrome who has symptomatic atlantoaxial instability.

Adolescent↗
PubMedDate not supplied

Rupture of the pectoralis major muscle. Outcome after repair of acute and chronic injuries.

We retrospectively studied 17 cases of distal pectoralis major muscle rupture to compare the results of repair in acute and chronic injuries and to compare operative and nonoperative treatment. Thirteen patients underwent surgery (six acute injuries [less than 2 weeks after injury] and seven chronic injuries) and four had nonoperative management. The mean age of the patients at injury was 29, and 10 of the 17 injuries were the result of weight lifting. Follow-up ranged from 18 months to 6 years (mean, 28 months). All patients subjectively rated strength, pain, motion, function with strenuous sporting activities, cosmesis, and overall satisfaction. Objectively, patients were examined for range of motion, deformity, atrophy, and strength. Isokinetic strength testing was performed in eight patients: six treated operatively (three acute and three chronic) and two treated nonoperatively. Overall subjective ratings were 96% in the acute group, 93% in the chronic group, and only 51% in the nonoperative group. Isokinetic testing showed that patients operated on for acute injuries had the highest adduction strength (102% of the opposite side) compared with patients with chronic injuries (94%) or nonoperative treatment (71%). There were no statistically significant subjective or objective differences in outcome between the patients treated operatively for acute or chronic injuries, but these patients fared significantly better than patients treated nonoperatively.

Adult↗
PubMedDate not supplied

Athletic activity after joint replacement.

The first decade of the 21st century has been declared the "Bone and Joint Decade" by 35 nations and 44 states in the United States as of March 2001. It is not surprising that Americans are interested in musculoskeletal disease and the treatment of bone and joint disorders because our population is aging, the prevalence of arthritic joints is increasing, and senior Americans are demonstrating a strong desire to stay active in activities of daily living and athletics. One of the most successful treatments for painful arthritic joints, which limit activity, is total joint replacement, which predictably relieves pain and improves function. Much has been written about the technical aspects of total joint arthroplasty. Less has been written about safe and appropriate activities for patients who have had joint replacement operations. This article evaluates athletic activity after joint replacement by reviewing the orthopaedic literature and surveying members of The Hip Society, The Knee Society, and The American Shoulder and Elbow Surgeons Society. The authors have developed consensus recommendations for appropriate athletic activity for patients who have had joint replacement operations. This article is intended to serve as a guide for orthopaedic surgeons and primary care physicians who give patients recommendations for athletic activity after joint replacement. This article is also intended to stimulate further research in the area of athletic activity after total joint arthroplasty.

Arthroplasty, Replacement↗
PubMedDate not supplied

Acromioclavicular separation. Reconstruction using synthetic loop augmentation.

A total of 110 patients with a diagnosis of acromioclavicular joint separation were seen at our clinic between 1986 and 1991. Of these, 14 patients (12.7%) with grade III, IV, or V injuries required surgical reconstruction and were examined 2 years after surgery. All 14 patients underwent acromioclavicular reconstruction using a synthetic loop passed through drill holes in the base of the coracoid and the anterior third of the clavicle. When the loop is tightened, the clavicle is reduced anatomically without the anterior subluxation caused by simple clavicular cerclage. At an average followup of 44.2 months, patients were evaluated using the University of California, Los Angeles, rating scale. Twelve of the 14 had good or excellent results and returned to normal sport and work activities at 6 months. Of the two initial poor results, one required revision 1 month post-operatively because the patient was noncompliant, and the other required manipulation under anesthesia 3 months after surgery. The results in these two patients at 2 years were good and excellent, respectively. We concluded that, when medically indicated, fixation of the clavicle to the coracoid using this technique yields satisfactory results in an athletic population.

Acromioclavicular Joint↗
PubMedDate not supplied

The evaluation and treatment of the injured acromioclavicular joint in athletes.

Injuries to the acromioclavicular joint are among the most commonly occurring problems in the athletic patient population. However, these injuries are often confused with other problems associated with the shoulder complex. This confusion was noted by Hippocrates (460-377 BC), who realized that acromioclavicular dislocation often was misdiagnosed as a glenohumeral injury. Galen (129-199 AD) experienced an acromioclavicular dislocation and could not tolerate the tight bandaging recommended at the time and thus became one of the earliest noncompliant patients. The understanding of acromioclavicular injuries and their management has evolved rapidly during the last 2 decades. This review will clarify the current concepts in the management and treatment of acromioclavicular injuries in the athlete.

Acromioclavicular Joint↗