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Biomedical subjects

M L Ecker

Publications and source records attributed to M L Ecker.

At least 37 records · Page 2Linked to original sources
PubMed1986

Stress fracture as a cause of chronic pain following revision total hip arthroplasty. Report of two cases.

Femoral stress fractures following revision total hip arthroplasty developed about a cortical window in two patients. These cases differ from previously reported fractures in that there was no significant trauma, the pain was gradual in onset, and there was no displacement at the fracture site. Tomograms and radionuclide bone scans were necessary to reveal the fracture. One femur healed with hip spica immobilization, while the other required bone grafting. Femoral stress fractures should be considered in the differential diagnosis of patients with thigh pain after revision total hip arthroplasty, particularly if a cortical window had been necessary.

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PubMed1985

Osteonecrosis of the knee.

We have described two entities of osteonecrosis-like syndromes about the knee. One involves the medial femoral condyle and may or may not be associated with radiolucent lesions and collapse of the femoral condyle. Treatment depends on identification of the size and location of the lesion. The other entity is an osteonecrosis-like lesion of the tibial plateau. It usually occurs medially and may not be associated with radiographic changes. However, increased uptake on a bone scan from the medial side of the knee, best noted on the lateral view, will identify these lesions. Once the condition is recognized, the patient should be treated conservatively until the clinical course is defined. It is important to recognize these clinical problems so that unnecessary surgery may be avoided.

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PubMed1984

Indications for the treatment of deep venous thrombosis following total knee replacement.

The diagnosis of deep venous thrombosis in the lower extremity has usually been thought to mandate the initiation of anticoagulation therapy. However, there has been evidence to show that this approach may not be necessary for deep venous thrombosis at or distal to the knee, and that the risks of treatment may be greater than those of the thrombosis itself. One hundred and seventy-five patients who underwent total knee replacement were examined postoperatively by venography, plethysmography, fibrinogen scans, and ventilation-perfusion lung scans. We found that 126 (72 per cent) of them had small or large clots in the calf, and that only forty-nine (28 per cent) had no thrombi. Seventy-one (41 per cent) of the patients had small thrombi in the calf and fifty-five (31 per cent) had large thrombi in the calf. Six patients had thrombi in the thigh, all of which were associated with large thrombi in the calf. In only two patients, however, did clinically recognized pulmonary emboli develop, one in the group of patients without known thrombi and the other in a patient with a large iliofemoral thrombus. The ventilation-perfusion scans showed six asymptomatic pulmonary emboli that were not associated with the presence of either large or small thrombi in the calf. The fibrinogen scans that were done in the postoperative period were capable of revealing large but not small thrombi in the calf. The preoperative plethysmography did not aid in determining in which patients a large thrombus of the calf or thigh was likely to develop.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1983

Osteonecrosis-like syndrome of the medial tibial plateau.

Thirty-six patients with an osteonecrosis-like lesion of the proximal tibia presented due to the sudden onset of pain along the medial side of the knee and marked tenderness over the medial tibial plateau. Initially, the roentgenograms were within normal limits or showed mild degenerative joint changes. All patients had positive radionuclide bone scans; the lateral view clearly demonstrated the lesion within the tibia. The symptoms remained severe for six to 12 weeks, after which they gradually resolved. Most patients were asymptomatic after nine to 12 months. Differentiating this entity from a torn meniscus or pes anserinus bursitis is difficult without obtaining a bone scan. As more bone scans are obtained, this may prove to be a common entity; recognition of the condition may prevent unnecessary surgery.

Adult↗
PubMed1981

Late results following medial meniscectomy in an older population.

We reviewed the cases of 101 patients who had an isolated medial meniscectomy after the age of forty-five years. Sixty-six patients were available for re-evaluation at an average of 10.8 years after operation. The patients were grouped according to preoperative radiographs. Patients with normal preoperative radiographs had a 90 per cent chance of having a good or excellent result, while patients with pre-existing moderate or marked degenerative changes had only a 21 per cent chance of a good or excellent result. The patient's age per se did not appear to affect the results, but pre-existing degenerative arthritis clearly diminished the quality of the result. Other causes of symptoms in the medial aspect of the joint, such as osteonecrosis, must be carefully excluded prior to meniscectomy in an elderly patient.

Age Factors↗
PubMed1979

Late reconstruction of the patellar tendon.

Late reconstruction of undiagnosed ruptures of the patellar tendon by transfer of the gracilis and semitendinosus tendons, supplemented by a heavy-gauge encircling wire to bridge the gap, was successful in four patients. These tendons are stronger than fascial strips which have previously been used for the purpose. The four patients treated by this technique returned to their preinjury functional levels.

Adolescent↗
PubMed1977

Influence of positioning of prosthesis in total knee replacement.

The early clinical results of geometric total knee arthroplasty were compared with the position of the prosthetic device by a roentgenographic score system. It was noted that there is a statistically significant positive correlation between a good clinical result and a well positioned prosthesis. In addition, it was appreciated that perfect positioning of the device was difficult to obtain. We believe that the long-term clinical results, wear resistance, and resistance to prosthetic failure depend on correct positioning of the devices.

Arthroplasty↗
PubMed1977

Painful knees in older patients: radionuclide diagnosis of possible osteonecrosis with spontaneous resolution.

The syndrome of osteonecrosis of the femur at the knee presents as sudden onset of knee pain in elderly patients. It is classically associated with a subchondral radiolucency and a positive radionuclide bone scan. The lesion may progress to collapse of the bone. In this report, twelve cases are described in which the clinical entity of osteonecrosis of the femoral condyle was diagnosed because the patients had a clinical picture identical to that of osteonecrosis and also had positive bone scans. However, roentgenographic changes supposedly diagnostic of the condition were not seen. In twelve patients, arthrotomy was avoided. They became asymptomatic and their bone scans returned to normal in a few months.

Age Factors↗
PubMed1976

Early experience with total knee arthroplasty.

Early results of 76 geometric total knee replacements were reviewed with assistance from computer analysis. A 92% patient follow-up for one to three years showed an overall satisfactory result with substantial improvement, especially in relief of severe pain. However, several problems are noted, including fractures beneath the tibial plateau and loosening. The long-term results are still unknown. The indications for total knee replacements should remain conservative until long-term results and experience have been achieved.

Age Factors↗
PubMed1975

The treatment of trochanteric hip fractures using a compression screw.

One hundred and four consecutive intertrochanteric hip fractures treated with a compression screw were reviewed. Despite death and lack of follow-up, the late results in sixty-two cases of fracture were analyzed. Three non-unions and one malunion gave the technique a failure rate of only 6.4 per cent. Twenty-two patients with both stable and unstable fractures were allowed to bear weight as early as tolerated, in an average of fourteen days. Early weight-bearing did not appear to compromise the end result.

Adult↗
PubMedDate not supplied

Subchondral magnetic resonance imaging changes in early osteoarthrosis associated with tibial osteonecrosis.

SUMMARY: The authors report on 41 patients with acute or subacute knee pain and early or midstage degenerative arthrosis with osteonecrotic lesions in the subchondral and metaphyseal region of the medial proximal tibia. Each lesion was identified only on magnetic resonance images (MRI). These MRI changes are classified and the clinical course is defined during a follow-up period averaging 4.5 years. Radiographically, 22 patients had minimal degenerative changes; 12 had moderate arthritis; and 7 were normal. With MRI, 3 distinct types of lesions were identified. Type A lesions had localized areas of decreased signal in the subchondral area. Type B lesions had diffuse signal changes with extension into the metaphysis. Type C lesions had metaphyseal involvement as well as a marginated serpentine subchondral rim usually associated with advanced osteonecrosis. There were 9 type A lesions, 23 type B, and 9 type C. At the end of 1 year, 33 patients (80%) had no or mild symptoms, and 8 (20%) had persistent moderate pain. At 4.5-year follow-up, most patients had symptoms consistent with progressive osteoarthrosis, 12 patients had severe symptoms (29%), 17 (41%) had mild or moderate symptoms, and only 12 (29%) were asymptomatic or had minimal symptoms. The type of MRI change seen initially was predictive of prognosis. Only 6 (19%) of the 32 patients with type A or B findings had severe symptoms at last follow-up. Six (66%) of the 9 patients with a type C MRI lesion had severe symptoms or had an operation by last follow-up. Twelve patients had follow-up MRI at a mean 15 months (range, 12 to 18 months) after the initial evaluation. The type A and B changes were either absent or significantly reduced. The type C subchondral marginated rim changes remained but metaphyseal involvement was reduced. There appears to be a spectrum of tibial subchondral MRI changes associated with sudden onset of medial knee pain in patients with early osteoarthritis of the knee. These changes may be indicative of osteonecrosis. The initial MRI classification is useful in predicting prognosis. Recognition of this problem may avoid unnecessary intra-articular surgery.

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