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Biomedical subjects

Norman A Johanson

Publications and source records attributed to Norman A Johanson.

7 recordsLinked to original sources
PubMed2006

Distal femoral allograft reconstruction for massive osteolytic bone loss in revision total knee arthroplasty.

Massive osteolytic bone loss in revision total knee arthroplasty has been an uncommon challenge. From 2001 to 2002, 11 knees in 10 patients underwent revision of failed modular PFC (Johnson and Johnson Orthopaedics, Raynham, Mass) total knee arthroplasties with distal femoral allografts and long-stemmed revision implants for massive osteolytic induced femoral bone loss. The mean follow-up was 42 months (range, 36-48 months). Radiographic graft incorporation was demonstrated in all 11 knees with no cases of loosening. The Knee Society Pain Scores improved by an average of 25.4 points, and the function scores improved by an average of 23.3 points. The outcomes of distal femoral allografts in the reconstruction of massive osteolytic bone loss associated with failed modular PFC (Johnson and Johnson Orthopaedics) total knee arthroplasties are favorable.

Aged↗
PubMed2006

Knee arthrodesis.

Arthrodesis is one of the last options available to obtain a stable, painless knee in a patient with a damaged knee joint that is not amenable to reconstructive measures. Common indications for knee arthrodesis include failed total knee arthroplasty, periarticular tumor, posttraumatic arthritis, and chronic sepsis. The primary contraindications to knee fusion are bilateral involvement or an ipsilateral hip arthrodesis. A variety of techniques has been described, including external fixation, internal fixation by compression plates, intramedullary fixation through the knee with a modular nail, and antegrade nailing through the piriformis fossa. Allograft or autograft may be necessary to restore lost bone stock or to augment fusion. For the carefully selected patient with realistic expectations, knee arthrodesis may relieve pain and obviate the need for additional surgery or extensive postoperative rehabilitation.

Arthrodesis↗
PubMed2004

A comparison of self-reported hip symptomatology in hip replacement patients and a population-based sample of medicare beneficiaries.

BACKGROUND: There exists variation over geographic areas in the use of total hip arthroplasty. This variation is not explained by the variation in the density per unit area of surgeons. The objective was to compare the severity of hip symptoms between a population-based sample of community-dwelling Medicare beneficiaries and a hospital-based sample of patients undergoing total hip replacement surgery. MATERIAL/METHODS: Population-based survey data on 113 community residents were compared to data from an independent sample of 157 hospital-based patients who underwent total hip replacement surgery, all of whom were 65 years and older. Severity of symptoms in both groups was rated using the Hip Rating Questionnaire (HRQ). RESULTS: The average population sample HRQ score was 63+/-9.0; overall arthritis impact 12+/-5, pain 14+/-6, walking 18+/-4, function 19+/-4. The average patient sample HRQ score was 56+/-14; overall arthritis impact 10+/-7, pain 11+/-4, walking 15+/-4, function 20+/-3. CONCLUSIONS: Community-dwelling individuals report symptoms as severe as patients who have undergone total hip arthroplasty. Further research is necessary to identify the reasons for the low incidence of treatment for those living in the community.

Activities of Daily Living↗
PubMed2004

Periprosthetic supracondylar femur fractures following total knee arthroplasty.

Periprosthetic supracondylar femur fractures following total knee arthroplasty (TKA) are an infrequent, but devastating, complication. From 1998 to 2000, we treated 30 supracondylar femur fractures above TKAs. Eighteen fractures were managed with retrograde intramedullary rod fixation (FIMR) and the other 12 fractures with traditional open reduction with internal fixation (ORIF). Follow-up averaged 3 years, with Knee Society knee scores being 84 and 82, respectively. Complications included 1 above-knee amputation for deep sepsis and 1 nonunion with varus alignment. FIMR appears to be the treatment of choice when it is feasible. However, traditional ORIF also may yield satisfactory results in those designs that cannot accommodate retrograde FIMR fixation.

Aged↗
PubMed2004

Cementless bipolar hemiarthroplasty for displaced femoral neck fractures in the elderly.

Controversy exists regarding the use of cementless femoral fixation for hip arthroplasties in elderly patients. This study reviews the clinical and radiographic outcomes of cementless bipolar hemiarthroplasties in patients older than 65 years of age. From 1998 to 2000, 256 cementless bipolar hemiarthroplasties were performed in 248 patients with displaced femoral neck fractures who had a mean age of 77 years. The mean final follow-up was 3.5 years and Harris hip scores averaged 82 points. Two loose femoral stems were revised and the rest of the implants were radiographically stable and demonstrated evidence of bone ingrowth. Six patients had debilitating groin pain necessitating conversion to total hip arthroplasty. Cementless bipolar hemiarthroplasty can be safely performed in elderly patients and can provide predictable clinical and radiographic results.

Aged↗
PubMed2004

American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change.

BACKGROUND: The American Academy of Orthopaedic Surgeons (AAOS) has developed an array of outcomes assessment instruments designed for the efficient collection of outcomes data from patients of all ages with musculoskeletal conditions in all body regions. The Lower Limb Instruments were developed through a process of literature review, consensus-building, and field-testing. METHODS: The instruments were distributed to a total of 290 subjects in twenty orthopaedic practices throughout the United States and Canada. Of the 290 patients, seventy each had a diagnosis in the categories of foot and ankle, sports/knee, and hip and knee and forty each had a diagnosis in the categories of trauma and rehabilitation. Retests to be taken twenty-four hours after the first test were distributed to subsamples of patients for each instrument. Seventy-one one-year follow-up questionnaires (twenty-five Sports/Knee, twenty-five Foot and Ankle, sixteen Hip and Knee, and five Lower Limb Core instruments) were returned. RESULTS: The Lower Limb Core Scale and the Hip and Knee Core Scale, each consisting of seven items addressing pain, stiffness and swelling, and function, performed at an acceptable level. Additional Sports/Knee and Foot and Ankle Modules proved to have internal and retest reliability of 0.80 or better, comparable with the values for well-established measures such as the Short Form-36 (SF-36). All of the new scales were moderately to strongly correlated with other measures of pain and function, such as physician ratings, the SF-36, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Seventy-one patients provided follow-up information for the analysis of sensitivity to change. The Lower Limb Core was found to contribute independently to the prediction of the transition score based on the patient and physician assessments of change. CONCLUSIONS: The AAOS Lower Limb Instruments for outcomes assessment are highly reliable and are correlated with other measures for similar constructs. They are also sensitive to change in patient status. The Lower Limb Core Scale may be used with attribution of pain either to the lower limb or to a specific joint or side without sacrificing reliability. Combined with the SF-36, the AAOS outcomes assessment instruments comprehensively and efficiently measure outcomes in orthopaedic patients with lower-limb conditions.

Adult↗