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Biomedical subjects

P F Lachiewicz

Publications and source records attributed to P F Lachiewicz.

At least 37 records · Page 2Linked to original sources
PubMed1997

Results and complications of total hip arthroplasties in patients with sickle-cell hemoglobinopathies. Role of cementless components.

The complications and results of 16 primary and revision total hip arthroplasties in patients with sickle-cell hemoglobinopathies were evaluated. One patient died from renal failure at 1 year, leaving 15 hips in 10 patients for review at a mean follow-up period of 6 years (range, 2-12 years). There were 7 cementless primary total hip arthroplasties and 8 revision arthroplasties, 6 of which were uncemented. Patients were evaluated clinically using a standard hip rating system and radiographically using accepted criteria. There were no early or late deep infections; however, 7 of 8 primary arthroplasties and 5 of 8 revisions had one or more early complications. No cementless component demonstrated loosening; however, there was asymptomatic polyethylene wear in 2 primary arthroplasties, treated with grafting and liner exchange, and femoral osteolysis was present in 4 of 13 cementless arthroplasties, one of which was revised to permit extensive grafting. Of the original 15 arthroplasties performed by the senior author, 5 required some type of reoperation during the study. At most recent follow-up evaluation, no component in the study was radiographically loose. In the hips that did not require reoperation, the overall results were excellent in 6 hips, good in 3, and poor in 1 hip. Of the 5 hips requiring reoperation, the results were excellent in 3 hips, good in 1, and fair in 1 hip at most recent follow-up evaluation. Cementless components should be considered for all primary and revision arthroplasties in patients with sickle-cell hemoglobinopathies, but early complications are frequent and a high incidence of polyethylene wear and osteolysis requiring reoperation may be expected.

Adult↗
PubMed1997

The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement.

The senior one of us performed 438 primary and 181 revision total hip arthroplasties with use of so-called modern prostheses between July 1983 and January 1994. Fifty-three patients, who had had forty-seven primary procedures and twelve revisions, either died or were lost to follow-up less than two years after the operation and were excluded from the study. The results for the remaining 446 patients (391 primary procedures and 169 revisions) were analyzed to determine the influence of patient-related and operative factors and the position of the acetabular component on the rate of dislocation. Dislocation occurred after thirty-two (6 per cent) of the 560 total hip arthroplasties: seventeen (4 per cent) of the 391 primary procedures and fifteen (9 per cent) of the 169 revisions (p = 0.046). There was no relationship between the variables of age, gender, obesity, or preoperative diagnosis and dislocation after either primary or revision arthroplasty. Seven (23 per cent) of the thirty arthroplasties in the patients who had a history of excessive intake of alcoholic beverages (more than 2.1 liters [seventy-two ounces] of beer or more than 0.2 liter [six ounces] of other alcoholic beverages a day) were followed by a dislocation compared with twenty-five (5 per cent) of the 530 arthroplasties in the patients who did not have such a history. This difference was significant for the patients who had had a revision arthroplasty (p = 0.00005), but with the numbers available we could not detect a difference for those who had had a primary arthroplasty (p = 0.264). Radiographic analysis was performed for thirty-two hips that had dislocated and thirty-two that had not (seventeen primary procedures and fifteen revisions in each group), matched exactly according to the type of prosthesis and the operative approach (but not age). We detected no association between either the version or the abduction angle of the acetabular component (within the range of 39 to 56 degrees for the primary prostheses and 38 to 57 degrees for the revision prostheses) and the risk of dislocation. Thirty of the thirty-two hips in each group had an abduction angle of the acetabular component that was in the so-called safe range of 30 to 50 degrees.

Acetabulum↗
PubMed1997

The role of aspiration and contrast-enhanced arthrography in evaluating the uncemented hip arthroplasty.

OBJECTIVE: The purpose of this study was to determine the value of aspiration and contrast-enhanced arthrography in evaluating uncemented total hip arthroplasty components. A retrospective study was performed to determine the sensitivity, specificity, and accuracy of these procedures. MATERIALS AND METHODS: Preoperative aspiration of the hip joint and contrast-enhanced arthrography were performed by a skeletal radiologist in 33 hips with uncemented components before exploration or revision. In one patient, the hip aspiration yielded grossly purulent fluid and arthrography was not performed. Twenty-one uncemented acetabular components and 29 uncemented femoral components were evaluated by arthrography. The aspiration of the hip provided fluid for culture in 33 hips; in one hip, no fluid could be obtained. RESULTS: A preoperative diagnosis of infection based on growth on solid media was made in five hips (15%). An additional infection was determined to be present in the hip in which no fluid was obtained when purulent fluid was found at operation. On the basis of the operative findings, contrast-enhanced arthrography of the 21 acetabular components had a sensitivity of 50%, a specificity of 77%, and an accuracy of 68%. Arthrography of the 29 femoral components had a sensitivity of 63%, a specificity of 64%, and an accuracy of 63%. CONCLUSION: Aspiration of the hip joint before revision of uncemented hip arthroplasties was valuable because the diagnosis of infection was made preoperatively in five of six hips. However, contrast-enhanced arthrography was not valuable, with a low sensitivity and specificity for both uncemented acetabular and uncemented femoral components. Only a preoperative aspiration of the hip joint is recommended before revision of uncemented components.

Cementation↗
PubMed1997

Primary synovial osteochondromatosis of the hip: report of two cases with long-term follow-up after synovectomy and a review of the literature.

Primary synovial osteochondromatosis of the hip joint is rare. Two cases treated successfully by open synovectomy of the hip joint and removal of loose bodies, with a follow-up of 7 years in one case and 5 years in the other, are described. A review of all published case reports in the English language suggests that an open synovectomy of the hip will relieve pain and may prevent or delay the progression of degenerative changes.

Chondromatosis, Synovial↗
PubMed1996

Survivorship analysis of cemented total hip arthroplasty acetabular components implanted with second-generation techniques.

The clinical and radiographic results of primary cemented total hip arthroplasty performed by a single surgeon, with particular emphasis on the performance of acetabular components implanted with so-called second-generation cement techniques, were studied. Seventy hips with 48 metal-backed and 22 polyethylene acetabular components were followed for a mean of 9 years (range, 5-11.5 years). The clinical results were evaluated using a recognized hip score. The fixation status of the cemented acetabular component was evaluated using two methods of measuring radiolucent lines at 5 years and at the last evaluation. Acetabular component loosening was defined as a circumferential radiolucent line, component migration, or revision for loosening. This study was unable to confirm the findings of others that demonstrated higher failure rates with cemented metal-backed components when compared with all-polyethylene components. The survival of cemented acetabular components with 28-mm head femoral prostheses was worse than the survival of cemented acetabular components with 22-mm femoral heads in other published reports, despite advances in cement techniques. Because of the high rate of loosening of cemented 28-mm-inner-diameter acetabular components at 5 and 10 years, the authors no longer use these cemented components for acetabular reconstruction.

Acetabulum↗
PubMed1996

Clinical and radiographic results of the Total Condylar III and Constrained Condylar total knee arthroplasty.

The Total Condylar III (Johnson and Johnson, Braintree, MA) and Constrained Condylar (Zimmer, Warsaw, IN) knee prostheses are nonlinked, semi-constrained prosthetic alternatives to rigid or rotating hinge prostheses for use in complex knee reconstructions. Forty-six Total Condylar III or Constrained Condylar prostheses were implanted with cement in 36 patients and followed for a mean of 5 years (range, 2-9 years). There were 25 primary total knee arthroplasties and 21 revision total knee arthroplasties. The knees were evaluated using The Hospital for Special Surgery 100-point knee rating system. Overall, 40 knees (87%) had a good or excellent clinical result, 2 knees (4%) had a fair result, and 4 knees (9%) had a poor result. There was one revision for loosening of a cemented, nonmodular Constrained Condylar prosthesis, and one knee had a debridement for a late, metastatic infection, but the components were retained. There were no mechanical failures in those knees that were primary arthroplasties, but two mechanical failures occurred in those knees that were revision arthroplasties. Radiographic review showed one asymptomatic loosening of a Constrained Condylar tibial component with an uncemented press-fit stem, and only 8 knees had scattered nonprogressive tibial bone-cement radiolucent lines. The Total Condylar III and Constrained Condylar semiconstrained prostheses are successful when used in complex knee reconstructions.

Adult↗
PubMed1996

Modern cement technique and the survivorship of total shoulder arthroplasty.

Thirty-eight consecutive Neer II total shoulder arthroplasties were performed in 35 patients by one surgeon using the so called modem cement technique and followed for a mean of 5 years (range, 2-9.5 years). The preoperative diagnosis was osteoarthritis or avascular necrosis in 22 shoulders, rheumatoid arthritis in 10 shoulders, and posttraumatic arthritis in 6 shoulders. The components were implanted using specific improved techniques for cement fixation initially described for total hip arthroplasty. Twenty-six metal-backed and 12 polyethylene glenoid components were used. The humeral component was implanted with cement in 32 shoulders. There were no intraoperative fractures or postoperative neurapraxias. At most recent followup, 36 shoulders had no or slight pain with activity. The mean increase in active forward elevation was 38 degrees and in active external rotation was 29 degrees. There have been no revisions, and all components remain in place. With failure defined as definite radiographic loosening of the components, there was 97% survivorship at 5 years, and 93% at 8 years. Radiolucent lines around more than 50% of the bone cement interface of the humeral component were present in only 3 shoulders. Radiolucent lines around more than 50% of the bone cement interface of the glenoid component were seen in only 2 shoulders. Both components in 1 severely osteopenic shoulder had a complete radiolucent line and a change in position. Meticulous attention to cement technique may improve the long term survival of cemented total shoulder arthroplasty components.

Adult↗
PubMed1996

Aspiration of the knee joint before revision arthroplasty.

Sixty-four operative procedures were performed on 55 patients with knee arthroplasties for pain, loosening, instability, or suspicion of infection. Forty-three knees had a preoperative aspiration. In 19 knees, the aspiration showed growth on solid media, and in 18 of these knees the diagnosis of infection was confirmed by the intraoperative cultures. In 1 knee with an infected total knee replacement, the patient was receiving an intravenous antibiotic at the time of arthroscopic irrigation and debridement and the cultures showed no growth. In 23 of 24 knees with a negative preoperative aspiration, the intraoperative cultures showed no growth on solid media. In 1 knee with a preoperative aspiration that had negative results, a single intraoperative culture grew Staphylococcus epidermidis. However, the presenting symptoms, examination, preoperative radiographs, and intraoperative evaluation were consistent with aseptic loosening of a cemented total knee arthroplasty. Thus, the preoperative aspiration of the prosthetic knee joint had a sensitivity of 100%, specificity of 100%, and accuracy of 100%. The Westergren erythrocyte sedimentation rate, peripheral leukocyte count, and presenting symptoms correlated poorly with infection. Radiographs were also not helpful in the diagnosis of infection, with loosening of components, periostitis, focal osteolysis, and radiolucent lines frequently seen in infected and noninfected knees. Preoperative aspiration of the knee is the most helpful study for the diagnosis or exclusion of infection in a prosthetic knee joint.

Adult↗
PubMed1996

Aspiration of the hip joint before revision total hip arthroplasty. Clinical and laboratory factors influencing attainment of a positive culture.

The value of routine aspiration of the hip joint before revision of a hip arthroplasty remains controversial. We reviewed the results of such aspirations in an attempt to determine clinical or laboratory factors that could help the surgeon to identify hips that are infected and that should be aspirated preoperatively. One hundred and fifty consecutive revision total hip arthroplasties were performed by one of us. Preoperative aspiration was not performed or data were excluded for eight hips; no fluid was obtained from one of these hips (0.7 percent of the 150). Of the remaining 142 hips, 128 had preoperative aspiration once and fourteen, twice. Twenty-one (15 percent) of the 142 hips were infected, as demonstrated by the intraoperative culture. The intraoperative culture for two of these hips, however, was considered to be false-positive. The initial aspiration was considered to be positive only if an organism grew on the solid medium or if grossly purulent fluid was obtained. The initial aspiration was positive for nineteen hips; on culture of specimens from one hip, Bacteroides thetaiotaomicron grew in the liquid medium only; and purulent fluid was obtained from one hip but no organisms grew on culture. Fourteen aspirations were repeated for various reasons, most commonly to confirm the presence of an unusual organism. The repeat aspiration did not change the diagnosis for these hips. When the two hips with a false-positive intraoperative culture were excluded, preoperative aspiration had a sensitivity of 92 percent, a specificity of 97 percent, and an accuracy of 96 percent. Seventeen of the nineteen truly infected hips were associated with an abnormally elevated erythrocyte-sedimentation rate (mean, 80.8 millimeters per hour). However, fifty-eight (50 percent) of the 116 hips that were not infected, and for which the results were available, also had an abnormally elevated erythrocyte-sedimentation rate (mean, 32.0 millimeters per hour). This difference was significant (p = 0.001, Fischer exact test). The peripheral leukocyte count was not helpful in predicting infection. Hips in which the implants had been in situ for more than five years were less likely to be infected (p = 0.008, Fisher exact test) than those in which the implants had been in situ for five years or less. None of the infected hips in which the implants had been in situ for more than five years were associated with a normal erythrocyte-sedimentation rate. In this study, preoperative aspiration of the hip joint had an excellent sensitivity and specificity with regard to the prediction of infection, On the basis of our findings, we now favor a selective approach to aspiration, as determined by the erythrocyte sedimentation rate and the amount of time that the implant has been in situ.

Adult↗
PubMed1996

Porous-coated acetabular components with screw fixation. Five to ten-year results.

The results of 136 consecutive primary total hip arthroplasties performed by one surgeon with the Harris-Galante-I porous-coated acetabular component were reviewed at a mean of seven years (range, five to ten years). In all hips, the outer diameter of the acetabular component was the same as the diameter of the final reamer used in the preparation of the acetabulum. However, this reamer was used only briefly at the rim of the acetabulum, and therefore the components had so-called press-fit stability. A mean of four screws (range, three to six screws) were used for additional fixation of the component. The clinical evaluation was performed with use of the Harris hip score. Standardized anteroposterior radiographs of the pelvis were assessed for migration of the component, radiolucent and radiodense lines, linear wear of the polyethylene, and osteolysis. No acetabular component had been revised for loosening and none were radiographically loose at the time of the most recent follow-up evaluation. There were no complications related to the use of the screws, and no screw had bent or broken. A non-progressive radiolucent line was seen in one acetabular zone in thirty-four hips (25 per cent) and in two acetabular zones in six hips (4 per cent). No hip had a radiolucent line in all three acetabular zones. The mean rate of linear wear of the polyethylene was 0.1 millimeter per year. There was no dissociation of the acetabular liner from the metal shell. Two hips (1 per cent) had asymptomatic osteolysis in the ischium and adjacent to the rim of the acetabular component; this was treated with grafting at the site of the lesion and exchange of the femoral head and the worn polyethylene liner. Five femoral components inserted without cement and one inserted with cement were revised because of loosening. The data suggest that, at a mean of seven years, fixation of this porous-coated component was uniformly excellent. The low prevalence of radiolucent lines and the absence of loosening are probably related, in part, to the technique of implantation. The low prevalence of polyethylene wear and pelvic osteolysis is a notable improvement compared with the results of arthroplasty with other porous-coated acetabular components. Although the results of the present study are encouraging, longer follow-up is necessary to determine the prevalence of late loosening and osteolysis.

Acetabulum↗
PubMed1996

Pneumatic compression or aspirin prophylaxis against thromboembolism in total hip arthroplasty.

We prospectively studied the use of either aspirin or intermittent pneumatic compression (IPC) as prophylaxis against thromboembolism after 330 consecutive total hip arthroplasties. Duplex ultrasonography of the veins of both lower extremities and ventilation-perfusion lung scans were done preoperatively and 7 to 14 days postoperatively. Eight patients in the IPC group (5%) had asymptomatic deep vein thrombosis; there were no symptomatic thrombi. In the aspirin group, 10 patients (7%) had asymptomatic deep vein thrombosis and two patients (1%) had symptomatic deep vein thrombosis. This difference was not statistically significant. There were no fatal pulmonary emboli in either group. In the IPC group, only one patient had symptomatic pulmonary embolism and 20 patients (22 hips [12%]) had asymptomatic pulmonary embolism. In the aspirin group, two patients (1%) had symptomatic pulmonary embolism and 26 patients (18%) had asymptomatic pulmonary embolism. This difference in asymptomatic pulmonary embolism between the two groups was statistically significant. Both groups had a low incidence of deep vein thrombosis, as shown by Duplex ultrasonography, but IPC was more effective than aspirin in preventing asymptomatic pulmonary embolism after total hip arthroplasty.

Adult↗
PubMed1995

Monoclonal antibodies that detect biochemical markers of arthritis in humans.

OBJECTIVE: To evaluate the potential of using monoclonal antibodies (MAb) 3-B-3(-) and 7-D-4 to detect biochemical markers of altered cartilage metabolism in human arthritides. METHODS: Fifty-five samples of normal articular cartilage (subjects' age range 18 weeks of gestation to 83 years of age) and 89 samples of arthritic cartilage (patients' age range 20-81 years) were collected, and their proteoglycans were extracted and analyzed for the presence of the epitopes recognized by MAb 3-B-3 and 7-D-4. RESULTS: Native 3-B-3(-) mimotope was expressed at a high incidence in proteoglycans extracted from the cartilage of patients with most of the arthritic diseases examined (osteoarthritis, juvenile rheumatoid arthritis, rheumatoid arthritis, avascular necrosis, and degenerative meniscal tears). Its expression in normal cartilage specimens was very low or absent, occurring mainly in the young, skeletally immature individuals. In contrast, expression of the 7-D-4 epitope was more variable in patients with different arthritides and was also frequently found in normal cartilage specimens. Immunohistochemical analyses with both 3-B-3(-) and 7-D-4 showed strong focal positive staining in superficial areas, where cartilage degeneration, remodeling, and repair were greatest. CONCLUSION: The biochemical markers recognized by MAb 3-B-3(-) and 7-D-4 are indicative of altered proteoglycan synthesis and metabolism in human articular cartilage. The data suggest that in human cartilage, the 3-B-3(-) epitope might be a better marker of biochemical changes than the 7-D-4 epitope.

Adolescent↗
PubMed1995

Hip arthroplasty in hemophilic arthropathy.

As hemophilic arthropathy infrequently affects the hip joint, we performed a multicenter retrospective study to determine the results of hip arthroplasty in hemophilic patients. Thirty-four hip arthroplasties were performed in twenty-seven male patients at four major hemophilia centers from October 1972 through September 1990. Twenty-six patients had classic hemophilia and one had factor-IX deficiency. The mean age of the patients at the time of the operation was thirty-eight years (range, fifteen to seventy-three years). The mean duration of follow-up was eight years, with a minimum of two years for all patients who were still alive at the time of this review. Four patients were seropositive for the human immunodeficiency virus at the time of the operation, and sixteen patients were seropositive at the time of the most recent follow-up examination. Nine patients (33 per cent) died before the time of this review; seven had been seropositive for the human immunodeficiency virus. There were twenty-six total hip arthroplasties performed with cement, six total hip arthroplasties performed without cement, one total hip arthroplasty in which the femoral component was inserted with cement and the acetabular component was inserted without it (so-called hybrid arthroplasty), and one bipolar arthroplasty performed with cement. There were no early infections after these thirty-four primary arthroplasties. There were three late infections around prostheses inserted with cement, and all led to a resection arthroplasty. Six (21 per cent) of the twenty-eight cemented femoral components and six (23 per cent) of the twenty-six cemented acetabular components were revised because of aseptic loosening.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1995

Rheumatoid arthritis of the ankle: the role of total ankle arthroplasty.

The indications for total ankle replacement are limited to older patients with rheumatoid arthritis, especially those with multiple joint involvement and limited physical activity. The recommended surgical technique for total ankle arthroplasty includes an anterior surgical approach, minimal bone resection, and meticulous technique for cemented fixation of components. The results of published studies suggest total ankle arthroplasty should not be performed in patients who have had previous surgery on the ankle or foot, or who are younger than 57 years of age.

Age Factors↗
PubMed1995

Survivorship analysis of cemented total condylar knee arthroplasty.

From 1977 to 1989, the authors performed and prospectively followed 151 cemented total condylar knee arthroplasties in 113 patients. A metal-backed tibial component was implanted in 133 knees (88%). The mean followup of all knees was 7 years (range, 0.5-16 years); 36 knees were seen in followup for a minimum of 10 years. Survivorship analysis was used to calculate the predicted cumulative rate of success of these knees. Using the criteria for failure as revision performed or recommended, the 10-year survival of these knees was 96.9% (95% confidence interval, 93.8%-100%). Including those knees with radiographic loosening, the 10-year survival was 84.1% (95% confidence interval, 73.4%-96.3%). The cemented total condylar prosthesis remains the standard for success and durability of total knee arthroplasties.

Adult↗
PubMed1994

A prospective study of a titanium femoral component for cemented total hip arthroplasty.

The authors studied the clinical and radiographic results of a modern titanium-alloy femoral stem with a cobalt-chrome-alloy head for use in cemented total hip arthroplasty. One hundred sixteen hips (102 patients) were operated on using modern cement techniques and prospectively followed using the Hospital for Special Surgery hip rating system and standard radiographic criteria. At a mean follow-up period of 4.8 years (range, 2-8 years), 69 hips were rated excellent, 38 good, 4 fair, and 5 poor. A total of 13 femoral components (11%) were radiographically loose according to the criteria of Harris. In 11 of these loose femoral components, debonding or separation at the cement-prosthesis interface, was the initial cause of failure, with bone-cement interface erosions occurring later in five hips. Revision of a loose femoral component has been performed in three hips and is pending in two other hips (4.3%). Significant calcar resorption was seen in only 17 hips (14.6%), and serial measurements of distal femoral cortical widths showed no distal cortical hypertrophy except in one femur. The incidence of loosening with this cemented titanium-alloy femoral component (with a cobalt-chrome-alloy head) is much higher than published reports of similar cobalt-chrome-alloy stems. The authors have abandoned the use of titanium-alloy femoral components for cemented total hip arthroplasty.

Adolescent↗