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Biomedical subjects

R D Scott

Publications and source records attributed to R D Scott.

At least 19 recordsLinked to original sources
PubMed2001

Measuring the economic costs of antimicrobial resistance in hospital settings: summary of the Centers for Disease Control and Prevention-Emory Workshop.

Health systems administrators and clinicians need refined calculations of the attributable cost of infections due to drug-resistant microorganisms to develop and assess cost-effective prevention strategies that deal with these infections. To date, however, efforts to provide this information have yielded widely variable and often conflicting estimates. This lack of reproducibility is largely attributable to problems in study design and in the methods used to identify and measure costs. Addressing these methodological issues was the focus of a workshop that included participants from a broad range of backgrounds, including economics, epidemiology, health care management, health care outcomes research, and clinical care. This workshop summary presents the advantages and disadvantages of various research designs as well as particular methodological issues related to the measurement of the economic cost of resistance in health care settings. Suggestions are made for needed common definitions and approaches, study areas for future research are considered, and priority investigations are identified.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Unicompartmental knee arthroplasty: long-term results.

Unicompartmental knee arthroplasty has been controversial since its introduction in the early 1970s. Some initial reports suggested that medial compartment replacement did not yield good enough early results to be a viable long-term option, although lateral compartment replacement seemed to be promising. By the early 1980s, however, good initial results were being published for medial and lateral replacements and enthusiasm for the procedure began to increase. Refinements were made in patient selection, surgical technique, and prosthetic design. Ten-year followup studies were reported that showed survivorship was slightly less than that reported for total knee arthroplasty but acceptable considering the theoretically conservative nature of unicompartmental surgery. Unicompartmental knee arthroplasty now can be characterized as a procedure with a reliable 8- to 10-year outcome in properly selected patients with osteoarthritis who receive a skillfully implanted proper design. Unicondylar knee arthroplasty can be an attractive alternative to osteotomy or total knee arthroplasty especially some middle-aged women. Approximately all studies with followups of 10 years or greater show that unicompartmental knee arthroplasty will have inferior survivorship to total knee arthroplasty whether from loosening, prosthetic wear, or secondary degeneration of the opposite compartment in the second decade. Recently published 10-year results from two centers (one using a mobile-bearing design, the other using a fixed-bearing design) are comparable with those of total knee arthroplasty. This suggests that enhanced second-decade survivorship and therefore an expansion of the indications for unicompartmental knee arthroplasty are possibilities.

Arthroplasty, Replacement, Knee↗
PubMed2000

A comparison of 4 intraoperative methods to determine femoral component rotation during total knee arthroplasty.

A total of 100 consecutive posterior cruciate-retaining total knee arthroplastics were performed in 81 patients with an average age of 69 years by 1 surgeon. Diagnoses included osteoarthritis in 93 knees and rheumatoid arthritis in 7 knees. The femoral alignment necessary to create a rectangular flexion gap was determined and compared with Whiteside's line, the transepicondylar axis, and a line in 3 degrees of external rotation relative to the posterior condyles of the femur. The transepicondylar axis most consistently recreated a balanced flexion space, whereas 3 degrees of external rotation off the posterior condyles was least consistent, especially in valgus knees.

Aged↗
PubMed2000

Tibial osteotomy coincident with long stem total knee arthroplasty: a surgical technique.

Tibial deformity secondary to previous fracture or osteotomy requires corrective osteotomy in some patients undergoing total knee arthroplasty (TKA). This can be performed in either two stages or coincident with the arthroplasty. Literature on coincident tibial osteotomy and TKA has been published previously, but details of the complicated surgical technique are lacking for surgeons performing this procedure for the first time. This article details the preoperative planning involved and the intraoperative technique used in tibial osteotomy coincident with TKA.

Arthroplasty, Replacement, Knee↗
PubMed1999

Humeral hemiarthroplasty of the elbow joint in young patients with rheumatoid arthritis: a report on 7 arthroplasties.

This article evaluates the early results of 7 humeral hemiarthroplasties of the elbow joint in 5 female rheumatoid patients using only the humeral component of the capitellocondylar prosthesis. The follow-up period was 25 to 109 months. All patients were 50 years old or younger; 3 patients were between 22 and 26 years. Because all patients were rather young, the intention was to perform a procedure that conserves a maximal amount of bone stock for future salvage procedures. One prosthesis had to be removed because of an infection unrelated to the primary procedure. The remaining bone stock provided a stable and pain-free excision arthroplasty. The other arthroplasties showed good pain relief; however, postoperative motion was not as reliable as described for total capitellocondylar prostheses.

Adult↗
PubMed1999

Prodromes of failure in total knee arthroplasty.

A total of 102 revision total knee arthroplasties (TKAs) were reviewed to determine the prodromal symptoms and radiographic findings associated with failure. Presenting symptoms included pain (84%); swelling (76%); progressive varus or valgus deformity (19%); instability (17%); stiffness (17%); clicking or grinding (7%); catching (4%); and patellar pain, subluxation, or clicking (4%). Radiographs were diagnostic in 91% of cases, demonstrating complete radiolucencies (80%), polyethylene wear (43%), component breakage (5%), metallic debris (3%), patellar subluxation or dislocation (4%), and osteolysis (4%). Gross intraoperative findings included polyethylene wear (72%), osteolysis (22%), metal-wear synovitis (9%), component breakage (6%), patellar wear and dissociation (4%), and occult sepsis (5%). The average duration of symptoms was 13 months; the interval between orthopedic evaluations averaged 23 months. Based on this information, we recommend that an annual questionnaire and weight-bearing radiographs be used to ensure adequate surveillance of TKA patients and avoid complications associated with delay in diagnosis of polyethylene wear or implant loosening.

Aged↗
PubMed1999

Synovial cyst of the proximal tibiofibular joint with peroneal nerve compression after total knee arthroplasty.

Synovial or ganglion cysts of the proximal tibiofibular joint are less common than synovial cysts of the knee joint but may present in a similar manner and may be difficult to diagnose clinically. Although synovial cysts arising from the knee joint after prosthetic arthroplasty have already been described, we report a case in which a lateral knee mass compressing the peroneal nerve was found to be a synovial cyst arising from the tibiofibular joint.

Arthroplasty, Replacement, Knee↗
PubMed1999

Total knee arthroplasty in patients with rheumatoid arthritis. An overview.

Total knee arthroplasty in patients with rheumatoid arthritis presents several unique challenges. Patients with rheumatoid arthritis often have additional medical, anesthetic, and global musculoskeletal problems that are not present in the patient with osteoarthritis. In terms of the knee, these patients usually have osteopenia and may present with an array of bone and soft tissue deformities, each of which can impact the initial success and long term durability of a total knee replacement. Despite these potential difficulties, the early and long term results of total knee arthroplasty in patients with rheumatoid arthritis have proven to be excellent.

Arthritis, Rheumatoid↗
PubMed1999

Total knee arthroplasty in Paget's disease: technical problems and results.

Eleven total knee arthroplasties performed in 10 patients with Paget's disease were reviewed at 2 to 16 years postoperatively. Cemented total knee arthroplasties were performed in all cases. Range of motion improved by 21 degrees postoperatively and the follow-up Knee Society score averaged 83 points. One knee was rated poor with a score <70 points; this knee was the only knee with a loose component. All components resting on pagetic bone had a solid interface on radiographic review at an average of 5.7 years postoperatively. Although technical difficulties are encountered in achieving correct alignment and exposing the knee with local Paget's disease, good long-term outcome can be achieved.

Aged↗
PubMed1999

The Ranawat Award. Femoral component rotation during total knee arthroplasty.

One-hundred consecutive posterior cruciate retaining total knee arthroplasties were performed by one surgeon in 81 patients with an average age of 69 years. Diagnoses included osteoarthritis in 93 knees and rheumatoid arthritis in seven. The femoral alignment necessary to create a rectangular flexion gap was determined and compared with Whiteside's line, the transepicondylar axis, and a line in 3 degrees external rotation relative to the posterior condyles of the femur. The transepicondylar axis most consistently recreated a balanced flexion space whereas 3 degrees external rotation off the posterior condyles was least consistent especially in knees in valgus.

Aged↗
PubMed1999

Selective patellar nonresurfacing in total knee arthroplasty. 10 year results.

Patella nonresurfacing in total knee arthroplasty was reviewed retrospectively in 49 knees (42 patients). Thirteen patients (17 knees) died leaving 29 patients (32 knees) in the final study group. The minimum length of followup was 10 years and averaged 11.7 years (range, 10-13.4 years). The diagnosis was primary osteoarthritis in 26 knees, posttraumatic arthritis in four, osteonecrosis in one, and Paget's disease in one. Patients were evaluated using the Knee Society score, a patella score, and radiographs. The mean Knee Society score improved from 52.8 to 87.5 points postoperatively and functional score improved from 57.5 to 84.5 points postoperatively. Anterior knee pain was reported in six knees (20%). Only one patient required secondary resurfacing of the patella because of postoperative anterior knee pain. No significant correlation was found between anterior knee pain and patellofemoral joint space, patellar sclerosis, Insall-Salvati ratio, patellar tilt, gender, obesity, or age. Based on the need for secondary patellar resurfacing because of anterior knee pain, the 10-year survival was 97.5%. At minimum 10-year followup, retaining the patella in total knee arthroplasty in selected patients with osteoarthritis of the osteoarthritic knee can yield acceptable results.

Adult↗
PubMed1999

Total knee arthroplasty with posterior cruciate retention in patients with rheumatoid arthritis.

The objective of the present study was to evaluate posterior cruciate ligament retention in total knee arthroplasty for patients with rheumatoid arthritis to determine long term ligamentuous stability. The study concerns an average 11-year followup (range, 10-13 years) of 52 patients (81 knees) with rheumatoid arthritis who had a total knee arthroplasty using a contemporary posterior cruciate retaining prosthesis. Particular attention was given to component survivorship and clinical stability. Fourteen patients (20 knees) died; none of these patients required revision surgery. No patients were lost to followup. Sixty-one knees in 38 patients were examined. In this group, the Knee Society knee score averaged 95 points (range, 63-100 points) and function score averaged 74 points (range, 0-100 points). Postoperative flexion averaged 112 degrees and extension averaged 0 degree. Four knees had 3 degrees asymptomatic hyperextension; one knee with 5 degrees hyperextension occasionally gave way. Five well aligned knees had between 6 degrees and 9 degrees varus or valgus laxity in extension, but no patient reported subjective instability. Two patients underwent revision surgery. One patient had a worn metal backed patella component replaced and the other patient had an open synovectomy for recurrent active rheumatoid synovitis. Thirteen-year survivorship based on need for revision surgery was 97% with the 95% confidence limits between 88% and 100%. There was no radiographic loosening or subsidence of prosthetic components. At 11-year followup, patients with rheumatoid arthritis whose knees were replaced with posterior cruciate retention prostheses experienced results equivalent to or better than those reported for patients with osteoarthritis at a similar followup. Late hyperextension and subsequent instability may be a concern in the second decade of followup.

Adolescent↗