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R L Worland

Publications and source records attributed to R L Worland.

At least 19 recordsLinked to original sources
PubMed1999

Non-Hodgkin's lymphoma as an unexpected diagnosis in a shoulder arthroplasty.

Shoulder arthroplasty (SA) is commonly performed in patients with rheumatoid arthritis (RA) who have been treated with long-term immunosuppressive medication. RA is associated with an increased risk of neoplasms of the immune system. A case of non-Hodgkin's lymphoma as an unexpected diagnosis after the routine pathologic examination of the soft tissues after SA was detected in a 54-year-old woman with long-standing RA and prolonged immunosuppressive therapy. Although this case does not support the cost-effectiveness of routine specimen evaluation during SA, we suggest that histological analysis of the surgical tissues is appropriate and should be performed in all patients who have been treated with prolonged immunosuppressive medication, especially RA patients as well as patients who have suspicious surgical findings.

Arthritis, Rheumatoid↗
PubMed1998

Bipolar shoulder arthroplasty for painful conditions of the shoulder.

Between April 1991 and March 1997, 182 bipolar shoulder replacements were implanted in 174 patients (8 bilateral) for painful conditions of the shoulder. The study group comprises 108 patients who were followed for an average of 2.9 years (range, 2-6 years). Diagnoses included osteoarthritis (51), rotator cuff arthropathy (27), avascular necrosis (3), revisions (8), rheumatoid arthritis (2), and fractures--both old and recent (17). A satisfactory rating (University of California at Los Angeles shoulder rating score greater than or equal to 28 points of 35) was achieved by 72% of the patients (including rotator cuff arthropathy patients). Patients with osteoarthritis obtained 90.2% of satisfactory results (46 of 51). The overall pain score after surgery was 8.8 points (of 10), meaning that none or occasional pain was present. Five patients required prosthetic revision, and 102 (94.4%) were satisfied with the surgical procedure.

Adult↗
PubMed1998

Home continuous passive motion machine versus professional physical therapy following total knee replacement.

A vigorous rehabilitation program following discharge from the hospital is necessary for patients having a total knee arthroplasty to maintain and improve range of motion and function. To compare the effectiveness of the continuous passive motion (CPM) machine as a home therapy program versus professional physical therapy, a prospective, comparative, randomized clinical study of 103 consecutive primary total knee arthroplasties in 80 patients (23 bilateral) was performed. The CPM group consisted of 37 patients (49 knees), and the physical therapy group consisted of 43 patients (54 knees). At 2 weeks, knee flexion was similar in the two groups, but a flexion contracture was noted in the CPM group (4.2 degrees). This difference is felt by the authors to be clinically insignificant. At 6 months, there were no differences in knee scores, knee flexion, presence of flexion contracture, or extensor lag between the two groups. The cost for the CPM machine group was $10,582 ($286 per patient), and the cost for professional therapy was $23,994 ($558 per patient). We conclude that the CPM machine after the hospital discharge of patients having total knee replacement is an adequate rehabilitation alternative with lower cost and with no difference in results compared with professional therapy.

Adult↗
PubMed1998

Scintigraphic evaluation in total knee failure secondary to severe metallosis.

The scintigraphic findings are described for a patient with severe metallosis in a failed noninfected total knee arthroplasty secondary to metal-metal friction between the femoral and tibial components as a result of polyethylene wear. Technetium-99m phosphate and gallium-67 citrate scans were positive in incongruent uptake areas. This uptake is classically associated with septic loosening. The recommendation is made that metallosis be suspected before surgery as a possible cause of a false positive scan where sequential technetium-gallium scans are employed.

Arthroplasty, Replacement, Knee↗
PubMed1998

Nonunion after a tibial shaft fracture complicating tibial tubercule osteotomy.

Tibial shaft fracture after tibial tubercle osteotomy in total knee replacement is a rare complication. We report on a 67-year-old man who had a knee revision arthroplasty in which a long tubercle osteotomy was performed to facilitate exposure. Three weeks after surgery, he presented with a transverse shaft fracture, which became a nonunion requiring surgical management. This shaft nonunion and its solution after tibial tubercle osteotomy is discussed as well as relevant literature.

Aged↗
PubMed1997

Posterior cruciate recession in total knee arthroplasty.

Incremental recession of the posterior cruciate ligament (PCL), as a part of ligamentous balancing in total knee arthroplasty, is critical if the PCL is too tight. This study was undertaken to evaluate any possible untoward effects of PCL recession. Twenty-one patients who underwent simultaneous bilateral total knee arthroplasty between 1988 and 1992 with a PCL recession performed only on one side (necessary to balance the knee) served as the study group. The average follow-up period was 4 years. The patients were evaluated subjectively, by manual physical testing, by radiography, and by KT-1000 arthrometry (Medmetric, San Diego, CA). There were no significant differences between the recessed and nonrecessed knees. The conclusion is that PCL recession is appropriate and safe long-term for the patient in whom the PCL is found to be too tight at the time of knee arthroplasty.

Aged↗
PubMed1997

Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty.

Thigh pain following tourniquet application is a common patient complaint in the early postoperative period following total knee arthroplasty. Postoperative thigh pain was evaluated in 28 consecutive simultaneous bilateral total knee arthroplasty patients between April 1996 and October 1996. A prospective, double-blind, randomized clinical trial was performed. Tourniquet pressure of 350 mmHg was used on 1 thigh (thigh 1) and 100 mmHg plus systolic blood pressure on the other (thigh 2). A scale of pain (no pain, mild, moderate, or severe) was applied on the first, second, and third days, as well as 2 and 6 weeks after surgery. There were 16 men and 12 women with a mean age of 72 years (range, 55-85 years). The mean tourniquet time was similar in both groups (thigh 1 = 23 minutes, thigh 2 = 22 minutes). The mean tourniquet pressure in thigh 2 was 230 mmHg (range, 212-260 mmHg). There was a statistically significant difference in thigh pain on the first (P = .01), second (P = .01), and third (P = .001) postoperative days between both groups, with more thigh pain on the 350 mmHg side. At 6 weeks after surgery, the difference in thigh pain was gone. For total knee arthroplasty, using the tourniquet at a pressure of 100 mmHg above the systolic blood pressure is recommended. This is adequate to provide a bloodless field and will result in a less unpleasant postoperative period.

Aged↗
PubMed1997

Restoration of limb alignment in total knee arthroplasty: evaluation and methods.

Obtaining adequate alignment is critical in the proper performance of total knee arthroplasty (TKA). This study prospectively evaluates 350 patients who had previous TKA. Its goals are to establish the best method of measuring limb alignment as well as the best method of restoring ideal alignment. Intramedullary alignment techniques were compared with extramedullary, and alignment of each limb was evaluated by both long (scanogram) and short films (14 inches x 17 inches). Conclusions reached were (1) that only data obtained from full limb radiographs are accurate for determining and reporting limb alignment in TKA, (2) that alignment values should be reported relative to the mechanical axis of the limb because of the variability of the femoral anatomic angle, (3) that intramedullary femoral guides are required to make accurate femoral bone cuts, (4) that extramedullary tibial guides permit accurate cuts of the proximal end of the tibia, and (5) that tibial intramedullary guides are not only unnecessary but also potentially misleading.

Biomechanical Phenomena↗
PubMed1997

Midterm results in metal-backed patella revisions for metallosis.

Nine patients underwent isolated patellar revisions and synovectomies for metallosis secondary to the mechanical failure of metal-backed patellar components. These patients were followed for an average of 5 years (range, 2 to 8 years). In all cases, the femoral and tibial components were left in place, and in one patient the patellar bone was deemed too thin to resurface. Two patients (22%) developed deep infection. One infection (enterococcal) required arthrodesis, and the other (staphylococcal) was successfully managed with a two-staged reimplantation. A third patient sustained an inferior patella pole fracture that was treated conservatively. The remaining six patients are functioning satisfactorily. Metallosis is a serious complication in knee arthroplasty, and these patients merit close follow-up.

Enterococcus↗
PubMed1996

Recurrent hemarthrosis after total knee arthroplasty.

Seven patients developed recurrent hemarthroses following total knee arthroplasty. The average interval between arthroplasty and the first bleed was more than 20 months (range, 1-30 months). All seven required open synovectomy an average of 21 months (6-31 months) after arthroplasty. Follow-up evaluation averaged 44 months (19-60 months) and all had an excellent result without further bleeds. A prolific synovitis was seen in all cases, with histologic features revealing a chronic synovitis with fibrosis and hemosiderin staining. Entrapment of the proliferative synovial tissue between the components is postulated to be the etiology for these recurrent bleeds which averaged four per patient prior to synovectomy.

Aged↗
PubMed1996

Preoperative medical evaluation in patients having joint replacement surgery: added benefits.

Elderly patients having elective total joint replacement surgery are at increased perioperative risk because of comorbid conditions. To show the importance of the preoperative medical evaluation for total joint replacement, we reviewed the records of 238 patients who had screening for total joint replacement surgery in 1994. Of these 238 patients, 76 (32%) benefited from findings on the preoperative medical evaluation. Four percent of these patients were found to have a condition that warranted the postponement or cancellation of surgery, and others were found to have a condition that was immediately treatable. Some patients required referral to their primary care provider or to a specialist. This study emphasizes the importance and added benefits of the preoperative medical evaluation for elderly patients having elective total joint replacement surgery.

Adult↗
PubMed1996

Simultaneous bilateral total knee replacement versus unilateral replacement.

Over a 5-year period the two authors performed 213 simultaneous (sequentially) bilateral total knee arthroplasties (426 knees). A matched series of 107 unilateral arthroplasties was performed within this time frame, and the two groups of patients were evaluated based on postoperative complications and functional improvements. The patients in both groups were primarily osteoarthritics with an average age of 70 years. Knee function according to Hospital for Special Surgery (HSS) scores showed no significant difference, with the postoperative scores for the bilaterals and unilaterals averaging 93.6 and 93.4, respectively. The complication rate in the bilateral series was not increased over the unilaterals; it was less. These results lead to the conclusion that in patients with bilateral arthritis, both knees should be operated on under a single anesthetic, providing the surgical team is able to carry out the operative procedure expeditiously.

Aged↗
PubMed1993

Treatment of rotator cuff impingement.

The author performed 497 shoulder decompression procedures between 1978 and 1989. Of these procedures, 252 (51%) had tears of the rotator cuff that were repaired concomitantly. The results were successful in over 90% of the cases. It is suggested that articular-surface tears or intratendinous tears are the possible cause of some of the failures of the open procedure. The findings also suggest that the use of arthroscopy or magnetic resonance imaging may be indicated in selected cases. However, for the appropriate patient, open shoulder decompression continues to be an excellent treatment.

Arthroscopy↗