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Biomedical subjects

R Poss

Publications and source records attributed to R Poss.

At least 73 records · Page 4Linked to original sources
PubMed1987

Effects of reducing physical therapy services on outcomes in total joint arthroplasty.

A natural experiment provided an opportunity to determine whether physical therapy (PT) service reduction would affect the outcomes of total joint arthroplasty. A sample of 200 patients with rheumatoid arthritis or osteoarthritis who underwent total hip or total knee replacement during successive reduction of services was randomly selected. The demographic and clinical characteristics of patients in each period were similar. Despite large differences between groups in hours of PT per patient, there were no major differences in length of stay between the groups, or compared to similar hospitals, functional status at discharge, or numbers of surgical complications. Implications for health services organization are discussed.

Aged↗
PubMed1987

Current status of total joint arthroplasty: observations and projections.

The 10-20 year results and complications of the first generation of total hip arthroplasties suggest that early problems such as infection, component breakage, and early loosening have been controlled, but that late aseptic loosening is now the major problem. Newer approaches will bring with them a new set of complications which must be carefully monitored. A standardized rating scheme and computerized information bank will allow more rapid analysis of trends and problems. A number of joint preserving alternatives to total replacement are available but intervention must be early, before a salvage situation exists.

Arthritis, Rheumatoid↗
PubMed1986

Radiographic comparison of cementing techniques in total hip arthroplasty.

Using a single prosthetic design, the authors conducted a radiographic comparison of the results of changes in cementing techniques in 58 total hip arthroplasties with respect to the initial postoperative and equivalent follow-up radiographs. The study period, 1975-1982, spanned the advent of cement restrictors, canal preparation, and pressurization techniques. In matched patients, the use of modern cementing techniques and canal preparation led to a significant improvement in the initial postoperative radiographic appearance and subsequent loosening rate of the femoral component, suggesting that these techniques may change the expected rate of late femoral component loosening, based on previous studies done with prepressurization cementing techniques.

Aged↗
PubMed1985

Long-term results of revision total hip replacement. A follow-up report.

The results of 110 revision total hip replacements performed for aseptic failure, with an average follow-up of 3.4 years, were reported in 1982. We were able to continue to follow ninety-nine of these patients for an average of 8.1 years (range, five to 12.5 years). With this longer follow-up, we found that twenty-nine (29 per cent) of these revised arthroplasties have since failed. Most of the failures after 1982 occurred in the hips that were known to have a progressive radiolucency at the time of the first evaluation. We concluded that there is an increased failure rate with longer follow-up of revision total hip replacement, and that progressive radiolucency at an interface indicates a poor prognosis for the arthroplasty.

Activities of Daily Living↗
PubMed1984

Functional adaptation of the human locomotor system to normal and abnormal loading patterns.

The adaptation of bone to its mechanical environment can be understood only in the context of its relationships to the soft tissues of the locomotor system, and its dual requirements to provide structural support and preserve articular cartilage. Radiographic analysis of the human skeleton provides insights into the nature of load transmission. Bone's adaptation to abnormal situations such as arthritis, or total joint implants, provides information about the limits of its tolerance to altered load or strain patterns. Knowledge gained from analysis of the first 20 years of total joint arthroplasty should provide prostheses of improved design and materials in the future.

Adaptation, Physiological↗
PubMed1984

Kinematic total knee replacement.

We reviewed 124 consecutive kinematic condylar total knee replacements (in ninety-one patients) at two to four years postoperatively. One hundred and eleven (90 per cent) were rated as good or excellent. The average active postoperative flexion was 106 degrees (range, 94 to 120 degrees). Twenty-two knees (18 per cent) had incomplete, non-progressive radiolucent lines, less than one millimeter in width, at the tibial bone-cement interface; these were considered insignificant. Restriction of stair-climbing ability in this series appeared to be a function of involvement of multiple joints rather than of patellar replacement, as the rheumatoid patients with resurfaced patellae performed the worst. The osteoarthritic patients with involvement of a single joint performed the best, regardless of whether the patella was resurfaced or not. When compared with a similar series of total knee replacements in which the tibial component was made entirely of plastic, less reaction at the bone-cement interface was found with the metal-backed kinematic tibial component. We suggest that this finding is clinical confirmation of in vitro studies that demonstrated the advantage of metal-backed tibial components. We concluded that this procedure, if meticulously performed, will give predictably good to excellent results with a low complication rate, a good postoperative range of motion, and a favorable-appearing bone-cement interface at two to four years.

Adult↗
PubMed1982

Adverse psychological sequelae associated with total joint replacement surgery.

Although total joint replacement surgery is generally successful in pain relief and improved joint function, adverse psychological sequelae sometimes do occur. This report highlights potential problems associated with total joint replacement surgery and illustrates with brief cases from a referral hospital for arthritis patients. An appreciation of psychological factors can ensure patients' motivation to participate in the rehabilitative efforts after surgery, and thus enhance optimal results from the surgery.

Adaptation, Psychological↗
PubMed1982

Primary total hip or knee replacement: evaluation of patients.

Total joint replacement surgery has revolutionized the management of chronic arthritis. Careful patient selection, medical follow-up, patient education, and rehabilitation management produce the best results. The indications, contraindications, and results of total knee and hip replacement are reviewed.

Arthritis↗
PubMed1982

Revision total hip arthroplasty.

In this review, 110 hips in 107 patients underwent revision total hip arthroplasty at The Hospital for Special Surgery and the Robert B. Brigham Hospital. The minimum follow-up period was two years (average, 3.4 years). Failures of the original total hip arthroplasties were due to loosening of the femoral component (44 hips), loosening of both components (23 hips), loosening of the acetabular component (17 hips), fracture of the femoral component (14 hips), recurrent dislocation due to prosthetic malposition (7 hips), acetabular protrusion (3 hips), and fracture of the femoral shaft (2 hips). Sixty-six hips were categorized as good or excellent, and 25 hips were rated as fair. Nineteen poor results were due to: (a) deep infection (2 hips); (b) mechanical failure (15 hips); and (c) recurrent dislocation (2 hips). Complications included infection (3.6%), trochanteric problems (13%), mechanical failure (14%), and progressive radiolucent zones (26%). The quality of the result of a revision total hip arthroplasty is potentially as good as that of the original arthroplasty. However, the higher incidence of infection and mechanical failure reduces the frequency of such good results in the long-term. The extremely high incidence of progressive radiolucent zones at the bone-cement interface makes predictions for even longer term results guarded.

Adult↗
PubMed1981

The role of manipulation following total knee replacement.

During a twelve-month period, 23 per cent of a series of knees undergoing total replacement were manipulated two weeks postoperatively to increase flexion. While manipulation achieved an immediate increase in flexion from a mean of 71 degrees to a mean of 108 degree, by one week after manipulation the mean flexion was reduced to 88 degrees. By one year postoperatively, the manipulated knees were found to have a range of motion similar to that of their non-manipulated counterparts. Such factors as preoperative flexion and diagnosis appear to be the major determinants of ultimate flexion, and they seem to offset the temporarily increased flexion afforded by manipulation. The primary reason for manipulation is to facilitate the postoperative rehabilitation program for patients with painful, limited motion of the knee.

Arthritis, Rheumatoid↗
PubMed1980

Dislocation in total hip arthroplasties.

In a series of 1,443 total hip arthroplasties performed between 1970 and 1975, dislocation was the most frequent complication and its incidence was found to be increasing. Dislocatin was frequently associated with component malposition that the surgeon was not aware of at the time of surgery and was relatively frequent among less experienced surgeons. It was especially frequent if the patient had had previous hip surgery and was related to the difficulty of the surgery rather than the primary hip disease. Increasing incidence was associated with change in operative technique and less stringent patient selection. Dislocation was 2 1/2 times more frequent if trochanteric osteotomy was not performed. The tip of the greater trochanter was moved significantly closer to the center of the prosthetic head in the patients who dislocated. Traction for up to three weeks did not lower the incidence of subsequent dislocation compared with mobilization of the patients as soon as tolerated after dislocation. Surgery was effective in preventing further dislocations in patients with recurrent dislocation and component malposition. The use of an articulated prosthesis is not recommended.

Anthropometry↗
PubMed1980

Capitellocondylar total elbow arthroplasty.

Sixty-nine non-constrained capitellocondylar metal-to-plastic total elbow-replacement prostheses were implanted in sixty-four patients with rheumatoid arthritis. These patients were followed for an average of 3.5 years. Postoperative flexion and pronation were significantly improved, but no significant increase in postoperative extension or supination could be demonstrated. Based on a rating system evaluating pain and function, there were 87 per cent good or excellent results. The complication rate based on the total number of prostheses implanted was 39 per cent. Eight patients required revision of the arthroplasty: four for dislocation of the prosthesis, two for sepsis, one for loosening, and one for a fracture. Eight other asymptomatic patients showed minimum radiolucent lines adjacent to the ulnar component. No patient demonstrated radiolucent lines adjacent to the humeral component.

Adolescent↗