Symposium on disorders of the knee joint. Foreword.
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Humans↗
Biomedical subjects
R S Laskin
Publications and source records attributed to R S Laskin.
Intertrochanteric fractures of the hip in the elderly: a retrospective analysis of 236 cases.
A series of 236 patients over the age of 80 with intertrochanteric fractures were treated on a protocol established basis in an attempt to decrease postoperative morbidity and mortality. Rigid fixation with interfragmentary compression using the compression hip screw permitted us to begin early mobilization and immediate weight-bearing. Vigorous pulmonary tiolette, prophylactic antibiotics, and aspirin "anticoagulation" were used as adjuncts. Three month mortality was 7%. Overall, 76% of the patients who ambulated in any manner before their fracture walked again after surgery. Many, however, lost one grade level of walking postoperatively. Effective treatment for a patient with an intertrochanteric fracture, regardless of advanced age, is surgery and early mobilization.
Age Factors↗
Unicompartmental tibiofemoral resurfacing arthroplasty.
Thirty-seven patients with unicompartmental osteoarthritis were treated by replacement arthroplasty using the Marmor modular prosthesis and each patient was followed for at least two years. Despite rigid preoperative criteria for the selection of cases, the over-all results were definitely inferior to those seen after either bicompartmental or tricompartmental replacement arthroplasty. Complications included recurrent pain and degeneration of the other compartment, often associated with abrasion of the remaining cartilaginous surfaces caused by polyethylene particles. There was also more settling of the tibial component in these patients than in patients treated by bicompartmental replacement arthroplasty. Because of these findings, we no longer use unicompartmental replacement of the medial side of the knee. The results after the three lateral compartment replacements, on the other hand, were good, and use of this procedure for post-traumatic arthritis is still under investigation.
Arthroplasty↗
Modular total knee-replacement arthroplasty. A review of eighty-nine patients.
Fifty-eight osteoarthritic and thirty-one rheumatoid patients underwent modular total knee-replacement arthroplasty. The major indication for the operation was relief of pain. Contraindications to this resurfacing arthroplasty included varus-valgus instability of over 20 degrees, combined varus-valgus instability with flexion contracture of over 40 degrees, marked recurvatum, and predominant patellofemoral symptoms. In 59 per cent of the osteoarthritic and 58 per cent of the rheumatoid patients, complete relief of pain was evident when they were evaluated twenty-four months after surgery, while another 35 per cent of each group had only mild pain related to inclement weather. Their ability to walk long distances without support or limp was increased. Range of motion and ability to climb stairs were not significantly improved.
Aged↗
A single stage osteotomy and epiphysiodesis for treatment of moderately displaced femoral capital epiphyses.
Epiphysiodesis and subtrochanteric osteotomy have long been recognized as valuable procedures in the treatment of the patient with a moderately or markedly displaced femoral capital epiphysis. Typically these have been performed individually or sequentially. The operation herein described combines the two in one single-stage procedure. Using a stainless steel Lorenzo Screw, the epiphyseal plate is transfixed and further capital displacement prevented. The subtrochanteric compensatory osteotomy is performed using simple visual clinical guidelines and is held rigidly immobilized with a variable angle sideplate affixed to the Lorenzo Screw. The firm fixation enables one to dispense with plaster immobilization and begin the patient on an early exercise program. Restoration of a more normal range of motion, especially regarding rotation internally, abduction, and flexion is easily obtained. Radiographic correction of varus and posterior tilting are thereby secured.
Adolescent↗