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R T Trousdale

Publications and source records attributed to R T Trousdale.

At least 19 recordsLinked to original sources
PubMed2005

Pregnancy and childbirth after total hip arthroplasty.

We surveyed 343 young women with 420 total hip arthroplasties (THAs) regarding pregnancy and childbirth after THA. The mean age at surgery was 35 years (18 to 45). The mean length of follow-up after the initial arthroplasty was 16 years (6 to 27). Of these 343 women, 47 (13.7%) had a successful pregnancy after their primary THA. The first baby after a THA was delivered vaginally in 30 patients and by Caesarean section in 17. Of the 343 patients, 138 underwent a revision. For the entire series, the risk of revision at five years was 5%, at ten years 24%, and at 20 years 50%. After adjusting for age at surgical intervention, the risk of revision was not significantly associated with childbirth. Of the 47 patients who had a successful pregnancy, 28 (60%) noted an increase in pain in the hip during pregnancy and ten of these patients had persistent pain after their pregnancy. Seven patients complained of pain in the groin in the replaced hip after childbirth. At the time of this survey, five of these patients (70%) had had revision THA. Childbirth is not affected by the presence of a THA. Pregnancy after THA is not associated with decreased survival of the prosthesis. Pain in the hip is common during pregnancy in these patients. Pain in the groin which persists after delivery commonly leads to revision of the THA.

Adolescent↗
PubMed2002

The decision to accept treatment for osteoporosis following hip fracture: exploring the woman's perspective using a stage-of-change model.

Despite the availability of medications that reduce fracture risk, most women who sustain a hip fracture are not evaluated or treated for osteoporosis. While a number of studies have attributed this to a lack of physician awareness, no studies have evaluated this problem from the patient's perspective. To explore the process a woman negotiates when deciding to accept pharmacologic treatment for osteoporosis after hip fracture, we used a stage-of-change model to characterize a consecutive series of 70 postmenopausal women (mean age 85 years) admitted to a tertiary care hospital with an acute low-impact hip fracture between May 2000 and August 2000. We measured stage-of-change using a modified form of the Weinstein Precaution Adoption Process Model (PAPM). The majority of patients (65%) were ineligible because of dementia or delirium; only 29 were eligible and 21 were enrolled. Most women (62%) were in stages 1 or 2 of the PAPM, indicating that they were unaware of osteoporosis or had never considered pharmacologic treatment for it. The only factors associated with a more advanced PAPM stage (indicating active consideration or currently taking treatment) were a previous bone mineral density (BMD) evaluation ( p = 0.007) and a diagnosis of osteoporosis ( p = 0.001). Although 48% of women had a previous fragility fracture and osteoporosis knowledge was poor overall (mean score 52% correct), neither was associated with a more advanced PAPM stage in this sample. In conclusion, women evaluated after hip fracture were not ready to accept pharmacologic treatment for osteoporosis; they were unaware that they had osteoporosis or had never considered treatment for it. For a woman to advance through the behavior change process, she must first be made aware of the problem that requires a change in behavior. Physicians play a crucial role in promoting awareness of the diagnosis of osteoporosis after fracture, which in turn is associated with patient advancement through the behavior change process and the decision to accept pharmacologic intervention. The large number of cognitively impaired patients in this population, however, will certainly make efforts to improve osteoporosis awareness, diagnosis and intervention more challenging.

Aged↗
PubMed2001

Thirty-day mortality after total knee arthroplasty.

BACKGROUND: There have been sporadic reports on perioperative mortality associated with total knee arthroplasty. The purpose of this study was to determine risk factors for such mortality. METHODS: A computer-assisted review of the records of 22,540 consecutive patients who had undergone total knee arthroplasty between 1969 and 1997 was performed to identify all patients who had died within thirty days after the procedure. A detailed analysis of the medical, surgical, anesthetic, and pathological records of the patients was performed, and the mortality was determined according to age, gender, diagnosis, and fixation method. RESULTS: The rate of mortality within thirty days after the operation was 0.21% (forty-seven of 22,540). All deaths occurred in the group of 18,810 patients who had received a cemented implant, and no deaths occurred among the 3730 patients who had received an uncemented implant (p < 0.0001). The mortality rate was 0.24% (forty-three of 18,165) after primary arthroplasty and 0.09% (four of 4375) after revision arthroplasty (p < 0.0003). Three patients (0.01%) died during the operation. Forty-three of the forty-seven patients who died had a history of preexisting cardiovascular and/or pulmonary disease. Simultaneous bilateral total knee arthroplasty was associated with a significantly higher rate of perioperative mortality (p < 0.002). CONCLUSIONS: Factors that were associated with a significantly increased mortality after total knee arthroplasty included an age of more than seventy years, primary (as compared with revision) knee surgery, use of a cemented prosthesis, preexisting cardiopulmonary disease, and simultaneous bilateral arthroplasty.

Aged↗
PubMed2001

Total knee arthroplasty in patients with ankylosing spondylitis.

BACKGROUND: Ankylosing spondylitis is a seronegative spondyloarthropathy that primarily affects the sacroiliac joints, spine, hips, and, less commonly, the knee joints. The purpose of this study was to evaluate the results in a consecutive group of patients with ankylosing spondylitis who underwent total knee arthroplasty. METHODS: The results of thirty total knee arthroplasties in twenty patients with ankylosing spondylitis were reviewed. There were seventeen men and three women, with an average age of fifty-five years (range, twenty-eight to sixty-seven years) at the time of the arthroplasty. The diagnosis of ankylosing spondylitis was established preoperatively with use of the New York criteria. All patients received a cemented condylar-type implant. The average duration of follow-up was 11.2 years (range, three to sixteen years). RESULTS: The average Knee Society pain score improved from 14 points preoperatively to 76.3 points at the time of the latest follow-up. The improvement in the average Knee Society function score was less impressive, with an increase from 16.3 points preoperatively to 58.7 points at the time of the latest follow-up. The average arc of motion was 84.8 degrees prior to the arthroplasty and 86.7 degrees at the time of the final follow-up. Six knees (20%) had heterotopic bone formation. Three knees required manipulation under anesthesia because of poor motion postoperatively. There was one revision, due to loosening of a patellar component. All other components were radiographically stable at the time of the latest follow-up. CONCLUSIONS: Total knee arthroplasty with cement in patients with ankylosing spondylitis provided excellent pain relief and durable fixation at an average of 11.2 years postoperatively. However, patients with ankylosing spondylitis are at increased risk for the development of stiffness and heterotopic bone formation.

Adult↗
PubMed2001

Uncemented acetabular components with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: results at five to twelve years.

BACKGROUND: Anterolateral acetabular bone deficiency is one of the technical problems associated with total hip arthroplasty in patients with developmental hip dysplasia. The purpose of this study was to evaluate the results of one method of acetabular reconstruction for hip dysplasia-placement of an uncemented socket in conjunction with a bulk femoral head autograft. METHODS: Forty-four hips in thirty-five patients (twenty-nine female and six male; average age, thirty-nine years) with developmental hip dysplasia were treated with primary total hip arthroplasty with use of an uncemented porous-coated titanium cup fixed with screws and an autogenous bulk femoral head graft. The patients were followed clinically in a prospective fashion for five to 12.3 years (mean, 7.5 years), and radiographs were analyzed retrospectively. RESULTS: Four acetabular components were revised: two, because of severe polyethylene wear and osteolysis; one, because of aseptic loosening; and one, because of fracture of the acetabular shell. The mean Harris hip score for the unrevised hips improved from 51 points preoperatively to 91 points postoperatively. No unrevised socket had definite radiographic evidence of loosening. Forty-three of the forty-four hips had no radiographic evidence of resorption of the graft or had radiographic evidence of resorption limited to the nonstressed area of the graft lateral to the edge of the cup. CONCLUSIONS: This method of reconstruction provided reliable acetabular fixation and appeared to restore acetabular bone stock in patients with developmental hip dysplasia. We use this technique for patients with moderate anterolateral acetabular bone deficiency requiring total hip arthroplasty.

Acetabulum↗
PubMed2001

Poor outcomes of isolated tibial insert exchange and arthrolysis for the management of stiffness following total knee arthroplasty.

BACKGROUND: Severe stiffness after total knee arthroplasty is a debilitating problem. In patients with securely fixed and appropriately aligned components, arthrolysis of adhesions and exchange to a thinner tibial polyethylene insert may appear to be a reasonable and logical solution. We reviewed our experience with this procedure to determine its efficacy. METHODS: From 1992 through 1998, seven knees with marked stiffness after total knee arthroplasty were treated at our institution with arthrolysis of adhesions and conversion to a thinner tibial polyethylene insert. Only patients in whom the total knee prosthesis was well aligned, well fixed, and not associated with infection were included. There were five women and two men with a mean age at revision of sixty-one years (range, thirty-eight to seventy-four years). The average time to revision was twelve months, and the mean arc of motion prior to revision was 38.6 degrees (range, 15 degrees to 60 degrees ). The duration of follow-up after the insert exchange averaged 4.2 years (range, two to eight years). RESULTS: Mean Knee Society pain and function scores changed from 44 and 36.4 points preoperatively to 39.6 and 46 points at the time of final follow-up. Two knees were rerevised, one because of infection and the other because of aseptic loosening of the components. The five remaining knees were painful and stiff at the time of final follow-up. Four of these five knees were severely painful, and one knee was moderately and occasionally painful. The mean arc of motion of these five knees was 58 degrees (range, 40 degrees to 70 degrees ) at the time of final follow-up. CONCLUSION: Isolated tibial insert exchange, arthrolysis, and débridement failed to provide a viable solution to the difficult and poorly understood problem of knee stiffness in a group of carefully selected patients following total knee arthroplasty. We therefore have little enthusiasm for the continued use of this strategy.

Adult↗
PubMed2001

Thromboembolic disease in total knee arthroplasty.

Good data exist to support the use of low molecular weight heparins, warfarin, or intermittent pneumatic compression to prevent thromboembolic disease in TKA patients. Emerging data suggest that low molecular weight heparins may be more efficacious than warfarin, but are probably associated with slightly higher bleeding complications. There is little data to support the efficacy of aspirin alone as a prophylactic agent in TKA patients. Routine screening in asymptomatic low risk patients is probably not cost-effective. Prophylactic inferior vena caval filters are recommended in high-risk patients in whom other forms of anticoagulation are not feasible.

Adult↗
PubMed2000

Total joint arthroplasty in patients surgically treated for morbid obesity.

The results of 20 total hip and knee arthroplasties performed in patients with morbid obesity who were treated with bariatric surgery before arthroplasty are reviewed. Bariatric surgery was successful in reducing the Quetelet ratio (weight in kilogram divided by height in square meters) of patients from a mean of 49 kg/m(2) (range, 38-56 kg/m(2)) to a mean of 29 kg/m(2) (range, 25-32 kg/m(2)). The average time from bariatric surgery to arthroplasty was 23 months (range, 7-65 months). The cumulative Knee Society score had improved significantly from a mean of 103.6 (range, 45-165) before arthroplasty to a mean of 148.9 (range, 66-185) at final follow-up in 12 knees undergoing total knee arthroplasty (P<.01). The Harris hip score also had increased significantly from a prearthroplasty mean of 40 (range, 25-55) to 67.5 (range, 50-95) at final follow-up in 8 hips receiving total hip arthroplasties (P<.05). All but 1 patient with continuing patellofemoral pain were satisfied with the result of the arthroplasty at final follow-up. One hip was revised at 5 years for aseptic loosening of the femoral component; no knee revisions were required. All other prostheses were stable with no evidence of radiographic loosening or wear at final surveillance. Morbidly obese individuals, with severe degenerative joint disease, who are considered unsuitable for arthroplasty because of excess weight should be considered for bariatric surgery. Total joint arthroplasty after surgical treatment of obesity has an excellent outcome with an acceptable complication rate.

Adult↗
PubMed2000

Bilobed oblong porous coated acetabular components in revision total hip arthroplasty.

Thirty-eight oblong bilobed noncustom uncemented, porous-coated titanium acetabular components were used to reconstruct failed hip arthroplasties with large superior segmental acetabular bone deficiencies. No structural bone grafts were used. All patients were followed up for 2 to 5 years (mean, 3 years) after the operation. One patient (whose socket rested primarily on a structural bone graft from a previous procedure) had revision surgery for acetabular loosening. No other patients have had revision surgery or had another ipsilateral hip operation. At latest followup, 35 patients had no or mild pain and two patients had moderate pain. Two implants migrated more than 2 mm in the first year, then stabilized. On the latest radiographs, two implants had bead shedding, but there was no measurable migration or change in position. For selected patients with large superolateral acetabular bone deficiencies, this implant facilitated a complex reconstruction, provided good clinical results, and showed satisfactory stability at early to midterm followup in most patients.

Acetabulum↗
PubMed2000

The anterior centre-edge angle. A cadaver study.

The anterior centre-edge (VCA) angle quantifies the anterior cover of the femoral head, and angles of less than 20 degrees are considered abnormal. We have measured the VCA angles in hips without osteoarthritic changes. We took bilateral false-profile radiographs of nine female and 30 male cadavers without signs of osteoarthritis. The mean age at the time of death was 72 years (46 to 92). The mean VCA angle was 32.8 degrees (17.7 to 53.6). The SD was 7.9 degrees. Our findings suggest that the threshold of abnormality of the VCA angle may be slightly lower than previously thought. This information may be useful in counselling patients with asymptomatic acetabular dysplasia.

Acetabulum↗
PubMed2000

Possible guidelines for autologous red blood cell donations before total hip arthroplasty based on the surgical blood order equation.

OBJECTIVES: To determine, in patients undergoing total hip arthroplasty (THA), clinical predictive criteria for preoperative autologous blood donation and to propose guidelines to increase the efficiency and reduce the cost of preoperative autologous blood donation. PATIENTS AND METHODS: In this retrospective analysis of 165 adult patients undergoing primary THA, a stepwise regression analysis was used to determine which clinical variables predict erythropoiesis in patients donating autologous blood before THA. The surgical blood order equation (SBOE), which includes values for hemoglobin lost at surgery, preoperative hemoglobin level, and minimal acceptable hemoglobin level, was used to estimate the number of units of red blood cells (RBCs) needed for each patient at surgery and thus identify which patients should have made preoperative autologous blood donations. RESULTS: The statistically significant indicators for RBC production were predonation hemoglobin concentration (P<.001) and male sex (P=.003). Combining the regression equation for erythropoiesis with the SBOE allowed development of guidelines for the use of preoperative autologous RBC donation and erythropoietic therapy. For primary THA surgery, a patient with a predonation hemoglobin level higher than 14.7 g/dL does not need preoperative autologous donation. Preoperative autologous RBC donation would be effective for men with hemoglobin concentrations of 14.7 g/dL or less and for women with predonation hemoglobin levels of 13.2 to 14.7 g/dL. In women whose hemoglobin level is less than 13.2 g/dL, erythropoietic therapy should accompany autologous donation. CONCLUSION: Incorporation of patient factors with the SBOE system may result in increased efficiency and decreased cost of autologous blood ordering practices before THA.

Adult↗
PubMed2000

Asymmetric patella resurfacing in total knee arthroplasty.

Three hundred consecutive primary, cemented, condylar total knee arthroplasties (TKAs) were reviewed for the presence of asymmetric patella resurfacing using a postoperative Merchant or sunrise patellar radiograph. Twenty-one knees in 14 patients were found to have the patella asymmetrically resurfaced. Asymmetric resurfacing typically involved the inadvertent preferential resurfacing of the lateral facet with underresection of bone from the medial patellar facet. All patients underwent follow-up for a minimum of 5 years, with a mean follow-up of 7.5 years. Of the 21 knees, 3 revisions were required for patellar complications. One patellar component was loose on radiographs and there was marked patellofemoral pain in 6 knees. Overall, 11 of 21 knees (52%) underwent revision or were recommended for revision for patellar complications or had anterior knee pain that limited activities. Inadvertent asymmetric patella resurfacing using the kinematic condylar implant adversely affects the outcome after TKA.

Aged↗