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Biomedical subjects

Robert T Trousdale

Publications and source records attributed to Robert T Trousdale.

At least 19 recordsLinked to original sources
PubMed2006

Modified complete synovectomy prevents recurrence in synovial chondromatosis of the hip.

Synovial chondromatosis of the hip is a rare disorder with few published reports regarding treatment and outcomes, and therefore, selecting the optimal surgical treatment is difficult. We reviewed eight patients with monoarticular synovial chondromatosis of the hip who had joint débridement and a modified total synovectomy performed through a surgical hip dislocation with a trochanteric flip osteotomy. Patients were evaluated for recurrence of disease, progression of osteoarthritis, clinical outcomes, and subsequent reoperations. The minimum followup was 4 years (mean, 6.5 years). At final review, no patient had recurrence of disease. Two patients had progression of osteoarthritis requiring total hip arthroplasties at 5 and 10 years after the initial surgical intervention. These patients did not show recurrent disease on histologic examination of the synovial membrane at the time of the arthroplasty. The six patients with preserved joints were followed up for a mean of 6.2 years. The mean Merle d'Aubigné and Postel score in this group was 16.5 points (range, 15-18 points) at the latest followup. There were no major or minor complications related to this treatment. Our midterm results suggest that open débridement with modified total synovectomy is an effective treatment that prevents recurrence of disease and provides substantial pain relief. Surgical hip dislocation allows safe and complete access to the joint for débridement and synovectomy with no added morbidity.

Adult↗
PubMed2006

Anatomy of the extensor mechanism in reference to quadriceps-sparing TKA.

The introduction of minimally invasive surgical techniques in total joint arthroplasty has ushered in a range of new terminology that often is unclear. One such term is quadriceps-sparing total knee arthroplasty (TKA). We examined 100 knees intraoperatively in 100 patients at the time of TKA, dissected 45 entire cadaveric leg specimens, and did high-resolution 3-Tesla magnetic resonance imaging scans on five normal knees to specifically determine: (1) the distal most insertion point of the vastus medialis obliquus; (2) the angle of insertion of the vastus medialis obliquus; and (3) the length of the vastus medialis obliquus tendon. The medial anatomy of the extensor mechanism was consistent. The inferior edge of the VMO inserted at or near the midpole of the patella in each case. The tendon inserted at 50 degrees (range, 46 degrees - 52 degrees). One hundred of the 150 patients (66%) had a tendon that measured 1.2 +/- 0.1 cm, whereas 50 of 150 patients (33%) had a substantially longer tendon (2.2 +/- 0.2 cm). Any medial arthrotomy that extends more proximal than the midpole of the patella detaches a portion of the quadriceps tendon. The term "quadriceps sparing" should not be applied to any surgical approach with a capsular incision that extends more proximal than the midpole of the patella.

Adult↗
PubMed2006

Patients preferred a mini-posterior THA to a contralateral two-incision THA.

The two-incision total hip arthroplasty (THA) technique has been touted as offering substantially faster recovery than other methods of THA, but direct comparison studies in similar groups of patients have not been done. We sought to determine if there was a difference in the early functional outcome after a two-incision THA compared to a mini-posterior THA as measured by the time to reach defined milestones of daily activity. We also evaluated which procedure the patients preferred. Twenty-six patients underwent staged bilateral total hip arthroplasties with a two-incision minimally invasive THA on one hip and a mini-posterior THA on the contralateral hip. The same comprehensive anesthesia and rapid rehabilitation protocol was used after each operation. Patients were reviewed retrospectively a minimum of 6 months after the second total hip arthroplasty. There were no differences in the time to discontinue ambulatory aids, return to driving, climb stairs, return to work, or walk 1/2 mile. Sixteen of 26 patients preferred the mini-posterior total hip arthroplasty and two patients had no preference. The added surgical technical difficulty of the two-incision minimally invasive total hip arthroplasty was not rewarded with an earlier return to functional activities and more patients preferred their mini-posterior total hip arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2006

Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach.

Decreased muscle damage is a reported benefit of minimally invasive surgical (MIS) approaches in total hip arthroplasty (THA). We compared the extent and location of muscle damage during THA using the MIS anterior Smith-Petersen and MIS posterior surgical approaches. THA was performed in six human cadavers (12 hips). One hip was assigned to the Smith-Petersen approach and the contralateral hip to the posterior approach. Muscle damage was graded with a technique of visual inspection to calculate a proportion of surface area damage. Less damage occurred in the gluteus minimus muscles and minimus tendon with the Smith-Petersen approach. A mean of 8% of the minimus muscle was damaged via the Smith-Petersen approach, compared to 18% via the posterior approach. The tensor fascia latae muscle was damaged (mean of 31%), as well as direct head of the rectus femoris (mean 12%) during the Smith-Petersen approach. The piriformis or conjoined tendon was transected in 50% of the anterior approaches to mobilize the femur. The posterior approach involved intentional detachment of the piriformis and conjoined tendon and measurable damage to the abductor muscles and gluteus minimus tendon in each specimen. Clinical outcome studies and gait analysis are necessary to ascertain the functional implications of these findings.

Aged↗
PubMed2006

Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. Surgical technique.

BACKGROUND: In patients with symptomatic hip impingement, surgical resection of the femoral head-neck junction may improve the range of motion and relieve pain. A risk of this procedure is fracture. We evaluated the amount of resection of the anterolateral aspect of the femoral head-neck junction that can be done safely. METHODS: Cadaveric proximal femoral specimens (fifteen matched pairs) were divided into three groups: 10%, 30%, or 50% of the diameter of one femoral neck was removed, and the contralateral femoral neck was left intact to serve as the control. A compressive load was applied directly to the femoral head. Peak load, stiffness, and energy to fracture were compared among the groups. RESULTS: The energy to fracture differed significantly (p = 0.0015) among the 10%, 30%, and 50% resection groups. The peak load after the 50% resection was significantly less (p = 0.0025) than that after the 10% or 30% resection. With the numbers available, there was no significant difference in peak load between the 10% and 30% resections. CONCLUSIONS: Resection of up to 30% of the anterolateral quadrant of the head-neck junction did not significantly alter the load-bearing capacity of the proximal part of the femur. However, a 30% resection significantly decreased the amount of energy required to produce a fracture. Thirty percent should be considered to be the greatest feasible amount of resection because of the change in the pattern of the femoral head-neck response to axial loads that we observed.

Acetabulum↗
PubMed2005

Functional results after revision of well-fixed components for stiffness after primary total knee arthroplasty.

Between 1990 and 2001, 16 well-fixed, aseptic, primary total knee arthroplasties were revised in 15 patients for a diagnosis of stiffness. Patients were followed for a mean of 42 months (range, 2-6 years). Of 15 patients, 10 (66%) were satisfied with the results of the procedure. The mean Knee Society pain score improved from 28 to 65 points, and the mean functional score improved from 45 to 58 points. The mean arc of motion improved from 40 degrees preoperatively to 73 degrees postoperatively. Recurrent stiffness required additional intervention in 4 knees (3 patients, 25%). The results of revision of a well-fixed, stiff, primary total knee arthroplasty were mixed in our hands and provided only modest improvements in pain, function, and arc of motion. Key words: knee, arthroplasty, stiffness, revision, arthrofibrosis.

Aged↗
PubMed2005

Extended femoral osteotomy for revision of hip arthroplasty: results and complications.

Seventy-five revision total hip arthroplasties (73 patients) performed using an extended greater trochanteric osteotomy for exposure and an extensively porous-coated uncemented stem were reviewed after 2 years (range, 1 to 5). The mean osteotomy length was 14 cm (range, 7 to 19 cm) and fixation was with at least 2 cables. One stem was revised at 4 months for stem subsidence and loosening. Of the remaining 74 osteotomies, 73 healed without further procedures. A single nonunion was reoperated at 4 months and healed. Sixty-eight of 73 osteotomies healed with no migration and 5 did with less than 5 mm of proximal migration of the osteotomy fragment. Complications included 3 intraoperative and 1 postoperative osteotomy fragment fractures. Extended trochanteric osteotomy, executed preserving the fragment's vascularity and fixed with rigid fixation, can be performed with a low rate of complications.

Adult↗
PubMed2005

Long-term results of total knee arthroplasty in young patients with rheumatoid arthritis.

Forty-seven cemented total knee arthroplasties in 32 patients with rheumatoid arthritis who were 55 years or younger (average, 43) were followed until death or a minimum of 15 years. The average follow-up was 18 years. There were 6 revisions; 5 of 6 revisions had severe polyethylene wear and osteolysis. All revisions occurred after 17 years (range, 17-23). Three of these had fracture of the tibial component associated with polyethylene wear through; the remaining 2 had loose tibial and femoral components. One patient sustained a distal femoral periprosthetic fracture requiring revision of the total knee. Cemented total knee arthroplasty in the young patient with rheumatoid arthritis is reliable and durable at an average 18 years of follow-up with an estimated survivorship of 100% at 15 years and 93.7% at 20 years.

Adult↗
PubMed2005

Solitary bony metastasis from renal cell carcinoma: significance of surgical treatment.

To define the importance of the type of surgical treatment, we retrospectively analyzed the survival rate of 60 patients with solitary bony metastasis from renal cell carcinoma. Thirteen patients had wide resection, 20 had local stabilization, and 27 patients had no surgical treatment, but had adjuvant treatment alone. The 1-, 3-, and 5-year survival rates were 83%, 45%, and 23%, respectively. Patients with surgical treatment (wide or intralesional resection) survived longer compared with patients who had no surgical treatment but had adjuvant treatment modalities. However, there was no survival advantage for patients who had a wide resection of the lesion compared with patients who had intralesional resection or intramedullary stabilization alone. Our results indicate that wide surgical excision of a solitary bony metastasis from renal cell carcinoma is not mandatory to improve survival. However, because three of 20 patients (15%) treated with stabilization alone had local disease progression, wide resection of metastatic lesions and stabilization may be necessary to prevent local disease progression and complications.

Adult↗
PubMed2005

Prevention of wound contamination using DuraPrep solution plus Ioban 2 drapes.

The use of the preoperative skin preparation DuraPrep is thought to enhance the adhesion qualities of an incise drape. If there is less drape lift it was hypothesized that there may be a reduction in wound contamination. We did a single-center, randomized trial to determine if a preoperative skin preparation containing DuraPrep solution plus Ioban 2 drapes reduced wound contamination in total joint replacement surgery compared with a povidone iodine scrub and paint plus Ioban 2 drapes. Secondary research questions focused on comparisons of differences in drape lift and cost between the two groups. Of the 176 evaluable patients, the proportion of patients with a contaminated wound was similar in the two groups (DuraPrep 28.0% versus povidone iodine 36.4%). The mean drape lift in the DuraPrep group was less than the povidone iodine group (1.5 cm versus 9.9 cm respectively). The mean cost of prepping was lower for the DuraPrep group compared with the povidone iodine group (dollars 93.36 and dollars 248.91, respectively). A preoperative skin preparation regimen containing DuraPrep solution plus Ioban 2 drapes is equivalent to a povidone iodine scrub and paint and Ioban 2 for the prevention of wound contamination during total joint replacement surgery. Improved drape lift and cost may influence the choice between the two methods.

Adult↗
PubMed2005

Revision total knees done for extensor problems frequently require reoperation.

UNLABELLED: We retrospectively reviewed 361 patients who had a revision total knee arthroplasty done for an extensor mechanism problem to assess the prevalence, etiology, and risk factors for subsequent reoperation. The prevalence of reoperation was 23% because 84 patients were reoperated on one or more times. The average time to the first reoperation was 2.4 years. The total number of reoperations was 127 with 58 patients reoperated on once, 15 reoperated on twice, and 11 reoperated on three or more times. The cumulative risk of a reoperation for any reason after index revision was 7% at 1 year, 19.6% at 5 years, and 35.9% at 10 years. The most common reason for reoperation was a new or recurrent patellofemoral problem, which accounted for 33% of the first reoperations. The risk of reoperation was substantially lower for patients that had femoral or tibial component malrotation corrected at the time of revision TKA. The risk of reoperation after revision TKA for an extensor mechanism complication increased in patients operated on in the 1990s compared with patients operated on in the 1970s and 1980s. LEVEL OF EVIDENCE: Therapeutic study, Level-IV-1 (case series). See the Guidelines for authors for a complete description of levels of evidence.

Arthroplasty, Replacement, Knee↗
PubMed2005

Patellectomy after total knee arthroplasty.

UNLABELLED: We retrospectively reviewed nine patients who had condylar TKA and subsequently had a patellectomy between 1969 and 2003. One patient was lost to followup, but the remaining eight patients were followed up for an average of 49 months after patellectomy. All patellectomies were done after comminuted patellar fractures at an average of 21 months (range, 4-88 months) after the initial arthroplasty. Knee scores after the initial arthroplasty were 83 points (range, 69-97 points) and 49 points (range, 10-100 points) for pain and function, respectively. Knee scores after patellectomy were 81 (range, 20-97) and 28 (range, 0-80) for pain and function, respectively. The average range of motion before and after patellectomy was 0 degrees to 104 degrees and 2 degrees to 106 degrees , respectively. Four patients had mild extensor lags at final examination, but all were less than 10 degrees . Two patients were unable to use stairs. Two patients had complications consisting of quadriceps tendon rupture and secondary instability. Midterm results after patellectomy show knee scores for pain that are comparable to those after initial arthroplasties, but the function scores were not as good. Fifty percent of the patients had extensor lags but all were mild (< 10 degrees ). Patellectomy can provide pain relief after a patellar fracture after total knee arthroplasty but the functional results are frequently poor. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

Dislocation of primary THA done through a posterolateral approach in the elderly.

UNLABELLED: We assess the rate of dislocation of total hip arthroplasty (THA) through a posterolateral approach in elderly patients and determine if this complication can be minimized. We retrospectively reviewed 150 THAs done between 1992 and 2002, through a posterolateral approach in patients 80 years and older. A hybrid THA was done in 46% of patients and both components were cemented in 54% of patients. A 28-mm head was used in 83% of the patients and a 32-mm head was used in 17% of patients. An elevated liner, with the elevation placed posteriorly, was used in 38% of hybrid cases. Starting in mid-1998, the posterior capsule was preserved and repaired at the time of wound closure (n = 77, 51%). Dislocation occurred in eight hips (five recurrent) at an average time to dislocation of 26.9 months (range, 1-79 months). No dislocations occurred when using a 32-mm head or a 28-mm head with a lipped liner in association with repair of the posterior capsule. Statistical regression analysis indicated that capsular repair was the single most important predictive factor for dislocation. When using the posterolateral approach for THA in patients older than 80 years, we suggest using a 32-mm head in combination with posterior capsular repair to reduce the incidence of dislocation. LEVEL OF EVIDENCE: Therapeutic study, Level III-1 (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Aged, 80 and over↗
PubMed2005

The Frank Stinchfield Award: muscle damage after total hip arthroplasty done with the two-incision and mini-posterior techniques.

Some surgeons have suggested that a minimally invasive two-incision approach allows total hip arthroplasty to be done without cutting or damaging any muscle or tendon. To our knowledge that claim has not been supported by any published clinical or basic science data. Our purpose in doing this study was to quantify the extent and location of damage to the abductor and external rotator muscles and tendons after two-incision and mini-posterior total hip arthroplasty. Ten cadavers (20 hips) were studied. In each cadaver one hip randomly was assigned to the two-incision group and the contralateral hip was assigned to the mini-posterior group. After inserting the total hip arthroplasty components the muscle damage was assessed using a technique described previously. Damage to the muscle of the gluteus medius and gluteus minimus was substantially greater with the two-incision technique than with the mini-posterior technique. Every two-incision total hip replacement caused measurable damage to the abductors, the external rotators, or both. Every mini-posterior hip replacement caused the external rotators to detach during the exposure and had additional measurable damage to the abductor muscles and tendon. We do not support the contention that a two-incision total hip arthroplasty is done without cutting muscle or tendon. None of the two-incision hip replacements were done without cutting, reaming, or damaging the gluteus medius or gluteus minimus muscle or external rotators.

Aged↗
PubMed2005

Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection.

BACKGROUND: In patients with symptomatic hip impingement, surgical resection of the femoral head-neck junction may improve the range of motion and relieve pain. A risk of this procedure is fracture. We evaluated the amount of resection of the anterolateral aspect of the femoral head-neck junction that can be done safely. METHODS: Cadaveric proximal femoral specimens (fifteen matched pairs) were divided into three groups: 10%, 30%, or 50% of the diameter of one femoral neck was removed, and the contralateral femoral neck was left intact to serve as the control. A compressive load was applied directly to the femoral head. Peak load, stiffness, and energy to fracture were compared among the groups. RESULTS: The energy to fracture differed significantly (p = 0.0015) among the 10%, 30%, and 50% resection groups. The peak load after the 50% resection was significantly less (p = 0.0025) than that after the 10% or 30% resection. With the numbers available, there was no significant difference in peak load between the 10% and 30% resections. CONCLUSIONS: Resection of up to 30% of the anterolateral quadrant of the head-neck junction did not significantly alter the load-bearing capacity of the proximal part of the femur. However, a 30% resection significantly decreased the amount of energy required to produce a fracture. Thirty percent should be considered to be the greatest feasible amount of resection because of the change in the pattern of the femoral head-neck response to axial loads that we observed.

Aged↗
PubMed2004

Femoral osteotomies for avascular necrosis of the femoral head.

Avascular necrosis of the femoral head affects 10,000 to 20,000 people every year and often these patients are in their 30s and 40s. The natural history of this disease is important to understand because the rate of femoral head collapse and treatment options are related to multiple factors including the cause of the disease, its stage at initial presentation, and the size and location of the lesion. Various treatment options have been purposed for different stages of avascular necrosis of the femoral head. Nonoperative treatments include protected weightbearing, electrical stimulation, and pharmacologic treatments. Operative treatment includes core decompression with or without grafting, debridement and grafting, osteotomy, fusion, hemiresurfacing, hemiarthroplasty, and total hip arthroplasty. The purpose of the current study was to discuss the history, indications, techniques, and results of proximal femoral osteotomies for the treatment of avascular necrosis of the femoral head.

Arthroplasty, Replacement, Hip↗