Search PubMed⌕ Search

Biomedical subjects

Thomas H Mallory

Publications and source records attributed to Thomas H Mallory.

13 recordsLinked to original sources
PubMed2004

Cementless double-tapered total hip arthroplasty in patients 75 years of age and older.

Concerns exist with cementless total hip arthroplasty (THA) femoral fixation in the elderly patient population. This study reviews the outcomes of a tapered cementless femoral component in elderly patients 75 years of age and older. Forty-seven patients (49 hips) older than 74 years of age (average age, 79 years) underwent primary cementless THA with a double-tapered stem between 1996 and 2000. Radiographs and clinical data were reviewed. At a mean follow-up of 5 years, the mean postoperative Harris Hip Score was 84, with 87% having no or minimal pain; none had severe thigh pain. Two cases of stem subsidence and no progressive radiolucencies were seen. One well-fixed stem was revised for unexplained pain (2%). Survival with aseptic loosening as an end-point was 100%. Overall implant survival was 98% at an average of 5 years. No perioperative deaths or significant orthopedic complications were identified. Advanced age is not a contraindication for tapered cementless THA.

Aged↗
PubMed2004

Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: results at 2 to 16 years.

Initial stability is critical for fixation and survival of cementless total hip arthroplasty. Occasionally, a split of the calcar occurs intraoperatively. A review of 1,320 primary total hip arthroplasties with 2-year follow-up, performed between August 1985 and February 2001 using the Mallory-Head Porous tapered femoral component, revealed 58 hips in 55 patients with an intraoperative calcar fracture managed with single or multiple cerclage wires or cables and immediate full weight bearing. At 7.5 years average follow-up (range, 2-16 years), there were no revisions of the femoral component, radiographic failures, or patients with severe thigh pain, for a stem survival rate of 100%. Average Harris hip score improvement was 33.8 points. Fracture of the proximal femur occurs in approximately 4% of primary THAs using the Mallory-Head Porous femoral component. When managed intraoperatively with cerclage wire or cable, the mid- to long-term results appear unaffected with 100% femoral component survival at up to 16 years.

Adult↗
PubMed2004

Ileus following total hip or knee arthroplasty is associated with increased risk of deep venous thrombosis and pulmonary embolism.

Venous thromboembolic disease (VTD), deep venous thrombosis and pulmonary embolism, causes morbidity and mortality following total hip and total knee arthroplasties, while ileus complicates up to 4.0%. The clinical courses of 2,949 patients undergoing 3,364 consecutive primary and revision total hip and total knee arthroplasties, radical debridements, and reimplantations at one institution over a 2-year period were reviewed to examine the relationship between ileus and VTD. VTD prophylaxis consisted of aspirin and intermittent plantar pulse boots for all patients except those at high risk, who received parenteral chemical prophylaxis and boots. Ileus occurred in 62 patients (2.1%) and symptomatic DVT in 51 (1.7%). With ileus, the incidence of DVT was 8.1%: odds ratio 5.5 (P =.0036). Symptomatic pulmonary embolism occurred in 7 patients (0.24%); with ileus the incidence was 3.2%: odds ratio 19.6 (P =.0082). A significant increase was observed in rates of VTD with ileus. We recommend using parenteral chemical and mechanical prophylaxis in patients with ileus following total hip and total knee arthroplasties.

Arthroplasty, Replacement, Hip↗
PubMed2004

Mid-term results of a polyethylene-free metal-on-metal articulation.

Beginning in December 1995, 193 patients (195 hips) were enrolled into this prospective, randomized, controlled multicenter investigational device exemption study. Ninety-eight patients (99 hips) with 46 polyethylene liners and 53 metal liners had minimum 5-year follow-up (mean, 5.7 years). Average follow-up, Harris hip score improvement, and radiographic analysis were not statistically different between groups. No stress shielding or osteolysis was observed in either group. Three polyethylene liners and no metal liners had acetabular radiolucencies <1 mm in 1 or more zones. There have been no device-related complications, no acetabular revisions performed, and none pending in either group. Based on these mid-term results, the authors conclude that a metal-on-metal articulation represents a viable alternative in young, high-demand, active patients.

Arthroplasty, Replacement, Hip↗
PubMed2003

Lessons from the other side of the knife.

The overall success or failure of knee arthroplasty is predicated on the successful combination of patient selection, meticulous surgical technique, and prosthetic design. Discussions regarding the outcome of knee arthroplasty frequently focus on the implants used and the surgical technique employed, with a less frequent focus on patient profile. However, the patient experience was further highlighted to me when I became the patient and experienced the consequences of knee arthroplasty firsthand. This experience offered me a greater insight into patient expectations, the importance of preoperative counseling, the severity of perioperative pain, and the issues involved in the rehabilitative period. Joint arthroplasty outcomes are dependent on the harmony existing between the patient's perioperative status, expectation level, motivational status, physician diagnostic and surgical skill, and the design characteristics of the prosthesis.

Adult↗
PubMed2003

Future practice risks: obstacles with opportunities.

The encouragement of a consumer-directed insurance market and the involvement of corporate America have led to a transformation of the healthcare system that will redefine patient expectations and the role of the physician. The expectation of a higher level of customer service, the role of electronic media, and an earnest regard for healthcare by the patient will impact the physician. Consumer-directed healthcare will call for a reprioritization, focusing on service, convenience, competency, quality, and low cost. Indifference to patient courtesies or failure to become involved in modern technology may cause the physician to be bypassed from this new healthcare system. As the business world integrates the business model into the medical profession, healthcare organizations will restructure themselves into well-organized business enterprises employing physicians. The singular physician may no longer be competitive with such business enterprises, leading to consolidation of organizations and a significant decision for the physician. The physician will have the unusual opportunity to either remain exclusively a medical professional or to also venture into the business world as an equity investor, participating in financial growth possibilities of those medical practice organizations that are for-profit. With the emergence of these new equity models of healthcare, the primary focus will be on profit, production, and service efficiencies. It is the responsibility of the physician to maintain professionalism and the commitment to quality and appropriateness of patient care. However, at the same time, the physician has the unique opportunity to participate in the distribution, economics, and subsequent financial profit of healthcare. The medical experience of the physician, coupled with business acumen, will be an unbeatable combination.

Humans↗
PubMed2003

The relationship of lateral release and tourniquet deflation in total knee arthroplasty.

A total of 242 knees in 198 patients undergoing total knee arthroplasty were reviewed to evaluate the effect of tourniquet deflation on lateral release rates, possible variables associated with the need for lateral release, and adequacy of intraoperative evaluation on final radiographs. The need for lateral release was determined using the "no-thumbs" and "full contact" rules and visual evaluation. Lateral release was performed after tourniquet deflation. A total of 171 (71%) knees needed a lateral release before tourniquet deflation. After tourniquet deflation, only 53 (22%) required lateral release, representing a 69% reduction. Obesity was the only other significant factor in lateral release requirement. Based on the observations of this study, it is recommended that the need for lateral release be evaluated after tourniquet deflation. A 69% reduction in lateral release supports the hypothesis that tourniquet pressure has an effect on patellar tracking. Lateral release appears to be effective in restoring normal patellar tilt, and obesity increases its need.

Adult↗
PubMed2002

Pain management for joint arthroplasty: preemptive analgesia.

Scheduled preoperative and postoperative analgesia should be offered in a multimodal management model. By a combined drug synergy effect, the central nervous system, afferent pathways, and peripheral wound site are modified collectively. In an ongoing effort to improve perioperative pain management, we retrospectively compared the results of a previously reported pain management protocol with 2 more recent groups of patients managed with modified pain protocols. In the earlier control protocol, epidural anesthesia was discontinued on arrival to the postanesthesia care unit, and regularly scheduled oral opioids and intravenous hydromorphone for breakthrough pain were initiated. The first more recent group used epidural anesthesia, and the second group used spinal anesthesia. Both protocols featured the use of cyclooxygenase-2-inhibiting anti-inflammatory medication administered for 2 weeks preoperatively and continued for 10 days postoperatively and patient-controlled analgesia for 24 hours followed by scheduled oral opioids.

Aged↗
PubMed2002

Why a taper?

Explore the source record for details and available documents.

Femur↗
PubMed2002

Stem modularity: rarely necessary in primary total hip arthroplasty.

A retrospective review of two consecutive series of cementless primary THA performed simultaneously from November 1987 to February 1994 within a single orthopedic practice by three surgeons was conducted. A series using non-modular Mallory-Head Porous (Biomet Inc, Warsaw, Ind) femoral components was compared to a series using modular Sivash Range of Motion (DePuy, Warsaw, Ind) femoral components to evaluate whether modularity of the femoral stem body is necessary in cementless primary THA. Clinically and radiographically, both components performed at comparable levels with equally satisfactory results. Both series demonstrated effective femoral fixation as evidenced by excellent Engh fixation scores. However, this study has shown the importance of circumferential proximal porous-coating to form an effective seal, preventing the propagation of particulate debris. Modular systems were associated with a higher degree of technical difficulty, operative time, and blood loss.

Arthroplasty, Replacement, Hip↗
PubMed2000

Surgical Technique in Total Hip Arthroplasty Utilizing the Anterolateral Approach.

The surgical approach is an important element in the quality of total hip replacement. Adequate surgical exposure based upon thorough fundamental knowledge of anatomy facilitates surgery and ensure optimum results in total hip replacement. Several surgical exposure techniques are utilized and have been described in the literature; all stress the importance of visualization of the acetabulum and the proximal femur in affording an atraumatic, expedient entry into the hip joint. Additionally, surgical exposure should be versatile, allowing for development to easily accommodate revision scenarios.

Journal Article↗