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Biomedical subjects

W H Harris

Publications and source records attributed to W H Harris.

At least 235 records · Page 13Linked to original sources

Contact pressures from an instrumented hip endoprosthesis.

A pressure-measuring Moore-type endoprosthesis was implanted in a seventy-three-year-old patient who had sustained a displaced fracture of the femoral neck. The measurement and telemetry of contact pressures in the hip began in the operating room, and data were acquired periodically for more than thirty-six months. Unexpectedly high localized contact pressures between the acetabular cartilage and the prosthesis were recorded. Early in the period of recovery, activities such as using a bedpan or performing isometric exercise produced pressures that were close to those recorded during normal walking. The highest pressure, eighteen megapascals, was recorded one year postoperatively, while the patient was rising from a chair. High pressures occurred in the superior and posterior aspects of the acetabulum.

Acetabulum↗

Limitations of the continuum assumption in cancellous bone.

Most existing stress analyses of the skeleton which consider cancellous bone assume that it can be modelled as a continuum. In this paper we develop a criterion for the validity of this assumption. The limitations of the continuum assumption appear in two areas: near biologic interfaces, and in areas of large stress gradients. These limitations are explored using a probabilistic line scanning model for density measurement, resulting in an estimate of density accuracy as a function of line length which is experimentally verified. Within three to five trabeculae of an interface, a continuum model is suspect. When results as predicted using continuum analyses vary by more than 20-30% over a distance spanning three to five trabeculae, the results are suspect.

Biomechanical Phenomena↗

Surveillance of deep vein thrombosis in asymptomatic total hip replacement patients. Impedance phlebography and fibrinogen scanning versus roentgenographic phlebography.

Nine hundred thirty-seven limbs in 537 patients over the age of 39 years who underwent total hip replacement were studied by roentgenographic phlebography, cuff-impedance phlebography, and iodine-125 fibrinogen scanning. Cuff-impedance phlebography had a sensitivity of only 12.3 percent for thigh thrombi. Fibrinogen scanning had a sensitivity of only 59.1 percent for calf thrombi and 13.7 percent for thigh thrombi. The combined use of the two methods resulted in only a 23.2 percent sensitivity for thigh thrombi and an overall sensitivity of 47.4 percent. We have concluded that in asymptomatic patients, in contrast with symptomatic patients, the combination of cuff-impedance phlebography and fibrinogen scanning is not an effective screening method.

Adult↗

Revision of nonseptic, loose, cemented femoral components using modern cementing techniques.

A series of 43 hips (41 patients) in which a cemented revision arthroplasty was performed for a symptomatic, nonseptic, loose (42) or broken (1) femoral component was reviewed clinically and radiographically. The operation was done using femoral components of contemporary design, a trochanteric osteotomy, a cement gun, and a PMMA femoral plug. The femoral compactor and water pic were used once they became available (36%). The average follow-up period was 74 months (range, 60-111 months). The primary diagnoses included osteoarthritis (52%), CDH (32%), posttraumatic arthritis (6%), AVN (6%), and SCFE (4%). The average age of the patients at the time of the operation that failed was 52.2 years and at revision was 57.4 years. Only one revised cemented femoral component (2% of hips) required rerevision surgery for septic loosening. The average postoperative Harris hip score was 87 points. Four hips (9%) were classified radiographically as definitely loose, one (2%) as probably loose, and one (2%) as possibly loose, but all of these patients had a good or excellent clinical rating. Complications included deep venous thrombosis in 16 patients, trochanteric nonunion in 3 hips, femoral shaft perforations in eight hips, and postoperative dislocations in 6 hips. These techniques appear to represent an improvement over prior techniques.

Cementation↗

Elevated partial thromboplastin time as an indicator of hemorrhagic risk in postoperative patients on warfarin prophylaxis.

Warfarin provides effective prophylaxis against postoperative venous thromboembolic complications in adults undergoing elective hip surgery, but at the risk of increased bleeding complications. Although patients on this drug are routinely monitored by prothrombin time (PT), mild elevations of the partial thromboplastin time (PTT) have been reported with warfarin therapy. In a prospective study of 194 patients undergoing elective hip surgery, the authors assessed the incidence of elevation of the PTT above 50 seconds while the patient was receiving warfarin prophylaxis and the effect of this elevation on bleeding complications. The prophylactic warfarin was begun the night prior to surgery. Thirty-eight patients (19.6%) had a PTT greater than 50 seconds (group 1) and 156 had milder or no elevation of the PTT (group 2). The mean maximum PTT in group 1 was 61.2 ( +/- 12.9), versus 39.9 ( +/- 5.0) seconds in group 2. Major postoperative bleeding complications occurred in 26.3% of group 1 patients, versus 4.5% of group 2 (P less than .01). This subset of patients with an abnormal PTT elevation despite appropriate control of the PT is at a significantly increased risk of major postoperative bleeding. This observation may also prove valuable in reducing bleeding complications from warfarin use in nonsurgical patients.

Blood Coagulation Tests↗

Results of total hip reconstruction using acetabular mesh in patients with central acetabular deficiency.

Fifty-three patients (54 hips) treated with cemented total hip reconstruction with the aid of an acetabular mesh made of Vitallium (Howmedica Inc., Rutherford, New Jersey), a cobalt-chrome molybdenum alloy, to reinforce the medial cement for deficient bone stock in the central acetabular region, were evaluated at an average follow-up period of 6.8 years (range, five to ten years). Thirty of these patients (30 hips) were treated with revision operations for either failed cup arthroplasty (ten hips), failed endoprosthesis (six hips), or failed total hip arthroplasty (14 hips) and presented difficult problems for acetabular reconstructions. Although none of the hips required reoperations for acetabular loosening, three patients showed roentgenographic evidence of acetabular component migration, and three others showed signs of impending failure of fixation of the acetabular component. The overall mean Harris hip rating improved from a mean of 43 points preoperatively to 87 points at follow-up evaluations. The extent of bone loss in the central acetabular region had the greatest influence on the results of acetabular fixation at the follow-up evaluation. None of the hips with intact medial acetabular cortex had roentgenographic evidence of failure of fixation, while 14% of the hips with medial cortical defects measuring less than 1 cm, and 75% of the hips with larger defects developed acetabular component loosening. The results of total hip reconstruction using acetabular mesh were unsatisfactory in patients with moderate or severe central acetabular bone loss and defects through the medial wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗

Deep-wound infection after total hip replacement under contemporary aseptic conditions.

The role of the combination of perioperative antibiotics, laminar air-flow operating rooms, and body-exhaust systems in reducing the incidence of deep-wound sepsis after total hip replacement remains controversial. We evaluated the incidence of deep-wound infection as associated with the magnitude of the operation in 575 patients (659 procedures) who had all three methods of prophylaxis. The same surgeon performed all of the operations. The procedures were divided into five groups, according to the complexity of the operation and the need for major bone-grafting. Only one patient (who had previously had an infection) had early sepsis. After the 376 standard primary operations, the over-all incidence of sepsis (early and late) was 0.38 per cent. No infection occurred after fifty-four complex primary operations without femoral-head autografting. After fifty-nine complex primary operations with femoral-head autografting, three patients had a late deep infection. No infection occurred within two years after the 170 revision operations. There was no late infection after the 104 revisions without major bone-grafting, but late sepsis developed in two patients after the sixty-six revisions with major bone-grafting. Of the total of six cases of late infection in five patients, five had an identifiable source of infection that was extrinsic to the wound. The incidence of early postoperative sepsis after total hip replacement, even complex primary total hip replacement and revision, was extremely low when using the three contemporary methods of prophylaxis for infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Trochanteric osteotomy for revision total hip arthroplasty. 97% union rate using a comprehensive approach.

In current practice most primary total hip arthroplasties (THAs) are performed without trochanteric osteotomy. The superior exposure afforded by trochanteric osteotomy, however, can be valuable in revision total hip surgery. Between 1969 and 1983, 188 revisions in 177 patients were carried out with osteotomy of the greater trochanter. Ninety-one percent were reattached with a three- or four-wire method. Sixty-one percent of the trochanters (N = 114) were advanced to the lateral cortex. Supplemental trochanteric mesh was used in 75% of the revisions (141 hips). Its use is now routine for all revisions. Most patients (N = 137) were permitted to ambulate within five days, using a walker or two crutches, bearing partial weight on the operative hip. Ninety-seven percent (182 of 188) of the trochanters united. Six failed to unite (3%) and eight others had delayed healing (4%). Two trochanters migrated proximally prior to union (1%). Retrospective evaluation of the initial postoperative radiographs for each patient with nonunion identified one or more technical errors in the reattachment technique. While the overall incidence of wire breakage was 27%, most (42 of 51) of these trochanters healed uneventfully. Five of the six patients with trochanteric nonunion, however, had failure of one or both vertical wires by 12 weeks after surgery. The average hip score for the patients with nonunion was 89 points (versus 57 points before surgery), indicating that the average clinical outcome in this group was not substantially comprised by trochanteric complications. In light of the improvement in surgical exposure, high rate of union of the trochanter, and limited number of complications, trochanteric osteotomy is recommended for most revision THA.

Adolescent↗

The effect of centrifugation on the fatigue life of bone cement in the presence of surface irregularities.

Reduction of the porosity of bone cement by centrifugation significantly improves the fatigue life of the cement when smooth, waisted specimens are tested. However, bone cement in vivo has surface irregularities at the interdigitation of the cement with the trabecular bone. The effect of centrifugation on the fatigue life of Simplex P in specimens containing surface irregularities was investigated by examining both composite specimens of trabecular bone and bone cement and specimens containing a sharp, circumferential notch. For the specimens with the sharp notch, the bone cement that had been centrifuged lasted significantly longer in fatigue (47,039 +/- 40,277 cycles) than the uncentrifuged specimens (3103 +/- 1950 cycles). Eleven of 15 uncentrifuged specimens broke at the location of a void, rather than the notch. In contrast, when the porosity was reduced by centrifugation, 13 of the 15 specimens broke at the notch. For the specimens that were a composite of bone cement and trabecular bone, the centrifuged specimens had a significant increase in fatigue life compared to the uncentrifuged specimens when tested at both 7 MPA (641,056 +/- 444,131 cycles vs. 237,969 +/- 124,153 cycles) and 15 MPA (8800 +/- 4673 cycles vs. 1534 +/- 719 cycles). Reduction of porosity in bone cement by centrifugation significantly extends its fatigue life even in the presence of trabecular bone or sharp surface notches as used in total joint replacements. These data support the concept that reduction of porosity of bone cement by centrifugation may extend the duration of fixation of the components in cemented total joint arthroplasties.

Animals↗

Loosening of cobalt chrome beads from a porous-coated acetabular component. A report of ten cases.

Seventy consecutive total hip arthroplasties were performed using a porous-coated acetabular component consisting of a cobalt chrome substrate to which cobalt chrome beads were sintered. Fifty-six were primary arthroplasties and 14 were revisions. The authors analyzed the immediate postoperative roentgenographs of all 70 hips and the follow-up roentgenographs of the 66 hips that were followed for a minimum of two years, the average follow-up period being 30 months. Loose cobalt chrome beads were diagnosed in ten of the 70 hips (14.3%), five (8.9%) in the primary arthroplasties, and five (35.7%) in the revision arthroplasties. In two of the primary arthroplasties and three of the revision arthroplasties, the loose beads were observed on the immediate postoperative roentgenographs. None of the acetabular components appeared loose by other roentgenographic criteria. The sintering technique used in the manufacture of these implants did not prevent loosening of cobalt chrome beads from porous-coated cobalt chrome acetabular components. A longer follow-up period is required to assess fully the clinical significance.

Acetabulum↗

Modern use of modern cement for total hip replacement.

Proof is now at hand that improved cementing techniques lead to marked improvement in longevity of femoral component fixation. The loosening rate at 6 years has been reduced from 20 per cent with the old techniques to less than 2 per cent. In addition, the new advances of pressurization, porosity reduction, and precoating should further enhance longevity.

Biophysical Phenomena↗

Reverse skeletal traction for instability following revision total hip arthroplasty. A report of two cases.

Dislocation is a recognized complication following total hip arthroplasty (THA). Immobilization of the hip has been used successfully to treat those cases due to soft-tissue laxity. In two patients who had severe instability of the hip following complex revision THA, skeletal traction through the tibia was applied in a cephalad direction for three weeks. This unique method of employing traction maintained a reduction and resulted in a stable hip at the six-month follow-up evaluation in both patients. Reverse skeletal traction is a valuable treatment option when more conventional methods of immobilization of the hip will not maintain a reduction due to soft-tissue compromise.

Female↗

Results of cementless revisions of total hip arthroplasties using the Harris-Galante prosthesis.

Sixty patients were treated with Harris-Galante prosthesis for failed, nonseptic, cemented total hip arthroplasties. The minimum follow-up period was 12 months, although 23 patients were followed for two or more years. Acetabular bone grafting was done in 86% and femoral bone grafting in 57% of the patients. The average postoperative hip score was 84 (range, 48-100). Seventy-one percent of the patients were rated good or excellent. Among those with a minimum two-year follow-up examination, 73% had good or excellent results. Ninety-six percent had no, slight, or only mild pain. None of the components has required revision. No pads have become loose or displaced and no sepsis has occurred. One femoral component has subsided, but the patient is asymptomatic. No socket has migrated. The results are excellent for this group of patients.

Acetabulum↗

Comparison of the mechanical properties of Simplex P, Zimmer Regular, and LVC bone cements.

The mechanical properties of the three cement preparations most widely used in the United States were compared by conducting tensile and fatigue tests on Simplex P, LVC, and Zimmer Regular bone cements. Specimens of all three cement preparations were prepared for mechanical testing with and without centrifugation of the cement immediately after mixing. Although the results of the tensile testing revealed a few specific instances of significant differences in the tensile properties of the three cement preparations, there was no consistent evidence that one cement was superior in tension to the others. However, the fatigue properties of Simplex P were consistently and significantly superior to the fatigue properties of both LVC and Zimmer Regular bone cements. Centrifugation of the cement immediately after mixing significantly improved both the tensile and fatigue properties of all three bone cements. However, the fatigue strength of centrifuged Simplex P was substantially and significantly superior to the fatigue strength of the centrifuged LVC and Zimmer Regular bone cements. Since in total joint replacements bone cement is subjected to cyclic loading, these data suggest that centrifuged Simplex P is a preferable bone cement to LVC and to Zimmer Regular cement with or without centrifugation.

Biomechanical Phenomena↗

Comparison of the fatigue characteristics of centrifuged and uncentrifuged Simplex P bone cement.

Fatigue test specimens of Simplex P bone cement (Howmedica Inc., Rutherford, NJ) prepared according to the manufacturer's instructions and specimens of Simplex P prepared by centrifuging the cement immediately after mixing were subjected to fully reversed tension-compression fatigue tests at initial strain levels ranging from 0.01 to 0.001. S:N curves for both cement preparations were generated and compared on the basis of regression analysis, Weibull analysis, and Student's t tests. Centrifuged Simplex P was able to withstand significantly more fatigue cycles than uncentrifuged Simplex P at all strain levels tested. Importantly, at the more physiologic strain levels of 2,000 and 1,000 microstrain, the centrifuged cement demonstrated superior fatigue life. Specifically, at the 1,000-microstrain level eight of the 11 uncentrifuged specimens fractured before undergoing 10 million cycles. Of those that failed, the average number of cycles to failure was 1.8 million with a range of 560,000 to 4 million cycles. In contrast, all 11 centrifuged specimens tested at 1,000 microstrain remained intact at 10 million cycles.

Analysis of Variance↗

Low-dose warfarin versus external pneumatic compression for prophylaxis against venous thromboembolism following total hip replacement.

Lower doses of warfarin are effective in the treatment of proven proximal deep vein thrombosis (DVT), and at a substantially lower risk of bleeding complications than with standard doses. The authors compared low-dose warfarin with external pneumatic compression (EPC) boots for prophylaxis against DVT and efficacy and safety in a population of total hip replacement patients at high risk for DVT and bleeding complications. DVT developed in 12 of 72 patients on low-dose warfarin and 11 of 66 patients on EPC. Both regimens were as efficacious as traditional higher doses of warfarin used in prior studies. No major bleeding complications occurred in either group. Low-dose warfarin appears to be an effective and relatively safe form of prophylaxis against postoperative DVT, as does sequential EPC of the calf and thigh.

Adult↗