Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ARTHROPLASTY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed2000

Deep venous thrombosis after total hip or total knee arthroplasty in patients in Japan.

A single center, prospective, epidemiologic study was conducted to estimate the incidence of deep venous thrombosis detected by venography in patients in Japan undergoing total hip arthroplasty or total knee arthroplasty without prophylactic anticoagulant therapy. Venograms of 164 patients who had total hip arthroplasty and 138 patients who had total knee arthroplasty were evaluated. The incidences of deep venous thrombosis were 22.6% in patients who had total hip arthroplasty and 48.6% in those who had total knee arthroplasty. The incidences of proximal deep venous thrombosis were 9.8% in patients who had total hip arthroplasty and 14.5% in those who had total knee arthroplasty. Statistical analysis revealed that the type of operation influenced the development of deep venous thrombosis. Patients who had total knee arthroplasty were 3.2 times more likely to have deep venous thrombosis develop than were patients who had total hip arthroplasty. Body mass index and age were identified as statistically significant risk factors.

Adult↗
PubMed1997

Outcome of hip and knee arthroplasty in persons aged 80 years and older.

Recent studies have established the cost effectiveness and safety of total joint arthroplasties. As the population ages, it is important to determine whether these procedures are equally beneficial in the elderly. The short term safety and efficacy of total hip and knee arthroplasties in subjects 80 years of age and older was evaluated. Between 1988 and 1993, preoperative and postoperative physical and functional information was collected on 99 consecutive elective hip and knee arthroplasties in subjects 80 years of age or older. These data were compared with those derived from a younger otherwise matched control group. Data collected included subject demographics and characteristics, information concerning the acute and postacute hospital stay, comorbid conditions, postoperative complications, discharge disposition, Hospital for Special Surgery knee and Harris hip scores, pain scores, and functional capacity. The average age of the subjects was 83 years; osteoarthritis was the most common diagnosis; and the average followup was 25 months. Complication rates and length of stay in acute care facilities were not significantly different than for the control group. Mean preoperative Hospital for Special Surgery knee and Harris hip scores were 58 and 60, respectively, with postoperative scores of 77 and 88, respectively. Pain dramatically improved with 98% of total knee arthroplasty and 100% of total hip arthroplasty subjects reporting mild or no pain at followup. Preoperatively, none of the knee or hip subjects could walk unlimited distances. Postoperatively 51% of the total knee arthroplasty and 54% of the total hip arthroplasty subjects could walk more than five blocks; 71% of the total knee arthroplasty and 86% of the total hip arthroplasty subjects walked with a cane or no assistive device. The most dramatic postoperative functional gains were seen in the most disabled subjects. Total charges of care for patients 80 years of age and older was slightly greater than for a younger group. It was established that total joint arthroplasty can be performed safely in patients 80 years of age and older, promising excellent pain relief and improved functional outcome.

Activities of Daily Living↗
PubMed2001

Simultaneous bilateral total knee arthroplasties: who decides?

The purpose of the current retrospective review was to compare the results of 1498 patients having 1090 simultaneous bilateral total knee arthroplasties and 958 unilateral total knee arthroplasties in a 3-year period, focusing on perioperative complications, length of hospital stay, and discharge disposition. Gender, age, diagnosis, and weight were similar between the groups. Patients undergoing simultaneous bilateral total knee arthroplasties had statistically significant higher amounts of intraoperative blood loss, with more patients requiring blood transfusion, and a higher average number of units of blood transfused compared with patients undergoing unilateral total knee arthroplasty. Overall, a significantly higher incidence of gastrointestinal complications was reported in patients who had simultaneous bilateral knee arthroplasties compared with patients who had unilateral knee arthroplasty. Comparing age subgroups within the unilateral group revealed significantly higher incidences of pulmonary, neurologic, cardiac, and genitourinary complications among patients 80 years or older versus patients younger than 80 years. Patients having simultaneous bilateral arthroplasties who were 80 years or older had significantly higher incidences of pulmonary, neurologic, and cardiac complications than patients younger than 80 years in that same group. These results suggest that age, not procedure, has a more significant role in the perioperative morbidity of total knee arthroplasty. Based on the results from the current study and previous literature documenting patient preference, patient satisfaction, efficacy, and outcomes comparable with those of patients having unilateral total knee arthroplasty, the authors continue to offer patients the option of simultaneous bilateral total knee arthroplasties.

Aged↗
PubMed2001

Determining the need for hip and knee arthroplasty: the role of clinical severity and patients' preferences.

BACKGROUND: Area variation in the use of surgical interventions such as arthroplasty is viewed as concerning and inappropriate. OBJECTIVES: To determine whether area arthroplasty rates reflect patient-related demand factors, we estimated the need for and the willingness to undergo arthroplasty in a high- and a low-use area of Ontario, Canada. RESEARCH DESIGN: Population-based mail and telephone survey. SUBJECTS: All adults aged > or =55 years in a high (n = 21,925) and low (n = 26,293) arthroplasty use area. MEASURES: We determined arthritis severity and comorbidity with questionnaires, established the presence of arthritis with examination and radiographs, and evaluated willingness to have arthroplasty with interviews. Potential arthroplasty need was defined as severe arthritis, no absolute contraindication for surgery, and evidence of arthritis on examination and radiographs. Estimates of need were then adjusted for patients' willingness to undergo arthroplasty. RESULTS: Response rates were 72.0% for questionnaires and interviews. The potential need for arthroplasty was 36.3/1,000 respondents in the high-rate area compared with 28.5/1,000 in the low-rate area (P <0.0001). Among individuals with potential need, only 14.9% in the high-rate area and 8.5% in the low-rate area were definitely willing to undergo arthroplasty (P = 0.03), yielding adjusted estimates of need of 5.4/1,000 and 2.4/1,000 in the high- and low-rate areas, respectively. CONCLUSIONS: Demonstrable need and willingness were greater in the high-rate area, suggesting these factors explain in part the observed geographic rate variations for this procedure. Among those with severe arthritis, no more than 15% were definitely willing to undergo arthroplasty, emphasizing the importance of considering both patients' preferences and surgical indications when evaluating need and appropriateness of rates for surgery.

Activities of Daily Living↗
PubMed2004

Outcomes of total hip arthroplasty are similar for patients with displaced femoral neck fractures and osteoarthritis.

This study attempted to evaluate whether total hip arthroplasty for displaced femoral neck fractures had significantly different outcomes when compared with total hip arthroplasty for osteoarthritis. This is a retrospective study of 60 patients who had total hip arthroplasties between 1997 and 2001. Thirty patients (mean age, 79.7 years) had total hip arthroplasties for displaced femoral neck fractures; 30 patients (mean age, 76.9 years) were treated with total hip arthroplasties for osteoarthritis. The same surgeon used the modified lateral approach for all surgeries. All patients had radiographic assessment, physical examination, and evaluation with the Harris hip score. The mean followup was 38 months. The mean Harris hip score for the 25 patients treated with a total hip arthroplasty for a femoral neck fracture was 81 points; the mean hip score for the 27 patients treated with a total hip arthroplasty for osteoarthritis was 87 points. No statistically significant differences between these groups were observed. Patients who were treated with a total hip arthroplasty for a femoral neck fracture did not have increased perioperative morbidity compared with patients who had a total hip arthroplasty for osteoarthritis. This study suggests that the outcomes for total hip arthroplasties in this consecutive series of patients treated for displaced femoral neck fractures and osteoarthritis are comparable.

Aged↗
PubMed2007

Outcomes of shoulder arthroplasty in Olmsted County, Minnesota: a population-based study.

Most studies on shoulder arthroplasty include a diverse group of patients presenting to a tertiary care center. Little information is available regarding outcomes in a community setting. We reviewed 98 residents (110 shoulders) of Olmsted County, Minnesota who had shoulder arthroplasties from 1976 to 2000. There were 65 total shoulder arthroplasties and 45 humeral head replacements. The most common indications were osteoarthritis for total shoulder arthroplasties (48/65) and acute fracture for hemiarthroplasties (27/45). The Neer ratings were excellent or satisfactory in 92% of total shoulder arthroplasties and 56% of hemiarthroplasties. The 10-year survival rate was 96%. The mean postoperative active forward elevation was greater in patients who had a total shoulder arthroplasty (132 degrees) compared with a hemiarthroplasty (113 degrees), as was external rotation (total shoulder arthroplasties = 58 degrees, humeral head replacements = 38 degrees). The outcomes for total shoulder arthroplasty and hemiarthroplasty compared favorably with outcomes reported in the literature. There was a high rate of satisfactory or excellent results after total shoulder arthroplasty for osteoarthritis. Hemiarthroplasty offered less satisfactory results, most likely related to the use of this procedure for trauma. This information will assist the community surgeon in counseling patients and weighing the risks and benefits of a shoulder arthroplasty.

Adult↗
PubMed1998

Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long-term results.

Seventy-eight Neer hemiarthroplasties and thirty-six Neer total shoulder arthroplasties were performed at our institution, between January 1, 1976, and December 31, 1985, in ninety-eight patients who were fifty years old or less. Two patients (two shoulders) died, and four patients (four shoulders) were lost to follow-up. The remaining seventy-four hemiarthroplasties (95 per cent) in sixty-four patients and thirty-four total shoulder arthroplasties (94 per cent) in thirty-one patients were included in the clinical analysis as the preoperative and operative records were complete and the patients had been followed for at least five years (mean, 12.3 years) or until revision. All 114 shoulders were included in the survivorship analysis. Both total shoulder arthroplasty and hemiarthroplasty resulted in significant long-term relief of pain (p < 0.0001) as well as improvement in active abduction (p < 0.0001) and external rotation (p < 0.0001). However, with the numbers available, we could not detect a significant difference between the two procedures with respect to these variables. A complete set of radiographs was available for sixty-eight (92 per cent) of the seventy-four shoulders that had a hemiarthroplasty and for thirty-two (94 per cent) of the thirty-four shoulders that had a total shoulder arthroplasty. A radiolucent line around the humeral component was noted after sixteen (24 per cent) of the hemiarthroplasties and after seventeen (53 per cent) of the total shoulder arthroplasties. A radiolucent line around the glenoid component was seen after nineteen (59 per cent) of the total shoulder arthroplasties. Erosion of the glenoid was found after forty-six (68 per cent) of the hemiarthroplasties. The results were graded according to a modification of the system of Neer et al. and of Cofield. Fifteen hemiarthroplasties led to an excellent result; twenty-four, a satisfactory result; and thirty-five, an unsatisfactory or unsuccessful result. Four total shoulder arthroplasties were followed by an excellent result; thirteen, a satisfactory result; and seventeen, an unsatisfactory or unsuccessful result. The estimated survival of the hemiarthroplasty prostheses (with 95 per cent confidence intervals) was 92 per cent (86 to 98 per cent) at five years, 83 per cent (75 to 93 per cent) at ten years, and 73 per cent (59 to 88 per cent) at fifteen years. Analysis of the results in association with the two major diagnoses revealed that the risk of revision was higher for the thirty shoulders that had the hemiarthroplasty for the treatment of the sequelae of trauma than for the twenty-eight that had the procedure for the treatment of rheumatoid arthritis (p = 0.017). The estimated survival of the total shoulder prostheses (with 95 per cent confidence intervals) was 97 per cent (92 to 100 per cent) at five years, 97 per cent (91 to 100 per cent) at ten years, and 84 per cent (70 to 100 per cent) at fifteen years. The risk of revision was higher for the seven shoulders that had had a tear of the rotator cuff at the time of the operation than for the twenty-seven that had not had one (p = 0.029). The data from the present study indicate that a shoulder arthroplasty provides marked long-term relief of pain and improvement in motion; however, nearly half of all young patients who have a shoulder arthroplasty have an unsatisfactory result according to a rating system. Care should be exercised when either a hemiarthroplasty or a total shoulder arthroplasty is offered to patients who are fifty years old or less.

Adult↗
PubMed2004

Minimally invasive total knee arthroplasty.

Currently, minimally invasive total knee arthroplasty is defined as an incision length of < 14 cm. However, the length of the incision is not the primary influence on potential postoperative benefits to the patient and should not be the only characteristic of the minimally invasive approach for knee arthroplasty. Some other factors that should also be included in this definition are: 1. The amount of soft-tissue dissection (including muscle, ligament, and capsular damage). 2. Patellar retraction or eversion. 3. Tibiofemoral dislocation. Minimally invasive surgery should not be considered to be a cosmetic procedure but rather one that addresses patients' concerns with regard to postoperative pain and slow rehabilitation. Standard total knee arthroplasties provide pain relief, but returning to activities of daily living remains a challenge for some individuals, who may take several weeks to recover. Several studies have demonstrated long-term success (at more than ten years) of standard total knee arthroplasties. However, many patients remain unsatisfied with the results of the surgery. In a study of functional limitations of patients with a Knee Society score of > or = 90 points after total knee arthroplasty, only 35% of patients stated that they had no limitations. This finding was highlighted in a study by Dickstein et al., in which one-third of the elderly patients who underwent knee replacement were unhappy with the outcome at six and twelve months postoperatively. Although many surgeons utilize objective functional scoring systems to evaluate outcome, it is likely that the criteria for a successful result of total knee arthroplasty differ between the patient and the surgeon. This was evident in a report by Bullens et al., who concluded that surgeons are more satisfied with the results of total knee arthroplasty than are their patients. Trousdale et al. showed that, in addition to concerns about long-term functional outcome, patients' major concerns were postoperative pain and the time required for recovery. Patients undergoing total knee arthroplasty have specific functional goals, such as climbing stairs, squatting, kneeling, and returning to some level of low-impact sports after surgery. Our clinical investigations demonstrated that the minimally invasive surgical approach reduces hospital stays, decreases postoperative pain, and decreases rehabilitation needs as well as enables patients to return to normal function more quickly. It is important for surgeons to take an evolutionary, rather than a revolutionary, approach when performing minimally invasive total knee arthroplasty. The surgeon should downsize incisions progressively to prevent severe damage to the quadriceps mechanism. Extensive open exposure, prolonged patellar eversion, and dislocation of the tibiofemoral joint should evolve into a vastus medialis muscle split with patellar subluxation, retraction but not dislocation of the patella, and avoidance of gross dislocation of the tibiofemoral joint. Developing the techniques of minimally invasive total knee arthroplasty may be difficult and time-consuming, but patient benefits and satisfaction should outweigh the extra effort required. These changes require well-designed clinical studies to further document their effectiveness.

Arthroplasty, Replacement, Knee↗
PubMed2005

Hospital resource utilization for primary and revision total hip arthroplasty.

BACKGROUND: Previous reports have suggested that hospital resource utilization for revision total hip arthroplasty is substantially higher than that for primary total hip arthroplasty. However, current United States Medicare hospital-reimbursement policy does not distinguish between the two procedures. The purpose of this study was to compare primary and revision total hip arthroplasties with regard to actual hospital resource utilization and to identify clinical and demographic factors that are predictive of higher resource utilization associated with these procedures. METHODS: We evaluated the clinical, demographic, and economic data associated with 491 consecutive unilateral primary or revision total hip arthroplasties performed by two surgeons at a single institution between January 2000 and December 2002. The distributions of various demographic, clinical, and utilization characteristics were compared between the two types of arthroplasty procedures, and multivariable linear regression techniques were used to determine independent patient characteristics that were predictive of higher costs for both the primary and the revision procedures. RESULTS: The mean total hospital cost was $31,341 for the revision procedures compared with $24,170 for the primary procedures (p < 0.0001). The mean operative time was 41% longer for the revisions than for the primary procedures (4.5 hours compared with 3.2 hours, p < 0.0001), the mean estimated blood loss was 160% higher (1348 mL compared with 518 mL, p < 0.0001), the mean complication rate was 32% higher (29% compared with 22%, p = 0.072), and the mean length of the hospital stay was 16% longer (6.5 days compared with 5.6 days, p = 0.0005). A higher severity-of-illness score (a measure of preoperative medical health) was predictive of higher resource utilization for both primary and revision arthroplasty even after adjustment for other factors. Preoperative femoral and ace-tabular bone loss and a diagnosis of periprosthetic fracture were predictive of higher resource utilization associated with revision procedures. CONCLUSIONS: At one institution, hospital resource utilization for revision total hip arthroplasty was found to be significantly higher than that for primary arthroplasty. This information is not reflected by current United States Medicare hospital reimbursement, which is the same for all lower-extremity arthroplasty procedures, regardless of the diagnosis, the complexity of the procedure, or the patient's baseline medical health. If these findings are generalizable to other institutions, appropriate reimbursement formulas should be developed to accurately reflect the true costs of caring for patients with a failed total hip arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2001

Pregnancy after total hip arthroplasty.

BACKGROUND: Younger patients are having total hip arthroplasty now, and a woman who has had such a procedure may want to become pregnant. The purposes of this study were to report on a series of women who had completed a pregnancy after a total hip arthroplasty and to determine if pregnancy affects the function and longevity of the prosthesis. METHODS: Five women, with a total of seven uncemented total hip replacements, had six successful pregnancies. The mean age at the arthroplasty was twenty-nine years (range, twenty-two to thirty-eight years), and the mean time from the hip arthroplasty to the pregnancy was 2.5 years (range, one to seven years). These patients (Group A) were compared with a matched group of five women with a total of eight uncemented total hip prostheses (Group B) who had not completed a pregnancy. The mean follow-up time was eight years (range, two to thirteen years) for Group A and seven years (range, two to twelve years) for Group B. Patients were clinically evaluated with the Harris hip score. Radiographs were evaluated for component fixation and osteolysis. RESULTS: The five women completed a total of six successful pregnancies. One patient, with a bilateral total hip arthroplasty, had two successful pregnancies, 2.5 years apart. Three children were delivered vaginally (with the mother in the lithotomy position) and three, by cesarean section. There were no complications related to the total hip arthroplasty after delivery. The mean weight gain during the pregnancy was 13 kg (range, 8 to 14.2 kg). In Group A, the mean Harris hip score was 94 points prior to the pregnancy and 97 points at the time of the most recent follow-up. In group B, the mean Harris hip score was 91 points at one to two years after the arthroplasty and it was unchanged at the time of the most recent follow-up. There were six excellent results and one good result of the hip arthroplasty in Group A and five excellent and three good results in Group B. The mean total arc of hip motion was 217 degrees in Group A before the pregnancy and 241 degrees at the time of the most recent follow-up. The mean total arc of hip motion was 193 degrees in Group B at one to two years postoperatively and 190 degrees at the time of the most recent follow-up. The difference in the total arc of hip motion between the two groups at the latest follow-up evaluation was significant (p = 0.025). There were no reoperations in either group. Radiographs showed osteolysis of the femur in three hips in Group A and three hips in Group B. CONCLUSIONS: It appears that successful pregnancy and normal vaginal delivery can occur safely after total hip arthroplasty. The overall result, function, and radiographic appearance after the total hip arthroplasty was not adversely affected by pregnancy in this small group of patients.

Adult↗
PubMed1991

Heterotopic bone formation following hip arthroplasty. A retrospective study of 65 bilateral cases.

Heterotopic bone formation after two-stage bilateral cemented total hip arthroplasty was evaluated in 65 patients (23 women and 42 men) who had not received treatment with antiinflammatory drugs in the immediate postoperative weeks. The mean age at the first operation was 65 years, and the median interval between the two arthroplasties was 3 months. Fifty-two patients developed heterotopic ossification after the initial hip arthroplasty. Of these patients, 40 also developed ossifications after contralateral hip arthroplasty. Out of 11 males developing Grade-III heterotopic ossification after the initial hip arthroplasty, 8 also developed Grade-III ossification after contralateral hip arthroplasty. Two females developed Grade-III ossification after the initial arthroplasty, but neither of them developed a Grade-III lesion after contralateral total hip arthroplasty. Males with Grade-III heterotopic ossification after the initial hip arthroplasty were shown to be at a high risk of developing the same severe lesion after contralateral total hip arthroplasty, making them candidates for postoperative prophylaxis.

Aged↗
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↗
PubMed2006

Economic burden of revision hip and knee arthroplasty in Medicare enrollees.

UNLABELLED: The economic burden to Medicare due to revision arthroplasty procedures has not yet been studied systematically. The economic burden of revisions was calculated as annual reimbursements for revision arthroplasties relative to the sum total reimbursements of primary and revision arthroplasties. We evaluated this revision burden for total hip and knee arthroplasties through investigation of trends in charges and reimbursements in the Medicare population (Parts A and B claims from 1997-2003), while taking into account age and gender effects. Mean annual economic revision burdens were 18.8% (range, 17.4-20.2%) and 8.2% (range, 7.5-9.2%) for total hip arthroplasties and total knee arthroplasties, respectively. Procedural charges increased while reimbursements decreased over the study period, with higher charges observed for revisions than primary arthroplasties. Reimbursements per procedure were 62% to 68% less than associated charges for primary and revision total hip and knee arthroplasties. The effect of age and gender on reimbursements varied by procedure type. Unless some limiting mechanism is implemented to reduce the incidence of revision surgeries, the diverging trends in reimbursements and charges for total hip and knee arthroplasties indicate that the economic impact to the Medicare population and healthcare system will continue to increase. LEVEL OF EVIDENCE: Prognostic study, level II-1 (retrospective study). See Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2002

Persistent non-specific FDG uptake on PET imaging following hip arthroplasty.

Hip arthroplasty is a common surgical procedure, but the diagnosis of infection associated with hip arthroplasty remains challenging. Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has been shown to be a promising imaging modality in settings where infection is suspected. However, inflammatory reaction to surgery can result in increased FDG uptake at various anatomic locations, which may erroneously be interpreted as sites of infection. The purpose of this study was to assess the patterns and time course of FDG accumulation following total hip replacement over an extended period of time. Firstly, in a prospective study nine patients with total hip replacement were investigated to determine the patterns of FDG uptake over time. Three FDG-PET scans were performed in each patient at about 3, 6 and 12 months post arthroplasty. Secondly, in a retrospective analysis, the medical and surgical history and FDG-PET imaging results of 710 patients who had undergone whole-body scans for the evaluation of possible malignant disorders were reviewed. The history of arthroplasty and FDG-PET findings in the hip region were reviewed for this study. Patients with symptomatic arthroplasties or related complaints during FDG-PET scanning were excluded from the analysis. During the entire study period, all nine patients enrolled in the prospective study were demonstrated to have increased FDG uptake around the femoral head or neck portion of the prosthesis that extended to the soft tissues surrounding the femur. Among the patients reviewed in the retrospective study, 18 patients with a history of 21 hip arthroplasties who were asymptomatic at the time of FDG-PET scan met the criteria for inclusion. The time interval between the hip arthroplasty and the FDG-PET study ranged from 3 months to 288 months (mean+/-SD: 80.4+/-86.2 months). In 81% (17 of 21) of these prostheses, increased FDG uptake could be noted around the femoral head or neck portion of the prosthesis. The average time interval between arthroplasty and FDG-PET scan in these patients was 71.3 months. In only four prostheses (19%, 4 of 21) was no abnormally increased FDG uptake seen around the prostheses or adjacent sites. The average time interval in these patients was 114.8 months. It is concluded that following hip arthroplasty, non-specifically increased FDG uptake around the head or neck of the prosthesis persists for many years, even in patients without any complications. Therefore, to minimize the number of false-positive results for infection with PET studies obtained to evaluate a painful hip prosthesis, caution should be exercised when interpreting FDG uptake around the head or neck portion of the prosthesis.

Arthroplasty, Replacement, Hip↗
PubMed2004

Clinical outcomes in the revision of unicondylar arthoplasties to bicondylar arthroplasties. A matched-pair study.

INTRODUCTION: The aim of the following study was to find out how much a previously implanted unicondylar prosthesis affects the clinical and functional outcome of a total knee arthroplasty in case of revision surgery. MATERIALS AND METHODS: A matched-pair comparative analysis was performed on 28 patients (group A) who required bicondylar knee arthroplasty following failed unicondylar arthroplasty and 28 patients (group B) with primary bicondylar knee arthroplasty. Both groups were matched according to age, sex, weight, height, type of prosthesis, and follow-up time after bicondylar arthroplasty. The patients' evaluation was based on the Knee Society Score and the WOMAC Score. Radiographs (AP weight-bearing and lateral) were taken of the knee. The average follow-up time after bicondylar arthroplasty was 55+/-15 months in group A and 56+/-13 months in group B. RESULTS: The knee score was 71.8+/-18 and 80.4+/-10 points (p=0.01) and the function score 56.1+/-15 and 64.1+/-19 points (p=0.1) for group A and group B, respectively. The subjective assessment according to the WOMAC Score was statistically significant in terms of the functional outcome. Increased postoperative range of motion of 109 degrees +/-11 degrees was noticed for group B in comparison with group A (101 degrees +/-8 degrees ; p=0.004). Patients revised from an unicondylar arthroplasty required a significantly thicker polyethylene inlay (12.9+/-3 mm) compared with the primarily implanted group (10.3+/-3 mm; p=0.004). CONCLUSION: Revision of an unicondylar to a bicondylar knee replacement showed inferior functional results in comparison to primary bicondylar knee arthroplasty. Patients are satisfied after conversion of an unicondylar to bicondylar prosthesis, but not quite as much as patients who received a primary bicondylar arthroplasty. However, in the small number of patients where revision surgery after failed unicondylar prosthesis is required, the patient had already been successfully treated for many years.

Aged↗
PubMedDate not supplied

Shoulder arthroplasty in recreational golfers.

A retrospective review of 24 patients who had shoulder arthroplasty revealed that 23 were able to resume playing golf. The 23 patients (mean age 52.4 years, range 26.4 to 71.9 years) underwent 26 shoulder arthroplasties, 20 total shoulder arthroplasties, and 6 hemiarthroplasties. The average follow-up was 53.4 months (range 24.4 to 127.2 months). The average length of time from shoulder arthroplasty to playing an entire round of golf was 4.5 months. Eighteen patients were able to report their preoperative handicap and noted an average improvement after surgery of almost 5 strokes. Playing golf did not result in increased radiographic evidence of component loosening, and no increase occurred in lucent lines when the golfers were compared with a control group of 76 patients with osteoarthritis who had 103 shoulder arthroplasties (P < .05). Fifty members of the American Shoulder and Elbow Society were mailed a standardized questionnaire of 11 questions concerning patients who had shoulder arthroplasty and played golf. Most surgeons (91%) encouraged such patients to resume playing golf. The average length of time members of the Society recommended that patients should wait after shoulder arthroplasty before resuming golf was 4.3 months. Approximately 60% of surgeons believed that no limit should be placed on the number of golf rounds played weekly, and 91% denied an increase in complications among those who returned to playing golf after undergoing shoulder arthroplasty. Fewer than one third of the surgeons (29.5%) believed that component wear would be a problem in patients who undergo shoulder arthroplasty and play golf frequently and would recommend a hemiarthroplasty for an active golfer because of concern about future glenoid problems.

Adult↗
PubMed2002

Orthopaedic crossfire--can we justify unicondylar arthroplasty as a temporizing procedure? in opposition.

The indications for unicompartmental arthroplasty are quite specific. Overall, there should be involvement of 1 tibiofemoral compartment, mild malalignment, and ligamentous stability. In a review of 250 osteoarthritic knees, these pathologic findings were present in 19 patients (8%). Technique, despite improvement in instrumentation, still is more demanding than tricompartmental knee arthroplasty, and failure to achieve an optimal arthroplasty occurs more frequently. In the literature, long-term results with unicompartmental arthroplasty have been inferior to tricompartmental arthroplasty. The concept that unicompartmental arthroplasty is a temporizing procedure is not a valid one in that the patient has to undergo another arthroplasty with all the risks of revision arthroplasty surgery. Many of these revision procedures require bone grafting or component augmentation. Tibial osteotomy remains the procedure of choice in younger, active patients with unicompartmental arthritis (in highly selected patients), and tricompartmental arthroplasty is preferred in older, lower demand patients.

Arthritis↗
PubMed2005

[Resection arthroplasty of the carpometacarpal joint of the thumb - results of 132 cases].

BACKGROUND: Resection arthroplasty of the carpometacarpal joint of the thumb is considered to be the most frequently used surgical treatment for arthrosis of the trapeziometacarpal joint. To avoid proximalisation and to improve stability of the first metacarpal, tendon-sling resectional arthroplasties have gained general approvement. To further simplify surgery, we have used a surgical technique since 1995, that consists in a fixation of the first metacarpal with local capsular tissue. METHOD AND CLINICAL MATERIAL: From 2000 to 2001, 152 resections of the trapezium were performed in 147 patients with arthrosis of the first carpometacarpal joint. 48 surgical procedures included a tendon-sling arthroplasty; in 104 cases stabilisations of the first metacarpal were achieved by fixing local radiopalmar capsular tissue to the flexor-carpi-radialis tendon. After a mean follow-up of 30 months (18 to 41 months), patients were asked to complete a questionnaire concerning pain, physical strength, practical skills, maximal physical capacity and aesthetic result. The general surgical result had to be scored and the recovery time until the thumb could be used for activities of daily living had to be recorded. RESULTS: 132 of 152 questionnaires, 43 of the patients with tendon-sling arthroplasty and 89 of the patients with arthroplasty with local radiopalmar capsular tissue, were returned. After tendon-sling arthroplasty, 69.8 % of the patients judged their results to be good or very good, after stabilisation with radiopalmar capsular tissue 69.7 % of the patients valued their surgical results good or very good. Unsatisfactory results were found in 18.6 % of the patients after tendon-sling arthroplasty and in 19.1 % of the patients after stabilisation with radiopalmar capsular tissue. The thumb could be used for every-day life after a mean time of 6.7 months. There was no significant difference between the operative procedures. CONCLUSION: The collected data implies that resection-arthroplasty of the carpometacarpal joint of the thumb with stabilisation by radiopalmar capsular tissue yields similar results compared to tendon-sling arthroplasty.

Activities of Daily Living↗