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PubMed1990

Results of reconstruction for failed total elbow arthroplasty.

Failure of total elbow arthroplasty leads to difficult and complicated surgical reconstruction. This study evaluates the results of reconstruction after implant removal with respect to pain, motion, and functional ability. Between 1978 and 1985, 11 patients required implant removal. Indications for removal were infection for seven, implant fracture for three, and recurrent dislocation for one. The original diagnosis was rheumatoid arthritis in six elbows and traumatic arthritis in five. The average length of the follow-up period was 5.5 years after implant removal (minimum, two years). Treatment consisted of implant removal and soft-tissue arthroplasty combined with external fixation in ten patients, and attempted arthrodesis with external fixation in one. There were four good, one fair, two poor, and four failed results. Satisfactory results were obtained in seven of the eight elbows in which an anatomic arthroplasty was achieved. This consisted of containment of the ulna by the humeral epicondylar remnants. All eight elbows were pain-free with an average arc of motion of 85 degrees (range, 55 degrees to 120 degrees). They had excellent elbow flexion power; however, triceps strength was often compromised. In the three elbows in which anatomic arthroplasty could not be achieved, one was flail, one was later converted to an arthrodesis with a customized plate, and the third required an immediate arthrodesis. All three were rated as failures. Fractures occurred in five of the 11 elbows. One occurred preoperatively, three occurred intraoperatively, and one occurred postoperatively. All healed satisfactorily during the course of immobilization. The importance of an anatomic arthroplasty when removing a total arthroplasty cannot be overemphasized. Retaining the epicondylar segments is important because satisfactory results were obtained in patients in whom entrapment of the olecranon within the epicondylar ridges was obtained. Such patients can achieve a satisfactory soft-tissue arthroplasty without the use of an interpositional material. When the epicondylar ridges were not retained and there was marked instability, the patients did not achieve satisfactory results.

Adult↗
PubMed1993

The natural history of unicompartmental arthroplasty. An eight-year follow-up study with survivorship analysis.

From 1983 to 1987, 82 unicondylar arthroplasties were performed for primary unicompartmental osteoarthrosis. Seven knees had lateral compartment arthroplasties and 75 had medial unicompartmental knee arthroplasties (UKA). At a minimum follow-up period of four years, eight patients had been revised, one patient was scheduled for revision, and one patient had died with a failed UKA, for a total failure rate of 12%. Reasons for failure were progression of tricompartmental arthritis in two patients (2.4%), polyethylene wear in two (2.3%), component failure in two (2.3%), component loosening in three (3.5%), and technical error in one (1.6%). Furthermore, 14 (17%) patients showed roentgenographic evidence of impending failure and an additional 12 (15%) patients showed a gradual decline in Hospital for Special Surgery knee scores. Unicondylar knee arthroplasty does not appear to provide as reliable pain relief as total knee arthroplasty. Progression to tricompartmental arthritis, polyethylene wear, and component loosening were seen to limit the usefulness of this arthroplasty. Unlike total knee arthroplasty, factors affecting the success or failure of UKA cannot be predictably controlled by the surgeon.

Aged↗
PubMed1997

Relationship of total hip arthroplasty outcomes to other orthopaedic procedures.

The Medical Outcomes Study Short Form-36 was used preoperatively and 2 years postoperatively to compare patients' self reported assessment of health and function between 151 patients who had primary total hip replacement and 49 patients who had total hip revision, 149 patients who had primary total knee replacements, 41 patients who had lumbar laminectomy, and 43 patients who had scoliosis surgery. Primary total hip arthroplasty and lumbar laminectomy posted equivalent followup scores. Primary total hip arthroplasty showed significant improvements in physical function and health perception when compared with revision total hip arthroplasty; all other health parameters were similar. Primary total hip arthroplasty showed significantly better followup scores and greater improvement in scores in four of nine categories of the SF-36 when compared with primary total knee arthroplasty (despite identical scores preoperatively). Despite a higher level of assessed health preoperatively, patients who had scoliosis surgery compared least favorably with patients who had primary total hip arthroplasty at 2 years followup. In terms of patient self assessment of health and function, primary total hip arthroplasty and lumbar laminectomy for radiculopathy gave the best results.

Adult↗
PubMed2000

Total joint arthroplasty in haemophilia.

In severely affected haemophilic patients arthropathy is a common problem which can lead to considerable pain and functional deficit. Surgical management, including total joint arthroplasty, can be undertaken if conservative management fails. A search of the literature showed that a number of studies describing the use of total knee arthroplasty (TKA) and total hip arthroplasty (THA) in haemophilia have been published, whereas shoulder, elbow and ankle arthroplasties are confined to case reports. This paper reviews the functional outcome of arthroplasty in the different joints, the postoperative and long-term complications, and the impact of HIV. Although complications are commonly described and the surgery is technically demanding, the results suggest that arthroplasty, particularly of the hip and knee, can be a valuable option in the management of severe haemophilic arthropathy.

Arthroplasty, Replacement↗
PubMed1992

Venous thromboembolism associated with hip and knee arthroplasty: current prophylactic practices and outcomes.

Joint registry and hospital data bases for 5,024 total hip and total knee arthroplasties done between 1986 and 1988 at the Mayo Clinic were used to study prophylactic measures and frequency of symptomatic deep venous thrombosis and pulmonary embolism. In virtually all patients, graduated compression stockings were used, with or without another type of prophylaxis. Only 44 of 3,115 patients who underwent hip arthroplasty (1.4%) and 32 of 1,909 patients who underwent knee arthroplasty (1.7%) had definite or probable deep venous thrombosis or pulmonary embolism. Death definitely or possibly attributable to pulmonary embolism occurred in 11 patients who underwent hip arthroplasty (0.35%) and 1 patient who underwent knee arthroplasty (0.05%). Although patients with a history of deep venous thrombosis or pulmonary embolism were more likely to receive warfarin than were patients without such a history, the relative risk of symptomatic deep venous thrombosis or pulmonary embolism in patients who underwent hip arthroplasty and received warfarin postoperatively was approximately half that in patients who received other types of prophylaxis. The risk of death from pulmonary embolism was similarly diminished in the group that received warfarin. The lower rates of these complications in the patients who received warfarin support the prophylactic use of this agent after total hip arthroplasty.

Aspirin↗
PubMed1995

Comparative outcomes of total joint arthroplasty.

A prospective pre- and postoperative general health/quality-of-life factor comparison, using the Rand SF-36 Health Status Questionnaire (TyPE Specification, Quality Quest [Health Outcomes Institute, Minneapolis, MN]), was carried out on a consecutive series of patients with diagnosed osteoarthritis undergoing total hip and knee arthroplasty between March 1991 and March 1994. Study groups consisted of 85 total hip arthroplasty patients, 93 total knee arthroplasty patients, and 65 single-stage bilateral total knee arthroplasty patients, all treated at the same specialty hospital, under the care of three senior orthopaedic surgeons. The average patient age was 69 years. Significant improvements in quality-of-life measures including physical functioning, social functioning, role functioning/physical problem, role functioning/emotional problem, mental health, energy/fatigue, pain, and change in health were noted in all hip and knee arthroplasty patients 6 months, 1 year, and 2 years after surgery (P < .05). There appeared to be no significant differences in quality-of-life measures between hip and knee arthroplasty patients. Results therefore indicate that total hip and knee arthroplasty significantly improve the functional status and quality of life among patients suffering from osteoarthritis.

Activities of Daily Living↗
PubMed2001

[Is chronic, untreated scapho-trapezoid arthrosis after resection arthroplasty of the carpometacarpal joint clinically relevant?].

Basal joint arthrosis and scapho-trapezio-trapezoid arthrosis (triscaphe-arthrosis) are common degenerative diseases with proven surgical treatment. Besides the extirpation of the trapezium during the resection-suspension arthroplasty, we have performed additional fusion of the scaphoid and the trapezoid (ST arthrodesis) in patients with heavy arthrotic changes in both locations. But the combination of these two surgical procedures results in a prolonged rehabilitation and may lead to more complications, e.g. nonunion. Thus the question arises, whether there is any clinical relevance to an untreated scapho-trapezoid arthrosis after resection-suspension arthroplasty of the carpometacarpal joint of the thumb. From 1992 to 1998, we performed resection-suspension arthroplasty of the carpometacarpal joint of the thumb without additional intervention at the scapho-trapezoid joint in 229 patients. In reviewing the perioperative X-rays of these patients, we found 55 cases with untreated arthrosis of the scapho-trapezoid joint. 36 of these patients were reviewed and re-examined. We used the wrist-score as well as new X-rays for our retrospective examination. The untreated arthrosis of the scapho-trapezoid joint does not lead to any reduction of wrist movement and only in some cases to a slight decrease of grip strength (compared with the other side). 23 of the 36 patients were free of pain. Two thirds of the reviewed patients (24 of 36) did not feel any loss of usability of the hand. Only four in 36 cases suffered a significant loss of function. The X-rays for this follow-up showed an increase in arthrotic changes of the scapho-trapezoid joint in comparison to the X-rays after the resection-suspension arthroplasty of the carpometacarpal joint of the thumb in one-third of the patients. In conclusion, in the majority of the patients there are no clinical symptoms of an untreated scapho-trapezoid arthrosis after resection-suspension arthroplasty of the carpometacarpal joint of the thumb. Individual subjective symptoms did exist, even with increased radio-morphologic changes, only in a few cases. We cannot recommend combining of the resection-suspension arthroplasty of the carpometacarpal joint of the thumb with the risky, uncomfortable fusion of the scaphoid and the trapezoid. Presently, we treat very severe arthrotic changes in both joints with a double-resection arthroplasty. These are very rare cases. If there are any advantages in this procedure, those will need to be proven in another follow-up study.

Aged↗
PubMed1997

The efficacy of prophylaxis with low-dose warfarin for prevention of pulmonary embolism following total hip arthroplasty.

The selection of a prophylaxis regimen and its implementation have been influenced considerably by the decreased duration of hospital stays and the pressures of cost containment. The purpose of the present study was to determine the rate of symptomatic pulmonary embolism both before and after discharge, the number of days required to achieve an adequate level of anticoagulation, and the complications associated with the use of low-dose warfarin after total hip arthroplasty. Between 1987 and 1993, 1099 primary and revision total hip arthroplasties were performed in 940 patients who received low-dose warfarin for prophylaxis against thromboembolic disease. The average duration of prophylaxis was fifteen days (range, one to twenty-nine days). The target level of anticoagulation (as indicated by a prothrombin time of fourteen to seventeen seconds) was achieved an average of three days (range, one to sixteen days) after the operation. The level of anticoagulation was lower than the target range at the time of discharge after 257 total hip arthroplasties (23.4 per cent), and the target level was never achieved during the period of hospitalization after fifty-four such procedures (4.9 per cent). Twelve total hip arthroplasties were associated with a symptomatic pulmonary embolism; the over-all prevalence of this complication therefore was 1.1 per cent (95 per cent confidence interval, 0.4 to 1.9 per cent). Four pulmonary emboli were diagnosed before discharge and eight, after discharge. A fatal pulmonary embolism occurred after one procedure (0.1 per cent). Patients who had a history of symptomatic venous thromboembolic disease had a significantly increased risk of symptomatic pulmonary embolism after total hip arthroplasty (p = 0.001, Fisher exact test). A major bleeding episode occurred after thirty-two total hip arthroplasties (2.9 per cent). Patients who had a prothrombin time of more than seventeen seconds had a significantly increased risk of hematoma formation (p = 0.003, chi-square analysis). Prophylaxis with low-dose warfarin is safe and effective for the prevention of pulmonary embolism after total hip arthroplasty.

Adult↗
PubMed1987

Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis.

The cases of twenty-one consecutive patients who had a minimally constrained total knee arthroplasty (six of whom had a cemented and fifteen, an uncemented prosthesis) after a failed proximal tibial osteotomy for osteoarthritis were compared with those of a non-consecutive group of twenty-one patients who had had a primary total knee arthroplasty for osteoarthritis. The groups were matched according to age and sex of the patient, type of prosthesis and fixation, and length of follow-up. At an average length of follow-up of 2.9 years, a good or excellent result was obtained in 81 per cent of the patients who had had a previous osteotomy. At an average length of follow-up of 2.8 years, a good or excellent result was obtained in 100 per cent of the patients who had had a primary arthroplasty. Two patients in the osteotomy group and none in the primary arthroplasty group required additional surgery. At the time of arthroplasty, technical difficulties in exposing the proximal part of the tibia were noted in three patients in the group that had undergone an osteotomy. The results of total knee arthroplasty after failed proximal tibial osteotomy approached but did not equal the results after primary total knee arthroplasty.

Adult↗
PubMed1995

Revision and primary hip and knee arthroplasty. A cost analysis.

The cost of health care in the United States has been rising steadily during the past 10 years. Total joint arthroplasty, a commonly performed orthopaedic procedure, accounts for approximately $10 billion dollars per year. The objective of this study was to perform a clinician-oriented cost analysis of primary and revision hip and knee arthroplasty. Twenty-five consecutive cases each of total knee arthroplasty, total hip arthroplasty, revision total knee arthroplasty, and revision total hip arthroplasty were analyzed. The length of stay and number of minutes spent in the operating room were significantly higher for the patients with revision hip surgery than for the other groups. The total charges for the prosthesis in the 4 groups exceeded 40% of the total charges for the procedure. Primary hip and knee surgery had similar billed costs, and work for revision hip surgery has a significantly higher billed cost than physician's work. The implant selection process by an orthopaedic surgeon performing arthroplasty of the hip and knee needs to include economic aspects.

Costs and Cost Analysis↗
PubMed1995

Autotransfusion of drained blood after total knee arthroplasty.

Osteoarthritic knees were treated by cemented (20 knees) or uncemented (five knees) total knee arthroplasty. The drained blood of the first six postoperative hours was collected, filtered and autotransfused. The blood loss of 20 first postoperative hours averaged 970 ml in the cemented and 1360 ml in the uncemented arthroplasties. An average of 60% of the shed blood was returned to the patients. Transient fever reaction took place during the autotransfusion of three patients, all in the cemented arthroplasty subgroup. No other complications were recorded. The amount of drained blood and transfused blood was compared with a similar series of 16 arthroplasties, treated without autotransfusion. Autotransfusion of filtered blood appears safe and useful in arthroplasty of the knee. Marked reduction of foreign blood transfusion but no direct financial benefit was attained by autotransfusion in these cases. Autotransfusion after uncemented arthroplasty of the knee appears advisable, because of the lack of side-effects, possibly caused by acrylic monomers and because the bleeding (and collection of shed blood) was more extensive than after cemented arthroplasty.

Aged↗
PubMed2005

[Early results of one-stage septic revision arthroplasties with antibiotic-laden cement. A clinical and statistical analysis].

BACKGROUND: Periprosthetic infections will generally require revision arthroplasty. The one-stage revision arthroplasty with antibiotic-laden cement is hence an attractive therapeutic option, since it only requires one operation, has a low morbidity and, if successful, is cost-efficient. MATERIALS AND METHODS: We performed one-stage revision arthroplasties. The exchanged prostheses were fixed with antibiotic-laden cement after biotic resistance was determined. All patients were treated with postoperative systemic antibiotics. RESULTS: After a mean postoperative examination period of 18.4 months, we confirmed eradication of infection in 14 of 15 knee joints and in 15 of 16 hip joints. The mean duration of hospital stay was 23 days. Patients' satisfaction was high (93.55%) and the clinical results were satisfactory. CONCLUSION: Our analysis shows that our low early reinfection rate (6.45%) is within statistical expectation. Furthermore, we have showed that there is evidence to suggest that the rate of successful outcomes in one-stage revision arthroplasties, at least at the hip, is not different from the rate of two-stage revision arthroplasties and that the difference may be interpreted as stochastic deviation (p=0.264494). According to existing studies, an analogy to knee arthroplasties can be assumed. We demonstrated that one-stage revision is an adequate therapeutic option if patients are carefully selected and under the supervision of an experienced surgeon.

Anti-Bacterial Agents↗
PubMed2005

[What effect does of obesity have on the outcome of total hip and knee arthroplasty. Review of the literature].

As the prevalence of obesity worldwide continues to rise, defining the relationship between obesity and arthroplasty outcomes becomes increasingly important. The effect of obesity on the outcome of total hip or knee arthroplasty has been reported to be variable. Some authors believe that a high body weight will lead to less than optimal arthroplasty outcomes, because increased body weight leads to increased stress across the components and an increased load on the surrounding bone. Although this should, in turn, lead to a higher incidence of aseptic loosening or prosthetic failure in obese patients, studies have suggested that the effect of increased body weight and arthroplasty outcome are not so straightforward. The lower activity level typically observed in obese patients may partially counter the negative effects of increased weight on the bone-prosthesis interface. Although results do not show significant differences in all studies, it appears that obesity has negative impact on the results of total hip and knee arthroplasty. Therefore, long-term studies using large sample sizes should be conducted. If significant differences are demonstrated, an altered course of treatment, such as having a patient lose weight before considering a total hip or knee arthroplasty, might be advocated.

Arthroplasty, Replacement, Hip↗
PubMed2000

Development of outcome research for total joint arthroplasty.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are now the most common major orthopedic procedures in the world. Outcome research for patients undergoing total joint arthroplasty is now the accepted method of choice for evaluating the results of surgery. This study design incorporates the use of patient-derived data collected from patient self-administered questionnaires that will capture data on the patient's experience of pain, functional disability, and general health status. These questionnaires do not replace traditional measures of clinical endpoints, such as mortality and complication rates, but will be additions to data collection. The patient-derived data allow orthopedic surgeons to assess the impact of total joint arthroplasty on the health status of their patients. The need to collect these data is increasingly necessary with the growing demands on orthopedic surgeons to demonstrate the efficacy of total joint arthroplasty to maintain funding from both public and private funding sources. This article introduces the development of outcome research for patients undergoing total joint arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed1998

Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty.

A hospital-based computer system was used to compare the inpatient costs of performing bilateral simultaneous sequential, staged, and unilateral total hip and knee arthroplasties. Bilateral simultaneous sequential total knee arthroplasty was 36% less costly than 2 unilateral total knee arthroplasties. Bilateral simultaneous sequential total hip arthroplasty saved 25% over the costs of performing 2 unilateral hip arthroplasties. Prosthetic costs range between 28% and 43% of the total costs of hospitalization. There was a significant correlation between hospital length of stay, morbidity, and total costs, but no correlation with patient age and sex except in the unilateral knee patients. Bilateral simultaneous sequential joint arthroplasty can save more than $10,000 for each total knee patient and more than $8,000 for each total hip patient.

Adult↗
PubMed2005

Comparison of analog and digital preoperative planning in total hip and knee arthroplasties. A prospective study of 173 hips and 65 total knees.

INTRODUCTION: Digital correction of the magnification factor is expected to yield more accurate and reliable preoperative plans. We hypothesized that digital templating would be more accurate than manual templating for total hip and knee arthroplasties. PATIENTS AND METHODS: Firstly, we established the interobserver and intraobserver reliability of the templating procedure. The accuracy and reliability of digital and analog plans were measured in a series of 238 interventions, which were all planned using both techniques. RESULTS: Interobserver reliability was good for the planning of knee arthroplasties (e-values 0.63-0.75), but not more than moderate for the planning of hip arthroplasties (e-values 0.22-0.54). Analog plans of knee arthroplasties systematically underestimated the component sizes (1.1 size on average), while the digital procedure proved to be accurate (0.1-0.4 size too small on average). The following figures show percentage of cases receiving a correct implant, allowing an error of one size. Digital templating of the hip arthroplasty was less frequently correct (cemented cup and stem: 72% and 79%; uncemented cup and stem: 52% and 66%) than analog planning (cemented cup and stem: 73% and 89%; uncemented cup and stem: 64% and 52%). INTERPRETATION: Planning of component sizes for total knee arthroplasties is an accurate procedure when performed digitally. Our digital preoperative plans which were performed by someone other than the surgeon were less accurate than the analog plans prepared by the surgeon.

Arthroplasty, Replacement, Hip↗
PubMed2004

Multivariate analysis of the factors affecting duration of acute inpatient rehabilitation after hip and knee arthroplasty.

OBJECTIVE: To determine which factors predict length of stay at a rehabilitation hospital for total hip and knee arthroplasty patients. DESIGN: Length of stay at an acute rehabilitation hospital was analyzed with respect to demographic, surgical, and comorbidity factors using univariate and multivariate statistical techniques. Data were retrospectively collected of 808 hip and knee arthroplasty rehabilitation patients from years 2000 and 2001 at a large, urban, university-affiliated acute rehabilitation hospital. Demographic factors included age, insurance, marital status, sex, race, and body mass index. Surgical factors included knee/hip arthroplasty, unilateral/bilateral arthroplasty, and indication for surgery. Also, the 22 most prevalent comorbid illnesses for the patient group were analyzed for their association with length of stay. RESULTS: Significant factors for predicting length of stay were indication for surgery, number of comorbid illnesses, unmarried marital status, and black race. Also, advanced age and male sex approached significance. CONCLUSION: Length of stay in rehabilitation for total hip arthroplasty and total knee arthroplasty can be statistically modeled using various factors. These findings will help clinicians address prolonged length of stay and resource allocation issues.

Age Factors↗
PubMed2005

[Retransfusion of unwashed drainage blood after total hip and knee arthroplasty].

The method of retransfusion of drainage blood as known from the literature was investigated in a prospectiv study regarding effectivness and rate of side effects. 200 patients who underwent total hip and knee arthroplasty were investigated concerning hemoglobin, hematocrit, amount and quality of the retransfused drainage blood, the amount of autologous and homologous transfusions as well as complications and costs. 100 of these patients were selected as the control group. The amount of the retransfused drainage blood after hip arthroplasty amounted an average of 387 +/- 194 ml and after knee arthroplasty 595 +/- 250 ml. The retransfused blood had an average hemoglobin of 5,2 +/- 0,9mmol/l with a hematocrit of 0,24 0,05. No complications directly associated to the retransfusion were found. The need of transfusion was reduced for patients with knee arthroplasty about 30% and for hip arthroplasty about 25%. The retransfusion of unwashed drainage blood is a sufficient method to reduce perioperative homologous blood transfusion in patients with arthroplasty of hip and knee. Substantial complications were not observed, so that this method seems to be save enough for clinical usage. The method is easy to handle and usable without special technical devices. The autologous retransfusion of drainage blood can contribute to lower costs in patients treatement.

Aged↗