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At least 343 records · Page 19Linked to original sources
PubMed1982

Reconstructive surgery following total elbow endoprosthesis.

Elbow arthroplasty should only be undertaken by surgeons who have considerable experience in total arthroplasty and special training in upper-extremity surgery. The failed total prosthesis presents a formidable challenge. The recognition of this fact fortunately has had an impact on prosthetic design, so that less bone stock is removed at surgery. In addition, second- and third-generation arthroplasties are becoming available that biomechanically are more suitable and that may be expected to be somewhat more durable than those of the first generation. Early and decisive action is recommended in the case of the loose elbow joint prosthesis before the cement mantle causes further abrasive wear to the cortex, which eventually may be broken through, rendering revision much more difficult. If there is any doubt about the adequacy of the bone stock to receive a further prosthesis after removal of the failed joint, a nonprosthetic salvage procedure, or, alternatively, revision as a two-stage procedure is recommended. In the case of the failed surface implant, nonprosthetic interposition arthroplasty will usually give a satisfactory result.

Elbow Joint↗
PubMed1981

Clinical and radiographic assessment of a non-constrained total shoulder.

This paper presents the early post-operative results of a nonconstrained total shoulder joint prosthesis of the UCLA design in ten patients. Substantial relief of pain was achieved in eight patients. Half the patients showed and increased range of shoulder movement and ony one prosthesis was unstable requiring reoperation. Radiolucent zones at the cement-bone interface of the glenoid developed in several patients. The significance of these with regard to joint mobility, resultant forces and incipient loosening of the polyethylene component are discussed. No clinical signs of loosening occurred in the observation period.

Adult↗
PubMed2003

Antibiotic prophylaxis for patients with joint prostheses - still a dilemma for dental practitioners.

OBJECTIVES: To provide a critical review of the current evidence that implicates dental-induced bacteraemia as a risk for joint infections in patients fitted with joint prostheses and appraise the need for antibiotic prophylaxis. DESIGN: Retrospective analysis. SETTING: Mainly hospital-based patients or subjects. OUTCOME MEASURES: The relationship between joint infections and dental treatment is equivocal at the best and there is no evidence that antibiotic prophylaxis provides such patients with any protection. RESULTS: Microbiological evidence linking dental treatment-induced bacteraemia to joint infections is weak and if an oral commensal is implicated, it is more likely to have arisen either from a spontaneous bacteraemia or from a dental infection. As a consequence of the latter, we recommended the institution of good dental health prior to joint replacement. There may be a case for providing prophylaxis to the immuno-compromised patient, but only if the immuno-suppression is associated with a neutropenia. In such circumstances, only emergency treatment should be considered until the neutropenia is resolved. Antibiotic regimens that are recommended by orthopaedic surgeons have not been evaluated in a randomised placebo-controlled study and many of the drugs are not licensed for this purpose. The evidence on cost-risk benefit seems to demonstrate that antibiotic prophylaxis with either amoxicillin or penicillin is not cost effective when compared with no prophylaxis. CONCLUSION: The case for providing antibiotic prophylaxis prior to dental treatment in patients fitted with a joint prosthesis is weak or virtually non-existent. Furthermore, the risk from providing prophylaxis is greater than the risk of a joint infection.

Antibiotic Prophylaxis↗
PubMed1993

Nickel sensitivity and the implantation of orthopaedic prostheses.

There is no evidence that nickel-sensitive patients, when given a modern plastic-to-stainless-steel hip replacement, develop cutaneous reactions or loosening of their prostheses. However, eczema is occasionally seen with static metal prostheses and eruptions sometimes accompanied the use of the older types of joint prosthesis. Modern plastic-to-metal joint replacements rarely cause sensitization to the composite metals. In the rare instances when this has been detected by patch testing, the affected patients have not developed eczema or loosening of their prostheses.

Dermatitis, Allergic Contact↗
PubMed2002

[Reconstruction-arthrodesis of the first metatarsophalangeal joint iatrogenic bone defects].

PURPOSE OF THE STUDY: Arthrodesis-reconstruction for metatarsophanlangeal bone defects of the great toe after hallux valgus or hallux rigidus is rarely performed and only a few series are found in the literature. In these series, retarded bone fusion, skin rupture, and interphalangeal intolerance (both clinically and radiologically) have been frequent. The purpose of this work was to determine what parameters contribute to minimizing these postoperative risks. MATERIAL AND METHODS: Thirteen patients, mean age 60 years, were reviewed at a mean follow-up of 7 years. Mean delay from initial surgery to revision surgery was greater than 6 years. Preoperative complaints included metatarsophalangeal pain and especially transfer metatarsalgia. The procedure used corticocancellous bone grafting associated with osteosynthesis and unloading of the forefoot for three months. RESULTS: Eleven of the 13 patients achieved full relief of their metatarsophalangeal pain and metatarsalgia. Twelve of the 13 patients had a satisfactory great toe axis, including 2 who had a secondary osteotomy for correction. Bone fusion was achieved in all 13 patients; one at 8 months. Mean lengthening was 5.1 mm; reconstruction with the corticocancellous graft reconstruction generally filled the bone defect resulting from ablation of the joint prosthesis in 7 cases. The interphalangeal joint was pain free at last follow-up in all cases despite radiological evidence of suffering in one (similar to the situation before the revision surgery). DISCUSSION AND CONCLUSION: Correct position of the arthrodesis is essential to alleviate transfer metatarsalgia. A moderate lengthening of the great toe can minimize the risk of skin rupture. In order to preserve the interphalangeal joint, the position of the arthrodesis must be precise both in the sagittal and horizontal plane, leaving sufficient valgus and avoiding the need for temporary interphalangeal pinning.

Adult↗
PubMed1978

Instantaneous center of rotation by least square method.

In the design of the total replacement of the human joint, the joint center of rotation is often important. This paper describes an analytical technique to study joint kinematics, especially the instantaneous center of rotation. The empirical data for the analysis were obtained by the sonic digitizer system which works acoustically and electronically. As biomechanical applications of the technique, the elbow, the metacarpophalangeal, and wrist joints were studied.

Biomechanical Phenomena↗
PubMed1976

[Results in the implantation of total or partial prosthesis in the knee joint].

A report of the results achieved by treating of corrosive diseases of knee joint by partial and total endoprosthesis. A total of 74 knee joints were operated on. Improvement of movement and stress capability was achieved in 93% of all cases. Complications are presented and discussed. Follow-up and summary of all cases reveals that the total endoprosthesis is increasingly indicated. The replacement of a sliding endoprosthesis by a total endoprosthesis has since become necessary in three cases and resulted in marked improvement of function. One patient is not free of complaints, and an exchange operation is indicated. The indications for implantation of a sliding endoprosthesis will in the future surely be much more closely drawn. Follow-up reveales that increasing reactive changes of the knee joint cause pain of increasing measure. An initially painless interval is followed by a period of increasing pain. Results of follow-uthesis may be extended. The continued pain that totally operated patients in part by the high-grade and progressive changes in the femoro-patellar joint.

Aged↗
PubMed1995

Infections with Chryseomonas luteola (CDC group Ve-1) and flavimonas oryzihabitans (CDC group Ve-2).

We have described 15 cases of infection due to Chryseomonas luteola and Flavimonas oryzihabitans isolated between May 1990 and May 1994. These infections were often associated with the presence of a foreign body, especially central venous access and joint prosthesis. The high frequency of isolating C. luteola and F. oryzihabitans probably expresses the awareness of the clinicians and the laboratory to the importance of these bacteria, especially in patients with the presence of a foreign material.

Abscess↗
PubMed2005

[Partial prosthesis of the shoulder joint--personal experience].

Hemiarthroplasty of the shoulder is a treatment of choice for severe types of proximal humeral fractures. From 2001 to 2003, 8 hemiarthroplasties were performed at the University Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Novi Sad. The aim of this study was to retrospectively assess functional outcomes of those patients. By determing the factors that affected the outcome, we would try to improve results of future patients.

Aged↗
PubMed1977

Transformation in the presence of metals of lymphocytes from patients with total joint prostheses.

A lymphocyte transformation test has been used to study metal sensitivity in patients receiving total joint replacements. In the case of nickel, very significant levels of transformation were obtained with lymphocytes from patients with positive patch tests for this metal. In the case of patch test negative recipients of total joint prosthesis an elevated index of transformation was found in seven out of 15. Transformation in the presence of cobalt was less striking and there was evidence of toxicity of the metal in doses used to obtain stimulation. In eight out of 12 patch test positive individuals a significant level of transformation was obtained. Two of the seven patients carrying joint prostheses who wwere also patch test negative gave an elevated index of transformation. The clinical implications of these results are discussed.

Cobalt↗
PubMed1978

Total hip replacement in children with arthritis.

Fourteen children with juvenile rheumatoid arthritis and two with ankylosing spondylitis received 29 total hip replacements (THR). The ages at THR were 12 to 18 years, the median duration of prior hip disease was 7.1 years, and the minimum followup was one year (range 1--4 years, median 2.2 years). The primary indication for THR was pain in 5 hips and severe malposition or flexion contractures in 24 hips. (Sixteen of these also had some degree of pain.) All 29 hips demonstrated improved postoperative range of motion, and all were free of pain. In children, active rheumatic disease in other joints, prosthesis longevity, and possible lack of adequate motivation all merit special consideration prior to THR, but the results are encouraging.

Adolescent↗
PubMed2000

[DIGITOS-prosthesis for the proximal interphalangeal joint. A 2-year follow-up].

The treatment of osteoarthrosis of the proximal interphalangeal joint by prosthesis bears several specific problems. With the DIGITOS-prosthesis a new implant is now available. It is a cemented modular hinged prosthesis. We report our experiences with this implant from a prospective clinical trial. Seven patients with osteoarthrosis of the proximal interphalangeal joint had ten prosthetic middle joint replacements performed with DIGITOS-prostheses. Over an observation period of two years, the functional results were found to be good. The mean preoperative range of motion in the affected joints was 51.5 degrees. Three months after surgery, this had improved to 60.5 degrees, but then decreased to 53.0 degrees after one year and to 49.5 degrees, i.e. the original range of motion, by the end of the second postoperative year. No implant became loose. Nearly all patients were free from pain. The only serious complication was an iatrogenic lesion of the middle slip of the extensor aponeurosis resulting in a buttonhole deformity. In spite of these encouraging two-year results, the further follow-up has to be observed carefully.

Aged↗
PubMed2006

Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis.

PURPOSE: Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women. Many different surgical techniques have been proposed for extensive degenerative arthritis of the first carpometacarpal (CMC) joint. Joint replacement has been an effective treatment of this condition. The purpose of this article is to present the outcome of a total cemented trapeziometacarpal implant in the treatment of more advanced stages of this disease. METHODS: Total joint arthroplasty of the trapeziometacarpal joint was performed on 26 thumbs in 25 patients to treat advanced osteoarthritis (Eaton and Littler stages III and IV) between 1998 and 2003. Indications for surgery after failure of conservative treatment were severe pain, loss of pinch strength, and diminished thumb motion that limited activities of daily living. A trapeziometacarpal joint prosthesis was the implant used in this series. The average follow-up time was 59 months. RESULTS: At the final follow-up evaluation, thumb abduction averaged 60 degrees and thumb opposition to the base of the small finger was present. The average pinch strength was 5.5 kg (85% of nonaffected side). One patient had posttraumatic loosening, which was revised with satisfactory results. Radiographic studies at the final follow-up evaluations did not show signs of atraumatic implant loosening. One patient complained of minimal pain, and the remaining 24 patients were pain free. CONCLUSIONS: In our series, total joint arthroplasty of the thumb CMC joint has proven to be efficacious with improved motion, strength, and pain relief. We currently recommend this technique for the treatment of stage III and early stage IV osteoarthritis of the CMC joint in older patients with low activity demands. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Aged↗
PubMed2004

Role of anti-granulocyte Fab' fragment antibody scintigraphy (LeukoScan) in evaluating bone infection: acquisition protocol, interpretation criteria and clinical results.

Scintigraphy using anti-granulocyte Fab' fragment (LeukoScan) was performed in a series of 220 consecutive patients with suspected bone infection referred to our centre between September 1999 and June 2002. Two protocols were compared for interpreting scans: (1) evaluation of early 4 h imaging alone (protocol A), and (2) evaluation both of early and delayed 24 h imaging (protocol B). Protocol A and protocol B showed equal values of sensitivity (91.9% in patients with diabetic foot and 84.2% in patients with joint prosthesis/peripheral bone implants). Conversely, specificity was higher adopting protocol B than protocol A: 87.5% vs 75.0% in patients with diabetic foot, and 85.7% vs 76.2% in patients with joint prosthesis/peripheral bone implants, respectively. In particular, an improvement in specificity using protocol B was found in those patients with infection and with only a mild LeukoScan uptake in the early 4 h imaging: in these patients an increasing uptake intensity pattern observed in the delayed 24 h imaging was indicative of infection while a decreasing pattern suggested a negative result. Instead, the evidence of a high uptake intensity in the early LeukoScan imaging was a strong indicator of infection and delayed imaging in these cases did not further improve specificity. In conclusion, in our experience, LeukoScan showed high sensitivity in diagnosing bone infection in patients with diabetic foot and joint prosthesis or other peripheral bone implants. Moreover, in patients with an early high LeukoScan uptake intensity further delayed images appears unnecessary for the purpose of diagnosing infection. In contrast in patients with an early mild LeukoScan uptake intensity only, delayed imaging appears to be recommendable for improving specificity.

Adult↗
PubMed1983

[Possibilities for orthopedico-surgical reconstruction in joint damage in elderly patients].

If no higher risk operation for the older patient is involved, indication for an arthroplastic joint prosthesis is given on the basis of today's large and world-wide experience. The postoperative mortality is naturally higher than with the younger patients and amounts to 2% in our statistics. A smooth cooperation between the internist and the orthopaedic surgeon enables also to the older patients with higher risk operations, especially thanks to the modern anaesthetic possibilities (f.i. lumbar anaesthetics), a functional recovery of the joint. We should, however, use already with the younger patients all possible joint preserving and supporting surgical operations in order to save the old patients in many cases from the need of implanting a prosthesis.

Aged↗
PubMed1975

The problem of infection in total prosthetic arthroplasty of the hip.

In summary, deep wound infection carries a special and disastrous significance for the patient with a total joint prosthesis. Such patients seem to be at greater than usual risk of infection, and special precautionary measures to prevent it are not only justified but imperative. These include careful preoperative preparation; special attention to rigid and exacting operative techniques for control of potential exogenous contaminants; sensible preoperative, intraoperative, and postoperative antibiotic prophylaxis for control of potential endogenous cantaminants; and continued supervision of the patient throughout the postoperative years so as to prevent potential metastatic infection from other primary sources. Pre-existing and active infections of the hip constitute contraindications to total prosthetic arthroplasty, but these rules may be suspended in certain special situations provided that the patient is willing to cooperate with the arduous and prolonged program of treatment, and fully understands the special risks involved.

Arthroplasty↗
PubMed2000

Devices for use as an artificial articular surface in joint prostheses or in the repair of osteochondral defects.

The covering of ultra high molecular weight polyethylene (UHMWPE) and calcium hydroxyapatite (HA)/tricalcium phosphate (TCP) porous solid substrate with polyHEMA hydrogel has been studied aiming at the development of devices to be used as artificial articular surfaces in joint prosthesis or osteochondral repair grafts. Commercial porous UHMWPE was used. Ceramic porous substrate was prepared by load compaction of an HA and TCP powder mixture obtained by aqueous precipitation technique. Two different compaction loads and grain size distribution was used. Polymer particles were added to the powder mixture in order to increase the substrate porosity after the sintering process. The porous substrate was covered with polyHEMA hydrogel by in situ polymerization. Morphological analysis (SEM) showed that a hydrogel layer formed in the porous solid top surface was fixed to the substrate by mechanical interlocking because the porous surface was filled by the hydrogel. After hydrogel covering, the resultant devices showed a decrease in the compressive elastic modulus that was influenced by the porous substrate material.

Calcium Phosphates↗