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PubMed1986

Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty.

Palmar oblique ligament reconstruction combined with tendon interposition (LRTI) arthroplasty with part of the flexor carpi radialis tendon was developed for advanced osteoarthritis of the thumb basal joint. Twenty-five procedures are reviewed with an average follow-up of 2 years, ranging from 1 to 4 1/2 years. LRTI arthroplasty more consistently improved pinch strength, increased grip strength endurance, and restored thumb web space than did silicone implant arthroplasty. Proximal metacarpal migration averaged only 11% of the initial arthroplasty space versus nearly 50% loss of height with silicone implants. Subluxation averaged only 7% of the width of the thumb metacarpal base relative to the scaphoid versus subluxation of 35% of the base of the implant with silicone arthroplasty. Excellent results were achieved in 23 thumbs or 92% of cases. No deterioration of function or stability has been noted over time, and no revisional procedures have been necessary. On the basis of these encouraging early results, LRTI arthroplasty has become our preferred surgical treatment for advanced basal joint osteoarthritis of the thumb.

Arthroplasty↗
PubMed2003

Efficacy of a single dose of cefazolin as a prophylactic antibiotic in primary arthroplasty.

We analyzed the wound infection rate of 1,367 primary total hip and knee arthroplasties performed between 1991 and 1999. Two hundred and fifteen arthroplasties were performed with 3 doses (3 x 750 mg) of cefuroxime, and 1,152 arthroplasties were performed with a single preoperative dose (1 x 1 g) of cefazolin as antimicrobial prophylaxis. All wound infections that occurred within 2 years of the index surgery were analyzed. The deep wound infection rate of total hip arthroplasty was 1.1% (95% confidence interval [CI], 0%-3.3%) in the cefuroxime group and 1.1% (95% CI, 0%-2.2%) in the cefazolin group (Fisher's exact test, P = 1.0). The deep wound infection rate of total knee arthroplasty in the cefuroxime group (1.6%; 95% CI, 0%-3.8%) was not significantly different from the cefazolin group (1.0%; 95% CI, 0.3%-1.7%) (Fisher's exact test, P =.63). We concluded that a single dose (1 g) of cefazolin given at anesthetic induction offered similar protection to 3 doses (3 x 750 mg) of cefuroxime in preventing infection in primary total joint arthroplasty.

Aged↗
PubMed2003

Ninety-day mortality after shoulder arthroplasty.

Although mortality associated with knee and hip arthroplasty has been reported, there is no information about shoulder arthroplasty. The purpose of this study was to determine the incidence and risk factors associated with perioperative mortality after shoulder arthroplasty. Between 1970 and 2000, 2,953 patients underwent shoulder arthroplasty at our institution. A retrospective review identified all patients who died within 90 days of the procedure. The 90-day mortality incidence was 0.58% (17 of 2,953). Twelve hemiarthroplasties were performed for a pathologic fracture and one for rotator cuff arthropathy. Total shoulder arthroplasties were performed for the sequelae of trauma (2), rheumatoid arthritis (1), and avascular necrosis (1). Ninety-day mortality was closely associated with the underlying diagnosis. Perioperative mortality after shoulder arthroplasty for non-neoplastic conditions is low.

Aged↗
PubMed1998

Unicompartmental knee arthroplasty in middle-aged patients: a 2- to 6-year follow-up evaluation.

Twenty-eight unicompartmental knee arthroplasties performed as an alternative to high tibial osteotomy or tricompartmental knee arthroplasty in patients under 60 years of age were reviewed after 2 to 6 years of follow-up. The patient's age at the time of operation averaged 52 years. Using the Knee Society Score, 90% were rated good or excellent results in terms of function and pain relief. The average flexion angle obtained was 124 degrees, and the average postoperative alignment was 4 degrees of anatomic valgus for varus deformities and 8 degrees for valgus deformities. The average activity level according to the Tegner and Lysholm score slightly improved (preoperative, 2.3; follow-up, 2.7 points). Of the 28 knees, 9 (32%) presented radiolucent lines about the tibial component and two had incomplete radiolucent lines at the bone-cement interface on the femoral side. There was no correlation between activity level and tibial radiolucent lines. Two revisions were performed because of loosening of the femoral component at the prosthesis-cement interface. One was converted to another unicompartmental arthroplasty and the other to a tricompartmental arthroplasty. One tibial component exhibited an asymptomatic slowly progressive radiolucency. Unicompartmental knee arthroplasty in middle-aged patients yields 2- to 6-year results competitive with osteotomy but inferior to tricompartmental arthroplasty in terms of revision. The specific prosthetic design used in this series appeared to be vulnerable to femoral component loosening possibly because of constrained tibial topography and smooth tapered femoral fixation lugs.

Adult↗
PubMedDate not supplied

A comparison of hemiarthroplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: results of a multicenter study.

Six hundred one total shoulder arthroplasties and eighty-nine hemiarthroplasties were performed for primary osteoarthritis of the shoulder. Patients were evaluated with a physical examination, Constant score, and radiographic evaluation. The minimum follow-up was 2 years. At follow-up, the Constant score averaged 64 points, the adjusted Constant score averaged 86%, active anterior elevation averaged 130 degrees, and active external rotation averaged 36 degrees for the hemiarthroplasties. The Constant score averaged 70 points, the adjusted Constant score averaged 96%, active anterior elevation averaged 145 degrees, and active external rotation averaged 42 degrees for the total shoulder arthroplasties. Eighty-six percent of hemiarthroplasties and ninety-four percent of total shoulder arthroplasties had good or excellent results. Differences were statistically significant for all parameters. Total shoulder arthroplasty provided better scores for pain, mobility, and activity than hemiarthroplasty. Fifty-six percent of total shoulder arthroplasties had a radiolucent line around the glenoid component. Total shoulder arthroplasty provides results superior to those of hemiarthroplasty in primary osteoarthritis.

Adult↗
PubMed1999

A preliminary report: cementless trapeziometacarpal arthroplasty.

A cementless ball and socket trapeziometacarpal arthroplasty was used for the treatment of Eaton and Littler stage II and III trapeziometacarpal osteoarthritis. Forty-two joints were placed in 36 patients between 1986 and 1992. Five joints in 4 patients required revision. Thirty-four joints in 30 patients were evaluated with a mean follow-up period of 47 months (range, 15-86 months). Of the 33 monitored patients (39 joints), 79% reported good to excellent pain relief and excellent functional improvement and 12% reported poor to fair pain relief and functional improvement. Five joints required revision surgery and constituted 13% of the original arthroplasties. Thirty-three functional tests were graded before and after surgery and improvement was noted in all categories. Dramatic improvement was noted in the typical complaints for trapeziometacarpal joint disease, which are encountered in the activities of daily living. Radiolucent lines were present in 13 of 25 implants (52%), which were radiographically monitored. Radiographic loosening was present in 32%; 12 were around the trapezial component and 1 was around the metacarpal component. Radiographic loosening did not correlate with less satisfactory clinical results. Cementless trapeziometacarpal arthroplasty provides an operative alternative to arthrodesis in properly selected patients with trapeziometacarpal joint osteoarthritis. This joint is not intended to replace excisional or ligament reconstruction tendon interposition arthroplasty in lower demand patients or in those with pantrapezial arthritis. It also is not recommended in patients with rheumatoid arthritis or poor bone stock. It offers the advantages of maintaining excellent motion and stability. The cementless arthroplasty failures can be effectively salvaged by converting them to ligament reconstruction tendon interposition arthroplasty.

Activities of Daily Living↗
PubMedDate not supplied

[Cement-free revision arthroplasty of the acetabulum--intermediate term outcome with trabecular-oriented acetabulum implant].

PURPOSE: In the case of hip revision arthroplasty, cementless implants combined with bone grafts are increasingly used to reconstruct the acetabular bone stock. The study on hand reports about the results with the trabecular orientated cup implant of CopflHolz after 10 years of application. METHOD: A total of 256 hip revision arthroplasties were prospectively recorded with a mean follow-up period of 5.6 years. For the osseous augmentation of the acetabulum, autogenous bone was used in 227 cases, allogenic spongy bone in 15 cases and mixed bony materials in 8 cases. The clinical and radiological follow-ups were done after 3, 6, 12 months and then in 2-years intervals. RESULTS: Within the 10 years follow-up 3 rerevisions must be done because of deep infection, 6 rerevisions because of aseptic loosening or primary instable fixation. The specific failure rate of the used cup implant amounts to 96.2% five years after revision arthroplasty, and 86.8% ten years after revision arthroplasty. Revealed from a radiological point of view, the transplanted spongiosa showed in 83.5% a complete osseous integration one year after the operation. Worse incorporation was conspicuous especially when allografts or mixed bone grafts were used. Clinically, a permanent improvement of motion, pain and walking ability was seen postoperatively. 91% of all follow-up patients were satisfied with the result of the revision arthroplasty. CONCLUSIONS: The trabecular orientated cup implant has proven itself worthy for cementless cup revision arthroplasty and will be an alternative to the cups and rings used up to now for the reconstruction of great acetabular bone deficiencies.

Acetabulum↗
PubMed2000

Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips.

100 patients 75 years or older, with displaced femoral neck fractures, were randomly assigned to osteosynthesis with two parallel and percutaneously inserted screws (Olmed) or total hip arthroplasty (Lubinus IP). Mean age was 84 (75-101) years, 74% were women and 45% had mental dysfunction. General complications were commoner in the arthroplasty group but the mortality rates did not differ. In the osteosynthesis group, fracture complications were seen in 27/50 hips. In the arthroplasty group, dislocation was the main complication and occurred in 11/50 cases. At 3 months and after 1 year, the Harris Hip Scores were significantly better in the arthroplasty group. When mental dysfunction was present, the dislocation rate after arthroplasty was 32%, whereas the reoperation rate after osteosynthesis was 5%. The opposite pattern of complications was found in patients with normal mental function, 12% versus 60%. The 2-year mortality rate among those with mental dysfunction was 26/45, compared to 7/55 of those with normal function (p < 0.001). We conclude that total hip arthroplasty should be considered for a displaced femoral neck fracture in old patients with normal mental function and high functional demands.

Aged↗
PubMed2002

Delayed reimplantation arthroplasty for candidal prosthetic joint infection: a report of 4 cases and review of the literature.

Fungal prosthetic joint infection (PJI) is rare, with Candida species being the most frequently reported pathogen in the medical literature. The risk of relapse following delayed reimplantation arthroplasty for candidal PJI is unknown. We describe 4 new cases and summarize 6 previously reported cases of candidal PJI treated with delayed reimplantation arthroplasty. Ninety percent of the patients received antifungal therapy. Eight patients received amphotericin B either alone or in combination with other antifungals. One patient received fluconazole alone. The median duration of time from resection arthroplasty to reimplantation for total hip and total knee arthroplasties was 8.6 and 2.3 months, respectively. Eight patients did not have relapse of candidal PJI following delayed reimplantation arthroplasty after a median duration of follow-up of 50.7 months (range, 2--73 months). Candidal PJI can be successfully treated with delayed reimplantation arthroplasty after receipt appropriate antifungal therapy.

Adult↗
PubMed2006

Temporomandibular joint bony ankylosis: comparison of treatment with transport distraction osteogenesis or the matthews device arthroplasty.

Temporomandibular joint (TMJ) bony ankylosis with micrognathia is a rare congenital condition that is difficult to treat and may result in recurrence. In a series of affected patients, we compared two new methods of treatment: transport distraction osteogenesis and Matthews Device arthroplasty. All patients had computed tomography scan documented bilateral TMJ bony ankylosis. Group I (transport distraction osteogenesis) underwent distraction advancement of the mandible (for micrognathia) followed by resection of the condyles, recontouring of the glenoid fossas with interposition temporoparietal-fascial flaps, and transport distraction osteogenesis of mandibular rami segments. Group II (Matthews Device arthroplasty) underwent all of the above procedures except for transport distraction osteogenesis. Instead, the Matthews Devices were anchored to the temporal bone and mandibular rami. Hinged arms allowed for motion at the reconstructed TMJ. In both groups, patients underwent extensive postoperative therapy. Preoperative, postoperative, and follow-up lateral cephalograms were obtained, and incisor opening distances were recorded. All patients but one had severe micrognathia (n = 9). For group I (transport distraction osteogenesis), mean age was 6.8 years. and mean advancement was 28.5 mm. For group II (Matthews Device arthroplasty) mean age was 8.2 years, and mean advancement was 23.5 mm. In group I (transport distraction osteogenesis), mean incisor opening was 1 mm preoperatively and 27.5 mm postoperatively; however, it relapsed to 14.3 mm by 12.5 months follow-up (48% relapse). Mean incisor opening in group II (Matthews Device arthroplasty) was 3.9 mm preoperatively and 33.4 mm postoperatively and remained at 30.6 mm after 11.1 months follow-up (8% relapse). One patient in group I (transport distraction osteogenesis) underwent surgical revision because of relapse. Our data showed that for congenital TMJ bony ankylosis both transport distraction osteogenesis and Matthews Device arthroplasty techniques were successful initially; however, the Matthews Device arthroplasty avoided long-term relapse.

Adolescent↗
PubMed1999

Total hip arthroplasty after failed intertrochanteric valgus osteotomy for advanced osteoarthrosis.

Thirty hips that had undergone conversion total hip arthroplasty because of failed intertrochanteric valgus osteotomy for advanced osteoarthrosis were analyzed clinically and radiographically for more than 2 years. The average followup after total hip arthroplasty was 7 years (range, 2-18 years). The average age of the patients at the time of valgus osteotomy was 42 years (range, 30-63 years). The average age of the patients at the time of conversion total hip arthroplasty was 57 years (range, 43-76 years), and the average period between valgus osteotomy and conversion was 14 years (range, 3-24 years). Perioperative complications in conversion total hip arthroplasties were minimal, and intramedullary reaming was performed easily. Of the 30 conversion total hip arthroplasties, 12 cemented and 18 cementless components were used, respectively. Kaplan-Meier's survival analysis indicated that survivorship of cemented stems was significantly higher than that of conventional cementless stems. Cemented stems are preferable for conversion total hip arthroplasty after failed femoral valgus osteotomy.

Adult↗
PubMed1999

The Frank Stinchfield Award. Sudden death during primary hip arthroplasty.

The records of 23 patients who died intraoperatively during hip arthroplasty at the authors' institution were reviewed. Of the 38,488 hip arthroplasties in 29,431 patients performed between 1969 and 1997, there were 23 deaths during surgery. There were 15 women and eight men with a mean age of 80.9 years. Preoperative diagnoses were acute hip fracture (13 patients), pathologic fracture (four patients), femoral neck nonunion (one patient), osteoarthritis (four patients), and rheumatoid arthritis (one patient). Eleven patients undergoing cemented total hip arthroplasty died and 12 patients undergoing cemented hemiarthroplasty died. All deaths occurred because of irreversible cardiorespiratory disturbances that were initiated during cementing. There were no deaths among 12,551 patients receiving 15,411 uncemented hip arthroplasties during the 28-year period under review. Autopsy was performed in 13 patients. Bone marrow microemboli were seen in the lungs of 11 of 13 patients in whom an autopsy was performed and methylmethacrylate particles were seen in the lungs of three of 13 patients. These data suggest that elderly patients with preexisting cardiovascular conditions undergoing cemented arthroplasty, especially for fracture diagnosis, are at increased risk for intraoperative death compared with patients undergoing elective hip arthroplasty. In the latter years of the current study, modifications of the operative techniques designed to minimize intramedullary hypertension were associated with a reduction greater than three-fold in overall intraoperative mortality rate. These changes in surgical technique should be considered when cement fixation is used in patients thought to be at risk for having cardiopulmonary disturbances develop from venous embolization of marrow contents.

Age Distribution↗
PubMed2001

Instability in primary total hip arthroplasty with the direct lateral approach.

Instability after a total hip arthroplasty is a serious complication. Dislocation rates as much as 6.5% after posterior approaches have been reported within the past decade. For this reason, the authors use the direct lateral approach for primary and revision total hip arthroplasties. A review of the arthroplasty database yielded 1515 primary total hip arthroplasties done via a direct lateral approach in 1333 patients. These arthroplasties were done within a 10-year period and patients with followup data less than 12 months were excluded. At the most recent examination, 11.6% of the patients had a moderate or severe limp and 2.5% had severe heterotopic ossification. Only six hips (0.4%) had a dislocation or episode of instability. Three patients had more than one dislocation and required revision surgery. The results of the current study show that dislocation after primary total hip arthroplasty almost can be eliminated using the direct lateral approach. The associated risks of heterotopic ossification or limp are acceptable.

Aged↗
PubMed2002

Patellar component resection arthroplasty for the severely compromised patella.

When severe bone loss precludes reimplantation of a new patellar component during revision knee arthroplasty, the treatment options include patellar bone grafting, patellar component resection arthroplasty, and patellectomy. The purpose of this study was to evaluate the clinical and functional results of patellar component resection arthroplasty for the severely compromised patella for which insertion of another patellar component was not possible. Thirty-five knees (31 patients) were treated with patellar component resection arthroplasty for aseptic patellar component failure associated with severely compromised patellar bone stock. Followup averaged 7.9 years (range, 2-18 years). There was a significant improvement in Knee Society pain and function scores. Pain relief was more dramatic than functional improvement. The range of motion also improved significantly and in particular preoperative extensor lag was resolved in the majority of patients. Patients treated with isolated patellar resection arthroplasty were more likely to have continuing pain and require reoperation compared with patients who had concomitant revision of the tibial and femoral components. Correct positioning and the stability of tibial and femoral components should be tested carefully at the time of patellar resection arthroplasty and considered for revision if malpositioned either axially or rotationally.

Adult↗
PubMed2002

Joint proprioception before and after total knee arthroplasty.

To investigate the effects of total knee arthroplasty on joint proprioception, the absolute angular error of the knee in 38 consecutive patients before and after total knee arthroplasty for osteoarthritis and in 23 age-matched control subjects were examined. Varus and valgus laxity of the knee and muscle strengths of the thigh were measured using appropriate instruments. There were no significant differences in absolute angular error before and after total knee arthroplasty, independent of retaining or substituting the posterior cruciate ligament. The absolute angular error of the knee with a normal appearing anterior cruciate ligament was larger than that with a missing anterior cruciate ligament before total knee arthroplasty and decreased significantly after surgery. The absolute angular error correlated with the varus and valgus laxity of the knee, but did not correlate with the strength of thigh muscles after total knee arthroplasty. These results suggest that deficiency of the anterior cruciate ligament may not adversely affect proprioception in severe knee osteoarthritis. In addition, proper ligament balance may partly contribute to better proprioception after total knee arthroplasty.

Aged↗
PubMed2002

Results of direct exchange or debridement of the infected total knee arthroplasty.

In this literature review, 30 reports provided outcome data on 37 direct exchange arthroplasties, 530 open debridements, and 23 arthroscopic debridements. The average followup was approximately 4 years, but the range was broad (range, 0.02-14 years). Infection was controlled in 33 of the 37 infected total knee arthroplasties (89.2%) treated by direct exchange arthroplasty, in only 173 of the 530 infected total knee arthroplasties (32.6%) treated by open debridement and retention of the prosthetic components, and in 12 of the 23 infected total knee arthroplasties (52.2%) treated by arthroscopic debridement. There was wide variability in associated antibiotic therapy. Factors associated with successful direct exchange included infections by gram-positive organisms, absence of sinus formation, use of antibiotic-impregnated bone cement for the new prosthesis, and 12 weeks of antibiotic therapy. Direct exchange arthroplasty failed in four of 37 knees; two were in patients with rheumatoid arthritis who were taking corticosteroids. Factors associated with successful debridements included those done within 4 months of the index procedure, or in patients with less than 4 weeks of symptoms, antibiotic sensitive gram-positive organisms, well-fixed components with no radiologic evidence of osteitis, and in young healthy patients. Factors associated with the failed debridements included postoperative drainage for more than 2 weeks, sinus tracts present at the time of the debridement, a hinged prosthesis, and an immunocompromised host. Direct exchange can be successful with a sensitive organism in a healthy host with prolonged antibiotic therapy. Debridement can be successful in early infections in a healthy host.

Anti-Bacterial Agents↗
PubMed2002

Stability of total hip arthroplasty in patients 75 years or older.

Increasing patient age (> 75 years) is a known risk factor for dislocation of total hip arthroplasty. This is a study of total hip arthroplasties by one surgeon in patients 75 years or older to determine the prevalence of dislocation and a review of the surgical options for prevention and treatment of instability in this population. Of 140 primary total hip arthroplasties done in patients 75 years or older who were followed up for at least 1 year, the preoperative diagnosis was osteoarthritis in 82% and the mean followup time was 4 years. The acetabular component was cementless: modular in 121 arthroplasties and cemented in 19 arthroplasties. There were five dislocations (3.5%), but only two were recurrent and the patients were treated successfully by modular component exchange. Bipolar arthroplasty has a lower rate of dislocation, but there are problems with residual pain and high rates of reoperation, wear, and osteolysis. Constrained components may be indicated in older patients with dementia, abductor insufficiency, or failure of modular exchange. Large femoral heads, to increase the range of motion before dislocation occurs, may be used with highly cross-linked acetabular liners. Modular cementless acetabular components are preferable in patients who are 75 years or older. A 28-mm or 32-mm femoral head is recommended, but larger femoral heads should be considered in patients with fractures and for the treatment of recurrent dislocation.

Aged↗
PubMed2004

Long-term survivorship of hip shelf arthroplasty and Chiari osteotomy in adults.

The current authors retrospectively assessed 56 hip shelf arthroplasties (48 patients) with a mean followup of 17 years (range, 15-30 years) and 89 Chiari osteotomies (82 patients) with a mean followup of 13 years (range, 6-25 years) done in adults with painful hip dysplasia. Preoperative joint space narrowing was observed in 32 of 56 shelf arthroplasties and in 67 of 89 Chiari osteotomies. Survival rates, using hip replacement as the end point, were 37% (20% to 54%) at 20 years for shelf arthroplasty and 68% (54% to 81%) at 18 years for Chiari osteotomy. The severity of preoperative arthrosis was the main factor that impaired the survivorship of shelf arthroplasty and Chiari osteotomy. With arthritic changes without joint space narrowing, the 18-year survival rates were 83% (69% to 97%) for shelf arthroplasty and 94% (89% to 99%) for Chiari osteotomy. Shelf arthroplasty is best indicated for moderate dysplasia (center edge angle >0 degrees) without severe arthrosis. Chiari osteotomy is best suited for severe dysplasia (center edge angle <0 degrees) especially without or with slight arthrosis. Chiari osteotomy also can be a salvage procedure when marked joint space narrowing is present but only if it is related to severe dysplasia (center edge angle <0 degrees).

Adolescent↗