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PubMed2004

The future in the care of the cervical spine: interbody fusion and arthroplasty. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion. Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty. In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

Arthroplasty, Replacement↗
PubMedDate not supplied

Single-stage bilateral total hip arthroplasty.

The number of single-stage bilateral total hip arthroplasties done each year is increasing. The risk of postoperative complications in medically stable patients is acceptable; complications are approximately 1.3 times more frequent than with unilateral total hip arthroplasty. Although there are no absolute indications for a single-stage bilateral total hip arthroplasty, the procedure is usually contraindicated in patients with such comorbidities as heart disease, pulmonary insufficiency, or diabetes, and it is absolutely contraindicated in patients with a documented patent ductus arteriosus or septal defect. The primary postoperative concern is that the cardiopulmonary insult associated with two surgical wounds and surgeries can lead to an increase in thromboembolic events. The cost for single-stage bilateral total arthroplasty is less than that for a two-stage bilateral total hip arthroplasty, with savings predominantly due to reduced length of acute hospital stay. However, the decision to undergo single-stage bilateral total hip arthroplasty is one that must be made in concert with the patient.

Arthroplasty, Replacement, Hip↗
PubMed1999

[Arthroplasty with a mobile cup for shoulder arthrosis with irreparable rotator cuff rupture: preliminary results and cineradiographic study].

PURPOSE OF THE STUDY: Management of patients with massive irreparable rotator cuff tears associated with severe glenohumeral joint degeneration presents a difficult clinical challenge. The present study reports on 24 patients with disabling shoulder pain due to rotator cuff arthropathy treated using a bipolar arthroplasty. MATERIAL AND METHODS: Between 1995 and 1997, a bipolar shoulder arthroplasty (Biomet, Warsaw, In) was used in 24 patients (25 shoulders) with rotator cuff arthropathy. Patients were monitored for an average of 14.5 months (range 12 to 24 months). The coracoacromial ligament was maintained in all patients to provide anterosuperior stability. The rotator cuff was irreparable and no attempt was made to cover the superior defect. Postoperative results were reviewed with the Constant score and the Swanson score. In order to verify the head-shell motion and to analyze the dynamic comportement of bipolar arthroplasties, we recorded anterior active elevation and active rotations with video-fluoroscopy. RESULTS: At final the follow-up, 21 shoulders had no or slight pain. Average active flexion improved to 84.8 degrees after operation from 62.4 degrees beforehand. 13 patients achieved more than 90 degrees of active flexion after operation. Active external rotation improved from a mean 3 to 28.8 degrees. Before surgery the average Constant score was 17.62. Postoperatively, the average Constant score was 46.97 and the average Swanson score was 23.13. Complications requiring reoperation occurred in 2 cases: 1 component dislocation (Head-shell), 1 subluxation of the long head of the biceps. Radiographic evaluation at follow up demonstrated no humeral stem loosening or component migration and no bony erosion of the coracoacromial arch. Rupture of the infraspinatus tendon (absolute Constant score: p = 0.04, adjusted Constant score: p = 0.02, Swanson score: p = 0.03, Functional score: p = 0.04), preoperative anterior subluxation of the humeral head (absolute Constant score: p = 0.03, adjusted Constant score: p = 0.05, anterior elevation: p = 0.01, functional score: p = 0.04), preoperative narrowing of the acromio-humeral interval (adjusted Constant score: p = 0.02, overall mobility: p = 0.02, anterior elevation: p = 0.03) may jeopardize the subsequent success of bipolar shoulder arthroplasty. The results of this study suggest that the radius curvature of the shell must match that of the bony surface of the glenoid and the coracoacromial arch (absolute Constant score: p = 0.003, adjusted Constant score: p = 0.005, overall mobility: p = 0.002, anterior elevation: p = 0.0008, functional score: p = 0.002). Recording of anterior active elevation with video-fluoroscopy allowed to identify 3 different types of movements after bipolar shoulder arthroplasty. Recording of internal and external rotation allowed to distinguish 2 differents types of movements. Motion appeared to occur between the bipolar shell and the head. The amount of motion was variable and depended on the biomechanics. DISCUSSION AND CONCLUSION: Bipolar shoulder arthroplasty is an effective surgical option for patients with massive irreparable tears of the rotator cuff with concomitant glenohumeral arthritis. Satisfactory pain relief and modest gains in motion result in significant functional improvement in this "low functional demand" population. Predictive factors have been identified and should be discussed before surgery.

Activities of Daily Living↗
PubMed2000

Total ankle arthroplasty: indications, results, and biomechanical rationale.

Total ankle replacement was developed in the 1970s after the success of total hip and knee arthroplasty. The goal of total ankle arthroplasty is to decrease pain and improve function in the lower limb. Ideally, to be superior to an arthrodesis, the ankle replacement should provide the patient with good patterns of joint motion and the ability to walk and run and should have low complication rates. Unfortunately, total ankle arthroplasty has not been as successful as replacement of other joints. Published studies of early series with greater follow-up show that ankle arthroplasties did not provide lasting pain relief or improve function, and most ultimately failed. During the 1980s, many authors concluded that a total ankle arthroplasty was not warranted because of the generally poor long-term results and the high rate of complications. However, newer second-generation design techniques, innovative operative procedures, and dissatisfaction with the results of ankle arthrodesis have renewed interest in total ankle arthroplasties. This review describes the numerous types of ankle joint replacements, critically reviews the results, and reports on newer prostheses that incorporate more anatomic designs.

Ankle Joint↗
PubMed2001

Role of knee aspiration after resection of the infected total knee arthroplasty.

Recognizing persistent infection after resection arthroplasty and implantation of cement spacers in the infected total knee arthroplasty is often difficult. The purpose of this study was to determine whether aspiration of the knee after resection arthroplasty is valuable for determining the presence of ongoing infection. Thirty-four previously infected knees that were aspirated and cultured after resection arthroplasty, implantation of cement spacers, and intravenous antibiotics for an average of 6.3 weeks were identified. There were 8 cases of persistent infection-none identified on preoperative aspiration. Two preoperative cultures were false positive for Staphylococcus epidermidis. Preoperative cultures were negative in 32 knees, with 8 false-negative results. The antibiotic-free interval among all cases averaged 20 days; the cases with false-negative results from aspiration had an antibiotic-free interval averaging 11.5 days, compared with an average of 26 days among all other cases. Aspiration of knees after resection arthroplasty had sensitivity of 0%, positive predictive value of 0%, and accuracy of 71%. Specificity was 92%, and negative predictive value was 75%. A negative result from joint aspiration after resection arthroplasty does not necessarily rule out the presence of ongoing infection. False-negative results may be observed if joint aspiration is not delayed more than 2 to 3 weeks.

Aged↗
PubMed2001

Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid.

BACKGROUND: The marked loss of glenoid bone volume or alteration of glenoid version can affect glenoid component fixation in patients undergoing total shoulder arthroplasty. The purpose of this study was to evaluate the long-term results associated with the use of bone-grafting for restoration of glenoid volume and version at the time of total shoulder arthroplasty. METHODS: Twenty-one shoulders received an internally fixed, corticocancellous bone graft for the restoration of peripheral glenoid bone stock at the time of total shoulder arthroplasty between 1980 and 1989. Grafting was indicated when glenoid bone stock was insufficient to maintain adequate version or fixation of the prosthesis. Seventeen shoulders were available for follow-up; the average duration of follow-up for the thirteen shoulders that did not have prosthetic failure within the first two years was seventy months. Total shoulder arthroplasty was performed because of osteoarthritis in five shoulders, chronic anterior fracture-dislocation in five, capsulorrhaphy arthropathy in three, inflammatory arthritis in two, recurrent dislocation in one, and failure of a previous arthroplasty in one. All patients had some form of anterior or posterior instability preoperatively. There were five anterior and twelve posterior glenoid defects. Bone from the resected humeral head was used for grafting in fifteen shoulders, and bicortical iliac-crest bone was used in two. RESULTS: The average glenoid version after grafting was 4 degrees of retroversion, with an average correction of 33 degrees. The graft failed to maintain the original correction in three shoulders due to nonunion, dissolution, or shift. Five total shoulder replacements failed, necessitating glenoid revision at two to ninety-one months postoperatively. The failures were associated with recurrent massive cuff tears (one shoulder), persistent instability (two shoulders), improper component placement (one shoulder), and loss of graft fixation (one shoulder). There were no humeral component failures. According to the criteria of Neer et al., the functional result was rated as excellent in three shoulders, satisfactory in six, and unsatisfactory in eight. CONCLUSIONS: Despite the finding that eight shoulders had an unsatisfactory functional result at the time of longterm follow-up, corticocancellous grafting of the glenoid successfully restored glenoid version and volume in fourteen of the seventeen shoulders in the present study. Patients with glenoid deficiency often have associated glenohumeral instability, which may affect the results of total shoulder arthroplasty. Bone-grafting of the glenoid is a technically demanding procedure that can restore bone stock in patients with structural defects.

Adult↗
PubMed2001

[Iliopsoas impingement in 12 patients with a total hip arthroplasty].

PURPOSE OF THE STUDY: We report 12 cases of iliopsoas impingement, an under-recognized cause of hip pain in total hip arthroplasty patients. MATERIAL AND METHODS: Between January 1998 and October 2000, we diagnosed 12 cases of iliopsoas impingement among 280 total hip arthroplasty patients with hip pain (4.3%). Our population was composed of 9 women and 3 men aged 62 to 80 years (mean 72 years). Nine patients had a first intention arthroplasty and 3 had a revision prosthesis. Delay from implantation to diagnosis of impingement ranged from 6 months to 5 years. Common cases of pain after hip arthroplasty, infection, loosening, were ruled out in all cases. A standard x-ray series including an AP view of the pelvis, an AP view of the hip and a surgical false-lateral view of the hip as well as a CT scan were obtained when iliopsoas impingement was suspected. The CT series extended from the lower part of the acetabulum through the fixation screws. RESULTS: Pain had been observed immediately after implantation in 10 cases (83%) and in 2 cases (17%) 3 to 5 years later. These patients did not have to use crutches when pain started to develop. Pain projected anteriorly and was always exaggerated when moving from the sitting position to the upright position and when going up stairs. In one patient, palpation revealed a mass in the groin that corresponded to a massive iliopsoas bursitis. Two non-pathognomonic physical signs were found in all cases: groin pain induced by active flexion against force in the lateral reclining position and at hip extension, and pain in the dorsal reclining position at deflexion of the hip, starting at 45 degrees. The standard AP views showed evidence of defective anteversion of 4 press fit cups, 1 off-centered screwed cup and 3 oversized cups. The CT scan demonstrated that the impingement involved the anterior border of the cup applied against the iliopsoas tendon in 8 cases either due to anterior uncovering in a dysplasic hip or anterior cup overhang. In 4 cases the cup fixation screws protruded anteriorly in front of the ilion and came in contact with the posterior aspect of the iliopsoas muscle. A bursitis had developed in 50% of the cases. DISCUSSION: When infection and loosening have been ruled out, hip pain after total hip arthroplasty would suggest a possible impingement of the acetebular component on the iliopsoas muscle due to defective anteversion or centering, the use of oversized cups, and/or the use of fixation screws. We emphasize the importance of a correct position for the cup to avoid an overhanging anterior border and discuss the use of screwed cups for primary total hip arthroplasty and of oversized cups for revision procedures.

Aged↗
PubMed2002

[Outcome after total hip arthroplasty performed for rapidly progressive hip destruction].

PURPOSE OF THE STUDY: Rapidly progressive destruction of the hip joint occurs in approximately 5 to 10% of patients with degenerative hip disease. The cause and natural history remain unclear, but total hip arthroplasty is almost always necessary. We performed a retrospective analysis to determine the particular clinical and radiological features of this condition and to assess long-term outcome after total hip arthroplasty. MATERIAL AND METHODS: One hundred total hip arthroplasties were performed between 1984 and 1988 in patients with rapidly progressive hip destruction (67 women and 11 men, mean age 71 years). The transtorchanteric approach was used in all cases to implant cemented Charnley-Kerboull prostheses. Mean follow-up was 7 years 10 months. RESULTS: There were seven complications: two nonunions of the trochanter, three extensive periprosthetic ossifications, one case of recurrent dislocation, and one late hematogenous infection. At last follow-up, the Merle d'Aubigné classification showed an excellent or very good functional result in 95 hips. Stable fixation was observed for 94 acetabular implants and 97 femoral implants. Six acetabular implants showed signs of loosening: certain=1, probable=4, potential=1. Three femoral implants showed signs of loosening: certain=1, potential=2. All the femoral loosenings were associated with acetabular loosening. Four hips required revision surgery: one for nonunion of the trochanter, one for septic loosening, two for aseptic loosening. DISCUSSION: This series confirmed the radiological and clinical definitions of rapidly progressive hip destruction and demonstrated the reliability of pathological examination of the femoral head and joint capsule. Among the different hypotheses put forward to explain this condition, neither overloading nor use of antiinflammatory drugs would appear to be operating in this series. We were unable to confirm or infirm the micro-crystalline or vascular origin of this condition. Nevertheless, the vascular phenomena observed in the femoral head could be compared with those observed in ischemic joint disease. Arthroplasty led to major blood loss (2706 ml, hematocrit 35). This appears to be higher than observed for arthroplasty performed with the same technique in patients with the usual form of degenerative hip disease. Excepting this fact, the complications observed and the clinical results as well as the longevity of these implants suggest that arthroplasties performed for rapidly degenerative hips are not substantially different from those performed for common degenerative hip disease.

Aged↗
PubMed2003

Instability after shoulder arthroplasty: results of surgical treatment.

BACKGROUND: Currently, there is little available information regarding the surgical treatment of instability following shoulder arthroplasty. The purpose of the present study was to review the results of revision surgery performed for the treatment of instability after shoulder arthroplasty to better define the causes of instability and the risk factors for an unsatisfactory outcome. METHODS: Between 1985 and 1999, thirty-three shoulders (seven of which had had a hemiarthroplasty and twenty-six of which had had a total shoulder arthroplasty) were treated surgically at our institution for anterior instability (nineteen shoulders) or posterior instability (fourteen shoulders). The primary arthroplasty had been performed for the treatment of degenerative arthritis in sixteen shoulders, arthritis of dislocation in six, acute fracture in four, rheumatoid arthritis in three, and other conditions in four. RESULTS: The instability was attributed to abnormal capsular tension and/or rotator cuff dysfunction in twenty-one shoulders, component malpositioning in one shoulder, and a combination of both in eleven shoulders. One shoulder was treated with removal of the components. In the remaining thirty-two shoulders, each of the elements that was contributing to the instability was specifically addressed at the time of surgery. Revision surgery restored stability in nine of the thirty-two shoulders. Anterior instability was associated with a higher failure rate than posterior instability was (p = 0.04). Although eleven shoulders had additional surgery for the treatment of recurrent instability, only fourteen of the thirty-three shoulders were stable at the time of the final follow-up. According to the Neer rating system, there were four excellent, six satisfactory, and twenty-three unsatisfactory results. CONCLUSIONS: Soft-tissue imbalance is present in most cases of instability following shoulder arthroplasty, and component malpositioning plays an additional role in some cases. More than one-half of the shoulders in the present study remained unstable despite attempts at revision. Surgical treatment of instability following arthroplasty is associated with only a modest success rate.

Adult↗
PubMed2003

[GUEPAR I total elbow arthroplasty in rheumatoid arthritis: 19 implants followed an average of 67 months].

INTRODUCTION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant used since 1985. Only one multicenter study has reported the mid-term results of this implant in rheumatoid arthritis. We presented a monocentric retrospective study evaluating the results of 19 GUEPAR I total elbow arthroplasty in rheumatoid arthritis with a mean follow-up of 67 months. MATERIALS AND METHODS: Between 1988 and 1996, 19 GUEPAR I total elbow arthroplasties have been performed on 16 patients (3 bilateral). There were 15 women and one man, averaged age 58 years. Radiographically, the elbow was classified as stage IIIA in 8 cases, and stage IIIB in 11 cases, according to the Mayo Clinic classification. A triceps splitting approach with tendon reflection was performed in all cases. A postoperative immobilization at 45 degrees extension was used for all patients during 21 days averaged, and active mobilization was then started. RESULTS: At 67 months averaged follow-up (range, 2 to 12 years) the Mayo Elbow score improved from 36 to 75 points. The overall results were considered as excellent for 8, good for 5, fair for 2, and poor for 4. Nine elbows were totally painfree and six had minimum pain. Postoperative arc of motion reached 36 to 126 degrees in extension-flexion and 147 degrees in rotation. Eleven out of 19 elbows had a normal functional score. Two elbows dislocated and two others had a valgus instability lower than 10 degrees. There were thirteen complications affecting 11 of the 19 elbows (68%), and six of these eleven elbows had a revision procedure (31%): 3 peroperative medial column fractures, one postoperative medial column fracture which has been fixed, two elbow dislocated with one ulnar component revision, and 3 loosed implants which has been revised. There were persistent ulnar paresthesiae in two cases with a secondary neurolysis performed in one. Finally two infections developed 6 years after the initial procedure, one superficial, and one deep, which lead to removal of the total elbow arthroplasty. DISCUSSION-CONCLUSION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant indicated essentially in rheumatoid arthritis. Without intrinsic stability this implant must be contraindicated in front of bone stock deficiency, or chronic instability of the elbow. In selected cases the GUEPAR I total elbow arthroplasty offers a painfree elbow with a functional range of motion.

Adolescent↗
PubMed2003

[Shoulder arthroplasty for osteoarthritis after prior surgery for anterior instability: a report of 27 cases].

PURPOSE OF THE STUDY: The purpose of this study was to analyze the natural history of shoulder osteoarthritis secondary to prior surgery for anterior instability, to evaluate clinical and radiological results of shoulder prosthesis, and to compare results with reports in the literature. MATERIAL AND METHODS: Twenty-seven shoulder prostheses (Aequalis) were implanted in patients with osteoarthritis of the shoulder after prior instability surgery. These shoulders were reviewed retrospectively at a mean follow-up of 46 months (range 24-48). Prior surgery had been performed with coracoid block in two-thirds of the shoulders and with soft-tissue procedures in one-third. Twenty-four shoulders had had one instability procedure, several procedures had been performed in three. The Constant score was used to assess clinical status preoperatively and at last follow-up. Male gender predominated (16/27), and mean age at first dislocation was 31.6 years (4 patients experienced their first dislocation after the age of 60 years). The patients had a mean 18.2 dislocations. The natural history of osteoarthritis was long: 24.2 years on the average. Mean age at arthroplasty was 55.8 years. The preoperative images demonstrated an iatrogenic factor in 5 shoulders and constructive osteoarthitis in 24. Posterior glenoid wear was observed in 24% of the cases, fatty degeneration of the subscapularis in 45% and full-thickness tears of the supraspinatus in 4 cases. The anterior scar tissue was released and implants were positioned anatomically in 26 cases. Total arthroplasty was used for 21 shoulders and a humeral prosthesis for 6. RESULTS: There were five complications including three anterior prosthetic instability, all three in patients who were over 60 years of age at their first instability surgery (one of these three patients required revision arthroplasty). Outcome was good or excellent in 56% of the shoulder with a mean weighted Constant score of 83%: mean gain in pain score=8.3 points, in anterior elevation=51 degrees, in external rotation=33.5 degrees. The type of prior instability surgery and preoperative active external rotation had no determining effect on outcome. Factors correlated significantly with outcome were fatty degeneration of the rotator cuff muscles, particularly the subscapularis. DISCUSSION: Osteoarthritis of the shoulder has a long natural history, 26 years in our patients excepting those whose first dislocation occurred after the age of 60 years. Posterior glenoid wear, described by others, was only found in 24% of the shoulders in this series. Surgical dissection and release of anterior scar tissue was difficult. The overall results of arthroplasty were good and were correlated with fatty degeneration of the rotator cuff muscles, particularly the subscapularis, but not with the type of instability surgery. These results were less satisfactory than reported in series of arthroplasty for primary centred osteoarthritis: complications occurred in 18% of the shoulders with three cases of anterior dislocation. Unlike reports of arthroplasty after instability surgery where many of the patients had several operations, overall results in our series were not compromised by a large number of multiple interventions.

Adolescent↗
PubMed2004

Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study.

BACKGROUND: Following the reintroduction of metal-on-metal articulating surfaces for total hip arthroplasty in Europe in 1988, we developed a surface arthroplasty prosthetic system using a metal-on-metal articulation. The present study describes the clinical and radiographic results of the first 400 hips treated with metal-on-metal hybrid surface arthroplasties at an average follow-up of three and a half years. METHODS: Between November 1996 and November 2000, 400 metal-on-metal hybrid surface arthroplasties were performed in 355 patients. All femoral head components were cemented, but only fifty-nine of the short metaphyseal stems were cemented. The patients had an average age of forty-eight years, 73% were men, and 66% had a diagnosis of osteoarthritis. Clinical and radiographic follow-up were performed at three months postoperatively and yearly thereafter. RESULTS: The majority of the patients returned to a high level of activity, including sports, and 54% had activity scores of >7 on the University of California at Los Angeles activity assessment system. Kaplan-Meier survivorship curves demonstrated that the rate of survival of the components at four years was 94.4%. For patients with a surface arthroplasty risk index score of >3, the rate of survival of the components at four years was 89% compared with a rate of 97% for those with a score of </=3. The patients with a higher risk index were 4.2 times more likely to undergo revision to a total hip replacement at four years. Twelve hips (3%) had a revision to a total hip replacement. Seven of the twelve hips were revised because of loosening of the femoral component, and three were revised because of a femoral neck fracture. Substantial radiolucencies were seen around sixteen uncemented metaphyseal femoral stems. No femoral radiolucencies were observed among the hips in which the metaphyseal stem was cemented. The most important risk factors for femoral component loosening and substantial stem radiolucencies were large femoral head cysts (p = 0.029), patient height (p = 0.032), female gender (p = 0.005), and smaller component size in male patients (p = 0.005). CONCLUSIONS: The preliminary experience with this hybrid metal-on-metal bearing is encouraging. Optimal femoral bone preparation and component fixation are critical to improving durability. The metal-on-metal hybrid surface arthroplasty is easily revised to a standard femoral component if necessary. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2004

[Results of Menon's arthroplasty in basal joint osteoarthritis].

PURPOSE OF THE STUDY: Osteoarthritis of the basal joints is a frequent degenerative disease. The wide range of arthritic lesions of the first carpal metacarpal joint should be treated by targeted surgical techniques. These methods, including arthroplasty, arthrodesis and alloplasty, for use in relevant indications are available in the Department of Orthopedics at the Medical Faculty Teaching Hospital in Hradec Králové. In this study, the results of Menon's arthroplasty modified by the authors are evaluated. MATERIAL AND METHODS: The interpositional arthroplasty, first used and published by Menon in 1955, was introduced in January 2002 by the authors in the treatment of arthritic lesions, classified as stage III disease by the Eaton radiological rating system, in middle-aged, manually working women. The procedure consists of resection of the trapezium articular surface affected by osteoarthritis, tendon interposition, and the reconstruction of the articular capsule soft tissues using tenodesis of the abductor pollicis muscle tendons. Sixteen female patients were treated by our modified technique. The post-operative outcome of arthroplasty was evaluated by comparison of both hands' efficiency, with the use of the Cooney score system. RESULTS: At 2 years of follow-up, in 14 treated hands there was pain relief, improved mobility and an increase in grip strength; excellent and very good outcomes, as evaluated by the Cooney score, were achieved in 80% of the operated hands. In one patient, conversion of Menon's arthroplasty to an alloplasty with a Rubena prosthesis had to be carried out due to persistent complaints. DISCUSSION: The authors evaluate the surgical procedure used and present the reasons for their modification of the Menon's technique with the use of the long palmar muscle tendon. The choice of operative techniques for specific indications, as available in the authors' department, is discussed. The outcomes reported in this study are compared with the results published in the foreign literature. Complications and risks of this treatment are mentioned. The advantage of a partial over a total trapeziectomy is emphasized. CONCLUSIONS: The early outcomes of Menon's arthroplasty, which was indicated in manually working, middle-age female patients with stage III basal-joint osteoarthritis, are satisfactory. This precisely indicated and correctly performed technique has so far fulfilled the authors' expectations.

Adult↗
PubMed2004

MIS unicondylar knee arthroplasty: surgical approach and early results.

Unicondylar arthroplasty of the knee has seen a resurgence of interest in the United States. The principles of unicondylar arthroplasty of the knee are different from those for total knee arthroplasty, allowing replacement of only the affected joint compartment with less bone loss. Minimally invasive surgery allows for less soft tissue dissection with the potential for less morbidity. The key question is: will the changes associated with the minimally invasive surgery procedure improve the clinical results of the standard unicondylar arthroplasty of the knee or will the changes make the procedure too difficult and lead to an increasing failure rate? This study reviews the surgical technique and presents the 2 to 4 year results of the minimally invasive unicondylar arthroplasty of the knee 47 knees in 41 patients. The average range of motion increased from 121 degrees -132 degrees . The Knee Society pain score improved from 45-80 and the function score improved from 47-78. Only one knee has been revised. With proper patient selection, minimally invasive unicondylar arthroplasty of the knee allows for results that are at least equal to those of the standard open procedure at 2 to 4 years after the surgery.

Adult↗
PubMed2005

The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures.

UNLABELLED: Patellofemoral arthroplasty is going through a recent resurgence in interest with various new designs being introduced for general orthopaedic use. With this renewed enthusiasm for the procedure, it is important to understand the various indications and contraindications for using patellofemoral arthroplasty devices with the expectation that proper patient selection will improve outcome. Our purpose was to analyze the appropriate usage of these prostheses based on published historical results. A literature search was done to review the indications, contraindications, and factors contributing to the failure of these devices. We analyzed 12 studies reporting results of patellofemoral arthroplasty between 1979 and 2005. Commonly cited contraindications for using these devices have been tibiofemoral arthritis, uncorrected patellofemoral or tibiofemoral malalignment, and inflammatory arthritis. The highest failure rates were in patients with progression of osteoarthritis in other compartments or persistence of congenital or surgically uncorrected malalignment. In analyzing the reasons for failures in these reports together with issues already known to affect total knee arthroplasty surgery, we suggest an expanded list of outcome-altering factors to consider when choosing to do a patellofemoral arthroplasty. Finally, based on these observations and our own experience, suggestions on the best approach to the patient with patellofemoral arthritis are made to avoid less than optimal results if patellofemoral arthroplasty is considered. LEVEL OF EVIDENCE: Prognostic Study, Level II-3 (systematic review of Level-II studies. See the Guidelines for Authors for a complete description of levels of evidence.

Arthroplasty, Replacement, Knee↗
PubMed2006

[Total hip arthroplasty for treatment of developmental dysplasia of the hip].

OBJECTIVE: To summarize the techniques of the total hip arthroplasty in the treatment of osteoarthritis secondary to developmental dysplasia of the hip joint (DDH). METHODS: Between February 1986 and November 2004, a total of 32 hips in 24 patients with advanced osteoarthritis secondary to DDH underwent the total hip arthroplasty. Among the patients, 4 were male and 20 were female, with their ages ranging from 33 to 59 years and an average age of 47 years. The bilateral arthroplasty was performed in 8 patients and the unilateral arthroplasty in 16 patients. The patients mainly suffered from pain and claudication. According to the Hartofilakidis classification, semidislocation occurred in 2 hips, low-dislocation in 21 hips, and high-dislocation in 9 hips; and the Harris scores before operation were 56.70 +/- 2.75, 36.09 +/- 4.16, and 29.45 +/- 2.16, respectively. RESULTS: All the patients were followed up for 6 months to 8 years (averaged 3 years and 4 months). The Harris scores after operation were 93.10 +/- 2.10, 92.7 +/- 3.20, and 88.09+/- 3.67, respectively. The differences between preoperation and postoperation were significant (P < 0.01). All the patients were pain-free and there was no sign of aseptic loosening and subsidence. CONCLUSION: The total hip arthroplasty is an effective method for the treatment of osteoarthritis secondary to DDH. The key techniques for the total hip arthroplasty are as follows: deepening the medial wall of the acetabulum, improving the techniques of the bone graft, and firmly placing the acetabular component in the true acetabulum.

Acetabulum↗
PubMed2006

[Dislocations hip arthroplasty].

The authors present analysis of dislocation following hip arthroplasty based on their own clinical material of 1985-2005 year. It contain 2712 cases of total hip arthroplasty, 2171 (80.1%) cases were cemented including 64 (2.4%) cases of revised arthroplasty, 541 (19.9%) cases were cement-free stabilized including 7 (0.2%) cases of revised arthroplasty. Obtained outcomes of analysis permit to make assertion that dislocation following hip arthroplasty occurred during first three month after surgery, more frequently in case of revised arthroplasty and following fractures of femoral neck. Requirement of success is appropriate steady of implant and right done supervision of rehabilitation with learned necessary motoric behaviors.

Arthroplasty, Replacement, Hip↗
PubMed2006

Revision knee arthroplasty.

Total knee arthroplasty (TKA) is a satisfactory procedure regarding functional outcome and pain relief. The ever increasing number of total knee arthroplasties and expanding indications have led to a high number of revisions. The principles of revision arthroplasty are to understand the cause of failure, adequate surgical exposure, restoration of limb alignment, achieving appropriate soft tissue balance, correct implant alignment, restoration of joint line and a good range of motion. The literature on revision TKA is diverse and is not conclusive in many aspects. The results of revision surgery are not as good as the primary TKA with main causes being increased polyethylene wear, aseptic loosening, malalignment of components, instability, extensor mechanism problems, infection and stiffness. Revision knee Arthroplasty is not a repeat primary Arthroplasty but it is a technically and economically demanding procedure and its successful performance requires thorough preoperative planning, adherence to the principles of revision knee arthroplasty, availability of diverse implant options and adequate bone graft.

Age Factors↗