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PubMed1997

Comparison of joint position sense after total knee arthroplasty.

A comparison of joint position sense, determined by reproducibility of index angles and their subsequent change, was performed in 55 knees that had undergoing a semiconstrained total knee arthroplasty. Knees were stratified into groups that represented arthroplasties performed with or without posterior cruciate ligament retention, with or without resurfacing of the patella, and with or without cement for fixation. There was no significant difference in joint position sense among all the arthroplasty groups. Likewise, there was no difference in joint position sense between any of the arthroplasty groups and an age-matched control group of 32 knees in 32 patients who had not previously undergoing a total knee arthroplasty. Knee arthroplasty does not affect joint position sense.

Aged↗
PubMed1996

Preliminary observations on possible premalignant changes in bone marrow adjacent to worn total hip arthroplasty implants.

Previous epidemiologic studies have suggested that there may be a risk of malignancy, especially lymphoma and leukemia, after joint replacement, but the followup has been relatively short. This is a preliminary study to see if there is any biologic basis for such a risk. Blood and bone marrow samples from 71 patients at revision arthroplasty of a loose or worn prosthesis and 30 control patients at primary arthroplasty were analyzed with cytogenetic techniques and molecular biology. There was a higher chromosomal aberration rate in cells adjacent to the prosthesis at revision surgery compared with iliac crest marrow from the same patients or with femoral bone marrow at primary arthroplasty. Clonal expansion of lymphocytes without a serum paraprotein was seen in 2 of 21 patients at revision arthroplasty performed more than 10 years after primary arthroplasty. The results of this preliminary study suggest that future epidemiologic studies should concentrate on patients with longer postoperative intervals to see if there is any risk that would be pertinent to a young patient at primary arthroplasty.

Aged↗
PubMed1981

Results of geometric arthroplasty for rheumatoid and osteoarthritis of the knee.

The Geometric Total Knee Arthroplasty was one of the earliest unconstrained knee arthroplasties available for the replacement of knees severely affected by destructive arthritis. This paper presents the results of Geometric knee arthroplasty performed by surgeons of the Alfred Hospital, Melbourne, during the years 1973 to 1977, this being the initial five years experience with this procedure. One hundred and fifty arthroplasty operations were performed in 106 patients, 78 for osteoarthritis and 72 for rheumatoid arthritis, with the average time from operation to review being four years. The Geometric arthroplasty was used in 147 of these operations. Assessment was based on a modification of the British Orthopaedic Association Knee Function Assessment Chart (1978) and 137 knees were available for review. Eighty nine percent of patients suffering osteoarthritis, and 79% of patients with rheumatoid arthritis were satisfied or enthusiastic with their prosthesis. Nineteen percent of rheumatoid patients and 4% of osteoarthritic patients considered the result of their operation disappointing. In both groups, the operated knee constituted minimal persisting disability to the patient when reviewed. Seventeen knees (11.3%) were assessed as unsatisfactory, of which 7 (4.6%) were due to infection, and 5 (3.3%) were due to loosening. Revision procedures were performed in 7 knees (5%), for instability or loosening. Improvements in arthroplasty design have resulted in alternative prostheses now being chosen by most surgeons for knee replacement, and the long term results of these newer prostheses must be evaluated with those results obtained using the original geometric prosthesis.

Arthritis, Rheumatoid↗
PubMed1996

Effect of preoperative donation of autologous blood on deep-vein thrombosis following total joint arthroplasty of the hip or knee.

The effect of preoperative donation of autologous blood on postoperative deep-vein thrombosis was retrospectively studied in men who had been managed consecutively with elective total joint replacement of the hip or knee because of osteoarthrosis. The patients had, on the average, two of nine considered risk factors for deep-vein thrombosis. Two hundred and thirty-seven patients were evaluated postoperatively with ascending venography, and they form the basis of this study. Fifty-four patients had venographic evidence of deep-vein thrombosis of the lower extremity, with most having asymptomatic clots distal to the knee. The prevalence of deep-vein thrombosis was nineteen (16 per cent) of 116 after total hip arthroplasty, compared with thirty-five (29 per cent) of 121 after total knee arthroplasty (chi square=4.6, p=0.03). Deep-vein thrombosis developed in twenty-eight (17 per cent) of the 161 patients who had donated blood preoperatively, compared with twenty-six (34 per cent) of the seventy-six patients who had not donated blood preoperatively (chi square=7.7, p=0.006). Through logistic regression analysis, the donation of autologous blood was shown to reduce significantly the development of postoperative deep-vein thrombosis for patients managed with total knee arthroplasty (p<0.01) but not for patients managed with total hip arthroplasty. Additional neural network analysis showed the donation of autologous blood to be the most important prognostic factor in predicting the absence of postoperative deep-vein thrombosis. In addition to diminishing the need for transfusion of homologous blood after total joint arthroplasty, preoperative donation of autologous blood appears to protect against postoperative deep-vein thrombosis after total knee arthroplasty.

Adult↗
PubMed2002

Patellar fracture after total knee arthroplasty.

BACKGROUND: Patellar fracture can occur as a complication following total knee arthroplasty. The purpose of this study was to evaluate a large series of patellar fractures to determine the results of different forms of treatment of specific fracture types. METHODS: A retrospective review identified eighty-five fractures (in seventy-seven patients) following 12,464 consecutive total knee arthroplasties performed between 1985 and 1998. Seventy-eight fractures occurred after primary total knee arthroplasty and seven, after revision total knee arthroplasty. Five fractures were treated elsewhere, and two others were lost to follow-up. The results of treatment of the remaining seventy-eight fractures were reviewed. Fractures were classified according to three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone stock. The mean duration of follow-up was 3.6 years. RESULTS: The prevalence of patellar fracture after total knee arthroplasty was 0.68%; fractures were significantly more prevalent among men (1.01%) than among women (0.40%) (p = 0.0004). Thirty-eight fractured patellae had a stable implant and an intact extensor mechanism (Type I). All but one were treated nonoperatively, and there was only one late failure of nonoperative treatment, which required operative intervention. Twelve fractures were associated with disruption of the extensor mechanism (Type II). Eleven were treated operatively; six knees had complications and five had a reoperation. Twenty-eight fractures occurred in association with a loose patellar component (Type III). Twenty were treated operatively; nine knees had complications, and four had a reoperation. CONCLUSIONS: Patellar fractures after total knee arthroplasty are infrequent. Treatment can be guided by three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone. Fractures associated with a stable implant and an intact extensor mechanism were usually treated successfully with nonoperative means, with minimal complications. When operative treatment was required, it was associated with a high rate of complications and reoperations.

Adult↗
PubMed2002

Shoulder arthroplasty for osteoarthritis secondary to glenoid dysplasia.

BACKGROUND: Between 1980 and 1997, six patients (seven shoulders) with glenoid dysplasia and osteoarthritis underwent shoulder arthroplasty at our institution because of moderate or severe shoulder pain. There were four hemiarthroplasties and three total shoulder arthroplasties. METHODS: All six patients (seven shoulders) were followed for a minimum of two years or until the time of revision surgery. The average duration of follow-up was 7.3 years (range, 1.3 to sixteen years). RESULTS: One shoulder treated with total shoulder arthroplasty underwent revision surgery because of infection and loosening of the glenoid component 5.8 years following the arthroplasty. Three shoulders treated with hemiarthroplasty underwent revision to total shoulder arthroplasty as a result of glenoid arthrosis at sixteen months, twenty months, and thirty-four months. In each of these shoulders, glenoid deficiency and cartilage loss were not addressed at the time of the original hemiarthroplasty. The one shoulder that did not undergo revision after hemiarthroplasty had a glenoid osteotomy performed at the time of the hemiarthroplasty. CONCLUSIONS: The data from this study suggest that glenoid deficiency and cartilage wear should be addressed in some way at the time of shoulder arthroplasty in patients with glenoid dysplasia.

Adult↗
PubMed1999

Poor survival of cementless Biomet total hip: a report on 1,047 hips from the Finnish Arthroplasty Register.

In Finland, almost 50% of all hip replacements done after 1989 have been inserted without cement. Biomet components have been the most commonly used implants in cementless arthroplasties. Between 1985 and 1997, 4,300 prostheses were implanted because of primary osteoarthrosis. 4 different acetabular component designs have been identified as Biomet implants (Mallory-Head, Romanus, T-TAP, Universal) and were used in 1,047 hips. The 9-year survival of all arthroplasties using Biomet cups was only 65 (95% CI 61-69)% while that of arthroplasties using T-TAP-cups was only 58 (52-65)%. In contrast, the 7.5-year survival of arthroplasties using Romanus cups was 85 (79-91)%. The 98 (96-99)% 5-year survival of arthroplasties with Mallory-Head cups should be interpreted cautiously, since similar results of arthroplasties using the Universal cup with the same type of liner decline sharply to 93 (88-98)% only 1 year later. The poor survival of Biomet cementless prostheses in our series seems to be related to the poor survival of the cup. This finding was common to all metal shell designs using Hexloc liners. We recommend that Biomet cups with Hexloc liners should not be used and patients who have had them inserted should undergo regular clinical and radiographic follow-ups.

Adult↗
PubMed1991

Revision total knee arthroplasty for failed unicompartmental replacement.

The results in nineteen patients (twenty-one knees) who had a failed unicompartmental knee replacement followed by a revision total knee arthroplasty were evaluated. There were twelve excellent, four good, one fair, and two poor results. The interval between the unicompartmental replacement and the revision total knee arthroplasty ranged from eight months to eight years. At the time of the revision, a major osseous defect was found in sixteen knees (76 per cent). The duration of follow-up after the revision ranged from two to ten years. At the most recent follow-up examination, radiographs revealed at least one radiolucent line in thirteen knees (62 per cent). The technical difficulties associated with the revision operation are evidence that unicondylar arthroplasty is not a conservative procedure that allows a total knee arthroplasty to be done easily later. The results also do not support the argument that a revision performed after failure of a unicondylar arthroplasty is less technically demanding than one performed after a failed primary total knee arthroplasty.

Aged↗
PubMed1989

Two-stage reconstruction of a total hip arthroplasty because of infection.

From 1969 to 1985, eighty-one patients (eighty-two hips) who had an infection after a previous total hip arthroplasty were treated with a resection arthroplasty, followed by delayed reconstruction in the form of a repeat total hip arthroplasty. For all of the reconstructions, the femoral and acetabular components were fixed to bone with cement that did not contain antibiotics. An average of 5.5 years (range, 2.0 to 13.6 years) after reimplantation, infection had recurred in eleven hips (13 per cent). The presence of retained cement at the time of the resection arthroplasty appeared to be associated with recurrent sepsis, as three of seven patients who had retained cement had a recurrent infection, compared with only eight (11 per cent) of seventy-five patients from whom the cement had been completely removed (p less than 0.01). The twenty-six patients (twenty-six hips) who had the reimplantation less than one year after the resection arthroplasty had seven recurrent infections (27 per cent), while the fifty-six patients who had reimplantation more than one year after the resection arthroplasty had only four recurrences (7 per cent) (p less than 0.001). Three of the seven patients in whom the infection was caused by gram-negative bacilli and group-D streptococcal organisms (which are considered highly virulent) and who received systemic antimicrobial therapy for less than twenty-eight days had a recurrence. In contrast, only one of the thirteen patients in whom the infection was caused by a virulent organism and who were treated for longer than twenty-eight days had a recurrence (p = 0.055). The two-stage reconstruction is an effective, safe technique even when the infection is caused by a virulent organism.

Adult↗
PubMed1989

Total knee arthroplasty for patients younger than 55 years.

There are few reports in the literature that deal with the results of total knee arthroplasty in the younger patient. The present study was undertaken to evaluate the results of total knee arthroplasty in patients under the age of 55 years. Ninety-three knee arthroplasties in 62 patients were performed between 1974 and 1982. The preoperative diagnosis was rheumatoid arthritis in 76 knees and osteoarthritis in 17 knees. The total condylar knee prosthesis was used in all knees. Defects in the tibial plateau were noted in 13 knees, and supplemental support was required. Ninety knees (17 with osteoarthritis and 73 with rheumatoid arthritis) were available for follow-up study at a mean of 6.1 years. The knee rating for the entire group was 87.1. The subgroup scores for the osteoarthritis and rheumatoid arthritis groups were also 87.1. Roentgenographic evaluation revealed a lucency rate of 30%. Two implants were found to have global radiolucencies and were considered loose. Survivorship analysis resulted in a cumulative survivorship rate of 96% at ten years for the entire group. These results are comparable to the long-term results of total knee arthroplasty in the older patient and better than the results of total hip arthroplasty in the younger patient. Total knee arthroplasty in the younger patient is a reliable and durable procedure but should be used with caution despite the excellent results reported here.

Arthritis, Rheumatoid↗
PubMed1988

Comparative analysis of ankle arthroplasty versus ankle arthrodesis.

In a retrospective study of 41 patients with total ankle arthroplasty (25 patients) and ankle arthrodesis (18 patients), the mean follow-up period was 3.8 years for total ankle arthroplasties and 3.3 for ankle arthrodeses. Sixteen of the 23 ankle arthroplasty patients, and 17 of the 18 arthrodesis patients had good or excellent results. Total ankle arthroplasty was successful in patients with rheumatoid arthritis, but not posttraumatic arthrosis. Total ankle arthroplasty is indicated in rheumatoid patients with severe ankle involvement who have not responded to medical management. It also may be used in the elderly or debilitated patients who will place minimal stress on the ankle. The elderly may not tolerate the prolonged immobilization or repeated operations that fusion may require. Total ankle arthroplasty should not be used in young patients with posttraumatic arthrosis.

Adult↗
PubMed1987

Total joint arthroplasty for steroid-induced osteonecrosis in cardiac transplant patients.

Ten cardiac transplant patients have had bilateral total hip or knee surgery for treatment of osteonecrosis secondary to corticosteroid immunosuppression. Nine had bilateral total hip arthroplasty and one had bilateral total knee arthroplasty for osteonecrosis of the tibial plateaus. The only immediate postoperative complication was in a single hip patient who had a nonfatal pulmonary embolism. Two patients died from cardiovascular causes; the remaining eight had excellent results from arthroplasty, with an average Harris hip rating of 95 at a mean follow-up period of 34 months. No patient had required revision surgery and radiographic follow-up examination has revealed no evidence of loosening of any of these cemented arthroplasties. One patient developed a late hematogeneous sepsis of one hip seven years after replacement from atypical mycobacterium three months following renal transplantation, which was done 11 years after cardiac transplantation. Total joint arthroplasty has resulted in excellent clinical and radiologic results in this patient population. Despite the increased risks of major surgery in these immunocompromised transplant recipients, total joint arthroplasty appears to be a safe and effective method of treatment of osteonecrosis of the hip.

Adrenal Cortex Hormones↗
PubMed1987

Arthroplasty of the ipsilateral shoulder and elbow in patients who have rheumatoid arthritis.

Over a ten-year period, arthroplasty of the ipsilateral shoulder and elbow was performed in thirty-five extremities of thirty-one patients who had advanced rheumatoid arthritis. The results of the procedures were retrospectively reviewed to determine the appropriate sequence of surgery and the functional results that were obtained. All patients were followed for a minimum of two years after the last arthroplasty. The elbow had been operated on first in twenty-one extremities and the shoulder had been operated on first in fourteen. The time-interval between arthroplasties was significantly longer (p less than 0.005) when the elbow had been operated on first (forty-five compared with 13.4 months). All motion of the elbow and elevation and external rotation of the shoulder improved significantly (p less than 0.005), similar to the improvement in motion that is noted when either joint is operated on alone. Also, there was a highly significant reduction in pain and improvement in function (both, p less than 0.001). Review of the roentgenograms of twenty-three patients demonstrated no humeral fractures or interference in the proper placement of the humeral component of the prosthesis either by the stem of the other prosthesis or by the methylmethacrylate. All of the arthroplasties of the shoulder that were performed as the second arthroplasty were done at least five months after the arthroplasty of the elbow, and no dislocations or subluxations of the components of the elbow prosthesis occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Arthrodesis for failed arthroplasty of the hip.

The results of Girdlestone arthroplasty after failure of total hip arthroplasty have been found to be functionally poor in the physiologically young patient. The authors have evaluated 14 patients who were treated by hip arthrodesis following repeated failed arthroplasty. The average number of previous procedures was 2.6. Seven were infected prior to arthrodesis. A modified A.O. technique was used in all cases and was followed by hip spica immobilization. The average age of the patients was 38 years. All but one were men. Thirteen of the patients healed their arthrodesis primarily. Pain relief was excellent and most patients were able to return to their original jobs, in contrast to the results in patients with Girdlestone arthroplasty. Osteotomy or arthrodesis is preferred to total hip arthroplasty in the young, active patient with unilateral osteoarthritis. Arthrodesis is also possible and has a high rate of functional success after failed arthroplasty, infected or noninfected.

Acetabulum↗
PubMed1982

Alternatives to arthrodesis for the failed total knee arthroplasty.

Surgical options for the failed total knee arthroplasty include resection arthroplasty, arthrodesis, and total knee revision. Resection arthroplasty has not been a satisfactory alternative for revision of the failed total knee in a rheumatoid patient population. The arthrodesis experience has been associated with a high incidence of pseudarthrosis (30%), significant shortening, a high complication rate, and poor functional results. Sixty-five failed noninfected total knee arthroplasties were revised to metal-to-plastic total knee arthroplasty. The most common mechanism of failure was loosening (57%). The average follow-up period following revision was 33 months (range, 24-60 months). Fifty-three of the knees were improved at last follow-up examination, compared with the prerevision score. The average postoperative score in the revision series was 80 points. Eight knees have required further surgery. Total knee revision of the failed noninfected total knee arthroplasty is a successful and preferable alternative to knee arthrodesis. Knee revision surgery is technically demanding and requires the availability of multiple components of varying constraint, including custom-made components.

Adult↗
PubMed1982

Revision of aseptic loose total hip arthroplasties.

Sixty-six patients were revised for aseptic loosening of their conventional hip arthroplasties; follow-up periods ranged from one to nine years. In comparing them with an overall conventional arthroplasty series, there was a higher failure rate with dysplasia and post-traumatic patients, and a lower incidence in osteoarthritic and rheumatoid patients. The average time to revision was four years. The patients were eight years younger than those in the overall UCLA conventional hip arthroplasty series. Forty-two per cent had undergone hip surgery prior to the original hip arthroplasty that failed. The average improvement, as well as the follow-up pain, walking, and function ratings, and the postoperative flexion arc were less than those in the overall conventional arthroplasty series. The quality of femoral and acetabular fixation obtained at revision was considerably inferior to that of the primary surgery. Six patients (9%) have already required re-revision of their hip arthroplasties. In a further 20%, the radiolucencies progressed substantially in extent and width, and are radiographically loose. Although these patients are relatively asymptomatic, prognosis is guarded. Forty-four per cent had no complications and are radiographically well fixed. Other complications included trochanteric migration (7.6%), dislocation (10.6%), and peroneal nerve palsy (7.6%), but there were no deaths or other serious medical complications and only one case (1.5%) of sepsis.

Acetabulum↗
PubMed1982

Surface replacement hip arthroplasty: results of the first seventy-four consecutive cases at the University of California, San Francisco.

Although surface replacement hip arthroplasty has been viewed by some as a conservative alternative to conventional total hip arthroplasty, the surgical technique requires substantially more acetabular bone loss. To evaluate the efficacy of this operation, a retrospective study of 74 consecutive cases of surface replacement hip arthroplasty done at the University of California, San Francisco between February 1977 and June 1980 is reported and concludes that (1) there was no noteworthy difference in end result between cases using the Indiana, THARIES, or Freeman prostheses; (2) although there were major improvements in pain, function, and range of motion, unexplained pain persisted in 51.6% of cases; (3) the failure rate of 33.8% in the first 3 years was higher than that reported for conventional total hip arthroplasty; and (4) hips with a history of trauma failed the most frequently and showed the least improvement, whereas hips with osteoarthritis showed the fewest failures and the best results. We conclude that surface replacement hip arthroplasty is not superior to conventional total hip arthroplasty, judged by the criteria of pain relief, improvement of function, and failure rate.

Adolescent↗
PubMed1995

The John Charnley Award. Thrombogenesis during total hip arthroplasty.

The activation of the clotting cascade leading to deep venous thrombosis begins during total hip arthroplasty, but few studies have assessed changes in coagulation during surgery. A better understanding of thrombogenesis during total hip arthroplasty may provide a more rational basis for treatment. In 3 separate studies, the following observations were made. Circulating indices of thrombosis and fibrinolysis: prothrombin F1.2, thrombin-antithrombin complexes, fibrinopeptide A, and D-dimer, did not increase during osteotomy of the neck of the femur or during insertion of the acetabular component, but rose significantly during insertion of the femoral component. Thrombin-antithrombin complexes, fibrinopeptide A, and D-dimer were higher after insertion of a cemented component than insertion of a noncemented femoral component. A significant decline in central venous oxygen tension was observed after relocation of the hip joint and after insertions of cemented and noncemented femoral components, providing evidence of femoral venous occlusion during insertion of the femoral component. In patients receiving a cemented femoral component, mean pulmonary artery pressure increased after relocation of the hip joint, indicating intraoperative pulmonary embolism. No changes in mean pulmonary artery pressure were noted with noncemented total hip arthroplasty. Administration of 1000 units of unfractionated heparin before insertion of a cemented femoral component blunted the rise of fibrinopeptide A. The results of these studies suggest that (1) the greatest risk of activation of the clotting cascade during total hip arthroplasty occurs during insertion of the femoral component; (2) femoral venous occlusion and use of cemented components are factors in thrombogenesis during total hip arthroplasty; and (3) measures to prevent deep venous thrombosis during total hip arthroplasty (such as intraoperative anticoagulation) should begin during surgery rather than during the postoperative period and be applied during insertion of the femoral component.

Aged↗