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PubMed1986

[Bilateral prosthesis of the knee in a hemophilia A patient with an inhibitor].

A forty-one year old severe haemophiliac A (factor VIII less than 1%) complicated by an antifactor VIII inhibitor was operated on for a bilateral arthroplasty of the knees. Substitutive treatment was started by giving anti-haemophilic A cryoprecipitate at a dose of 40 IU . kg-1. The anamnestic response occurred at day 6. Consumption of the inhibitor begun with the injection of 50,000 IU of concentrated factor VIII. This method proved to be insufficient for mastering the haemorrhagic syndrome, because the antibody titre quickly reached 10 IU Oxford. Treatment was continued with Autoplex (100 IU . kg-1), during three weeks, without any clinical or biological complications. It is suggested that Autoplex be used as the substitutive treatment in cases of major surgery in severe haemophilia complicated by a factor VIII inhibitor.

Adult↗
PubMedDate not supplied

[Muscle function of the thigh 10 years following a malignant bone tumor and implantation of a tumor prosthesis in the knee].

To objectify the muscle function of 5 patients ten years after implantation of a tumor endoprosthesis of the knee simultaneous muscle force and IEMG was recorded. The muscular activity in the operated leg was found to be reduced for the extension muscles (8-20%) and for the flexion muscles (28-52%) when comparing to the normal leg. Knee extension of the operated leg resulted from the function of the rectus femoris muscle. During normal exercise in daily life all patients were not handicapped und some of them did sport.

Adolescent↗
PubMed2003

Applications of fluorodeoxyglucose positron emission tomography in the diagnosis of infection.

The purpose of this study was to assess the accuracy of fluorodeoxyglucose positron emission tomography (FDG PET) in diagnosing infection in a large population of patients and in a variety of clinical circumstances where the performance of conventional imaging modalities has been questioned. We retrospectively analysed 167 FDG PET scans obtained to evaluate 175 anatomical sites for the presence of infection. The major indications for the scans were (1) complicated orthopaedic hardware (n=97), (2) chronic osteomyelitis (n=56), and (3) other (n=14: six fever of unknown origin, three vascular grafts, and five soft tissue). We assessed the overall diagnostic accuracy of FDG PET for each of these indications. In addition, we further analysed this modality's effectiveness by grouping the scans into specific clinical situations. A final diagnosis was made on the basis of surgical pathology and clinical follow-up for a minimum of 6 months. The overall accuracy of FDG PET in evaluating orthopaedic hardware was 96.2% for hip prosthesis, 81% for knee prosthesis, and 100% in 15 patients with other orthopaedic devices. Among the patients in our sample suspected of having chronic osteomyelitis, the accuracy was 91.2%. FDG PET was inaccurate in three cases of fever of unknown origin and accurate in all vascular graft and soft tissue infections. In 49 patients with a clinically apparent soft-tissue infection, FDG PET was able to detect or exclude underlying osteomyelitis with an accuracy of 92.3%. Among the 23 patients who had recent orthopaedic procedures, FDG PET imaging was accurate in 87% of cases. It is concluded that FDG PET is a highly effective imaging modality in the assessment of patients with suspected infection.

Adult↗
PubMedDate not supplied

Challenges in hip joint modeling for a patient with proximal femoral focal deficiency.

We were presented with a technical challenge driven by a clinical need. A patient with proximal femoral focal deficiency required gait analysis, but our typical biomechanical model [Vicon Clinical Manager (VCM)] would not have correctly identified his abnormal right hip center (RHIP). His underdeveloped right femur was fused to his ileum, his anatomical knee functioned as his right hip, and an above-knee prosthesis provided functional knee and ankle joints. During a special calibration, we estimated the global location of RHIP as the center of the femoral epicondyles, also identifying the global location of pelvic markers. These data were used in equations after Davis et al. to establish local coordinates for RHIP. We used a system of three simultaneous equations to solve for input to VCM that would reproduce this location for RHIP. This procedure allowed for inverse dynamics in VCM, and showed the emergence of an abduction moment at the right hip postoperatively, that exceeded changes predicted by sensitivity analyses. Although our clinical need was met, we concluded that a better approach would have involved full implementation of custom models to reflect abnormal patient anatomy.

Adolescent↗
PubMed2006

Bone impaction grafting for corticosteroid-associated osteonecrosis of the knee.

BACKGROUND: Osteonecrosis of the distal portion of the femur produces a segment of dead bone in the weight-bearing portion of the femoral condyle, frequently associated with subchondral fracture and collapse and eventually resulting in secondary osteoarthritis. Treatment of these late stages of osteonecrosis in the knee can be problematic. The purpose of the present study was to evaluate a new surgical technique in which the subchondral osteonecrotic lesion is removed. The bone defect is then reconstructed with impacted bone grafts to prevent collapse and/or to regain distal femoral sphericity. METHODS: In this prospective, one-surgeon study, nine consecutive knees in six patients were studied, all of which had extensive corticosteroid-associated osteonecrotic lesions of the femoral condyles. Six knees had collapsed lesions when they were initially treated. The mean age of the patients was thirty-one years. Both the clinical and radiographic outcomes were assessed at a minimal follow-up time of two years. RESULTS: At a mean follow-up time of fifty-one months, none of the reconstructed knees had been converted to a total knee prosthesis. The objective Knee Society score improved from a mean of 63 to 89 points. The functional Knee Society score improved from a mean of 19 to 81 points. During the follow-up period, there was no progression of collapse observed; however, three knees showed early signs of osteoarthritis. Clinical success was achieved in six of eight knees, and radiographic success was achieved in seven of nine knees. CONCLUSIONS: At the time of writing (at the time of midterm follow-up), this method appears attractive as a joint-preserving procedure. It is a relatively simple procedure that is not likely to interfere with future knee procedures. It appears that this technique can be effective in knees with collapse of the femoral condyle, and it may delay the need for a total knee arthroplasty. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Comparison of range of motion of high-flexion prosthesis and mobile-bearing prosthesis in total knee arthroplasty.

The purpose of this study was to compare the range of motion (ROM) of conventional total knee arthroplasty (TKA) using high-flexion, posterior cruciate ligament (PCL) stabilized prostheses and the ROM of conventional knee arthroplasty using navigation-assisted TKA, with mobile-bearing, cruciate ligament-retaining knees. Fifty conventional TKAs with high-flexion knees and 50 navigation-assisted TKAs with mobile-bearing knees were included in this study. The ROM and number of knees that allowed comfortable kneeling and cross-legged sitting 2 years postoperatively were evaluated and compared. Functional outcomes of the two groups were assessed with the Hospital for Special Surgery (HSS) scores. The authors found no difference between the ROM and functional outcomes of conventional TKA with high-flexion knees and navigation-assisted TKA with mobile-bearing knees.

Aged↗
PubMed1999

Surgical closing in total knee arthroplasty. A series followup.

The benefits of closing the surgical wound of a primary and revision total knee prosthesis with the knee in full flexion are examined. A previous study showed that surgically closing the primary knee arthroplasty with the knee in full flexion produced significantly more postoperative flexion at 6 months: 114.7 degrees compared with 108.1 degrees. Of 108 selected sequential primary knee arthroplasties, the first 52 knees were closed surgically with the leg in full knee extension, and the second 56 knees were closed in 90 degrees to 110 degrees flexion, depending on the available motion of the joint. The patients in each group were matched closely in age, weight, height, gender, and surgical technique. At all followup intervals, the flexion measurements were significantly better in the flexion closure group. At 1 year, the flexion group had 117.9 degrees and the extension group had 112.9 degrees flexion. The revision series also was a selected sequential series with 13 knees in each closure group. In the revision case, the 1-year findings were similar, with significantly more knee flexion in the flexion closure group (118.7 degrees compared with 112.7 degrees). In matched groups, flexion closure in primary and revision knee replacements significantly increased total range of motion, as seen at the 1-year followup.

Aged↗