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PubMedDate not supplied

Total wrist arthroplasty.

Although arthroplasty is a well-established procedure for many joints, its use in the wrist is less common, and the indications are less well defined. The standard procedure for the painful arthritic wrist remains radiocarpal arthrodesis. However, as technology and surgical procedures improve, wrist arthroplasty is being used more frequently. The authors provide a brief history of total wrist arthroplasty and review the arthroplasties most commonly used in the United States. Results with total wrist implants, the complications related to arthroplasty, technical aspects of the procedure, and salvage options are also discussed.

Arthritis, Rheumatoid↗
PubMedDate not supplied

The failed total knee arthroplasty: evaluation and etiology.

Evaluation of a patient with a failed total knee arthroplasty begins with a detailed history of the index knee arthroplasty and with the patient's medical history. The nature of the complaint after arthroplasty can help determine the etiology of failure. The primary causes of failure of total knee arthroplasty are pain, postoperative stiffness, and instability. Pain associated with weight bearing is most often mechanical and is caused by loosening, component failure, or patellar dysfunction. Continuous pain can be associated with infection or complex regional pain syndrome. Persistent postoperative stiffness may be caused by inadequate rehabilitation or improper balancing of flexion and extension spaces. However, loss of motion after satisfactory mobility has been achieved may be associated with infection, synovitis, tendinitis, or component loosening. Instability after total knee arthroplasty results from improper balancing, inappropriate component size, and component failure. Posterior instability generally occurs during flexion. Medial-lateral instability can result from either improper balancing of components or incompetent collateral ligaments. Radiographs can detect loosening and osteolysis, as well as component wear, fracture, and malposition. Nuclear scans can aid in detecting loosening and infection. If infection is suspected, aspiration is mandatory to attempt to confirm the diagnosis and identify an organism.

Age Factors↗
PubMed2002

Ximelagatran versus warfarin for the prevention of venous thromboembolism after total knee arthroplasty. A randomized, double-blind trial.

BACKGROUND: Warfarin is used for prophylaxis of venous thromboembolism in patients undergoing total knee arthroplasty. However, it is associated with rates of deep venous thrombosis (DVT) of approximately 38% to 55% and requires routine coagulation monitoring and frequent dose adjustment. Ximelagatran, an oral direct thrombin inhibitor, has shown promising efficacy and tolerability in patients undergoing total hip or knee arthroplasty. OBJECTIVE: To compare the efficacy and safety of ximelagatran and warfarin for prophylaxis of venous thromboembolism after total knee arthroplasty. DESIGN: Randomized, double-blind, parallel-group trial. SETTING: 74 North American hospitals. PATIENTS: 680 patients who had undergone total knee arthroplasty. INTERVENTION: 7 to 12 days of treatment with oral ximelagatran, 24 mg twice daily, starting on the morning after surgery, or warfarin (target international normalized ratio, 2.5 [range, 1.8 to 3.0]), starting on the evening of the day of surgery. MEASUREMENTS: Principal end points were asymptomatic DVT on mandatory venography; symptomatic DVT confirmed by ultrasonography or venography; symptomatic, objectively proven pulmonary embolism; and bleeding. All were assessed by blinded adjudication locally and at a central study laboratory. RESULTS: On central adjudication, incidence of venous thromboembolism was 19.2% (53 of 276 patients) in the ximelagatran group and 25.7% (67 of 261 patients) in the warfarin group (difference, -6.5 percentage points [95% CI, -13.5 to 0.6 percentage points]; P = 0.070). On local assessment, incidence was 25.4% in the ximelagatran group and 33.5% in the warfarin group (P = 0.043). In the ximelagatran and warfarin groups, respectively, major bleeding occurred in 1.7% and 0.9% of patients and minor bleeding occurred in 7.8% and 6.4% of patients. No variables related to bleeding differed significantly between the two groups. CONCLUSIONS: For prophylaxis of venous thromboembolism, fixed-dose ximelagatran started the morning after total knee arthroplasty is well tolerated and at least as effective as warfarin, but it does not require coagulation monitoring or dose adjustment.

Administration, Oral↗
PubMed1999

[Influence of knee replacement arthroplasty on modalities of weight transfer during the lateral step].

INTRODUCTION: The aim of this work was to study the relations between equilibrium and movement in patients after total knee arthroplasty. A previous study, conducted in patients with unilateral knee osteoarthritis, had shown that the timing of the events occurring during a side-step was modified in an asymmetrical way according to the supporting leg with respect to the affected one. METHOD: A kinetic and kinematic analysis was performed in a population of 9 patients before and after total knee arthroplasty and in 11 control subjects, using an ELITE system and two AMTI force-plates. The different phases (i.e. postural, monopodal, landing and stabilization) of a side step were studied. RESULTS AND DISCUSSION: Before surgery, the postural phase was longer and the monopodal phase was shorter in knee arthritis patients when the affected leg was the supporting one than when the sound leg was supporting. Total step duration and landing-stabilization phase duration were longer in patients no matter which leg was supporting than in control subjects. After total knee arthroplasty, the postural phase remained longer when the operated leg was supporting than when the sound leg was supporting. Altered proprioception can provide an explanation for this result. However, the duration of the postural phase decreased significantly when the operated leg was supporting as compared to when the affected leg was supporting before surgery. The duration of the monopodal phase was the same when the operated leg was supporting than when the sound limb was supporting and increased significantly as compared to when the affected leg was supporting before surgery. This result can be related to the decrease of pain which was observed in all patients after surgery. The duration of the landing-stabilization phase and the total movement duration remained longer in patients after surgery no matter which leg was supporting than in control subjects. CONCLUSION: This study shows that relations between equilibrium and movement tend to become symmetrical with respect to the leg used as supporting one in patients after undergoing total knee arthroplasty but remain different from those of control subjects. This movement analysis method enables to determine and to quantify differences in patients before and after undergoing total knee arthroplasty and thus provides additional information for the functional evaluation of patients with total knee prosthesis.

Aged↗
PubMed2000

Hip and knee arthroplasty: a comparison and the endocrine, metabolic and inflammatory responses.

Changes in circulating levels of catecholamines, cortisol, glucose, interleukin-6 and C-reactive protein and in the leucocyte count were investigated for 7 days after surgery in 158 patients undergoing hip or knee arthroplasty. We compared the responses to the two operations, and also examined the effects of pathology (osteoarthritis and rheumatoid arthritis) on the changes associated with knee arthroplasty. Exploratory factor analysis was applied to the data to identify the variables and sampling times that could be used in future to provide a concise description of the response. Patients undergoing knee arthroplasty showed significantly greater changes in noradrenaline, adrenaline and glucose levels, but not in cortisol levels, compared with those undergoing hip arthroplasty. Interleukin-6 and C-reactive protein concentrations were also significantly greater in knee patients than hip patients; however, when corrected for pathology, many of these differences were not significant. Minimal effects of pathology (chronic inflammation with rheumatoid arthritis) were found on the hormonal changes in knee patients. In particular, there was little evidence to support the inference from animal data that the hypothalamic-pituitary-adrenal axis is impaired. The expected increases in interleukin-6 and C-reactive protein concentrations were found in the rheumatoid arthritis patients. Exploratory factor analysis showed that the response could be separated into six components, accounting for 60% of the total variance, and identified the variables and sampling times indicative of each. In conclusion, there are differences in the hormonal, but not inflammatory, responses to hip and knee arthroplasty. Little evidence was found for an important effect of pathology on the changes associated with knee surgery. Factor analysis provided a useful summary of the data.

Aged↗
PubMed2000

Results of revision total knee arthroplasty.

BACKGROUND/AIM OF STUDY: The results of primary total knee arthroplasties have improved over the years but some still fail, requiring revision. Revision total knee arthroplasty is technically more difficult and has not enjoyed the same success rates as the index operation. The aim of this retrospective study was to review the results of revision total knee arthroplasties carried out at our centre. This is the first study in Singapore on revision total knee arthroplasty. METHODS: A retrospective study where 17 patients (18 knees) had been followed up since their revision operations were clinically assessed. Based on the Knee Society Clinical Scoring System, they were assigned separate knee and function scores (each having a maximum possible 100). RESULTS: The mean knee score was 76 (range 35-93), which rates as good. Of the 18 knees, 67% had excellent or good knee scores. By comparison, the mean function score was 56 (range 0-90) which rates as poor and 33% had excellent or good function scores. CONCLUSION: Revision total knee arthroplasty achieves good and excellent results in spite of technical difficulties often associated with the revision operation. The difference in mean knee and function scores emphasises that many other factors such as physical strength and stamina affect function. Nevertheless, 15 patients were able to walk out of their house and around their neighbourhood for varying distances. This satisfied their expectations and the poor mean function score may reflect different expectations of patients overseas from whence this scoring system originated.

Aged↗
PubMed1975

The Walldius hinge arthroplasty.

Eighty-three Walldius arthroplasties, performed by one surgeon as salvage operation on the knee joint between 1966 and 1972, were independently reviewed. The fifty-seven living patients with sixty-seven arthroplasties were interviewed and examined and the clinical records of the deceased patients were inspected. Sixty-seven arthroplasties (81 per cent) were successful and sixteen failed (19 per cent). Acrylic cement was used to secure the prosthesis on eight occasions only. There were two primary infections (2-4 per cent) and two delayed (2-4 per cent). Major loosening occurred in three arthroplasties (3-6 per cent). Minor loosening was compatible with a good result. Arthrodesis was successful on the two occasions on which it became necessary to remove the implant. There were no disasters. On the basis of these results it is considered that the Walldius arthroplasty can justifiably be offered as an alternative to primary arthrodesis of the knee.

Adolescent↗
PubMed2001

[Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases].

PURPOSE OF THE STUDY: Impingement of the iliopsoas muscle due to a protruding acetabular component is an uncommon cause of pain after total hip arthroplasty. Diagnostic signs may be misleading and therapeutic management has varied, leading to divergent findings reported in the literature. The purpose of this prospective work was to determine the frequency of groin pain due to iliopsoas impingement (with or without an identified causal mechanism) in patients with painful total hip arthroplasties and to identify diagnostic criteria that can be used to determine the appropriate therapeutic strategy. MATERIAL AND METHODS: This prospective study was conducted between 1998 and 2000 and included 206 painful total hip arthroplasties. From this series, we excluded cases where pain was related to loosening (139 cases, 67%), infection (45 cases, 21.7%), bursitis on trochanteric sutures (2 cases, 1%), and aortic aneurysm with gluteal claudication and resulting from a lumbosacral disorder (10 cases, 4.8%). This left 9 cases (4.3%) with a clinical picture suggestive of iliopsoas impingement. These 9 patients (mean age 50 years, age range 38 - 65) had 8 uncemented press-fix cups and 1 cemented cup with an acetabular mesh. Mean delay to the development of pain after the arthroplasty procedure was 7.3 months (1 - 48 months). The most suggestive clinical sign was groin pain triggered by active flexion of the hip and flexion of the hip against force with a painful arc measuring 30 degrees to 70 degrees. None of these 9 patients had any sign of material loosening and puncture aspiration ruled out infection. The final diagnosis was confirmed by sedation of pain after extra-articular infiltration at the anterior border of the cup (overhanging cup in 6/9 cases) under computed tomographic guidance. RESULTS: Infiltrations with xylocaine and long-release corticosteroids led to complete sedation of pain in 4 out of 9 patients and partial sedation in 1 other. Recurrent pain led to terminal tenotomy of the iliopsoas in 4 patients, that provided total sedation in 3 and partial sedation in 1. In all, successful pain relief was achieved in 7 out of 9 cases: 4 after infiltration (repeated in 1 cases) and 3 after tenotomy. At last follow-up physical examination has not identified any loss of flexion force. DISCUSSION AND CONCLUSION: Irritation of the iliopsoas muscle can be the cause of pain in 4.3% of patients experiencing pain after total hip arthroplasty. The delay to symptom onset is variable but there appears to be a pain-free period after implantation. An anatomic element (anterior cup overhang) is not necessary for diagnosis since the infiltration test was positive in 1 out of 3 cases without any identified acetabular factor. The infiltration test is an important element for positive diagnosis and should be the first therapeutic measure taken. We achieved success in 4 out of 9 cases. Tenotomy is indicated in case of recurrence, providing complete cure in 3 out of 4 cases in our series. Cure may be achieved without changing the cup by simple infiltration or tenotomy of the iliopsoas that led to complete cure in 7 out of 9 cases in our series, even in patients with an overhanging cup (6 out of 9 cases). An elective procedure might be indicated if a specific anomaly is identified (overly long screw, cement leakage) or for a screwed cup. The infiltration test should however be performed beforehand to confirm the diagnosis.

Adrenal Cortex Hormones↗
PubMed2002

[Bipolar arthroplasty in rotator cuff arthropathy: 13 cases].

PURPOSE OF THE STUDY: A series of 13 patients with an excentered osteoarthritis of the glenoid who underwent bipolar shoulder arthroplasty is reported. MATERIAL AND METHODS: The series included 13 patients treated in two centers between 1995 and 1998. Mean age was 70 years (58-88). Constant's absolute score and Swanson's score were used for clinical assessment. The Hamada and Fukuda classification was used for the radiographic assessment. The follow-up radiography series included an AP view in the three rotation positions, an AP view in maximum abduction to assess intraprosthetic mobility, a lateral view (Lamy) and measurements of both humeri. Several measurements were made to assess humerus lateralization and glenoid wear: deltoid lever arm, lateral humeral displacement, distance between the lateral border of the coracoid and the center of the glenoid and the subacromial space. Mean preoperative Constant score was 23 points: pain 3 pts, activity 5 pts, motion 13 pts, force 2 pts. Mean preoperative Swanson score was 11. Active anteflexion was 78 degrees, active abduction 68 degrees and passive external rotation 17 degrees. The Hamada and Fukuda classification was 9 grade 4 and 4 grade 5. All patients had a full thickness unrepairable rotator cuff tear: three with 2 tendon tears, and 10 with 3 tendon tears. All patients were reviewed clinically and had a complete radiography series at last follow-up (mean 28 months, range 7 - 56 months). RESULTS: At last follow-up, the mean absolute Constant score was 37 points: pain 10 pts, activity 9 pts, motion 14 pts, force 4 pts. Mean Swanson score at last follow-up was 19 points. Mean active anteflexion was 69 degrees, active abduction was 63 degrees and passive external rotation was 29 degrees. A satisfactory deltoid lever arm had been achieved compensating the glenoid wear by a greater lateral displacement of the humerus. At last follow-up, there were no cases of humeral loosening but three cases with important glenoid wear were observed after two years. Comparing the results obtained using small cups (40 and 44) with arthroplasties using large cups (48 and 52) showed a trend favoring small cups: Constant score 43 vs 32 points, Swanson score 21 versus 17 points, anteflexion 72 degrees versus 66 degrees and passive external rotation 34 degrees versus 26 degrees. DISCUSSION: Our results confirmed the efficacy of bipolar arthroplasty for pain relief, but the mobility outcome was less than satisfactory, excepting passive external rotation. It would appear to be preferable to use small cups. Comparing our results with data in the literature, particularly the better results for mobility using simple humeral prostheses, suggests that the principles of shoulder and hip arthroplasty concern different mechanisms: a sufficient deltoid lever arm must be achieved, but without overstretching the periarticular soft tissue (capsule, subcapsule, teres minor), and using a cup size close to the size of the healthy humeral head. Glenoid reaming should not be reserved only for asymmetrical glenoid wear in the horizontal plane. CONCLUSION: Our results suggest that bipolar arthroplasty for excentered osteoarthritis of the glenoid cavity is indicated for: stiffness in external rotation, major concentric wear in patients under 65 years of age, or asymmetric glenoid wear.

Aged↗
PubMed2002

[Total hip arthroplasty after proximal femoral osteotomy: 75 cases with 9-year follow-up].

PURPOSE OF THE STUDY: Clinical outcome and technical difficulties observed after total hip arthroplasty subsequent to osteotomy of the proximal femur were studied in 75 total hip arthroplasties. MATERIAL AND METHOD: Sixty-four patients underwent 75 total hip arthroplasty procedures at the Caen University Hospital between 1978 and 1995. These patients were reviewed at least two years after implantation. The Postel Merle d'Aubigné (PMA) score was used to assess clinical outcome and the Lequesne criteria to determine acetabular and femoral parameters on the weight-bearing AP radiograph. Off-set of the femoral epiphysis was determined by measuring the relation between the femoral shaft axis and the digital fossa. The population was composed of young active subjects who had had several operations. The main underlying diseases were: congenital dislocation of the hip (32%), dysplasia (23%), and primary degenerative hip disease (34%). Two-thirds of the hips were stiff and more than three-quarters were unstable. There were 28 osteotomies for varisation, 19 medial translations, 20 osteotomies for valgisation, and 7 subtrochanteric osteotomies. All femoral pieces except one were cemented. Implantation required 39 trochanterotomies, 39 Hardinge approaches, and 5 deosteotomies. RESULTS: The medial offset of the digital fossa compared with the diaphysis led to operative difficulties and femoral complications: Their were eight femoral fractures: 7 of these occurred with a digital fossa situated medially to the diaphysis. The Postel-Merle-d'Aubigné score at last follow-up was satisfactory in 57 cases (76%). Among the 18 non-satisfactory results, there was 7 failures requiring surgical revision, 5 potential loosenings, and 6 stiff hips in patients with congenital dislocation. For the 7 revisions (9.3%), 3 were for infection (2 late hematogenous), 1 for early dislocation, 2 for aseptic acetabular loosening, and 1 for aseptic femoral loosening. Medial translation of the digital fossa led to a larger number of varus positions (44%). For femoral cementing, 10 hips showed a non-progressive secondary lucent line; these prostheses were considered as potentially loose. Among them, varisation osteotomies has been performed in 5 cases, and in 8 the digital fossa was medial to the diaphyseal axis. There was only one aseptic femoral loosening requiring surgical revision. Implant survival, established according to the actuarial method, was 94.9% at 10 years. DISCUSSION: The almost 95% implant survival at 10 years observed in our patients is comparable with most reports in the literature and slightly better than those reported at the 1997 SOFCOT symposium on total hip arthroplasty after 50 years (84%). The most important factor determining surgical difficulty and operative complications at the femoral level was the position of the digital fossa, more than the type of initial osteotomy. CONCLUSION: Indications for osteotomy must account for subsequent total hip arthoplasty. Implantation is difficult after subtrochanteric osteotomy which can cause important technical problems. The rate of failure is very high. The risk of femoral complications and misalignment of the femoral stem, irrespective of the type of initial osteotomy, is greater when the digital fossa lies medially to the diaphyseal axis. We prefer trochanterotomy or desosteotomy for such cases. Osteotomy did not rule out arthroplasty for any of the femurs. There were however important operative difficulties and the frequency of complications suggest we should be most prudent about careful preoperative planning in the frontal plane.

Adult↗
PubMed2002

Periprosthetic humeral fractures after total elbow arthroplasty: treatment with implant revision and strut allograft augmentation.

BACKGROUND: Periprosthetic fractures are among the most challenging complications of elbow arthroplasty, and published information about the outcome of treatment is limited. The purpose of the present study was to determine the results of implant revision and strut allograft augmentation for the treatment of humeral periprosthetic fractures that occur around a loose humeral component. METHODS: Between 1991 and 1999, eleven periprosthetic fractures that occurred around a loose humeral component were treated with cortical strut allograft augmentation and revision arthroplasty with use of a Coonrad-Morrey semiconstrained implant. Six fractures occurred after a primary arthroplasty, and five occurred after a revision arthroplasty. Two parallel strut grafts were used for fracture fixation in most cases. Patients were followed for an average of three years (range, nine months to 7.8 years) and were evaluated clinically and radiographically. RESULTS: Clinical and radiographic fracture union was obtained in ten of the eleven patients. One patient required revision surgery because of aseptic loosening of the humeral component seven years and nine months after fracture union; there were no other implant failures. Complications included one additional nondisplaced humeral periprosthetic fracture after surgery that failed to heal with closed treatment, one olecranon fracture, one permanent ulnar nerve injury, and one case of triceps insufficiency. At the time of the most recent follow-up, seven of the eight patients with an intact reconstruction had a functional arc of motion and no or slight pain and one had limited motion and moderate pain. CONCLUSIONS: Periprosthetic humeral fractures that are associated with a loose humeral component can be effectively treated with revision elbow arthroplasty and strut allograft augmentation. The technique is associated with a high rate of fracture union, implant survival, and satisfactory clinical results. However, the complication rate is substantial.

Adult↗
PubMed2002

[Treatment of infected total knee arthroplasty].

OBJECTIVE: To investigate the treatment of infected total knee arthroplasty (TKA). METHODS: Between 1983 and 2000, 6 patients with infection after TKAs were treated, including 2 men and 4 women, aged on average 63 years (44 - 75 years). Initial knee arthroplasty was performed for osteoarthritis in 4 patients and for rheumatoid arthritis in 2 knees. The timing of diagnosis of infection after knee arthroplasty averaged 50 months (range, 1 month-11 years). Simple debridement and antibiotic treatment were prescribed for 3 patients, debridement and one-stage reimplantation for 1, debridement and two-stage reimplantation for 1, and athrodesis for 1. RESULTS: Of the 3 patients with simple debridement, one was cured, one failed but underwent athrodesis later, and one lost to follow up. Two patients with reimplantation were cured and had good function recovery. All of the 6 patients were followed up on average for 4 years. No infection recurred except one who lost to follow-up. CONCLUSIONS: Management of infection after total knee arthroplasty includes antibiotic suppression and debridement with prosthesis retention, insertion of another prosthesis as a one-stage or two-stage exchange technique, knee arthrodesis and amputation. These treatments have specific indications. To treat infection after total knee arthroplasty, suitable method should be taken according to patient's condition. Arthrodesis is the best salvage operation, though it may handicap patients' daily life. Reimplantation of another prosthesis could maintain a functional joint.

Adult↗
PubMed2003

[Our clinical experience with non-cemented total hip revision arthroplasty].

OBJECTIVES: We evaluated the results of non-cemented revision arthroplasty in patients who had undergone cemented total hip arthroplasty. METHODS: Twenty patients (12 women, 8 men; mean age 72 years; range 61 to 84 years) underwent non-cemented revision arthroplasty after a mean of 9.4 years (range 3 to 16 years) following primary surgery. The mean follow-up period was 4.5 years (range 3 months to 6.3 years). RESULTS: During revision arthroplasty, femur fractures were observed in three patients (15%). Three patients (15%) had femoral cortex perforations. Trochanteric osteotomy was performed in five patients (25%). The mean Harris hip score after the operation was 76.7 (range 50 to 90). The results were excellent in three patients (15%), good in seven (35%), fair in seven (35%), and poor in three patients (15%). CONCLUSION: Despite a high intraoperative complication rate during non-cemented revision total hip arthroplasty, we believe that non-cemented revision should be the preferred method because of low infection and low aseptic loosening rates.

Acetabulum↗
PubMed2003

[Patellar reconstruction during total knee arthroplasty after previous patellectomy].

PURPOSE OF THE STUDY: In order to limit the consequences of prior total patellectomy on knee function after total knee arthroplasty, we propose an original technique using an en bloc patellar graft to reconstruct the quadriceps lever arm. The purpose of this work was to describe the technique and present preliminary results obtained in seven patients. PATIENTS AND METHODS: Seven en bloc patellar grafts were performed in seven patients (6 women and 1 man) during total knee arthroplasty procedures for femorotibial degenerative joint disease after prior patellectectomy (mean 13 years before arthroplasty, range 5-20 years). We implanted three posterior stabilized prostheses, one ultracongruent prosthesis, two prostheses preserving the posterior cruciate ligament, and one bi-cruciate prosthesis. The patella was reconstructed with an autologous bone graft fashioned from the tibial plateau in six cases, and with a homologous graft fashioned from a bone-bank femoral head in one. Transosseous sutures were used to fix the graft to the extensor system. A polyethylene button was cemented on five of the grafts. RESULTS: Active extension was defective in five knees prior to the patellar graft and in only one knee after patellar reconstruction. The IKS knee score improved from 41 points (range 35-45) before surgery to 78 points (range 55-95) after grafting and the IKS function score from 35 (range 5-50) to 72 (range 40-100). Four of the seven grafts were removed (eight weeks to five years after implantation, mean two years) mainly due to failure of fixation leading to progressive migration. Follow-up varied from eight weeks to six years. Mean follow-up for the three grafts still in place was 4.6 years (4-6 years). After removing the patellar graft (4 knees) the IKS knee score decreased to 68 points (20-95) and the IKS function score to 62 points (30-100). Lack of active extension reappeared in three of the knees after removing the patellar graft but was not observed in the three knees with the patellar graft in place (and flexion was at least 110 degrees ). Microradiography of the patellar graft explanted after two years revealed peripheral corticalization with areas of living bone tissue seen on the pathology specimens. Inversely, the autografts explanted at eight weeks and at five years exhibited bone necrosis. CONCLUSION: This preliminary study shows that patellar autograft can improve the performance of total knee arthroplasty on patellectomized knees. The fixation technique must be improved using transosseous transverse sutures in addition to peripheral sutures in order to limit secondary migration of the graft. A patellar autograft fixed into the extensor system can remain viable two years after implantation. This technique can be proposed when total knee arthroplasty is indicated for a patellectomized knee, particularly in patients with lack of active extension.

Adult↗
PubMed2004

Risk factors affecting outcome of metal-on-metal surface arthroplasty of the hip.

We evaluated radiologic and clinical features affecting the outcome of hybrid metal-on-metal surface arthroplasty of the hip in 119 hips in patients 40 years and younger. Only the hips that had either failed or had minimum 2-year followup were reviewed. Ninety-four hips in 83 patients with a mean age of 34.2 years (range, 15-40 years) were reviewed. Seventy-one percent of the patients were males and 29% of the patients were females; 14% had previous surgery. The Chandler index and surface arthroplasty risk index were calculated. The mean followup at 3 years (range, 2-5 years) showed that three hips were converted to a total hip replacement at a mean of 27 months (range, 2-50 months) after the original surgery, and 10 hips had significant radiologic changes. The mean surface arthroplasty risk index for these 13 problematic hips versus the remaining hips was significantly higher, 4.7 and 2.6, respectively. The mean angle between the prosthesis stem and femoral shaft in the problematic group was significantly smaller than in the remaining hips: 133 degrees and 139 degrees, respectively. With a surface arthroplasty risk index score greater than 3 the relative risk of early problems is 12 times greater than if surface arthroplasty risk index less than or equal to 3.

Adult↗
PubMed2004

Current recommendations for extended out-of-hospital thromboprophylaxis following total hip arthroplasty.

Patients who have undergone total hip arthroplasty are at risk for venous thromboembolic disease, including deep venous thrombosis, pulmonary embolism, and postphlebitic syndrome. Although the number of annual total hip arthroplasties in the United States has steadily risen in the past decade, the rate of venous thromboembolic disease within that patient group has declined as a result of advances in surgical and postoperative procedures, including prompt mobilization and safety and efficacy of thromboprophylactic alternatives. This paper reviews the therapeutic options for deep venous thrombosis prophylaxis following total hip arthroplasty, with an emphasis on recommendations of the Sixth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy. The implications of recent randomized clinical trials on care provided by physiatrists in the rehabilitation facility setting are also discussed. The low-molecular-weight heparins have become widely accepted alternatives to aspirin, heparin, and warfarin as results from randomized clinical trials have proved their superior safety and efficacy in the postoperative period. Prolonged prophylaxis up to 30 to 35 days postoperatively in total hip arthroplasty may offer additional protection against venous thrombosis. Therefore, to prescribe optimal thromboprophylactic regimens following total hip arthroplasty, physicians require an understanding of the current recommendations of the Sixth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy and the implications of recently concluded clinical trials.

Anticoagulants↗
PubMed2004

Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision.

BACKGROUND: Stiffness is an uncommon but disabling problem after total knee arthroplasty. The prevalence of stiffness after knee replacement has not been well defined in the literature. In addition, the outcomes of revision surgery for a stiff knee following arthroplasty have not been evaluated in a large series of patients, to our knowledge. The purposes of this study were to define the prevalence of stiffness after primary total knee arthroplasty and to evaluate the efficacy of revision surgery for treatment of the stiffness. METHODS: We defined a stiff knee as one having a flexion contracture of >/=15 degrees and/or <75 degrees of flexion. Two separate groups were evaluated. First, the results of 1000 consecutive primary total knee replacements were reviewed to determine the prevalence of stiffness. Second, the results of fifty-six revisions performed because of stiffness, sometimes associated with pain or component loosening, after primary total knee arthroplasty were evaluated. RESULTS: The prevalence of stiffness was 1.3%, at an average of thirty-two months postoperatively. The patients with a stiff knee had had significantly less preoperative extension and flexion than did those without a stiff knee (p < 0.0001). There were no significant differences in age, gender, implant design, diagnosis, or the need for lateral release between the patients with and without stiffness. The second cohort, of knees revised because of stiffness, were followed for an average of forty-three months. The mean Knee Society score improved from 38.5 points preoperatively to 86.7 points at the time of follow-up; the mean Knee Society function score, from 40.0 to 58.4 points; and the mean Knee Society pain score, from 15.0 to 46.9 points. The mean flexion contracture decreased from 11.3 degrees to 3.2 degrees, the mean flexion improved from 65.8 degrees to 85.4 degrees, and the mean arc of motion improved from 54.6 degrees to 82.2 degrees. The arc of motion improved in 93% of the knees, and flexion increased in 80%. Extension improved in 63%, and it remained unchanged in 30%. CONCLUSIONS: The prevalence of stiffness in our series of 1000 primary knee arthroplasties was 1.3%. Revision surgery was a satisfactory treatment option for stiffness, as the Knee Society scores improved, the flexion contractures diminished, and 93% of the knees had an increased arc of motion. However, the results suggest that the benefits are modest.

Adult↗
PubMed2004

[Case report--total hip arthroplasty after femoral osteotomy].

Osteoarthritis that is the most common cartilage disease is difficult to treat conservatively. Usually it is treated by operative therapy. Osteotomy and arthroplasty are the popular operation. Osteotomy has a problem of unstable results. Some patients need arthroplasty after osteotomy, cause of getting worse of pain. It is difficult to operate arthroplasty for deformity of proximal femor after osteotomy. We report arthroplasty using ROBODOC is easy to operate cementless hip arthroplasty after osteotomy.

Arthroplasty, Replacement, Hip↗