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At least 73 records · Page 4Linked to original sources
PubMed2004

Comparing cruciate-retaining total knee arthroplasty and cruciate-substituting total knee arthroplasty: a prospective clinical study.

BACKGROUND: This prospective clinical study was performed to compare the clinical outcomes and radiographic changes between patients with cruciate-retaining (CR) and cruciate-substituting (CS) total knee arthroplasty (TKA). METHODS: From 1997 through 1998, 228 patients (183 females and 45 males) with a total of 267 knees with an average age of 55 years (range, 20 to 83 years) were enrolled in this study. Patients were randomly divided into two groups including group I of 137 patients underwent 157 CR TKA, and group II of 91 patients underwent 110 CS total knee arthroplasties. The evaluation parameters included knee scores, functional scores, radiographs of the knees and SF-12 surveys. The average follow-up period was 42 months (range, 24 to 66 months). RESULTS: The overall results for group I were 74.3% excellent, 17.7% good, 7.1% fair and 0.9% poor for; and 76.9% excellent, 19.2% good and 3.8% fair for group II. No significant differences were noted in the overall results between the two groups. The radiographic changes showed no discernable differences. CONCLUSIONS: Cruciate-retaining and cruciate-substituting total knee arthroplasties function equally well at 2 to 5 years postoperatively. The ultimate differences between the patients who underwent CR TKA and CS TKA need to be examined after long-term follow up.

Adult↗
PubMed1998

Femur fractures in patients with hip arthroplasty: indications for revision arthroplasty.

The number of periprosthetic femur fractures has increased due to the increase in the number of patients having total hip arthroplasty. In this study, we define indications for operative treatment in patients with femur fractures after hip arthroplasty. Fifty-three patients with 56 periprosthetic fractures were available for retrospective review of charts, radiographs, and physical examination; 42 fractures were treated with open reduction and internal fixation, 8 had replacement of hip prosthesis, 4 were treated with a retrograde genucephalic nail, and 2 patients were treated conservatively. The choice of treatment depended on the stability of the prosthesis and on the type and location of the fracture. Fifty-two fractures healed primarily. Three patients sustained a refracture, one an additional fracture, and two a deep infection. We recommend treatment with plate fixation for fractures without signs of prosthetic loosening. In fractures with loose implants, revision arthroplasty is required. Distal femoral fractures should be stabilized with a plate or with genucephalic nailing.

Aged↗
PubMed1984

Characterization of arthroplasty tissue after 14 years post-cup arthroplasty: a morphological and biochemical assessment.

The cup arthroplasty has been reported to cause the formation of a fibrocartilaginous joint surface, which may result in a painless, functional joint. The joint surface of a 38-year-old man with a failed cup arthroplasty implanted for 14 years was examined histologically and biochemically. The joint surface tissue of this patient resembled fibrous connective tissue, with major types of collagen being Type I and Type III. No evidence of cartilaginous transformation in the healing scar was demonstrated, despite several years of successful functioning of the cup arthroplasty.

Adult↗
PubMed1999

Metacarpophalangeal joint arthroplasty in rheumatoid arthritis: results of Swanson implants and digital joint operative arthroplasty.

We discuss 69 metacarpophalangeal (MP) implant arthroplasties performed in 30 patients with rheumatoid arthritis. The follow-up averaged 5 years. We studied 19 finger joint prostheses by Condamine, digital joint operative arthroplasty (stabilized version; DJOA) and 50 flexible silicone Swanson implants. We used a new comprehensive scoring system to evaluate the MP alloarthroplasties. Such a scoring system incorporates clinical and radiological data. The outcome following MP joint replacement with DJOA was never evaluated as 'good'; in 11 joints the result was 'fair', and in 8 joints, 'poor'. As regards MP arthroplasty with Swanson implants, the results were evaluated as 'good' in 40 joints, as 'fair' in 10 joints, and in none as 'poor'. In our series, DJOA did not provide stability in arthritic MP joints. In all joints replaced with DJOA, dislocation of the articulating surfaces and signs of loosening were present. We regard three factors as being the main causes contributing to the poor outcome of DJOA when used as MP replacements. Firstly, the proximal prosthetic component is poorly matched to the anatomical shape of the metacarpal bone (conisation of the bone). Secondly, adequate coaptation cannot be achieved with this prosthetic design, even in the presence of extensive soft-tissue reconstruction. Thirdly, the use of polyethylene in MP joint replacements is questionable. In contrast, the silicone Swanson implants in our series provided superior results when used as MP implants in the rheumatoid hand.

Adult↗
PubMed1996

Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties.

Questionnaires are commonly used in orthopaedic outcome studies. This study sought to determine if responses to a simple standardized questionnaire correlated with responses obtained during a physician interview in evaluation of clinical outcome following hip and knee arthroplasty. One hundred sixty-two patients with 201 hip and knee arthroplasties were asked to fill out a questionnaire prior to returning for routine follow-up evaluation. There was a highly significant correlation (P < .0001, r = .74) between scores calculated from patient responses on the questionnaire and those calculated from responses recorded during the subsequent physician visit. There was no significant difference between patient and physician clinical hip scores, but physicians gave significantly higher knee scores than patients for both long- ( > 4.5 years, P < .05) and short-term ( < or = 4.5 years, P < .0001) follow-up periods; however, 97% of patient responses were within one grade of physician-recorded answers to the same questions. Eight and one-half percent of scores differed in overall evaluation from good-excellent to fair-poor categories. This study both validates and defines more clearly the limitations of questionnaires for follow-up evaluation of clinical results following total hip and knee arthroplasty.

Aged↗
PubMed1996

Revision total hip arthroplasty with cement after cup arthroplasty. Long-term follow-up.

Ninety-six cup arthroplasties (eighty-three patients) were converted to total hip arthroplasties with cement between July 1970 and August 1982. Fifty-eight hips (fifty patients) were followed for at least ten years, or to failure after a shorter interval, and eight other hips (eight patients) had a subsequent operation because of a deep infection. Of the fifty-eight hips that were followed for at least ten years or to failure, nine (16 per cent) were revised because of aseptic loosening of the acetabular component, one (2 per cent) was revised because of a traumatic fracture of the femur, and none were revised because of loosening of the femoral component. Kaplan-Meier survivorship analysis with revision for any reason (including infection) as the end point showed a rate of survival of 92 +/- 6 per cent (average and 95 per cent confidence interval) at ten years and of 74 +/- 12 per cent at twenty years. When the hips in which an infection had occurred were excluded, and with revision because of aseptic loosening of the acetabular component as the end point, the rate of survival was 84 +/- 10 per cent at twenty years; no acetabular component was revised because of aseptic loosening in the first ten years. When the hips in which an infection had occurred were excluded, and with radiographic evidence of definite or probable loosening of the acetabular component, or aseptic loosening of the acetabular component necessitating revision, as the end point, the rate of survival was 91 +/- 6 per cent at ten years and 53 +/- 22 per cent at twenty years. The present study demonstrates the durability of total hip replacement with cement after the failure of a cup arthroplasty and further substantiates the excellent long-term clinical and radiographic results that can be obtained with insertion of a femoral component with cement.

Adolescent↗
PubMed1989

[Treatment of infected hip joint arthroplasty. Results of treatment of 62 infected total prosthesis arthroplasties].

The treatment of 62 cases of infected total joint arthroplasty of the hip is reported. The treatment regimen for each patient was dependent on the general medical condition of the patient and the clinical signs of infection, as well as the type of bacteria, the bony anchorage of the prosthesis and the bone stock of femur and acetabulum. Surgical treatment was one of the following: treatment of the infection leaving the prosthesis in situ; one-stage or two-stage revision arthroplasty; or excision arthroplasty (Girdlestone procedure). There were 11 early and 51 late infections. The commonest bacterium isolated was Staphylococcus epidermidis (30%). The primary success rate of revision of the shaft was somewhat better with cemented than with uncemented prostheses. The overall success rates for cemented and for uncemented shafts were similar (91.5% versus 90%).

Adult↗
PubMed1999

Factors influencing choice of implants in total hip arthroplasty and total knee arthroplasty: perspectives of surgeons and patients.

To determine the factors influencing surgeons' choice of implants for total hip arthroplasty (THA) and total knee arthroplasty (TKA), 650 surveys were mailed to all active members of the American Association of Hip and Knee Surgeons practicing in the United States; 364 surveys (56%) were completed and returned. Analysis revealed that the average number of total hip and total knee replacements performed by the respondents in 1997 was 81 and 97; there was substantial regional variation. The average number of hip implant and knee implant brands used by these surgeons in 1997 was 2.4 and 1.8. Anticipated improvement in clinical results and cost of components were the most frequently listed reasons for changing brands. Surgeons were also queried about cost reduction programs at their particular institution. The most frequently listed strategies for cost reduction of implants included surgeon cost-awareness programs and volume discounting. More than half of the respondents (53.5%) anticipate manufacturers to decrease the cost of implants in the next 2 years. Most of the respondents (93.7%) currently have the ability to choose a particular implant. About half (46.7%) anticipate losing some or all control of this decision in the next 3 years. These respondents foresee their hospitals requiring the use of a discounted implant in the future. An additional survey was completed by 102 consecutive patients scheduled either for primary THA (64) or primary TKA (38) at our institution. When asked about implant selection, 93.1% responded that their orthopaedic surgeon should choose the prosthesis; 5.9% responded that their physician in consultation with the patient should choose the prosthesis. When asked what should be the primary determinant of implant choice, cost or quality, the overwhelming majority (97.1%) chose quality. A small percentage (2.9%) chose cost and quality. No patient chose cost alone. A large number of patients (84.8%) responded that they would pay additional costs if their insurance companies or health maintenance organizations refused to pay for a better but more expensive implant. Most patients realized how expensive components are, and 51% of the respondents correctly estimated the cost of an implant. Orthopaedic surgeons perceive that they are losing control of implant choice in THA and TKA. Cost of implants is one of the most significant factors influencing which implant is chosen. Patients (the true payors), however, overwhelmingly want their surgeons to choose the implant used at surgery, and they want quality, not cost, to be the primary determinant of this decision.

Arthroplasty, Replacement, Hip↗
PubMed2001

Venous thromboembolic disease management patterns in total hip arthroplasty and total knee arthroplasty patients: a survey of the AAHKS membership.

The American Association of Hip and Knee Surgeons (AAHKS) distributed a survey to its members exploring practice patterns implemented to prevent venous thromboembolic disease (VTED) in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Of 720 (33%) members, 236 responded. Prophylaxis was prescribed for 100% of patients during the course of hospitalization for THA and TKA. Warfarin was the commonest pharmacologic treatment used for THA (66%) and TKA (59%) patients. Low-molecular-weight heparin was used in 16% of THA patients and 18% of TKA patients. The most commonly employed mechanical modality was pneumatic devices in THA (51%) and TKA (50%). Universal acceptance of the need for prophylaxis administration for patients undergoing THA and TKA is shown. The method and duration remain highly variable; although the survey illustrates such variation, it suggests there is no one best method of prophylaxis.

Anticoagulants↗
PubMed2002

Changing incidence of primary total hip arthroplasty and total knee arthroplasty for primary osteoarthritis.

This study reports on the incidence of primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) for primary osteoarthritis in Australia. Age-specific and gender-specific numbers for Australia, 1994 through 1998, and South Australia, 1988 through 1998, were obtained. Incidences were calculated per 100,000 population. In Australia, primary THA increased from 50.9/10(5) (1994) to 60.9/10(5) (1998). TKA increased from 56.4/10(5) to 76.8/10(5). Stratified by age and gender, changes in incidence for South Australia with respect to time were tested using regression analysis. South Australia showed a significant increase in the overall incidence of THA (P=.012) and TKA (P<.001), although this was not uniform across all age groups. No significant gender differences were found. The incidence of THA is increasing, and the incidence of TKA is increasing at a greater rate.

Adult↗
PubMed2004

Knee arthroplasty for spontaneous osteonecrosis of the knee: unicompartimental vs bicompartimental knee arthroplasty.

Spontaneous osteonecrosis of the knee (SON) is an osteonecrosis that mainly affects the medial femoral condyle. In endstage SON, knee arthroplasty is the therapy of choice. Because of the unicompartimental nature of the knee, unicondylar knee arthroplasty is considered an ideal implant for treatment of this condition. The purpose of this study was to prove that the long-term results of unicondylar implants are better than the results of bicondylar implants for the treatment of SON. All patients treated for SON between 1984 and 2000 have been recorded. Two groups were formed according to the implant used. In all patients the preoperative radiograph was analyzed according to stage and size of the osteonecrotic lesion and the osteoarthritic changes. Postoperatively, the Knee Society Score and the radiograph were recorded. Thirty-nine patients were included in this study, of which 23 patients were treated by a unicondylar implant and 16 by a bicondylar implant. On a short-term basis, unicondylar implants had better clinical results; however, on a long-term basis bicondylar implants were better. In comparison, only unicondylar implants had to be revised. Radiolucency lines were mainly observed in patients with unicondylar impants and large areas of osteonecrosis. Our long-term results suggest that patients with SON are better treated by bicondylar implants. The reasons for the higher failure rate for unicondylar implants are poor bone stock and secondary arthritic changes.

Aged↗
PubMed2005

Does bilateral total knee arthroplasty affect gait in women?: comparison of gait analyses before and after total knee arthroplasty compared with normal knees.

We performed gait analysis of 24 patients with bilateral knee osteoarthritis (OA) before, 1 year, and 2 years after bilateral total knee arthroplasty and compared these results to 12 normal controls. Cadence was significantly decreased in OA patients when compared with controls. Step and stride lengths were significantly different preoperatively (shorter) and postoperatively (P < .05), but postoperative results showed no significant difference when compared with normal controls (P < .05). Step and stride times were significantly different (P < .05) between the preoperative OA group and controls, but no difference was seen with the postoperative measurements when compared with controls. In the OA group, the mean vertical component of the ground reaction forces expressed as percent body weight was significantly lower when compared with controls and postoperative results. No correlation was found between the preoperative and postoperative clinical scores and objective data obtained from gait analysis. Our results demonstrate that gait analysis is not a useful tool in evaluating the success of total knee arthroplasty patient.

Aged↗
PubMed2006

Simultaneous primary total hip arthroplasty and contralateral revision hip arthroplasty: role for use of femoral head autograft.

We report the outcome of revision hip arthroplasty for patients with acetabular bone loss in whom the femoral head retrieved from arthritic contralateral hip during the same anesthesia was used as autograft for acetabular reconstruction. Thirty-two hips in 16 patients with a mean age of 63.8 years (range, 43-79 years) were followed for an average of 3.5 years. All primary arthroplasties were successful. Evidence of autograft incorporation was found in all except 2 patients. The acetabular component failed and required revision in the latter 2 patients. The use of femoral head autograft in a select group of patients with symptomatic arthritis of hip and a failed prosthetic hip with severe bone loss in the contralateral side is a viable option. However, this technique should not be applied to acetabular reconstructions in which protected weight-bearing in the postoperative period may be necessary.

Adult↗
PubMed2006

The optimal metal-metal arthroplasty is still a total hip arthroplasty: in the affirmative.

Metal-metal hip resurfacing offers the advantage of conservation of femoral bone stock. In addition, the implant may offer enhanced resistance to dislocation in comparison with conventional total hip arthroplasty (THA). However, early and intermediate results of the procedure do not exceed those of conventional THA. The learning curve is steep for the procedure, and there are biomechanical and anatomic limitations to resurfacing that limit the applicability of the procedure. Although there will undoubtedly be a place for hip resurfacing in the armamentarium of the reconstructive hip resurfacing, it cannot be argued at this time that the optimal metal-metal hip arthroplasty is a hip resurfacing. Conventional metal-metal THA remains the "gold standard" at this time.

Arthroplasty, Replacement, Hip↗
PubMed2006

One-stage bilateral total hip arthroplasty compared with unilateral total hip arthroplasty: a prospective study.

It is believed that patients undergoing 1-stage bilateral joint arthroplasty are at higher risk for developing cardiopulmonary and possibly other complications. The aim of this prospective matched study was to evaluate and compare the morbidity profile of patients undergoing 1-stage bilateral uncemented total hip arthroplasty (BTHA) vs unilateral uncemented THA (UTHA). One hundred consecutive patients undergoing 1-stage bilateral THA (50 patients, 100 hips) and unilateral THA (50 patients) were recruited and prospectively followed. There were no statistically significant differences in 90-day mortality, individual major (BTHA, 8%; UTHA, 10%) or minor (BTHA, 20%; UTHA, 26%) complications between the 2 groups. Bilateral THA patients required more autologous and allogenic blood transfusion and had lower hemoglobin at discharge than UTHA patients. Patients undergoing BTHA should expect a slightly higher incidence of complications related to postoperative anemia.

Adolescent↗
PubMed2000

The introduction period of unicompartmental knee arthroplasty is critical: a clinical, clinical multicentered, and radiostereometric study of 251 Duracon unicompartmental knee arthroplasties.

One hundred twenty-eight consecutive knees were operated on with the Duracon unicompartmental knee arthroplasty. Of 111 knees, followed 3 years (range, 1-6 years), 109 knees were satisfactory. Two knees were revised because of progression of osteoarthritis and inexplicable pain. Radiostereometric analysis in 49 knees showed a migration of 0.6 mm after 2 years. The magnitude of migration was lower in comparison with published series. In a multicenter study comprising 4 other hospitals, there were 8 revisions in 123 operated knees. The reasons were loosening, subsidence, or fracture. These revisions were within 1 year and mostly related to operative technique. Unicompartmental knee arthroplasty is a demanding procedure that needs special experience and includes a risk of early failures during the introduction of a system.

Aged↗
PubMed2001

Outcomes of limited femoral resurfacing arthroplasty compared with total hip arthroplasty for osteonecrosis of the femoral head.

This study compared the results of limited femoral head resurfacing arthroplasty versus total hip arthroplasty (THA) for osteonecrosis. Thirty consecutive patients who had undergone a femoral head resurfacing procedure for osteonecrosis of the femoral head were compared with 30 consecutive patients who had undergone a THA. Both groups of patients had Steinberg stage III or IV disease with no acetabular cartilage involvement radiographically and by intraoperative inspection. At a 7-year mean follow-up for the resurfacing group and an 8-year mean follow-up for the THA group, the survival rate was 90% and 93% (P=.3). This study supports the femoral head resurfacing procedure as an alternative to THA for the time period studied.

Adolescent↗
PubMed2002

Fixation of the NexGen HA-TCP-coated cementless, screwless total knee arthroplasty: comparison with conventional cementless total knee arthroplasty of the same type.

We performed a 12-month prospective study on 59 patients (92 knees) who underwent NexGen (Zimmer Inc, Warsaw, IN) cruciate-retaining total knee arthroplasty. In the control group, uncoated components were fixed using screws, whereas the hydroxyapatite-tricalcium phosphate (HA-TCP) group underwent screwless fixation of coated components. At 12 months postoperatively, there was a radiographic clear zone around the femoral and tibial components of 56.5% and 32.6% of the knees in the control group. The HA-TCP group showed a clear zone at the medial aspect of the tibial component in only 1 knee. These results suggested that HA-TCP-coated articular components show good initial fixation without using screws. The NexGen coated knee arthroplasty may be useful for solving the problems of cementless fixation.

Aged↗