Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ARTHROPLASTY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 721 records · Page 40Linked to original sources
PubMed1981

Hip arthroplasties in Gaucher's disease.

In six patients with Gaucher's disease, arthroplasties were performed on ten hips for avascular necrosis of the femoral head. The follow-up ranged from two to twelve years. There were three Vitallium mold (cup) arthroplasties, seven primary total hip-replacement arthroplasties, and two revisions of total hip-replacement arthroplasties. Increased intraoperative and postoperative bleeding was often encountered. The cup arthroplasties yielded good results on long-term follow-up, but there was a high rate of loosening of the prosthetic components in the total hip replacements. There was one postoperative pathological fracture but there were no infections.

Adult↗
PubMed1981

Wagner resurfacing total hip arthroplasty: early results.

This preliminary report deals with the early results obtained from a new conservative hip arthroplasty--the Wagner resurfacing total hip arthroplasty in which the acetabulum is replaced with a high-density polyethylene cup and the femoral head resurfaced with a metallic cup. Between February 1977 and September 1978, 51 patients, ranging in age from 12 to 70 years, underwent this operation. They had a variety of hip diseases. All patients were assessed prospectively by the Harris hip rating method. The results of operation were excellent. All patients but one had complete or marked relief of pain. To date there have only been two failures. With this procedure the considerable problem associated with the conventional hip arthroplasty, that of stem loosening, is avoided. It is possible to salvage a failed Wagner resurfacing operation by hip arthrodesis or by conventional total hip arthroplasty. While it is still too early to advocate its universal acceptance, the Wagner resurfacing total hip arthroplasty is expected to be widely adopted and used with success.

Adolescent↗
PubMed1995

[Infection following shoulder and elbow arthroplasty. Diagnosis and therapy].

The rate of infection reported in recent publications is 0.8% after shoulder arthroplasty and ten times higher (8.1%) after elbow arthroplasty. The figures for shoulder arthroplasty correspond well with our own rate of revision for infection of 0.5% after 363 primary shoulder replacements. However, our average rate of revision for infection (1.8%) after 278 GSB-III elbow arthroplasties was considerably lower and included rheumatoid as well as post-traumatic indications. Our experience concerning etiologic factors, nature, diagnosis, treatment options, and long-term consequences of superficial and deep infections after shoulder and elbow arthroplasty are discussed for each joint separately and in relation to the literature.

Aged↗
PubMed1995

History of the contralateral knee after primary knee arthroplasty for osteoarthritis.

Published reports of series of total knee replacements vary between 20% and 75% in the percentage of patients eventually having bilateral replacements. There are no data in the literature on the predicted course of the contralateral knee for patients presenting for total knee replacement. This study reviewed the history of the contralateral knee in patients with a diagnosis of osteoarthritis presenting for unilateral primary total knee arthroplasty. The current study group comprised 185 patients who had either a minimum 5 year followup (range 5-12.5 years) or who were known to have had a second knee arthroplasty before 5 years. Evaluation included a full clinical and radiographic examination of the contralateral knee at index arthroplasty and at final followup. Of the 185 patients, the contralateral side initially was asymptomatic in 36%, mildly symptomatic in 16%, moderately symptomatic in 28%, and severely symptomatic in 20%. Seventy-nine (43%) knees eventually underwent contralateral arthroplasty. Ninety-three percent of patients who had moderate or severe symptoms and severe radiographic arthritis of the contralateral side at the time of presentation later underwent total knee replacement. However, patients who presented initially with mild symptoms or who had no symptoms had only a 9% incidence of knee arthroplasty.

Adult↗
PubMed1995

Is there a place for patellofemoral arthroplasty?

Indications for patellofemoral arthroplasty were studied based on a 2- to 10-year followup review. Of 183 patellofemoral prostheses implanted between 1980 and 1990, 104 were associated with unicompartmental arthroplasty, and 79 were implanted alone. Thirteen patients were lost to followup. The results of 66 patellofemoral arthroplasties are reported at an average followup of 66 months. The mean age of the patients at surgery was 57 years. Underlying causes of the osteoarthritis included patellar dislocation or dysplasia (22), patellar fracture (20), and primary osteoarthritis (24). A metallic femoral groove was associated with a polyethylene patella with no metal backing. Two (9%) prostheses were revised in the dysplasia group, 1 (5%) in the posttraumatic group, and 7 (29%) in the primary osteoarthritis group. In this latter group, the indications of patellofemoral arthroplasty must be restricted to lesions of the patellofemoral joint in a knee in neutral axis evaluated preoperatively on full standing and stress radiographs. The best results of patellofemoral arthroplasty were obtained in osteoarthritis after patellar dislocation or patellar fracture.

Activities of Daily Living↗
PubMed1995

Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty.

From 1976 to 1992, 24 knees (24 patients) were treated for reinfection after reimplantation of a prosthesis to treat an infected total knee arthroplasty. Including the index total knee arthroplasty, the average number of total procedures for the affected knee was 9.3 procedures (range, 5-23 procedures), and surgical procedures used for the affected knee after reinfection averaged 3.7 procedures (range, 1-12 procedures). The final outcome included 10 knees with a successful knee arthrodeses, 5 patients with infected prostheses who were prescribed suppressive oral antibiotic treatment, 4 above the knee amputations, 3 persistent pseudarthroses of the knee joint, 1 resection arthroplasty, and 1 uninfected total knee prosthesis. A poor prognosis was associated with use of a hinged knee design: 3 of the 4 amputations were done after a hinge knee prosthesis was implanted; 2 patients had a persistent pseudarthrosis after a failed attempt at knee arthrodesis; 1 patient had a resection arthroplasty; and 1 patient had a retained infected prosthesis. A successful arthrodesis in which the initial attempt included use of an external fixation devices was more likely for prostheses without stems (75%) when compared with cemented stemmed prostheses (40%). Long intramedullary arthrodesis was successful in all 3 attempts. Aspiration for diagnosis followed by oral antibiotic suppression was universally unsuccessful in 4 patients, whereas early aggressive open debridement facilitated retention of the prosthesis in 4 of 6 patients. The increased difficulty in achieving a healed wound, a successful knee arthrodesis, and eradication of infection with subsequent nonprosthetic salvage procedures as well as the attendant morbidity associated with reinfection must be considered carefully and discussed with the patient before the reimplantation prosthesis is inserted to treat the infected total knee arthroplasty.

Adult↗
PubMed1995

The impact of modularity in total hip arthroplasty.

Use of modularity in total hip arthroplasty has been of benefit in terms of allowing inventory reduction while providing surgeon versatility and thus optimal joint reconstruction. As with any advancement, the improvements gained must be weighed against their cost. The authors sought to examine the effects that modularity may have on the results of total hip arthroplasty in terms of bone loss, durability of fixation, time to failure, and incidence of revision. Using data from their total joint registry, the authors examined their experiences with total hip arthroplasties done during the past 25 years. They sought to compare the results of total hip arthroplasties in patients who differed chiefly by the number of modular junctions present in their hip prostheses. With each incremental increase in modularity, an earlier appearance of radiolucencies, an earlier occurrence of aseptic loosening, and an increased incidence of osteolysis in the absence of loosening was found. The authors conclude that suboptimal design rather than the concept of modularity best explains these results. The presence of suboptimal design in a total hip arthroplasty may cause polyethylene to be stressed beyond its performance limits.

Hip Prosthesis↗
PubMed1995

Cementless total hip arthroplasty in patients with osteonecrosis of the femoral head.

The authors studied 61 patients (78 hips) who had avascular necrosis of the femoral head, seen in followup for an average of 7.2 years (range, 6-9 years) after they had primary cementless porous-coated total hip arthroplasty. This study was undertaken to determine whether cementless porous-coated prostheses have any merit over reported cemented total hip arthroplasty using contemporary techniques. The average age of the patients at the time of surgery was 48 years old (range, 20-73 years). The average preoperative hip score was 45.6 points (range, 28-75 points), which improved to 90.3 points (range, 34-100 points) at the 7.2-year followup examination. Sixteen of 78 arthroplasties failed in the period of followup, for an overall failure rate of 20.5%. Of the failed hips, 11 had femoral component loosening, 4 had femoral and acetabular component loosening, and 1 had excessive wear in the polyethylene liner. Four femoral components and 5 acetabular components were revised. Twenty-one of the 78 hips (27%) had an average of 5.6 mm (range, 3-9 mm) of wear in the polyethylene liner. Sixteen (20.5%) of 78 hips had acetabular and femoral periprosthetic osteolysis, and 22 (28.2%) hips had femoral periprosthetic osteolysis only. The cementless total hip arthroplasty in this series had a higher incidence of aseptic loosening of the femoral component, polyethylene liner wear, and periprosthetic osteolysis than that reported for cemented total hip arthroplasty using contemporary techniques.

Adult↗
PubMed1994

Racial differences in the use of total knee arthroplasty for osteoarthritis among older Americans.

The purpose of this study was to determine differences in the use of total knee arthroplasty for osteoarthritis among black and white older Americans and to determine whether clinical and economic factors contribute to these differences. Data on black and white Americans aged 65 years and older were gleaned from national Medicare hospitalization records for 1980 through 1988 and the Medicare enrollment file for 1987, the First National Health and Nutrition Examination Survey of 1971 through 1975, the National Hospital Discharge Survey of 1979 through 1988, the 1980 through 1988 US census counts and estimates, and 1980 census economic data. Information gathered includes prevalence of osteoarthritis of the knee among blacks and whites; rate of total knee arthroplasty use in the United States by race, sex, and age of subjects at the time of operations; use of competing procedures; and economic factors. Results showed that blacks were less often treated with total knee arthroplasty than were whites (white-to-black rate ratios = 3.0 to 5.1 for men and 1.5 to 2.0 for women) but had nonsignificantly higher rates of clinical osteoarthritis of the knee (white-to-black rate ratios = 0.39 for men and 0.78 for women). This racial difference in total knee arthroplasty rates was consistent across income levels and was unexplained by black patients' having operations at earlier ages or using competing procedures. Furthermore, the discrepancy occurred even among Medicaid-eligible Medicare recipients, who had no direct economic disincentive for surgery. These findings suggest that even though elderly blacks have higher rates of knee osteoarthritis, they do not receive total knee arthroplasty as often as do elderly whites. This discrepancy does not appear to have an economic explanation. Even if a comprehensive care system were in place to remove economic barriers, inequality in the use of this procedure would likely persist. Future studies should assess the nonclinical and noneconomic causes of these differences.

Black or African American↗
PubMed1994

Evaluation of biocompatible osteoconductive polymer shelf arthroplasty for the surgical correction of hip dysplasia in normal dogs.

Biocompatible osteoconductive polymer (BOP) shelf arthroplasty was performed on ten nondysplastic dogs, divided into five groups. Each group was evaluated at 6, 13, 17, 26 or 39 weeks postsurgery. Evaluation consisted of clinical, radiological and histological studies. The dogs were injected with three fluorochrome markers, 28 days, 14 days and 6 hours before euthanasia. Transverse sections of undecalcified arthroplasty site were examined by microradiography and fluorescence microscopy; surface-stained sections were evaluated by light microscopy. The BOP shelf arthroplasty was not technically difficult. Minimal mineralization of the shelf was noted by radiography, 26 and 39 weeks postop. A moderate to large amount of fibrous mature connective tissue was observed around the BOP fibers throughout the study. Bone ingrowth occurred around the BOP fibers, but was minimal within them. This osseous proliferation of the arthroplasty was very slow to take place; it was first noted microscopically 17 weeks postsurgery and was still minimal 39 weeks after surgery. These findings suggest that there may be interference to the osteoconductive properties of BOP by fibrous tissue. Ossification of the shelf arthroplasty was too unsatisfactory to recommend its use for the treatment of canine hip dysplasia.

Animals↗
PubMed1994

Bipolar shoulder arthroplasty.

Bipolar shoulder arthroplasty was designed as a salvage procedure for the arthritic shoulder with a massive rotator cuff tear. Between 1985 and 1989, 14 patients were treated with a bipolar shoulder arthroplasty and were followed for a mean of 3.3 years (range, 2-4.8 years). Two patient populations were studied, including: (1) rheumatoid patients undergoing a primary shoulder arthroplasty, and (2) reconstructive patients undergoing a secondary reconstructive procedure. The rheumatoid group had overall good pain relief. The average postoperative active forward flexion, abduction, and external rotation was 79 degrees, 66 degrees, and 20 degrees, respectively. The reconstructive group had fair pain relief, with an average postoperative active forward flexion, abduction, and external rotation of 39 degrees, 44 degrees, and 12 degrees, respectively. Six of seven complications were noted in the reconstructive group, including two bipolar cup dislocations, one bipolar cup subluxation, and one loosening of the prosthesis. The factors associated with complications included absence of an intact subacromial arch and deltoid abnormality. The bipolar shoulder arthroplasty appears to be an alternative to a primary arthroplasty for the arthritic rheumatoid shoulder with a massive rotator cuff tear.

Activities of Daily Living↗
PubMed1994

Hip arthroplasty for osteonecrosis after renal transplantation.

The treatment of osteonecrosis in renal-transplant patients with hip arthroplasty was reviewed. From 1972 to 1988, the surgical treatment evolved from the use of cemented total hip arthroplasty (THA) to uncemented bipolar hemiarthroplasty to, most recently, porous-ingrowth THA. During this period, 46 patients had 77 hip arthroplasties. Cemented replacement was used in 32 hips, uncemented bipolar replacement in 32, and porous-ingrowth arthroplasty in 13. At the two- to 18-year follow-up evaluations, the average Harris hip rating was 89 points. Ratings averaged 82 points at 8.7 years in cemented hips, 91 points at six years in bipolar hips, and 90 points at 3.1 years in uncemented hips. Loosening occurred in 46% of hips with cemented total hip prostheses, 9% of hips with bipolar prostheses, and in no hips with porous-ingrowth components. Aseptic revision rates were 31%, 12.5%, and 0% respectively. Infection rates were 0%, 9%, and 10% respectively. Although the follow-up period was shorter for bipolar and uncemented THAs, uncemented bipolar hemiarthroplasty and porous-ingrowth THA may be reasonable alternatives for the renal-transplant patient with osteonecrosis rather than cemented THA, which has a high long-term failure rate. The early results of porous-coated hip arthroplasty are satisfactory in patients with a functioning renal transplant.

Adult↗
PubMed1994

Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol.

Forty-four patients (46 hips) with infected total hip arthroplasties were evaluated. They were entered into a protocol that included resection arthroplasty, six weeks of intravenous antibiotics which obtained a minimum postpeak serum bactericidal titer of 1:8, and possible reimplantation. Thirty-two of 46 hips (70%) were reimplanted. At an average of 40 months (range, 24-74 months) after reimplantation, infection recurred in three hips (9%). In two of the three recurrent infections, 1:8 bactericidal titers were not attained. Both of these hips were infected with gram-negative organisms. Minimum postpeak serum bactericidal titers of 1:8 were attained in 28 of 32 hips that were reimplanted, and only one of these hips (4%) had a recurrent infection (p = 0.035). The presence of retained cement after resection arthroplasty (ten hips) was not associated with recurrent infection. Fourteen hips (12 patients were not reimplanted as a result of a combination of factors, including inadequate bone stock, poor soft-tissue quality, and antibiotic resistance of the infecting organism. The treatment of an infected total hip arthroplasty with resection arthroplasty, six weeks of intravenous antibiotics that attains a minimum postpeak serum bactericidal titer of 1:8, and reimplantation can be an effective and safe treatment.

Adult↗
PubMed1993

Allograft salvage of failed total elbow arthroplasty. A report of two cases.

Infection after total elbow arthroplasty (TEA) is a devastating complication. Current management options include (1) salvage of the implant with debridement and parenteral antibiotics, (2) resection arthroplasty, and (3) arthrodesis. Most infected TEA patients ultimately require resection arthroplasty. Inadequate bone may preclude both revision TEA and successful resection arthroplasty. It is in these cases that the patient may benefit from allograft reconstruction. Two patients with painful flail elbows secondary to previous resection arthroplasties were treated successfully with cadaver allograft augmented with in situ autograft. Use of the allograft resulted in improvement from failure to excellent in this patient with posttraumatic arthrosis at five years after operation and from failure to good in a rheumatoid patient at two years after operation. Autograft-augmented allografts in the resected failed-TEA patient are a valuable and bone-preserving option. This may be especially useful in patients with significant bone loss or young patients with posttraumatic arthrosis, for whom arthrodesis may be the only other surgical option. The method should not preclude further revision TEA.

Aged↗
PubMed1993

A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient.

The goal of this study was to determine if obesity is a risk factor for total joint arthroplasty. This was a retrospective review of 130 patients treated with either primary total hip arthroplasty or primary total knee arthroplasty during a two-year period (154 consecutive arthroplasties). The patients were placed in the nonobese or obese group. Obesity was defined as 20% above ideal weight for height, based on life insurance tables. There were 51 in the nonobese groups and 103 in the obese group. Charts were reviewed for a number of factors associated with postoperative complications. Operative time, intravenous fluids administered, and total blood loss were found to be slightly higher in the obese group. Only the difference in operative time proved statistically significant, however. The hospitalization time, number of days with a fever, number of transfusions, preoperative and postoperative hemoglobin levels, and days requiring intramuscular narcotics were very similar between the two groups. There were 0.29 minor complications per nonobese patient, but only 0.22 per obese patient. Major complications were encountered 0.22 times per nonobese patient and 0.10 times per obese patient. The patient is not necessarily at a higher risk for peroperative complications in total joint arthroplasty. The longevity of the implant in the obese patient was not determined in this perioperative study.

Aged↗
PubMed1996

Assessment of HCFA's 1992 Medicare hospital information report of mortality following admission for hip arthroplasty.

OBJECTIVE: The Health Care Financing Administration (HCFA) produced annually from 1987 through 1994 mortality data information as part of the Medicare Hospital Information Project (MHIP) report. We assessed the validity of these data for hip arthroplasty for one state Medicare population and we analyzed the accuracy of the predictions derived from the Bailey-Makeham mortality model for this procedure. DATA SOURCES AND STUDY SETTING: The study sample consisted of claims and model data from 1,421 Medicare patients who underwent hip arthroplasty at acute care Arkansas hospitals from October 1990 through September 1991. STUDY DESIGN: Patients were stratified into two groups based on reason for surgery (fracture status): reconstruction or fracture management. Patient survival experience was compared between the two groups. The effect of fracture status on the HCFA model's predictive ability was examined empirically and via a simulation study. RESULTS: Our results indicate that hip arthroplasty patients are not uniform with regard to outcome, depending on the reason for the surgery. Patients with fracture had a much higher 30-day mortality rate than those who underwent reconstruction (p < .001). The empirical data and the simulation study suggest that the Bailey-Makeham model underestimates mortality for reconstructive surgery in fracture patients, providing a false benchmark for those institutions that perform hip arthroplasty on predominantly one category of patients. CONCLUSION: Published HCFA data concerning mortality for hip arthroplasty combines two different patient populations into one statistic. Casual examination of these data could result in a false benchmark for analysis of institutional performance. An important implication from this study for policymakers who base decisions on "report cards" or performance measurement reports is that, although they are necessary,generic case-mix, comorbidity, and severity of illness adjustments may not be sufficient to achieve accurate representations of outcomes, and that more disease/procedure--specific adjustments may be needed to avoid inappropriate conclusions.

Arkansas↗
PubMedDate not supplied

Total knee arthroplasty after proximal tibial osteotomy.

The cases of ten total knee arthroplasty after a proximal tibial osteotomy were compared with those of 50 primary total knee arthroplasty for osteoarthritis. The groups were matched according to age of patients, length of follow-up and type of prosthesis used. On the basis of HSS, an excellent or good result was obtained in 90% of patients who had had arthroplasty after osteotomy and in 94% of patients after a primary arthroplasty. Though some intraoperative difficulty may be encountered in a secondary prosthesis, osteotomy does not compromise a subsequent arthroplasty.

Aged↗
PubMed1996

Perioperative alterations of the thromboelastography in patients receiving one-stage bilateral total knee arthroplasty.

BACKGROUND: Total knee arthroplasty is associated with activation of coagulation and fibrinolytic system in the perioperative period. The coagulation and fibrinolytic activation in one-stage bilateral total knee arthroplasty has not been described before. Thromboelastography is a real-time aid in the monitoring of coagulation and is clinically valuable in the evaluation of whole blood hemostasis. We evaluated the coagulation and fibrinolysis system activation during and after one-stage bilateral total knee arthroplasty by thromboelastography. METHODS: Twenty patients, ASA class I-II, undergoing one stage bilateral total knee arthroplasty were included in this study. All patients received continuous spinal anesthesia with isobaric 0.2% bupivacaine. Arterial blood samples were obtained for thromboelastography in the following sequences (1) after induction of anesthesia (baseline), (2) 20 min after releasing tourniquet of the first leg (3) 20 min after releasing tourniquet of the second leg, (4) 2 h postoperatively, (5) 24 h postoperatively. RESULTS: There was a significant shortening of reaction time (R value) after deflation of the first leg tourniquet, and a further decrease of R value after deflation of the second leg tourniquet and two hours postoperatively. The perioperative change of coagulation time was similar to that of R value. The maximum amplitude decreased after releasing tourniquet of the second leg and two hours postoperatively. CONCLUSION: The activation of coagulation, as monitored by thromboelastography, is predominant in one-stage bilateral total knee arthroplasty after releasing tourniquet of the second leg and returns to baseline 24 h postoperatively.

Aged↗