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PubMed1997

The Rotaflex total knee replacement--a 5 year review.

We report the results of a retrospective analysis of 43 patients who received 56 Rotaflex total knee arthroplasties, with a mean follow-up of 55.7 months. The British Orthopaedic Association (BOA) knee assessment protocol was used in evaluating the clinical results. Two patients could not receive post-operative scores. In the remaining 54 knees, the mean pre-operative score was 25.6, improving to 30.8 post-operatively. Ten knees showed a decrease in knee score, two were unchanged and 42 improved. The greatest improvements were in pain relief and maximum flexion. Wound infection and dehiscences were common, the latter requiring further surgery in five cases. Later, there were eight fractures involving the prosthesis, seven dislocated or subluxed patellae, two deep infections and three cases of severe aseptic loosening. A common feature was severe patellar wear, due to the design fault of an absent femoral groove. The high rate of complications and poor functional result of the Rotaflex knee preclude its use in current practice.

Activities of Daily Living↗
PubMedDate not supplied

Cerebrospinal fluid shunt complications.

We report our experience with cerebrospinal fluid shunt procedures performed on 306 patients between 1983 and 1993. Patients were between the ages of one day and 15 years (average 14.9 months) on admission. Three hundred and thirty-six shunt placements and 274 revisions were done. The first complication occurred in the first postoperative month in 52 patients and within the first six months following surgery in 97 patients. Age was determined as a statistically significant factor in only infection and the slit ventricle syndrome (SVS). Shunt types and systems were not significant factors causing complications. The level of consciousness of the patients at the time of surgery influenced the rate of complications; patients with impaired consciousness at the time of surgery had higher complication rates than those operated on in a normal state of consciousness (41% and 8.5%, respectively).

Adolescent↗
PubMed1997

[Radiologic aspects of the loosening of cemented hip prostheses: mechanical, septic or granulomatous etiology?].

Radiologic diagnosis of hip prosthesis loosening is based on the evaluation of each component (prosthesis, cement, bone) and of their interfaces. Both the prosthesis and the cement may deteriorate and the prosthesis/cement interface or cement/bone interface may become abnormal in prosthesis loosening of any etiology. In contrast, the aspect of the bone changes (erosion, periostitis) and their distribution vary according to the condition etiology. It appears from a retrospective study of 50 cases of chronic hip prosthesis loosening that the most specific signs for infection are unsharp bone resorption and acute-like or multifocal periostitis. In granulomatous loosening, bone resorption is sharp (as in mechanical loosening), but its distribution is not conform to the prosthesis shape (as in septic loosening), and periosteal changes are not observed.

Arthroplasty, Replacement, Hip↗
PubMed1997

The Insall Award. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications.

A series of patients with rheumatoid arthritis underwent total knee replacement with posterior cruciate ligament retention and was observed a minimum of 6 years and a mean of 8.2 years. A group of patients with osteoarthritis with an identical prosthesis and a group of patients with rheumatoid arthritis with a posterior stabilized implant served as controls. In the rheumatoid arthritis group with posterior cruciate ligament retention, there was an increased incidence in posterior instability and recurvatum deformity, resulting in an increased revision rate. Those patients undergoing revision for instability had a higher incidence of recurrent synovitis, and at revision the posterior cruciate ligament was grossly absent with a Grade 1 synovial reaction. In patients with rheumatoid arthritis undergoing total knee replacement, a posterior stabilized prosthesis rather than a posterior cruciate ligament sparing prosthesis should be used.

Aged↗
PubMed1997

10- to 20-year followup of total knee arthroplasty for valgus deformities.

One hundred eight knees in 83 patients with a valgus alignment of greater than 10 degrees underwent total joint replacement performed by a single surgeon using the same technique for ligament balancing, which involved releasing the lateral retinaculum and iliotibial band, followed when necessary by detaching the lateral collateral ligament and popliteus tendon from the femur. Sixty knees in 46 patients had followup of at least 10 years and were the focus of study. At an average followup of 14.1 years, the mean Knee Society knee score was 88.7 and the mean functional score was 69.2. Postoperative knee alignment averaged 4.5 degrees with 75% of the knees corrected to between 2 degrees and 7 degrees valgus. Postoperative flexion averaged 101 degrees. There were no cases of peroneal nerve palsy or patellar dislocation. Six knees underwent revision surgery with two for sepsis, three for aseptic loosening, and one for a traumatic patella fracture. Radiographic component loosening also was seen in one knee. The probability of retention of the prosthesis was 91% (+/- 11.7%) at 13.2 years. Although the results in this group of patients seem acceptable, the rate of postoperative instability for all patients treated using this ligament balancing technique was 24%. Because of the high rate of instability, a new soft tissue release technique has been developed and is the preferred method for ligament balancing of the valgus knee during total knee arthroplasty.

Adult↗
PubMed1997

[Temporary antibiotic-loaded cemented prosthesis for two-stage septic hip arthroplasty].

PURPOSE OF THE STUDY: During the excision period of a two-stage revision arthroplasty, the hip has a low function and an unacceptable leg length discrepancy. The goal of this study was to expose technical details in order to perform a simple articulated cement spacer which could be implanted during this period to improve hip function, to authorize partial weight bearing and to avoid leg length discrepancy. MATERIAL: This method was applied in three two-stage procedures justified because of particular immunodeficiency conditions: a 43 years old man who had bone marrow allograft and immunosuppressive therapy because of leukemia suffering of subacute septic hip arthritis; a 58 years old man suffering of diabetes and active C-hepatitis who had a septic loosening of a total hip arthroplasty (THA); a 76 years old woman suffering of diabetes who had a third septic loosening of THA. METHOD: The prosthesis was made of antibiotic-impregnated cement according to organisms antibiotic resistance. The prosthetic junction between head and diaphysis was reinforced with a tibial plate. Prosthetic shape was identical to the one of femoral broaches inserted in the femur after prosthetic and cement removal. The broach size was chosen when mechanical stability in the femur was obtained, and avoided leg length discrepancy after trials with cups. The tibial plate was bent in order to reinforce the junction with regard to the shape of the determined broach. Two doses of antibiotic-impregnated cement were mixed and molded with hands, then the plate was incorporated at the appropriate location, finally the broach was applied on this composite and cement in excess was removed before polymerisation. For prosthetic head, two options were available: to mold the cephalic zone of the cement at the patient acetabulum diameter with a soft aluminium cup previously molded in the acetabulum; to mold the cement cephalic zone with a trial cup in order to obtain a 22 or 28 ball. For this last option, a third dose of antibiotic-impregnated cement was prepared and placed in the acetabulum, a trial femoral head was applied in it to mold the location for the 22 or 28 prosthetic head. Before insertion, a collar was applied on the stem to prevent migration. Active mobilization was encouraged, and partial weight-bearing authorized. RESULTS: The mean range of hip flexion during period was 60 degrees. The patients were discharged approximatively 12 days after the first stage. Two patients had effective painless partial weight-bearing. The second stage was performed six weeks later on the average. The second procedure was easier than the second stage of a conventional two-stage procedure because of: easy and low hemorrhagic dissection authorized by the prosthesis; low difficulties with soft tissue tension as the prosthesis prevents leg length discrepancy; preservation of the articular space which prevents soft tissue sacrifice during the second stage. CONCLUSION: This simple technique is effective to prevent complications related to the excision period of a two-stage hip revision arthroplasty. Likewise, the economical aspect (short delay of hospitalisation, quick functional recovery) should be considered when compared with the excision period of a conventional two-stage procedure.

Adult↗
PubMed1997

Experience with proximal ingrowth implantation in hip revision surgery.

A 2 to 8 year review of 104 cases of Type III hip revisions with a proximally modular proximal ingrowth non-cemented stem has been carried out. Four re-revisions were required, 1 early for a femur which was too broken up to support an implant, 1 for late sepsis re-activation, 1 for knee pain, and 1 at 4 years for aseptic loosening. Of the remainder, 81.8% had a good or excellent result with most problems being experienced in the acetabular side. 68.8% show no radiolucency and only 3 cases, including the revised one, show complete stem radiolucency. It is concluded that in the medium term, proximal ingrowth implants can be used in revision hip surgery.

Adult↗
PubMed1997

The HA-coated ABG socket in revision arthroplasty.

The favourable results we achieved in primary THR with the ABG HA-coated hemispheric metal backed cup led us to use this same cup in revision arthroplasty. Changes in inclination and migration of the cup were measured, as well as the radiologic appearance of the bone-cup interface. The most important features are quick osseointegration and immediate stability. The early and three to five years results with the use of the ABG HA-coated cup in revision arthroplasty are promising.

Acetabulum↗
PubMed1998

4- to 10-year results with the anatomic modular total knee.

The outcome of 186 consecutive total knee arthroplasties performed with the Anatomic Modular Knee is reported. One hundred forty-two knees had followup of 4 to 10 years (mean, 6.9 years). Two knees required revision of all components, one because of infection and the other for instability. Seven patients underwent exchange of the modular tibial polyethylene insert at an average of 84 months postoperatively. The mean age of these seven patients at primary arthroplasty was 54 years. No implant showed clinical or radiographic evidence of loosening and there were no complications related to patellofemoral articulation. The revision rate of the femoral, tibial, and patellar components was two of 142 or 1.4%. The revision rate including exchange of the polyethylene insert was nine of 142 or 6.3%. This minimally constrained posterior cruciate retaining modular design performed well at intermediate followup. The absence of patellofemoral complications and aseptic loosening was notable. Wear related phenomena were the most common indications for reoperation and these occurred in younger, active individuals with relatively thin polyethylene bearings. The relative value of modular tibial inserts and the outcome of isolated polyethylene exchanges warrant additional study.

Adult↗
PubMed1998

Advances in total hip arthroplasty.

Total hip arthroplasty is an operative procedure in which the diseased and destroyed hip joint is resected and replaced with a new bearing surface. Since its introduction into the surgical management of the arthritic hip in the early 1960s, total hip arthroplasty has helped alleviate the suffering of millions of patients throughout the world. Patients with coxarthrosis can now look to total hip arthroplasty as a reliable means of pain relief and improved function. While the operation has been successful over the years, problems have manifested themselves as the length of follow-up has increased. As total hip arthroplasty approaches its fourth decade of use, we outline these problems and the proposed solutions.

Acetabulum↗
PubMed1998

Maximizing cost-effectiveness while minimizing complications in total hip replacement.

Between July 1989 and June 1994, a consecutive series of 651 cemented total hip arthroplasties were performed in 577 patients using relatively inexpensive implants and standardized surgical and postoperative protocols. We set out to determine what effect these cost-saving measures have on the overall success and complication rate after total hip replacement surgery. Surgical results remained excellent, and perioperative, early, and late complications, including infection, loosening, and revision hip surgery, remained minimal, indeed, below usual complication rates. We concluded that cost-effective measures can be implemented while maintaining the overall excellent results of hip replacement surgery without the risk of increasing complication rates.

Adult↗
PubMed1997

-Arthrography of the hip prosthesis-.

Arthrography of hip arthroplasties is a safe, easy-to-perform procedure. It is mainly indicated when infection of the arthroplasty is suspected: the contrast agent fills bone defects that may be present between normal bone and the prosthesis and reaspiration of injected fluids may lead to bacteriological diagnosis. Another indication for arthrography of hip arthroplasties is unexplained painful hip prosthesis.

Arthrography↗
PubMed1997

-Knee prosthesis-.

The initial radiological assessment of knee osteoarthritis includes the evaluation of the osteochondral destruction, collateral ligament laxity and the determination of the position of the patella in both the axial and the sagittal planes and the femorotibial angulation in the coronal plane. The different types of knee prostheses are described. Post-operative radiological features of knee arthroplasties are discussed including normal findings and criteria of prosthesis instability and loosening.

Arthroplasty, Replacement, Knee↗
PubMed1998

[Surgery of infectious endocarditis].

Thirty to fifty percent of patients with infective endocarditis are operated on during the active phase of the disease; this percentage is higher in case of some valvular localizations (aortic), in case of early prosthetic valve endocarditis, in case of some microorganisms (Staphylococcus aureus, gram-negative, fungus, intracellular microorganism). Operative death (at 30 days) is below 10% in native valve endocarditis, close to 50% in early prosthetic valve endocarditis, and below 20% in late prosthetic valve endocarditis. When active infective disease has been healed by medical treatment alone, half the patients need surgery in the first 2 years of follow-up; the indications for surgery are the functional status, the degree of valvular leaks and other lesions, the degree of ventricular dilatation.

Aortic Valve↗
PubMed1998

[The total knee prosthesis: indications and complications].

Severe pain, impaired movement, serious deformity and (or) instability of the knee due to osteoarthritis or another joint disease are indications for total knee replacement. Contraindications are a high surgical risk and poor function of the M. quadriceps femoris. The main problems immediately after the operation are: wound infection and prosthetic infection, palsy of the peroneal nerve and deep venous thrombosis. These occur in approximately 2% of the patients. After replacement and 3 months' rehabilitation the knee is usually free of pain and stable with a good range of movement. After 10 years, 93-98% of the operated knees are still satisfactory, and after 15 years, 85-95%. Reasons for revision are infection, mechanical loosening of components, wear of polyethylene and progressive instability.

Antibiotic Prophylaxis↗
PubMed1999

Reoperation for failed prosthetic replacement used for limb salvage.

Patients with segmental bone and joint replacement prostheses because of tumors increasingly need revision surgery because of their long term survival. Between 1970 and 1990, 208 custom prosthetic replacements were performed for limb salvage in patients with tumors. Reoperations were required in 52 patients. The mean time to reoperation was 37 months. The reoperation procedures included 35 prosthetic revisions, 11 amputations, four arthrodeses, one vascularized fibular graft, and one open reduction and internal fixation of a fracture with supplemental bone graft. Functional assessment using the new Musculoskeletal Tumor Society scoring system was available for the 36 living patients, and their mean rating was 63% (18.9) at 12 years' mean followup. Of the 35 patients who received a new prosthesis, 12 (33%) patients needed a third operation at mean followup of 68 months. The probability of prosthetic survival in the group of 35 patients needing revision to the same or another prosthesis was 79% at 5 years and 65% at 10 years. The chance and frequency of needing reoperation increased as patients survived longer. Reoperations for tumor recurrence or infection usually resulted in amputation. Reoperation for failed initial segmental bone and joint prosthetic replacement is feasible and effective and can be done without jeopardizing subsequent patient and implant survival or without significantly affecting functional results compared with the values before reoperation.

Adolescent↗