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At least 775 records · Page 43Linked to original sources
PubMed2004

[Osteomyelitis after endoprostheses].

Today over 170,000 total hip arthroplasties and about 70,000 total knee arthroplasties are performed in Germany. An overall infection rate of 0.5-1.4% is reported in the literature. This means that 800-1700 infections after total hip arthroplasty and 300-850 infections after total knee arthroplasty can occur. The surgical treatment of early or late infections after arthroplasty of the hip or knee needs different intervention. Depending on when the infection develops, a simple Débridement, an allinone exchange arthroplasty, or the explantation of the endoprosthesis with implantation of a spacer followed by the reimplantation of a new prosthesis must be performed. The first hint of postoperative infection is the increase of the C-reactive protein. By correct treatment of the postoperative wound the first sign of an infection can be detected early.

Anti-Bacterial Agents↗
PubMed2004

Mobile- vs. fixed-bearing total knee arthroplasty: a clinical and radiologic study.

A consecutive series of patients undergoing total knee arthroplasty (TKA) using either a mobile-bearing (MB) or a fixed-bearing (FB) implant were studied. Forty-four patients received 57 MB rotating platforms, and 40 patients received 45 FB posterior stabilized implants. At an average 41-month follow-up (range, 2-6 years), no significant differences were found between the groups with respect to Knee Society ratings or pain scores. Postoperative flexion was not different between the groups (116 degrees for MB and 118 degrees for FB). Three MB knees were revised for implant-related complications. There was no difference between these MB or FB knee implants clinically or radiographically at early follow-up. However, more patients with a MB knee required early revision for failure of rotating patellar or tibial polyethylene implants.

Adult↗
PubMed2007

Guidelines for the replacement of temporomandibular joints in the United Kingdom.

BAOMS has requested that guidelines be formulated for the replacement of the temporomandibular joint (TMJ). This is an expensive and technique sensitive method of TMJ reconstruction and in the current climate warrants an agreed approach. The following document states the indications and contraindications for this technique as discussed and agreed amongst surgeons currently carrying out this procedure in the UK.

Arthroplasty, Replacement↗
PubMed2005

Total joint arthroplasties: current concepts of patient outcomes after surgery.

Total hip and knee arthroplasties are effective surgical interventions for relieving pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all reports gains or are satisfied after receiving a total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no one patient-related or peri-operative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2006

Implant arthroplasty of the first metatarsalphalangeal joint.

Few topics in foot and ankle surgery incite as much debate as artificial replacement of the great toe joint. As with other implant arthroplasty procedures, such as the hip and knee, the first metatarsalphalangeal joint (MTPJ) has most assuredly had its share of failed designs. This article reviews the shortcoming of nonimplant procedures and discusses the advantage of the Arthrosurface system, a new implant that has been used in all major joints to replace degenerative areas and postpone the need for total joint replacement.

Arthroplasty, Replacement↗
PubMed2006

Rheumatoid arthritis: silicone metacarpophalangeal joint arthroplasty indications, technique, and outcomes.

Silicone implant arthroplasty has been used for more than 40 years for severe rheumatoid disease at the metacarpophalangeal (MCP) joint. Multiple investigations have shown that silicone arthroplasty places the MCP joint in a more extended posture, with some improvement in the total arc of motion. Ulnar drift is also improved, but strength and other objective measures have not demonstrated marked changes postoperatively. The lack of prospective data and more complete outcome assessment has been, at least in part, responsible for the marked difference in opinions between rheumatologists and hand surgeons on the effectiveness of MCP arthroplasty. Recent reports using patient-centered outcome measures have shown that early outcome is favorable, with improvements in appearance, pain, and function.

Arthritis, Rheumatoid↗
PubMed2004

Metacarpophalangeal joint mechanics after 3 different silicone arthroplasties.

PURPOSE: This study was performed to compare metacarpophalangeal (MCP) joint mechanics after arthroplasty with 3 currently available silicone implants and to determine how postarthroplasty mechanics compares with the mechanics of the intact joint. METHODS: Planar 2-dimensional kinematic analysis was performed using digitized radiographs on 10 isolated fingers harvested from 5 fresh-frozen human cadavers. Radiopaque markers were affixed to the metacarpals and proximal phalanges, sewn to the flexor and extensor tendons, and placed into the stems and hinges of the implants. Each finger was tested intact, and after MCP joint replacement with 3 implants (Swanson [Wright Medical, Memphis, TN], Avanta [Avanta Orthopaedics, San Diego, CA], and NeuFlex [DePuy Orthopaedics, Warsaw, IN]). The fingers were secured to the test fixture and the flexor digitorum profundus flexor and extensor tendons were loaded with physiologic weights. Lateral radiographs were taken at approximately 10 degrees intervals and were digitized on a high-resolution scanner. Instantaneous center of rotation (ICR), tendon excursion, and tendon moment arm were calculated. Statistical analysis was performed using repeated measures one-way analysis of variance and Dunnett post tests. RESULTS: The ICRs of the intact and implanted MCPs did not follow a smooth path. The variability of the ICRs of the intact MCP joints was 2.1 +/- 0.8 mm. The variations in the Avanta and DePuy implants were similar (3.1 +/- 1.0 mm and 3.5 +/- 1.5 mm, respectively), whereas the Swanson implant was higher (4.9 +/- 1.7 mm). Implant pistoning was most pronounced with the Swanson implant, which moved 2.40 +/- 0.97 mm over the full range of motion. The Avanta and DePuy implants pistoned significantly less than the Swanson implant (1.05 +/- 0.45 mm and 0.69 +/- 0.31 mm, respectively). Flexor tendon excursion was greater for the intact joint when compared with all 3 implants while extensor tendon excursion was similar for all. Flexor tendon moment arm was similar for the intact joint and the Avanta and NeuFlex implants whereas the Swanson implant was reduced significantly; extensor tendon moment arms were similar for all. CONCLUSIONS: The ICR of the NeuFlex implant most closely matched that of the intact MCP joint. The Swanson implant had greater pistoning and dorsal-volar translation when compared with the intact joint and the Avanta and NeuFlex implants. The block-hinge type design of the Avanta and NeuFlex implants improved tendon moment arm overall when compared with the Swanson, likely imparting greater functional ability for finger motion. Overall the NeuFlex implant most closely matched the ICR, tendon excursion, and moment arm when compared with the intact native MCP joint.

Aged↗
PubMed2005

A comparative study of outcome between the Neuflex and Swanson metacarpophalangeal joint replacements.

This prospective double blind trial compares the clinical findings of Swanson and Neuflex metacarpophalangeal joint replacements in patients with rheumatoid arthritis, up to 2 years follow-up. There were 37 joints (10 patients) in the Swanson group and 40 joints (12 patients) in the Neuflex group. Assessments of range of movement, grip strength and hand function were undertaken in a double blind fashion, pre-operatively and up to 2 years following implantation. The mean and standard deviation of the data were calculated. A two-tailed student's t-test was used when comparing groups of data. An X-ray analysis was also undertaken to identify any implant failure. There was no significant difference between the two groups with respect to flexion and extension before surgery. At follow-up there was also no significant difference in the extensor lag, with mean extension lags of 19 degrees and 16 degrees for the Swanson and Neuflex implants, respectively. However, there was a significant difference in flexion, with mean active flexion values of 59 degrees and 72 degrees for the Swanson and Neuflex implants, respectively. There were no differences between the two groups in respect to arc of metacarpophalangeal joint motion, ulnar deviation, grip strength or the SODA function test at follow-up. At this early stage there was no evidence of any case of implant failure. In conclusion, patients who underwent Neuflex metacarpophalangeal joint replacements obtained greater flexion than those who underwent a Swanson replacement.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Influence of glenohumeral conformity on glenoid stresses after total shoulder arthroplasty.

Glenohumeral conformity has been reported to be one of the most critical implant-related features that may affect the occurrence of glenoid loosening. This study evaluated the mechanical effects of this parameter with a 3-dimensional finite element model of a prosthetic shoulder, which included the scapula, the humerus, and the rotator cuff muscles. Aequalis humeral and glenoid components were implanted numerically according to manufacturer's recommendations for 2 different orientations of the glenoid component (0 degrees and 15 degrees of retroversion). Different values of glenohumeral conformity (1-15 mm of radial mismatch) were tested by a progressive flattening of the glenoid surface. Free and countered rotation movements were simulated. Glenohumeral contact pressure, cement stress, shear stress, and micromotions at the bone-cement interface were calculated. At 0 degrees of retroversion, conformity had only a slight effect, whereas at 15 degrees of retroversion, all quantities increased by more than 200% and exceeded critical values above 10 mm of mismatch.

Arthroplasty, Replacement↗