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 829 records · Page 46Linked to original sources
PubMedDate not supplied

Shoulder arthroplasty for locked posterior dislocation of the shoulder.

Currently, there are no published series with mid- to long-term results on patients undergoing shoulder arthroplasty for locked posterior dislocation of the shoulder. We reviewed the results of patients who underwent shoulder arthroplasty for locked posterior dislocation of the shoulder to determine the results, the risk factors for an unsatisfactory outcome, and the rates of failure. Twelve shoulder arthroplasties were performed at our institution, between January 1, 1980, and December 31, 1997, in 12 patients who had a locked posterior dislocation of the shoulder. All 12 patients were followed up for a minimum of 5 years (mean, 9.0 years) or until the time of revision surgery. There was significant pain relief (P <.001) as well as improvement in external rotation from -13 degrees to 28 degrees (P =.001). On the basis of a modified Neer result rating system, there was 1 excellent, 6 satisfactory, and 5 unsatisfactory results. Three patients underwent revision surgery for posterior instability (two) and component loosening (one). Recurrent instability occurred in two patients in the early postoperative period. There were no cases of recurrent instability greater than 1 year from the time of surgery. The data from this study suggest that shoulder arthroplasty for locked posterior dislocation provides pain relief and improved motion. Among those with recurrent posterior instability, it usually appears in the early postoperative period.

Adult↗
PubMedDate not supplied

Total elbow arthroplasty failure due to overuse, C-ring failure, and/or bushing wear.

Semiconstrained, linked total elbow arthroplasty gives excellent functional results. However, the complication rate is relatively high, and complications are frequently significant enough to require revision surgery. The purpose of this study is to report on bushing wear and C-ring failure as a mid- to late-term complication of the Coonrad-Morrey total elbow arthroplasty. Two surgeons at different institutions treated 10 patients who had a previous Coonrad-Morrey total elbow arthroplasty and presented with C-ring and/or bushing wear. There were 8 men and 2 women. The mean age at the time of the initial total elbow arthroplasty was 54 years (range, 37-67 years). Time to revision averaged 60 months (range, 9-156 months). Common associated factors were posttraumatic arthritis (3), supracondylar nonunion (5), male sex, young age, and high activity level. A proposed mechanism of failure is postulated.

Activities of Daily Living↗
PubMed2006

The outcome of resection shoulder arthroplasty for recalcitrant shoulder infections.

Postarthroplasty infection is a devastating complication. In some patients, virulent pathogens or poor health complicate reconstruction. Resection arthroplasty is a viable option in such cases. Seven patients with resection arthroplasty following infection after shoulder arthroplasty were reviewed retrospectively at an average 20- month follow-up (range, 12-41). Average time between the initial procedure and the first debridement was 59.5 months (4-151 months). The average number of debridements was 2.2 per patient (range, 1-4 procedures). There were no complications, no recurrence of deep infection, no nerve damage, and no fractures. All patients were able to reach the opposite axilla, their backpocket and perineum, and their mouth. All but 1 patient were satisfied with their result. No patient had a satisfactory outcome via Neer's criteria. Resection arthroplasty is a reasonable salvage option for patients who are not good candidates for prosthetic reimplantation. This yields patients who can reliably perform basic activities of daily living.

Aged↗
PubMed2005

5 degrees to 6 degrees of distal femoral cut for uncomplicated primary total knee arthroplasty: is it safe?

The angle formed between the anatomical axis and mechanical axis of the femur determines the angle of resection of distal femur in total knee arthroplasty. The objective of this study was to analyse the safety of the routine practice of selecting 5-6 degrees of valgus for distal femoral cut during uncomplicated primary total knee arthroplasty. A retrospective study was undertaken involving a review of pre-operative CT scout films of osteoarthritic knees in 83 consecutive patients (44 males and 39 females; mean age 70 years) who presented for total knee arthroplasty. The anatomical and mechanical axis of femur were plotted on CT scout films and the angle between the two femoral axes were measured. Mean femoral axes angle was 5.4 degrees (range 3.3-7.6 degrees, SD 0.9 degrees). Estimated 95% confidence interval of the mean for the population was 5.2-5.6 degrees. There were no significant differences for age, gender or laterality of the limb. The routine practice of selecting 5 degrees to 6 degrees of the distal femoral cut for an uncomplicated primary total knee arthroplasty is safe.

Aged↗
PubMed2006

Total knee arthroplasty effectiveness in patients 55 years old and younger: osteoarthritis vs. rheumatoid arthritis.

In the past, total knee arthroplasty, although very successful, was only indicated for an elderly population. Recently though, several papers have been published confirming that total knee arthroplasty is effective in younger patients. This paper supports the results of those papers. In our study, 207 total knee arthroplasties were performed on patients 55 years old and younger using a posterior cruciate-retaining prosthesis. There was an overall survival rate of 97.6% with an average follow-up of 9.1 years. There were some minor variations in the outcome of the operation based on diagnosis (osteoarthritis vs. rheumatoid arthritis). The success also continued over time with an estimated survival rate of 94.8% at 12 years. Total knee arthroplasty is an effective operation in patients younger then 55 years old.

Adolescent↗
PubMed2005

Biomechanics of lumbar arthroplasty.

There are many issues to consider in evaluating the biomechanics of lumbar arthroplasty, which may consist of a nucleus replacement, a total disc replacement, or a mobile posterior device. The goal of spinal arthroplasty is to replicate or augment the function of the normal spinal elements, by taking into consideration both in the quantity and quality of motion that occurs across the replaced joint. This article describes the relevant parameters for studying the biomechanics of lumbar arthroplasty and briefly summarizes the current knowledge with regard to those parameters in some well-known lumbar nucleoplasty, facet replacement, and total disc arthroplasty devices.

Arthroplasty↗
PubMed2005

Patient selection and surgical technique for surface arthroplasty of the hip.

Factors such as patient selection, surgical technique, and durable fixation of the components are critical in surface arthroplasty of the hip. The Surface Arthroplasty Risk Index helps determine the risk of failure, with an index score </=3 having a 97% survivorship at 4 years. Because surface arthroplasty of the hip is conservative in nature and has the goal to closely reproduce the normal anatomy of the proximal femur, surgeons performing this procedure need to take into consideration the underlying pathology that led to the degenerative changes. Consequently, choice of surgical approach and positioning of the implants may have a greater impact on implant survivorship and patient function than in standard hip replacement. This article presents case illustrations of different hip pathologies treated by surface arthroplasty of the hip.

Adolescent↗
PubMedDate not supplied

Assessing the potential impact of total disc arthroplasty on surgeon practice patterns in North America.

BACKGROUND CONTEXT: Intervertebral disc replacement has enjoyed a recent surge in popularity largely because of its anticipated release into the North American market. These devices offer an alternative to the 450,000 lumbar and cervical fusion procedures performed by US spine surgeons each year. The unanswered question at the present time is the potential impact, technologically and economically, of cervical and lumbar disc arthroplasty on the practice patterns of North American spine surgeons. PURPOSE: To assess the economic and societal impact of motion-sparing technology in the North American Market. SETTING: A review of the literature and an economic market analysis of the impact of intervertebral disc replacements on surgeon practice in North America. CONCLUSION: The potential economic effect of spine arthroplasty in the United States is staggering with conservative figures approximating $2.18 billion and 47.9% of the market share being captured by motion-sparing technology. Modeling spinal arthroplasty usage and influence after other spinal products, such as cylindrical cages and pedicle screws, may provide insight into the effects of motion-sparing technology. Regardless of the clinical outcome of disc arthroplasty, its potential economic impact will be significant.

Arthroplasty, Replacement↗
PubMedDate not supplied

Design limitations of Bryan disc arthroplasty.

BACKGROUND CONTEXT: Disc arthroplasty is gaining momentum as a surgical procedure in the treatment of spinal degenerative disease. Results must be carefully scrutinized to recognize benefits as well as limitations. PURPOSE: The aim of this study was to investigate factors associated with segmental kyphosis after Bryan disc replacement. STUDY DESIGN/SETTING: Prospective study of a consecutively enrolled cohort of 10 patients treated in a single center using the Bryan cervical disc prosthesis for single-level segmental reconstruction in the surgical treatment of cervical radiculopathy and/or myelopathy. Radiographic and quality of life outcome measures. METHODS: Static and dynamic lateral radiographs were digitally analyzed in patients undergoing Bryan disc arthroplasty throughout a minimum 3-month follow-up period. Observations were compared with preoperative studies looking for predictive factors of postoperative spinal alignment. RESULTS: Postoperative end plate angles through the Bryan disc in the neutral position were kyphotic in 9 of 10 patients. Compared with preoperative end plate angulation there was a mean change of -7 degrees (towards kyphosis) in postoperative end plate alignment (p=.007, 95% confidence interval [CI] -6 degrees to -13 degrees). This correlated significantly with postoperative reduction in posterior vertebral body height of the caudal segment (p=.011, r2=.575) and postoperative functional spine unit (FSU) kyphosis (p=.032, r2=.46). Despite intraoperative distraction, postoperative FSU height was significantly reduced, on average by 1.7 mm (p=.040, 95% CI 0.5-2.8 mm). CONCLUSIONS: Asymmetrical end plate preparation occurs because of suboptimal coordinates to which the milling jig is referenced. Although segmental motion is preserved, Bryan disc arthroplasty demonstrates a propensity towards kyphotic orientation through the prosthesis likely as a result of intraoperative lordotic distraction. FSU angulation tends towards kyphosis and FSU height is decreased in the postoperative state from lack of anterior column support. Limitations of Bryan cervical disc arthroplasty should be carefully considered when reconstruction or maintenance of cervical lordosis is desirable.

Adult↗
PubMed2000

[Factors related to functional outcomes and quality of life after knee arthroplasty].

BACKGROUND: The aim of this work was to describe the early evolution of functional capacity and health related quality of life (HRQL) in patients in rehabilitation after knee arthroplasty, and to identify predictive factors of better outcomes. PATIENTS AND METHODS: Prospective cohort of 141 patients with knee arthroplasty which immediately after the intervention were referred to the rehabilitation unit. The functional capacity (Knee Society Score, KSS) and the HRQL (Medical Outcomes Study Survey Form 36, MOS SF36) were administrated in the first visit and at 3 months of follow-up. Changes between the interval and factors associated to better outcomes were analysed with nonparametric test and multivariate analyses. RESULTS: Patients with knee arthroplasty experienced an important improvement in the KSS score and in 6 dimensions of the MOS-SF36 (except emotional role and general health). Worst functional status and quality of life at the time of starting rehabilitation, rheumatoid arthritis diagnosis and gender (women) were associated with worse prognosis. Age, comorbidity, study level, work situation, social help, live alone and ambulatory treatment were not associated with outcomes. CONCLUSIONS: Patients in rehabilitation after knee arthroplasty improve their functional status and quality of life. The identification of factors with worst prognosis could be useful to modify treatments in some patient's groups.

Aged↗
PubMed1998

Humeral technique in total shoulder arthroplasty.

Humeral head replacement arthroplasty has been performed for more than 40 years. As the technique has been refined and advances have been made in joint arthroplasty of the lower extremity, the indications and success of shoulder arthroplasty have greatly improved. The humeral component in a shoulder arthroplasty can be implanted with either cement or press fit fixation. Both techniques are precise and demand meticulous attention to detail to achieve optimum results for the patient. Press fit fixation, with or without porous coating for biologic ingrowth, can be considered for a patient with good bone stock, if it is felt that a stable interface can be obtained. In patients with abnormal bone, such as those with rheumatoid arthritis who are on corticosteroids and those with osteoporosis, the use of cement can provide stable long-term fixation.

Adrenal Cortex Hormones↗
PubMed1998

Revision of failed total shoulder arthroplasty.

The complexity of revision shoulder surgery remains a supreme challenge for the experienced shoulder surgeon. The difficulty of surgery is often accompanied by unpredictable patient cooperation during the postoperative rehabilitation program. Recognition of the problems associated with the failed shoulder arthroplasty is necessary for successful revision surgery. Numerous reconstructive techniques are necessary for restoration of soft tissue and bony deficiencies. Component revision is often necessary in treating component loosening or glenohumeral instability. Glenoid component removal may be necessary in the presence of severe rotator cuff insufficiency or marked glenoid bone deficiency. Humeral revision is most predictably treated with methylmethacrylate fixation. Humeral fractures associated with humeral arthroplasty are most successfully treated surgically, except in those instances where a long oblique or spiral fracture is not associated with prosthetic loosening. Deep infection is most predictably treated by extensive debridement, parenteral antibiotics, and delayed exchange of the components. The success of revision shoulder arthroplasty is often unpredictable, with 60% of revisions offering satisfactory pain relief and restoration of function. Critical to the success of revision arthroplasty is the status of the soft tissues, particularly the anterior deltoid and rotator cuff.

Anti-Bacterial Agents↗
PubMed1998

Assessment of outcome in shoulder arthroplasty.

This article discusses outcome measures for the patient requiring shoulder arthroplasty and the weakness and strengths of various assessment tools in current use. The optimal method to measure the outcome of patients with shoulder arthroplasty is yet to be defined; however, the ideal assessment should include measures of general health, a shoulder-specific assessment, and an assessment that is specific to the disease state for which shoulder arthroplasty is indicated. The authors also provide appendices with their recommended calculations for the elevation of the shoulder arthroplasty patient.

Arthroplasty, Replacement↗
PubMed2004

[Revision total knee arthroplasty after unicompartmental femorotibial prosthesis: 54 cases].

PURPOSE OF THE STUDY: We analyzed technical difficulties encountered when performing revision total knee arthroplasty in patients with unicompartmental femorotibial prostheses. MATERIAL AND METHODS: This multicentric retrospective study included 54 revisions of unicompartmental femorotibial prosthesis with implantation of a total knee prosthesis. The series included 45 medial and nine lateral compartment prostheses. A gliding total knee prosthesis was implanted in 53 cases (98%) (39 standard, 14 revision). Mean time to failure of the unicompartmental prosthesis was four years. IKS scores were established at review. The radiological work-up included AP and lateral views in single leg stance and goniometry for 22 medial compartment revisions. Twenty-seven patients were seen for physical examination and x-rays and eight were lost to follow-up; data were recorded from medical files for 19 patients. RESULTS: The revision procedure was considered easy in 82% of the cases. Mean follow-up after revision was four years (range 2 - 12 years). Subjective outcome was very satisfactory for 56% of the patients, satisfactory for 36% and unsatisfactory for 8%. The mean function score was 62 points, the mean knee score 85 points, and the mean flexion was 113 degrees. No laxity was found for 90% of the knees. The femorotibial angle was 180 +/- 2 degrees in 46% of the patients. The mechanical femoral angle was 90 degrees in 54% of the patients with 2-4 degrees varus in 42%. The mechanical tibial angle was 90 degrees in 46% of the patients with 2-8 degrees valgus in 37%. Complications included pulmonary embolism (n=2), mobilization under general anesthesia (n=3), arthrolysis (n=1), lateral vertical patellectomy (n=1), and secondary infection (n=1). There were five failures requiring changing the total knee prosthesis. DISCUSSION: Loss of bone stock raises specific problems during revision of unicompartmental knee prostheses. Loss of tibial bone is more frequent but it is more difficult to correct for loss of femoral bone. A gliding knee prosthesis is generally preferred for first intention revision. We recommend a long stem when the bone defect is important or involves loss of cortical bone. We have had good mid-term results with revision total knee prostheses after unicompartmental prostheses. Longer follow-up is needed. Poor results were obtained when revision was performed for persistent pain without a clearly defined cause. The presence or not of significant bone loss did not appear to affect outcome. The observation of medial laxity in case of failed lateral unicompartmental prostheses suggests a more constrained total knee prosthesis might be indicated. Compared with earlier series, our results with total knee prostheses after unicompartmental prostheses appear to be better than after tibial valgus osteotomy and also better than after total knee arthroplasty. Conversely, they would be less satisfactory than for primary total knee arthroplasty. The surgical procedure for revision total knee arthroplasty after unicompartmental prosthesis requires precision and skill but is not technically difficult.

Aged↗
PubMed2005

[Patellar position and lateral approach for total knee arthroplasty in degenerative knees with lateral femoropatellar arthrosis].

PURPOSE OF THE STUDY: Patellar malposition is a well-recognized patellar complication after total knee arthroplasty. Such residual malposition is particularly frequent when the knee presents lateral femoropatellar arthrosis. We compared the radiological position of the patella after total knee arthroplasty in degenerative knees with lateral femoropatellar arthrosis performed via a medial or lateral approach with elevation of the anterior tibial tuberosity. MATERIAL AND METHODS: Twenty-six total knee arthroplasties were reviewed retrospectively. Thirteen prostheses had been inserted via a medial approach and thirteen via a lateral approach. A posterior stabilized implant was used with an original technique for insertion of the patellar implant. The only difference between the groups was the approach. In the "lateral" group, the lateral approach was used to raise the tibial tuberosity and perform lateral marginal patellectomy. The tibial tuberosity was reinserted in all cases without transposition. Preoperative and 3-month postoperative radiographs (weight-bearing, AP, lateral, femoropatellar 30 degrees flexion) were reviewed. Preoperative patellar displacement was at least 5 mm. There was no difference between the two groups for age, gender, weight, height, joint motion, pre- and postoperative mechanical alignment (HKA), or preoperative patellar gliding (7.6 mm in the "medial" group and 9.7 mm in the "lateral" group). RESULTS: Recurrent patellar dislocation occurred in one patient in the "medial" group and one patient in the "lateral" group had an anterior impaction of the tibial plateau following a fall. Patellar gliding was corrected in both groups: 0.7 +/- 1.8 mm in the "medial group" and 0.0 +/- 0 in the lateral group (p > 0.05). Residual patellar tilt was +4.2 +/- 3 degrees in the medial group (lateral tilt) and -3.3 +/- 5.4 degrees in the lateral group (medial tilt) (p = 0.003). DISCUSSION: Pateller gliding was corrected irrespective of the approach. Conversely, the medial approach did not allow effective correction of patellar tilt. The lateral approach with elevation of the anterior tibial tuberosity did not increase morbidity compared with the medial approach. It enabled avoiding residual lateral patellar tilt which can be a source of patellar complications. We prefer this approach for arthroplasty on degenerated knees with lateral femoropatellar arthrosis.

Aged↗
PubMed2006

[Intra- and postoperative fractures of the femur in total knee arthroplasty: risk factors in 32 cases].

PURPOSE OF THE STUDY: We reviewed fractures of the distal femur occurring during or after total knee arthroplasty in order to identify risk factors. MATERIAL AND METHODS: Twelve intraoperative fractures occurred between 1990 and 2000 among 617 total knee arthroplasties performed during this period. The circumstances of these fractures were noted in comparison with other prosthetic implants. Twenty other fractures of the distal femur occurred in 20 patients who had had a total knee arthroplasty during the same time period. Mean patient age at surgery was 72 years (range 69-77). In addition to demographic data, we noted risk factors: bone demineralization related to general condition, rheumatoid arthritis or corticosteroid therapy, trochlear notch prior to the trochlear cut, bone resorption under the femoral implant, repeated knee surgery, abnormal stress on the distal femur due to hip disease, periprosthetic osteolysis without loosening related to polyethylene debris or metallosis, loosening, type of prosthesis, loss of bone stock because of the femoral implant, life of prosthesis. RESULTS: Intraoperative fractures usually occurred in specific circumstances: use of a posterior stabilized prosthesis, probably with insufficient preparation and position of the stabilization element, probably excessive impaction in osteoporotic bone (rheumatoid arthritis), difficult exposure (arthroplasty after prior osteotomy), fracture starting from the separator passing over the posterior aspect of the tibia and reaching the intercondylar notch. Independently of these intercondylar fractures, supracondylar or diaphyseal fractures were essentially observed for revision prostheses using a femoral stem. Postoperative fractures were observed in patients who had prior surgery of the distal femur (revision of femoral osteotomy, fracture of the distal femur, arthrodesis), in patients with significant loss of bone stock (posterior stabilized prosthesis), or poor bone quality (rheumatoid arthritis), and in elderly patients with neurological impairment and frequent falls. The trochlear notch did not appear to be sufficient to be the only cause of fracture but was nevertheless an element frequently associated with other risk factors. DISCUSSION AND CONCLUSION: This study shows that fracture of the distal femur occurs in certain preferential circumstances. Considering these elements, a certain number of preventive measures can be discussed for technical modifications or choice of implants.

Aged↗
PubMed2006

[Total knee arthroplasty for recent severe fracture of the proximal tibial epiphysis in the elderly subject].

PURPOSE OF THE STUDY: Bone comminution, serious cartilage damage, and the poor mechanical quality of osteoporotic bone create a difficult challenge for osteosynthesis of joint fractures in the elderly subject. Poor results with certain hip, elbow and shoulder fractures have lead certain authors to propose emergency arthroplasty in selected cases. We report our experience with four knee arthroplasties implanted for recent severe fracture of the proximal tibial epiphysis in elderly subjects. MATERIAL AND METHODS: Four independent patients aged over 75 years presented a severe comminutive fracture of the proximal epiphysis of the tibia (Three Schatzker 5, one Schatzker 4). After obtaining the patients' informed consent, early knee arthroplasty was performed. A long-stem cemented tibial piece was used on which the epiphysis was reconstructed. Implants providing support for ligament deficits were used in all cases. Immediate weight-bearing was authorized. RESULTS: Follow-up ranged from two to seven years. The IKS function score (15, 60, 100, 100) depended on the patient's general status. The IKS knee score was excellent for three knees (90, 95, 95), and fair in one (45). Re-operations were not needed in any of the patients. All x-rays showed bone healing with correctly aligned limbs (less than 2 degrees deformation). There were no lucent lines at last follow-up. DISCUSSION: Early arthroplasty for complex fractures of the proximal epiphysis of the tibia is a realistic option. Using a cemented long-stem tibial piece ensures primary stability sufficient for early weight-bearing before bone healing. Use of a constrained prosthesis, or better a hinged prosthesis, can be questioned but avoids the difficulty of ligament balance on an osteoporotic knee with a destroyed joint surface. None of the patients required reoperation and the results in terms of pain were excellent. The overall outcome depends on the general status of the patient.

Aged↗
PubMed1986

Reactive synovitis after silicone arthroplasty.

A number of patients with silicone rubber implants performed by us and other surgeons initially had excellent results; however, they returned with swelling and discomfort. We studied 18 patients ranging in age from 16 years to 57 years who presented 8 to 78 months (average, 31.7 months) after silicone arthroplasty (four scaphoid, six lunate, one scapholunate, four finger, two wrist, one trapezium, and one ulnar head for metacarpal hemiarthroplasty). Erosive osteolysis was seen on x-ray films, with progressive destruction evident in patients followed serially. None of the patients' conditions responded to conservative care. The severity of the proliferative, inflammatory synovitis and the foreign material in the multinucleated giant cells correlated with the interval since arthroplasty. Implant surface analysis by scanning electron microscope and x-ray spectrometer showed that silicone microparticles were the result of implant degeneration and erosion. All joint cultures were negative. Silicone particulate synovitis and destruction were arrested by the removal of the implant, a synovectomy, and curettage of the lytic lesions at salvage (resection arthroplasty or arthrodesis). Patients who have had silicone arthroplasties should be followed indefinitely, at regular intervals, by x-ray films and clinical examination.

Adolescent↗