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Common orthopaedic implant failures are reviewed in the areas of total joint replacement and fracture fixation. In particular total hip and total knee arthroplasty, intertrochanteric hip fractures and long bone fractures are discussed. Excessive motion of implant bone interfaces, stress concentrations within the implant and stress shielding of bone are implicated in implant failures.
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Roentgenograms of 138 knee joint arthroplasties were examined for the presence and extent of a radiolucent zone at the bone-cement interface. Such a zone was significantly more common around the plastic tibial part than around the metallic femoral part of non-hinged prostheses. This observation argues for the theory that the development of heat plays a part in the causation of the zone. In some cases a zone was demonstrable within 1 month of the operation. The frequency and the sizes of such zones increased during the first 6 months after the operation. There was no definite correlation between the development of a radiolucent zone and the clinical symptoms.
This paper presents four patients with polycentric artificial knee joints in whom reoperation revealed new menisci interposed between the artificial joint surfaces. One of the menisci had a bucket handle tear and was excised. Histological examination showed a fibrocartilage structure with the appearance of a newly formed meniscus. The artificial knees functioned well and the reoperations were performed because of trauma in one patient, because of femoro-patellar problems in one knee, and for conversion of a hemi-arthroplasty to an arthroplasty including all the compartments of the knee joint in two patients.
The use of bone cement balls in chains loaded with gentamycin (gentamycin-PMMA-ketten) as part of a two-stage exchange operation has proven to be a good method of treatment for infected arthroplasty. The procedure is illustrated by three case reports.
This paper reports our experience of using the Silastic radial head prosthesis in 18 elbow joints affected by rheumatoid arthritis. There was a varying degree of severity of involvement in 15 of the elbows, and in a further 3 cases replacement was carried out at an early stage of the disease. The 3 cases in whom early replacement was carried out had the best results at follow-up and 11 of the remaining 15 were considered to have a satisfactory overall result. The major benefit of operation has been the relief of pain, even in the late cases, whilst preserving stability of the elbow in all but 3 cases.
A saline-cooled saw, which has been shown to give good control of the heat generation during bone cutting under laboratory conditions, was tested in in vivo. With a saline flow of 80 mL/min, the maximum cutting temperature in 30 knee prosthetic operations was 32 (25-37) degrees C in the saw blade and respectively 30 (26-35) degrees C and 29 (26-34) degrees C 2 and 3 mm underneath the cut surface. Because the temperature generated by conventional osteotomy equipment may exceed 70 degrees C, the use of our cooled double saw blade during joint replacement prevents heat osteonecrosis.
16 patients with rheumatoid arthritis underwent Swanson silastic arthroplasty in 60 MCP-joints. After 7 (5-10) years only 8 patients had pain relief, 7 were satisfied, and 13 implants had fractured. We conclude that the effects of Swanson silastic arthroplasty deteriorate with time.
Vigorous treatment is not always necessary to eradicate late postoperative infection after total knee implantation. Aspiration of the pus and intravenous antibiotic administration was enough to eradicate the infection in the case reported.
Total hip or knee replacement patients who are overweight or obese often consider their disabling joint disease a cause for their increased weight. This prospective study investigated weight change in 100 patients after successful total joint replacement to determine whether surgical treatment of hip or knee arthritis leads to weight reduction. Postoperatively, both hip and knee replacement patients gained weight, with no difference in weight gain between hip and knee replacement patients. Younger hip patients gained a significant amount of weight. Patients a with normal body mass index and obese patients did not lose weight, while overweight patients gained a significant amount of weight after surgery. These findings demonstrate successful treatment of lower-extremity arthritis does not lead to weight loss, and obesity should be treated as an independent disease that is not the result of inactivity from arthritis.
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A swan-neck or boutonniere deformity occurs in approximately half of patients with rheumatoid arthritis. The cause of boutonniere deformity is chronic synovitis of the proximal interphalangeal joint. Swan-neck deformity may be caused by synovitis of the metacarpophalangeal, proximal interphalangeal, or distal interphalangeal joints. Numerous procedures are available for the operative correction of these finger deformities. The choice of surgical procedure is dependent on accurate staging of the deformity, which is based on the flexibility of the proximal interphalangeal joint and the state of the articular cartilage. The patient's overall medical status and corticosteroid use, the condition of the cervical spine, the need for operative treatment of large joints, and the presence of deformities of the wrist and metacarpophalangeal joints must also be considered when planning treatment. In the later stages of both deformities, soft-tissue procedures alone may not result in lasting operative correction.
Although metacarpophalangeal joint arthroplasty is occasionally performed for joints affected by osteoarthritis, it is most often done in patients with rheumatoid arthritis. The metacarpophalangeal joint is critical for proper finger function but is the most common site of involvement in the rheumatoid hand. A thorough understanding of the anatomy, pathophysiology, and mechanics of the metacarpophalangeal joint is a prerequisite for the evaluation and treatment of patients requiring metacarpophalangeal arthroplasty. Silicone rubber implants are the most frequently used device for treatment of revised metacarpophalangeal arthroplasty. Follow-up studies show that this surgery improves function and deformity and achieves nearly uniform patient satisfaction.
The aims of knee replacement are to provide freedom from pain and a return to a resonable level of function. A survey was undertaken to determine the functional advantages of knee replacement and problems that may still be encountered by the patient. The results of the survey highlighted certain advantages and problem areas. It also pointed out the seemingly greater functional value of the knee replacement in those patients who had no problems in other joints.
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