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At least 919 records · Page 51Linked to original sources
PubMed2003

Clinical consequences of stress shielding after porous-coated total hip arthroplasty.

From a series of 223 extensively porous-coated total hip arthroplasties, 208 hips had radiographic followup at a minimum of 2 years, which could be evaluated for radiographic evidence of stress-shielding. These patients had a mean 13.9-year followup (range, 2-18 years). We compared the outcome of 48 total hip arthroplasties that had radiographically evident stress-shielding with 160 total hip arthroplasties that did not have radiographically visible stress-shielding or that had less severe stress-shielding. Stress-shielding was more likely in females, patients with a low cortical index, and patients with larger stems. At the most recent followup, patients with stress-shielding had a lower mean walking score than patients without stress-shielding and less osteolysis. No patients with stress-shielding had femoral loosening, implant fractures, or loss of porous coating. The revision rate was 13% (six hips) among hips with stress-shielding and 21% (33 hips) among hips without stress-shielding. Fifteen-year survivorship was 93% among hips with stress-shielding and 77% among hips without stress-shielding. Stress-shielding did not produce adverse consequences in these extensively porous-coated total hip arthroplasties.

Arthroplasty, Replacement, Hip↗
PubMed2004

Higher cumulative revision rate of knee arthroplasties in younger patients with osteoarthritis.

This study was designed to test the hypothesis that younger patients treated for osteoarthritis and similar conditions using total knee arthroplasty and unicompartmental knee arthroplasty have a lower implant survival rate when compared with older patients. Previous studies have been done on a small number of patients and only included the younger patients. In many cases patients treated for rheumatoid arthritis have been included in the studies and exceptional survival rates have been reported. The current study compared the cumulative revision rate of the components in 33,251 patients older than 60 years and 2606 patients younger than 60 years treated with total knee arthroplasty or unicompartmental knee arthroplasty for osteoarthritis or similar conditions. Cox regression was used to compare the risk for revision between the two age groups and between gender and the effect of year of operation. The results showed a higher cumulative revision rate for the group of younger patients in all statistical analyses and the risk ratio for revision was significantly lower for the group of older patients. The risk for revision decreased for both groups when considering the year of surgery. This is probably attributable to better implant components and surgical techniques.

Adult↗
PubMed2004

Previous Bernese periacetabular osteotomy does not compromise the results of total hip arthroplasty.

It is not known if a previous periacetabular osteotomy poses technical difficulties and may increase the incidence of complications after total hip arthroplasty. The records of 41 patients who had THA after periacetabular osteotomy were evaluated. Followup averaged 6.9 years (range, 2-14 years). The average interval from osteotomy to total hip arthroplasty was 6.3 years (range, 4 months-14 years). Total hip arthroplasty provided significant relief of pain and improvement in function for all the patients. The acetabulum was judged to be retroverted in 23 patients and special attention to component positioning was needed. An abnormal proximal femoral anatomy secondary to previous intertrochanteric osteotomy or underlying dysplasia, or trochanteric overgrowth necessitated the use of trochanteric osteotomy for exposure in 24 patients. There were an acceptable number of complications and two revisions in the series. Aseptic loosening of the femoral component in one patient (one hip) and acetabular component in another patient (one hip) were the reasons for the two revisions. Total hip arthroplasty with technical consideration and careful evaluation of the acetabular version and relocated teardrop can be done safely in patients with a previous periacetabular osteotomy and should provide excellent results.

Acetabulum↗
PubMed2004

Navigation improves accuracy of rotational alignment in total knee arthroplasty.

Successful total knee arthroplasty is dependent on the correct alignment of implanted prostheses. Major clinical problems can be related to poor femoral component positioning, including sagittal plane and rotational malalignment. A prospective randomized study was designed to test whether an optical navigation system for total knee arthroplasty achieved greater implantation precision than a nonnavigated technique. The primary variable was rotation of the femoral component in the transverse plane, measured from postoperative radiographs and computed tomography images. Sixty-four patients were included in the study. All patients received the Duracon total knee prosthesis. The patients were randomly divided into two groups: Group C patients had conventional total knee arthroplasty without navigation; Group N patients had total knee arthroplasty using a computer-assisted knee navigation system. Analysis showed that patients in Group N had significantly better rotational alignment and flexion angle of the femoral component than patients in Group C. In addition, superior postoperative alignment of the mechanical axis, posterior tibial slope, and rotational alignment was achieved for patients in Group N. The use of a navigation system provides improved alignment accuracy, and can help to avoid femoral malrotation and errors in axial alignment.

Aged↗
PubMed2004

Complications and results of arthroplasty for salvage of failed treatment of malignant pathologic fractures of the hip.

The purpose of this study was to evaluate the results and complications of hip arthroplasty done for salvage of failed treatment of pathologic proximal femoral fractures secondary to malignancy. Between 1980 and 2000, 42 patients with a mean age of 63 years were treated with hip arthroplasty to salvage failed treatment of a pathologic proximal femoral fracture. Total hip arthroplasty was done in 16 patients (3 uncemented, 2 hybrid, 11 cemented), and bipolar hemiarthroplasty in 26 (2 uncemented, 24 cemented). A modular, proximal femoral replacement construct was used in 15 patients. Patients were followed a mean of 5.8 years (range, 15 days-20 years). Four hips required reoperation, all for deep infection. Harris Hip score improved from an average of 42 points (range, 17-76 points) preoperatively to an average of 83 points (range, 52-100 points) postoperatively. Most recent radiographs showed femoral component loosening in only one patient. Implant survivorship free of revision for any reason at 5 years was 90% (range, 65-96%) and free of revision for aseptic failure or radiographic failure was 97% (range, 64-99%). Hip arthroplasty is an effective treatment for salvage of failed treatment of pathologic proximal femoral fractures. Modular proximal femoral replacements were often required. The most concerning complication was deep prosthetic infection, which occurred in nearly 10% of this patient population, and in 21% of patients with prior irradiation.

Adult↗
PubMed2004

Minimally invasive knee arthroplasty.

Interest in minimal-incision surgery among physicians and patients has led to the investigation of whether minimal-incision concepts have a role in knee arthroplasty. Successful outcomes in knee arthroplasty have been traditionally measured by long-term implant performance and low revision rates, with less emphasis on the size of the incision or the length of time to complete recovery. There are two evolving lines of development in minimal-incision knee arthroplasty: the small-incision approach and the new technology approach. The small incision approach seeks to minimize the length of the incision required to implant standard total knee components by altering the approach and instrumentation. The new technology approach seeks to develop lower profile implants and computer-assisted techniques to fundamentally change the way knee arthroplasty is done. The burden of proof as to whether these new approaches will stand the test of time remains with the investigators.

Arthroplasty, Replacement, Knee↗
PubMed2004

A high flexion total knee arthroplasty design replicates healthy knee motion.

Deep flexion affects both femorotibial contact pattern and the patellofemoral articulation. The purpose of this study was to compare the patellofemoral motion of nonimplanted and implanted knees and to analyze femorotibial kinematics after total knee replacement designed for deep flexion. Three-dimensional patellofemoral kinematics were evaluated during a deep knee bend using fluoroscopy for five control patients with a healthy knee, five patients with an anterior-cruciate-ligament-deficient knee, and 20 patients who had a high flexion total knee arthroplasty. Less translation of patellofemoral contact position was seen in patients who had knee replacements than in patients with healthy knees, but the average motion and the patella tilt angles were similar to the healthy knees. On average, patients who had a total knee arthroplasty had 4.9 degrees normal axial rotation, and all patients had at least -4.4 mm of posterior femoral rollback. The average weightbearing range of motion of the patients in the total knee arthroplasty group was 125 degrees . In this study, patients implanted with a high-flexion knee replacement design had kinematic patterns that were similar to the healthy knee. It can be hypothesized that forces acting on the patella were not substantially increased for patients who had a total knee arthroplasty compared with the control patients.

Anterior Cruciate Ligament↗
PubMed2005

Radiographic comparison of two glenoid preparation techniques in total shoulder arthroplasty.

We compared the prevalence of periglenoid radiolucencies between two glenoid component preparation techniques used in total shoulder arthroplasties. Seventy-two consecutive patients with primary osteoarthritis had total shoulder arthroplasties using one prosthetic system with flat-back keeled polyethylene glenoid components. Thirty-seven shoulders had glenoid implants that were cemented after standard curettage preparation of the keel slot. Thirty-five shoulders had glenoid implants that were cemented after using bone compaction to prepare the keel slot. The immediate postoperative and 2-year postoperative radiographs were examined to evaluate the presence and progression of periglenoid radiolucencies. The curettage group had a higher rate (38%) of keel radiolucencies than the compaction group (11%) seen on the immediate postoperative radiographs. Both groups had progression of periglenoid radiolucencies with time. Progression of the radiolucent lines was worse in the curettage group 2 years after arthroplasty. Preparation of the glenoid component keel slot with the bone compaction technique seems to achieve better fixation of flat-back keeled polyethylene glenoid components in total shoulder arthroplasties.

Adult↗
PubMed2005

The association between hospital volume and total shoulder arthroplasty outcomes.

The purpose of this study was to evaluate the relationship between increasing hospital volume and the following outcomes for total shoulder arthroplasties done in the state of New York: length of stay, hospital costs, readmission within 60 days, revision surgery within 24 months, and death within 60 days. The Statewide Planning and Research Cooperative System (SPARCS) database from the New York State Department of Health, a census of all hospital discharges in the state, was used to evaluate the relationship between hospital volume and outcomes for total shoulder arthroplasties for 1996 to 1999. One thousand three hundred seven total shoulder arthroplasties were done in New York from 1996 to 1999. Nearly (1/2) were done at the five highest-volume hospitals. Middle-volume hospitals has the least lengths of stay and hospital costs. Independent of age and comorbidities, patients at hospitals with greater volumes of total shoulder arthroplasties were at reduced risk of patients being readmitted within 60 days. No other outcomes were significantly associated with hospital volume. The finding that greater hospital volume decreases risk of readmission may have important public health implications, but additional research is needed before implementing policy changes.

Age Distribution↗
PubMed2005

Lumbar disc arthroplasty.

Degenerative disc disease is the leading cause of pain and disability in adults in North America, and spinal fusion is the standard treatment. Despite this, it has been discussed among surgeons that (1) spinal fusion deserves reexamination in terms of its long-term consequences and benefits and (2) modern clinical research and development in disc arthroplasty strongly supports its emergence as an alternative. The ability to relieve pain by maintaining motion may be a critical factor in obtaining not only greater pain relief but in preventing adjacent segment degeneration. Early research in arthroplasty devices was promising but cut short. New knowledge in the functional anatomy and biomechanics of the spine has made possible the development of modern arthroplasty devices (eg, Charite Artificial Disc, ProDisc, Maverick device, FlexiCore device) of different constructions and materials (metal-on-plastic, metal-on-metal) and various ranges of motion/mobility that provide a basis for a classification of spinal mode and an assistance in implant selection. Current research also is confronting the critical obstacles of wear and tear and axial compression. Several devices currently are in clinical trials. A detailed review of their characteristics shows the exciting progress of a new treatment era of total disc replacement in spine-lumbar disc arthroplasty.

Arthroplasty, Replacement↗
PubMed2005

Development and early results of a new patellofemoral arthroplasty.

UNLABELLED: A new patellofemoral arthroplasty is described, based on a previous design of total knee arthroplasty. The indications are for patients with specific isolated patellofemoral disease with advanced chondral or arthritic damage. The design and technique of insertion is detailed. Three hundred six patellofemoral arthroplasties have been done in 240 patients. The initial results show a high level of pain relief and improvement in function. Two-year followup is available for treatment of 124 knees and 5-year followup is available for treatment of 33 knees. There has been no deterioration in pain or function with followup to 5 years, and there were no late complications attributable to the arthroplasty. Disease progression in the tibiofemoral joint has occurred in 14 patients (16 knees, 5%) requiring revision in 10 of these patients (11 knees, 3.6%). Persistent anterior knee pain was recorded in 14 knees (4%). The short-term results using this new design were better than those of the prosthesis that we used previously, especially concerning malalignment and wear. It offers a reasonable alternative to total knee replacement in the small group of patients with isolated patellofemoral disease. LEVEL OF EVIDENCE: Therapeutic study, Level II (prospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

Mini-incision total knee arthroplasty can increase risk of component malalignment.

UNLABELLED: Interest in minimal-incision total knee arthroplasty has increased in recent years. We compared a group of 30 patients who had total knee arthroplasty with a mini-incision to a similar group of 30 patients who had total knee arthroplasty with a standard length incision. The minimal-incision group had some minor early advantages (less pain medication use, earlier improvement in range of motion), but these advantages dissipated by 3 months followup. Radiographic evaluations showed that four of the 30 patients with minimal incisions had tibial component varus malalignment (< 87 degrees ), whereas no patients with the standard length incision had malalignment. Although total knee arthroplasty performed using a minimal incision may provide some early advantages, minimal incisions can impede a surgeon's vision and may influence component alignment and possibly compromise long-term outcome. LEVEL OF EVIDENCE: Therapeutic study, Level III-1 (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity.

UNLABELLED: There has been increasing use of and expanding indications for unicompartmental knee arthroplasty using minimally invasive techniques. We sought to define contraindications by examining failures. We retrospectively reviewed the early results of a consecutive series of minimally invasive medial unicompartmental knee arthroplasty using two implant designs. Seventy-nine consecutive unicompartmental knee arthroplasty cases (48 instrumented and 31 noninstrumented) with minimum 2-year followup were reviewed. Patients with radiographic involvement with or without pain referable to the lateral compartment or to the patellofemoral joint were not considered candidates. Failure was defined as revision or pending revision. The average followup was 40.2 months. There were 16 failures (six tibial loosening, three plateau fracture, four persistent medial pain, one progressive arthritis, and two sepsis). Age, gender, disease severity and implant design did not predict failure. Body mass index greater than 32 did predict failure and was associated with a reduction in survivorship by log-rank and Wilcoxon analyses. These results show reliable success if obesity is considered a contraindication and technical errors resulting in fracture are eliminated. Better defining the ideal candidate for unicompartmental knee arthroplasty, with obesity remaining a contraindication, will make this a more predictable and reliable procedure. LEVEL OF EVIDENCE: Prognostic study, Level IV-2 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

Patellectomy after total knee arthroplasty.

UNLABELLED: We retrospectively reviewed nine patients who had condylar TKA and subsequently had a patellectomy between 1969 and 2003. One patient was lost to followup, but the remaining eight patients were followed up for an average of 49 months after patellectomy. All patellectomies were done after comminuted patellar fractures at an average of 21 months (range, 4-88 months) after the initial arthroplasty. Knee scores after the initial arthroplasty were 83 points (range, 69-97 points) and 49 points (range, 10-100 points) for pain and function, respectively. Knee scores after patellectomy were 81 (range, 20-97) and 28 (range, 0-80) for pain and function, respectively. The average range of motion before and after patellectomy was 0 degrees to 104 degrees and 2 degrees to 106 degrees , respectively. Four patients had mild extensor lags at final examination, but all were less than 10 degrees . Two patients were unable to use stairs. Two patients had complications consisting of quadriceps tendon rupture and secondary instability. Midterm results after patellectomy show knee scores for pain that are comparable to those after initial arthroplasties, but the function scores were not as good. Fifty percent of the patients had extensor lags but all were mild (< 10 degrees ). Patellectomy can provide pain relief after a patellar fracture after total knee arthroplasty but the functional results are frequently poor. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

Venous thromboembolic prophylaxis after elective total hip arthroplasty.

Elective total hip arthroplasty is a common orthopaedic procedure that has been proven to relieve pain and reliably improves the quality of life of its patients. However, patients having a total hip arthroplasty are among those at greatest risk for venous thromboembolic disease. Therefore, most orthopaedic surgeons use routine prophylaxis. Although several agents have been shown to reduce the risk of thromboembolic disease, there is no clear preference for a particular agent in elective total hip arthroplasty. This evidence-based review focuses on the efficacy and safety of the agents that currently are used for prophylaxis against deep venous thrombosis. These agents include warfarin, low-molecular-weight heparin, fondaparinux, aspirin, and mechanical devices. Furthermore, the influence of shorter hospital stays on duration of prophylaxis and screening will be discussed. The most effective prophylactic agents for patients after total hip arthroplasty include low-molecular-weight heparin, warfarin, and fondaparinux. Pneumatic compression devices have been proven to reduce distal thromboembolic events but multi-center, randomized studies need to be done to determine the efficacy of mechanical prophylaxis with short hospital stays. The selection of a prophylaxis regimen is a balance between efficacy and safety, and individual patient factors can influence the prophylaxis regimen that is used.

Arthroplasty, Replacement, Hip↗
PubMed2005

Single-incision anterior approach for total hip arthroplasty on an orthopaedic table.

UNLABELLED: Dislocation remains the leading early complication of total hip arthroplasty; surgical approach and implant positioning have been recognized as factors influencing total hip arthroplasty stability. We describe a total hip arthroplasty technique done through a single, tissue sparing anterior approach that allows implantation of the femoral and acetabular components without detaching or sectioning any of the muscles and tendons around the hip joint. A series of 437 consecutive, unselected patients who had 494 primary total hip arthroplasty surgeries done through an anterior approach on an orthopaedic table from September 1996 to September 2004 was reviewed. There were 54 hybrid and 442 uncemented hips in the 437 patients (57 bilateral). The average patient age was 64 years. Radiographic analysis showed an average abduction angle of 42 degrees , with 96% in the range of 35 degrees to 50 degrees abduction. The average cup anteversion was 19 degrees with 93% within the target range of 10 degrees to 25 degrees . Postoperative leg length discrepancy averaged 3 +/- 2 mm (range, 0-26 mm). Three patients sustained dislocations for an overall dislocation rate of 0.61%, and no patients required revision surgery for recurrent dislocation. There were 17 operative complications, including one deep infection, three wound infections, one transient femoral nerve palsy, three greater trochanter fracture, two femoral shaft fractures four calcar fractures, and three ankle fractures. Operative time averaged 75 minutes (range 40-150 minutes), and the average blood loss was 350 mL (range, 100-1300 mL). The mean hospital stay was 3 days (range, 1-17 days). The anterior approach on the orthopaedic table is a minimally invasive technique applicable to all primary hip patients. This technique allows accurate and reproducible component positioning and leg-length restoration and does not increase the rate of hip dislocation. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

The Frank Stinchfield Award: muscle damage after total hip arthroplasty done with the two-incision and mini-posterior techniques.

Some surgeons have suggested that a minimally invasive two-incision approach allows total hip arthroplasty to be done without cutting or damaging any muscle or tendon. To our knowledge that claim has not been supported by any published clinical or basic science data. Our purpose in doing this study was to quantify the extent and location of damage to the abductor and external rotator muscles and tendons after two-incision and mini-posterior total hip arthroplasty. Ten cadavers (20 hips) were studied. In each cadaver one hip randomly was assigned to the two-incision group and the contralateral hip was assigned to the mini-posterior group. After inserting the total hip arthroplasty components the muscle damage was assessed using a technique described previously. Damage to the muscle of the gluteus medius and gluteus minimus was substantially greater with the two-incision technique than with the mini-posterior technique. Every two-incision total hip replacement caused measurable damage to the abductors, the external rotators, or both. Every mini-posterior hip replacement caused the external rotators to detach during the exposure and had additional measurable damage to the abductor muscles and tendon. We do not support the contention that a two-incision total hip arthroplasty is done without cutting muscle or tendon. None of the two-incision hip replacements were done without cutting, reaming, or damaging the gluteus medius or gluteus minimus muscle or external rotators.

Aged↗
PubMed2006

Proximal humerus fracture sequelae: impact of a new radiographic classification on arthroplasty.

UNLABELLED: Our goal was to analyze the results of unconstrained shoulder replacement in a large series of sequelae of proximal humeral fractures in order to validate a previously described surgical classification. In a multicenter study, we retrospectively evaluated 203 patients with sequelae of proximal humeral fractures who were treated with a nonconstrained modular and adaptable prosthesis. The mean followup was 42 months (range, 24-96 months). We identified 137 impacted fractures with humeral head collapse or necrosis (Type 1 sequelae), 25 unreducible dislocations or fracture-dislocations (Type 2), 22 nonunions of the surgical neck (Type 3), and 19 severe tuberosity malunions (Type 4). Results of nonconstrained shoulder arthroplasty for the treatment of Type 1 and Type 2 sequelae were predictably good because no greater tuberosity osteotomy was performed. The distorted anatomy was accepted, and both the prosthesis and technique were modified accordingly. Total shoulder arthroplasty yielded better results than hemiarthroplasty. Patients with Type 3 or Type 4 sequelae had poor functional results with nonconstrained arthroplasty because greater tuberosity osteotomy was needed. This study validates our fracture sequelae classification. We no longer use unconstrained prostheses in Type 3 and Type 4 fracture sequelae and propose peg bone grafting or low-profile fracture prosthesis for patients with Type 3 sequelae and reverse arthroplasty for those with Type 4 sequelae. LEVEL OF EVIDENCE: Prognostic study, level IV (case series). See Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗