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At least 1,063 records · Page 59Linked to original sources
PubMed2006

Effect of risedronate on bone metabolism after total hip arthroplasty: a prospective randomised study.

Aseptic loosening due to bone remodeling and osteolysis is the main reason for revision hip arthroplasty. At present, there is no established prophylaxis for this complication. On the other hand, it has been demonstrated that bisphosphonates prevent bone loss around total hip arthroplasties (THA). The aim of this study was to assess the efficacy of oral bisphosphonate risedronate for the prevention of deleterious changes in bone metabolism after hip replacement. Twenty-four patients who underwent THA were randomised to two treatment arms: 35 mg risedronate once weekly for 6 months (12 patients) and no treatment for controls (12 patients). Markers of bone turnover bone specific alkaline phosphatase, serum osteocalcin and urinary deoxypiridinoline were evaluated at baseline, third and sixth postoperative month. Dual energy X-ray absorptiometry of the nonsurgical hip was performed preoperatively and at 6 months postoperatively. There were no significant differences in clinical or radiographic findings between the two groups at either 3 or 6 months. In the two groups, all biochemical marker responses at the third postoperative month were suppressed compared with baseline. Values of bone resorption marker urinary deoxypiridinoline increased significantly at six months in the control group. For the 10 risedronate patients with bone densitometry bone mineral density reached 1.01% increase at 6 months. Administration of oral risedronate led to a significant reduction in bone metabolism at 6 months after hip replacement. This therapeutic strategy may improve the results and longevity of total hip arthroplasty. The beneficial effect of risedronate should be confirmed in further studies including larger number of patients and longer follow-up. The action of risedronate could prevent aseptic loosening of hip arthroplasty by preserving periprosthetic bone stock.

Absorptiometry, Photon↗
PubMed2006

[Effect of morphological changes in proximal femur on prosthesis selection of total hip arthroplasty in patients with ankylosing spondylitis].

OBJECTIVE: To investigate the effect of the morphological changes in the proximal femur on the prosthesis selection in the total hip arthroplasty in the patients with ankylosing spondylitis. METHODS: The experimental group was composed of 13 patients (16 hips) with ankylosing spondylitis, which was treated with the total hip arthroplasty, and the control group was composed of 16 patients (19 hips) with non-ankylosing spondylitis, which was also treated with the total hip arthroplasty. In the two groups, the measurements of Singh index, canal flare index, morphological index of the cortex and cortical index were performed in the two groups. RESULTS: The results of the statistical analysis on Singh index, canal flare index, morphological index of the cortex and cortical index in the experimental group were 3.81 +/- 0.54, 2.63 +/- 0.41, 2.02 +/- 0.38 and 1.69 +/- 0.69, respectively, but 4.63 +/- 0.62, 3.03 +/- 0.27, 2.76 +/- 0.28 and 2.12 +/- 0.24, respectively in the control group. There was a significant difference in Singh index, canal flare index, and morphological index of the cortex between the two groups (P < 0.05), while there was no statistical difference in cortical index between the two groups (P > 0.05). The patients with ankylosing spondylitis had more serious osteoporosis in their proximal femur. CONCLUSION: Cemented femoral prosthesis should be used in the total hip replacement in patients with ankylosing spondylitis, and the revision total hip arthroplasty should be performed on patients with more serious osteoporosis.

Adult↗
PubMed2006

Resection arthroplasty of the infected shoulder: a salvage procedure for the elderly patient.

Infection of the shoulder joint is a challenging problem for the orthopaedic surgeon. Several treatment options have been proposed. Here, we evaluate the results achieved following resection arthroplasty of the shoulder in seven patients. We performed resection arthroplasty in seven cases to treat a chronic uncontrollable infection of the shoulder. Three patients had an infected shoulder arthroplasty, one had an infected non-united arthrodesis, one was treated for an infected osteosynthesis, one had an infected rotator cuff repair and one patient had a septic arthritis of the shoulder joint. All patients were reviewed after a mean of 252 days. The functional outcome was evaluated using the Constant and DASH score. C-Reactive Protein levels were determined to evaluate the presence of residual infection. Except for one doubtful result, all our patients remained free of infection and there was excellent pain relief after the resection. Nevertheless, the functional outcome was poor: the mean Constant score was 25.7 and the mean DASH score was 69.3. Resection arthroplasty of the shoulder is a valuable treatment option for infection of the shoulder, especially in older patients with a poor mental and physical condition who suffer intolerable pain.

Adult↗
PubMed2006

A radiographic review of 135 total hip Charnley arthroplasties followed between 15 and 35 years.

The long-term radiologically interpreted results of low-friction Charnley hip arthroplasties have been previously suggested to be influenced by surgical details, such as orientation of the femoral component, degree of coverage of the plastic acetabulum and other features. We carefully analyzed the radiographs of 135 Charnley arthroplasties that had remained functional, had not been revised and had follow-ups between 15 and 35 years. Several common denominators were identified amongst these radiographs: 93.5% arthroplasties had 100% coverage of the acetabular component; 88% had acetabular inclination between 40-45 degrees ; 84.5% had a proximal/medial column of cement between 3 and 5 millimeters at the level of femoral head resection; 81% had a femoral canal/stem ratio more than 50%; and 84% had a column of cement that extended below the tip of the prosthesis. This study supports the importance of technical surgical details that enhance the chances of long-term survival of cemented total hip arthroplasties.

Adolescent↗
PubMed2006

Shoulder arthritis in the young adult: arthroscopy to arthroplasty.

Young adult patients with shoulder arthritis present challenging treatment decisions for the orthopaedic surgeon. Patients treated with shoulder arthroplasty have the youngest average age of all patients who undergo joint arthroplasty. However, in the young, active patient or in those without advanced disease, joint arthroplasty may not be appropriate. Arthroscopic treatment or interposition arthroplasty may provide symptomatic relief without radically compromising future procedures.

Arthritis↗
PubMed2006

[Influence of preoperative range of motion on the early clinical outcome of total knee arthroplasty].

OBJECTIVE: To retrospectively analyze the influence of preoperative range of motion (ROM) and maximal flexion degree on the early clinical outcome of total knee arthroplasty (TKA). METHODS: From January 2000 to December 2003, 97 knees of 65 patients that were underwent total knee arthroplasty with Scorpio posterior-stabilized knee prosthesis were reviewed. There were 55 osteoarthritis patients (81 knees), and 10 rheumatoid arthritis (16 knees). Thirty-three patients were underwent unilateral TKA, 32 patients were underwent bilateral TKA. According to the preoperative ROM of knee, these patients were divided into two groups, one 90 degrees (range, 95 degrees - 140 degrees ). Finally the clinical outcomes of two groups (include ROM, maximal flexion degree, KSS score and function score) were evaluated. Three days later after operation, continuous passive motion (CPM) and active functional exercise of the knee were begun, and the wound healed well in all patients. All these operations were primary total knee arthroplasty. RESULTS: The patients were followed up for average 2 years 5 months (range, 10 months to 3 years 8 months). The average ROM of knee was improved to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation from 84.2 degrees (range, 5 degrees - 140 degrees ) before operation (P = 0.000); the average maximal flexion degree was decreased from 103.5 degrees (range, 25 degrees - 140 degrees ) before operation to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation (P = 0.439); KSS of knee joint was improved to 78.8 points after operation (range, 50 - 95 points) from 19.5 points (-24 - 62 points) before operation (P = 0.000). There was statistically difference between the clinical outcomes (ROM, maximal flexion degree, KSS score and function score) in the two groups before and after operation. Those knees with good preoperative ROM tend to lose flexion, while those with poor preoperative ROM gain flexion after TKA. No revision and deep infection happened. CONCLUSIONS: TKA is a complex operation, the clinical outcome of TKA is mainly determined by the good operation skill, abundant clinical experience and the familiarity with the prosthesis of the surgeon. At the same conditions such as same surgeon, same prosthesis and same physical therapy, preoperative range of motion of knee influence on the early clinical outcome of total knee arthroplasty, knees that have good preoperative ROM have better clinical outcomes postoperatively than those with poor preoperative ROM.

Adult↗
PubMed1976

Peripheral neuropathies associated with total hip arthroplasty.

The clinical and electromyographic findings in fourteen patients in whom peripheral nerve damage developed after total hip arthroplasty were reviewed (an incidence of 0.7 per cent in 2,012 procedures). In addition, a prospective study of the clinical, electromyographic, and nerve-conduction findings before and after arthroplasty was performed on twenty-eight patients who had thirty total hip arthroplasties. In the prospective study many patients showed evidence of mild nerve damage, most likely due to operative trauma. Peroneal neuropathies at the knee did not occur in either study. Nerve damage was more frequent in women, but no other predisposing factor could be identified. The prognosis for most patients with severe nerve injuries after total hip arthroplasty is good.

Arthroplasty↗
PubMed1991

A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis.

An historical prospective study was performed to compare two surgical management alternatives in the treatment of patients with knee arthritis. There were 120 unicompartmental and 81 tricompartmental knee arthroplasties in 98 and 66 patients, respectively. All living patients were available for follow-up observation, and survivorship data on all arthroplasties were obtained. The average follow-up interval was 78 months (range, eight-162 months) in the unicompartmental series and 68 months (range, two- 186 months) in the tricompartmental group. Patients receiving the unicompartmental arthroplasty were treated with nonmetal-backed polyethylene tibial components. Prosthetic survivorship was 92% at ten years in the unicompartmental patient group. There were no statistically significant differences in aseptic loosening between these two patient groups. In appropriately selected patients unicompartmental arthroplasty was associated with better range of motion and ambulatory function than patients being treated with tricompartmental knee replacement.

Adult↗
PubMed1991

Primary total knee arthroplasty in patients with severe varus deformity. A comparative study.

Varus deformity is a common finding in candidates for total knee arthroplasty (TKA), but very little has been written concerning the problems encountered in correcting these deformities at the time of arthroplasty. Compared to patients without deformities, this group of patients require more attention to the technical aspects of the arthroplasty, especially bony alignment and ligament balancing. Specific operative techniques used to correct severe varus deformities at primary TKA were evaluated, and the clinical and roentgenographic results were compared with those of a control group of patients without preoperative angular deformity. Operative findings and clinical results in 27 knees (20 patients) with a minimum preoperative varus deformity of 20 degrees (average follow-up period, 58.7 months; range, 24-102 months) were compared with those of 40 knees (31 patients) with a preoperative angulatory deformity of less than 5 degrees varus or valgus (average follow-up period, 50.0 months; range, 24-90 months), in whom a minimally constrained, posterior-cruciate-ligament-sparing prosthesis was implanted. Operative time was an average of 30 minutes longer in the varus deformity group. The average knee evaluation score in the varus group was 89 points, and for the nondeformity group it was 92 points (p less than 0.02). There were no fair or poor results in the varus deformity group; there was one poor result in the nondeformity group. Postoperative knee are of motion was 98 degrees in the varus deformity group and 107 degrees in the nondeformity group. After arthroplasty, the average angle between the mechanical axis of the femur and the tibia was 3 degrees varus in the varus deformity group and 0 degree varus in the nondeformity group (p less than 0.006). Postoperative functional scores of patients in the varus deformity group approached, but were not equal to, the nondeformity group. Greater variability in results and longer operative times were needed in the varus deformity group. Postoperative alignment of the varus deformity group tended to be in residual varus.

Adult↗
PubMed1988

Unicompartmental knee arthroplasty. Ten- to 13-year follow-up study.

In the past decade, two concepts have caused considerable controversy in orthopedic surgery of the knee. Some orthopedic centers contend that osteotomy of the tibia is the procedure of choice for unicompartmental gonarthrosis of the knee and resist the concept of unicompartmental arthroplasty. The other concept is that if unicompartmental arthroplasty is necessary, the entire joint should be replaced, since the uninvolved compartment may develop arthritis in the future. This concept is illogical and contrary to the basic orthopedic principle of preserving normal structures whenever possible. It is obvious that joint replacements may not last the life of the patient and the need for revision must be considered; therefore, the original procedure should preserve as much bone stock as possible. The purposes of this review of unicompartmental replacement are to resolve these questions with data on long-term results of unicompartmental arthroplasty compared with data on high tibial osteotomy, to evaluate the cause of failures, and to improve future results. Eighty-seven consecutive unicompartmental arthroplasties were performed between November 1972 and April 1976. There were 60 knees available for study, with a minimum ten-year (average, 11-year) follow-up period. The results were evaluated using the Hospital for Special Surgery rating system, with 30 excellent, eight good, four fair, and 18 poor results. Seventy percent of the patients had satisfactory results, and pain relief was accomplished in 86.6% of patients. Of the 21 failures, the majority were due to material or technical problems and improper selection of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty.

Of 285 total hip arthroplasties (260 patients) performed for primary osteoarthritis during a six-year period, 135 were resurfaced using a Tharies prosthesis (total hip articular replacement with internal eccentric shells) and 150 were treated with the Trapezoidal-28 total hip replacement. From each of these two groups 100 hips (ninety-one patients in the Tharies group and eighty-six in the Trapezoidal-28 group) that had been followed for two to seven years were evaluated at the time of follow-up in accordance with a predetermined protocol. The patients were younger in the Tharies than in the Trapezoidal-28 group (average ages, fifty-eight and sixty-six years), included more men (sixty compared with thirty-five), and were more active postoperatively. The average follow-up was forty-seven months for the total joint-replacement group and thirty-eight months for the surface replacement group. At follow-up the ratings for pain, walking, and function according to the University of California at Los Angeles 10-point scale and the clinical results were identical in the two groups. Heterotopic ossification (Brooker grade III or IV) developed after thirteen Trapezoidal-28 and twenty-two Tharies arthroplasties. Radiographs made at six and twelve months and at final follow-up showed that the incidence of radiolucencies about the acetabular component was higher in the resurfacing group: fifty-seven with complete radiolucent lines after an average follow-up of thirty-eight months compared with thirty-six with complete lines after an average follow-up of forty-seven months. There were three failures in the joint-replacement group: a hematogenous staphylococcal deep infection that required a Girdlestone procedure, a femoral stem fracture that required revision, and loosening of an acetabular component for which revision was performed. There was also one dislocation, successfully treated by closed reduction. Similarly, in the resurfacing group there were three failures: two loose acetabular components, revised successfully, and one loose femoral component that necessitated total joint arthroplasty. Multivariate stepwise regression analysis showed that the factors that affected the final extent and width of the acetabular radiolucencies adversely after resurfacing were: any radiolucent lines that were visible at six months, a high level of physical activity after arthroplasty, and a thin superior cement mantle.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMed1982

The femoral head remnant in resurfacing arthroplasty.

The femoral head remnant was examined in six patients after Indiana resurfacing arthroplasty. Four hips failed by femoral neck fracture and two by acetabular loosening. Three of the four specimens that failed by fracture had total osteonecrosis, as assessed by histological criteria. The tissue did not evidence foreign body response to methyl-methacrylate, suggesting that osteonecrosis may have occurred at the time of resurfacing arthroplasty. Bony remodeling at the site of fracture indicates that fracture may have occurred through a weakened zone at the junction of viable and necrotic bone. In contrast, examination of the femoral specimens removed owing to acetabular loosening revealed viable bone, membrane formation and a foreign body reaction. The small number of specimens and lack of tetracycline labeling prohibit firm conclusions. These observations nevertheless suggest that resurfacing arthroplasty may, in some cases, cause osteonecrosis of the femoral head remnant, which may play a role in femoral neck fracture. Efforts should be made to obtain the femoral head remnant at autopsy and at revision surgery when indicated so that the state of the femoral head remnant after resurfacing arthroplasty and its role in the success or failure of the various procedures could be better understood.

Adult↗
PubMed1994

Imaging after arthroplasty.

Arthroplasty is now an important and frequently performed orthopedic procedure. This article focuses on the imaging of abnormalities frequently encountered in patients who have undergone arthroplasty. The emphasis is on plain film analysis, although arthrography, computed tomography and nuclear medicine are also discussed. Among the problems illustrated are loosening of the prosthesis, component fatigue or failure, and infection. The authors recommend techniques to optimize imaging. Although most of the entities illustrated involve hip arthroplasty, the principles are valid for arthroplasty at other sites.

Arthrography↗
PubMed1994

Unicompartmental knee arthroplasty. Sequential radiographic and scintigraphic imaging with an average five-year follow-up.

Clinical, radiographic, and scintigraphic results of 33 consecutive unicompartmental knee arthroplasties were reviewed after a mean follow-up period of 68 months (range, 24 to 112 months). Clinical grades employing criteria established by the Hospital for Special Surgery showed 74% good to excellent and 11% fair to poor results. Four knees (15%) required revision to a total knee arthroplasty after an average postoperative interval of 7.4 years. Within the subset of surviving medial compartment arthroplasties (23 knees), superior clinical results were associated with a central or slightly medialized mechanical axis (p < 0.05). Periprosthetic radiolucency showed no correlation with clinical scores or failures resulting in revision surgery. There was no radiographic evidence of progressive arthrosis within the unreplaced compartments. Comparative analysis of preoperative and annual postoperative technetium bone scans showed no temporally related changes indicative of impending prosthetic failure or disease progression within the unoperated compartments. The surgically treated compartments maintained uniformly intense femorotibial activity, whereas the unoperated compartments, including the patellofemoral joint, remained scintigraphically quiescent. Disease progression in unreplaced compartments is unusual after contemporary unicompartmental knee arthroplasty. Most failures and poor results arise from mechanical inadequacies amendable to surgical technique and/or future design considerations.

Aged↗
PubMed1977

Cup arthroplasties in teen-agers and children.

Review of cup arthroplasties performed prior to 1970 in sixty hips of fity-one consecutive patients less than twenty years old, with follow-up on fifty-three hips, revealed that fifteen (28%) of the cup arthroplasties were followed by other salvage operations, usually total hip arthroplasty. Of the remaining thirty-eight hips, only twenty-four (63%) were rated satisfactory clinically, although most of the patients considered their cup arthroplasty an improvement over their preoperative status. Patients with bilateral hip disease did very poorly, and results were inconsistent in others. The final range of motion was frequently poor. Results were improved in hips in which acetabular reaming was not required.

Adolescent↗
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↗
PubMedDate not supplied

Semiconstrained total elbow arthroplasty.

Diminution of elbow function may be both embarrassing and severely disabling, especially in patients with multiple arthritic joints. Over the past century, multiple techniques of soft tissue reconstruction of the elbow have been advocated. In general, they do not compare well with total elbow arthroplasty. Arthrolysis has often resulted in little improvement of elbow motion and interposition arthroplasty to instability. Synovectomy may however offer satisfactory relief of disability for the rheumatoid elbow provided that initially there is little evidence of joint destruction. The major problem with rigidly linked total elbow arthroplasty has been a high incidence of prosthetic loosening. Biomechanical analysis has shown that high moments tend to disrupt the osseousmethacrylate junction in the humoral medulary canal. Development of a semi-constrained total elbow prosthesis transfers the developed stress to the collateral soft tissues and reduces prosthetic loosening to approximately 3 per cent. This is about one-tenth of the incidence of loosening of the hinge type arthroplasty. This reduction in prosthetic loosening has been coupled with excellent gains in flexion and estension. However, improvement in forearm rotation has not been predictable, especially in elbows exhibiting preoperative fusion or fibrous ankylosis. Though the semi-counstrained total elbow has only been generally available for 3 years, a review of these results justifies its continued use for elbow reconstruction.

Arthritis, Rheumatoid↗
PubMed1999

Dislocation after total hip arthroplasty using the anterolateral abductor split approach.

The three basic surgical approaches used most commonly in total hip arthroplasty are transtrochanteric, posterior, and anterolateral. Complications related to each of these surgical approaches have been reported including dislocation, trochanteric nonunion, heterotopic ossification, neurovascular damage, postoperative limp, and implant malalignment. The anterolateral abductor split approach previously has been reported to allow ease of access into the hip joint, optimum joint visualization, protection of neurovascular structures of the hip, and predictable results for postoperative hip function restoration. Reviewing a large consecutive series of primary total hip arthroplasty cases (1518), the authors report an overall dislocation rate less than 1% (12:1518; 0.79%). Stratified by preoperative diagnosis, patients undergoing total hip arthroplasty after trauma, or presenting with congenital dysplastic hip are at the highest risk for postoperative dislocation. Primary total hip arthroplasty using the anterolateral, abductor split approach can minimize the rate of postoperative dislocation in the prevailing preoperative diagnostic categories.

Adult↗