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At least 1,063 records · Page 59Linked to original sources
PubMed1999

Staphylococcus aureus prosthetic joint infection treated with prosthesis removal and delayed reimplantation arthroplasty.

OBJECTIVE: To estimate in patients with Staphylococcus aureus prosthetic joint infection after total hip arthroplasty (THA) or total knee arthroplasty (TKA) the microorganism-specific cumulative probability of treatment failure after prosthesis removal and delayed reimplantation arthroplasty. PATIENTS AND METHODS: All patients with S aureus THA or TKA infection, according to a strict case definition, who were treated with prosthesis removal and delayed reimplantation arthroplasty at Mayo Clinic Rochester between 1980 and 1991 were identified. The study group comprised patients who were free of infection at the time of reimplantation arthroplasty. This cohort was followed up until treatment failure, infection with another organism, prosthesis removal, death, or loss to follow-up occurred. The Kaplan-Meier survival method was used to estimate the cumulative probability of treatment failure. RESULTS: Among 120 S aureus prosthetic joint infections treated with prosthesis removal during the study period, 38 episodes (22 THA, 16 TKA) in 36 patients met the study inclusion criteria. After a median of 7.4 years (range, 0.9 year-16.4 years) of follow-up, treatment failure occurred in 1 (2.6%) of 38 episodes 1.4 years after reimplantation arthroplasty. The 5-year cumulative probability of treatment failure was 2.8% (95% confidence interval, 0%-8.2%). CONCLUSIONS: These data suggest that prosthesis removal and delayed reimplantation arthroplasty is an effective treatment to limit the recurrence of S aureus prosthetic joint infection, provided there is no evidence of infection at the time of reimplantation arthroplasty.

Adult↗
PubMedDate not supplied

Implant failures.

Explore the source record for details and available documents.

Dental Implants↗
PubMedDate not supplied

[The value of preoperative knee aspiration and arthroscopic biopsy in revision total knee arthroplasty].

AIM: The accurate preoperative diagnosis of occult sepsis in endoprosthetic loosening of total knee arthroplasty is the key to successful management of revision total knee arthroplasties. The aim of this study was to evaluate the results of preoperative aspiration in comparison with preoperative arthroscopic biopsy of the synovial tissue. METHOD: From 2000 to 2004 eighty-six revision total knee arthroplasties in 86 patients were performed. 60 patients had only a knee aspiration, 15 an arthroscopic biopsy and an aspiration, 11 only arthroscopic biopsy. The results of both methods were compared with the intraoperative cultures during revision surgery. RESULTS: 69 aseptic and 17 septic knee exchange arthroplasties were performed. The preoperative aspiration of the prosthetic knee joint had a sensitivity of 68.8 %, specificity of 96.6 %, positive predictive value of 84.5 % and a negative predictive value of 92.2 %. The preoperative arthroscopic biopsy had a sensitivity of 100 %, specificity of 94.7 %, positive predictive value of 87.4 % and a negative predictive value of 100 %. CONCLUSION: Preoperative aspiration of the knee is a very helpful study for the diagnosis or exclusion of infection in a prosthetic knee joint and should be a standard procedure in the diagnosis of prosthetic loosening. If after aspiration a suspicion of infection remains, then the biopsy is an accurate procedure to diagnose or exclude periprosthetic sepsis.

Aged↗
PubMedDate not supplied

[Long-term results with the Harris-Galante press-fit-cup].

AIM: The present work aims at evaluating the clinical and radiological long-term results of the Harris-Galante press-fit cup. METHOD: At an average follow-up time of 9.5 years (min. 9, max. 10.3) 123 patients with 138 Harris-Galante press-fit cups (HGP) were examined clinically and radiology. The clinical evaluation was done with the Harris hip score. Together with the HGP, which was inserted in all cases, five different femoral stems were implanted. A lateral approach, according to the technique of Watson-Jones, was used in all cases. RESULTS: The mean follow-up Harris hip score was 89 of 100 points and is assessed as a good result. 7 cups (5%) were classed as being radiological loose, but only one case had also clinical symptoms. A total of 10 cups (6.8%) had to be revised. 3 cups (2 %) had to be revised because of aseptic loosening. This result represents a survival rate of 93.2% according to Kaplan-Meier. CONCLUSION: The long-term clinical and radiological results of the Harris-Galante press-fit cup and there fixation method can assessed as good.

Arthroplasty, Replacement, Hip↗
PubMed2005

Analysis of recurrent mitral regurgitation after mitral valve repair.

Mitral valve repair was performed in 437 patients with mitral regurgitation from January 1994 to January 2002. The causes of mitral regurgitation were degenerative in 238 (54%), rheumatic in 134 (31%), and others in 65 (15%). The most frequently employed surgical techniques were ring annuloplasty in 417 (95%) cases, new chordae formation in 216 (50%), and quadrangular resection in 117 (27%). The mean follow-up was 29.04 +/- 22.81 months. There were 5 (1.2%) early and 5 (1.2%) late deaths. The reoperation rate was 1.6% with 41 (9%) cases of recurrent mitral regurgitation. Of these 22 were procedure-related: incomplete repair in 13, discordant new chordal length in 7, suture dehiscence and leaflet perforation in 1 case each. There were 19 cases of valve related failures: progression of rheumatic disease in 18 and subacute infective endocarditis in 1. Valve-related failure strongly correlated with progression of rheumatic disease. As initial operative success was the prime determinant of repair durability, intraoperative repair assessment with transesophageal echocardiography was essential.

Adolescent↗
PubMed1999

Modelling evaluation of the testing condition influence on the maximum stress induced in a hip prosthesis during ISO 7206 fatigue testing.

In vivo fatigue failure of hip prosthesis stems has been extensively reported in literature. The ISO 7206 international standard has been developed to assess the fatigue reliability of hip prostheses. It describes the fatigue testing apparatus and procedure and it is currently adopted by several testing laboratories throughout the world. In this work we evaluate the maximum stress in a titanium alloy commercial stem in different testing conditions, ranging within the standard specification, using the finite element method applied to a 3D model of the stem. The calculated maximum von Mises stress ranges from +4.5 to -1.5% (for different cement constraint levels) and from +6.7 to -6.8% (for different stem angular orientations) with respect to that calculated at the nominal testing conditions. The results suggest that the ISO 7206 testing specification will give experimental data of reasonable accuracy, with probably no more scatter than that found in typical specimen test results. This is particularly important in the case of components manufactured from materials showing a fatigue resistance highly sensitive to stress variations, such as the Ti6A14V alloy, for which a small increase of the maximum applied stress corresponds to a significant decrease of the statistical fatigue life.

Alloys↗
PubMed2004

The expression of CD44 in archival paraffin embedded interface tissues of failed orthopaedic implants.

CD44 hyaluronan receptor is present on large number of different cell type. It acts as one of the adhesion proteins, binding to hyaluronan and is known to play a part in cell migration from vessels in inflammation. The aim of this study was to examine the presence and distribution of CD44 in interface membrane in aseptic loosening. Immunohistochemistry (IHC) using human anti-mouse CD44 antibody studied 20 aseptically loosened interface samples. Extracted protein from all cases was examined by Western blot and RT-PCR. CD44 was detected in 85% of interfaces by IHC and the presence of protein confirmed by blotting and RT-PCR, which showed the mRNA level for CD44. CD44 was expressed by macrophage, multinucleated giant cells, mast cells and lymphocytes. Further studies are needed to characterise the role of this molecule in the inflammatory response to wear debris in aseptic loosening.

Aged↗
PubMed2006

Risk factors for failure after treatment of a periprosthetic fracture of the femur.

Periprosthetic fracture of the femur is an uncommon complication after total hip replacement, but appears to be increasing. We undertook a nationwide observational study to determine the risk factors for failure after treatment of these fractures, examining patient- and implant-related factors, the classification of the fractures and the outcome. Between 1979 and 2000, 1049 periprosthetic fractures of the femur were reported to the Swedish National Hip Arthroplasty Register. Of these, 245 had a further operation after failure of their initial management. Data were collected from the Register and hospital records. The material was analysed by the use of Poisson regression models. It was found that the risk of failure of treatment was reduced for Vancouver type B2 injuries (p = 0.0053) if revision of the implant was undertaken (p = 0.0033) or revision and open reduction and internal fixation (p = 0.0039) were performed. Fractures classified as Vancouver type B1 had a significantly higher risk of failure (p = 0.0001). The strongest negative factor was the use of a single plate for fixation (p = 0.001). The most common reasons for failure in this group were loosening of the femoral prosthesis, nonunion and re-fracture. It is probable that many fractures classified as Vancouver type B1 (n = 304), were in reality type B2 fractures with a loose stem which were not recognised. Plate fixation was inadequate in these cases. The difficulty in separating type B1 from type B2 fractures suggests that the prosthesis should be considered as loose until proven otherwise.

Age Factors↗
PubMed1991

Adaptation of NASA technology for the optimum design of orthopedic knee implants.

NASA technology originally developed for designing aircraft turbine-engine blades has been adapted and applied to orthopedic knee implants. This article describes a method for tailoring an implant for optimal interaction with the environment of the tibia. The implant components are designed to control stresses in the bone for minimizing bone degradation and preventing failures. Engineers expect the tailoring system to improve knee prosthesis design and allow customized implants for individual patients.

Aerospace Medicine↗
PubMed1992

Risk factors for failure of immediate breast reconstruction with prosthesis after total mastectomy for breast cancer.

BACKGROUND: Immediate breast reconstruction (IBR) after mastectomy represents a clear improvement in the quality of life of patients with breast cancer, but prosthesis removal is relatively frequent. Therefore, it is important to identify risk factors related to this removal. METHODS: A series of 142 patients treated with mastectomy and IBR at the Institut Gustave-Roussy between January 1976 and December 1988 were studied. Forty-seven had an in situ carcinoma, 93 an infiltrating carcinoma, and 2 a fibrosarcoma. IBR failures were defined as removal of the prosthesis, and early failures as removal during the first 7 weeks after IBR. RESULTS: The early failure rate was significantly higher in patients with invasive carcinomas or fibrosarcomas than patients with in situ carcinomas (12% versus 0%, P = 0.04). The risk of late IBR failure was significantly higher in patients who had received postoperative radiation therapy than patients who did not (P = 0.0002). However, this increased risk applied only to women in whom the chest wall was exposed to radiation because of a high risk of recurrence. CONCLUSION: It might be preferable to postpone breast reconstruction for patients with infiltrating breast carcinoma because early complications are not infrequent and could delay adjuvant chemotherapy. Late complications associated with chest wall irradiation could be avoided with the use of alternative techniques such as the transverse rectus abdominis myocutaneous (TRAM) flap procedure.

Breast↗
PubMed2005

Rehabilitation of edentulous mandibles by means of turned Brånemark System implants after one-stage surgery: a 1-year retrospective study of 152 patients.

BACKGROUND: Rehabilitation of the edentulous mandible with oral implants is today predominantly executed with one-stage surgery and early or immediate loading. It is generally claimed that the outcome is similar to that of the classic two-stage technique. PURPOSE: The aim of the present investigation was to retrospectively evaluate the 1-year results of one-stage surgery and early loading performed in edentulous mandibles in a large group of patients. The outcome was compared with that of a study, from the same clinic (control), that used the two-stage surgical technique in edentulous mandibles and whose data were well controlled. MATERIALS AND METHODS: The study included 152 individuals with 750 turned Brånemark System implants of various designs placed in edentulous mandibles by means of one-stage surgery. The prosthetic procedure was commenced at a mean of 13 days after the surgical intervention. Intraoral apical radiography was performed at the time of prosthesis placement and at the 1-year annual checkup. Comparison of failure rates between the test and the control groups was made by means of the chi-square test. RESULTS: A total of 18 implants in 12 patients in the study group were found to be mobile up to and including the first annual checkup, equivalent to a 1-year implant cumulative survival rate (CSR) of 97.5%. The corresponding CSR for the control group was 99.7%. Differences between the two groups in regard to implant survival reached significant levels when analyzed with the chi-square test (p < .05). No such significant difference was seen on the patient level (p > .05). Because of implant failures one prosthesis in the study group was remade. The mean marginal bone resorption during the first year of function was 0.4 mm in both groups. CONCLUSIONS: The present investigation showed a high but (compared with the classic two-stage technique) somewhat lower CSR after 1 year for the one-stage technique. More prosthetic adjustments due to implant failures were observed in the study group, and the results emphasize the need for large study samples in order to statistically verify small differences between various treatment techniques.

Adult↗