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 109 records · Page 6Linked to original sources
PubMed1991

Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties.

From 1971 through 1987, 9200 total knee arthroplasties were performed at the Mayo Clinic. Actuarial analysis was used to estimate cumulative rates of survival. Use of a proportional-hazard, general linear model led to the identification of four independent variables that were associated with a significantly lower risk of failure: primary total knee arthroplasty, a diagnosis of rheumatoid arthritis, an age of sixty years or more, and use of a condylar prosthesis with a metal-backed tibial component. When all four of these favorable variables were present (without regard for radiographic changes and non-disabling symptoms), the probability of an implant being in situ was 97 per cent at both five and ten years.

Aged↗
PubMed2003

Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register.

On the basis of the Norwegian Arthroplasty Register, which has recorded nearly all primary hip prostheses and revisions in Norway since 1987, we studied risk factors for prosthesis luxation leading to revision. 7 prosthesis brand combinations used in 42,987 primary operations were included from 1987-2000. We found that femoral head size was an important risk factor; 28 mm heads led to revision more often than 32 mm ones (failure rate ratio (FRR) 4.0, 95% confidence interval (CI) 2.2-7.3). Charnley (22 mm head) performed equally well or better than the 28 mm heads. The Exeter stem and cup is the type of prosthesis on the Norwegian market with more than two femoral head sizes (26, 28, 30, 32 mm) and 26 mm heads led to revision due to luxation significantly more often than 30 mm heads (FRR 4.1, 95%CI 2.2-8.1). Old age, preoperative diagnosis, and choice of prosthesis brand combination were also important factors affecting the revision rate due to luxation. A posterior approach increased the risk of revision more than a lateral one (FRR 1.9, 95% CI 1.4-2.5). Gender, trochanteric osteotomy and duration of the operation did not affect the results.

Aged↗
PubMed2004

"Wandering resident" surgical exposure for 1- or 2-stage revision arthroplasty in stiff aseptic and septic knee arthroplasty.

A retrospective study was performed on 18 patients who had undergone revision total knee arthroplasty (TKA) between 1992 and 2000 with stiff knee (average, 50 degrees range of motion). The so-called "wandering resident" surgical exposure was used. This procedure was used twice in 5 cases with low-grade infection in a 2-stage revision of their septic prosthesis. Follow-up was from 1 to 8 years (average, 3.5 years). All patients had good clinical results, with an 86 degrees average range of motion. The Knee Society Score preoperatively ranged from 35 to 52 (average, 40) and improved to 72 to 89 (average, 84). Postoperative rehabilitation was slower, requiring the use of a knee brace in extension for 6 weeks for support while the patient ambulated and without this support for daily physiotherapy and continuous passive motion at 0 degrees to 70 degrees. Full range of motion with no brace was started after 6 weeks.

Arthroplasty, Replacement, Knee↗
PubMed2004

2003 Hap Paul Award Paper of the International Society for Technology in Arthroplasty. Design and activity dependence of kinematics in fixed and mobile-bearing knee arthroplasties.

Knee arthroplasty implants are designed with features that provide varying articular constraint over the range of flexion such that the pattern of knee motion may also vary. Because the motions of total knee implants have a direct influence on patient function and device longevity, it is important to understand how knee implants based on a variety of design philosophies perform in vivo. Fifty-nine knees in patients with 5 designs of implants were studied with fluoroscopic imaging during gait and stair-climbing activities. Many knees showed significantly different kinematics between the gait and stair activities, as well as differences from knees having other implant designs. The measured motions were consistent with the intrinsic constraint provided by the implant components and the variation in constraint over the flexion range.

Analysis of Variance↗
PubMed2006

Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial.

The purpose of this study was to evaluate the hypothesis that a less invasive (LIS) surgical technique using a navigation system would promote rapid recovery and improve alignment compared with conventional technique in total knee arthroplasty (TKA). This study compared 49 navigation-assisted LIS TKAs with 53 conventionally performed TKAs using a medial parapatellar arthrotomy with patellar eversion. Navigation-assisted LIS TKA used a shorter skin incision, a midvastus approach without patella eversion, and a navigation system. Navigation-assisted LIS TKA had better pain scores, shorter times to achieve 90 degrees flexion and straight leg raise, and a smaller extension lag during the very early postoperative period. However, there were no differences between the groups 2 weeks postoperatively. There were no differences in mean prosthetic alignment between the 2 groups, but the navigation-assisted LIS group had fewer "outliers" than the conventionally performed TKA group.

Adult↗
PubMed1986

Autogenous costochondral grafts in temporo-mandibular joint arthroplasty. A survey of 66 arthroplasties in 60 patients.

A clinical study of 60 patients who underwent 66 costochondral arthroplasties during the period 1969-1984 is presented. In nearly half of the cases ankylosis was the main indication for operation, followed by dysplasia, tumours and osteomyelitis. The results showed that all cases in which the rib was decorticated to fit into the mandible as an inlay healed well. The mean time of IMF was 3.5 weeks. In the majority of the patients (67%) the postoperative function of the mandible was considered to be good or excellent, and nearly all patients were pain free. There were no postoperative chest infections and only one case of pneumothorax. Motor and sensory disturbances in the lower lip were each diagnosed in ten per cent of the patients.

Adolescent↗
PubMed2001

Inpatient interdisciplinary rehabilitation after total hip arthroplasty surgery: a comparison of revision and primary total hip arthroplasty.

OBJECTIVES: To describe outcomes of revision total hip arthroplasty (THA) patients who underwent interdisciplinary inpatient rehabilitation, and to compare them with primary THA patients. DESIGN: Descriptive and case-control study. SETTING: Forty-bed, community-based, freestanding rehabilitation hospital. PATIENTS: Thirty-nine revision THA subjects, gender- and age-matched with 39 primary THA controls. INTERVENTION: Inpatient interdisciplinary rehabilitation. MAIN OUTCOME MEASURES: FIM instrument, length of stay, hospital charges, and disposition location. RESULTS: The average revision THA patient stayed 10.5 days, improved from an admission FIM score of 89 to a discharge FIM score of 110, and incurred a hospital charge of $10,600. Of the revision THA patients, 98% were discharged home, and orthopedic-related complications were uncommon. No significant differences existed between revision and primary THA patients in any outcome measures. A trend toward higher rehabilitation charges ($12,400 vs $9500, p =.07) was found in revision THA patients who wore a hip orthosis. Otherwise, no differences were found in outcome measures based on the type of revision surgery, the presence of weight-bearing restrictions, or the presence of orthopedic complications. CONCLUSIONS: THA patients selected for inpatient rehabilitation have favorable short-term functional outcomes. The type of THA (primary vs revision) is not an independent differentiating factor.

Aged↗
PubMed2000

The cruciate ligaments in total knee arthroplasty: a kinematic analysis of 2 total knee arthroplasties.

In vivo weight-bearing fluoroscopic kinematic analysis using an interactive model fitting technique with 3-dimensional computer-aided design solid models was done using 16 anterior and posterior (bicruciate)-sparing and 6 posterior cruciate-sparing total knee arthroplasties (TKAs). All patients had a satisfactory clinical result with a minimum of 12 months' follow-up. The femorotibial contact position of TKAs started posterior to the midline in extension. Bicruciate TKAs revealed gradual posterior femoral rollback and limited anterior-posterior translation but remained posterior to the sagittal plane midline in all positions. Posterior cruciate-sparing TKAs began significantly posterior in extension, demonstrated progressive anterior translation with flexion, and had exaggerated medial condyle translation on deep knee bend. The posterior cruciate-retaining TKAs of this study had the most abnormal kinematic performance.

Anterior Cruciate Ligament↗
PubMed2003

Paradoxic cerebral embolism after cemented knee arthroplasty: a report of 2 cases and prophylactic option for subsequent arthroplasty.

Major orthopaedic procedures that involve instrumentation of the medullary canal are well known to produce showers of embolic debris including fat, bone fragments, marrow constituents, and cement. A growing literature has identified paradoxic cerebral embolism as a rare but serious consequence of the passage of these emboli through an intracardiac right-to-left shunt to the cerebral arterial circulation. We report 2 cases of paradoxic cerebral embolism after cemented total knee arthroplasty and propose a novel treatment plan to prevent recurrent stroke during subsequent surgery.

Aged↗
PubMed2000

The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties.

In 1985, the Norwegian Orthopaedic Association decided to establish a national hip register, and the Norwegian Arthroplasty Register was started in 1987. In January 1994, it was extended to include all artificial joints. The main purpose of the register is to detect inferior results of implants as early as possible. All hospitals participate, and the orthopedic surgeons are supposed to report all primary operations and all revisions. Using the patient's unique national social security number, the revision can be linked to the primary operation, and survival analyses of the implants are done. In general, the survival analyses are performed with the Kaplan-Meier method or using Cox multiple regression analysis with adjustment for possible confounding factors such as age, gender, and diagnosis. Survival probabilities can be calculated for each of the prosthetic components. The end-point in the analyses is revision surgery, and we can assess the rate of revision due to specific causes like aseptic loosening, infection, or dislocation. Not only survival, but also pain, function, and satisfaction have been registered for subgroups of patients. We receive reports about more than 95% of the prosthesis operations. The register has detected inferior implants 3 years after their introduction, and several uncemented prostheses were abandoned during the early 1990s due to our documentation of poor performance. Further, our results also contributed to withdrawal of the Boneloc cement. The register has published papers on economy, prophylactic use of antibiotics, patients' satisfaction and function, mortality, and results for different hospital categories. In the analyses presented here, we have compared the results of primary cemented and uncemented hip prostheses in patients less than 60 years of age, with 0-11 years' follow-up. The uncemented circumferentially porous- or hydroxyapatite (HA)-coated femoral stems had better survival rates than the cemented ones. In young patients, we found that cemented cups had better survival than uncemented porous-coated cups, mainly because of higher rates of revision from wear and osteolysis among the latter. The uncemented HA-coated cups with more than 6 years of follow-up had an increased revision rate, compared to cemented cups due to aseptic loosening as well as wear and osteolysis. We now present new findings about the six commonest cemented acetabular and femoral components. Generally, the results were good, with a prosthesis survival of 95% or better at 10 years, and the differences among the prosthesis brands were small. Since the practice of using undocumented implants has not changed, the register will continue to survey these implants. We plan to assess the mid- and long-term results of implants that have so far had good short-term results.

Activities of Daily Living↗
PubMed2001

Outcome after total hip arthroplasty: Part II. Disease-specific follow-up and the Swedish National Total Hip Arthroplasty Register.

The Swedish National Total Hip Arthroplasty Register records primary hip replacements, revisions and surgical technique/environmental factors. The end-point for failure is revision. A prosthesis still in place, however, does not mean success. Clinical and radiographic outcomes should describe in more detail the efficacy of hip replacement surgery instead of the relatively blunt outcome measure that the register can provide. We performed a clinical outcome analysis on patients with primary total hip replacement thus testing the adequacy of the end-point for failure in the Swedish register. 1,113 randomly selected patients who had had total hip replacement surgery between 1986 and 1995 answered a disease-specific self-administered questionnaire (WOMAC). A cohort of 344 patients was studied, using the Harris Hip Score and a conventional radiographic examination as outcome measures. We found clinical failure rates of 13% and 20% for all implants after 10 years, using 60 points or revision as the definition of failure in the Harris Hip Score and WOMAC, respectively. The result, according to the register during the same period, was a 7% revision rate. The clinical failure rate depended on the type of evaluation tool, definition of failure and demographics, which made it difficult to decide whether there was a need for revision. With the exception of pain measured by the Harris Hip Score, the results showed no significant correlation between clinical failure and radiographic failure. Hence, with the knowledge that there is a difference between the revision rate according to the register and clinical outcome, the strict definition of failure in the register is useful as an end-point for primary hip replacement surgery.

Adult↗
PubMed2005

Survival of the AGC total knee arthroplasty is similar for arthrosis and rheumatoid arthritis. Finnish Arthroplasty Register report on 8,467 operations carried out between 1985 and 1999.

We report the survival of AGC knee endoprosthesis from the Finnish Arthroplasty Register for 2 indications, osteoarthrosis (OA, 6,306 knees) and rheumatoid arthritis (RA, 2,161 knees) during 1985-1999. Survivorship analysis was performed with revision as an endpoint. We found similar survival rates. In the OA group, survival after 5 years was 97% and it was 94% after 10 years. In the RA group the corresponding figures were 97% and 96%, respectively. There was no significant difference in survival whether or not cement was used for fixation. The revision rates were higher in men and in younger patients.

Aged↗
PubMed2006

High wear rates and extensive osteolysis in 3 types of uncemented total hip arthroplasty: a review of the PCA, the Harris Galante and the Profile/Tri-Lock Plus arthroplasties with a minimum of 12 years median follow-up in 96 hips.

BACKGROUND: High wear rates and femoral and acetabular osteolysis have been-and still are-the main problems in uncemented total hip replacement. We reviewed 96 consecutive cementless total hip replacements of 4 different designs. PATIENTS AND METHODS: 21 PCA, 25 Harris Galante Porous/Harris Galante I (stem/cup), 25 Profile pressfit/ Tri-Lock Plus (stem/cup) and 25 Profile HA-coated/Tri-Lock Plus (stem/cup) prostheses were included. The operations were performed in the period 1984-1991. Median follow-up ranged from 12-16 years. Wear and osteolysis were measured. RESULTS: Mean linear wear rates ranged from 0.17 to 0.21 mm/year in the 4 groups, and there were no statistically significant differences between the groups (p = 0.9, ANOVA). Moderate or extensive osteolysis was found in 46 of the 96 hips included. The association between high and low wear rates (more or less than 0.20 mm/ year) and extent of osteolysis was statistically significant (p < 0.001, t-test). We found poor 12-year survival of the primary prostheses in all 4 groups (50-70%), mainly due to revisions because of wear of the polyethylene liner and/or osteolysis. The infrequently documented Profile/Tri-Lock Plus systems did not perform differently from the PCA and the HG. INTERPRETATION: The poor long-term results with these uncemented total hip arthroplasties illustrate the necessity of regular radiographic evaluation in order to detect osteolysis and liner failure, which are both generally asymptomatic until catastrophic failure appears.

Adult↗
PubMed2003

Lumbar spine arthroplasty: early results using the ProDisc II: a prospective randomized trial of arthroplasty versus fusion.

This study represents the first 39 patients with at least 6-month follow-up enrolled in a prospective randomized Food and Drug Administration study evaluating the safety and efficacy of the ProDisc II versus the control, a 360 degrees lumbar spinal fusion. Data were collected preoperatively and at 6 weeks, 3 months, and 6 months postoperatively. Visual Analog Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODQ), and patient satisfaction rates were evaluated at these intervals, as well as range of motion, return to work, and recreational and ambulatory status. There were 28 ProDisc patients and 11 who underwent fusion. Six patients had two-level surgery. Estimated blood loss (ProDisc = 69 mL versus fusion = 175 mL) and operative time (ProDisc = 75 minutes versus fusion = 219 minutes) were significantly different (P < 0.01). Hospital stays were shorter (ProDisc = 2.1 days versus fusion = 3.5 days [P < 0.01]) for ProDisc patients. There was a significantly greater reduction in the ODQ scores at 3 months in the ProDisc group compared with the fusion group (P < 0.05). No difference was noted in VAS. A trend was identified at 6 months in patient satisfaction rates favoring ProDisc versus fusion (P = 0.08), and motion was significantly improved in ProDisc patients compared with the fusion group (P = 0.02). Ambulatory status as well as recreational activity improved faster in the ProDisc group. The data suggest that total disc arthroplasty may be an attractive option as opposed to lumbar fusion for the surgical treatment of disabling mechanical low back pain secondary to lumbar disc disease.

Activities of Daily Living↗
PubMed1978

Charnley low-friction arthroplasties of the hip in rheumatoid arthritis. A study of the complications and results of 378 arthroplasties.

During the years 1971 to 1975, 378 Charnley low-friction arthroplasties of the hip were performed on 278 patients with rheumatoid arthritis. The average age at operation was thirty-nine years. The follow-up time ranged from one to six years (mean two and a half years). Forty per cent of patients were receiving steroids at the time of operation. The most common complications were loosening of the prosthesis (3.4%), perforation of the femoral cortex and fracture. Deep infection occurred in 0.7%, dislocation in 0.7%, and thromboembolic episodes in 1.3%. Ninety-five per cent of patients were free of pain at follow-up compared to 84% who were severely handicapped by pain before operation. In addition, the increased mobility in 98.5% of patients and their improved independence makes hip replacement a recommendable procedure in these patients.

Adolescent↗
PubMed2003

Mountain sports and total hip arthroplasty: a case report and review of mountaineering with total hip arthroplasty.

Participation in certain sports after total hip arthroplasty (THA) is common. Some high-risk sports such as extreme endurance sports with risks of falls and fractures are often cautioned against, except when the sport was participated in preoperatively and an excellent physical condition is present postoperatively. In this article, current concepts pertaining to this issue in general and in relation to mountain sports are discussed after a description of the activities of a 69-year-old patient who received cementless bilateral THAs in 1987 and 1995 and who resumed, after each rehabilitation, his preoperative sports practice (eg, walking and high-altitude mountaineering [6000+ m]). The patient, who was experienced in alpine and high-altitude mountaineering, was able, after his first operation, to climb classic alpine peaks (4000+ m) as well as participate in difficult and strenuous climbs outside Europe (Kilimanjaro, Elbrus, and Rolwaling trekking). After the second operation and an intensive rehabilitation program, he was able to climb 2 mountains in the range of 6000+ m. With excellent physical training, a long preoperative practice of the sport, and an intensive and careful rehabilitation, patients with a THA are, under specific circumstances, able to perform mountaineering at a very high, even professional level without signs of prosthesis loosening or higher than normal wear of the bearing materials.

Aged↗
PubMed2003

Good performance of a titanium femoral component in cementless hip arthroplasty in younger patients: 97 arthroplasties followed for 5-11 years.

We performed 97 uncemented primary total hip arthroplasties in 80 patients having an average age of 50 years. The femoral implant was a titanium stem with a proximal circumferential plasma spray-coating. Three different acetabular components were used: a threaded and partly porous-coated design in 70% of the cases. The average follow-up period was 8 years. 1 stem was revised 9 years after insertion due to a comminuted fracture of the proximal femur, 1 stem was revised 9 years after insertion due to a deep infection. No stem revisions were due to aseptic loosening. 1 femora had areas of distal osteolysis associated with a deep infection, but no signs of proximal loosening. 3 femora had areas of minor proximal osteolysis. 16 acetabular components (14 threaded) had been revised in 13 patients. The average Harris hip score was 91 points at the latest follow-up. We conclude that the uncemented titanium femoral component with a circumferential porous coating performed well in these patients, most of whom were young. As reported previously, aseptic loosening of threaded acetabular components was common.

Adolescent↗