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PubMed1983

Surgery of the rheumatoid foot.

The typical rheumatoid foot deformity is that of hallux valgus, bunion, hammer claw toes with contracted dorsal soft tissue, depressed metatarsal heads and associated painful callosities and corns both under metatarsal heads and on dorsal surfaces of cocked-up lesser toes. Deformity and pain will be amendable with surgery if patients are selected properly and correct surgery is performed to achieve a pain free weight-bearing foot.

Adult↗
PubMed1983

Implant arthroplasty for metacarpal and interphalangeal joints in rheumatoid arthritis.

An ongoing research project for the development of flexible implants for small joint arthroplasty in the extremities has been carried out since 1962 by the senior author, based on the concept that a low-modulus implant would not harm bone because of its force dampening characteristics. Implants made of medical grade silicone elastomer were designed, developed and extensively tested in laboratory and clinical studies. Long term clinical, radiographic and biological studies have shown these implants to have excellent biocompatibility and biodurability. The flexible implants act as dynamic spacers to help maintain proper joint alignment and spacing, while supporting the new capsuloligamentous system that develops around them. The flexible implants act as an adjunct to resection arthroplasty to make its' results more predictable, reproducible and durable. Our long term results have shown that flexible implant resection arthroplasty can provide very good durability, range of motion, stability, pain relief, biotolerance and retrievability. The indications, contraindications, surgical techniques and postoperative rehabilitation methods will be discussed for the metacarpophalangeal and proximal interphalangeal joints.

Arthritis, Rheumatoid↗
PubMed1978

Geometric total knee replacement for treatment of the rheumatoid knee.

The results of fifty-four geometric total knee arthroplasties in forty-four patients with definite or classic rheumatoid arthritis were analyzed twenty-four to sixty-four months after the surgical procedure. There were no operative deaths, no postoperative infections, and no known pulmonary emboli. Three patients required additional operative procedures on the knee: one, a patellectomy for pain one year after arthroplasty; the second, resection of tibial bone and reinsertion of the tibial component to correct a flexion contracture; and the third, replacement of the tibial component because of loosening. The relief of pain and increase in ability to carry out the activities of daily living were dramatic in these patients, who, because of the limitations imposed by their rheumatoid arthritis, applied minimum stress on the prosthetic knees. Postoperatively, the average arc of knee flexion was 104 degrees.

Activities of Daily Living↗
PubMed1978

The number of total joint replacements in the United States.

By comparing estimates from several sources an assessment can be made of the number of total joint replacement procedures performed annually in the United States. Approximately 80,000 hips and 40,000 knee joints were replaced in the U.S. during 1976. Total hip replacement has been accepted by the orthopedic community as an efficacious mode of treatment of the many painful and disabling forms of arthritis. A substantial patient population could benefit from perfection of designs for treating joints other than the hip.

Hip Joint↗
PubMed1983

Bony ingrowth fixation of newly designed acetabular components in a canine model.

Implantation of a newly designed acetabular component with a porous coating has resulted in superior fixation when compared with acrylic cementation in the short term. Experiments in dogs demonstrate rapid ingrowth within the porous layers, resulting in rigid fixation of the acetabular components despite defects in the prepared bony bed. Acute infection prevents bony ingrowth and causes loosening. The absence of any foreign-body response to the titanium fiber mesh components suggests that this is a biocompatible metal. The fixation has been excellent; progressive or delayed loosening is not encountered once successful ingrowth is achieved. Progressive radiolucent zones generally do not appear in the short term but when visible soon after surgery, may consolidate and disappear. Ingrowth fixation of acetabular components appears to offer an attractive alternative to the use of acrylic cement and may even be feasible in patients with periarticular bony abnormalities.

Acetabulum↗