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PubMed1996

Differences between patients' and physicians' evaluations of outcome after total hip arthroplasty.

The purpose of this study was to compare patients' and physicians' evaluations of the results of 147 total hip arthroplasties. The patients and physicians independently evaluated pain and over-all satisfaction with the outcome of the procedure using a 10.0-centimeter visual-analog scale. They also answered a questionnaire with which they assessed general health, functional ability, and pain. The mean (and standard deviation) analog rating for pain (with 0.0 centimeters indicating no pain and 10.0 centimeters, severe pain) was 1.7 +/- 2.6 centimeters as assessed by the patients and 1.1 +/- 1.8 centimeters as assessed by the physicians (p < 0.001, paired t test). The mean analog rating for over-all satisfaction (with 0.0 centimeters indicating poor and 10.0 centimeters, excellent) was 8.6 +/- 2.1 centimeters as assessed by the patients and 8.8 +/- 1.7 centimeters as assessed by the physicians (p = 0.07, paired t test). There was a marked disparity between the patients' and the physicians' scores when the patients assigned a low score to a particular area. For the thirty patients who rated the pain as more than 4.0 centimeters, the mean analog rating was 6.8 +/- 2.1 centimeters according to the patients, while it was 3.6 +/- 2.7 centimeters according to the physicians (p < 0.001, linear regression). The mean analog rating for over-all satisfaction according to the nineteen patients who rated this parameter as less than 7.0 centimeters was 3.8 +/- 2.0 centimeters, while the mean rating according to the physicians 6.5 +/- 2.8 centimeters (p < 0.001, linear regression). The patients' and physicians' evaluations were similar regarding the results of the total hip arthroplasty when the patients had little or no pain and were satisfied with the result. However, the disparity increased as the patients' ratings for pain increased and their ratings for over-all satisfaction decreased. This study highlights a discrepancy between patients' and physicians' evaluations of the results of total hip arthroplasty. This discrepancy increased when the patient was not satisfied with the outcome. The use of patients' self-administered questionnaires as well as traditional physician-generated assessments may provide a more complete evaluation of the results of total hip arthroplasty.

Activities of Daily Living↗
PubMed1997

Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty. Sixteen-year-average follow-up.

Acetabular reconstruction with bulk structural autogenous grafts and allografts from the femoral head in complex total hip arthroplasty was highly successful at an average of five years postoperatively but was much less so by 11.8 years. To assess the longer-term fate of such grafts, we reviewed the results of eighty-one consecutive total hip arthroplasties performed by the senior one of us with use of these grafts. Nine hips in nine patients who had died and two hips that were infected in two patients were excluded. Therefore seventy hips (sixty-two patients) were included in this study. The average duration of follow-up was 16.5 years (range, 14.1 to 21.4 years). Sixty-one arthroplasties were performed to treat various forms of congenital dysplasia. Fifteen arthroplasties, ten of which were revision operations, were performed with allograft, and fifty-five were performed with autogenous graft. The average age of the patients at the time of the index operation was 45.2 years (range, sixteen to sixty-nine years). All of the sockets, which had an average outer diameter of forty millimeters (range, thirty-four to fifty millimeters), were inserted with cement. The average coverage of the acetabular component by the bulk graft was 49 per cent (range, 15 to 100 per cent). All of the grafts united. At the latest follow-up examination, twenty-five acetabular components (36 per cent) had been revised for aseptic loosening, eighteen (26 per cent) had radiographic evidence of loosening, and twenty-seven (39 per cent) were rigidly fixed and in place. The average Harris hip score for the hips in which the implant remained rigidly fixed was 74 points, while that for the hips in which the implant was loose but had not been revised was 69 points. Nine of the fifteen acetabular components supported by allograft and sixteen (29 per cent) of the fifty-five supported by autogenous graft were revised (p = 0.03). However, the total rate of acetabular components that were either loose or revised was ten of fifteen and thirty-three (60 per cent) of fifty-five, respectively. This difference was not significant (p = 0.4), with the numbers available. Regression analysis revealed that a younger age at the time of the operation and the extent of coverage of the acetabular component by the graft were associated with the need for revision. Twenty-one (78 per cent) of the twenty-seven acetabular components that remained rigidly fixed were supported by graft over less than 50 per cent of the contact area, while only nine (36 per cent) of the twenty-five that were revised were so supported (p < 0.05). None of the nine acetabular components with 30 per cent of the contact area or less covered by graft were revised. In nineteen of the twenty-two revisions of the acetabular component performed after the index operation, the socket was inserted without cement; the average outer diameter of the socket was fifty-three millimeters (range, forty to fifty-eight millimeters). Both the structural autogenous grafts and the structural allografts used in acetabular reconstruction in total hip replacement functioned well for the initial five to ten years. By an average of 16.5 years, nine of the fifteen hips treated with allograft and sixteen (29 per cent) of the fifty-five treated with autogenous graft had been revised. The greater the extent of the coverage of the acetabular component by the graft, the greater the rate of late failure.

Acetabulum↗
PubMed1997

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.

We retrospectively reviewed the results of primary total elbow arthroplasty for the treatment of an acute fracture of the distal aspect of the humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two years) at the time of the injury. The patients were managed between November 1982 and October 1992. The presence of rheumatoid arthritis in nine patients (ten elbows) influenced the choice of treatment. The mean interval between the injury and the total elbow arthroplasty was seven days (range, one to twenty-five days). The mean duration of postoperative hospitalization was seven days (range, four to thirteen days). The mean duration of follow-up was 3.3 years (range, three months to 10.5 years). All patients were followed for a minimum of two years or until the time of death; the duration of follow-up was less than two years for three patients who died. None of the patients were lost to follow-up. Twenty implants were intact at the latest follow-up examination. One patient had a revision total elbow arthroplasty twenty months after the index procedure because of a fracture of the ulnar component sustained in a fall on the outstretched arm. On the basis of the Mayo elbow performance score, fifteen elbows had an excellent result and five had a good result; there were inadequate data for one elbow. There were no fair or poor results. The mean arc of flexion was 25 to 130 degrees. There was no evidence of loosening on the radiographs. Postoperative complications included fracture of the ulnar component in one patient, ulnar neurapraxia in three, and reflex sympathetic dystrophy in one. The results suggest that total elbow arthroplasty can be an alternative form of treatment of a severely comminuted fracture of the distal aspect of the humerus in older patients even in the presence of rheumatoid arthritis. This procedure is not an alternative to osteosynthesis in younger patients.

Accidental Falls↗
PubMed1997

Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study.

During a two-year period, eighty-nine patients who were scheduled to have a total knee arthroplasty for the treatment of degenerative osteoarthrosis were randomly assigned to one of two groups: resurfacing of the patella or retention of the patella. All patients received the same posterior cruciate-sparing prosthesis, and all operations were performed by, or under the direct supervision of, one of us. Three patients died in the early postoperative period. The remaining eighty-six patients (118 knees; fifty-eight that had had resurfacing of the patella and sixty that had not) formed the study group. They were followed for a mean of thirty months (range, twenty-four to forty-four months). Evaluation was performed with use of the clinical scoring system of The Knee Society, a patient-satisfaction questionnaire, specific questions regarding patellofemoral symptoms and function, and radiographs. All clinical evaluations were performed by the same research nurse, without the involvement of a physician, in a blinded manner (neither the nurse nor the patient had knowledge of whether the patella had been resurfaced). Preoperatively, the mean Knee Society score, on a scale ranging from 0 to 200 points, was 89.7 points (range, 33 to 132 points); postoperatively, this score improved to a mean of 172.7 points (range, 98 to 200 points). With the numbers available for study, we could detect no significant difference between the knees that had had patellar resurfacing and those that had not with regard to the over-all score (p = 0.63), the subscore for pain (p = 0.56), or the subscore for function (p = 0.77). We also could detect no difference between the treatment groups, with the numbers available, with regard to patient satisfaction or the responses to questions involving the function of the patellofemoral joint, including the ability to exit from an automobile, to rise from a chair, and to climb stairs. Thirty-two patients had bilateral total knee replacement with resurfacing of the patella in one knee and retention of the patella in the other. These patients expressed no clear preference for either knee. Eight (13 per cent) of the sixty knees that had not had resurfacing were painful anteriorly compared with four (7 per cent) of the fifty-eight that had; this was not a significant difference (p = 0.38), with the numbers available. The anterior pain that was noted postoperatively was predominantly of new onset; it had not been observed preoperatively in three of the four knees that had had resurfacing or in four of the eight that had not. No additional treatment options were offered to the patients who had anterior pain in the knee after resurfacing. However, six (10 per cent) of the sixty knees that had not had resurfacing had it subsequently, because of anterior pain in the knee, after the twelfth postoperative month (range, fifteen to thirty-nine months). The pain decreased in four of these knees. Thus, total knee arthroplasty with retention of the patella yielded clinical results that were comparable with those after total knee arthroplasty with patellar resurfacing, but it was associated with a 10 per cent prevalence of the need for subsequent resurfacing. The prevalence of anterior pain after total knee arthroplasty was not influenced by whether or not the patella had been resurfaced. The postoperative clinical scores, the postoperative development of anterior pain, and the need for subsequent resurfacing were not predicted by the presence of preoperative anterior pain, obesity, or the grade of chondromalacia observed intraoperatively. Because of the short duration of follow-up, these results should be considered preliminary. Additional follow-up is planned.

Adult↗
PubMed1997

Effect of the elevated-rim acetabular liner on loosening after total hip arthroplasty.

Elevated-rim acetabular liners recently were shown to be associated with improved stability of total hip prostheses in a large clinical series. However, the effect of this design on loosening remains unknown. To address this question, we reviewed the results of 5167 primary and revision total hip arthroplasties that had been performed at our institution from September 1, 1985, through December 31, 1991; 2469 of the acetabular components had an elevated-rim liner (10 degrees of elevation), and 2698 had a standard liner. Five-year follow-up data were available for 1237 hips (174 that had an elevated-rim acetabular liner and 1063 that had a standard acetabular liner). The cumulative probability of revision because of loosening of the implant was estimated as a function of time since the operation with use of the Kaplan-Meier survivorship method. The five-year probability of survival of the acetabular component was 98.8 per cent (95 per cent confidence interval, 97.9 to 99.6 per cent) for the prostheses that had an elevated-rim liner and 98.3 per cent (95 per cent confidence interval, 97.7 to 99.0 per cent) for those that had a standard liner (p = 0.87). The effect of the elevated-rim acetabular liner on the probability of revision because of loosening of the acetabular or the femoral component was analyzed for several subgroups: components inserted with cement, components inserted without cement, primary total hip arthroplasties, revision total hip arthroplasties, male patients, and female patients. With the numbers available, no significant differences were found in the probability of survival of the acetabular or the femoral component in any of the subgroups. Theoretical considerations suggest that the geometric design of the elevated-rim acetabular liner may have biomechanical characteristics that predispose the implant to early loosening. However, our initial review of the results of total hip arthroplasties after a mean follow-up period of five years (range, 0.25 to ten years) failed to demonstrate any difference in the cumulative probability of revision because of loosening of the implant. Continued surveillance is warranted and ongoing.

Acetabulum↗
PubMed2002

In vivo comparison of hip separation after metal-on-metal or metal-on-polyethylene total hip arthroplasty.

BACKGROUND: Twenty subjects were analyzed in vivo with use of video fluoroscopy to determine if the femoral head separates from the acetabular component during normal gait and to determine if the amount of separation differs between metal-on-metal and metal-on-polyethylene total hip prostheses. METHODS: Ten subjects had been treated with a metal-on-metal total hip arthroplasty and ten, with a metal-on-polyethylene total hip arthroplasty. All of the prostheses were implanted by the same surgeon utilizing the same surgical technique, and all were judged to be clinically successful (a Harris hip score of >90 points). Each subject walked with a normal gait on a level treadmill while under fluoroscopic surveillance. The two-dimensional fluoroscopic videotapes were then converted into three-dimensional images with use of a computer-automated model-fitting technique. Each implant was analyzed at various flexion angles to assess the amount of femoral head sliding. RESULTS: No femoral head sliding was observed in the subjects with a metal-on-metal implant, whereas all ten subjects with a metal-on-polyethylene implant had sliding that was greater than our threshold value of 0.75 mm. The average amount of femoral head sliding in these subjects was 2.0 mm, and the sliding was observed during the swing phase of gait. The sliding was typically seen medially while the femoral head remained in contact with the acetabular component superolaterally. CONCLUSIONS: Femoral head sliding commonly occurred following traditional metal-on-polyethylene total hip arthroplasty but not after metal-on-metal arthroplasty. These kinematic data may be of value in future hip-simulation studies to better duplicate wear patterns observed in retrieval analyses, assist in the understanding of the lubrication and wear rates of metal-on-metal designs, and facilitate designing of prosthetic components that minimize wear and optimize hip kinematics.

Acetabulum↗
PubMed1989

Immediate silastic arthroplasty for non-salvageable intraarticular phalangeal fractures.

Fourteen patients with open non-salvageable intraarticular fractures of the proximal interphalangeal joint or metacarpophalangeal joint, underwent immediate silastic arthroplasty using Swanson H.P. hinged implants. The patients' ages ranged from 14 to 49 years, with an average of 29 years. Time from surgery to final examination ranged from 4 months to 6 years, with an average of 26 months. The active range of motion obtained at the metacarpophalangeal joint arthroplasties ranged from 45 to 80 degrees, with an average of 60 degrees. The active range of motion obtained at the proximal interphalangeal joint arthroplasties ranged from 0 to 70 degrees, with an average of 29 degrees. Better results were generally obtained at the metacarpophalangeal level, and in those arthroplasties performed in non-amputated digits. There were no post-operative infections and all but one joint were stable.

Adolescent↗
PubMedDate not supplied

Biomechanical factors in wound healing following knee arthroplasty.

A significant proportion of deep infections following knee arthroplasty are consequent on a failure of primary wound healing. The management of such infections is difficult and the functional outcome is poor. It is essential to ensure that the initial biomechanical conditions are such that wound healing is encouraged. The ability of a wound to heal is dependent on factors such as the orientation of the skin incision, the wound tension and the viability of the wound edges as assessed by skin oxygen tension estimations. Consideration of these factors has led us to advocate the use of the medial parapatellar incision for knee arthroplasty. Early, excessive knee flexion following arthroplasty can lead to significant wound edge hypoxia but by modifying the rehabilitation programme and with the administration of 24% oxygen to the patient in the perioperative period, this effect can be minimized. Modification of the surgical techniques involved in knee arthroplasty can help preserve the vascular supply and hence the viability of the wound edge, and thus achieve a suitable biomechanical environment for primary wound healing.

Biomechanical Phenomena↗
PubMed1985

Unicompartmental arthroplasty of the knee. Cadaver study of the importance of the anterior cruciate ligament.

The tibiofemoral articulation on horizontal and 10 degrees tilted tibial components was examined radiographically in 20 cadaver knees after lateral arthroplasty, and after cutting the anterior cruciate ligament in 10 knees with medial and 10 with lateral arthroplasty. Articulation took place more posteriorly on the horizontal components at any degree of flexion examined; a correlation was found between the operation-induced change in the inclination of the lateral tibial plateau and the point of articulation. Based on the regression equations, the expected point of articulation on an arbitrarily chosen component placement could be calculated for any degree of flexion provided the preoperative inclination was known. Cutting the anterior cruciate ligament caused articulation to move posteriorly on the tibial component at both medial and lateral arthroplasty. We concluded that it was possible to estimate the tilt of the tibial component that was required to avoid marginal articulations when the preoperative slope of the tibial plateau was known. Absence of the anterior cruciate ligament seems to contraindicate unicompartmental arthroplasty.

Biomechanical Phenomena↗
PubMed1991

The infected knee arthroplasty. A 6-year follow-up of 357 cases.

The incidence of deep infection after 12,118 primary knee arthroplasties performed in Sweden from October 1, 1975 through 1985 with a median follow-up of 6 years was 1.7 percent for arthrosis and 4.4 percent for rheumatoid arthritis. Risk factors for infection were large prostheses, postoperative wound-healing complications, rheumatoid arthritis, a prior deep infection, and skin infections. We have analyzed the treatment of 357 knee arthroplasties with a deep infection. Systemic antibiotics alone were primarily used in 225 knees, with healing of the infection in 44 knees, 20 of which had a functioning prosthesis at the final follow-up; the treatment did not compromise later revision surgery. Soft-tissue surgery was used in 154 knees--37 healed, 15 of which had a functioning prosthesis. Resection arthroplasty resulted in healing of the infection in 11 of 22 knees. Revision arthroplasty was performed in 107 knees, with eventual healing of the infection in 81 knees, 36 of which had a functioning prosthesis; there were no differences in the outcome of one-stage and two-stage procedures. Arthrodesis was attempted in 135 knees, with eventual healing of the infection in 120 knees and fusion in 105. Twenty-two patients were amputated. Thus, the infection healed in 315 knees (88 percent), but only 71 (20 percent) recovered with a functioning prosthesis, and 8 patients died of the infection. Attention should therefore focus on prophylactic measures directed towards the soft-tissue problems--by avoiding conflicting skin incisions, by gentle handling of the periarticular soft tissues, by avoiding the use of constrained prostheses and oversized compartmental prostheses, by letting wound healing take priority over motion in knees with compromised soft tissues, and by using prophylactic antibiotic treatment for skin ulcers until these have healed.

Adolescent↗
PubMed1993

Ectopic ossification in hip arthroplasty. A retrospective study of predisposing factors in 637 cases.

We investigated predisposing factors for the development of heterotopic ossification in a retrospective study of 637 hip arthroplasties, of which 484 were unilateral, 62 bilateral and 29 revision operations. The frequency of heterotopic ossification after a primary hip arthroplasty was 57 percent. In a univariate analysis, men, patients with hypertrophic arthrosis, and cemented arthroplasty were all at risk of developing heterotopic ossification. After a multivariate analysis, the male sex and the cemented arthroplasty remained as significant factors. In bilateral operations, the contralateral side developed heterotopic ossification in 82 percent when the primary hip operation had already caused ossification. There was no increase in ossifications after the contralateral operation. Half of the revision operations had an increase of heterotopic ossification from 1 to 4 Brooker classes.

Adult↗
PubMed1995

Air contamination during hip and knee arthroplasties. Horizontal laminar flow randomized vs. conventional ventilation.

In a randomized study 90 patients, operated on with a total hip or knee arthroplasty, were allocated to 1 of 3 different regimes, all including a reinforced single-use operating gown: (1) horizontal laminar flow ventilation and conventional clothes (cotton shirts and trousers) for all staff members, (2) horizontal laminar flow ventilation and occlusive garments (Klinidress) and (3) conventional ventilation and occlusive garments. Volumetric air sampling gave a low mean number of colony-forming units (< 10 cfu/m3) in the vicinity of the wound in all 3 groups. Laminar ventilation, with or without occlusive staff garments, resulted in less air contamination compared to conventional ventilation. During knee arthroplasty, the use of occlusive clothes in the laminar ventilation room, further reduced the number of airborne, bacteria-carrying particles to around 1 cfu/m3. No such reduction was seen during hip arthroplasty. We conclude that hip and knee arthroplasties can be performed in operating theaters with conventional ventilation when occlusive staff garments are used. However, laminar air flow ventilation in knee surgery, preferably in combination with occlusive garments, resulted in a substantially lower air contamination and should be preferred.

Aged↗
PubMed1999

Cytokine receptor profile of arthroplasty macrophages, foreign body giant cells and mature osteoclasts.

In the arthroplasty pseudomembrane surrounding a loose prosthesis there is a marked macrophage and foreign body giant cell (FBGC) response to implant-derived wear particles. These cells contribute to the osteolysis of loosening by releasing cytokines and growth factors which influence the formation and activity of osteoclasts. Using a panel of monoclonal antibodies directed against known cytokine/growth factor receptors, we have determined by immunohistochemistry whether arthroplasty macrophages, FB-GCs and osteoclasts express receptors for cytokines and growth factors that are known to modulate osteolysis. All these cell types reacted with antibodies directed against the following cytokine/growth factor receptors: gp130, IL-1R type 1, IL-2R, IL-4R, IL-6R, TNFR, M-CSFR, GM-CSFR and SCFR but not with antibodies directed against IL-3R and IL-8R. Arthroplasty macrophages, FBGCs and osteoclasts thus show a similar pattern of cytokine/growth factor receptor expression. This reflects the fact that arthroplasty macrophages are capable of osteoclast differentiation and that these cell types form part of the mononuclear phagocyte system. As regards the osteolysis of aseptic loosening, it also indicates that these cells are targets for numerous cytokines and growth factors which influence osteoclast formation and bone resorption.

Adult↗
PubMed1987

Total ankle arthroplasty using biological fixation components compared to ankle arthrodesis.

When conservative measures fail to alleviate pain and disability of ankle joint disease, tibiotalar arthrodesis is the present accepted surgical treatment. Unfortunately, ankle arthrodesis also carries a significant rate of complications and the success rate does not parallel the results of hip and knee joint arthroplasties. A large percentage of ankle arthrodeses remain painful, and function is not normal. There is no satisfactory "salvage procedure" to a painful ankle fusion. Patients with primary ankle arthritis tend to develop bilateral ankle involvement as well as involvement of the subtalar and midtarsal joints; bilateral ankle fusion results in a severe handicap to gait and function. Ankle fusion with involvement of the subtalar or midtarsal joints might well result in a painful fusion. Maintenance of tibiotalar motion appears essential in both instances. It is apparent that all ankle problems cannot be dealt with by fusion and a successful long-term ankle arthroplasty is needed. Total ankle arthroplasty using cement fixation remains controversial. Continued use of polymethylmethacrylate and additional design changes do not appear to be the answer to possible ankle joint replacement. Initial success using the PCA concept of biological cementless fixation of the Scholz total ankle prosthetic components appears to offer a new dimension in the success of total ankle arthroplasty.

Adult↗
PubMed1990

Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis.

Heterotopic bone formation was investigated in 392 Charnley low-friction total hip arthroplasties. A multivariate linear regression analysis was used to account for the influence of co-variables: sex, age at surgery, postoperative treatment with antiinflammatory drugs during at least the first 2 weeks, and previous ipsilateral hip surgery. A total of 232 hips had been treated for primary coxarthrosis, and 114 and 46 hips for secondary coxarthrosis due to congenital dislocation and fracture-dislocation of the hip, respectively. None of the hips with primary coxarthrosis previously had ipsilateral hip surgery, whereas 41 hips (36%) in patients with congenital dislocation of the hip and 28 hips (61%) in patients with fracture-dislocation of the hip had one or more ipsilateral surgical procedures prior to the arthroplasty. The sex ratio varied between the groups, with a male:female hip ratio of 1:1, 1:10, and 3:1 for the three groups, respectively. The risk of developing grades 2 or 3 heterotopic ossification after total hip arthroplasty were significantly higher in men, patients without postoperative treatment with antiinflammatory drugs, and patients above age 60. In contrast, the analysis documented that previous ipsilateral hip surgery and type of coxarthrosis did not influence lesion development, supporting the theory that a systemic, rather than local factor, is responsible for the development of heterotopic bone formation after total hip arthroplasty.

Adolescent↗
PubMed1995

Arthrodesis following failed total knee arthroplasty: comprehensive review and meta-analysis of recent literature.

With the increasing duration of follow up on total knee arthroplasties, more revision arthroplasties are being performed. When revision is not advisable, a salvage procedure such as arthrodesis or resection arthroplasty is indicated. This article provides a comprehensive review of the literature regarding arthrodesis following failed total knee arthroplasty. In addition, a statistical meta-analysis of five studies using modern arthrodesis techniques is presented. A statistically significant greater fusion rate with intramedullary nail arthrodesis compared to external fixation is documented. Gram negative and mixed infections are found to be significant risk factors for failure of arthrodesis.

Adult↗
PubMed1994

Interdisciplinary team approach in the rehabilitation of hip and knee arthroplasties.

Use of an interdisciplinary case management team approach in the treatment of patients with hip or knee arthroplasty has resulted in a decrease in length of stay and achievement of functional outcomes at the authors' center. Case management was used to standardize patient care and to measure each patient's progress toward independence against established criteria of treatment outcomes. Outcomes established for physical therapy were ambulation distance, performance of a home exercise program, stair climbing, amount of active knee flexion (for knee arthroplasties), and incorporation of hip precautions. Outcomes for occupational therapy were bed mobility, chair transfers, toilet transfers, and activities of daily living with emphasis on lower extremity dressing. The case management team consists of an occupational therapist, an occupational therapy assistant, a physical therapist, and two nurses. The specific role of the occupational therapy personnel in this team approach is to maximize, by discharge, a patient's functional level of independence in activities of daily living. Data from a 6-month period indicated that occupational therapy goals were achieved for 79% of the 33 knee arthroplasty patients and 73% of the 37 hip arthroplasty patients.

Activities of Daily Living↗
PubMed1995

Wrist arthroplasty with the trispherical total wrist prosthesis.

The clinical results and long-term implant survival of wrist arthroplasty with the Trispherical total wrist prosthesis was evaluated in patients with inflammatory arthritis. Using the Hospital for Special Surgery wrist scoring system, the clinical evaluation of 35 Trispherical total wrist arthroplasties showed an excellent result in 20, good result in 8, fair result in 3, poor result in 2, and failed result requiring revision in 2 wrists at an average follow-up of 9 years. Cumulative implant survival in 67 consecutive Trispherical total wrist arthroplasties was 97% at 5 years and 93% at 10 and 12 years postoperatively. Patient satisfaction with wrist arthroplasty using the Trispherical prosthesis was excellent. We attribute the favorable long-term results obtained with the use of this prosthesis to its inherent design that allows for accurate restoration of the center of rotation of the wrist.

Adult↗