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At least 1,261 records · Page 70Linked to original sources
PubMed1998

Osseointegrated implants and orbital defects: U.C.L.A. experience.

PURPOSE: A clinical study of 23 craniofacial implants placed in 8 irradiated and nonirradiated orbital detects was conducted over a 7-year period. MATERIAL AND METHODS: Implant-retained orbital prostheses were fabricated, implant success rate was determined, and the soft tissue responses were recorded at 6-month intervals. As a result of patient death, no data were gathered on three implants. A five-point scale was used to record the health of the peri-implant soft tissues and the patients were followed from 9 to 72 months. The unit of measure was a visit/site that was assigned for each instance an implant site was evaluated. Evaluations were conducted at 6-month intervals, and for the study period, there were 80 visit/sites. RESULTS: The study revealed that 42.5% (34/80) of the visit/sites demonstrated an absence of inflammation; 23.7% (19/80) of visit/sites demonstrated slight redness; 13.8% (11/80) demonstrated peri-implant red and moist tissues; 6.2% (5/80) demonstrated granulation tissue associated with the implants; and 13.8% (11/80) infection of the peri-implant soft tissues was noted. Implant success rate was 35% (7/20); implant success rate in the nonradiated patients was 37.5% (3/8) and the success rate for radiated patients was 33.3% (4/12). Implants placed in the orbital region demonstrated a high failure rate. Most implant failures occurred late as opposed to early in the study period. CONCLUSION: Orbital implants should be placed in patients who understand that long-term success rates may be low and require meticulous hygiene maintenance.

Adult↗
PubMed2002

Medium-term results of trapezio-lunate external fixation for scaphoid fractures.

We treated 36 scaphoid fractures in 34 patients with trapezio-lunate external fixation. According to the Herbert and Fisher classification, there were 16 type B1, 14 type B2, four type B3 and two type B4 fractures. Trapezial and lunate pins broke in three patients and these were rated as failures. The remaining 33 fractures were followed-up for 3 years and all had excellent outcomes, without signs of arthritis, avascularity or instability.

Adolescent↗
PubMed1993

An analysis of autopsy findings in 108 patients who died after valve replacement.

The pathological findings and the causes of death were reviewed in 108 patients who had received 142 heart valve prostheses (52 mechanical and 90 bioprostheses) at the National Cardiovascular Center in Osaka, Japan, from 1977 to 1991. Rheumatic heart disease was the major underlying disease (60.2%), and the age distribution at death ranged from 21 to 80-year-old. Survival duration after the surgery extended from 0 day to 9 years. Thirty-three patients (30.6%) died of perioperative complications such as myocardial haemorrhage and damage, or from heart failure which had been evident prior to the operation, a cause of death which pre-dominated in patients who died within 1 week of surgery (15/17; 88.2%). Thirty-eight patients (35.2%) died of prostheses-related problems such as prosthetic valve failure (cuspal tears and calcifying destruction of the xenograft), thromboembolism, and prosthetic valve endocarditis. Endocarditis was frequent in patients who had survived longer than 1 year (25/33; 75.8%). None of the patients died of prostheses-related problems within 1 week. Non-infectious valve failure was more common in patients with bioprostheses than in those with mechanical valves; thromboembolism showed the opposite association. Prosthetic valve infective endocarditis was nearly equal in frequency in both types of valve.

Adult↗
PubMed1996

One stage revision arthroplasty of the hip for deep gram negative infection.

We describe the use of one stage revision arthroplasty of the hip for deep gram negative infections. We have followed up 15 patients for an average of 8 years following operation. Two procedures failed, one at two years due to aseptic loosening and another because of persistent infection. We attribute the low reinfection rate (1/15) to meticulous surgical technique, preoperative parenteral antibiotics and antibiotic loaded cement. Both failures occurred in the two operations performed without antibiotic loaded cement. We do not recommend the use of plain cement for exchange hip arthroplasty in the presence of gram negative infection.

Aged↗
PubMed2006

Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb.

We reviewed retrospectively the results in 211 consecutive patients who had undergone limb salvage for bone neoplasia with endoprosthetic reconstruction of the proximal femur (96), distal femur (78), proximal tibia (30) and total femur (7). Their mean age was 50 years (11 to 86) and the mean follow-up period was 37.3 months (1 to 204). A total of 35 (16.6%) prostheses failed. Overall, implant survival was 78% (95% confidence interval (CI) 0.29 to 0.54) at five years, 60% (95% CI 0.93 to 2.35) at ten years and 60% (95% CI 1.27 to 3.88) at 15 years. Survivorship of the limb was 97.6% (95% CI 1.73 to 3.35) at ten years. The gender, age, diagnosis and location of the tumour were not prognostic variables for failure. Modular endoprosthetic replacement in the lower limb is a durable long-term reconstructive option, with the implants generally outlasting the patient.

Adolescent↗
PubMed1998

[Infectious endocarditis caused by Leuconostoc mesenteroides].

BACKGROUND: Leuconostoc spp. are gram-positive coccobacilli, catalase and oxidase negative, vancomycin resistant, with a not clearly defined role in human infectious. Cases of infection have been reported previously but it has not been described confirmed infective endocarditis due to Leuconostoc mesenteroides. METHODS: We describe a case of prosthetic valve endocarditis in a 72-years-old woman with a long previous history of cardiac disease but without other immunological disorders. She developed a heart failure because of prosthetic aortic valve dysfunction. CONCLUSIONS: Leuconostoc mesenteroides should be considered as a potential cause of infective endocarditis and listed in the group of vancomycin-resistant microorganism.

Aged↗
PubMedDate not supplied

Prognostic variables associated with implant failure: a retrospective effectiveness study.

The purpose of this study was to determine implant survival rates by means of life table analyses for a cohort of patients not part of a prospective efficacy trial and treated by practitioners at varying experience levels. Prognostic variables associated with implant failure were identified by means of proportional hazards models and advanced statistical methods that account for patient effects. Ninety-nine consecutive patients treated from 1987 to 1991 with follow-up to 1994 were included in this retrospective study. A total of 384 dental implants (79.7% Brånemark, 19.3% IMZ plasma-sprayed, 1% IMZ hydroxyapatite-coated) were placed and subsequently supported 108 prostheses. Survival and proportional hazards modeling were used to generate Kaplan-Meier survival curves and to identify variables associated with implant failure. Survey data analysis was used to adjust for any patient effects for variables identified as significant through the proportional hazards models. Thirty-four implants failed over the follow-up period (median follow-up time 3.6 years), resulting in an overall failure rate of 8.9%. Seventeen of 99 patients experienced an implant failure. When prosthesis type was excluded from the modeling process, survey data analysis identified posterior location and an implant width of less than 4.0 mm as being associated with implant failure (all P < .05).

Adult↗
PubMed2006

[Revision of unicompartmental knee arthroplasty].

Despite the good midterm survivorship reported for unicondylar knee arthroplasty, an increase in revision surgery has to be expected due to increased replacement rates. The reasons for failure as well as distribution are different for unicondylar knee arthroplasty compared to total knee arthroplasty. The main reasons for revision are aseptic loosening and the progression of osteoarthritis. In most cases, unicondylar knee arthroplasty will be revised to total knee arthroplasty. To obtain good revision results, the cause of implant failure has to be analysed carefully. In the case of contained bone defects, the reconstruction can be supported with bone grafting. For those cases with uncontained defects, implants with augmentation and, in some cases, stem extensions are needed. The modularity of the revision implant should cover different intraoperative requirements.

Arthroplasty, Replacement, Knee↗
PubMed2005

Arthrodesis of the knee after failed infected total knee arthroplasty.

Infection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47-81 years) and the mean number of previous surgical procedures was 6 (range: 4-11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2-11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk.

Aged↗
PubMed1991

Dental implants retrieved from humans: a diagnostic light microscopic review of the findings in seven cases of failure.

With the increased use of dental implant systems, an increase in the number of implants removed from patients has also been observed. This investigation attempted to elucidate some underlying causal determinants of implant failure employing light microscopic analyses. Valuable data can be obtained from implants retrieved from patients. Implant success is predicted on proper patient selection and treatment planning, careful surgical procedures, careful prosthodontic management, and continued oral hygiene maintenance.

Aged↗
PubMed1995

Knee arthrodesis in the treatment of failed total knee replacement.

Twenty-six primary arthrodeses and 6 repeat arthrodeses were done for a total of 32 arthrodesis procedures in 26 patients, with followup from 2 to 10 years (mean, 4 years). The indications for arthrodesis were septic failure in 18 patients and aseptic loosening in 8 patients. Thirteen arthrodeses were done using external fixators, and 12 arthrodeses were done using a closed fluted intramedullary nail for fixation (1 arthrodesis was done with a custom proximal and distal interlocked nail). In addition, 6 repeat arthrodeses with intramedullary nail fixation were done for treatment of nonunions after external fixation. Five (38%) of the 13 patients who underwent arthrodesis with an external fixator had clinical and radiographic union at a mean of 5 months. All 13 patients with primary intramedullary nail arthrodesis achieved union. The knees of the 6 patients with nonunions after external fixation that were treated with repeat intramedullary nail arthrodesis achieved union. Patients with septic failure had staged debridements before intramedullary nail arthrodesis. Intramedullary nail arthrodesis can be done safely in patients with sepsis as a staged procedure. Knee arthrodesis using intramedullary nail fixation gives a much higher union rate than does external fixation and is associated with fewer complications.

Aged↗
PubMed2006

Development and problems of metal-on-metal hip arthroplasty.

For over 40 years, the metal-on-polyethylene bearing has dominated the field of total hip replacement. Problems of wear, osteolysis (dissolution of bone), and ultimately failure of prostheses have led to the development of alternative bearing surfaces. Metal-on-metal hip resurfacing has taken current orthopaedic surgery almost by storm. However, metal ion release following metal-on-metal hip resurfacing remains a major cause for concern. This article looks into the development and examines problems and issues surrounding metal-on-metal resurfacing arthroplasty.

Bone Neoplasms↗
PubMed1999

The pathology of total joint arthroplasty.II. Mechanisms of implant failure.

Although the clinical results of total joint arthroplasty are usually excellent, some implants develop loosening and require revision. Implants usually fail by a combination of mechanisms, but different basic designs tend to show different dominant mechanisms of failure. Infection causes failure of about 1-5% of cases of primary arthroplasty. Clues to the presence of infection include clinical signs, a periosteal reaction, a positive culture of aspirated joint fluid, and acute inflammation identified in tissue around the implant. There are several different mechanisms and modes of implant wear, and perhaps the most important cause of aseptic loosening is an inflammatory reaction to particles of wear debris. Abrasive, adhesive, and fatigue wear of polyethylene, metal and bone cement produces debris particles that induce bone resorption and implant loosening. Particles can cause linear, geographic, or erosive patterns of bone resorption (osteolysis), the distributions of which are influenced by the implant design. Micromotion of implants that did not achieve adequate initial fixation is another important mechanism of loosening. Fatigue failure at the bone/cement and bone/implant interface may cause aseptic loosening, and may be especially important for implants with relatively smooth surfaces. Stress shielding can influence local bone density, but is rarely an isolated cause of implant loosening. Elevated hydrodynamic pressure has been associated with bone resorption in the absence of implants, and may also play a role in implant loosening.

Arthroplasty, Replacement↗
PubMed2000

Revision surgery after failed unicompartmental knee arthroplasty: a study of 35 cases.

This retrospective study evaluates the results of 35 revision procedures after failed unicompartmental knee arthroplasty (UKA) in 34 patients, which were done during the period 1986 to 1996. There were 28 women and 6 men with a mean age of 71 years (range, 54-85 years). In all cases, St. Georg and Endo (W. Link, Hamburg, Germany) unicompartmental prostheses were used except 1 PCA unicondylar implant (How medica, Rutherford, NJ) and 1 Böhler unicondylar implant (Allo Pro, Baar, Switzerland). Failures most frequently were due to aseptic loosening followed by polyethylene wear. Two deep infections occurred. Revisions were performed 1 week to 11 years after UKA; 23 were required within the first 5 years. In most cases, revision was to a total knee arthroplasty. Partial component exchange was done in 9 cases. All 34 patients were evaluated clinically after exchange arthroplasty. After a mean follow-up time of 4 years (range, 1-12.2 years), we found 11 excellent, 13 good, 4 fair, and 7 poor results according to the Hospital for Special Surgery score. The fair and poor results were due to aseptic loosening of the knee prosthesis in 6 knees. One of 2 patients with deep infection needed femoral amputation. With correct indication and considerable surgical experience, UKA is still a good alternative, especially in the elderly patient.

Aged↗
PubMed2006

Acetabular reconstruction with impacted bone allografts and cemented acetabular components: a 2- to 13-year follow-up study of 142 aseptic revisions.

We reviewed the clinical and radiological results of 131 patients who underwent acetabular revision for aseptic loosening with impacted bone allograft and a cemented acetabular component. The mean follow-up was 51.7 months (24 to 156). The mean post-operative Merle D'Aubigné and Postel scores were 5.7 points (4 to 6) for pain, 5.2 (3 to 6) for gait and 4.5 (2 to 6) for mobility. Radiological evaluation revealed migration greater than 5 mm in four acetabular components. Radiological failure matched clinical failure. Asymptomatic radiolucent lines were observed in 31 of 426 areas assessed (7%). Further revision was required in six patients (4.5%), this was due to infection in three and mechanical failure in three. The survival rate for the reconstruction was 95.8% (95% confidence interval 92.3 to 99.1) overall, and 98%, excluding revision due to sepsis. Our study, from an independent centre, has reproduced the results of the originators of the method.

Acetabulum↗
PubMed1996

[Third mitral valve replacement--review of clinical aspects and surgical management in 10 cases].

Third mitral valve replacement (3rd MVR) have become more frequent as use of replacement procedures has become more widespread. However, little information exists to clearly document the determinants of 3rd MVR. To evaluate backgrounds and risks and complications of 3rd MVR, we reviewed data on 10 patients (6 male and 4 female, age averaged 58 +/- 8 years) who underwent 3rd MVR because of prosthetic valve malfunction during December 1986-May 1995. This represented 7.1% of total number of reoperations for valve surgery (10/140) during that period. The incremental effect of the 3rd MVR on hospital mortality and mobidity was studied by comparing first mitral valve replacement (1st MVR) and second mitral valve replacement (2nd MVR) and 3rd MVR. After an interval of 134 +/- 23 months, 3rd MVR was undertaken for congestive heart failure due to primary tissue failure in 65%, paravalvular leakage in 20%, prosthetic valve endocarditis in 15%. One patient died at 11 days postoperatively, for a mortality rate of 10%. Cause of death was related to multiple organ failure due to low cardiac output syndrome. The surgical risk of 2nd MVR and 3rd MVR is higher than that of 1st MVR, but there is no conclusive evidence that the difference between 2nd MVR and 3rd MVR is statistically significant. With improvement intraoperative strategies, the operative risk in patients undergoing 3rd MVR has been markedly reduced.

Bioprosthesis↗
PubMed2005

The 20-year outcome of the charnley arthroplasty in younger and older patients.

The purpose of this study is to present the 20-year outcome of 206 Charnley low-friction arthroplasties done by the same surgeon on 181 patients who were separated into two age groups (younger and older). In Group A (76 patients, 92 hips) the mean age at surgery was 44 years (range, 24-55 years), and in Group B (105 patients, 114 hips) the mean age at surgery was 65 years (range, 56-82 years). All patients were evaluated clinically and radiographically. At final followup, 71 patients (87 hips) in Group A and 90 patients (99 hips) in Group B were available for study. The overall failure rate for the hips of Group A was 37.9%, and the overall failure rate for the hips of Group B was 20%. The main cause of failure in Group A was aseptic loosening of the components and breakage of the femoral stem, whereas in Group B the main cause of failure was deep infection. We concluded that by eliminating the above factors, and using new cementing techniques and improved implants, the 20-year results of this arthroplasty would be better. Our results show that the Charnley arthroplasty is a reliable procedure for hip replacement, even in younger patients.

Adult↗
PubMed1995

Immediate implant post-surgical complications.

Immediate surgical implants provide a convenient means of replacing missing teeth without requiring hard tissue reduction of restoration-free potential fixed partial denture abutments. Although the procedure is described as "predictable," complications and failures do occur. This report presents four cases of immediate implant complications and their management, and discusses possible causes of the untoward results. Careful pre-operative planning, adequate surgical technique and post-surgical management, timely and suitable loading, and meticulous hygiene maintenance can serve to minimize implant complications and failures. The prospective immediate implant patient must be provided with sufficient information to allow informed consent to be given. Minimal requirements are a description of the procedures in terms the patient can understand, an explanation of potential risks and complications, and adequate disclosure of information about alternative therapies.

Adolescent↗