Arthroplasty of the knee joint employing an acrylic prosthesis.
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Acrylic Resins↗
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[Sports with a total prosthesis of the hip joint].
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Follow-Up Studies↗
[Therapy of rheumatoid destruction of the middle finger metacarpophalangeal joint with a Swanson silastic implant stabilized resection arthroplasty: comparative study of long and intermediate term results with and without implantation of titanium grommets].
Resection arthroplasty of the metacarpophangeal joints stabilized by a Swanson-Silastic-spacer is the golden standard in MP-joint destruction in R.A. 57 (Gr. I), 91 (Gr. II), and 102 (Gr. III) arthroplasties of the metacarpophalangeal joint were assessed in three groups of patients 3.5 years (Gr. I), 4.3 years (Gr. II), and 10.1 years (Gr. III), respectively, postoperatively on the average. In patients of group I titanium protectors, called grommets, were used additionally. Nearly all patients reported a marked relief of pain. Ulnar drift was corrected from an average of 22 degrees (Gr. I), 23 degrees (Gr. II), and 34 degrees (Gr. III) preoperatively. to 8 degrees (Gr. I), 7 degrees (Gr. II), and 12 degrees (Gr. III), respectively, postoperatively. Active range of motion remains unchanged with an average of 33 degrees (Gr. I), 38 degrees (Gr. II), and 42 degrees (Gr. III) ROM preoperatively and 42 degrees (Gr. I), 37 degrees (Gr. II), and 36 degrees (Gr. III) ROM, respectively, postoperatively. The average extension deficit had improved from 45 degrees (Gr. I), 32 degrees (Gr. II), and 33 degrees (Gr. III) at surgery to 18 degrees (Gr. I), 11 degrees (Gr. II), and 11 degrees (Gr. III), respectively, at the time of follow-up. Functional improvement of the hand was found in the medium term in 82% and in the longterm in 75% of the patients. The radiographical findings showed surrounding osteolysis in 45.7% (Gr. I), 63.5% (Gr. II), and 89.4% (Gr. III) of the implants and 0% (Gr. I), 16.5% (Gr. II), and 26.9% (Gr. III) broken spacers. From the medium to the longterm run there is an increase in radiographical deterioration. The additional use of titanium grommets in MP-joint arthroplasty seems to reduce reactive osteolysis and protects Swanson Silastic-spacers from breakage without substantial influence on the clinical outcome.
Arthritis, Rheumatoid↗
Nonrheumatoid metacarpophalangeal joint arthritis. Unconstrained pyrolytic carbon implants: indications, technique, and outcomes.
Unconstrained pyrolytic surface replacement arthroplasty provides the benefits of a more natural center of rotation with preservation of native ligamentous joint stability. Initial short-term results show excellent motion, pain relief, and restoration of pinch and grip strength. These results are encouraging, and suggest that pyrolytic carbon arthroplasty may be a reasonable option for joint salvage in patients suffering from MP joint osteoarthritis.
Adult↗
Avanta versus Swanson silicone implants in the MCP joint--a prospective, randomized comparison of 30 patients followed for 2 years.
The results of Swanson and Avanta metacarpophalangeal joint arthroplasties in rheumatoid patients were compared in a prospective, randomized study of 30 patients (120 implants). At 2-year follow-up, grip strength was measured, hand function was assessed with the Sollerman test and the subjective outcome was determined with visual analogue scores. With both implants ulnar deviation and flexion deformities decreased, and there was no difference between the groups. The increase in range of motion was 7 degrees greater with Avanta implants than with Swanson implants. Grip strength and hand function were unaltered but the visual analogue scales showed decreased pain levels and subjective improvements in hand function, grip strength and cosmesis. Twenty-four of 30 patients were satisfied. Fracture of the silicone spacer occurred with 12 Avanta (20%) and eight Swanson implants (13%), with a higher fracture frequency in men.
Adult↗
[A new titanium-carbon finger joint implant. Apropos of 15 initial cases].
Arthroplasty of the MP and PIP joint remains a therapeutic challenge for the hand surgeon. The poor results of the currently available implants are due to their mechanical conception (non strained) or their material (silicone causing instability, ruptures and silicone synovitis). The authors present the preliminary results of a new digital articular implant (IAD). It is a strained implant with a rigid hinge allowing 105 degrees of range of movement (0 degree to 105 degrees). Three sizes are available and very soon four. The intramedullary stems are in titanium alloy (TA6V) and the gliding surfaces in pyrolytic carbon. This association allows solidity, endurance, excellent gliding and no wear debris. 15 implants were evaluated (13 PIP and 2 MP joints) with a follow-up from 4 to 1 year. A painless range of motion were restored in 11 cases and 4 articulations were only lightly painful during motion requiring strength and at the end of the movement. The gain of the range of movement was 50 degrees always in a useful sector. The grasp was 60% better in post than in pre operative conditions. No infection was found. It is only the beginning of this implant but the indications seem to be good for all the articular destructions of the digital joints what ever was the aetiology (traumatic, infection or rheumatoid arthritis).
Adult↗
A comparison of metacarpophalangeal joint silastic arthroplasty with or without crossed intrinsic transfer.
Forty-three hands in 36 adults undergoing Silastic interposition arthroplasty of the index, middle, ring and little finger metacarpophalangeal joints for rheumatoid arthritis were randomly allocated to undergo replacement with or without crossed intrinsic transfer. The patients were reviewed at a median of 17 (range, 7-50) months after surgery. The demographic characteristics and pre-operative clinical measurements of the two groups were indistinguishable. Both groups showed improvement in ulnar drift and an altered arc, but no change in total range of motion at the metacarpophalangeal joints. Grip strength and pulp to pulp pinch were significantly and comparably improved in both groups. There was no difference in pain scores or perceived function between the treatment groups. It is concluded that crossed intrinsic transfer does not significantly affect the outcome of Silastic interposition arthroplasty of the metacarpophalangeal joints in rheumatoid patients.
Aged↗
Use of titanium grommets in silicone implant arthroplasty of the hallux metatarsophalangeal joint.
Double-stem silicone implants protected by titanium grommets were placed in the hallux metatarsophalangeal joints of 32 patients (47 feet). All patients had a painful destroyed joint and most were women. Three patients (six feet) were lost to follow-up. Nineteen patients had a diagnosis of rheumatoid arthritis (25 feet) and 10 had degenerative joint disease (16 feet). The average age for the group was 57 years and the average follow-up was 51 months (range, 34-76 months). Twenty patients (30 feet) were completely satisfied with their result. Eight patients (10 feet), all with rheumatoid arthritis, had some minor postoperative complaints, usually involving the lateral toes. Two patients (three feet) in this group had no pain, but would have preferred more hallux motion. One patient with rheumatoid arthritis (one foot) had a poor result due to implant removal for deep sepsis. Radiographic analysis of these patients showed no evidence of implant fracture and the implant composite appeared to be well tolerated by the surrounding bone in which it was placed. When compared with another, similar group of patients in whom grommets were not used, this implant appeared to be much more stable, as there was significantly less evidence of radiolucency seen around those implants protected by the grommets. It appears that the titanium grommets may protect the silicone implant and may help provide a longer life for the silicone implant.
Adult↗
[Reconstruction of metacarpophalangeal and interphalangeal joints with endoprostheses following injuries].
Implants have been used since 1969 by the authors for the replacement of damaged finger joints following trauma. In several cases reconstruction of other damaged tissues in the same finger was also performed. A method is described for replacement of the central slip of the extensor tendon over the PIP joint. Analysis of twenty-one MP and sixty-eight PIP endoprostheses placed in eighty-three patients until 1979 is given. Significant improvement in the range of movement is seen. Preoperative pain was relieved in all cases. There was a need to change occupation in ten percent of patients. Careful analysis of early and late complications calls attention to the proper selection of patients for surgery.
Adolescent↗
Serratia marcescens as a cause of postoperative infection in a total joint implant.
Serratia marcescens is a rare cause of musculoskeletal infections and osteomyelitis occurring most frequently in nosocomial infections, debilitated patients, drug addicts, and traumatic open wounds. It is rarely a cause of postoperative infection in elective surgery with only a few such cases being reported in the United States and European literature. The authors present a case of Serratia marcescens infection of a total joint implant from an apparent perioperative source and review the literature concerning this organism as a cause of infection in man.
Cefotetan↗
The influence of design on the transmission of torque across knee prostheses.
Knee prostheses of eight different designs were tested experimentally to determine the axial torque necessary to rotate the tibial component relative to the femoral component with the prosthesis positioned at or near full extension. The results represent transmitted torque as a function of axial rotation. For six designs, the transmitted torque was 11.3 newton-meters (100 inch-pounds) or greater at 6 degrees of rotation, with an axial load of 1556.8 newtons (350 pounds). These prostheses either had close conformation between femoral and tibial components, or were mechanically linked. In these prostheses, the geometry of the articulating surfaces was the primary determinant of torque. For the other two types, under similar loading conditions the transmitted torques were 2.5 newton-meters (twenty-two inch-pounds) at 6 degrees of rotation. These prostheses were designed to allow greater freedom for rotation, and hence for them the primary determinant of torque was friction between the articulating surfaces. The predictive value of this torque characteristic relative to the incidence of loosening will have to be determined by comparison with clinical experience.
Biomechanical Phenomena↗
[Glenohumeral joint. Anatomical aspects and implications for prosthesis design].
Knowledge of normal anatomy and kinematics of the glenohumeral joint as well as analysis of the pathoanatomic changes that occur during the course of the disease is the condition for successful patient management. This review article critically discusses the most relevant geometrical variables. Systematically, normal anatomy, pathologic anatomy, and the implications for prosthetic design and implantation are presented. The most important aspects concerning the size and shape of the glenoid, the inclination of the articular surface in the horizontal and frontal planes, as well as the geometry of the scapular neck are discussed. The accumulated knowledge is of immediate practical use and might stimulate researchers and manufacturers to develop more adequate glenoid components.
Biomechanical Phenomena↗
[Treatment of thumb arthrosis using Swanson's trapezial silicone implant].
Complications related to silicone implants have been widely described since 1985. As trapezial replacement with a silicone implant constitutes our preferred treatment for osteoarthritis of the base of the thumb, we decided to evaluate our results by means of a retrospective critical study. Fifty records of patients operated or between 1975 and 1980 constitute an homogeneous study group as all were operated according to the same technique and by the same surgeon. Seven cases of implant instability have led us to modify our fixation technique. The results in terms of mobility, stability and pain relief are good and comparable to other published series. Only two cases presented bony changes around the implant but they both existed before surgery. Our conclusion is that trapezial resection with replacement by a silicone implant can still be recommended as elective treatment for CMC thumb osteoarthritis because of its simplicity effectiveness and reversibility.
Aged↗
The Biomet Total Toe System utilizing the Koenig score: a five-year review.
The two-component, durable first metatarsophalangeal joint implant has a 5-year history of clinical use. Unique for having plantar condyles, the Total Toe System is fully weightbearing, thus functional. A new scoring system, the Koenig Score, is introduced and applied to the Biomet Total Toe System to demonstrate the success of this implant postoperatively.
Adult↗
Osteolysis after Sutter metacarpophalangeal arthroplasty: a prospective study of 282 implants followed up for 5.7 years.
Our aim was to evaluate the incidence and degree of osteolysis in a prospective series of patients with rheumatoid arthritis operated on with Sutter implants. Eighty-seven of the 110 operated hands (104 patients) with 282 implants were evaluated after a mean of 5.7 years (2.1-7.4). Osteolytic changes were present in 142 (50%) of the metacarpal and 152 (54%) of the phalangeal bones. Twenty-six of the metacarpal (9%) and 36 of the proximal phalangeal (13%) bones had osteolytic changes that did not affect the cortical bone. Cortical invasion was recorded in 100 (35%) of the metacarpal and 103 (37%) of the proximal phalangeal bones. The cortex was perforated in both bones in 14 (5%). Osteolytic changes were related to fractures of implants and to the dominant hand, but not to pain. Surgeons who operate on patients with rheumatoid diseases should note that silicone rubber implants often cause osteolytic changes.
Arthritis, Rheumatoid↗
Infected arthroplasties.
Infection is potentially the most serious complication of total joint arthroplasty. Over the last 10 years, considerable advances have been made in the diagnosis and management of the infected implant. Modern methods of treatment are successful in up to 90% of cases in the lower limb, and results appear to be improving in the upper limb. This review places recent advances in the context of previous published work in the field.
Elbow Joint↗
Marking pin dislocation in total knee arthoplasty.
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Arthritis, Rheumatoid↗