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PubMed2002

German short musculoskeletal function assessment questionnaire (SMFA-D): comparison with the SF-36 and WOMAC in a prospective evaluation in patients with primary osteoarthritis undergoing total knee arthroplasty.

In a prospective clinical trial, the German short musculoskeletal function assessment (SMFA-D), the short form (SF)-36, and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) were evaluated in 63 patients with primary osteoarthritis undergoing total knee arthroplasty. All instruments were sensitive to change, demonstrating the effect of total knee arthroplasty at 1-year follow-up. The SMFA-D effect sizes in comparable scales were bigger than in the SF-36 and similar to those of the WOMAC. Significant correlations of the SMFA-D indices with the SF-36 and WOMAC scales preoperatively could be shown. After 1-year follow-up, all correlations between the SMFA-D indices and SF-36 scales were significant. In other comparison, only the correlation between the SMFA-D function index and the WOMAC function scales remained significant. The correlation of the SMFA-D function index with external validation criteria was higher than that using the other instruments. We recommend the SMFA-D for assessing change in functional status of patients with primary osteoarthritis of the knee following arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed2002

Heterotopic ossification around distal femur after total knee arthroplasty.

Heterotopic ossification after total knee arthroplasty is not well recognized. We found heterotopic ossification around the distal femur in 10 (5%) of 221 knees after primary total knee arthroplasty and evaluated clinical findings as well as risk factors. The duration of follow-up ranged from 1 to 5 years. Most patients with heterotopic ossification showed clinical findings that were suspected of being early infection after surgery such as continuing low-grade fever and erythematous, warm, and swollen knees, whereas blood examinations were normal. Heterotopic ossification developed by a mean period of 5 weeks, and the size increased for a mean period of 9 weeks. The maximum size of the ossification was <5 cm in 9 knees and >5 cm in 1 knee. After that, the size decreased without any treatment in all knees, and the ossification finally disappeared in 2 knees. Osteoarthrosis and the presence of postoperative effusion were the significant risk factors in the development of heterotopic ossification. Although it is difficult to draw valid conclusions from our small study, heterotopic ossification at the distal femur after total knee arthroplasty needed no treatment and was not progressive, nor did it affect the short-term outcome in this study.

Adult↗
PubMed2002

Japanese acrylic hemi-arthroplasty of the hip with a 45-year follow-up without revision.

We report the case of a patient who underwent acrylic hemi-arthroplasty of the hip and survived 45 years without revision. The patient had undergone hemi-arthroplasty of the hip at the age of 17 years following failure of a previous hemi-arthroplasty at the age of 12 years. We saw her 45 years later and carried out physical examination, standard radiographs of the hip as well as computed tomography. In addition, we reviewed the literature concerning the acrylic prosthesis and discussed the reasons for long-term durability.

Arthroplasty, Replacement, Hip↗
PubMed2003

Resurfacing knee arthroplasty in patients with allergic sensitivity to metals.

BACKGROUND: The problem of metal sensitivity (Ni, Cr, and Co) in arthroplasty is still unsolved. To prevent the risk of allergy in cases with proved metal allergy in an epicutaneous test, a Natural Knee total knee arthroplasty, made totally from titanium (Ti-6Al-4V) and polyethylene, can be implanted. The results of this device have to be compared to the results of normal knee arthroplasty designed with a femoral component out of CrCoNi alloy. The mechanical resistance of this alloy is much higher than that of titanium, and therefore it is the standard for the femoral components of most knee-resurfacing devices. METHODS: Thirty-five patients with a titanium Natural Knee were examined retrospectively after a mean follow-up of 2 years and 5 months (range 6 months to 5 years and 4 months). In comparison, 36 patients with a Genesis-I knee with a CrCoNi alloy femoral component were studied after a mean follow-up of 2 years and 4 months (range 8 months to 6 years and 2 months). RESULTS: In spite of the lower mechanical resistance of titanium, the Natural Knee showed better results (knee score 84.1 points, function score 77.7 points, HSS score 80.1 points, 82.9% excellent and good results) than the Genesis-I knee (knee score 80.6 points, function score 76.4 points, HSS score 76.4 points, 68.5% excellent and good results), although these differences had no statistical significance. CONCLUSIONS: The titanium Natural Knee prosthesis has proven to be a reliable knee joint replacement in the medium term.

Adult↗
PubMed2003

Indomethacin versus meloxicam for prevention of heterotopic ossification after total hip arthroplasty.

BACKGROUND: Heterotopic ossification (HO) is a recognized postsurgical complication after total hip arthroplasty. Brooker et al. [6] established a grading system to define the degree of HO. The results of several studies have shown that non-steroidal anti-inflammatory drugs (NSAID) and radiation therapy reliably reduce the occurrence of severe HO. The exact cause and mechanism of bone formation are not known. The efficacy of indomethacin versus meloxicam for the prevention of heterotopic periarticular ossification and clinical NSAID side-effects after primary, cementless total hip arthroplasty was evaluated. METHODS: Probands underwent cementless total hip replacements at the Orthopaedic Department, Hospital Wiener Neustadt, from January 1997 to January 1998, did not take NSAID up to 4 weeks preoperatively and had no NSAID contraindications. Patients were separated into two groups by different hospitalisation floors. All patients selected for this study suffered from primary or secondary coxarthrosis. Data were collected as a prospective, randomised, parallel group study. Patients were given 50 mg indomethacin 2 times daily ( n=58) vs 7.5 mg meloxicam ( n=58) in a 12-day treatment course. RESULTS: A two-sided Cochran-Armitage trend test showed no statistically significant difference ( p<0.05) for one of the drugs regarding influence on ectopic bone formation according to the grading system of Brooker et al. CONCLUSION: Our study demonstrates that there is no statistically significant trend that indomethacin or meloxicam protects a hip arthroplasty better from heterotopic bone formation. We prefer indomethacin therapy because it is almost half the price of meloxicam therapy, and we recommend indomethacin in a 12-day treatment course given 50 mg 2 times daily as an effective, inexpensive and easily administered HO prophylaxis.

Aged↗
PubMed2004

Sagittal laxity in vivo after total knee arthroplasty.

INTRODUCTION: A stress arthrometry study of 77 knees undergoing total knee arthroplasty was performed to determine the difference in anteroposterior (AP) laxity between posterior cruciate ligament (PCL)-retaining (PCLR) and PCL-substituting (PCLS) prostheses using the Genesis I TKA. MATERIALS AND METHODS: Fifty-three knees had PCLR and 24 had PCLS prostheses. The selected patients had successful arthroplasties after a minimum follow-up of 5 years. AP laxity was measured with a KT-2000 arthrometer (Medmetric, San Diego, CA, USA) using standard protocols. RESULTS: At 30 degrees of flexion, there was no statistical difference in anterior (PCLR: 4.7 mm, PCLS: 4.5 mm), posterior (PCLR: 1.1 mm, PCLS: 0.7 mm), or total (PCLR: 5.8 mm, PCLS: 5.3 mm) displacement. At 75 degrees , significant differences were seen in both anterior (PCLR: 3.3 mm, PCLS: 2.3 mm) and total (PCLR: 4.8 mm, PCLS: 3.4 mm) displacement (p=0.001 and p=0.009, respectively), although there was no statistical difference in posterior displacement (PCLR: 1.5 mm, PCLS: 1.1 mm). CONCLUSION: The above values are considered the suitable degree of AP laxity in total knee arthroplasty for a satisfactory clinical outcome 5-9 years after surgery. The PCL in a PCLR prosthesis and the central tibial spine and femoral cam in a PCLS prosthesis might play comparable roles in determining the laxity in the posterior direction in these prostheses.

Adolescent↗
PubMed2006

Migration of two different cementless hip arthroplasty stems in combination with two different heads: a biomechanical in vitro study.

The aim of the present in vitro study was to evaluate migrational characteristics of cementless primary hip arthroplasty stems in combination with a diameter 50 mm head (hemiarthroplasty) and a diameter 28 mm head in and with a polyethylene cup (total hip arthroplasty) in fresh-frozen human specimens. Two different types (Endo SL, FMT) were implanted into seven pairs of fresh-frozen human femoral specimens. The implanted stems were combined with a diameter 50 mm head (hemiarthroplasty) on one side and with a polyethylene cup and a 28 mm head (total hip arthroplasty) on the other side. Dynamic mechanical loading was applied for 50,000 cycles while recording relative motions between stem and bone stock using a 3-D motion analysis system. The Endo SL stem showed a significantly higher amplitude of relative motion in all translational and rotational components regardless of the head used. In both stem types a strong tendency for higher axial migration with the diameter 50 mm head in comparison to the THA head was found. The lowest axial migration was found in the FMTstem in combination with the small head and a PE cup. The highest axial migration was found in the Endo SL stem combined with the diameter 50 mm head. Our results indicate that the head might play an important role for axial migration of cementless stems.

Arthroplasty, Replacement, Hip↗
PubMed2006

Retrograde cement removal in periprosthetic fractures following hip arthroplasty.

INTRODUCTION: Revision of cemented hip arthroplasty after periprosthetic fractures of the femur is a demanding procedure. Many different technical devices have been developed for this purpose. This paper presents a new surgical technique of cement removal avoiding excessive exposure of the fracture site. MATERIALS AND METHODS: In six patients with periprosthetic fractures of the femur following hip arthroplasty (Johansson Type II and III) cement removal was performed by means of advancing a retrograde nail through the intercondylar notch of the knee. RESULTS: In all cases the cement was removed completely. Intraoperative complications or significant knee problems were not observed. CONCLUSION: The intracondylar approach provides a simple, rapid and less invasive technique for cement removal in revision hip arthroplasty.

Aged↗
PubMed1998

Unicompartmental knee arthroplasty for medial gonarthrosis: 5 to 9 years follow-up evaluation of 77 knees.

A total of 77 knees in 60 consecutive patients were operated on for medial gonarthrosis using a cemented porous coated anatomical (PCA) unicompartmental knee arthroplasty. Their average age was 71.3 years; 11 were men and 49 women. Clinically, the results in 67 knees were rated as being good to excellent, with mean preoperative and postoperative flexion of 123 and 122 deg, respectively. No deep infections or deep venous thrombosis occurred, but there was one dislocation of the femoral component. Overall clinical and radiographic results were satisfactory in 88% at 7.0 years' follow-up. Kaplan-Meier survivorship analysis indicated that the failure rate of unicompartmental knee arthroplasty was 12% at average follow-up. In patients aged 70 years or more, unicompartmental knee arthroplasty for medial gonarthrosis should be considered an excellent alternative to high tibial osteotomy.

Aged↗
PubMed2000

Therapeutic effect of transtrochanteric rotational osteotomy and hip arthroplasty on quality of life of patients with osteonecrosis.

We reviewed 37 patients with avascular necrosis of the femoral head (ANF). There were 23 men and 14 women with a mean age of 36 years at the time of the operation. The duration of follow-up was 9 years. Twenty patients had undergone transtrochanteric rotational osteotomy (TRO) and 17, hip arthroplasties. Assessment of their quality of life (QoL) was performed using the Rosser Index Matrix for disability and distress. Concerning TRO, the mean preoperative and postoperative QoL scores were 0.944 and 0.957, respectively. Twelve patients exhibited increases and 7 patients decreases in their scores. Regarding the arthroplasty, the mean preoperative and postoperative QoL scores were 0.949 and 0.998, respectively. All patients showed increases in QoL scores after arthroplastic surgery. Concerning heavy manual work, all five of those patients returned to their preoperative occupations. These findings suggest that hip arthroplasty has more reliable therapeutic effects than TRO on QoL improvement for patients with ANF.

Adult↗
PubMed2002

Total hip arthroplasty in patients younger than 30 years of age following developmental dysplasia of hip (DDH) in infancy.

Total hip arthroplasty (THA) in young patients is a controversial subject, due to the high failure rates reported in the literature, and even more so in patients with a history of developmental dysplasia of the hip (DDH). A group of 11 patients, all under the age of 30 years at the time of surgery, underwent THA due to congenital dislocation of the hip. Mean age at the time of operation was 23.3 years (range 16-30 years). The mean follow-up period was 9 years (range 3-14 years). The mean preoperative Harris' hip score (HHS) was 56.9 compared with the postoperative HHS of 90.6. Due to aseptic loosening of the cup, 4 patients underwent successful revision arthroplasty. These encouraging medium-term results in our patients suggest that THA may be a good solution for young patients suffering from coxarthrosis due to DDH, at least temporarily, especially when other alternatives, such as arthrodesis or resection arthroplasty, are considered.

Adolescent↗
PubMed2005

The effect of single-level, total disc arthroplasty on sagittal balance parameters: a prospective study.

A prospective radiographic study of the influence of total disc replacement on spinal sagittal balance. The goal of this study was to prospectively determine the effect of a single-level, total disc replacement on the sagittal balance of the spine, especially on sacral tilt (ST), pelvic tilt (PT), and lumbar lordosis. It has been shown that lumbar fusion may deleteriously alter the sagittal balance of the spine, including a decrease in the ST and lumbar lordosis. Clinically, postfusion pain has been shown to be significantly related to a decreased ST, increased PT, and decreased lumbar lordosis, independent of other factors such as pseudoarthrosis. To our knowledge, the influence of total disc replacement on spinal sagittal balance has not yet been reported in the literature. This is a prospective study of 35 patients who received a single level disc replacement using the Maverick Total Disc Arthroplasty system (Medtronic Sofamor Danek, Memphis, Tennessee) by a single surgeon at one institution from March 2002 to September 2003. The preoperative and postoperative radiographic evaluation included standing anteroposterior and lateral full spine films that included the femoral heads. The parameters studied were ST, PT, global and segmental lordosis, and global kyphosis. The average age of the 35 patients studied was 44.3 years (range 35-57). There were 18 females and 17 males. The disc arthroplasty was performed at the L4-L5 level in 19 patients and at the L5-S1 level in 16 patients. The average follow-up was 14 months (range 6-22 months). The preoperative values of global lordosis, ST, and PT were 51.5 degrees , 37.8 degrees , 16.9 degrees and, at last follow-up, they were 51.4 degrees , 37.4 degrees , and 17.5 degrees , respectively. These changes were not significantly different. When the groups were separated according to the level operated, there was still no statistical difference with regard to the overall lordosis, ST, PT or kyphosis from pre- to postoperative period or when the two groups were compared with each other. The level above the prosthesis has always significantly less lordosis. In the present study with use of a motion-preserving Maverick prosthesis, it appears that the patient is able to maintain the preoperative sagittal balance. The prosthesis has enough freedom of motion to allow the patient to maintain the natural sagittal and spinopelvic balance needed to prevent potential undue stress on the muscles and the sacroiliac joint. Although the number of patients is small, this is the first study to our knowledge that evaluates the sagittal balance after motion-preserving total disc arthroplasty.

Adult↗
PubMed2003

Coronal laxity in extension in vivo after total knee arthroplasty.

We performed stress arthrometric studies on 77 knees (71 patients) with total knee arthroplasty to determine the presence and magnitude of femoral abduction and adduction in knee extension. A total of 53 knees (49 patients) had posterior cruciate ligament-retaining (PCLR) prostheses, and 24 (22 patients) had PCL-substituting (PCLS) prostheses. The selected patients had successful arthroplasties with no clinical complications a minimum of 5 years after primary surgery. Each patient was subjected to a successive abduction and adduction stress test at 0 degrees -20 degrees of flexion using a Telos arthrometer. The mean values for abduction and adduction were 4.8 degrees and 4.5 degrees with a PCLR prosthesis, respectively, and 4.6 degrees and 4.0 degrees with a PCLS prosthesis. There were no statistical differences between PCLR and PCLS knees. The results suggest that approximately 4 degrees of laxity in these directions is suitable in total knee arthroplasty for a satisfactory clinical outcome 5-9 years after surgery.

Aged↗
PubMed2003

Effect of calf-thigh intermittent pneumatic compression device after total hip arthroplasty: comparative analysis with plantar compression on the effectiveness of reducing thrombogenesis and leg swelling.

The purpose of this study was to evaluate the efficacy of two intermittent pneumatic compression devices as prophylaxis against intravascular coagulation and leg swelling following total hip arthroplasty. We studied 121 patients by assessing thrombogenesis using the D-dimer level before and after total hip arthroplasty. In addition, the patients' postoperative swelling was evaluated by measuring the thigh and lower leg circumference. Altogether, 58 patients were assigned to the calf-thigh pneumatic compression group, and the other 63 were assigned to the plantar compression group; the two pneumatic compression devices were compared to evaluate which was more effective for reducing thrombogenesis. At 7 days postoperatively, the mean D-dimer levels of the calf-thigh compression group and the plantar compression group were 8.86 and 9.26 microg/ml, respectively. There was no significant difference ( P = 0.697) between the two groups. However, the increased ratio of the circumference of the thigh, which was compared after arthroplasty, averaged 1.22% in the calf-thigh compression group and 3.19% in the plantar compression group, which was significantly different ( P << 0.01). Calf-thigh pneumatic compression was found to be more effective than plantar compression for reducing thigh swelling during the early postoperative stage.

Adult↗
PubMed2004

Tendon suspension sling arthroplasty for degenerative arthritis of the thumb trapeziometacarpal joint: long-term follow-up.

Twenty-two tendon suspension sling arthroplasties for thumb trapeziometacarpal osteoarthritis were reviewed. Age at operation ranged from 53 to 74 years (average, 65 years); 20 of the 22 patients were women. The average follow-up period was 101 months (range, 63-139 months). At the final follow-up, 18 of 22 thumbs were painless. Grip and side pinch measurements averaged 98% and 79% of unaffected opposite sides, respectively. Range of motion at the trapeziometacarpal joint improved, and the average shortening of the trapezial space was 6.4 mm. Function was improved in all cases. The long-term results show that tendon suspension sling arthroplasty is a useful surgical procedure and an attractive alternative to existing tendon interposition arthroplasty with ligament reconstruction.

Aged↗
PubMed2006

Treatment of Kienböck's disease with cultured stem cell-seeded hybrid tendon roll interposition arthroplasty: experimental study.

BACKGROUND: Several procedures that consist of excision arthroplasty, intercarpal arthrodesis with or without excision of the lunate, proximal row carpectomy, and joint leveling procedures are used to treat advanced Kienböck's disease. However, no reconstructive surgery for a collapsed lunate has been established. The aim of this study was to develop a method of tendon roll interposition arthroplasty using a tissue-engineering technique to improve the clinical results of the tendon roll interposition arthroplasty for treating advanced Kienböck's disease. METHODS: Twenty-four Japanese white rabbits were used for this study as three treatment models of Kienböck's disease. The lunate of the right paw was excised, and then one of three kinds of tendon roll was interposed into the excision space as follows: group A (controls), a conventional tendon roll made of autologous Achilles tendon; group B (cored tendon roll) a tendon roll with a core of the collagen-ceramic composite; and group C (hybrid tendon roll), a scaffold seeded with cultured cells was rolled in the Achilles tendon. In all groups the right wrist was immobilized with cast 6 weeks after surgery. Wrist radiography was evaluated 0, 4, 6, and 12 weeks after surgery; specimens were sectioned and evaluated histologically 12 weeks after surgery. RESULTS: In group C the small shadow of the hydroxyapatite granule gradually increased until 12 weeks after surgery, whereas in group B the shadow of the core gradually decreased. The deficit spaces of the lunate remained radiographically lucent for 12 weeks after surgery in group A. Histological findings revealed new bone formation at the center and stained cartilage matrix at the peripheral of the hybrid tendon roll group (group C) but not in group A or B. CONCLUSIONS: Radiological and histological examinations proved that it is possible to make new hybrid tendon rolls using this method, as osteogenesis in the center and cartilage matrix in the peripheral of the tendon roll were revealed.

Animals↗
PubMed1999

Total shoulder arthroplasty -- current problems and possible solutions.

The concept and design of a cemented unconstrained total shoulder arthroplasty (TSA), introduced by Charles Neer II 25 years ago, has been successful in the management of degenerative and inflammatory conditions of the shoulder, controlling pain and, in many patients, significantly improving function. The clinical outcome is very much determined by the nature and severity of the pathology, as well as by the surgeon's experience and ability to correctly locate and fix the components. Total shoulder arthroplasty is a technically difficult procedure with perhaps a greater potential for technical errors and complications compared with other commonly performed arthroplasties. Current systems are modular on the humeral side, with varying head diameters and neck lengths, allowing more accurate coverage of the cut surface of the humeral neck and improved ability to establish the position of the joint line within the requirements of correct soft tissue tension and balance. Cemented all-polyethylene glenoid components remain the most favored, but the majority now have an increased radius of curvature compared with their corresponding humeral head, to allow translation during movement. Aseptic glenoid component loosening is the most frequently encountered long-term complication and is hastened by conforming prostheses, incorrect positioning, rotator cuff tears, and capsular contractures, but is protected by secure glenoid fixation. Cemented one-piece metal-backed glenoids have been disappointing, but non-cemented glenoids are being trialed with promising early results, although they have introduced their own particular problems of rapid polyethylene wear and component dissociation. Although cemented humeral components have a very low incidence of symptomatic loosening, most surgeons currently use press-fit designs supplemented with metaphyseal porous coating for osseous integration. Based on increased understanding of the morphology of the upper humerus, current designs are evolving with increased modularity, allowing the surgeon to choose the appropriate size, inclination, offset and version of the humeral component. These changes will, it is hoped, result in improved functional recovery and increased survivorship of the glenoid component.

Arthrography↗
PubMed2001

Fibrin monomer could be a useful predictor of pulmonary embolism after total hip arthroplasty: preliminary report.

We examined 17 total hip arthroplasty patients in order to develop a method for the predictive diagnosis of pulmonary embolism (PE) after joint arthroplasty. Scintigraphy revealed the presence of PE in 4 patients. Prothrombin time (PT), activated partial thromboplastin time (aPTT), antithrombin III (ATIII), and thrombin-AT III complex (TAT) did not show significant differences between patients with and without PE. D-dimer 7 days after surgery showed significant differences between patients with and without PE. Fibrin monomer (FM) increased sharply after surgery, and it was significantly different between the patients with and without PE immediately after surgery and 2 days after surgery. Our findings suggest the importance of FM in the predictive diagnosis of pulmonary embolism after total hip arthroplasty, and 40 microg/ml or higher levels with our measurement method could represent a high-risk condition.

Aged↗