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At least 1,333 records · Page 74Linked to original sources
PubMed2002

An assessment of histopathological criteria for infection in joint arthroplasty in rheumatoid synovium.

Intraoperative frozen section is reported to be a reliable means of identifying occult infection for preoperative evaluation of arthroplasty. The aim of this study was to determine whether the reported histopathological criteria--the existence of more than 10 polymorphonuclear cells (PMN) per high-power field--is valuable for determination of infection during the arthroplasty of patients with rheumatoid arthritis (RA). The permanent histological sections of RA synovium were analysed to study the degree of infiltration of PMNs. Furthermore, in order to examine the penetrative distribution of PMNs within the synovial tissues, immunohistochemical staining of PMNs was performed. In addition, the clinical history, from the postoperative period to the present, was investigated in 46 patients (60 joints). The presence of early- and/or late-stage postoperative infection, the development of postoperative fever, the progression of erythrocyte sedimentation rate (ESR) (more than 30 mm per hour) and the changes in CRP (more than 10 mg per litre) were further examined and compared with the histopathological tissue analyses and findings. The results demonstrated the presence of more than five PMNs per high-power field, excluding surface fibrin and inflammatory exudate in at least five separate microscopic fields in 10 joints (16.7%) of nine patients, out of 60 joints of 46 patients, in which no postoperative infection was evident. As to the magnitude of penetrative distribution of PMNs in 10 joints, there was a trend of deepening infiltration among the patients with intensive PMN infiltration. In addition, no development of postoperative fever, CRP or continuous indications of high ESR values were evident in this group. As the existence of more than 10 PMN per high-power field was not absolutely indicative of occult infection, investigation of frozen section during arthroplasty should be carefully managed.

Adult↗
PubMed1993

Resection arthroplasty of the proximal interphalangeal joint.

Palmar plate resection arthroplasty of the PIP joint, a new technique for operative treatment of destroyed PIP joints, is presented. By combining palmar plate arthroplasty with a flexor tenodesis a stable arthroplasty with adequate active motion can be performed. It can be used even in severely destroyed joints and still provide adequate post-operative stability and motion. Exercise can be started early.

Arthroplasty↗
PubMed1992

Long-term follow-up of trapeziometacarpal arthroplasty with coexisting scaphotrapezial disease.

Visualization of the scaphotrapezial joint during basal joint arthroplasty has been recommended to establish the stage of degeneration. This study attempts to clarify that recommendation and evaluate whether moderate wear of the joint precludes a good result of trapeziometacarpal hemiarthroplasty. To assess the need for inspection of the scaphotrapezial joint, x-ray films, tomograms, and operative findings in 23 cases of basal joint arthroplasty were reviewed. X-ray findings agreed with operative findings at the scaphotrapezial joint in only 76% of the cases. We also evaluated 18 thumbs in 15 patients who underwent interposition arthroplasty of the trapeziometacarpal joint and at surgery had moderate degenerative changes of the scaphotrapezial joint. The scaphotrapezial joints were left intact and the trapeziometacarpal joints were reconstructed. Follow-up averaged 8 years. In no case was there x-ray or symptomatic progression of the disease at the scaphotrapezial joint. Clinically, 78% were rated excellent, 17% good, and 5% fair.

Adult↗
PubMed2004

Total knee arthroplasty in Ehlers-Danlos syndrome.

The Ehlers-Danlos syndromes (EDS) are a rare group of connective tissue disorders characterized by severe joint hypermobility and instability. Ten patients with 12 primary knee arthroplasties were identified. Average age at time of surgery was 43.3 years, with follow-up data acquired at an average of 65 months after surgery. Primary indications for surgery were tibiofemoral or patellar instability (n = 8) and arthritis (n = 4). Knee Society Functional scores averaged 29.6 before surgery and 51.3 at time of interview (P<.005). Knee Society Knee scores at time of follow-up evaluation averaged 70. Tibiofemoral and patella stability were significantly improved. Arthroplasty appears to be an effective option for knee arthritis and instability in EDS patients, although results and satisfaction are lower than that reported for conventional arthroplasty indications.

Adult↗
PubMed2004

The incidence of heterotopic ossification after total knee arthroplasty.

Five hundred consecutive patients undergoing primary cemented knee arthroplasties were prospectively followed up and evaluated for the presence of heterotopic ossification. Of the patients studied, 95% had osteoarthritis and 5% had inflammation. A radiographic grading system was devised based on the size and location of the heterotopic bone. The overall incidence of heterotopic ossification in this group was 15%. The patients who developed HO tended to be heavier than the average and were more likely to be men. This is the most comprehensive prospective study of the incidence of HO in primary cemented knee arthroplasty. Other than a small subset of the patients (4 of 500), HO does not appear to have a major influence on the outcome of knee arthroplasty.

Aged↗
PubMed2004

Accuracy of haptic assessment of patellar symmetry in total knee arthroplasty.

Resection resulting in asymmetrically thick patellar arthroplasty in knee arthroplasty may lead to increased compression forces, wear, fracture, or loss of quadriceps power. Assessing the cut patella between the thumb and forefinger (haptic assessment) represents a convenient way to recognize asymmetry. In 2 test series, 8 orthopedic surgeons evaluated 24 precut solid foam patellae of varying asymmetric thickness by feeling the patella between thumb and forefinger, without visualization. Of 384 responses, in 73.2% asymmetry was underestimated, 10.4% assessments were exact, and in 16.4% asymmetry was overestimated. Specifically, 35.9% were correct within 1 mm, 60.7% within 2 mm, 81% within 3 mm, and 91.4% within 4 mm. The thickest half of the patella was correctly identified in 90.6% of responses. Haptic assessment of patellar symmetry is a useful technique in knee arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed2004

Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation.

A group of 42 primary total hip arthroplasties performed through an abridged surgical incision (group 1) was prospectively compared to a cohort of 42 primary total hip arthroplasties performed through a standard surgical incision (group 2). The length of the incision was 8.8 +/- 1.5 cm for group 1 and 23.0 +/- 2.1 cm for group 2. The groups were not significantly different with respect to age, height, preoperative Harris Hip scores (HHS), estimated blood loss, or length of hospital stay (P>.05). Group 1 patients had a lower body mass index than group 2 patients (P<.01). Length of surgery was slightly less for group I (P =.02). A 0% incidence was found of infection, nerve palsy, component malposition, and aseptic loosening in both groups. No dislocations occurred in group 1, and one dislocation occurred in group 2. Patients in group 1 have expressed considerable enthusiasm regarding the cosmetic appearance of the surgical incisions, and their postoperative HHS are slightly higher than those of group 2 (P =.042). Total hip arthroplasty can be performed safely and effectively through an abridged surgical incision, but this investigation confirms no dramatic clinical benefit other than cosmetic appeal.

Aged↗
PubMed2004

Bone bleeding during total hip arthroplasty after administration of tranexamic acid.

Numerous methods of controlling bleeding during total hip arthroplasty have been used. Thromboplastic agents have been used with some success, but the resultant fibrin layer interposed between the bone and cement weakens the interface. Topical freezing saline and hypotensive anesthesia have proved to be the most effective to date. The goal of this randomized, double blind, controlled study is to determine the effect of a single bolus dose of tranexamic acid, administered at the time of anesthesia, on bleeding during primary total hip arthroplasty. Fifty patients were randomized to receive either 10 mg/kg of tranexamic acid or a similar volume of normal saline as a preoperative bolus. Patients were not given pharmacologic thrombotic prophylaxis until 48 hours after surgery. The goal was to measure blood loss from the femoral canal at the time of surgery. An estimate of the internal and external blood loss during and after surgery was performed, and the transfusion requirement was recorded. No significant difference was found between the groups in terms of blood loss from the femoral canal, the perioperative bleeding, and postoperative hemoglobin. In the group that received tranexamic acid, a greater number of patients required transfusion than in the placebo group. The results of this study do not support the routine use of tranexamic acid in primary total hip arthroplasty.

Aged↗
PubMed2004

Mobile-bearing knee arthroplasty: rotation is our salvation!

Rotating-platform knee arthroplasties have enjoyed an outstanding clinical history since their introduction in 1978. Mechanical complications requiring further surgery have been identified and include loosening, bearing dislocation, bearing wear, and osteolysis. No structural, metallic failures were reported, although extreme bearing wear was noted to cause metal surface damage sufficient to require revision in isolated cases. Survivorship of primary LCS cemented rotating-platform knee arthroplasties using an endpoint of revision of any component for any reason was 97.7% at the 20-year interval. Survivorship of primary LCS cementless rotating-platform knee arthroplasties using the same endpoint was 98.3% at the 18-year interval.

Arthroplasty, Replacement, Knee↗
PubMed2004

Leg length discrepancy after total hip arthroplasty.

Restoration of hip biomechanics, including femoral offset and leg length are desired goals in performing total hip arthroplasty. Minor leg length discrepancies, less than a centimeter, are common after total hip arthroplasty and usually well tolerated. However in some patients, even these small discrepancies are a source of dissatisfaction. In addition, more significant discrepancies can be a risk factor for nerve injury and are a relatively common cause of litigation. Although leg length discrepancy cannot be eliminated after hip arthroplasty, it can be minimized through a series of steps both preoperatively and intraoperatively. These include physical examination to determine true and apparent leg length, and radiographic evaluation to both assess leg length and to preoperatively template the surgical procedure. Finally, the preoperative plan needs to be executed in the operating room using appropriate intraoperative cues.

Arthroplasty, Replacement, Hip↗
PubMed2004

Bone loss in total knee arthroplasty: graft augment and options.

The alternatives available for management of bone defects in total knee arthroplasty include prosthetic augments, autograft, allograft, and the use of bone cement. The selection of the augment technique should be based on the defect size, the patient age and life expectancy, and an assessment of the documented clinical results of each method. Prosthetic augments will address the vast majority of defects. The use of allograft is primarily indicated in the setting of major bone loss in revision knee arthroplasty, whereas the use of autograft is appropriate in the management of small defects in primary arthroplasty. Bone cement can be used for small defects if the stability of the implant is not compromised by the defect.

Arthroplasty, Replacement, Knee↗
PubMed2004

Lack of mental-status changes in patients undergoing total knee arthroplasty.

According to the literature, a significant number of patients present with mental-status changes following total joint arthroplasty. It has been postulated that mental-status changes would be increased in patients undergoing bilateral joint arthroplasty. To assess the mental status of patients undergoing total knee arthroplasty (TKA), a validated test was performed in a prospective fashion. Thirty patients underwent unilateral TKA, and 30 underwent sequential simultaneous bilateral TKA. The Folstein Mini Mental Status examination was performed before and after surgery. No significant changes were noted in this patient population after surgery. Furthermore, there were no significant differences between the unilateral and the bilateral groups.

Aged↗
PubMed2004

Hybrid total knee arthroplasty: a retrospective analysis of clinical and radiographic outcomes at average 10 years follow-up.

Cemented total knee arthroplasty has demonstrated high success rates at 10-12 years. Although many cementless designs have demonstrated inferior outcomes, hybrid fixation has not been studied in detail. We retrospectively reviewed 112 hybrid total knee arthroplasties (PCA-67 and Duracon-45) after clinical and radiographic review using the SF-12 and Knee Society Scores at an average 10-year follow-up. The revision rate was 4.5%: 4 occurred in patients with metal-backed patellae and 1 in a patient with infection. No revisions were performed for aseptic loosening of the femoral component. Hybrid total knee arthroplasty with these designs provided excellent clinical and radiographic performance at 10 years comparable to cemented series. Aseptic loosening and radiographic failure rates were 0% if patients with metal-backed patellae were excluded. The durability of hybrid fixation beyond 10 years deserves further study.

Aged↗
PubMed2005

Accurate femur repositioning is critical during intraoperative total hip arthroplasty length and offset assessment.

Techniques for intraoperative leg length equalization are based on measurements between fixed points on the pelvis and femur. These techniques have not been reliable because they are based on accurate femur repositioning. We examined the error that results from inaccurate femur repositioning during total hip arthroplasty. Total hip arthroplasty was simulated on a calibrated test bench and changes in leg length and femoral offset were measured. Before dislocation, the femur was held in neutral alignment. Total hip arthroplasty was simulated without changing length or offset and the femur was returned to neutral. Length and offset changes were measured with the femur held in 5 degrees and 10 degrees of abduction/adduction and flexion/extension. Five degrees of abduction/adduction malpositioning caused 8 mm of apparent change in leg length. Errors in femoral offset followed a similar trend. When using common techniques for intraoperative leg length equalization and offset restoration, inaccurate abduction/adduction repositioning of the femur with respect to the pelvis can cause substantial errors in the measurement of length and offset change.

Arthroplasty, Replacement, Hip↗
PubMed2005

Immediate cementless total hip arthroplasty for the treatment of active tuberculosis.

We report the results of a primary total hip arthroplasty (THA) in 7 patients with advanced active tuberculous arthritis of the hip and had lost the chance of preserving the hip without replacement surgery. Tuberculosis was confirmed in all cases by the culture or histological examination. All patients were treated with primary THA followed by antituberculous medications for 1 year. Cementless stems and sockets were used in all patients. The average follow-up period was 4.8 years. The reactivation of the infection was not detected in all cases. The result was excellent in all patients according to the Harris Hip Score. Total hip arthroplasty in the tuberculous hip is a safe procedure and produces superior functional results compared with resection arthroplasty or arthrodesis. The results of primary THA in the selected patients was satisfactory as they rapidly recover from the disease.

Adult↗
PubMed2004

Metal-on-metal surface arthroplasty with a cemented femoral component: a 7-10 year follow-up study.

Forty-two McMinn metal-on-metal surface arthroplasties were implanted in 23 males and 16 females, average age 47.5 years old. The overall survivorship at 7 years was 79%; with any reoperation surgery as endpoint, 80%; and 93%; with aseptic loosening of the socket and femoral component, respectively. The average Surface Arthroplasty Risk Index of patients who had failed or were at risk of failing on the femoral side was significantly greater than for the rest of the cohort, 3.9 versus 1.9. The overall survivorship of the McMinn component was unacceptably low, with the majority of failures occurring with the cemented acetabular components. The recent reintroduction of surface arthroplasty of the hip using metal-on-metal bearings and cementless acetabular components may benefit young patients with hip arthritis with appropriate patient selection.

Adult↗
PubMed2004

Surface arthroplasty for osteonecrosis of the hip: hemiresurfacing versus metal-on-metal hybrid resurfacing.

Eighty-four hips with Ficat stage III and IV osteonecrosis were treated: 56 with metal-on-metal surface arthroplasty (MMSA) and 28 with hemi-surface arthroplasty (HSA). Average follow-up was 4.9 years. UCLA hip scores were significantly better for MMSA versus HSA for function and activity as well as Harris Hip scores and physical component of the SF-12 scores. In the MMSA group, 2 hips were revised to total hip arthroplasty for femoral loosening, and 5 hips had adverse radiological changes. In the HSA group, 4 hips were revised (1 sepsis and 3 for pain). There was no evidence of any femoral loosening or neck narrowing in the HSA group. Although the functional clinical outcome of MMSA is superior to HSA, long-term follow up of MMSA will determine the reliability of the femoral fixation.

Adolescent↗
PubMed2004

Can metal levels be used to monitor metal-on-metal hip arthroplasties?

In this review, the prospects for using blood, serum, and/or urine metal levels for monitoring the performance of metal-on-metal hip arthroplasty systems are explored. This approach does have substantial potential for serving this function; however, the methodology is technically challenging and the interpretation of the values requires an extensive database with correlative clinical information. At this time, it is premature to recommend metal concentration analysis on a routine clinical basis for patients with metal-on-metal total hip arthroplasties. Nonetheless, metal concentration analysis remains a powerful research tool in the evaluation of metal-on-metal hip arthroplasty systems.

Arthroplasty, Replacement, Hip↗