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At least 1,423 records · Page 79Linked to original sources
PubMed2003

Hemiresurfacing arthroplasty of the hip for failed free-vascularized fibular graft.

Management of Ficat stage III and IV osteonecrosis of the hip remains challenging, with the average patient aged in the mid 30s. Joint- and bone-preserving procedures such as free vascularized fibular graft, redirectional osteotomies, and hemiresurfacing hip arthroplasty are often considered. If these treatments fail, that is, after progression of joint destruction or persistent pain and decreasing function, total hip arthroplasty is often the procedure of choice. We describe the case of a patient with failed bilateral free vascularized fibular graft treated with bilateral hemiresurfacing arthroplasty.

Adult↗
PubMed2003

Unicompartmental knee arthroplasty for osteoarthritis of the knee: remaining postoperative flexion contracture affecting overall results.

The success rate of unicompartmental knee arthroplasty has been variable, and controversy still surrounds its use. Achieving good functional results from this surgery may require understanding surgical principles, precise operative techniques, and careful patient selection. This paper evaluates clinical results and factors influencing postoperative knee function after unicompartmental knee arthroplasty. The follow-up assessment of 109 knees that underwent unicompartmental knee arthroplasty showed that 90 of 109 knees were classified as excellent or good (82.6%) using the Hospital for Special Surgery knee scoring system. In the excellent group (54 knees), 52% of the postoperative, standing femorotibial angles converged on a range of 170 degrees to 175 degrees with a mean of 174 degrees +/- 4 degrees. The knees with residual flexion contracture after surgery showed poorer clinical results. Therefore, complete elimination of the flexion contracture during surgery is considered mandatory.

Arthroplasty, Replacement, Knee↗
PubMed2003

Shoulder arthroplasty in the young patient.

We reviewed the performance of 22 shoulder implant arthroplasties in 19 patients age 50 or younger at surgery. Patients were evaluated by telephone interview, written questionnaire, and radiographic examination. The average age at surgery was 38.6 years, and the average follow-up was 5.6 years. Patients were grouped by disease process (rheumatoid arthritis [RA], avascular necrosis [AVN], trauma, and hemophilic arthropathy [HA]) and type of prosthesis (total vs. hemiarthroplasty). The highest scores (best shoulder function) were seen in patients with hemiarthroplasty for HA. Patients with hemiarthroplasty for trauma and AVN scored similarly, whereas those with a hemiarthroplasty for RA scored lowest. Patients with RA who had a total shoulder arthroplasty scored higher than patients with hemiarthroplasty. When patients in our population with longer follow-up were compared with those with a shorter follow-up, no downward trends in shoulder function were seen. Accelerated deterioration of function of shoulder arthroplasties was not observed in our young patient population.

Activities of Daily Living↗
PubMed2003

Clinical outcome and incidence of pregnancy after bipolar and total hip arthroplasty in young women.

Female patients under 45 years of age (average, 32.5; range, 14-44) at the time of primary bipolar or total hip arthroplasty (THA) were surveyed an average 10.5 years (range, 1.7 to 20.3 years) after the index procedure. Most patients were satisfied with the pain relief and functional abilities. Of the 109 respondents (137 hips), 37 (34%) had undergone 50 additional hip procedures. Thirteen women (12%) had 19 children at an average of 3 years after hip arthroplasty. Seven women had 1 child each; 6 had 2 children; and 1 had dizygotic twins. Eleven infants were delivered vaginally and 8 by cesarean section (5 planned, 3 unplanned). Two pregnancies were considered high risk unrelated to the hip arthroplasty. Pregnancy-related complications for these patients did not differ from those in the general population.

Adolescent↗
PubMed2003

The 90/90 pillow reduces blood loss after knee arthroplasty: a prospective randomized case control study.

Our goal was to evaluate the 90/90 pillow as an effective means of preventing blood loss after knee arthroplasty. We performed a prospective randomized case-control study on 40 patients undergoing knee arthroplasty. All patients were treated in a standard fashion, except for the use of the 90/90 pillow in one group. The 90/90 pillow flexes the knee to 90 degrees and is in situ for 24 hours after surgery. We measured blood loss at time points from 1 to 48 hours. Range of motion was assessed, as were analgesic requirements. Statistical analysis was performed on our results. We found a statistically significant reduction in blood loss without compromising range of motion. We advocate the 90/90 pillow after all knee arthroplasties.

Aged↗
PubMed2003

Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty.

The purpose of this study was to review our experience in treating acute gram-positive infections after total knee arthroplasty with debridement, component retention, and intravenous antibiotics. Thirty-one total knee arthroplasties with acute gram-positive infections, seen at our institution over a 10-year period, were treated with open debridement and component retention. Eleven (35%) of 31 patients successfully retained their components at most recent follow-up, without ongoing infection (mean, 4 years; range, 2-10 years). Only one (8%) of the 13 patients infected with Staphylococcus aureus was successfully treated, compared with 10 (56%) of 18 patients with either Staphylococcus epidermidis or a streptococcal species. The difference between these groups is statistically significant (P=.007). The high failure rate of debridement and component retention suggests that immediate component removal should be considered in the presence of acute S. aureus infection in total knee arthroplasty.

Acute Disease↗
PubMed2003

Twenty- to twenty-six-year radiographic review in patients 50 years of age or younger with cemented Charnley low-friction arthroplasty.

This is a retrospective radiographic study at 20 to 26 years of follow-up of a single surgeon's consecutive series of patients operated on at 50 years of age or younger with Charnley low-friction arthroplasty. Loosening, osteolysis, and wear were evaluated. Fifty-four patients underwent 68 low-friction arthroplasties. Fifty percent were 40 years of age or younger at surgery. The average rate of wear was 0.08 mm/yr. Osteolysis was infrequent. Twenty-two-year survival estimates and corresponding confidence levels were 76% for the cup (all causes) and 78.8% for the stem. For aseptic loosening, the figure was 80.5% for the cup and 85.2% for the stem. Successful radiographic results can be achieved in younger patients undergoing Charnley low-friction arthroplasty with more than 20 years of follow-up.

Adult↗
PubMed2003

Tibial plateau stress fracture: a complication of unicompartmental knee arthroplasty using 4 guide pinholes.

Unicompartmental knee arthroplasty has gained popularity recently as a treatment for unicompartmental tibiofemoral non inflammatory arthritis. Tibial plateau stress fracture after unicompartmental knee arthroplasty (UKA) through guide pin holes placed in the proximal tibia has not been previously reported. In each case in this report, the compressive strength of the proximal tibia was reduced by the drilling of multiple holes for the placement of guide pins and holes for the lugs of the tibia component resulting in fracture through these holes between 3 and 18 weeks (median 8 weeks) post-operatively. In at least one case, the medial tibial cortex was violated by one pin. All cases required revision total knee arthroplasty (TKA). It is intuitive to caution against the use of multiple guide holes in the proximal tibia in UKA. If 3 or more hole pins are deemed necessary, surgeons must be aware of the potential for stress fracture and monitor patients accordingly. Peripheral pins that infract the medial tibial cortex should also be avoided.

Aged↗
PubMed2003

Stress fracture of the medial tibial plateau after minimally invasive unicompartmental knee arthroplasty: a report of 2 cases.

Minimally invasive unicompartmental knee arthroplasty has been increasingly popular for the past few years. Several short- and medium-term published reports have shown it to be as efficacious as open unicompartmental knee arthroplasty, with reduced morbidity. However, complications specifically related to the minimally invasive techniques are not well documented. We report 2 cases of stress fracture of the medial tibial plateau after unicompartmental knee arthroplasty with minimally invasive instrumentation. Awareness of this as a possible complication, with increased care in surgical technique, will help to avoid this problem.

Aged↗
PubMed1988

Long-term results of silicone trapezial implant arthroplasty.

The senior author has performed the Swanson implant arthroplasty for arthritis of the basal joint of the thumb for the past 12 years. Fifty-two patients with a total of 64 arthroplasties of the thumb were reviewed, with follow-up periods of 12-156 months (average, 4.4 years). The majority (80%) of the arthroplasties were performed for osteoarthritis; 11% were performed for rheumatoid arthritis, 6% for traumatic arthritis, and 3% for mixed connective tissue disease. Subjective and objective hand functional measurements and radiographic examinations were performed in the majority of patients (77%). The overall results were good both subjectively and objectively. Although degenerative changes involving the implant occurred with increasing frequency as the follow-up period increased, these changes were not symptomatic in the majority of cases.

Adult↗
PubMed1989

Blood supply to the patella. Significance in total knee arthroplasty.

Patellofemoral problems occur in approximately 5% of total knee arthroplasties and account for 50% of complications of total knee arthroplasty. Surgical disruption of the blood supply to the patella may cause an increase in the incidence of osteonecrosis, stress fracture, and loosening. The authors discuss patellar blood supply and surgical considerations in total knee arthroplasty and review the clinical experience with avascular patellae.

Adolescent↗
PubMed1996

Use of iliofemoral distraction in reducing high congenital dislocation of the hip before total hip arthroplasty.

The iliofemoral distraction with Wagner's apparatus was conducted in 20 adult patients with untreated unilateral congenital dislocation of the hip (Crowe group IV) before total hip arthroplasty. During the distraction period of 8 to 17 days, this technique had effectively reduced high dislocation of 4.5 cm (range, 3.5-5 cm). No pin-tract infection was encountered. Surgical difficulties in total hip arthroplasty for these patients were reduced. Potential problems, such as irreducibility, overshortening, nerve palsy, and displaced femoral fractures, were avoided. At an average follow-up period of 43 months (range, 25-63 months), all patients have excellent or good results, with an average Harris hip score of 94.3 (range, 84-100). Leg length was restored. The iliofemoral distraction is valuable prior to difficult total hip arthroplasty for high dislocation.

Adult↗
PubMed1997

Patellofemoral joint after total knee arthroplasty. Effect on contact area and contact stress.

Compressive contact stress between the patella and the anterior femur and between the quadriceps tendon and anterior femur was measured before and after total knee arthroplasty in 5 cadaver knee specimens using a digital electronic sensor. Contact stresses were measured in the normal knee and after total knee arthroplasty with an unresurfaced patella, a dome-shaped patella, and a conforming patella. Patellofemoral contact stresses did not change significantly after total knee arthroplasty when the patella was not resurfaced, but they increased significantly after the patella was resurfaced with both the dome-shaped and the conforming components. The conforming patella had the highest contact stresses because it tilted at flexion angles greater than 90 degrees and applied load to a small area on the superior portion of the patellar component. The conforming patella markedly decreased tendofemoral contact force because the thicker superior pole of the patella tented the quadriceps tendon at flexion angles greater than 120 degrees. This further increased patellofemoral contact force in deep knee flexion.

Arthroplasty, Replacement, Knee↗
PubMed1997

Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty.

Thigh pain following tourniquet application is a common patient complaint in the early postoperative period following total knee arthroplasty. Postoperative thigh pain was evaluated in 28 consecutive simultaneous bilateral total knee arthroplasty patients between April 1996 and October 1996. A prospective, double-blind, randomized clinical trial was performed. Tourniquet pressure of 350 mmHg was used on 1 thigh (thigh 1) and 100 mmHg plus systolic blood pressure on the other (thigh 2). A scale of pain (no pain, mild, moderate, or severe) was applied on the first, second, and third days, as well as 2 and 6 weeks after surgery. There were 16 men and 12 women with a mean age of 72 years (range, 55-85 years). The mean tourniquet time was similar in both groups (thigh 1 = 23 minutes, thigh 2 = 22 minutes). The mean tourniquet pressure in thigh 2 was 230 mmHg (range, 212-260 mmHg). There was a statistically significant difference in thigh pain on the first (P = .01), second (P = .01), and third (P = .001) postoperative days between both groups, with more thigh pain on the 350 mmHg side. At 6 weeks after surgery, the difference in thigh pain was gone. For total knee arthroplasty, using the tourniquet at a pressure of 100 mmHg above the systolic blood pressure is recommended. This is adequate to provide a bloodless field and will result in a less unpleasant postoperative period.

Aged↗
PubMed1997

Revision total knee arthroplasty with a cemented posterior-stabilized or constrained condylar prosthesis: a minimum 3-year and average 5-year follow-up study.

The results of 57 revision total knee arthroplasties performed for aseptic failure between 1984 and 1992 with a cemented posterior-stabilized or constrained condylar prosthesis were reviewed at follow-up examinations at a minimum of 36 and an average of 62 months (range, 36-120 months). The reason for revision was aseptic loosening of 1 or both components in 32 knees (56%), instability in 16 knees (28%), polyethylene wear and osteolysis in 4 knees (7%), supracondylar femur fracture in 2 knees (4%), and a failed allograft, pain, and arthrofibrosis in 1 knee each (5% total). The average age of the patients at the time of the revision was 74 years (range, 38-90), and the original diagnosis for the majority of patients was osteoarthritis (74%). All of the revision prostheses were cemented posterior stabilized or constrained condylar-type implants. Bone deficiencies were grafted with cancellous allograft in contained defects and cortical allograft in noncontained defects. Five knees were reconstructed with allograft-prosthesis composites. The average modified Hospital for Special Surgery knee score improved from 49 to 82 (100 points possible) at final follow-up evaluation (P < 0.001). Seventy-nine percent of knees were graded as good or excellent. Kaplan-Meier survivorship analysis predicted 94%+/-6.2% survival at 40 months and 75%+/-25% at 99 months. There were 4 clinical failures, 3 of which were related to residual instability in patients with a posterior-stabilized prosthesis. Complications (3 knees) were exclusively related to the extensor mechanism. Radiographically, overall knee alignment improved from 0.3 degrees varus to 3.0 degrees valgus. Fifty-six percent of tibial components were placed in slight varus alignment. Radiolucent lines occurred in 33% of knees, but there were no complete or progressive radiolucencies. Radiolucent lines were more prevalent adjacent to press-fit intramedullary femoral stems compared with cemented stems (P < .02), but the difference did not correlate with clinical or radiographic failure. The median bone defect score, as proposed by the Knee Society Committee on Bone Defects, was significantly greater in knees that were revisions of a failed cemented total knee arthroplasty compared with revision of a failed cementless total knee arthroplasty (P = .02) but was not correlated with clinical or radiographic outcome (P > .05).

Adult↗
PubMed1998

Complex primary and revision total knee arthroplasty using the condylar constrained prosthesis: an average 5-year follow-up.

The condylar constrained total knee arthroplasty was performed on 29 patients undergoing 33 procedures and were reviewed clinically and radiographically at an average follow-up of 5 years (range, 2-10 years). There were 21 women and 8 men. The average age at the time of surgery was 70 years (range, 32-84). Of the 16 knees that were revision total knee arthroplasties, 8 had a previous infected total knee arthroplasty, and 17 knees had severe deformities requiring the use of the condylar constrained prosthesis. The patients were rated according to the Knee Society clinical and radiological evaluation protocol. Measurements of femoral and tibial component position were obtained as well as femoral tibial angle, patella position, and cement bone radiolucencies. All clinical measurements were made by an independent physical therapist. Clinical results revealed an improvement from an average preoperative knee score of 38 points to an average postoperative score of 86 points. The clinical results for 19 (58%) knees were excellent, 8 (24%) had a good result, 1 (3%) was fair, 2 (6%) were poor, and 3 (9%) were failures. The patients' average functional levels increased from 24 to 58. The final average flexion was 96 degrees. Three knees have been revised (9%). One was revised for recurrent infection, one for periprosthetic fracture, and one for mechanical loosening of the tibial component. There were no other knees with evidence of radiologic loosening. We conclude that the condylar constrained total knee prosthesis provides an acceptable solution for revision and complex primary total knee replacements at an intermediate follow-up term of 5 years.

Adult↗
PubMed1998

A modified direct lateral approach in total hip arthroplasty: a comprehensive review.

A retrospective review of 770 consecutive primary total hip arthroplasties was conducted to determine the complications and utility of a modified direct lateral approach, which involves elevation of the anterior one-third of the gluteus medius and vastus lateralis in continuity. In 640 patients, 712 total hip arthroplasties were followed up for a minimum of 2 years (maximum 6.5 years, average 3.6 years). Two prosthetic dislocations occurred in the follow-up period, for a prevalence of instability of 0.3%. A moderate or severe limp was present in 10% of all patients at 2-year follow-up and in 4% of a subgroup of patients with only unilateral osteoarthritis of the hip (Charnley A). Severe heterotopic ossification (Brooker grade III or IV) developed in fewer than 3% of hips and was functionally limiting in only seven patients. Four sciatic nerve palsies occurred. Surgical exposure has been excellent through this approach, without the need for extensile measures, such as a trochanteric osteotomy. The duration of surgery has been considered acceptable, and the position of the components considered excellent while using this approach. From this review, it was concluded that this modified direct lateral approach has greatly diminished the potentially devastating complication of postoperative instability and is associated with an acceptable level and severity of limp and heterotopic ossification. The approach provides excellent exposure in primary total hip arthroplasty to allow accurate placement of components in an efficient manner.

Adult↗
PubMed1998

Patellofemoral complications in symmetrical total knee arthroplasty.

A review of 356 Kinemax (Howmedica, Inc, Rutherford, NJ) cemented posterior cruciate ligament-retaining condylar total knee arthroplasties employing a symmetrical femoral component articulating with a medially offset symmetrical dome patella component was carried out to examine the results and determine the incidence and nature of the patellofemoral complications. Follow-up was from 3 to 8 years, with a mean of 5.1 years. A review of patellofemoral complications in previously reported homogeneous series of symmetrical and asymmetrical implants is presented. Mean postoperative Knee Society scores improved to 91, function scores to 86, and Hospital of Special Surgery scores to 90 yielding 95% good and excellent results. Mean postoperative range of motion was -1.5 degrees extension to 113 degrees flexion. There were five patellofemoral complications (1.4%), including two symptomatic subluxations, two distal pole avulsion fractures, and one lateral facet fracture. There were two reoperations necessary for patellofemoral problems (0.56%), one to correct subluxation and one for excision of the fractured lateral facet. These rates are lower than those previously reported for asymmetrical implants as well as current and phased-out symmetrical designs of total knee arthroplasty in the intermediate term. This review suggests that cemented total knee arthroplasty with symmetrical patellofemoral resurfacing with an offset patella dome and posterior cruciate ligament retention yields low patellofemoral complications and reoperations. The symmetrical femoral component appears to be a satisfactory compromise of "normal" femoral anatomy, which decreases inventory and cost without adversely affecting patellofemoral function and complications.

Adult↗