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PubMed2001

Low contact stress mobile bearing total knee arthroplasty: results at 5 to 13 years.

A total of 139 mobile bearing knee arthroplasties in 104 patients were evaluated at a mean follow-up of 7.8 years (range, 5-13 years). There were 80 cemented knees, 50 uncemented, and 9 hybrid (cemented tibia, uncemented femur). Ten knees were revised. Four knees were revised for aseptic loosening of an uncemented tibial component, and 1 knee was revised for loosening of an uncemented femoral component. One knee was revised for a recurrent dislocating bearing, and 1 knee was revised for instability. No mechanical loosening occurred in the cemented components. Three knee arthroplasties were revised for infection. A total of 66 patients (92 knees) were evaluated clinically and radiographically. Radiographic evaluation showed a 27% incidence of radiolucent lines for the femur and a 31% incidence of radiolucent lines for the tibia. No components were considered radiographically loose. The survivorship of mobile bearing knee arthroplasties was 93% at an average follow-up of 7.8 years. Aseptic loosening was statistically higher in uncemented components (P=.0051).

Aged↗

PubMed2001

Early failure associated with the use of Hylamer-M spacers in three primary AMK total knee arthroplasties.

We report 3 cases of early failure associated with AMK total knee arthroplasties with the use of Hylamer-M spacers. In 2 of these cases, massive osteolysis of the posterior condyles was noted; revision with the use of allograft bone to fill in the cavitary defects yielded excellent results. In all cases, large areas of pitting and delamination of the Hylamer spacers were noted. Given these cases and the previous literature on early failure of hip arthroplasties with Hylamer inserts, we recommend caution in using Hylamer for knee arthroplasty surgery.

Aged↗

PubMed2002

Kinemax total knee arthroplasty: trial by template.

A retrospective radiologic study of Kinemax total knee arthroplasty templates is presented to establish their accuracy. The preoperative and postoperative radiographs of 49 Kinemax total knee arthroplasties were assessed using the Kinemax template. The size of the actual component used was compared with that predicted from the preoperative and postoperative radiographs. The preoperative radiograph template was accurate in 57% of cases, but the postoperative radiograph template was accurate in only 41%. Preoperative radiologic templating is of questionable benefit as part of preoperative management for patients undergoing Kinemax total knee arthroplasty.

Arthroplasty, Replacement, Knee↗

PubMed2002

Patient expectation and satisfaction in revision total hip arthroplasty.

Sixty-six consecutive revision total hip arthroplasty patients were asked about their expectations regarding future pain and walking ability. Expectations were high, regardless of background factors: 92% expected to have much less pain, and 82% expected the same walking ability as after the primary arthroplasty or a much improved walking ability. Of the patients, 56% stated a non-surgeon-related origin of expectations, 7% were uncertain, and 37% said expectations derived from the surgeon. At 1 year, Harris hip score had increased from a median 45 to 77 points, but only 69% and 55% said that their expectations had been fulfilled to a very large or rather large extent regarding pain and walking ability. The only predictor of fulfilled expectations was absence of complications (odds ratio, 4.8; 95% confidence interval, 1.1-20.8). Patient satisfaction was only moderate; 63% were very or rather satisfied with a moderate correlation (0.46-0.47) between satisfaction and fulfilled expectations. Patients with a poor preoperative hip condition generally were more satisfied (odds ratio, 5.0; 95% confidence interval, 1.4-17.9), and the most important reason probably was an improved walking ability (r = 0.64). Patient dissatisfaction may originate from unrealistic expectations. At preoperative consultation, it is recommended that the surgeon discuss the revision patient's expectations, especially regarding future walking ability, and inform the patient about the fundamental prognostic differences between revision and primary hip arthroplasty.

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PubMed2002

Does Chiari osteotomy compromise subsequent total hip arthroplasty?

We compared 28 total hip arthroplasties done in dysplastic hips after previous Chiari osteotomy (group I) with a well-matched control group of 50 primary procedures (group II) done during the same period at an average follow-up of 5 years (range, 25-199 months). Group I required significantly less acetabular augmentation, had significantly shorter operative times, had less intraoperative blood loss, and had fewer complications than group II. There was no significant difference between the 2 groups in terms of clinical or radiographic outcome. Total hip arthroplasty after a successful Chiari osteotomy leads to medium-term results similar to those of other dysplastic hips. In our experience, less bone grafting was required, better coverage of the cup by host-bone was obtained, and the center of motion of the hip was more anatomic. Chiari osteotomy may delay the need for total hip arthroplasty, may facilitate acetabular reconstruction, and does not seem to compromise the medium-term clinical or radiographic outcome.

Acetabulum↗

PubMed2002

Staged exchange arthroplasty for shoulder sepsis.

Eight patients with shoulder sepsis were treated with staged exchange arthroplasty using antibiotic-impregnated polymethyl methacrylate spacers shaped and fitted to the patient's anatomy after extensive joint débridement. Intravenous antibiotic therapy followed for a minimum of 3 months. At the end of 6 months, the patients were evaluated for any clinical or laboratory signs of infection; none were encountered. Exchange prosthetic reconstructions were performed using standard implants fixed with antibiotic-impregnated polymethyl methacrylate cement. Three patients underwent a revision to total shoulder arthroplasty, whereas 5 underwent hemiarthroplasty of the humerus with local capsular flap covering of the glenoid. All patients experienced substantial pain relief and improvement in function despite limited total overhead motion, showing this technique to be a satisfactory salvage procedure for managing sepsis of the glenohumeral joint primarily and after total shoulder arthroplasty.

Adult↗

PubMed2002

Clinical outcome in total hip arthroplasty using a cemented titanium femoral prosthesis.

Between 1988 and 1993, 118 total hip arthroplasties were carried out using cemented titanium alloy stems with modular cobalt-chrome heads. At a mean follow-up of 66.2 months, the overall clinical failure rate as a result of aseptic loosening of the femoral stem was 11.5%. Most failures occurred with smaller stems, especially in heavier patients. Clinical and radiographic data suggest that failure of femoral component fixation was due to high stresses in the cement mantle associated with the increased flexibility of the smaller stems. Radiographs of successful arthroplasties in patients with larger stems showed proximal stress shielding in most. The findings in this study do not support the contention that titanium alloys provide an advantage over more rigid materials in the manufacture of cemented femoral components for total hip arthroplasty.

Aged↗

PubMed2002

Cemented revision total hip arthroplasty with impaction bone grafting in Gaucher's disease.

Total hip arthroplasty in Gaucher's disease has been associated with high rates of loosening after all types of arthroplasty. We present a patient with type 1 Gaucher's disease who underwent revision cemented total hip arthroplasty for aseptic loosening after 12 months of enzyme replacement therapy. Major osteolysis was managed by impaction morcellized bone grafting. An excellent clinical and radiographic result was obtained at 5-year follow-up. Enzyme replacement therapy combined with modern revision techniques may offer improved outcomes for patients with Gaucher's disease.

Adult↗

PubMed2002

Functional outcome after total knee arthroplasty revision: a meta-analysis.

The objective of this study was to perform a systematic literature review to describe patient outcome after total knee arthroplasty revision procedures using various global knee score ratings. English language articles published from 1966 through 2000 were identified through a computerized literature search and bibliography review. A multistage assessment was used to determine the articles containing data that could meet our objective. Meta-analyses of global knee scores were undertaken using a fixed effects model with the assumption that the variances of each individual measurement were identical across studies. The initial inclusion criteria were met by 58 articles with a total of 1965 patients. There were 42 articles comprising 45 unique patient cohorts and a total of 1515 patients that had sufficient global knee score data for analysis and were used in the meta-analyses. Revision total knee arthroplasty is an effective procedure for failed knee arthroplasties based on global knee rating scales.

Adult↗

PubMed2003

The bubble sign: a new radiographic sign in total hip arthroplasty.

The production of metallic debris from the wear of nonbearing surfaces of a total hip arthroplasty is encountered frequently. We describe a case of extreme generation of metallic debris that resulted in the radiographic outlining of the joint cavity. A 71-year-old woman with a total hip arthroplasty experienced dislodgment of the polyethylene liner from its acetabular shell, resulting in metal-on-metal articulation of the femoral head and the cup. This articulation created severe metallosis that could be seen on preoperative radiographs, producing the described bubble sign. At the time of revision surgery, copious metallic debris was seen macroscopically. This newly described radiographic sign should alert the arthroplasty surgeon to the extent of metallic wear.

Acetabulum↗

PubMed2003

Rapid osteolysis after revision hip arthroplasty in Paget's disease.

Rapid bone turnover in Paget's disease has been of concern to many surgeons performing hip arthroplasties. We present the case of a 71-year-old man with Paget's disease affecting the proximal femur. He had undergone total hip arthroplasty 14 years before. He sustained a fracture at the tip of the femoral component, which was managed with revision total hip arthroplasty. His postoperative course was complicated by rapid and profound osteolysis of the femur distal to the fracture site, secondary to disease activity. This case highlights the need for awareness of Paget's disease activity and this potential complication.

Aged↗

PubMed2001

The effect of gap arthroplasty on temporomandibular joint ankylosis: an experimental study.

The aim of this study was to demonstrate the functional and anatomical changes after gap arthroplasty release of unilateral temporomandibular joint (TMJ) ankylosis. Five adult sheep weighing an average of 57 kg were used. All right joints were operated. Ankylosis was induced in the right TMJ by articular damage, disk removal and placement of a bone graft plus immobilization wire. At 3 months the gap arthroplasty were performed. All TMJs were examined functionally, radiologically, macroscopically and histologically. Functionally, the range of jaw movements decreased following induction of ankylosis (P<0.0001), increased immediately on release but was reduced again at 3 months after release (the vertical movement, no statistically significant difference; the right movement, P<0.001; the left movement, P<0.0001). Histologically, all operated joints showed fibrous adhesions across the gap, and further, the articular surface was irregular with osteophytes and with bony islands in the gap. This appearance is more consistent with a fibrous reankylosis than a functioning pseudo joint. This study shows that the gap arthroplasty for TMJ ankylosis did not restore the TMJ functionally and histologically to the preexisting state.

Analysis of Variance↗

PubMed2002

The dynamic radioulnar convergence of the Darrach procedure and the ulnar head hemiresection interposition arthroplasty: a biomechanical study.

Resection of the entire ulnar head (Darrach operation) and the hemiresection interposition arthroplasty are common methods of treating the arthritic distal radioulnar joint (DRUJ). Biomechnical investigation about both of these procedures is lacking. The purpose of this study was to evaluate the dynamic effects of both the hemiresection interposition arthroplasty and the Darrach procedure on radioulnar convergence and dorsal-palmar displacement and to compare their biomechanical behaviours. With a dynamic computer-controlled testing device, cadaveric forearm rotation was performed with simultaneous loading of relevant muscles. Torque along the forearm axis was generated by simulated muscle action through pneumoactuators attached to relevant tendons while the wrist was constrained to prescribed ranges of motion. The instability of the radius relative to the ulna was evaluated using displacement data of digitized landmarks in an ulnar coordinate system. Seven fresh-frozen cadaver upper extremities were used. The Darrach resection created an extreme instability of the forearm with movement of the radius ulnarly. Anteroposterior translations in each loading condition could also be detected, but the magnitude of displacement was small and less predictable. The results of the hemiresection interposition arthroplasty demonstrated significantly less instability compared with the Darrach results.

Aged↗

PubMed2002

[Bone defects in revision total knee arthroplasty: classification and management].

The goal of bone reconstruction in revision total knee arthroplasty is to provide a stable support for the implant and to re-establish the correct joint line. Therefore, a useful, therapy-based classification of the defects is necessary. According to Stockley et al. (1992), the defects are classified into contained and uncontained defects. Uncontained defects can be reconstructed using structural allografts or metal wedges. In contained defects, cancellous allograft can be used. For aseptic loosening of total knee arthroplasty, the defect classification according to Engh and Parks (1994) can be helpful because of its recommendations for reconstruction. In case of the more common first or second graded defects, reconstruction is performed using modular revision components or allografts. For the rare third graded defects, bulk allografts or modular tumour endoprostheses are recommended. On the basis of more than 150 revision total knee arthroplasties performed in our hospital the classification of bone defects and their clinical consequences are presented in this review.

Arthroplasty, Replacement, Knee↗

PubMedDate not supplied

[Quality of life five years after total or partial knee arthroplasty].

AIM: Multiple aspects of health-related quality of life were assessed in elderly patients after total or partial knee arthroplasty. METHOD: 187 subjects who had undergone knee arthroplasty 5 years ago were asked to fill out 3 questionnaires, the Nottingham Health Profile, the SF-36 Health Survey and the Funktionsfragebogen Hannover. Results were compared to standard data. The impact of gender and age was analyzed, and 3 different types of prostheses were compared. RESULTS: Response rate was 74 % (n = 138). Regarding the main symptoms pain and subjective function, as well as almost all other aspects, quality of life proved to be significantly reduced compared to the age-matched general population. Correlations between age and quality of life scales were low. Different types of implants led to similar results in all scales but one. CONCLUSION: 5 years after knee arthroplasty the quality of life is markedly reduced compared to the general population. The impact of age, gender, and type of implant is low. In our sample, the SF-36 showed methodological advantages compared to the NHP for the measurement of subjective pain and function.

Activities of Daily Living↗

PubMed2003

[Effect of tourniquet use on blood loss in total knee arthroplasty].

AIM: To reduce blood loss in total knee arthroplasty various physical measures including the use of a tourniquet are recommended. The question of an early tourniquet release is still unsettled. PATIENTS AND METHOD: To confirm our theory that blood loss and need of blood transfusions might be reduced while removing the tourniquet for meticulous hemostasis before wound closure we analysed 70 (41 male, 29 female) consecutive patients with total knee arthroplasty for osteoarthritis performed by a single surgeon in a prospective-randomized study between 1/1996 to 6/1998. In group I the tourniquet was released before, in group II after wound closure. RESULTS: We couldn't find any significant differences in the estimated blood loss, the decrease of hemoglobin and hematocrit level, and the transfusion need. In Group II we observed two cases of deep vein thrombosis. This difference was not significant. CONCLUSION: We conclude that tourniquet release for hemostasis is not an effective tool in reducing blood loss or transfusion need in total knee arthroplasty.

Aged↗

PubMed2003

[Ultrasonographic evaluation of the rotator cuff after shoulder arthroplasty].

AIM: Ultrasonography of the rotator cuff tendons is a standard imaging technique. Although increasing numbers of shoulder arthroplasty are performed, there is no available data concerning the use of ultrasound after shoulder replacement. Our experimental study was performed to analyse the value of ultrasonography after shoulder arthroplasty a) in an ex-vivo-setting and b) in a retrospective analysis of our patients after shoulder hemiprothesis. METHOD: After defrosting, anatomic modular humeral head replacement was performed in four fresh-frozen specimens with intact rotator cuffs. The supraspinatus and subscapularis tendons of each specimen were either detached to simulate a cuff defect or reattached anatomically (four times per specimen). Two experienced examiners then performed ultrasonography to evaluate the two tendons to be either intact or deficient. In a retrospective study, 22 patients with 25 hemiprotheses of the shoulder underwent clinical and sonographic examination. For documentation of the clinical findings, the Constant score was used. RESULTS: In the cadaver study, the reliability of the method was slightly higher for the subscapularis tendon (13 correct, 3 false results) than for the supraspinatus tendon (12 correct, 4 false results). In our patients, rotator cuff defects and effusions around the biceps tendon and in the subdeltoid bursa could be detected. Normal sonograms correlated with good clinical results. CONCLUSION: In the cadaver study, we found a good reproducibility of in-vivo conditions. We believe that ultrasonography is beneficial in follow-up evaluation after shoulder arthroplasty.

Arthroplasty↗

PubMedDate not supplied

[Revision total hip arthroplasty: analysis of the predictive value of a radiographic classification system for assessment of bone stock loss].

AIM: The aim of this study was to evaluate the predictive value of a radiographic classification system concerning implant and bone graft in revision total hip arthroplasty. This classification is used to assess bone stock loss prior to surgery, thus hypothetically enabling an adequate choice of the implant and bone graft required. METHOD: 33 consecutive patients with the diagnosis of aseptic failure of total hip arthroplasty were included in the study. The investigation was performed using the classification system according to Saleh et al. The predictive value was analyzed by comparing the radiographically based recommendation concerning implant and bone graft and the intraoperative procedure according to a blinded observer technique. The Spearman coefficient of correlation (r (s)) was used to establish levels of agreement among multiple ordinal variables. RESULTS: Analysis of correlation between preoperative radiological estimations and intraoperative conclusions concerning implant and bone graft revealed coefficients of correlation (r (s)) of 0.53 (p < 0.01) for the acetabular and of 0.63 (p < 0.01) for the femoral classification. CONCLUSION: Our results indicate that the Saleh classification does not provide sufficient information for preoperative assessment of the revision implant and bone graft required concerning the acetabular side, whereas planning of the operative procedure regarding the femoral implant seems to be possible. These ambivalent findings should be taken into account prior to revision total hip arthroplasty.

Acetabulum↗