Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ARTHROPLASTY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,729 records · Page 96Linked to original sources
PubMedDate not supplied

Aseptic complications after total knee arthroplasty.

Aseptic complications after total knee arthroplasty are occurring less frequently than they did one or two decades ago. This is related in part to technical advancements, design improvements, and changes in perioperative management. Extensor mechanism dysfunction is the most frequent complication and the most commonly cited reason for secondary surgery after total knee arthroplasty. Mechanical wear, tibiofemoral instability, periprosthetic fracture, thromboembolic disease, compromised wound healing, neurovascular problems, and stiffness are less common, but nevertheless troublesome, sources of dysfunction after total knee arthroplasty. Complications compromise outcomes, and the most effective way of dealing with complications is prevention.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Trochanteric osteotomy and fixation during total hip arthroplasty.

Once used routinely, trochanteric osteotomy in total hip arthroplasty now is usually limited to difficult primary and revision cases. There are three types: the standard trochanteric osteotomy and its variations, the trochanteric slide, and the extended trochanteric osteotomy. Each has unique indications, fixation techniques, and complications. Primary total hip arthroplasty procedures requiring the enhanced exposure provided by trochanteric osteotomy may be needed in patients with hip ankylosis or fusion, protrusio acetabuli, proximal femoral deformities, developmental dysplasia, or abductor muscle laxity. Trochanteric osteotomies in revision arthroplasties, primarily the extended trochanteric osteotomy, facilitate the removal of well-fixed femoral components, provide direct access to the diaphysis for distal fixation, and enhance acetabular exposure.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Metacarpophalangeal joint arthroplasty in rheumatoid arthritis.

Although metacarpophalangeal joint arthroplasty is occasionally performed for joints affected by osteoarthritis, it is most often done in patients with rheumatoid arthritis. The metacarpophalangeal joint is critical for proper finger function but is the most common site of involvement in the rheumatoid hand. A thorough understanding of the anatomy, pathophysiology, and mechanics of the metacarpophalangeal joint is a prerequisite for the evaluation and treatment of patients requiring metacarpophalangeal arthroplasty. Silicone rubber implants are the most frequently used device for treatment of revised metacarpophalangeal arthroplasty. Follow-up studies show that this surgery improves function and deformity and achieves nearly uniform patient satisfaction.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Total hip arthroplasty in sickle cell hemoglobinopathies.

Advances in medical treatment have led to improved life expectancy in patients with sickle cell hemoglobinopathies. Improved life expectancy has, in turn, led to an increasing number of patients with osteonecrosis requiring total hip arthroplasty. Patient evaluation begins with understanding the extent of the disease process and the patient's musculoskeletal manifestations (ie, pyogenic infection, marrow hyperplasia, osteonecrosis). A multidisciplinary approach to implementing effective preoperative treatment strategies increases the likelihood of a successful surgical outcome. Intraoperatively, consideration of bone stock, bone quality, and method of component fixation may help minimize the risk of eccentric reaming, perforation or fracture of either the acetabulum or the femur, and loosening. The optimal mode of acetabular and femoral fixation in these patients has not been conclusively determined, but recent results of cementless total hip arthroplasty have been encouraging. Although patients with sickle cell disease are at increased risk of medical and surgical complications, total hip arthroplasty in the appropriately selected patient can provide significant pain relief, restoration of function, and patient satisfaction.

Anemia, Sickle Cell↗
PubMed2005

Constraint in primary total knee arthroplasty.

Instability is an important cause of failure following total knee arthroplasty. Increasing component constraint may reduce instability, but doing so also can cause increased forces to be transmitted to fixation and implant interfaces, which may lead to premature aseptic loosening. Constraint is defined as the effect of the elements of knee implant design that provides the stability needed to counteract forces about the knee after arthroplasty in the presence of a deficient soft-tissue envelope. Determining the amount of constraint necessary can be challenging. Most primary total knee arthroplasties are performed for knees without substantial deformity or the need for difficult ligament balancing; in these cases, either a posterior-stabilized or a posterior cruciate-retaining design is appropriate. In certain situations, such as patients with prior patellectomies, rheumatoid arthritis, or substantial preoperative deformities, a posterior-stabilized knee may be favored. With their large posts, varus-valgus constrained implants typically are reserved for patients with substantial coronal plane instability, which is difficult to balance with a posterior-stabilized or cruciate-retaining implant alone. Rotating-hinge knee implants usually are recommended for patients with severe deformity or instability that cannot be managed with a varus-valgus implant.

Arthroplasty, Replacement, Knee↗
PubMed2006

Applications of porous tantalum in total hip arthroplasty.

Porous tantalum is an alternative metal for total joint arthroplasty components that offers several unique properties. Its high volumetric porosity (70% to 80%), low modulus of elasticity (3 MPa), and high frictional characteristics make it conducive to biologic fixation. Tantalum has excellent biocompatibility and is safe to use in vivo. The low modulus of elasticity allows for more physiologic load transfer and relative preservation of bone stock. Because of its bioactive nature and ingrowth properties, tantalum is used in primary as well as revision total hip arthroplasty components, with good to excellent early clinical results. In revision arthroplasty, standard and custom augments may serve as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fibrous ingrowth properties and allows for substantial soft-tissue attachment, indicating potential for use in cases requiring reattachment of muscles and tendons to a prosthesis. Development of modular components and femoral stems also is being evaluated. The initial clinical data and basic science studies support further investigation of porous tantalum as an alternative to traditional implant materials.

Animals↗
PubMed1998

Long-term follow-up of Keller arthroplasty with irradiated costochondral implants.

The authors present results of long-term follow-up of seven patients whose degenerative disease of the first metatarsophalangeal joint was treated with irradiated chondral graft implantation arthroplasty. In appropriate candidates, this procedure is a reasonable alternative to Keller arthroplasty alone, arthrodesis, and nonbiologic implant arthroplasty.

Adult↗
PubMed1976

[Sensitization to metals in patients submitted to arthroplasty].

The sensitization of the patients submitted to arthroplasty has been pointed out with increasing frequency. This paper attempted to establish the occurrence rate and the importance of this sensitization in patients submitted to arthroplasty of metallic or plastic type, by means of the patch-test, blastization and macrophage inhibition test. The highest positivity incidence was observed towards chromium (9.7%) and cobalt (6.4%) in the patients submitted to arthroplasty of metallic type, while that of plastic type showed a 1% positivity to methylacrylate. These data stress the importance of the adoption of the patch-test in all patients, before being submitted to any type of prosthesis, and of the preferential use of those prostheses which turned out less sensitizing.

Arthroplasty↗
PubMed1998

Functional improvement after knee arthroplasty without resurfacing of patella.

There has been no universal agreement so far regarding the necessity of patellar resurfacing in total knee arthroplasty. As resurfacing has been reported to be associated with high incidence of complications, this practice has been avoided in our Department. A report is given on the analysis of the functional outcome of 60 knee arthroplasties without patellar resurfacing in 53 patients (7 bilateral) followed up for twelve to thirty months, with special regard to the functions closely related to patelloformal articulation. The underlying diagnosis was osteoarthritis in 78.3%, rheumatoid arthritis in 13.3%, and posttraumatic arthritis in 8.3% of the patients. Graded according to the modified knee-rating system of the Hospital for Special Surgery, excellent or good results were obtained in the case of 55 knees (91.6%) and the mean score improved from 53.6 points preoperatively to 82.6 points following arthroplasty. Subjective and objective functional assessment of stair climbing and transfer activities have shown no functional deficit attributed to the patellofemoral joint of the replaced knee.

Adult↗
PubMed1999

Patellofemoral complications after total knee arthroplasty: a comparison of Modular Porous-Coated Anatomic with Duracon prostheses.

Clinical and radiographic analyses were used to compare results obtained in 45 patients who underwent a Modular Porous-Coated Anatomic total knee arthroplasty with results in a similar group of 45 patients who underwent a Duracon total knee arthroplasty. The surgeries were consecutively performed over an 8-month period, and follow-up evaluation averaged 63 months. The two patient groups were similar with regard to the following variables: age, sex, diagnosis, height, weight, and preoperative and postoperative activity levels. Whereas both Duracon and Modular total knee arthroplasty prostheses yielded similar results approximately 5 years after surgery, the data suggest that Duracon appears to minimize patellofemoral complications.

Adult↗
PubMed1999

Arthroplasty after war injuries to major joints.

From 1992 to 1995, replacement of the joint with an endoprosthesis after serious wounding and major destruction of joint elements was performed in 10 soldiers. Arthroplasty was performed on five knees, three hips, and two shoulders. The age range of the wounded soldiers was 22 to 55 years (mean, 37.7 years). Six soldiers suffered explosive injuries, and 4 were injured by gunfire. Time elapsed from the moment of wounding to the time of total joint replacement was 9 to 42 months. We decided on arthroplasty as the preferred treatment because of the presence of strong contractures and very painful movement. In 8 patients, the results of the treatment, based on a follow-up time of 36 to 48 months, were good. In 2 patients, early septic arthritis developed after arthroplasty of the knee with concomitant loosening of the endoprosthesis. Staphylococcus aureus was detected in both patients. In those 2 patients, therefore, arthrodesis of the knee with external fixation was performed.

Adult↗
PubMed1999

Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.

Polyethylene wear and the subsequent development of periprosthetic osteolysis are the major factors limiting the longevity of total hip arthroplasties. A minority eventually loosen, but no clinically applicable system exists for accurate early prediction of failure. The relationship between acetabular wear and the development of loosening, osteolysis, and revision was investigated in 235 Charnley low friction arthroplasties. The average age of the patient at surgery was 31.7 years (range, 17-39 years), and the duration of followup averaged 234 months (19.5 years; range, 74-364 months). Total wear averaged 2.1 mm (range, 0-7.2 mm), and the average wear rate was 0.11 mm per year (range, 0-0.55 mm/year), with the wear rate of revised components being twice that of surviving ones (0.19 mm/year versus 0.09 mm/year). The prevalence of osteolysis (33 hips, 14%) and of acetabular and femoral component loosening and revision rose significantly with increasing wear. Osteolysis also was associated significantly with femoral component loosening and revision, but the presence of calcar changes was not (90 hips, 38%). Twenty-five year survivorship exceeded 90% for arthroplasties with a wear rate less than 0.1 mm per year, but 20-year survivorship of acetabular components with a rate greater than 0.2 mm per year was below 30%, and none survived 25 years. For every additional millimeter of wear, the risk of acetabular revision in any one year increased by 45% and for the femur increased by 32%.

Adolescent↗
PubMed1999

Greater trochanteric blood flow during total hip arthroplasty using a posterior approach.

The authors investigated the effect of a posterior surgical approach on the local femoral blood supply during primary total hip arthroplasty. Greater trochanteric blood flow measurements were made with a laser Doppler flowmeter at intervals during the performance of eight uncemented and nine cemented total hip arthroplasties. Complete detachment of the quadratus femoris was associated with a significant decrease in trochanteric blood flow in the uncemented and cemented groups. The lowest perfusion levels during the procedure were seen transiently with posterior dislocation of the femoral head, after which trochanteric perfusion was decreased by 66% in the uncemented group, and 61% in the cemented group compared with baseline values. Blood flow remained approximately half of baseline values after insertion of the femoral prosthesis in the uncemented and cemented groups. These changes in greater trochanteric blood flow may serve as a marker for reduction in proximal femoral blood flow during total hip arthroplasty, and subsequently relate to the extent of bony ingrowth, periprosthetic bone loss, and ultimately the incidence of implant failure caused by aseptic loosening.

Adult↗
PubMed1999

[Tranexamic acid reduces the blood loss in knee arthroplasty--if it's administered at the right time].

Blood loss in total knee arthroplasty is some-times profuse and often necessitates transfusion which is associated with a risk of disease transmission and immunological burden to the recipient. The fibrinolytic system is activated during surgery, an activation augmented by the tourniquet often used in knee arthroplasty. We have found tranexamic acid, a well-known fibrinolytic inhibitor, to reduce blood loss by half in total knee arthroplasty, and the need of transfusion by two thirds. For optimal efficacy, the tranexamic acid should be administered as prophylaxis before release of the tourniquet. We have found no adverse effects of the drug.

Antifibrinolytic Agents↗
PubMed1999

[Knee replacement arthroplasty in hemophilia: results, complications and predictive elements of their occurrence].

PURPOSE OF THE STUDY: Determine the effect of supplementation rate and HIV disease on results and complications in total knee replacement in hemophilia. MATERIAL: Twenty-nine total knee arthroplasties were performed in twenty-one disabled patients with major hemophilia, from 1986 to 1995. All the implants were postero-stabilised prostheses. The average age of patients at the time of surgery was 40.8 years, average follow-up was 4.8 years. Preoperatively, all patients complained of severe pain, with stage IV or V arthropathies, according to Arnold classification. Twelve patients were HIV sero-positive. METHOD: Functional and radiological results, and postoperative complication rate was analyzed in relation with mean deficient factor titer, HIV status, and periarticular soft tissues quality. RESULTS: Results of the total knee arthroplasties, as determined by the IKS scoring system, were 86.2/100 for Pain, Motion, Stability and 88.7/100 for function. The average gain of motion was twenty-four degrees. One patient required amputation, and one an arthrodesis after deep infection. Postoperative complications, in addition to infections, included intra articular bleeding in nine patients, one peroneal nerve palsy, two instances of inhibition to factor VIII, four superficial skin necrosis, and one important gastric bleeding which required surgical treatment. A high titer of deficient factor (> 70 per cent of the average normal concentration) seemed correlated with a lower complication rate. In this study, surgery had no incidence on HIV disease evolution. DISCUSSION: Authors emphasize the high level of postoperative infections (6/29), particularly in patients with HIV infection (5/12) frequently after superficial skin necrosis, as well as the high postoperative complication rate. CONCLUSION: However good results were finally observed, association of HIV disease, insufficient deficient factor concentration, and altered quality of periarticular soft tissues increased particularly complication occurrence. With particular attention to these factors, and despite frequent complications, total knee arthroplasty in hemophilia restores good function and allows patients satisfaction.

Adult↗
PubMed1999

Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year followup.

Sixty-two consecutive cemented modular unicompartmental knee arthroplasties in 51 patients were studied prospectively. At surgery, the other compartments had at most Grade 2 chondromalacia. The average age of the patients at arthroplasty was 68 years (range, 51-84 years). One patient was lost to followup and 10 died with less than 6 years followup. The average followup of the remaining 51 knees was 7.5 years (range, 6-10 years). The preoperative Hospital for Special Surgery knee score of 55 points (range, 30-79 points) improved to 92 points (range, 60-100 points) at followup; 78% (40 knees) had excellent and 20% (10 knees) had good results. The mean range of motion at followup was 120 degrees with 26 knees (51%) having range of motion greater than 120 degrees. One patient underwent revision surgery for retained cement, one patient underwent knee manipulation, and one patient underwent revision surgery at 7 years for opposite compartment degeneration and pain. Radiographically, 26 knees (51%) had at least one partial radiolucency. There were no complete femoral radiolucencies, but there were three complete tibial radiolucencies, all less than 2 mm. No component was loose as seen on radiographs. At final followup, five of the opposite compartments (10%) and three of the patellofemoral joints (6%) had some progressive radiographic joint space loss; this was less than a 25% loss in all but one knee component that was revised. At 6- to 10-years followup, cemented unicompartmental knee arthroplasty yielded excellent clinical and radiographic results. The 10-year survival using radiographic loosening or revision as the end point was 98%. Using stringent selection criteria, unicompartmental knee replacement can yield excellent results and represents a superb alternative to total knee replacement.

Aged↗
PubMed1999

Patellar complications (total knee arthroplasty). Effect of lateral release and thickness.

One thousand, one hundred forty-six Anatomic Graduated Component total knee arthroplasties performed between 1987 and 1989 were used to investigate the effects of patellar thickness alone or coupled with lateral retinacular release on initial patellar complications and maximal flexion. Lateral release was found not to be statistically significant regarding radiolucency, patellar prosthesis loosening, or an increase or decrease in flexion. However, total knee arthroplasties in which a lateral release was done, which either saved the superior lateral genicular artery or sacrificed the superior lateral genicular artery, were found to increase the incidence of initial patellar fractures and/or loosening (complications within 1 year) when compared with total knee arthroplasties in which a lateral release was not performed. There was no statistical difference in failure rates regarding fractures and/or loosening of the patella between lateral releases in which the superior lateral genicular artery was saved and the lateral releases in which the superior lateral genicular artery was sacrificed. A difference in postoperative patellar thickness compared with preoperative patellar thickness was found not to be significant to initial patellar fracture and/or loosening, patellar fracture alone, patellar loosening alone, radiolucency, the need for a lateral release, or to an increase or decrease in flexion. Lateral release and patellar thickness had no significant effect on patellar fracture and/or loosening.

Adult↗
PubMed1999

Hip revision arthroplasty. Approach to the femoral side.

Total hip arthroplasty has proven to be a highly successful procedure but with its increased use in elderly patients and in young patients with high physical demands, there are an increasing number of joints requiring revision. Many factors, including loss of bone stock, joint instability, infection, fracture, trochanteric nonunion, and difficulty in implant or cement removal, make revision of the femoral component challenging to the surgeon. To address these factors and to achieve the goals of revision surgery, several key questions should be addressed. What exposure should be used? How can the implant be removed? What type of reconstruction should be used and which implant should be chosen? How can stable fixation be achieved? How can the bone defects be treated? The approach that the authors recommend to the femoral component in revision hip arthroplasty is outlined, taking into consideration each of the questions above. The classification system used by the authors for femoral bone defects present at the time of revision arthroplasty has four categories based on the integrity of the proximal cancellous bone and the cortical tube, which is used to select the technique of reconstruction. The literature on techniques for revision of a failed femoral component is reviewed.

Arthroplasty, Replacement, Hip↗