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At least 19 recordsLinked to original sources
PubMed2002

Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation.

BACKGROUND: Closed reduction and internal fixation is the preferred initial treatment for young active patients who sustain a displaced intracapsular hip fracture. However, there is a paucity of information on the outcome in patients in whom this procedure fails and who subsequently require revision to a total hip arthroplasty. The purpose of this study was to compare a group of patients with a displaced intracapsular fracture who required early salvage total hip arthroplasty following failure of internal fixation within the first year after fracture with a group treated with primary total joint replacement for treatment of the same type of fracture. METHODS: With use of a matched-pairs case-control design, a group of 107 patients, between the ages of sixty and eighty years, who required an early salvage total hip arthroplasty with cement following failed reduction and internal fixation of a displaced intracapsular hip fracture (Group I) was compared with an age and gender-matched group of patients who had undergone total hip arthroplasty with cement as the primary procedure for the treatment of such a fracture (Group II). RESULTS: During the first year after the arthroplasty, there were fifty-two early complications in thirty-nine patients in Group I and twenty-two complications in fourteen patients in Group II (p < 0.05). There were significantly more superficial infections and dislocations in Group I (p < 0.05). The rate of revision beyond one year was greater and the overall prosthetic survival rate at both five and ten years postoperatively was significantly worse in Group I (log-rank test, p < 0.05). The functional outcomes at one year and at the time of final follow-up were also significantly worse in Group I. CONCLUSIONS: Reduction and internal fixation will continue to be used as the primary treatment of displaced intracapsular fractures in many younger patients because of the benefits of preservation of the normal hip joint. However, patients should be counseled that if this method of treatment is unsuccessful and requires revision to a total hip arthroplasty with cement, the risk of early complications is higher and hip function may be poorer than if the arthroplasty had been performed as a primary procedure.

Aged↗
PubMed2000

Past incidence and future demand for knee arthroplasty in Sweden: a report from the Swedish Knee Arthroplasty Register regarding the effect of past and future population changes on the number of arthroplasties performed.

By combining data from the Swedish Knee Arthroplasty Register and Swedish census registers we have calculated the past age-specific incidence of primary knee arthroplasties and predicted the demand. During the last 20 years, osteoarthrosis has accounted for the largest increase in number of knee arthroplasties while operations for rheumatoid arthritis remained constant. The mean yearly number of operations between the periods 1976-1980 and 1996-1997 increased more than five-fold, while only 6% of that increase could be explained by changes in the age-profile of the population. Most operations were performed on persons of 65 years and older who also had the largest increase in incidence. By using the incidences for 1996 and 1997 and taking into account the expected future changes in the age profile of the Swedish population, we estimate that, in the absence of an effective preventive treatment, the number of knee arthroplasties will increase by at least one third until 2030.

Age Distribution↗
PubMed1998

Clinical study on arthroplasties for osteoarthritic hip by quantitative gait analysis. Comparison between total hip arthroplasty and bipolar endoprosthetic arthroplasty.

The present study was undertaken to serially observe gait of patients after hip arthroplasty, using quantitative gait analysis, and to compare it between patients after total hip arthroplasty (THA) and those after bipolar endoprosthetic arthroplasty (BEA). The subjects were 53 women with unilateral osteoarthritis of the hip. Thirty-one of them underwent THA (mean age: 59.5 years) and 22 underwent BEA (mean age: 58.0 years). The stance time and characteristic parameters calculated from the vertical component of floor reaction force (FRF) were analyzed by use of FRF plate. The stance time, which indirectly represents the walking speed, tended to decrease for one year after THA and for 3 years after BEA. The decrease in this parameter was greater on the unaffected side than on the affected side. The deceleration effect and the weighing-off effect are indicators useful for observation of gait recovery. Significant differences in these indicators between the unaffected and affected sides were seen for one year after THA and 3 years after BEA. This indicates that cadence and balance of the gait recovers earlier after THA than after BEA.

Acceleration↗
PubMed2001

The Swedish Elbow Arthroplasty Register and the Swedish Shoulder Arthroplasty Register: two new Swedish arthroplasty registers.

Two new national orthopedic quality registers were started in Sweden in 1999, the Swedish Shoulder Arthroplasty Register and the Swedish Elbow Arthroplasty Register. Both are owned by the Swedish Shoulder and Elbow Section of the Swedish Orthopedic Association. The purpose of the registers is to improve surgical techniques and selection of implants and identify individual risk factors. Two of the main problems in starting a new national quality register involve inducing all centers in the country to participate and deciding on the data to register.

Arthroplasty, Replacement↗
PubMed1997

Exeter and charnley arthroplasties with Boneloc or high viscosity cement. Comparison of 1,127 arthroplasties followed for 5 years in the Norwegian Arthroplasty Register.

During the years 1991-1994, the Norwegian Arthroplasty Register recorded 1,324 primary hip arthroplasties implanted with the Boneloc cement. We have compared the survival until revision due to aseptic loosening for charnley (n 955) and Exeter (n 172) prostheses. The Boneloc cemented hips were also compared with high viscosity cemented hips implanted during the same period. In the Boneloc cemented group, the estimated probability of survival at 4.5 years of a Charnley femoral component was 74% and for an Exeter femoral component 97% (p < 0.0001). Using a Cox regression model with adjustment for age, gender, type of cement, systemic antibiotic and stratified for diagnosis, an 8 times higher risk of revision was found in Boneloc cemented Charnley femoral components than in Exeter femoral components (p < 0.0001). For the acetabular components, the difference between the Charnley and Exeter components with Boneloc cement was not statistically significant. In both the Charnley and the Exeter prostheses, the high viscosity cemented components had significantly better survival than the Boneloc cemented components. The Cox regression model showed that a Boneloc cemented Charnley femoral component had a 14 times higher risk of revision than a high viscosity cemented component (p < 0.0001), and for Exeter femoral components a 7 times higher revision risk was found in the Boneloc cemented components (p = 0.003). Our results confirm the previously reported inferior results of Charnley prostheses implanted with Boneloc cement and inferior results of Boneloc cemented Exeter prostheses as well, but less pronounced than for Charnley prostheses.

Aged↗
PubMed2004

Ankle arthroplasties generate wear particles similar to knee arthroplasties.

Second-generation total ankle arthroplasties have encouraging medium-term results, but the wear of the joint materials is of concern. The aim of the current study was to examine and compare the size, shape, and concentration of polyethylene particles in synovial fluid with total ankle arthroplasties and established posterior-stabilized total knee arthroplasties. Synovial fluid was obtained from 15 patients with well-functioning total ankle arthroplasties and 11 patients with posterior-stabilized total knee arthroplasties at least 6 months after surgery. Polyethylene particles were isolated and analyzed using scanning electron microscopy. Particle size (equivalent circle diameter) in ankles was 0.81 +/- 0.09 microm (mean +/- standard error) and in knees was 0.78 +/- 0.08 microm. Particle shape (aspect ratio) in ankles was 1.57 +/- 0.04 and in knees was 2.30 +/- 0.22. The particle concentration was 1.02 +/- 0.43 x 10/mL in ankles and 1.13 +/- 0.56 x 10/mL in knees, and the particle concentration and size in total ankle arthroplasties were similar to those in total knee arthroplasties. Total ankle arthroplasties generated significantly rounder particles than total knee arthroplasties. These data suggest that the long-term result of total ankle arthroplasty should be as good as posterior-stabilized total knee arthroplasties in terms of polyethylene wear and the prevalence of osteolysis.

Aged↗
PubMed1996

Kinematics of the trapeziometacarpal joint: a biomechanical analysis comparing tendon interposition arthroplasty and total-joint arthroplasty.

The kinematics of the trapeziometacarpal joint were studied in 15 cadaver hands; normal joints were compared with simulated arthroplasties-either a total-joint arthroplasty of the ball-and-socket variety or a fibrous suspension arthroplasty of ligament reconstruction with tendon interposition. The motion of the thumb metacarpal was analyzed based on a trapezial coordinate system, using a magnetic tracking system. The pivot point (instantaneous center of rotation) for the thumb metacarpal changed during active and passive circumduction. Compared with normal trapeziometacarpal joint motion, the pivot point after ligament reconstruction with tendon interposition shifted significantly in palmar and ulnar directions in reference to the trapezial coordinate system, whereas after total-joint arthroplasty, the pivot point shifted slightly palmarly and radially. The axes of rotation were also compared for ligament reconstruction with tendon interposition and total-joint arthroplasty during thumb flexion-extension and abduction-adduction motions. After ligament reconstruction with tendon interposition, the center of flexion-extension shifted palmarly and the center of abduction-adduction shifted ulnarly. After total-joint arthroplasty, the center of rotation for flexion-extension shifted distally and palmarly and that for abduction-adduction shifted palmarly and proximally. In comparison with the normal joint, passive circumduction increased after tendon interposition arthroplasty but was less with total-joint arthroplasty. Changes in kinematics suggest a suspensory ligament function of ligament reconstruction with tendon interposition arthroplasty, whereas total-joint arthroplasty results in axes of rotation that reflect the joint replacement rather those of the normal joint.

Arthroplasty↗
PubMed1982

Girdlestone arthroplasty for infected total hip arthroplasty.

Results of a previous study of 21 patients who underwent conversion of infected total hip arthroplasties to Girdlestone resection arthroplasties suggested that Girdlestone resection arthroplasty provides a functionally poor salvage technique and is often painful. The present study was undertaken to assess further the salvage value of Girdlestone arthroplasties for the treatment of infected total hips. Fourteen additional cases were reviewed, summarizing the clinical experience of the past three years. These more recent data support the conclusion that resection arthroplasty provides a poor functional result when used as a salvage procedure following removal of infected total hip components. Of the 14 patients reviewed, only one obtained an acceptable functional result. The initial 21 patients studied were re-reviewed to obtain further follow-up data. The functional results obtained were essentially unchanged and are comparable with those from the series of 14 patients reviewed in this study. In some cases of infected total hip arthroplasty, resection arthroplasty is the best method of treatment available, but the results are often far from ideal. Direct or indirect prothesis exchange is an alternative in some cases. Total hip arthroplasty should not be recommended for the young patient who has one or two joint diseases and no limiting systemic factors, with the expectation that when the total hip fails, it can be converted to a resection arthroplasty and the patient improved as compared with the pre-total hip status. It may be wiser to utilize another procedure, e.g., fusion, resection arthroplasty, or osteotomy, primarily, and then revise to a total hip, if necessary, when the patient is older.

Adult↗
PubMed1989

Contralateral total hip arthroplasty or ipsilateral total knee arthroplasty in patients who have a long-standing fusion of the hip.

We studied the cases of twenty patients who had had an ipsilateral total knee arthroplasty or a contralateral total hip arthroplasty, or both, long after one hip had been fused in an acceptable position. Between 1972 and 1986, we performed twenty-one total joint arthroplasties (on thirteen hips and eight knees) and followed two additional patients (one hip and one knee) in whom the operation had been performed elsewhere. The average age of the patients at the time of arthroplasty was fifty-seven years (range, thirty-one to eighty-one years), and the average time from arthrodesis to arthroplasty was thirty-two years (range, eleven to fifty-four years). The results of eighteen of the twenty-three arthroplasties were evaluated at an average of seven years and nine months postoperatively. Four of the remaining five patients, who were followed for an average of eight years, died of a cause that was unrelated to the arthroplasty. After the hip arthroplasty, five hips were rated excellent; five, good; one, fair; and three, poor. Each hip that had a poor result was revised twice for mechanical loosening. Three hips for which the result was not considered poor had progressive radiolucency. After the knee arthroplasty, three knees were rated excellent; four, good; one, fair; and one, poor (because of infection). Seven knees were manipulated a total of fifteen times. Only one patient had progressive symptomatic radiolucency, nine years after the insertion of a posterior stabilized prosthesis. Clinically important ligamentous instability was not encountered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy.

A retrospective matched-pair comparative analysis was done between 30 total knee arthroplasties following failed high tibial osteotomies and 30 total knee arthroplasties following failed unicompartmental knee arthroplasties. The groups were matched according to age, gender, type of prosthesis, primary disease, and length of followup. A minimum followup of 2 years was required for inclusion in the study, and the average followup was 3.8 years (range, 2-9 years). The Knee Society Knee Score for the high tibial osteotomy group was significantly higher than that for the unicompartmental arthroplasty group. More osseous reconstructions were required in the unicompartmental revisions. Difficulty with exposure was not significantly greater in the osteotomy group. Rates of component loosening were not significantly different between the groups. A failed unicompartmental knee arthroplasty and a failed high tibial osteotomy can be revised successfully to a total knee arthroplasty. The results confirm that revisions after unicondylar arthroplasty and high tibial osteotomy are technically demanding. In this series, the results of total knee arthroplasty following unicompartmental knee arthroplasty approached but did not equal those obtained after high tibial osteotomy.

Aged↗
PubMed1987

Resection arthroplasty as a salvage procedure for a knee with infection after a total arthroplasty.

Between 1970 and 1983, resection arthroplasty was done as a salvage procedure for twenty-eight knees (twenty-six patients) with infection after total arthroplasty. Eleven patients had multiarticular rheumatoid arthritis; fourteen, osteoarthritis; and one, multiarticular neuropathic arthropathy. Systemic signs of infection were eliminated in all patients and local signs, in 89 per cent of the patients. After resection arthroplasty alone, fifteen patients were able to walk independently. Six patients with monoarticular osteoarthritis who found the resection arthroplasty to be unacceptable had a successful secondary arthrodesis. In three patients a spontaneous bone fusion developed after the resection, with the knee in a good position. Two patients who were unable to walk before the resection arthroplasty were still unable to do so postoperatively. Neither the patient's disease nor the type of prosthesis that had been used was a reliable predictor of success of the resection arthroplasty. The patients who had had the most severe disability before the total knee arthroplasty were most likely to be satisfied. Patients who had had less disability were more likely to find the results of resection arthroplasty to be unsatisfactory.

Adult↗
PubMed1996

Proprioception after unicondylar knee arthroplasty versus total knee arthroplasty.

Proprioception was measured in 2 groups of patients after successful knee arthroplasty. Twenty-eight patients had total knee arthroplasty and their results were compared with an age matched group of 10 subjects who had undergone unicondylar knee arthroplasty. The threshold to detection of passive motion was quantified as a measure of proprioception. The degree of preoperative arthritis was objectively classified according to Resnick. The anterior cruciate ligament and posterior cruciate ligament were present and preserved in all the patients who had undergone unicondylar knee arthroplasty. The anterior cruciate ligament was sacrificed and posterior cruciate ligament retained in 15 of the patients who had total knee arthroplasty and the anterior cruciate ligament and posterior cruciate ligament were sacrificed in 13 of the patients who had total knee arthroplasties. There was no difference in threshold to detection of passive motion among any of the 3 groups. Maintaining the anterior cruciate ligament and posterior cruciate ligament did not impart improved proprioception in unicondylar knee arthroplasty nor did maintaining the posterior cruciate ligament impart improved proprioception in total knee arthroplasty.

Aged↗
PubMed1993

Massive resection and prosthetic replacement for the treatment of metastases of the trochanteric and subtrochanteric femoral region bipolar arthroplasty versus total hip arthroplasty.

Twenty-eight metastases of the proximal femur were treated by resection and by prosthetic replacement using a large femoral component with diaphyseal support (megaprosthesis). When metastatic involvement of the acetabulum was not evident a mobile self-centering cup was used (bipolar hip arthroplasty: 17 cases). When metastatic destruction of the acetabulum was evident acetabular reconstruction was performed (total hip arthroplasty: 11 cases). Postoperative pain relief according to Habermann was excellent in 81.5% and good in 14.8% of the patients. The functional results according to Merle d'Aubigné were rated as excellent in 19%, very good in 22%, and good in 22% of the hips. The rate of postoperative dislocation was significantly lower (p < 0.05) in the bipolar arthroplasty group when compared to the total hip arthroplasty group. Our experience indicates that, when bone disease of the acetabulum is not evident, a bipolar arthroplasty rather than a total hip arthroplasty should be recommended. In the current series pain relief as well as postoperative walking ability were comparable in both groups but the dislocation rate was significantly lower with bipolar arthroplasty.

Acetabulum↗
PubMed2003

Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life.

The goal of this study was to evaluate the complications and efficacy of total joint arthroplasty in the extremely elderly and compare the survival with the normal age-matched population. One hundred one joint arthroplasties (45 total knee arthroplasties [TKAs], 56 total hip arthroplasties [THAs]) were performed in 83 patients 89 years old and older. Over an average follow-up period of 2.5 years, 26 (31%) of the patients died. Three patients (3.6%) died within the first 2 months' postoperatively. The perioperative medical complication rate (excluding deaths) was 14%. Significant improvements were noted in pain scores, Harris Hip Scores, and Knee Society Scores. The survival of patients in their nineties who undergo total joint arthroplasty is at least equal to the survival of an age-matched population for 2.5 years following surgery. With careful patient selection and patient care to minimize medical complications, total joint arthroplasty can be an excellent option for patients who are age 89 and older.

Age Factors↗
PubMedDate not supplied

Anatomical interposition arthroplasty with dermal graft. A study of 51 elbow arthroplasties on 48 rheumatoid patients.

Seventy anatomical interposition arthroplasties of the elbow joint without ulnar nerve transposition were performed on 67 rheumatoid patients by one surgeon during the years 1978-1984. Between 1 and 6 years after arthroplasty, 51 arthroplasties were re-examined, the average follow-up being 3 years. There were 48 patients, 44 female (aged 25 to 66 years, mean 51) and four male, (aged 59 to 69 years, mean 63). The duration of the rheumatoid disease (46 cases of rheumatoid arthritis, 2 of juvenile chronic arthritis) was 4 to 33 years, mean 17 years. The disease was clinically active in 47 cases. ESR ranged from 12 to 82, mean 50. 51 elbow joints, 32 right (31 dominant), 19 left (2 dominant), had been affected for six months to 29 years, mean 8 years. 21 joints had been operated on one to four times before arthroplasty. Preoperative radiological joint destruction was of Larsen grade IV in 45 cases and of grade V in six cases. Flexion contracture was diminished from preoperative 0 degrees to 70 degrees, mean 38 degrees, to postoperative 0 degrees to 70 degrees, mean 25 degrees. Range of flexion was improved from preoperative 20 degrees to 150 degrees, mean 90 degrees, to postoperative 40 degrees to 145 degrees, mean 109 degrees. Before arthroplasty there were ulnar nerve symptoms in 13 cases, two of which had temporary ulnar symptoms postoperatively, too. After arthroplasty, eight patients had ulnar nerve symptoms, five of which had had previous operations of the joint.

Adult↗
PubMedDate not supplied

Resection arthroplasty for nonseptic failure of total hip arthroplasty.

Although resection arthroplasty is a well-recognized salvage procedure for septic total hip arthroplasty, the nonseptic complications of total hip arthroplasty are customarily handled by revision and replacement of a new total hip implant. Some of the severe forms of failure of total hip arthroplasty in the absence of infection may require resection arthroplasty. The indication is massive loss of available bone stock for the revision operation. This may result from technical errors or progressive and extensive destruction of bone associated with loosened components. Concern for this outcome is important for assessing the probabilities of long-term success of the use of total hip arthroplasty in young patients.

Adult↗
PubMed1998

Simultaneous ipsilateral revision total hip arthroplasty and revision total knee arthroplasty with entire femoral allograft.

Treatment of periprosthetic fractures of both total hip arthroplasty and total knee arthroplasty has been well described in the literature. Treatments used have included closed treatment, revision arthroplasty with or without bone graft, open reduction internal fixation with plating, or intramedullary fixation [1-4]. However, treatment of periprosthetic fractures that involve a femur that has both a proximal total hip prosthesis and a distal total knee prosthesis has not been thoroughly described in the literature. We present a persistent distal femoral nonunion of a periprosthetic fracture, which was treated by using an entire femoral allograft with simultaneous ipsilateral revision total hip arthroplasty and total knee arthroplasty.

Arthroplasty, Replacement, Hip↗