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Sample records for arthroplasty preliminary study

  1. Initial Stability of Subtrochanteric Oblique Osteotomy in Uncemented Total Hip Arthroplasty: A Preliminary Finite Element Study

    PubMed Central

    Li, Liangtao; Yu, Mingyang; Ma, Renshi; Zhu, Dong; Gu, Guishan

    2015-01-01

    Background Subtrochanteric oblique osteotomy (SOO) has been widely used to reconstruct highly dislocated hips in uncemented total hip arthroplasty. The occurrence of complications can be attributed to the instability of the osteotomy region. The aim of this study was to evaluate the initial stability of SOO in uncemented total hip arthroplasty. Material/Methods A 3-dimensional finite element femur-stem model was created, and a virtual SOO was performed at 4 oblique angles: 30°, 45°, 60°, and 90°. The von Mises stress distribution in the femur-stem complex and the displacement under different oblique angles were evaluated in the SOO models, in comparison with that of the intact model. Results The study demonstrated that the distal fragment of the femur bore more stresses than the proximal fragment, and the maximum stress was concentrated in the femoral neck and the cortical bone, which contacted with the distal end of the stem. SOO increased the stress of both the femur and the stem, and fractures may occur in the stress concentration sites. Additionally, comparing the displacement at different oblique angles, the lateral region was larger than that of the medial region on the subtrochanteric osteotomy plane. The minimum micromotion on the osteotomy plane was obtained when the oblique angle was 45°. Conclusions The fit and fill of the distal fragment of the femur and the stem is essential for the stability of the subtrochanteric osteotomy region. The optimal oblique angle for SOO appears to be 45°. PMID:26153071

  2. Perceived exertion and rehabilitation with arm crank in elderly patients after total hip arthroplasty: a preliminary study.

    PubMed

    Grange, Celine Christine; Maire, Jerome; Groslambert, Alain; Tordi, Nicolas; Dugue, Benoit; Pernin, Jean-Noel; Rouillon, Jean-Denis

    2004-07-01

    This preliminary study examined, in a restricted randomized trial, the effects of a 6-week arm-crank rehabilitation training program in elderly osteoarthrosis patients after total hip arthroplasty, first on physiological and perceptual responses and second on physical function. Two groups of patients were studied: a training group (N = 7, mean age = 74.9 yr, standard deviation [SD] = 5.0 yr) who followed a training program in addition to traditional rehabilitation, and a control group who followed traditional rehabilitation only (N = 7 mean age = 75.4 yr, SD = 5.1 yr). At the beginning of the training program, the heart rate and the perceived exertion were not significantly correlated during the exercise session. However, at the end of the training program, five patients had a significant heart rate/perceived exertion relationship (p < 0.05). Furthermore, positive effects of the arm-crank rehabilitation training program were observed on cardioventilatory and functional responses in the training group compared with the control group. These results suggest that after an habituation period, most of our elderly osteoarthrosis patients experienced physical sensations that were connected to physiological responses. Therefore, perceived exertion could be useful in these patients to regulate exercise intensity, especially at the end of and after the rehabilitation period. PMID:15558389

  3. Single-blinded, randomised preliminary study evaluating the effects of 2 Hz electroacupuncture for postoperative pain in patients with total knee arthroplasty

    PubMed Central

    Tzeng, Chung-Yuh; Chang, Shih-Liang; Wu, Chih-Cheng; Chang, Chu-Ling; Chen, Wen-Gii; Tong, Kwok-Man; Huang, Kui-Chou; Hsieh, Ching-Liang

    2015-01-01

    Objective To explore the point-specific clinical effect of 2 Hz electroacupuncture (EA) in treating postoperative pain in patients undergoing total knee arthroplasty (TKA), Methods In a randomised, partially single-blinded preliminary study, 47patients with TKA were randomly divided into three groups: control group (CG, n=17) using only patient-controlled analgesia (PCA); EA group (EAG, n=16) with 2 Hz EA applied at ST36 (Zusanli) and GB34 (Yanglingquan) contralateral to the operated leg for 30 min on the first two postoperative days, also receiving PCA; and non-point group (NPG, n=14), with EA identical to the EAG except given 1 cm lateral to both ST36 and GB34. The Mann–Whitney test was used to show the difference between two groups and the Kruskal–Wallis test to show the difference between the three groups. Results The time until patients first required PCA in the CG was 34.1±22.0 min, which was significantly shorter than the 92.0±82.7 min in the EAG (p<0.001) and 90.7±94.8 min in the NPG (p<0.001); there was no difference between the EAG and NPG groups (p>0.05). The total dosage of PCA solution given was 4.6±0.9 mL/kg body weight in the CG, 4.2±1.0 mL/kg in the EAG and 4.5±1.0 mL/kg in the NPG; there were no significant differences (p>0.05) among the three groups. Conclusions In this small preliminary study, EA retarded the first demand for PCA in comparison with no EA. No effect was seen on the total dosage of PCA required and no point-specific effect was seen. PMID:25910930

  4. A FUNCTIONAL AND ROENTGENOGRAPHIC PRELIMINARY COMPARATIVE STUDY USING METAL-BACKED AND ALL-POLYETHYLENE TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    de Andrade, Marco Antônio Percope; dos Santos, Juliano Rodrigues; Gonzaga, Luiz Gustavo Alves; Silva, Guilherme Moreira Abreu e

    2015-01-01

    Objective: To describe and clinically and radiographically compare patients who underwent total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial implants. Methods: Patients who underwent TKA between January 1988 and December 2004 were grouped according to the type of implant received: all-polyethylene or metal-backed. Sixty patients came for evaluations, totaling 82 operated knees. Among these, 22 patients had undergone TKA only with ALP (12 unilateral and 10 bilateral cases), 33 patients only with MTB (26 unilateral and 7 bilateral cases) and five patients underwent TKA with ALP in one knee and MTB in the other. The knees were divided thus: group 1, 37 knees with ALP; and group 2, 45 knees with MTB. Results: There were no differences in clinical or functional evaluations between the groups. The mean radiolucency in the femur was 0.838 mm for the patients in group 1 and 0.356 mm for the patients in group 2 (p = 0.049). For the tibia, in the AP view, there was a mean value of 2.703 mm for group 1 and 0.733 mm for group 2 (p = 0.000). In the lateral view, the mean values for osteolysis was 0.405 mm for group 1 and 0.200 mm for group 2 (p = 0.074). Conclusions: There were no differences between the groups in the functional and clinical evaluations. However, greater radiolucency was observed in the arthroplasties with ALP, both in the femur in the lateral view and in the tibia in the AP view. Level of evidence IV – case series study. PMID:27022556

  5. Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy: A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion

    PubMed Central

    Yang, Li-Li; Liu, Zu-De; Yuan, Wen

    2016-01-01

    Objectives Cervical disc arthroplasty (CDA) with Discover prosthesis or anterior cervical discectomy and fusion (ACDF) with Zero-P cage has been widely used in the treatment of cervical spondylotic myelopathy (CSM). However, little is known about the comparison of the 2 zero-profile implants in the treatment of single-level CSM. The aim was to compare the clinical outcomes and radiographic parameters of CDA with Discover prosthesis and ACDF with Zero-P cage for the treatment of single-level CSM. Methods A total of 128 consecutive patients who underwent 1-level CDA with Discover prosthesis or ACDF with Zero-P cage for single-level CSM between September 2009 and December 2012 were included in this study. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI). For radiographic assessment, the overall sagittal alignment (OSA), functional spinal unit (FSU) angle, and range of motion (ROM) at the index and adjacent levels were measured before and after surgery. Additionally, the complications were also recorded. Results Both treatments significantly improved all clinical parameters (P < 0.05), without statistically relevant differences between the 2 groups. The OSA and FSU angle increased significantly in both groups (P <0.05). Compared with Zero-P group, ROMs at the index levels were well maintained in the Discover group (P < 0.05). However, there were no statistical differences in the ROMs of adjacent levels between the 2 groups (P > 0.05). Besides, no significant differences existed in dysphagia, subsidence, or adjacent disc degeneration between the 2 groups (P > 0.05). However, significant differences occurred in prosthesis migration in CDA group. Conclusions The results of this study showed that clinical outcomes and radiographic parameters were satisfactory and comparable with the 2 techniques. However, more attention to prosthesis migration of artificial cervical disc should be paid in the

  6. Genetic susceptibility to total hip arthroplasty failure: a preliminary study on the influence of matrix metalloproteinase 1, interleukin 6 polymorphisms and vitamin D receptor

    PubMed Central

    Malik, M H A; Jury, F; Bayat, A; Ollier, W E R; Kay, P R

    2007-01-01

    Background Matrix metalloproteinase (MMP)1, interleukin(IL)6 and vitamin D receptor (VDR) have been implicated in the biological cascade of events initiated by particulate wear debris and bacterial infection, resulting in periprosthetic bone loss around loosened total hip replacements (THRs). The individual responses to such stimuli may be dictated by genetic variation. Objective To study the effect of single‐nucleotide polymorphisms (SNPs) within these candidate genes. Methods A case–control study of the MMP1, IL6 and VDR genes was performed for possible association with deep sepsis or aseptic loosening. All cases included in the study were Caucasian patients with osteoarthritis who had received a cemented Charnley total hip arthroplasty (THA) and polyethylene acetabular cup. Cases consisted of 91 patients with early aseptic loosening and 71 patients with microbiological evidence of deep infection on surgery. Controls consisted of 150 patients with THAs that were clinically asymptomatic for over 10 years and showed no radiographic features of aseptic loosening. DNA samples from all individuals were genotyped using Taqman allelic discrimination. Results The C allele (p = 0.001; OR = 3.27; 95% CI 2.21 to 4.83) and C/C genotype (p = 0.001) for the MMP1 SNP were highly associated with aseptic failure when compared with controls. No statistically significant relationships were found between aseptic loosening and the MMP2, MMP4, IL6 –174 or VDRL SNPs. The T allele (p = 0.007; OR = 1.76; 95% CI 1.16 to 2.66) and T/T genotype (p = 0.028) for VDR‐T were statistically associated with osteolysis owing to deep infection as compared with controls. No statistically significant relationship was found between septic failure and any of the other SNPs examined in this study. Conclusions Aseptic loosening and possibly deep infection of THR may be due to the genetic influence of candidate susceptibility genes. SNP markers may serve as predictors of

  7. A biomechanical study on fracture risks in ulnohumeral arthroplasty.

    PubMed

    Degreef, I; Van Audekercke, R; Boogmans, T; De Smet, L

    2011-06-01

    In the Outerbridge-Kashiwagi ulnohumeral arthroplasty, bone strength may be weakened significantly as a result of the humeral fenestration. Therefore, fracture risks may be increased, particularly in the immediate postoperative period. The objective of this biomechanical cadaver study is to study the humeral bone strength after ulnohumeral arthroplasty. A biomechanical cadaveric study was done in which differences in force needed to fracture the humerus with and without fenestration was measured. First, the diaphysis of 12 distal humeri was embedded and a posterior force was applied until a fracture occurred. Second, a similar study was done with fixed humeral columns, to specifically compare the column strength. In the first part, the force needed to fracture was reduced by 17% after ulnohumeral arthroplasty, which was not statistically significant. However, a shift in the fracture pattern occurred: from diaphyseal fracture towards column fractures after the arthroplasty. In the second part, the force needed to fracture the columns proved to be significantly reduced by 41% after humeral perforation. Alterations in the biomechanical properties of the distal humerus after ulnohumeral arthroplasty may lead to a shift in fracture patterns from diaphyseal to column fractures. The strength of the columns is strongly reduced by 41%. PMID:21592841

  8. Modular hybrid total hip arthroplasty. Experimental study in dogs

    PubMed Central

    2011-01-01

    Background This prospective experimental study evaluated the surgical procedure and results of modular hybrid total hip arthroplasty in dogs. Methods Ten skeletally mature healthy mongrel dogs with weights varying between 19 and 27 kg were used. Cemented modular femoral stems and uncemented porous-coated acetabular cups were employed. Clinical and radiographic evaluations were performed before surgery and at 30, 60, 90, 120, 180 and 360 days post-operation. Results Excellent weight bearing was noticed in the operated limb in seven dogs. Dislocation followed by loosening of the prosthesis was noticed in two dogs, which were therefore properly treated with a femoral head osteotomy. Femoral fracture occurred in one dog, which was promptly treated with full implant removal and femoral osteosynthesis. Conclusions The canine modular hybrid total hip arthroplasty provided excellent functionality of the operated limb. PMID:21736758

  9. Clinical and roentgenographic evaluation of hydroxyapatite-coated and uncoated porous total hip arthroplasty: a preliminary report.

    PubMed

    Ciccotti, M G; Rothman, R H; Veress, S A; Hozack, W J; Moriarty, L; Beight, J

    1991-10-01

    Sixty osteoarthritic patients undergoing primary uncemented total hip arthroplasty were matched for age and weight and randomized into one of four groups with respect to implant coating and postoperative protected weight-bearing status: group 1, hydroxyapatite, 12 weeks; group 2, uncoated, 12 weeks; group 3, hydroxyapatite, 6 weeks; group 4, uncoated, 6 weeks. Tantalum spheres were implanted periprosthetically into the femur at the time of arthroplasty, thus providing constant references for stereoscopic radiographs. Patients were then evaluated over a 1-year period with clinical examination, plain radiography, and roentgen stereophotogrammetric analysis (RSA). Clinical evaluation using Charnley scoring showed no significant preoperative or postoperative intergroup differences, whereas visual analog testing noted less thigh pain with hydroxyapatite-coated stems at 12 weeks and 6 months follow-up. Plain radiographic analysis produced no significant differences, with no instability detected and bony ingrowth noted uniformly in all groups. The preliminary stereographic evaluation showed migration in all groups, but there were no significant differences between coated and uncoated stems or 6-week and 12-week partial weightbearing protocols. The Charnley, plain radiographic, and preliminary stereogrammetric evaluations all suggest that migration is unaltered by enhanced surfaces and that early unprotected weightbearing does not jeopardize implant fixation regardless of coating design. The lower incidence of visual analog thigh pain with the hydroxyapatite-coated stems, however, may be a reflection of bony ingrowth and as such add some validity to the theoretical advantages of enhanced surface prostheses. PMID:10149615

  10. Association between hypoxemia and anemia following arthroplasty: A pilot clinical study

    PubMed Central

    GAO, FUQIANG; SUN, WEI; GUO, WANSHOU; CHENG, LIMING; LI, ZIRONG; KUSH, NEPALI

    2016-01-01

    Hypoxia and anemia are common complications following joint arthroplasty. Whether hypoxia indicates that a patient is anemic and whether anemia causes a decline in arterial oxygen pressure accompanied by hypoxemia are not completely understood. The aim of the present study was to determine the association between hypoxemia and anemia following arthroplasty. A total of 135 patients who underwent arthroplasty at the China-Japan Friendship Hospital between January and May 2013 were retrospectively analyzed. The patients were divided into five groups depending on the type of arthroplasty they had experienced: Unilateral total knee arthroplasty (TKA), bilateral TKA, unilateral total hip arthroplasty (THA), bilateral THA or unilateral unicompartmental knee arthroplasty. Perioperative peripheral oxygen saturation (SpO2) and hemoglobin (Hb) levels were assessed, and the associations between the changes in SpO2 (ΔSpO2) and hemoglobin (ΔHb) levels on the first and third postoperative days (PODs) were analyzed using Pearson's correlation test for each group. The perioperative SpO2 curves for the various groups were typically at their lowest on the day of surgery. Significant hypoxemia was observed on POD 0–2, although a stable recovery curve was observed on POD 3–5. Trends in ΔHb were observed among the 5 groups, with the lowest Hb value observed predominantly on POD 2 and 3. By POD 4 and 5 Hb levels had recovered, with a steadily and consistently increasing curve. There was no statistically significant correlation between ΔSpO2 and decrease in Hb levels (P>0.05). SpO2 levels should not serve as a clinical indicator of the incidence and severity of anemia in patients who have undergone primary arthroplasty. To a point, the degree of postoperative anemic status does not affect SpO2 levels. PMID:27168828

  11. RESULTS FROM BI-CONTACT® TOTAL ELBOW ARTHROPLASTY: MULTICENTER STUDY

    PubMed Central

    Benegas, Eduardo; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emilio Conforto; de Sousa, Augusto Tadeu Barros; Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Ikemoto, Roberto Yukio; Murachovsky, Joel; Matsumoto, Marcelo Hide; Tamaoki, Marcel Jun Sugawara; Neto, Arnaldo Amado Ferreira

    2015-01-01

    Objective: To describe the initial experience of four orthopedic clinics from using Bi-Contact® total elbow arthroplasty (TEA), reporting the results and complications of the procedure. Methods: This was a retrospective study, through analysis on the medical records of patients who underwent primary TEA using a prosthesis model developed in conjunction with IOT-HCFMUSP. Forty-six elbows (45 patients) that were operated at four orthopedic clinics between 2000 and 2009 were evaluated. Results: The majority of the patients were female (74%), and the median age was 62.5 years. The diagnoses encountered were trauma sequelae (47.83%), rheumatoid arthritis (32.61%), primary osteoarthrosis (8.7%), acute fractures (6.52%) and heterotopic ossification (2.17%). The median length of follow-up was 2.08 years (0.25-9). The procedure significantly alleviated pain and improved range of motion. It was observed that at least one complication was present in 69.57% of the cases, and the main ones were infection (28.26%), need for revision (28.26%), intraoperative fracture (15.22%) and aseptic loosening (15.22%). Conclusion: Bi-Contact® TEA provided significant alleviation of pain and improvement of range of motion in the present series. The complication rate was high, and the most frequently observed complications were infection, aseptic loosening and intraoperative fracture. PMID:27027055

  12. SHOULDER ARTHROPLASTY RECORDS

    PubMed Central

    Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno

    2015-01-01

    The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463

  13. Computer navigation vs conventional mechanical jig technique in hip resurfacing arthroplasty: a meta-analysis based on 7 studies.

    PubMed

    Liu, Hao; Li, Lin; Gao, Wei; Wang, Meilin; Ni, Chunhui

    2013-01-01

    The studies on the accuracy of femoral component in hip resurfacing arthroplasty with the help of computer-assisted navigation were not consistent. This study aims to assess at the functional outcomes after computer navigation in hip resurfacing arthroplasty by systematically reviewing and meta-analyzing the data, which were searched up to December 2011 in PubMed, MEDLINE, EMBASE, MetaMed, EBSCO HOST, and the Web site of Google scholar. Totally, 197 articles about hip resurfacing arthroplasty were collected; finally, 7 articles met the inclusion criteria and were included in this meta-analysis (520 patients with 555 hip resurfacing arthroplasty). The odds ratio for the number of outliers was 0.155 (95% confidence interval, 0.048-0.498; P < .003). In conclusion, this meta-analysis suggests that the computer-assisted navigation system makes the femoral component positioning in hip resurfacing arthroplasty easier and more precise. PMID:22771091

  14. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.

    PubMed

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P; Sköldenberg, Olof

    2016-02-01

    Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  15. Efficacy and safety of rivaroxaban thromboprophylaxis after arthroplasty of the hip or knee: retrospective cohort study.

    PubMed

    Loganathan, L; Hua, A; Patel, S; Gibbons, C; Vizcaychipi, M P

    2016-09-01

    Introduction Venous thromboembolism (VTE) is a potentially fatal complication of hip arthroplasty and knee arthroplasty. The National Institute for Health and Care Excellence recommend rivaroxaban for VTE prevention. Amid concerns over bleeding complications, the modified thromboprophylaxis policy of Chelsea and Westminster Hospital (CWH; London, UK) advises enoxaparin given after surgery in the inpatient setting followed by rivaroxaban upon hospital discharge. This retrospective study investigated the efficacy and safety of rivaroxaban in this novel, modified venous-prophylaxis regimen in a surgical orthopaedic cohort at CWH. Methods A total of 479 patients who received modified thromboprophylaxis treatment at CWH after hip arthroplasty or knee arthroplasty between April 2013 and October 2014 formed the study cohort. Seven outcomes based on efficacy and safety while undergoing treatment with rivaroxaban were investigated: symptomatic deep-vein thrombosis (DVT), pulmonary embolism (PE), death, stroke, myocardial infarction (MI), major bleeding episodes (MBEs) and non-major bleeding episodes (NMBEs). Median follow-up was 369 days. Fisher's exact and Mann-Whitney U-tests were adopted to identify associations with these outcomes. Results Prevalence of symptomatic PE, DVT, death, stroke and MI during treatment was zero. One (0.2%) MBE and nine (1.9%) NMBEs occurred. The MBE (a wound haematoma) required a return to theatre for aspiration. Off-treatment VTEs occurred in four (0.8%) patients after completion of a course of rivaroxaban, and were associated with known risk factors. Conclusions Rivaroxaban is an effective and safe anticoagulant for thromboprophylaxis after hip arthroplasty or knee arthroplasty if used in a modified regimen involving enoxaparin administered in the inpatient setting followed by rivaroxaban upon hospital discharge. PMID:27580310

  16. [Scorpio TS prosthesis in severe deformity and revision knee arthroplasty--preliminary report].

    PubMed

    Kowalczewski, Jacek; Marczak, Dariusz; Wielopolski, Aleksander; Milecki, Marcin; Okoń, Tomasz

    2009-01-01

    Authors present early results of Scorpio TS prosthesis in primary and revision total knee arthoplasty due to aseptic and septic loosening. 26 arthroplasties were performed on 25 patients. There were 19 women and 6 men of age from 37 to 80 (average 68.4 years). 11 patients from this group were operated because of septic loosening. The follow up from 2 to 22 months (average 11 months). Early results were access according to Clinical Rating System of The Knee Society: 19 patients had very good and good (73%) including primaries, 1 satisfactory (4%) and 6 poor (23%) results. The satisfactory and poor results were obtained in 7 cases with septic loosening who had had four or more previous operations on the knee. Four of them had instability of prosthesis and we changed it for MRH type. In one case due to reinfection and sepsis amputation above the knee was performed. In another patient tibia fracture below stem and loosening of tibial component occurs after 6 months of revision. ORIF gave fracture union after 8 months and exchange Scorpio TS to MRH was performed. In two cases the wound problems occurred and was solved. There were no reinfection and aseptic loosening in another cases. We didn't notice any thrombosis complications. PMID:20201329

  17. Distraction arthroplasty.

    PubMed

    Morse, Kenneth R; Flemister, A Samuel; Baumhauer, Judith F; DiGiovanni, Benedict F

    2007-03-01

    Few joint-preserving surgical options exist for the patient who has ankle arthritis refractory to conservative measures. Therefore, continuous effort is afforded to the development of additional treatment options for such patients. Distraction arthroplasty has been proposed as one of these options for the patient in whom fusion or joint replacement is not appropriate. Although the mechanism of action remains unknown, the reports of several researchers support the potential beneficial effects that can be obtained from joint distraction arthroplasty in the severely osteoarthritic ankle. Furthermore, the studies published to date suggest that these effects may not only persist for years but also improve as time progresses during the first several years after treatment. Although additional laboratory studies are needed to understand the biochemical and biomechanical effects of distraction, additional prospective clinical studies are also needed to further understand its efficacy and appropriate patient population. The data thus far suggests that joint distraction arthroplasty may be a viable alternative treatment to arthrodesis and replacement for the young patient who has a congruent, painful, mobile, arthritic ankle joint. PMID:17350509

  18. Gait and stair function in total and resurfacing hip arthroplasty: a pilot study.

    PubMed

    Shrader, M Wade; Bhowmik-Stoker, Manoshi; Jacofsky, Marc C; Jacofsky, David J

    2009-06-01

    Standard total hip arthroplasty (THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis but survivorship curves wane in patients younger than 50. Resurfacing hip arthroplasty (RHA) is an alternative for younger, active patients reportedly providing superior range of motion. Quantitative investigation of functional recovery following arthroplasty may elucidate limitations that aid in device selection. Although limited long-term kinematic data are available, the early rate of recovery and gait compensations are not well described. This information may aid in refining rehabilitation protocols based on limitations specific to the implant. We presumed hip motion and forces for subjects receiving RHA are more similar to age-matched controls during physically demanding tasks, such as stair negotiation, at early time points than those for THA. In a pilot study, we quantified walking and stair negotiation preoperatively and 3 months postoperatively for seven patients with RHA (mean age, 49 years), seven patients with standard THA (mean age, 52 years), and seven age-matched control subjects (mean age, 56 years). Although both treatment groups demonstrated trends toward functional recovery, the RHA group had greater improvements in hip extension and abduction moment indicating typical loading of the hip. Further investigation is needed to determine if differences persist long term or are clinically meaningful. PMID:19305961

  19. The effect of mechanical massage on early outcome after total knee arthroplasty: a pilot study

    PubMed Central

    Kim, Sun Mi; Kim, Sang-Rim; Lee, Yong Ki; Kim, Bo Ryun; Han, Eun Young

    2015-01-01

    [Purpose] The aim of this study was to evaluate the efficacy of mechanical massage via Endermologie® after total knee arthroplasty in reducing edema and pain and improving knee range of motion, in the early postoperative period. [Subjects and Methods] Eighteen patients with knee edema following total knee arthroplasty were randomly assigned to the intervention group (n=8) or the control group (n=10). The intervention group received mechanical massage therapy using Endermologie® and the control group received conventional physical therapy for 20 minutes a day, 5 times a week from the seventh day postsurgery. Clinical assessments included active knee flexion and extension range of motion, knee pain using a numeric rating scale, the operated limb circumference, the soft tissue cross-sectional area using ultrasonography, the extracelluar fluid volume, and single frequency bioimpedance analysis at 5 kHz using bioelectrical impedance spectroscopy. [Results] Both groups showed significant reduction in edema and pain, and improvement in active knee flexion at the end of treatment. There were no significant inter-group differences before or after treatment. [Conclusion] Mechanical massage could be an alternative way of managing knee edema after total knee arthroplasty in early postoperative recovery. PMID:26696709

  20. The Quality of Life (QOL) after Total Knee Arthroplasties among Saudi Arabians: A Pilot Study

    PubMed Central

    Al-Omran, Abdallah S.

    2014-01-01

    Background and Objective: Total knee arthroplasty (TKA) is commonly performed in Saudi Arabia but there is very limited published data on outcome and quality of life (QOL) post Knee arthroplasty. To assess the QOL post TKA we performed this retrospective study. Methods: Total Knee arthroplasty was started in mid- 2000’s at the university hospital. Fifty–two patients of TKA who came for follow up during the study period were asked to fill a pre-determined questionnaire and clinical examination, were included in the study. Patients were assessed and at 2 parameters pre and postoperative time-points, for pain [1-9], walking [1-9] and asked whether they would recommend the procedure to their relatives and friends, and finally whether they were satisfied with the outcome. Results: We interviewed 52 patients (9 males and 43 females), mean age of 64.75 ± 7.90 years. Twenty (34.50%) had bilateral TKR, and the rest single sided. The preoperative night pain was 7.72 ± 2.03 compared to postoperative 1.92 ± 1.41 (P<0.001 (5.80 and < 6.47) and pain at walking was 8.39 ± 0.77 versus 2.39 ± 2.05 (P<0.001(5.40 and < 6.55). The overall satisfaction 93% (8.37 ± 1.32) and QOL as assessed preoperatively was 3.60 ± 2.15 and postoperatively was 8.41  ±  1.27 (P<0.001 (4.81and 4.13). Fifty-one (98.07%) patients indicated that they will recommend the procedure to others. Conclusions: The overall satisfaction and improvement of QOL in male patients was 93.77% and female patients 92.77% and all patients indicated that they will recommend others to undergo the similar procedure to improve their QOL. PMID:25324701

  1. Trajectories of Pain and Function after Primary Hip and Knee Arthroplasty: The ADAPT Cohort Study

    PubMed Central

    Lenguerrand, Erik; Wylde, Vikki; Gooberman-Hill, Rachael; Sayers, Adrian; Brunton, Luke; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2016-01-01

    Background and Purpose Pain and function improve dramatically in the first three months after hip and knee arthroplasty but the trajectory after three months is less well described. It is also unclear how pre-operative pain and function influence short- and long-term recovery. We explored the trajectory of change in function and pain until and beyond 3-months post-operatively and the influence of pre-operative self-reported symptoms. Methods The study was a prospective cohort study of 164 patients undergoing primary hip (n = 80) or knee (n = 84) arthroplasty in the United Kingdom. Self-reported measures of pain and function using the Western Ontario and McMaster Universities Osteoarthritis index were collected pre-operatively and at 3 and 12 months post-operatively. Hip and knee arthroplasties were analysed separately, and patients were split into two groups: those with high or low symptoms pre-operatively. Multilevel regression models were used for each outcome (pain and function), and the trajectories of change were charted (0–3 months and 3–12 months). Results Hip: Most improvement occurred within the first 3 months following hip surgery and patients with worse pre-operative scores had greater changes. The mean changes observed between 3 and twelve months were statistically insignificant. One year after surgery, patients with worse pre-operative scores had post-operative outcomes similar to those observed among patients with less severe pre-operative symptoms. Knee: Most improvement occurred in the first 3 months following knee surgery with no significant change thereafter. Despite greater mean change during the first three months, patients with worse pre-operative scores had not ‘caught-up’ with those with less severe pre-operative symptoms 12 months after their surgery. Conclusion Most symptomatic improvement occurred within the first 3 months after surgery with no significant change between 3–12 months. Further investigations are now required to

  2. Interpositional arthroplasty with Gore-Tex, Marlex or tendon for osteoarthritis of the trapeziometacarpal joint. A retrospective comparative study.

    PubMed

    Muermans, S; Coenen, L

    1998-02-01

    In this retrospective study of 26 patients with arthritis of the thumb carpometacarpal joint, we report the use of expanded polytetrafluoroethylene (ePTFE) (Gore-Tex) and polypropylene (Marlex) as interpositional materials for resection arthroplasty of the trapeziometacarpal joint. We have compared the results with those of "conventional" tendon interposition and those in the literature. In three patients the use of ePTFE (Gore-Tex) was complicated by marked clinical synovitis, resembling findings in silicone synovitis. Therefore, the use of ePTFE has been discontinued. Polypropylene seems to be a valuable alternative to tendon interposition arthroplasty. PMID:9571484

  3. Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach

    PubMed Central

    Dabboussi, Naji; Sakr, Mazen; Girard, Julien; Fakih, Riad

    2012-01-01

    Background: Minimally invasive surgery has gained popularity over the past several years. Early results have shown better functional outcome with early recovery and rapid rehabilitation. Aim: Evaluation of the short-term clinical and functional outcome of minimally invasive surgery total knee arthroplasty (MIS-TKA) compared with the traditional total knee arthroplasty (TKA). Materials and Methods: During 2009, all cases scheduled for primary TKA through the modified mini-mid-vastus approach (MIS group) were studied. This group included 40 knees and was compared to a cohort control group of similar number of patients (40 knees) that underwent the procedure through the standard conventional technique (standard group). Results: Patients in the MIS group showed significant decrease in postoperative pain, blood loss in first 24 hours, and in hospital stay. Furthermore, they achieved motion considerably faster than the standard group with earlier return of quadriceps function and greater early flexion. Conclusion: This study proved that MIS-TPA has the ability to couple the benefits of less invasive surgical approach. PMID:22408753

  4. Predicting bone remodeling in response to total hip arthroplasty: computational study using mechanobiochemical model.

    PubMed

    Tavakkoli Avval, Pouria; Klika, Václav; Bougherara, Habiba

    2014-05-01

    Periprosthetic bone loss following total hip arthroplasty (THA) is a serious concern leading to the premature failure of prosthetic implant. Therefore, investigating bone remodeling in response to hip arthroplasty is of paramount for the purpose of designing long lasting prostheses. In this study, a thermodynamic-based theory, which considers the coupling between the mechanical loading and biochemical affinity as stimulus for bone formation and resorption, was used to simulate the femoral density change in response to THA. The results of the numerical simulations using 3D finite element analysis revealed that in Gruen zone 7, after remarkable postoperative bone loss, the bone density started recovering and got stabilized after 9% increase. The most significant periprosthetic bone loss was found in Gruen zone 7 (-17.93%) followed by zone 1 (-13.77%). Conversely, in zone 4, bone densification was observed (+4.63%). The results have also shown that the bone density loss in the posterior region of the proximal metaphysis was greater than that in the anterior side. This study provided a quantitative figure for monitoring the distribution variation of density throughout the femoral bone. The predicted bone density distribution before and after THA agree well with the bone morphology and previous results from the literature. PMID:24509505

  5. Morsellized bone grafting compensates for femoral bone loss in revision total knee arthroplasty. An experimental study.

    PubMed

    van Loon, C J; de Waal Malefijt, M C; Verdonschot, N; Buma, P; van der Aa, A J; Huiskes, R

    1999-01-01

    This study was undertaken to examine the contribution of uncontained morsellized bone graft to the structural properties of a femoral reconstruction in total knee arthroplasty and to serve as a basis for an in vivo animal study. Ten human distal femora with a standard unicondylar uncontained medial bone defect were prepared to fit a femoral component of a cruciate sacrificing TKA. A cyclic axial load of 750 N was applied to the medial part of the femoral component in the presence of impacted morsellized bone graft. After removal of the bone graft, the cyclic loading was repeated for the unsupported situation. None of the grafts collapsed and all cement mantles stayed intact during the experiments. Elastic deformation during cyclic loading was significantly less when graft was added while time-dependent deformation was not affected. We conclude that impacted morsellized bone graft, used for reconstruction of uncontained femoral bone loss in revision knee arthroplasty, may improve the structural resistance against loading. Further animal experimentation for in vivo application is warranted. PMID:9916775

  6. Conservative gap arthroplasty in temporomandibular ankylosis not involving the sigmoid notch: a selected age group study.

    PubMed

    Temerek, Ahmed Talaat

    2016-06-01

    In this prospective, cohort, clinical follow-up study we aimed to investigate the role of conservative gap arthroplasty without interpositional material in managing ankylosis of the temporomandibular joint (TMJ). Thirteen patients (15 joints) with ankylosis who fulfilled the other inclusion criteria were enrolled. The ankylotic mass was excised to create a gap of 7-9mm. No interpositional material was used. Ipsilateral or bilateral masseter reflection, pterygomasseteric sling, and temporalis tendon release plus coronoidectomy were considered if maximum mouth opening failed to reach 35mm. A physiotherapy protocol was started on the first day. Patients' ages ranged from 13-38 (mean (SD) 18 (7) years). Trauma was the main cause. Duration of ankylosis at presentation ranged from 1-17 years (mean (SD) 5 (4) years). Eleven patients had unilateral, and two bilateral, ankylosis that did not involve the sigmoid notch. The mean (SD) maximum incisal opening (mm) was 38 (4) two years' postoperatively. The facial nerve was affected temporarily in two patients. Mean (SD) duration of follow-up was 4 (2) years without recurrence. Within our selection criteria, conservative gap arthroplasty of 7-9mm without interpositional material and with vigorous postoperative physiotherapy has a role in treating ankylosis of the TMJ and preventing its recurrence for more than four years. PMID:26972420

  7. Safety of desirudin in thrombosis prevention after total knee arthroplasty: the DESIR-ABLE study.

    PubMed

    Jove, Maurice; Maslanka, Marc; Minkowitz, Harold S; Jaffer, Amir K

    2014-01-01

    Desirudin, administered 30 minutes before total hip arthroplasty is superior to enoxaparin in preventing proximal deep vein thrombosis (DVT) and pulmonary embolism (PE) with similar bleeding. The purpose of this study was to determine the safety of desirudin in patients undergoing elective total knee arthroplasty (TKA) when the first dose of desirudin was administered the evening after surgery. This is a case series of patients undergoing TKA who received desirudin 15 mg every 12 hours subcutaneously for an average of 5 days with the first dose administered postoperatively. The primary endpoint was major bleeding; secondary endpoints included wound outcomes (oozing and infection) and new symptomatic DVT or PE. Desirudin has a favorable safety profile when administered postoperatively in patients undergoing TKA with no reports of major bleeding, wound ooze, or infection. No patients experienced symptomatic DVT, but 2 patients had PE detected by computed tomography after experiencing atypical symptoms. The safety profile of desirudin is improved when administered postoperatively. Bleeding and wound outcomes seem to occur less frequently than historical desirudin and enoxaparin controls. PMID:23344102

  8. Bicruciate retaining arthroplasty.

    PubMed

    Mont, Michael A; John, Mario; Johnson, Aaron

    2012-12-01

    Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures with 10 to 20 year survivorships from multiple studies of greater than 95%. These success rates typically apply to patients over 70 years of age who may only want to return to activities of daily living. However, recently there is a demand by both senior citizens as well as young patients to have TKAs that return them to high activity levels and occasionally high performance sports. In this review, we will describe bicruciate retaining prostheses, including knowledge of their kinematics from fluoroscopic and gait studies, results of clinical studies, a summary of their potential advantages and disadvantages, anterior cruciate ligament viability at time of arthroplasty, considerations for implantation of these devices, and their role in the future of total knee arthroplasty. PMID:22915498

  9. Cervical Total Disc Arthroplasty

    PubMed Central

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer. PMID:24353955

  10. Bicompartmental knee arthroplasty

    PubMed Central

    Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes. PMID:26855941

  11. Bicompartmental knee arthroplasty.

    PubMed

    Sabatini, Luigi; Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes. PMID:26855941

  12. Adductor Canal Block for Postoperative Pain Treatment after Revision Knee Arthroplasty: A Blinded, Randomized, Placebo-Controlled Study

    PubMed Central

    Jæger, Pia; Koscielniak-Nielsen, Zbigniew J.; Schrøder, Henrik M.; Mathiesen, Ole; Henningsen, Maria H.; Lund, Jørgen; Jenstrup, Morten T.; Dahl, Jørgen B.

    2014-01-01

    Background Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary total knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. Methods We included patients scheduled for revision knee arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an adductor canal block via a catheter with either ropivacaine or placebo; bolus of 0.75% ropivacaine/saline, followed by infusion of 0.2% ropivacaine/saline. Clinicaltrials.gov ID: NCT01191593. Results We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52±22 versus 71±25 mm (mean difference 19, 95% CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1–8 h/7 h) pain scores were 55±21 versus 69±21 mm during knee flexion (P = 0.11) and 39±18 versus 45±23 mm at rest (P = 0.43), ropivacaine and placebo group respectively. Groups were similar regarding morphine consumption and morphine-related side effects (P>0.05). Conclusions The only statistically significant difference found between groups was in the primary endpoint: pain during knee flexion at 4 h. However, due to a larger than anticipated dropout rate and heterogeneous study population, the study was underpowered. Trial Registration Clinicaltrials.gov NCT01191593 PMID:25386752

  13. Are patients more satisfied and have better functional outcome after bilateral total knee arthroplasty as compared to total hip arthroplasty and unilateral total knee arthroplasty surgery? A two-year follow-up study.

    PubMed

    Lim, Jason Beng Teck; Chou, Andrew Chia Chen; Chong, Hwei Chi; Lo, Ngai Nung; Chia, Shi-lu; Tay, Keng Jin Darren; Yeo, Seng Jin

    2015-12-01

    This study aims to review the quality of life and physical improvement achieved by total joint arthroplasty surgery, namely unilateral TKA, bilateral TKA and THA. We hypothesize that patients who undergo bilateral TKA should have greater improvement in patient-reported outcome measures, as compared to patients who had unilateral TKA, and their outcomes may be comparable to that of THA. We analyzed prospectively collected data of all patients who underwent unilateral TKA, bilateral TKA and THA (5291, 187 and 529 patients respectively) for end-stage osteoarthritis at a tertiary hospital during the 5-year period. Patients who underwent bilateral TKA had a greater degree of improvement in SF-36 and Knee Society Scores as compared to unilateral TKA at 6 months and 2 years follow-up. Bilateral TKA had the highest proportion of patients who were satisfied and had expectations met by surgery. PMID:26790791

  14. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: A retrospective study.

    PubMed

    Zhang, Zhendong; Zhuo, Qi; Chai, Wei; Ni, Ming; Li, Heng; Chen, Jiying

    2016-08-01

    Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case-control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty.The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218-20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138-9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001-1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06-5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007-44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103-59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656-38.966, P = 0.01) were all risk factors.Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take into account Vancouver

  15. Outcome in primary cemented total knee arthroplasty with or without drain: A prospective comparative study

    PubMed Central

    Kęska, Rafał; Paradowski, T Przemysław; Witoński, Dariusz

    2014-01-01

    Background: Suction drain insertion is a common practice in orthopedic surgery, especially after joint arthroplasty to prevent the formation of a hematoma. Theoretically the use of a drain should diminish the volume of hematoma; however the literature has conflicting data. Some authors state that drainage evacuates fluid from a limited area only and can be a cause of infection due to retrograde migration of bacteria. It can also impair the early postoperative rehabilitation. The aim of this study was to evaluate the clinical outcome (especially postoperative pain) and intake of analgesics in patients who had undergone primary cemented total knee arthroplasty (TKA) with or without a postoperative drain. Materials and Methods: A prospective comparative study of 108 consecutive patients (121 knees) was conducted. They were divided into two groups: A study group, with no drainage and a control group with drain inserted at the end of surgery. A total of 121 patients were recruited into two groups. A study group consisted of 59 knees, in which we did not use drainage after TKA and a control group with 62 knees, in which drain was inserted post surgery. Both groups were comparable in terms of preoperative characteristics. The indication for TKA was osteoarthritis (n = 105) and rheumatoid arthritis (n = 16). Results: In patients without drainage we observed lower need for opioids, higher blood loss on the 1st postoperative day and a lower need for change of dressings. There were no statistically significant differences in terms of total blood loss, hidden blood loss, transfusion rate, range of motion, length of hospital stay or incidence of complications between the two groups. In 1 year observation there were no differences in clinical outcome between the two groups. Conclusions: The present study conclude that there is no rationale for the use of drain after primary TKA. There are benefits in terms of lower opioid intake, lower blood loss on the first postoperative day

  16. The clinical efficacy of using autologous platelet rich plasma in hip arthroplasty: A retrospective comparative study

    PubMed Central

    Safdar, Atif; Shaaban, Hamid; Tibayan, Restituto; Miller, Richard; Boairdo, Richard; Guron, Gunwant

    2015-01-01

    Background: Platelet rich plasma (PRP) is a blood derivative concentrate of platelets, fibrin and growth factors obtained through withdrawal and centrifugation of autologous blood and use for its inherent hemostatic and adhesive properties to promote wound healing. Hip arthroplasty is often associated with significant perioperative complications including blood loss necessitating blood transfusions, which can lead to multiple adverse reactions, infection transmission, and longer hospital stay. Materials and Methods: We conducted this retrospective comparative study to determine whether the use of PRP can reduce the bleeding complications in hip replacement surgeries and therefore decrease analgesic requirements and shorten the hospital stay. Results: Sixty patients had consecutive hip replacement surgeries. The study group (n=23) received PRP applications while the control group (n=37) were operated without PRP applications. Postoperative drop of hemoglobin, number of red blood cell (RBC) transfusions, analgesic requirements, and duration of hospital stay were recorded. There was no significant difference in the drop of hemoglobin preoperatively and postoperatively comparing study and control groups (P=0.75). There was no difference in transfusion requirements between the two groups (P=0.16) but there was trend toward less transfusion in the PRP-treated group. There were also no statistical differences in analgesic use (P=0.83) and lengths of hospitalization (P=0.68) between the two groups. Conclusion: We concluded that there is no clinical efficacy in using PRP in hip replacement surgeries. We recommend a larger prospective study be conducted to determine its clinical utility as an optimization strategy to improve outcome after hip arthroplasty PMID:25810634

  17. Hybrid component fixation in total knee arthroplasty: minimum of 10-year follow-up study.

    PubMed

    Yang, Jae-Hyuk; Yoon, Jung-Ro; Oh, Chi-Hun; Kim, Taik-Sun

    2012-06-01

    Hybrid total knee arthroplasty (TKA) (uncemented femur with cemented tibia and patella) was introduced in the late 1980s to gain the theoretical advantage of durable cementless femoral fixation while avoiding the problems noted with cementless tibial fixation. From December 1992 to July 2000, 215 patients (235 knees) who underwent hybrid TKA were enrolled in this study. Five types of prosthesis (AGC, Maxim, LCS-M, LCS-APG, and Scorpio) were used. Revision rate for aseptic loosening was 16 (6.8%) of 235 knees. At 10 and 15 years, survivorship with tibial or femoral revision as the end point was 0.95 and 0.92, respectively. Hybrid TKA provides durable fixation with clinical and radiographic performance at minimum 10 years comparable with cemented series. PMID:22019322

  18. Screening for symptomatic metal sensitivity: a prospective study of 92 patients undergoing total knee arthroplasty.

    PubMed

    Niki, Yasuo; Matsumoto, Hideo; Otani, Toshiro; Yatabe, Taku; Kondo, Makoto; Yoshimine, Fumihiro; Toyama, Yoshiaki

    2005-03-01

    Metal sensitivity (MS) reactions to implant metals represent a rare but well-documented complication following total joint arthroplasty (TJA). Although 20-25% of post-TJA patients develop MS, only a few highly susceptible patients (< 1%) exhibit symptoms. Whether surgeons should perform screening for MS is currently a matter of debate. The present study investigated the clinical importance of screening for patients predisposed to symptomatic MS, and the specific metals causing symptomatic MS following total knee arthroplasty (TKA). Between 2000 and 2002, a total of 108 primary TKAs were performed on 92 patients. Preoperatively, all patients underwent modified lymphocyte stimulation test (mLST) to Ni, Co, Cr, and Fe. Of the 92 patients, 24 (26%) displayed positive preoperative responses to at least one metal. Five patients displayed implant metal-related eczema and were all mLST-positive preoperatively, suggesting that screening for symptomatic MS is clinically useful. Two of these underwent revision TKA and thereafter, eczema healed and mLST results changed from positive to negative. All mLST-positive patients were divided into three groups: Group I, patients with eczema; Group II, patients with clear history of MS; and Group III, patients neither eczema nor history of MS. When the type of sensitive metals were compared among the three groups, a significant association between presence of Cr-sensitivity and development of eczema (P < 0.05) was identified. No significant association was observed between other metals and development of eczema or history of MS. This indicates that Cr is a potential candidate metal for causing eczema in our TKA series, and Cr-sensitivity may offer a potential predictor for symptomatic MS. The present study indicates that the surgeons should undertake routine preoperative screening for MS, particularly to Cr. PMID:15369690

  19. Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register

    PubMed Central

    Koivu, Helka; Eskelinen, Antti; Ikävalko, Mikko; Paavolainen, Pekka; Remes, Ville

    2010-01-01

    Background and purpose Although total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide arthroplasty registry in Finland. Methods 573 primary TARs were performed during the period 1982–2006 because of rheumatic, arthritic, or posttraumatic ankle degeneration. We selected contemporary TAR designs that were each used in more than 40 operations, including the S.T.A.R. (n = 217) and AES (n = 298), to assess their respective survival rates. The mean age of the patients was 55 (17–86) years and 63% of operations were performed in women. Kaplan-Meier analysis and the Cox regression model were used for survival analysis. The effects of age, sex, diagnosis, and hospital volume were also studied. Results The annual incidence of TAR was 1.5 per 105 inhabitants. The 5-year overall survivorship for the whole TAR cohort was 83% (95% CI: 81–86), which agrees with earlier reports. The most frequent reasons for revision were aseptic loosening of one or both of the prosthesis components (39%) and instability (39%). We found no difference in survival rate between the S.T.A.R. and AES designs. Furthermore, age, sex, diagnosis, and hospital volume (< 10 and > 100 replacements in each of 17 hospitals) did not affect the TAR survival. Interpretation Based on our findings, we cannot conclude that any prosthesis was superior to any other. A high number of technical errors in primary TARs suggests that this low-volume field of implant arthroplasty should be centralized to fewer units. PMID:20180720

  20. Dielectric cure monitoring: Preliminary studies

    NASA Technical Reports Server (NTRS)

    Goldberg, B. E.; Semmel, M. L.

    1984-01-01

    Preliminary studies have been conducted on two types of dielectric cure monitoring systems employing both epoxy resins and phenolic composites. An Audrey System was used for 23 cure monitoring runs with very limited success. Nine complete cure monitoring runs have been investigated using a Micromet System. Two additional measurements were performed to investigate the Micromet's sensitivity to water absorption in a post-cure carbon-phenolic material. While further work is needed to determine data significance, the Micromet system appears to show promise as a feedback control device during processing.

  1. Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of Unplanned ICU Admission

    PubMed Central

    Kamath, Atul F.; McAuliffe, Caitlin L.; Kosseim, Laura M.; Pio, Finnah; Hume, Eric

    2016-01-01

    Background: Malnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown. Methods: 1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin <3.5 g/dL. Results: The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin <3.0 and <3.5 g/dL translated to 15.4% and 3.8% rates of unplanned ICU admission, respectively, indicating nutritional status to be a factor in postoperative ICU admission. Conclusion: Patients with poor nutritional status must be counseled on the risks of adverse medical complications. PMID:27200389

  2. Evaluation of the effects of a physiotherapy program on quality of life in females after unilateral total knee arthroplasty: a prospective study.

    PubMed

    Hudáková, Zuzana; Zięba, Halina Romualda; Lizis, Paweł; Dvořáková, Vlasta; Cetlová, Lada; Friediger, Teresa; Kobza, Wojciech

    2016-05-01

    [Purpose] Osteoarthritis is a chronic and degenerative joint disease and is considered to be one of the most common musculoskeletal disorders. This study evaluated the differences in the quality of life of females treated with supervised physiotherapy and a standardized home program after unilateral total knee arthroplasty. [Subjects and Methods] From January 2012 to May 2015, a total of 40 females were examined at the Central Military Hospital in Ruzomberk, Slovakia. Quality of life was assessed with the Short Form-36. Quality of life and intensity of pain after normal daily activity, according to the visual analog scale, were assessed before total knee arthroplasty, immediately after physiotherapy, 3 months after total knee arthroplasty, and 6 months after total knee arthroplasty. [Results] We found statistically significant improvement of the quality of life results and a decreased intensity of pain at each time point compared with before total knee arthroplasty. [Conclusions] The results of this study provide further evidence indicating that patients who undergo total knee arthroplasty for primary osteoarthritis of the knee can achieve a significant improvement in the quality of life by using supervised physiotherapy compared with a standardized home program. PMID:27313341

  3. Evaluation of the effects of a physiotherapy program on quality of life in females after unilateral total knee arthroplasty: a prospective study

    PubMed Central

    Hudáková, Zuzana; Zięba, Halina Romualda; Lizis, Paweł; Dvořáková, Vlasta; Cetlová, Lada; Friediger, Teresa; Kobza, Wojciech

    2016-01-01

    [Purpose] Osteoarthritis is a chronic and degenerative joint disease and is considered to be one of the most common musculoskeletal disorders. This study evaluated the differences in the quality of life of females treated with supervised physiotherapy and a standardized home program after unilateral total knee arthroplasty. [Subjects and Methods] From January 2012 to May 2015, a total of 40 females were examined at the Central Military Hospital in Ruzomberk, Slovakia. Quality of life was assessed with the Short Form-36. Quality of life and intensity of pain after normal daily activity, according to the visual analog scale, were assessed before total knee arthroplasty, immediately after physiotherapy, 3 months after total knee arthroplasty, and 6 months after total knee arthroplasty. [Results] We found statistically significant improvement of the quality of life results and a decreased intensity of pain at each time point compared with before total knee arthroplasty. [Conclusions] The results of this study provide further evidence indicating that patients who undergo total knee arthroplasty for primary osteoarthritis of the knee can achieve a significant improvement in the quality of life by using supervised physiotherapy compared with a standardized home program. PMID:27313341

  4. Quantitative and qualitative analysis of polyethylene wear particles in synovial fluid of patients with total knee arthroplasty. A preliminary report.

    PubMed

    Bosco, J; Benjamin, J; Wallace, D

    1994-12-01

    Synovial fluid from 13 knees undergoing revision total knee arthroplasty was subjected to chemical digestion and ultrafiltration. Scanning electron microscopy was used to visualize high-density polyethylene particles filtered from the fluid, and the images were analyzed using digital imaging software. This data were correlated with polyethylene wear patterns seen at the time of revision surgery. Patients' prostheses with gross polyethylene wear were differentiated from those with surface deformation and burnishing. The knees had been in situ for periods ranging from 3 to 112 months, and included 6 different prosthetic designs. The average area of the polyethylene particles measured ranged from 41 to 701 mu 2, and the total number of particles identified for each sample ranged from 38 to 279 mu 2. The largest particle identified had a surface area of 17,500 mu 2. Using the fluid volume analyzed, the particle area per milliliter of synovial fluid examined was calculated, and values ranged from 6.22 x 10(4) to 2.06 x 10(6) mu 2/ml. Visualization of high-density polyethylene using scanning electron microscopy allows greater resolution of morphologic detail than is possible with routine histologic examination using light microscopy. There were trends toward increasing particle size and total particle area in patients with gross polyethylene wear. The area of high-density polyethylene per milliliter of fluid in patients with gross wear was found to be statistically greater than that of patients without gross wear (p = 0.047). This technique offers a potentially valuable method of evaluating the status of high-density-polyethylene bearing surfaces in situ using a noninvasive technique. PMID:7994947

  5. Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study

    PubMed Central

    McMinn, D J W; Snell, K I E; Daniel, J; Treacy, R B C; Pynsent, P B

    2012-01-01

    Objectives To examine mortality and revision rates among patients with osteoarthritis undergoing hip arthroplasty and to compare these rates between patients undergoing cemented or uncemented procedures and to compare outcomes between men undergoing stemmed total hip replacements and Birmingham hip resurfacing. Design Cohort study. Setting National Joint Registry. Population About 275 000 patient records. Main outcome measures Hip arthroplasty procedures were linked to the time to any subsequent mortality or revision (implant failure). Flexible parametric survival analysis methods were used to analyse time to mortality and also time to revision. Comparisons between procedure groups were adjusted for age, sex, American Society of Anesthesiologists (ASA) grade, and complexity. Results As there were large baseline differences in the characteristics of patients receiving cemented, uncemented, or resurfacing procedures, unadjusted comparisons are inappropriate. Multivariable survival analyses identified a higher mortality rate for patients undergoing cemented compared with uncemented total hip replacement (adjusted hazard ratio 1.11, 95% confidence interval 1.07 to 1.16); conversely, there was a lower revision rate with cemented procedures (0.53, 0.50 to 0.57). These translate to small predicted differences in population averaged absolute survival probability at all time points. For example, compared with the uncemented group, at eight years after surgery the predicted probability of death in the cemented group was 0.013 higher (0.007 to 0.019) and the predicted probability of revision was 0.015 lower (0.012 to 0.017). In multivariable analyses restricted to men, there was a higher mortality rate in the cemented group and the uncemented group compared with the Birmingham hip resurfacing group. In terms of revision, the Birmingham hip resurfacings had a similar revision rate to uncemented total hip replacements. Both uncemented total hip replacements and Birmingham hip

  6. In Vitro Bioactivity Study of RGD-Coated Titanium Alloy Prothesis for Revision Total Hip Arthroplasty.

    PubMed

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Zhang, Laibo; Wu, Changshun; Jiang, Peng; Han, Xiaojuan; Li, Wei

    2016-01-01

    Total hip arthroplasty (THA) is a common procedure for the treatment of end-stage hip joint disease, and the demand for revision THA will double by 2026. Ti6Al4V (Titanium, 6% Aluminum, and 4% Vanadium) is a kind of alloy commonly used to make hip prothesis. To promote the osseointegration between the prothesis and host bone is very important for the revision THA. The peptide Arg-Gly-Asp (RGD) could increase cell attachment and has been used in the vascular tissue engineering. In this study, we combined the RGD with Ti6Al4V alloy using the covalent cross-linking method to fabricate the functional Ti6Al4V alloy (FTA). The distribution of RGD oligopeptide on the FTA was even and homogeneous. The FTA scaffolds could promote mouse osteoblasts adhesion and spreading. Furthermore, the result of RT-qPCR indicated that the FTA scaffolds were more beneficial to osteogenesis, which may be due to the improvement of osteoblast adhesion by the RGD oligopeptide coated on FTA. Overall, the FTA scaffolds developed herein pave the road for designing and building more efficient prothesis for osseointegration between the host bone and prothesis in revision THA. PMID:27493968

  7. Cementless total knee arthroplasty with Profix: a 8- to 10-year follow-up study.

    PubMed

    Hardeman, François; Vandenneucker, Hilde; Van Lauwe, Johan; Bellemans, Johan

    2006-12-01

    A consecutive series of 115 cementless Profix (Smith and Nephew, Memphis, USA) Total Knee Arthroplasties performed in 113 patients were followed in order to determine the functional results and survivorship at 8 to 10 years. All patients were included in a prospective database and were reviewed annually until final follow-up. Patients overall satisfaction was excellent or good in 91.3% of cases. The mean Knee Society's knee and function scores increased respectively from 49.3 and 36.7 preoperatively to 93.1 and 82.2 postoperatively. The Kaplan-Meier estimate of implant survival at 10 years was 97.1%. Two patients underwent revision and were considered as failures. One patient had a fracture of the medial condyle at 4 days post-surgery, and the other was revised for aseptic loosening of the tibial component at 6 years post-surgery. On the basis of this long-term follow-up study, we can conclude that the Profix Total Knee System is effective and safe. PMID:17064905

  8. In Vitro Bioactivity Study of RGD-Coated Titanium Alloy Prothesis for Revision Total Hip Arthroplasty

    PubMed Central

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Wu, Changshun; Jiang, Peng

    2016-01-01

    Total hip arthroplasty (THA) is a common procedure for the treatment of end-stage hip joint disease, and the demand for revision THA will double by 2026. Ti6Al4V (Titanium, 6% Aluminum, and 4% Vanadium) is a kind of alloy commonly used to make hip prothesis. To promote the osseointegration between the prothesis and host bone is very important for the revision THA. The peptide Arg-Gly-Asp (RGD) could increase cell attachment and has been used in the vascular tissue engineering. In this study, we combined the RGD with Ti6Al4V alloy using the covalent cross-linking method to fabricate the functional Ti6Al4V alloy (FTA). The distribution of RGD oligopeptide on the FTA was even and homogeneous. The FTA scaffolds could promote mouse osteoblasts adhesion and spreading. Furthermore, the result of RT-qPCR indicated that the FTA scaffolds were more beneficial to osteogenesis, which may be due to the improvement of osteoblast adhesion by the RGD oligopeptide coated on FTA. Overall, the FTA scaffolds developed herein pave the road for designing and building more efficient prothesis for osseointegration between the host bone and prothesis in revision THA. PMID:27493968

  9. Anterior Longitudinal Osteotomy of the Greater Trochanter in Total Hip Arthroplasty.

    PubMed

    Surace, Michele F; Regazzola, Gianmarco M V; Vulcano, Ettore; Monestier, Luca; Cherubino, Paolo

    2015-08-01

    The extra-articular impingement of the greater trochanter against the ileum is an underrated cause of early dislocation in total hip arthroplasty. In this preliminary study, the authors assess the effectiveness of an anterior longitudinal osteotomy of the greater trochanter for preventing dislocation. A total of 115 patients underwent a total hip arthroplasty through a posterolateral approach. All patients underwent clinical and radiological follow-up at 1, 3, and 6 months. No dislocation was reported. All patients demonstrated fast recovery of range of motion and walking. No trochanter fractures were observed. The osteotomy of the greater trochanter is an effective surgical technique that decreases anterior impingement and consequently lowers the dislocation rate in primary total hip arthroplasty. [Orthopedics. 2015; 38(8):490-493.]. PMID:26313167

  10. Primary total elbow arthroplasty

    PubMed Central

    Kumar, Suresh; Mahanta, Sunayan

    2013-01-01

    Background: Primary total elbow arthroplasty (TEA) is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years). The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained) hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80°) and average pronation was 70° (range 60-80°). Average flexion was 135° (range 130-135°). However, in 5 cases, there was loss of 15 to 35° (average 25°) of extension (45°) out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100). Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18%) out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head were replaced

  11. Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study.

    PubMed

    Parvizi, Javad; Restrepo, Camilo; Maltenfort, Mitchell G

    2016-07-01

    Studies suggest that total hip arthroplasty (THA) performed through direct anterior (DA) approach has better functional outcomes than other surgical approaches. The immediate to very early outcomes of DA THA are not known. A prospective, randomized study examined the very early outcome of THA performed through DA versus direct lateral approach. The functional outcomes on day 1, day 2, week 6, week 12, 6 months, and 1 year were measured. Patients receiving DA THA had significantly higher functional scores during the early period following surgery. The difference in functional scores leveled out at 6 months. PMID:27241374

  12. Radiographic Determination of Hip Rotation Center and Femoral Offset in Japanese Adults: A Preliminary Investigation toward the Preoperative Implications in Total Hip Arthroplasty.

    PubMed

    Takamatsu, Taichiro; Shishido, Takaaki; Takahashi, Yasuhito; Masaoka, Toshinori; Tateiwa, Toshiyuki; Kubo, Kosuke; Endo, Kenji; Aoki, Masaya; Yamamoto, Kengo

    2015-01-01

    The values of hip rotation center (HRC) and femoral offset (FO) evaluated according to Caucasian anatomical landmarks have been regarded as a useful reference also for Japanese patients in total hip arthroplasty (THA). In a strict sense, however, since there can be racial differences among their anatomical morphologies, it is clinically important to reconsider those parameters for the Japanese. In the present study, in order to investigate correlations among hip and pelvic morphometric parameters, frontal radiographs were taken from 98 Japanese adults (60 males and 38 females) without acetabular dysplasia and arthropathy in the standing position. Their mean age was 62.0 ± 16.7 years. The horizontal position of HRC was significantly correlated with the pelvic width in both genders (P = 0.0026 and 0.0010 for the males and the females, resp.). The vertical position of HRC was significantly correlated with the teardrop-sacroiliac distance in the males (P = 0.0003) and with the pelvic cavity height in the females (P = 0.0067). However, in both genders, there were no correlations among FO and the other parameters analyzed in this study. Our present findings might contribute to theoretical implications of an appropriate HRC position for Japanese OA patients in THA. PMID:26576428

  13. Radiographic Determination of Hip Rotation Center and Femoral Offset in Japanese Adults: A Preliminary Investigation toward the Preoperative Implications in Total Hip Arthroplasty

    PubMed Central

    Takamatsu, Taichiro; Shishido, Takaaki; Takahashi, Yasuhito; Masaoka, Toshinori; Tateiwa, Toshiyuki; Kubo, Kosuke; Endo, Kenji; Aoki, Masaya; Yamamoto, Kengo

    2015-01-01

    The values of hip rotation center (HRC) and femoral offset (FO) evaluated according to Caucasian anatomical landmarks have been regarded as a useful reference also for Japanese patients in total hip arthroplasty (THA). In a strict sense, however, since there can be racial differences among their anatomical morphologies, it is clinically important to reconsider those parameters for the Japanese. In the present study, in order to investigate correlations among hip and pelvic morphometric parameters, frontal radiographs were taken from 98 Japanese adults (60 males and 38 females) without acetabular dysplasia and arthropathy in the standing position. Their mean age was 62.0 ± 16.7 years. The horizontal position of HRC was significantly correlated with the pelvic width in both genders (P = 0.0026 and 0.0010 for the males and the females, resp.). The vertical position of HRC was significantly correlated with the teardrop-sacroiliac distance in the males (P = 0.0003) and with the pelvic cavity height in the females (P = 0.0067). However, in both genders, there were no correlations among FO and the other parameters analyzed in this study. Our present findings might contribute to theoretical implications of an appropriate HRC position for Japanese OA patients in THA. PMID:26576428

  14. Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry.

    PubMed

    Lee, Sahnghoon; Hwang, Jee-In; Kim, Yunjung; Yoon, Pil Whan; Ahn, Jeonghoon; Yoo, Jeong Joon

    2016-01-01

    The aim of this study was to examine the incidence and trends of clinically relevant venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) after hip and knee replacement arthroplasty (HKRA) in Korea. Between January 1 and December 31, 2010, 22,127 hip replacement arthroplasty (HRA) patients and 52,882 knee replacement arthroplasty (KRA) patients were enrolled in the analysis using the administrative claims database of the Health Insurance Review and Assessment Service (HIRA). All available parameters including procedure history and clinically relevant VTE during the 90 days after HKRA were identified based on diagnostic and electronic data interchange (EDI) codes. The overall incidence of VTE, DVT, and PE during the 90 days was 3.9% (n=853), 2.7% (n=597), and 1.5% (n=327) after HRA, while the incidence was 3.8% (n=1,990), 3.2% (n=1,699), and 0.7% (n=355) after KRA. The incidence of VTE after HKRA was significantly higher in patients who had previous VTE history (odds ratio [OR], 10.8 after HRA, OR, 8.5 after KRA), chronic heart failure (2.1, 1.3), arrhythmia (1.8, 1.7), and atrial fibrillation (3.4, 2.1) than in patients who did not. The VTE incidence in patients with chemoprophylaxis was higher than that in patients without chemoprophylaxis. The incidence of VTEs revealed in this retrospective review was not low compared with the results of the studies targeting other Asian or Caucasian populations. It may warrant routine prevention including employment of chemoprophylaxis. However, the limitation of the reviewed data mandates large scale prospective investigation to affirm this observation. PMID:26770042

  15. Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry

    PubMed Central

    2016-01-01

    The aim of this study was to examine the incidence and trends of clinically relevant venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) after hip and knee replacement arthroplasty (HKRA) in Korea. Between January 1 and December 31, 2010, 22,127 hip replacement arthroplasty (HRA) patients and 52,882 knee replacement arthroplasty (KRA) patients were enrolled in the analysis using the administrative claims database of the Health Insurance Review and Assessment Service (HIRA). All available parameters including procedure history and clinically relevant VTE during the 90 days after HKRA were identified based on diagnostic and electronic data interchange (EDI) codes. The overall incidence of VTE, DVT, and PE during the 90 days was 3.9% (n=853), 2.7% (n=597), and 1.5% (n=327) after HRA, while the incidence was 3.8% (n=1,990), 3.2% (n=1,699), and 0.7% (n=355) after KRA. The incidence of VTE after HKRA was significantly higher in patients who had previous VTE history (odds ratio [OR], 10.8 after HRA, OR, 8.5 after KRA), chronic heart failure (2.1, 1.3), arrhythmia (1.8, 1.7), and atrial fibrillation (3.4, 2.1) than in patients who did not. The VTE incidence in patients with chemoprophylaxis was higher than that in patients without chemoprophylaxis. The incidence of VTEs revealed in this retrospective review was not low compared with the results of the studies targeting other Asian or Caucasian populations. It may warrant routine prevention including employment of chemoprophylaxis. However, the limitation of the reviewed data mandates large scale prospective investigation to affirm this observation. PMID:26770042

  16. A comprehensive joint replacement program for total knee arthroplasty: a descriptive study

    PubMed Central

    Cook, Jon R; Warren, Meghan; Ganley, Kathleen J; Prefontaine, Paul; Wylie, Jack W

    2008-01-01

    Background Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP) – and report post-surgical outcomes. Methods 74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period. Results All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90° (91.7 ± 5.4°), but did not achieve the knee extension ROM goal of 0° (2.4 ± 2.6°). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period. Conclusion The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe

  17. Preoperative prediction of potentially preventable morbidity after fast-track hip and knee arthroplasty: a detailed descriptive cohort study

    PubMed Central

    Petersen, Morten Aa; Kehlet, Henrik

    2016-01-01

    Objectives Construction of a simple preoperative risk score for patients in high risk of potentially preventable ‘medical’ complications. Secondary objectives were to construct simple preoperative risk scores for ‘severe medical’, ‘surgical’ and ‘total’ potentially preventable complications. Design Prospective observational study. Setting Elective primary unilateral total hip and knee arthroplasty with prospectively collected preoperative patient characteristics; similar standardised fast-track protocols; evaluation of complications through discharge and medical records; and complete 90 days follow-up through nationwide databases. Participants 8373 consecutive unselected total hip arthroplasty (THA) and knee arthroplasty from January 2010 to November 2012. Results There were 557 procedures (6.4%) followed by potentially preventable complications resulting in hospitalisation >4 days or readmission. Of 22 preoperative characteristics, 7 were associated with 379 (4.2%) potentially preventable ‘medical’ complications. Patients with ≥2 of the following, age ≥80 years, anticoagulant therapy, pulmonary disease, pharmacologically treated psychiatric disorder, anaemia and walking aids, composed 19.1% of the procedures; 55.7% constituted potentially preventable ‘medical’ complications that were mainly falls, mobilisation issues, pneumonias and cardiac arrhythmias. The number needed to be treated for a hypothetical intervention leading to 25% reduction in potentially preventable ‘medical’ complications was 34. THA, use of walking aids and cardiac disease were associated with 189 (2.2%) ‘surgical’ complications, but no clinically relevant preoperative prediction was possible. Conclusions Preoperative identification of patients at high risk of preventable ‘medical’, but not ‘surgical’, complications is statistically possible. However, clinical relevance is limited. Future risk indices should differ between ‘medical’ and

  18. Cost benefit analysis of the use of tranexamic acid in primary lower limb arthroplasty: A retrospective cohort study

    PubMed Central

    McGoldrick, Niall P; O’Connor, Eabhann M; Davarinos, Nikos; Galvin, Rose; Quinlan, John F

    2015-01-01

    AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid (TXA) in lower limb arthroplasty. METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients (control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients (TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken. RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender (P = 0.47), proportion of total hip replacement to total knee replacement (P = 0.25) or pre-operative haemoglobin (P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2% (P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55 g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group (P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group (P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group. CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings. PMID:26716094

  19. Robotic-assisted knee arthroplasty.

    PubMed

    Banerjee, Samik; Cherian, Jeffrey J; Elmallah, Randa K; Jauregui, Julio J; Pierce, Todd P; Mont, Michael A

    2015-01-01

    Robotics in total knee arthroplasty (TKA) has undergone vast improvements. Although some of the systems have fallen out of favor due to safety concerns, there has been recent increased interest for semi-active haptic robotic systems that provide intraoperative tactile feedback to the surgeon. The potential advantages include improvements in radiographic outcomes, reducing the incidence of mechanical axis malalignment of the lower extremity and better tissue balance. Proponents of robotic technology believe that these improvements may lead to superior functional outcomes and implant survivorship. We aim to discuss robotic technology development, outcomes of unicompartmental and total knee arthroplasty and the future outlook. Short-term follow-up studies on robotic-assisted knee arthroplasty suggest that, although some alignment objectives may have been achieved, more studies regarding functional outcomes are needed. Furthermore, studies evaluating the projected cost-benefit analyses of this new technology are needed before widespread adoption. Nevertheless, the short-term results warrant further evaluation. PMID:26365088

  20. Outcome of Unicompartmental Knee Arthroplasty: A Systematic Review of Comparative Studies between Fixed and Mobile Bearings Focusing on Complications

    PubMed Central

    Ko, Young-Bong; Gujarathi, Manan Ramesh

    2015-01-01

    The purpose of this systematic review is to collate results of studies comparing fixed and mobile bearing unicompartmental knee arthroplasty (UKA), focusing on complications and timing for reoperations. Out of 723 results derived from PubMed, EMBASE and Cochrane database search engines on bearings in arthroplasty, 10 studies comparing clinical results of fixed bearings to mobile bearings in UKA were found eligible for analysis. The reoperation rate was calculated using a novel method such as reoperations per hundred component years, and the causes of specific reoperations were investigated. The overall reoperation rate per hundred component years was similar between the mobile bearings (1.392) and fixed bearings (1.377); however, mobile bearings were more susceptible to reoperations in cases with aseptic loosening (0.393>0.255), progression of arthritis (0.428>0.357) and implant dislocation (0.286>0). The overall incidence of complications is similar for fixed and mobile bearing designs in UKA. The discussion on complications presented above may assist surgeons in their choice of bearing design. PMID:26389066

  1. Outcome of Unicompartmental Knee Arthroplasty: A Systematic Review of Comparative Studies between Fixed and Mobile Bearings Focusing on Complications.

    PubMed

    Ko, Young-Bong; Gujarathi, Manan Ramesh; Oh, Kwang-Jun

    2015-09-01

    The purpose of this systematic review is to collate results of studies comparing fixed and mobile bearing unicompartmental knee arthroplasty (UKA), focusing on complications and timing for reoperations. Out of 723 results derived from PubMed, EMBASE and Cochrane database search engines on bearings in arthroplasty, 10 studies comparing clinical results of fixed bearings to mobile bearings in UKA were found eligible for analysis. The reoperation rate was calculated using a novel method such as reoperations per hundred component years, and the causes of specific reoperations were investigated. The overall reoperation rate per hundred component years was similar between the mobile bearings (1.392) and fixed bearings (1.377); however, mobile bearings were more susceptible to reoperations in cases with aseptic loosening (0.393>0.255), progression of arthritis (0.428>0.357) and implant dislocation (0.286>0). The overall incidence of complications is similar for fixed and mobile bearing designs in UKA. The discussion on complications presented above may assist surgeons in their choice of bearing design. PMID:26389066

  2. I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study

    PubMed Central

    2012-01-01

    Background Total knee arthroplasty (TKA) is often associated with a severe local inflammatory reaction which, unless controlled, leads to persistent pain up to one year after surgery. Standard and accelerated rehabilitation protocols are currently being implemented after TKA, but no consensus exists regarding the long-term effects. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has been demonstrated to exert an anti-inflammatory effect, to promote early functional recovery and to maintain a positive long-term effect in patients undergoing joint arthroscopy. The aim of this study was to evaluate whether PEMFs can be used to limit the pain and enhance patient recovery after TKA. Methods A prospective, randomized, controlled study in 30 patients undergoing TKA was conducted. Patients were randomized into experimental PEMFs or a control group. Patients in the experimental group were instructed to use I-ONE stimulator 4hours/day for 60days. Postoperatively, all patients received the same rehabilitation program. Treatment outcome was assessed using the Knee Society Score, SF-36 Health-Survey and VAS. Patients were evaluated pre-operatively and one, two, six and 12 months after TKA. Joint swelling and Non Steroidal Anti Inflammatory Drug (NSAID) consumption were recorded. Comparisons between the two groups were carried out using a two-tail heteroschedastic Student’s t-test. Analysis of variance for each individual subject during the study was performed using ANOVA for multiple comparisons, applied on each group, and a Dunnet post hoc test. A p value < 0.05 was considered statistically significant. Results Pre-operatively, no differences were observed between groups in terms of age, sex, weight, height, Knee-Score, VAS, SF-36 and joint swelling, with the exception of the Functional Score. The Knee-Score, SF-36 and VAS demonstrated significantly positive outcomes in the I-ONE stimulated group compared with the controls at follow-ups. In the I

  3. Effect of total knee arthroplasty on type II diabetes mellitus and hypertension: A prospective study

    PubMed Central

    Vaidya, Shrinand V; Arora, Arvind; Mathesul, Ambarish A

    2013-01-01

    Context: Advanced osteoarthritis of knee joint if bilateral, severely restricts patient mobility. This acts as an aggravating factor for pre existing comorbid elements of metabolical syndrome (MS) like Type II diabetes mellitus and hypertension as patients are unable to carry out therapeutic walks. Successfully implanted total knee arthroplasty (TKA) increases physical activity and enables to carry out therapeutic walks thus may help in better control of type II diabetes mellitus and hypertension. The objective of this prospective study was to find whether TKA for osteoarthritis knee had any effect to improve blood glucose levels and reduce blood pressure. Materials and Methods: A prospective study was done in which patients operated for tricompartmental osteoarthritis of knee with associated comorbidities like Type II diabetes mellitus or hypertension during a period of 2008 and 2009 were studied. One hundred and twenty patients were enrolled (55 diabetics, 65 hypertensives) who met our inclusion criteria. Preoperative knee society score, lower extremity activity scale fasting blood glucose level and systolic and diastolic blood pressure were compared with one year followup values. The KSS and LEAS scores were analysed by the Wilcoxon signed ranked test, while the fasting blood glucose (FBG) levels and systolic and diastolic blood pressure levels were analysed by paired ‘t’ test. Results: The reduction of systolic blood pressure by 8 mmHg (t = 5.6, P value < 0.05) and diastolic blood pressure by 6 mmHg (t = 7.6, P value < 0.05) was recorded which was statistically significant. However, no statistically significant effect on fasting blood glucose levels was observed (t = -0.77, P value = 0.442). KSS improved in DM from preoperative 29 to 86 and LEAS improved from 6.7 to 11.3. Conclusions: Authors are of the opinion that successful total knee replacement results in increased physical activity and reduces blood pressure (systolic and diastolic) in hypertensives

  4. Analysis of methodological deficiencies of studies reporting surgical outcome following cemented total-joint arthroplasty of trapezio-metacarpal joint of the thumb

    PubMed Central

    Gul, Arif; Priyanka, P

    2006-01-01

    Cemented total-joint arthroplasty has been increasingly used in the treatment of end stage arthritis of the thumb trapeziometacarpal joint. Evidence supporting its use in the treatment of trapeziometacarpal disorders in the literature is very limited. Most hand surgeons agree that there are concerns about the methodological quality of the limited literature available. In this study, we analysed the methodological quality of the outcome studies on cemented total-joint arthroplasty of the thumb. We included all the outcome studies published in the English literature on cemented total-joint arthroplasty of the trapeziometacarpal joint of thumb. We analysed these studies for methodological deficiencies and quality of outcome reporting based on the recommendations given by Coleman et al. Our study revealed that there were no uniform standards of outcome reporting. The mean Coleman score for the studies dealing with cemented total-joint arthroplasty of the thumb was 42.9. Major deficiencies were identified in areas like subject selection criteria (0/15), type of study (5.7/15), description of surgical procedure (3.7/5), description of the rehabilitation protocol (2/10), outcome measures (4.4/10) and outcome assessment (3.9/15). The methodological quality of the studies published within the last 10 years (49.9±9.7) was found to be slightly better than the studies published over 10 years ago (39.7±7.8). Our study highlights the need for more evidence in the form of randomised controlled prospective studies conducted with good methodological quality, comparing the cemented total-joint arthroplasty of the thumb to other procedures available for the treatment of disorders of the thumb. Further, to improve the standards of reporting, journal editors should try to standardise the outcome of the reporting by following the surgical procedures on the thumb. PMID:17021833

  5. Migration and wear of hydroxyapatite-coated press-fit cups in revision hip arthroplasty: a radiostereometric study.

    PubMed

    Nivbrant, B; Kärrholm, J

    1997-12-01

    Screw-fixated and hydroxyapatite-coated press-fit cups were studied using radiostereometry in 29 revision and 14 primary arthroplasties. The acetabular defects in the revision cases varied from none to type 3 (wall defects) according to Gustilo-Pasternak. Morsellized allograft was used in 25 revisions. Nine of these cups rested on less than 50% living bone. After 2 years, the mean migration in the revised group reached 0.36, 0.21, and 0.49 mm in the horizontal, longitudinal, and anteroposterior (AP) directions. The mean rotations varied between 0.5 degrees and 0.7 degrees depending on direction. The primary implants displayed smaller mediolateral migration and AP tilt. The mean proximal wear rate for the whole group was 0.11 mm/y. A central gap on the postoperative AP view implied less migration. The size of the preoperative bone defects or amount of bone-graft used had no influence on the migration. Despite extensive use of morsellized allograft, this implant displayed the smallest migration so far reported in revision hip arthroplasty. PMID:9458256

  6. Inequalities in use of total hip arthroplasty for hip fracture: population based study

    PubMed Central

    Metcalfe, David; Griffin, Xavier L; Costa, Matthew L

    2016-01-01

    Objectives To determine whether the use of total hip arthroplasty (THA) among individuals with a displaced intracapsular fracture of the femoral neck is based on national guidelines or if there are systematic inequalities. Design Observational cohort study using the National Hip Fracture Database (NHFD). Setting All hospitals that treat adults with hip fractures in England, Wales, and Northern Ireland. Participants Patients within the national database (all aged ≥60) who received operative treatment for a non-pathological displaced intracapsular hip fracture from 1 July 2011 to 31 April 2015. Main outcome measures Provision of THA to patients considered eligible under criteria published by the National Institute for Health and Care Excellence (NICE). Results 114 119 patients with hip fracture were included, 11 683 (10.2%) of whom underwent THA. Of those who satisfied the NICE criteria, 32% (6780)received a THA. Of patients who underwent THA, 42% (4903) did not satisfy the NICE criteria. A recursive partitioning algorithm found that the NICE eligibility criteria did not optimally explain which patients underwent THA. A model with superior explanatory power drew distinctions that are not supported by NICE, which were an age cut off at 76 and a different ambulation cut off. Among patients who satisfied the NICE eligibility, the use of THA was less likely with higher age (odds ratio 0.88, 95% confidence interval 0.87 to 0.88), worsening abbreviated mental test scores (0.49 (0.41 to 0.58) for normal cognition v borderline cognitive impairment)), worsening American Society of Anesthesiologists score (0.74, 0.66 to 0.84), male sex (0.85, 0.77 to 0.93), worsening ambulatory status (0.32, 0.28 to 0.35 for walking with a stick v independent ambulation), and fifths of worsening socioeconomic area deprivation (0.76 (0.66 to 0.88) for least v most deprived fifth). Patients receiving treatment during the working week were more likely to receive THA than at the

  7. Biofeedback to Promote Movement Symmetry After Total Knee Arthroplasty: A Feasibility Study

    PubMed Central

    ZENI, JOSEPH; ABUJABER, SUMAYAH; FLOWERS, PORTIA; POZZI, FEDERICO; SNYDER-MACKLER, LYNN

    2014-01-01

    STUDY DESIGN Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point. OBJECTIVES To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA). BACKGROUND TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes. METHODS Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean ± SD age, 61.4 ± 5.8 years; body mass index, 33.1 ± 5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean ± SD age, 61.8 ± 5 years; body mass index, 34.3 ± 5.1 kg/m2), that did not receive specialized symmetry retraining. RESULTS Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol. CONCLUSION Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared

  8. Failure of aseptic revision total knee arthroplasties

    PubMed Central

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-01-01

    Background and purpose In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. Method This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. Results 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). Interpretation In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties. PMID:25267502

  9. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study.

    PubMed

    Klatte, Till Orla; Kendoff, Daniel; Sabihi, Reza; Kamath, Atul F; Rueger, Johannes M; Gehrke, Thorsten

    2014-07-01

    During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction. PMID:24559522

  10. Arthroplasty of the elbow in rheumatoid arthritis.

    PubMed

    Kimura, C; Vainio, K

    1976-05-21

    The study consists of 208 elbow arthroplasties performed on rheumatoid arthritic patients. A straight resection of the joint was used in 53 cases and a modified Hass arthroplasty with skin interposition in 155 cases. The average postoperative range of motion in these groups was 100 degrees and 96 degrees respectively. Postoperatively the joint was painless in 81 and 67% of the elbows respectively. The Hass arthroplasty gave a better stability and extension power. The most common complications were paresthesias in the region of the ulnar nerve and bone resorption in the region of the ulnar nerve and bone resorption in the region of the olecranon fossa. PMID:779734

  11. Total shoulder arthroplasty outcome for treatment of osteoarthritis: a multicenter study using a contemporary implant.

    PubMed

    Wright, Thomas W; Flurin, Pierre-Henri; Crosby, Lynn; Struk, Aimee M; Zuckerman, Joseph D

    2015-11-01

    In this article, we present clinical results of primary total shoulder arthroplasty for osteoarthritis using an implant that provides dual eccentricity and variable neck and version angles for reconstruction of proximal humeral anatomy. Two hundred one patients with symptomatic osteoarthritis underwent 218 total shoulder arthroplasties with a fourth-generation anatomical shoulder and a replicator plate at 4 centers between August 1, 2006, and December 31, 2010. Fourth-generation implants allow for varying humeral neck and version angles and have dual eccentricity so as to be consistently able to cover the humeral head cut. At a mean follow-up of 3 years (minimum, 2 years), there was an 81% follow-up rate. At final follow-up, 3 objective measures were significantly (P < .05) improved over preoperative levels: average active elevation (preoperative, 92°; postoperative, 137°), active external rotation (pre, 15°; post, 42°), and active internal rotation (pre, S3; post, L2). The functional outcome scores that were significantly (P < .05) improved at final follow-up were Constant normalized (pre, 39; post, 79), Shoulder Pain and Disability Index (pre, 86; post, 20), Simple Shoulder Test (pre, 3.3; post, 10), UCLA Shoulder Rating Scale (pre, 13; post, 31), and American Shoulder and Elbow Surgeons Shoulder Assessment (pre, 33; post, 85). Complications were noted in 11% of the shoulders. The most common complications were rotator cuff failure (13, 6%) and infection (5, 2%). PMID:26566554

  12. Anabolic steroids after total knee arthroplasty. A double blinded prospective pilot study

    PubMed Central

    2010-01-01

    Background Total knee arthroplasty is reported to improve the patient's quality of life and mobility. However loss of mobility and pain prior to surgery often results in disuse atrophy of muscle. As a consequence the baseline functional state prior to surgery may result in poorer outcome "post surgery" and extended rehabilitation may be required. The use of anabolic steroids for performance enhancement and to influence muscle mass is well established. The positive effects of such treatment on bone and muscle could therefore be beneficial in the rehabilitation of elderly patients. The purpose of this study was to investigate the effects of small doses of Nandrolone decanoate on recovery and muscle strength after total knee replacement and to establish the safety of this drug in multimorbid patients. Methods This study was designed as a prospective double blind randomized investigation. Five patients (treatment group) with a mean age of 66.2 (58-72), average BMI of 30.76 (24.3-35.3) received 50 mg nandrolone decanoate intramuscular bi-weekly for 6 months. The control group (five patients; mean age 65.2, range 59-72; average BMI 31.7, range 21.2-35.2) was injected with saline solution. "Pre-operatively" and "post-operatively" (6 weeks, 3,6,9 and 12 months) all patients were assessed using the knee society score (KSS), isokinetic strength testing and functional tests (a sit-to-stand and timed walking tests). In addition, a bone density scan was used preoperatively and 6 month postoperatively to assess bone mineral density. Results Whilst the steroid group generally performed better than the placebo group for all of the functional tests, ANOVA failed to reveal any significant differences. The steroid group demonstrated higher levels of quadriceps muscle strength across the postoperative period which reached significance at 3 (p = 0.02), 6 (p = 0.01), and 12 months (p = 0.02). There was a significant difference for the KSS at 6 weeks (p = 0.02), 6 (p = 0.02) and 12 month

  13. Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study

    PubMed Central

    2010-01-01

    Background Supervised preoperative muscle strengthening programmes (prehabilitation) can improve recovery after total joint arthroplasty but are considered resource intensive. Neuromuscular electrical stimulation (NMES) has been shown to improve quadriceps femoris muscle (QFM) strength and clinical function in subjects with knee osteoarthritis (OA) however it has not been previously investigated as a prehabilitation modality. Methods This pilot study assessed the compliance of a home-based, NMES prehabilitation programme in patients undergoing total knee arthroplasty (TKA). We evaluated its effect on preoperative and postoperative isometric quadriceps femoris muscle (QFM) strength, QFM cross-sectional area (CSA) and clinical function (subjective and objective). Seventeen subjects were recruited with 14 completing the study (NMES group n = 9; Control group n = 5). Results Overall compliance with the programme was excellent (99%). Preoperative QFM strength increased by 28% (p > 0.05) with associated gains in walk, stair-climb and chair-rise times (p < 0.05). Early postoperative strength loss (approximately 50%) was similar in both groups. Only the NMES group demonstrated significant strength (53.3%, p = 0.011) and functional recovery (p < 0.05) from 6 to 12 weeks post-TKA. QFM CSA decreased by 4% in the NMES group compared to a reduction of 12% in the control group (P > 0.05) at 12 weeks postoperatively compared to baseline. There were only limited associations found between objective and subjective functional outcome instruments. Conclusions This pilot study has shown that preoperative NMES may improve recovery of quadriceps muscle strength and expedite a return to normal activities in patients undergoing TKA for OA. Recommendations for appropriate outcome instruments in future studies of prehabilitation in TKA have been provided. PMID:20540807

  14. Biomechanical and histologic investigation of cemented total hip arthroplasties. A study of autopsy-retrieved femurs after in vivo cycling.

    PubMed

    Maloney, W J; Jasty, M; Burke, D W; O'Connor, D O; Zalenski, E B; Bragdon, C; Harris, W H

    1989-12-01

    Eleven whole anatomic specimens of the femur were retrieved at autopsy from patients who previously had cemented total hip arthroplasty. Implant duration ranged from 0.5 to 210 months. Clinically and roentgenographically the implants were stable. A detailed biomechanical analysis evaluated bone strains and implant stability in both the single-limb stance and stair-climbing positions using a 100-pound spinal load. The stability offered by cement in these well-fixed prostheses was remarkable, with the maximum axial micromotion being 40 mu. This is a reflection of intimate osseointegration at the bone-cement interface with only rare intervening fibrous tissue. The strain gauge and photoelastic strain-coating studies revealed that marked stress shielding in the proximal medial femoral cortex persists long after a cemented femoral component is inserted. Even 17 years after surgery, the strain in the calcar region did not normalize. PMID:2582664

  15. Sleep Quality Effects Recovery After Total Knee Arthroplasty (TKA)--A Randomized, Double-Blind, Controlled Study.

    PubMed

    Gong, Long; Wang, ZhenHu; Fan, Dong

    2015-11-01

    This study examined the effects of sleep quality on early recovery after total knee arthroplasty. A total of 148 patients were randomized 1:1 to receive either zolpidem or placebo for 2 weeks. VAS pain scores (rest, ambulation and night), range of motion (ROM), total amount of opioid analgesics and antiemetics taken, postoperative nausea and vomiting (PONV), sleep efficacy and satisfaction were recorded. It was found that patients taking zolpidem achieved greater improvement in quality of life and reported better satisfaction. Patients in the intervention group had lower pain score and took less antiemetics. Moreover, a significant correlation between sleep quality and ROM was detected. These results demonstrated that improved sleep quality is beneficial to patients' post-TKA recovery. PMID:26344094

  16. Biomechanical Study of Lumbar Spinal Arthroplasty with a Semi-Constrained Artificial Disc (Activ L) in the Human Cadaveric Spine

    PubMed Central

    Ha, Sung-Kon; Kim, Daniel H.; Park, Jung-Yul; Lim, Dong-Jun; Lee, Sang-Kook

    2009-01-01

    Objective The goal of this study was to evaluate the biomechanical features of human cadaveric spines implanted with the Activ L prosthesis. Methods Five cadaveric human lumbosacral spines (L2-S2) were tested for different motion modes, i.e. extension and flexion, right and left lateral bending and rotation. Baseline measurements of the range of motion (ROM), disc pressure (DP), and facet strain (FS) were performed in six modes of motion by applying loads up to 8 Nm, with a loading rate of 0.3 Nm/second. A constant 400 N axial follower preload was applied throughout the loading. After the Activ L was implanted at the L4-L5 disc space, measurements were repeated in the same manner. Results The Activ L arthroplasty showed statistically significant decrease of ROM during rotation, increase of ROM during flexion and lateral bending at the operative segment and increase of ROM at the inferior segment during flexion. The DP of the superior disc of the operative site was comparable to those of intact spine and the DP of the inferior disc decreased in all motion modes, but these were not statistically significant. For FS, statistically significant decrease was detected at the operative facet during flexion and at the inferior facet during rotation. Conclusion In vitro physiologic preload setting, the Activ L arthroplasty showed less restoration of ROM at the operative and adjacent levels as compared with intact spine. However, results of this study revealed that there are several possible theoretical useful results to reduce the incidence of adjacent segment disease. PMID:19352479

  17. Evaluation of Distal Femoral Rotational Alignment with Spiral CT Scan before Total Knee Arthroplasty (A Study in Iranian population)

    PubMed Central

    Jabalameli, Mahmoud; Moradi, Amin; Bagherifard, Abolfazl; Radi, Mehran; Mokhtari, Tahmineh

    2016-01-01

    Background: Evaluating the landmarks for rotation of the distal femur is a challenge for orthopedic surgeons. Although the posterior femoral condyle axis is a good landmark for surgeons, the surgical transepicondylar axis may be a better option with the help of preoperative CT scanning. The purpose of this study was to ascertain relationships among the axes’ guiding distal femur rotational alignment in preoperative CT scans of Iranian patients who were candidates for total knee arthroplasty and the effects of age, gender, and knee alignment on these relationships. Methods: One hundred and eight cases who were admitted to two university hospitals for total knee arthroplasty were included in this study. The rotation of the distal femur was evaluated using single axial CT images through the femoral epicondyle. Four lines were drawn digitally in this view: anatomical and surgical transepicondylar axes, posterior condylar axis and the Whiteside anteroposterior line. The alignment of the extremity was evaluated in the standing alignment view. Then the angles were measured along these lines and their relationship was evaluated. Results: The mean angle between the anatomical transepicondylar axis and posterior condylar axis and between the surgical transepicondylar axis and posterior condylar axis were 5.9 ± 1.6 degrees and 1.6±1.7 degrees respectively. The mean angle between the Whiteside’s anteroposterior line and the line perpendicular to the posterior condylar axis was 3.7±2.1 degrees. Significant differences existed between the two genders in these relationships. No significant correlation between the age of patients and angles of the distal femur was detected. The anatomical surgical transepicondylar axis was in 4.3 degrees external rotation in relation to the surgical transepicondylar axis. Conclusion: Preoperative CT scanning can help accurately determine rotational landmarks of the distal femur. If one of the reference axes cannot be determined, other

  18. Preliminary study for the OFFELO

    SciTech Connect

    Hao, Y.; Litvinenko, V.N.

    2010-08-23

    X-ray Optics-Free FEL Oscillator (OFFELO) has potential of becoming a choice for next generation light sources. Using electron beam for the feedback allows OFFELO to be completely tunable and to combine the peak power of high-gain SASE FELs with extremely narrow bandwidth of the oscillator. While the high-gain X-ray FELs has been studied in depth and has been successfully demonstrated, two other concepts (the transport and the feed-back) involved in OFFELO still need detail studies. In this short paper we focus on the simulation of the feedback process and the evolution of FEL spectrum in X-ray OFFELO. In our initial studies of OFFELO studied the saturation of the system and also its evolution using Genesis 2.0 code with a homemade wrapping code. While and lattice design from the modulator to the radiator, in order to minimize the feedback information loss in transporting the beam.

  19. Uncemented total hip arthroplasty in patients younger than 50 years: a 6- to 10-year follow-up study.

    PubMed

    Liang, Tian J; You, Mu Z; Xing, Pei F; Bin, Shen; Ke, Zhou Zhong; Jing, Yang

    2010-04-01

    Young patients are expected to place increased demands on total hip arthroplasty (THA) because they are more active and have a longer life expectancy. The long-term outcome of the Charnley low-friction arthroplasty in young, active patients has been shown to be associated with a high degree of polyethylene wear and osteolysis. However, cementless acetabular components have been shown to be successful in young patients.We evaluated the clinical and radiographic results of 77 cementless THAs in 81 young, active patients at a mean follow-up of 7.5 years. Mean preoperative Harris Hip Score improved from 46.24 to 96.5 points at 6 years. One acetabular component showed aseptic loosening 10 years postoperatively. Three patients (3 hips) underwent bone grafts and liner renewal for severe osteolysis around the acetabular component. The rate of survival at 6 years for loosening was 98.8%, and for revision of the liner was 95.5% (95% confidence interval, 93%-98%). Mean liner wear rate was 0.125 mm/year (range, 0.0-0.39 mm/year). Acetabular osteolysis was found in 14% (9 hips) of the 67 hips and was related to polyethylene wear (P=.0024). Although there was only 1 cup loosening in this study, there was a high rate of linear wear of the polyethylene liner and acetabular osteolysis in young, active patients. Further follow-up is therefore needed, and osteolysis and polyethylene wear should continue to be observed in young, active patients. PMID:20415300

  20. Prospective study of the cementless "New Wave" total knee mobile-bearing arthroplasty: 8-year follow-up.

    PubMed

    Normand, Xavier; Pinçon, Jean-Louis; Ragot, Jean-Marie; Verdier, Régis; Aslanian, Thierry

    2015-02-01

    One of the main factors affecting the survival of a total knee arthroplasty (TKA) is the fixation method. The constraints placed on the bone-implant interface of a mobile-bearing TKA must be taken in account during the design and evaluation phases. For more than two decades, calcium phosphate ceramics, particularly hydroxyapatitis, have been used in Europe to accelerate the bone integration of cementless implants. A prospective study of patients continuously recruited by three senior surgeons at three French private hospitals has been carried out. There were no exclusion criteria. Eighty-four (84) cementless mobile-bearing total knee prosthesis of the brand "New Wave" were implanted in 74 patients over a 2-year period (2004-2005). Implant survival at 8 years was 95% [with a confidence interval of 95%: 80.2-96.4%] when revision for any cause was defined as the endpoint. Five implants required surgical revision to exchange all or part of the implant: two for aseptic loosening of tibial component, one for osteolysis, one for persistent flessum (30°) and one for tibial periprosthetic fracture. Completely integrated implants and event-free outcomes were recorded in 91.4% of the cases at eight-year follow-up. The Hospital for Special Surgery score significantly improved from 56.8/100 points before the surgery to 83.9/100 points at the last follow-up (p < 0.05). Radiologically, only one patient had radiolucent lines around the tibial and femoral components. This cementless total knee prosthesis yielded good medium-term survival. Cementless arthroplasty can generate solid and durable bone fixation in this total weight-bearing implant, and it seems that the hidroxyapathitis surface in this series stimulate the bone integration at the bone-implant interface. PMID:24858380

  1. Time Trends in Total Ankle Arthroplasty in the U.S.: A Study of the Nationwide Inpatient Sample

    PubMed Central

    Singh, Jasvinder A.; Ramachandaran, Rekha

    2014-01-01

    Objective To assess the time-trends in utilization, clinical characteristics and outcomes of patients undergoing total ankle arthroplasty (TAA) in the U.S. Methods We used the Nationwide Inpatient Sample (NIS) data from 1998 to 2010 to examine time-trends in the utilization rates of TAA. We used the Cochran Armitage test for trend to assess time-trends across the years and the analysis of variance (ANOVA), Wilcoxon test or chi-squared test (as appropriate) to compare the first (1998–2000) and the last time periods (2009–10). Results TAA utilization rate increased significant from 1998 to 2010: 0.13 to 0.84 per 100,000 overall, 0.14 to 0.88 per 100,000 in females and from 0.11 to 0.81 per 100,000 in males (p<0.0001 for each comparison for time-trends). Compared to the 1998–2000, those undergoing TAA in 2009–10: were older (41% fewer patients <50 years, p<0.0001); less likely to have RA as the underlying diagnosis (55% fewer patients, p=0.0001); more likely to have Deyo-Charlson index of two or more (197% more, p=0.0010); and had a shorter length of stay at 2.5 days (17% reduction, p<0.0001). Mortality was rare, ranging 0 to 0.6% and discharge to inpatient facility ranged 12.6–14.1%; we noted no significant time-trends in either (p>0.05). Conclusions The utilization rate of TAA increased rapidly in the U.S. from 1998 to 2010, but post-arthroplasty mortality rate was stable. Underlying diagnosis and medical comorbidity changed over time and both can impact outcomes after TAA. Further studies should examine how the outcomes and complications of TAA have evolved over time. PMID:24907036

  2. Cuban Identity: A Preliminary Study.

    ERIC Educational Resources Information Center

    Alvarez, Carlos; Bliss, Linda A.; Vigil, Peter

    This study explored patterns of differences and commonalities in the constructions of identity by Cuban Americans, focusing on the pain of their experiencing "Paradise Lost," a theme identified in earlier research in which Cuban American college students reported: strong Cuban connections; value for the Spanish language, food, and culture; and a…

  3. Total Shoulder Arthroplasty

    PubMed Central

    Sanchez-Sotelo, Joaquin

    2011-01-01

    Shoulder arthroplasty has been the subject of marked advances over the last few years. Modern implants provide a wide range of options, including resurfacing of the humeral head, anatomic hemiarthroplasty, total shoulder arthroplasty, reverse shoulder arthroplasty and trauma-specific implants for fractures and nonunions. Most humeral components achieve successful long-term fixation without bone cement. Cemented all-polyethylene glenoid components remain the standard for anatomic total shoulder arthroplasty. The results of shoulder arthroplasty vary depending on the underlying diagnosis, the condition of the soft-tissues, and the type of reconstruction. Total shoulder arthroplasty seems to provide the best outcome for patients with osteoarthritis and inflammatory arthropathy. The outcome of hemiarthroplasty for proximal humerus fractures is somewhat unpredictable, though it seems to have improved with the use of fracture-specific designs, more attention to tuberosity repair, and the selective use of reverse arthroplasty, as well as a shift in indications towards internal fixation. Reverse shoulder arthroplasty has become extremely popular for patients with cuff-tear arthropathy, and its indications have been expanded to the field of revision surgery. Overall, shoulder arthroplasty is a very successful procedure with predictable pain relief and substantial improvements in motion and function. PMID:21584206

  4. Preliminary design study of lunar housing configurations

    NASA Technical Reports Server (NTRS)

    Reynolds, K. H.

    1992-01-01

    A preliminary design study assesses various configurations for habitation of the lunar surface. The study assumes an initial 4-man habitation module expandable to a 48-man concept. Through the numerous coupling combinations of identical modules, five basic configuration types are identified. A design model presents each configuration in light of certain issues. The issues include circulation, internal and external spatial characteristics, functional organizations, and future growth potential. The study discusses the attributes, potentials, and unique requirements of each configuration.

  5. Total Knee Arthroplasty in Morbidly Obese Patients Treated with Bariatric Surgery: A Comparative Study

    PubMed Central

    Severson, Erik P.; Singh, Jasvinder A.; Browne, James A.; Trousdale, Robert T.; Sarr, Michael; Lewallen, David G.

    2012-01-01

    Our objective was to compare outcomes (anesthesia time, total operative time, tourniquet time, duration of hospital stay, 90-day complication rate and transfusion rates) of patients with total knee arthroplasty (TKA) who underwent bariatric surgery before or after TKA. One-hundred-twenty-five patients were included: TKA before bariatric surgery (group 1; n=39); TKA within two years of bariatric surgery (group 2; n=25); and TKA more than 2 years after bariatric surgery (group 3; n=61). Patients with TKA more than 2 years after bariatric surgery had shorter anesthesia, total operative and tourniquet times than other groups; differences were significant between groups. Ninety-day complication and transfusion rates approached but did not meet statistical significance. Ninety-day complication rates and duration of hospital stay did not differ significantly between the three groups. PMID:22554730

  6. Vascular complications following total hip arthroplasty: a case study and a review of the literature.

    PubMed

    Barbier, Olivier; Pierret, Charles; Bazile, Fabrice; De Kerangal, Xavier; Duverger, Vincent; Versier, Gilbert

    2012-11-01

    Vascular complications after total hip arthroplasty (THA) are rare but represent a real risk. The diversity of clinical presentations can make diagnosis difficult. They could manifest as an immediate and acute hemorrhage or subsequent ischemia. We report the case of a patient who presented a thrombosis of the femoral artery associated with a sciatic palsy after THA for a coxa profunda. The diagnosis was actually made 3 years after surgery because of atypical symptoms. The mechanism involved was either a crash of the artery by a retractor on the anterior wall of the acetabulum, or a stretching of the artery. A review of the literature of vascular complications occurring after THA recalls the multiplicity of clinical presentations and the diagnostic difficulties. They could manifest as an immediate and acute hemorrhage or deferred ischemia, as in our case. Knowledge of these complications should help prevent them, and the diagnosis should be considered in atypical sequences after THA. PMID:26662762

  7. Cervical disc arthroplasty: Pros and cons

    PubMed Central

    Moatz, Bradley; Tortolani, P. Justin

    2012-01-01

    Background: Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. Methods: This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Results: Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Conclusion: Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing. PMID:22905327

  8. Galaxy collisions - A preliminary study

    NASA Technical Reports Server (NTRS)

    Miller, R. H.; Smith, B. F.

    1980-01-01

    Collisions of spherical galaxies were studied in a series of numerical experiments to see what happens when galaxies collide. Each experiment starts with two model galaxies, each consisting of 50,000 stars, moving toward each other along a specified orbit. The series of experiments provides a systematic sampling of the parameter space spanned by the initial orbital energy and the initial angular momentum. Deeply penetrating collisions are emphasized. The collisions reported here scale to relative velocities as great as 500 km/s, well into the range for collisions within clusters of galaxies. It is found that: (1) the galaxies contract momentarily to about half their original sizes shortly after close passage; and (2) the initial galaxies blend into a single dynamical system while they are near each other.

  9. Outcomes Study of the TM Reverse Shoulder System Used in Primary or Revision Reverse Total Shoulder Arthroplasty

    ClinicalTrials.gov

    2016-05-11

    Osteoarthritis; Rheumatoid Arthritis; Post-traumatic Arthritis; Ununited Humeral Head Fracture; Irreducible 3-and 4-part Proximal Humeral Fractures; Avascular Necrosis; Gross Rotator Cuff Deficiency; Failed Total Shoulder Arthroplasty (Both Glenoid and Humeral Components Require Revision

  10. Introduction of total knee arthroplasty in Lithuania

    PubMed Central

    Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans

    2009-01-01

    Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. As in the hip replacement study, only patients with osteoarthritis (OA) were included. Primary knee arthroplasties without patellar resurfacing were included, and the endpoint was revision for any reason other than addition of a patellar component. Results We found that the cumulative revision rate was not statistically significantly different between the groups. The revision pattern was different, however, and we observed 24 isolated patellar component additions in Sweden, but none in Klaipeda. Interpretation Contrary to the results of our previous hip arthroplasty study, the cumulative revision rate after total knee arthroplasty was similar in the two groups. This suggests that compared to hip arthroplasty, the outcome of total knee arthroplasty was less dependent on surgical experience. The large difference regarding isolated patellar component additions may be explained by long-term accumulation of severe OA cases in Lithuania. To patients subject to a newly introduced surgical treatment offering great improvement in quality of life, patellofemoral pain may be a minor problem. Furthermore, patellar problems may not have seemed particularly relevant for the surgeons, considering the disability of other patients waiting to be treated. PMID:19297790

  11. Emerging Indications for Reverse Shoulder Arthroplasty.

    PubMed

    Urch, Ekaterina; Dines, Joshua S; Dines, David M

    2016-01-01

    Historically, reverse shoulder arthroplasty was reserved for older, low-demand patients in whom rotator cuff arthropathy was diagnosed. Other common indications included sequelae of previously treated proximal humerus fractures, failed anatomic total shoulder arthroplasty, tumor resection, and rheumatoid arthritis in the elderly population. Unpredictable implant durability and high complication rates have limited the use of reverse shoulder arthroplasty to a narrow group of patients. Over the past decade, however, research has led to an improved understanding of the biomechanics behind reverse shoulder prostheses, which has improved implant design and surgical techniques. Consequently, orthopaedic surgeons have slowly begun to expand the indications for reverse shoulder arthroplasty to include a wider spectrum of shoulder pathologies. Recent studies have shown promising results for patients who undergo reverse shoulder arthroplasty for the treatment of acute proximal humerus fractures, massive rotator cuff tears without arthropathy, primary osteoarthritis, and chronic anterior dislocation, as well as for younger patients who have rheumatoid arthritis. These data suggest that, with judicious patient selection, reverse shoulder arthroplasty can be an excellent treatment option for a growing patient cohort. PMID:27049188

  12. Bisphosphonate Use and Risk of Implant Revision after Total Hip/Knee Arthroplasty: A Meta-Analysis of Observational Studies

    PubMed Central

    Teng, Songsong; Yi, Chengqing; Krettek, Christian; Jagodzinski, Michael

    2015-01-01

    Objective Several studies investigated the association between bisphosphonate use and the risk of implant revision after total hip or knee arthroplasty (THA or TKA); However, the findings were inconsistent. We performed this meta-analysis to evaluate the overall relative risk of such an event. Methods We searched the PubMed, EMBASE and Cochrane library databases to identify relevant publications on April 22, 2015. To calculate the pooled risk ratios (RRs) with 95% confidential intervals (CIs), a fixed- or random-effects model was applied based on the heterogeneity across studies. Results Three cohort studies and one case-control study were included in this meta-analysis. Compared with the bisphosphonate nonusers, the patients who used bisphosphonates for a long period of time had a significantly decreased risk of implant revision after THA/TKA (summary adjusted RR = 0.48, 95% CI: 0.38–0.61), and the summary adjusted RRs for the users who underwent THA and those who underwent TKA were 0.47 (95% CI: 0.36–0.61) and 0.45 (95% CI: 0.21–0.95), respectively. Conclusions Long-term use of bisphosphonates is correlated with a significantly decreased risk of implant revision after THA/TKA. However, due to limited number of the included studies, the findings of the present study should be treated with caution. More well-designed studies are required to further confirm our findings. PMID:26444555

  13. The Utility of Digital Linear Tomosynthesis Imaging of Total Hip Joint Arthroplasty with Suspicion of Loosening: A Prospective Study in 40 Patients

    PubMed Central

    Göthlin, Jan H.

    2013-01-01

    Aim. The clinical utility of digital linear tomosynthesis in musculoskeletal applications has been validated in only a few reports. Technical performance and utility in hip prosthesis imaging have been discussed in technical reports, but no clinical evaluation has been reported. The purpose of the current study was to assess the added clinical utility of digital linear tomosynthesis compared to radiography in loosening of total hip joint arthroplasty. Materials and Methods. In a prospective study, radiography and digital tomosynthesis were performed in 40 consecutive patients with total hip arthroplasty referred for suspect prosthesis loosening. Tomosynthesis images were compared to anterior-posterior (AP) and cross-table lateral radiographs regarding demarcation and extent of demineralization and osteolysis. Further noted were skeletal fractures, cement fractures, fragmentation, and artifacts interfering with the diagnosis. Results. Tomosynthesis was superior to radiography with sharper delineation of demineralization and osteolysis in the AP projection. A limitation was the inability to generate lateral tomosynthesis images, with inferior assessment of the area anterior and posterior to the acetabular cup compared to cross-table radiographs. Artifacts interfering with diagnosis were found in one hip. Conclusion. Tomosynthesis improved evaluation of total hip arthroplasty in the AP projection but was limited by the lack of lateral projections. PMID:24078921

  14. Preliminary summary of the ETF conceptual studies

    NASA Technical Reports Server (NTRS)

    Seikel, G. R.; Bercaw, R. W.; Pearson, C. V.; Owens, W. R.

    1978-01-01

    Power plant studies have shown the attractiveness of MHD topped steam power plants for baseload utility applications. To realize these advantages, a three-phase development program was initiated. In the first phase, the engineering data and experience were developed for the design and construction of a pilot plant, the Engineering Test Facility (ETF). Results of the ETF studies are reviewed. These three parallel independent studies were conducted by industrial teams led by the AVCO Everett Research Laboratory, the General Electric Corporation, and the Westinghouse Corporation. A preliminary analysis and the status of the critical evaluation of these results are presented.

  15. Posterior cruciate ligament balancing in total knee arthroplasty: a numerical study with a dynamic force controlled knee model

    PubMed Central

    2014-01-01

    Background Adequate soft tissue balancing is a key factor for a successful result after total knee arthroplasty (TKA). Posterior cruciate ligament (PCL) is the primary restraint to posterior translation of the tibia after cruciate retaining TKA and is also responsible for the amount of joint compression. However, it is complex to quantify the amount of ligament release with its effects on load bearing and kinematics in TKA and limited both in vivo and in vitro. The goal of this study was to create a dynamic and deformable finite element model of a full leg and analyze a stepwise release of the PCL regarding knee kinematics, pressure distribution and ligament stresses. Methods A dynamic finite element model was developed in Ansys V14.0 based on boundary conditions of an existing knee rig. A cruciate retraining knee prosthesis was virtually implanted. Ligament and muscle structures were simulated with modified spring elements. Linear elastic materials were defined for femoral component, inlay and patella cartilage. A restart algorithm was developed and implemented into the finite element simulation to hold the ground reaction force constant by adapting quadriceps force. After simulating the unreleased PCL model, two models were developed and calculated with the same boundary conditions with a 50% and 75% release of the PCL stiffness. Results From the beginning of the simulation to approximately 35° of flexion, tibia moves posterior related to the femur and with higher flexion anteriorly. Anterior translation of the tibia ranged from 5.8 mm for unreleased PCL to 3.7 mm for 75% PCL release (4.9 mm 50% release). A decrease of maximum von Mises equivalent stress on the inlay was given with PCL release, especially in higher flexion angles from 11.1 MPa for unreleased PCL to 8.9 MPa for 50% release of the PCL and 7.8 MPa for 75% release. Conclusions Our study showed that dynamic FEM is an effective method for simulation of PCL balancing in knee arthroplasty. A tight

  16. The association between use of serotonergic antidepressants and perioperative bleeding during total hip arthroplasty--a cohort study.

    PubMed

    Dall, Michael; Primdahl, Annie; Damborg, Frank; Nymark, Tine; Hallas, Jesper

    2014-09-01

    In vitro studies have shown that selective serotonin reuptake inhibitors inhibit platelet aggregation. It is well documented that SSRIs cause serious gastrointestinal bleeding, but studies on other bleeding manifestations have been equivocal. Our objective was to determine a possible association between use of serotonergic antidepressants (SA) and perioperative bleeding during hip replacements. We conducted a retrospective study between 1 January 2007 and 30 June 2012 among patients that underwent a primary unilateral uncemented total hip arthroplasty (THA). Information was collected on the observed blood loss and the need for blood transfusions among this group. We compared the blood loss between users of SA, users of non-serotonergic antidepressants (NSA) and non-users, while adjusting for potential confounders using multivariate linear regression. We indentified 1318 patients that underwent a THA in the study period. The average volume of surgical bleeding was 350 ml. The adjusted incremental blood loss associated with use of SA and NSA was 93, 95% confidence interval (38-147) ml and -50 (-125 to 25) ml compared with non-use. Only 48 subjects (3.6%) had transfusions. Use of SA was associated with an increased blood loss compared with non-users. The hypothesis that SA impairs haemostasis is supported by these results. PMID:24548749

  17. A Finite-Element Study of Metal Backing and Tibial Resection Depth in a Composite Tibia Following Total Knee Arthroplasty.

    PubMed

    Tokunaga, Susumu; Rogge, Renee D; Small, Scott R; Berend, Michael E; Ritter, Merrill A

    2016-04-01

    Prosthetic alignment, patient characteristics, and implant design are all factors in long-term survival of total knee arthroplasty (TKA), yet the level at which each of these factors contribute to implant loosening has not been fully described. Prior clinical and biomechanical studies have indicated tibial overload as a cause of early TKA revision. The purpose of this study was to determine the relationship between tibial component design and bone resection on tibial loading. Finite-element analysis (FEA) was performed after simulated implantation of metal backed (MB) and all-polyethylene (AP) TKA components in 5 and 15 mm of tibial resection into a validated intact tibia model. Proximal tibial strains significantly increased between 13% and 199% when implanted with AP components (p < 0.05). Strain significantly increased between 12% and 209% in the posterior tibial compartment with increased bone resection (p < 0.05). This study indicates elevated strains in AP implanted tibias across the entirety of the proximal tibial cortex, as well as a posterior shift in tibial loading in instances of increased resection depth. These results are consistent with trends observed in prior biomechanical studies and may associate the documented device history of tibial collapse in AP components with increased bone strain and overload beneath the prosthesis. PMID:26810930

  18. Fractured rheumatoid elbow: treatment with Souter elbow arthroplasty--a clinical and radiologic midterm follow-up study.

    PubMed

    Ikävalko, M; Lehto, M U

    2001-01-01

    We report the results in 26 patients who had 32 preoperative fractures treated with Souter elbow arthroplasty. All were rheumatoid patients with a mean disease duration of 29.7 years (range, 10 to 43). Six of the fractures were of the olecranon and 26 of the distal humerus. The time interval between fracture and arthroplasty was 9 months (mean; range, 0 to 48). Fragments were not excised, and osteosynthesis was performed. The follow-up was 2.6 years (mean; range, 0.5 to 8), when 20 of the fractures had united and 12 had not. K-wire fixation, either alone or in combination with cerclage or PDS suture, and bone grafting led to satisfactory results. Union was verified in 14 of 17 cases treated with this technique. There were no severe early complications. Six patients had late complications. In 3 cases, loosening of the humeral component was observed radiologically. One patient had a hematogenous deep infection 4 years after the operation, and 2 patients had avulsion rupture of the triceps tendon. Fracture in the badly destroyed elbow can be more reasonably treated with an arthroplasty than with an attempt of osteosynthesis before arthroplasty. If excision of the fragments is avoided, original, or near original, anatomy of the elbow joint can be better restored and acceptable outcome obtained with elbow arthroplasty. PMID:11408908

  19. Early Pulmonary Complications following Total Knee Arthroplasty under General Anesthesia: A Prospective Cohort Study Using CT Scan

    PubMed Central

    Song, Kai; Rong, Zhen; Yang, Xianfeng; Yao, Yao; Shen, Yeshuai; Shi, Dongquan; Xu, Zhihong; Chen, Dongyang; Zheng, Minghao; Jiang, Qing

    2016-01-01

    Purpose. Postoperative pulmonary complications (PPCs) are common after major surgeries. However, the number of studies regarding PPCs following total knee arthroplasty (TKA) is limited. The aim of this study was to determine the incidence of early PPCs following TKA by computed tomography (CT) scan and to identify associated risk factors. Methods. Patients, who were diagnosed with osteoarthritis or rheumatoid arthritis and underwent primary TKA at our institution, were included in this prospective cohort study. Patients received a standard procedure of TKA under general anesthesia. Chest CT scan was performed during 5–7 days postoperatively. Univariate analysis and multivariate logistic regression analysis were employed to identify the risk factors. Results. The total incidence of early PPCs following TKA was 45.9%. Rates of pneumonia, pleural effusion, and atelectasis were 14.4%, 38.7%, and 12.6%, respectively. Lower body mass index and perioperative blood transfusion were independent risk factors for PPCs as a whole and associated with atelectasis. Postoperative acute episode of hypoxemia increased the risk of pneumonia. Blood transfusion alone was related to pleural effusion. Conclusions. The incidence of early PPCs following TKA was high. For patients with relevant risk factors, positive measures should be adopted to prevent PPCs. PMID:27069922

  20. [Cementless total hip arthroplasty--results of 8-year follow-up study].

    PubMed

    Wall, Andrzej; Dragan, Szymon

    2006-01-01

    The subjects of the clinical examinations were 382 patients who from 1994 to 1999 were treated with the method of total cementless arthroplasty. The observation time ranged from 3 to 8 years. In the examined group the secondary cause of degenerative changes was identified in 210 (55%) patients. In the remaining 172 cases (45%) the primary cause of degenerative changes in the hip was diagnosed. Four types of cementless endoprostheses, varied in their construction, structure of their surfaces and material they were made of, were used to carry out the postoperative treatment of the degenerative changes in the hip: Antega, Zweymüller SL PLUS (Endoprosthetic) or Alloclasic type of stem, GSS-CL and PM-Plasmapore. The findings of the clinical investigation made it possible to determine the probability of surviving of an endoprosthesis up to the 8th year after an operation depending on a type of implanted stem, which according to Kaplan-Meier's method, amounted to 0.9603. The results of Harris scale evaluation of the function of the operated joints demonstrated the existence of the relationship between the function and the course of bone osteointegration and growth process. The detailed analysis of the X-ray examinations, and especially of the roentgenometric ones, taking into account stability of the endoprosthesis stem enabled to distinguish two stages of the clinical and roentgenological changes: the early stage (up to 6 months after an operation) characterised by settling and micromotions of the stem and the late stage (starting 6-9 months after an operation) with slowly gradual increasing of the function and holding back of stem settling. PMID:17017478

  1. Gait Variability before Surgery and at Discharge in Patients Who Undergo Total Knee Arthroplasty: A Cohort Study

    PubMed Central

    Hiyama, Yoshinori; Asai, Tsuyoshi; Wada, Osamu; Okada, Shuichi

    2015-01-01

    This study aimed to determine gait ability at hospital discharge in patients undergoing total knee arthroplasty (TKA) as an indicator of the risk of falling. Fifty-seven patients undergoing primary TKA for knee osteoarthritis participated in this study. Gait variability measured with accelerometers and physical function including knee range of motion (ROM), quadriceps strength, walking speed, and the Timed Up and Go (TUG) test were evaluated preoperatively and at discharge from the hospital (1 month before and 5 days after surgery). All patients were discharged directly home at 5 days after surgery. Knee flexion of ROM, quadriceps strength, walking speed, and the TUG test results were significantly worse at hospital discharge than preoperatively (p < 0.001). However, gait variability was not significantly different before and after TKA. This result indicated that patients following TKA surgery could walk at hospital discharge as stably as preoperatively regardless of the decrease in physical function, including knee ROM, quadriceps strength, and gait speed after surgery. PMID:25617842

  2. Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches

    PubMed Central

    Nutton, Richard W.; Wade, Frazer A.; Coutts, Fiona J.; van der Linden, Marietta L.

    2014-01-01

    This pilot double blind randomised controlled study aimed to investigate whether the midvastus (MV) approach without patellar eversion in total knee arthroplasty (TKA) resulted in improved recovery of function compared to the medial parapatellar (MP) approach. Patients were randomly allocated to either the MV approach or the MP approach. Achievements of inpatient mobility milestones were recorded. Knee kinematics, muscle strength, Timed Up and Go, WOMAC, and daily step count were assessed before and up to six months after surgery. Cohen's effect size d was calculated to inform the sample size in future trials. Twenty-eight participants (16 males, 12 females) participated. Patient mobility milestones such as straight leg raise were achieved on average 1.3 days (95% CI −3.4 to 0.7, d = 0.63) earlier in the MV group. Knee extensor strength at 6 weeks after surgery was higher (95% CI −0.38 to 0.61, d = 0.73) in the MV group. No trends for differences between the groups were observed in knee kinematics, TUG, WOMAC, or step count. Our results suggest a short term advantage in the first 6 weeks after surgery of the MV approach over the MP approach, but a larger study is required to confirm these findings. This trial is registered with NCT056445. PMID:25349736

  3. Microsection analysis of cortical form-fit of a custom femoral component in total hip arthroplasty: an in vitro study

    PubMed Central

    Leichtle, Ulf Gunther; Leichtle, Carmen Ina; Martini, Franz

    2012-01-01

    Custom femoral components have been developed for total hip arthroplasty to maximize cortical form-fit and thereby to reduce the problems of stress shielding and aseptic loosening. Limited information is available about how much endosteal cortical contact can actually be achieved with these expensive implants. The aim of this study was therefore to verify the exact cortical contact of a custom made stem using microsections and comparing it to a standard stem with similar design. In 8 human femurs (3 matched pairs and 2 separate specimens), custom femoral prostheses (Adaptiva; 5 femurs: 3 matched and 2 separate) and conventional femoral prostheses (Alloclassic; 3 matched femurs) were implanted. Endosteal cortical contact was determined from CAD planning drafts and microsections cut from the specimens with a diamond saw. Microsection analysis of the paired femurs showed that contact between prosthesis and bone varied clearly along the length of the femoral stem. Total cortical contact was considerably greater in custom prostheses than conventional prostheses (custom, 47%; conventional, 32%), but markedly less than the total contact predicted by the manufacturer (84% to 90%). The custom prosthesis had more lateral cortical contact on CAD planning drafts (cortical contact: medial, 60%; lateral, 53%) than on specimen microsections after implantation (medial, 64%; lateral, 24%). In summary, the philosophy of anchorage of both prostheses types could be confirmed. However, areas of cortical contact of the custom made prosthesis were considerably smaller compared to the pre-operative planning. PMID:23066498

  4. Sports Activity after Low-contact-stress Total Knee Arthroplasty – A long term follow-up study

    PubMed Central

    Vielgut, Ines; Leitner, Lukas; Kastner, Norbert; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-01-01

    The purpose of this study was to provide comprehensive long-term data about sports activity levels in patients following total knee arthroplasty (TKA) and to determine the impact of pre-operative function, pain and specific performed sports on the results. 236 patients who have undergone TKA for severe osteoarthritis of the knee were asked to provide specific information regarding exercised types of sports before surgery and after at least 10 years following TKA. Pre- and postoperative function and pain were evaluated by the use of Tegner-, WOMAC- and VAS Score. After a mean of 14.9 years, a significant improvement regarding pain and function was observed. Pre-operative Tegner- and WOMAC scores revealed significant positive correlations with the post-operative Tegner-Score. Accordingly, a high percentage of patients (70.9%) stayed actively involved in sports. Nevertheless, the number of performing patients has decreased according to the sports impact. 71.3% continued practising low-impact-, 43.7% intermediate-impact sports whereas only 16.4% kept performing high impact sports. We conclude that TKA is highly effective in long-time pain reduction as well as improvement of function. Additionally, we found considerable sports activities preserved in the investigated series. However, sports activities in particular, seem to decrease according to the impact of sports. PMID:27090945

  5. A comparative microstructural study of vitamin-E blended and infused highly crosslinked UHMWPE for total knee arthroplasty.

    PubMed

    Puppulin, Leonardo; Leto, Andrea; Hasegawa, Masahiro; Pezzotti, Giuseppe

    2014-11-01

    The impact of adding antioxidant vitamin-E (α-tocopherol) to the microstructure of ultrahigh molecular weight polyethylene (UHMWPE) for total knee arthroplasty has been studied in detail by means of Raman microprobe spectroscopy. Three tibial insert samples prepared by different manufacturing methods were investigated, as follows: (A) a sample manufactured without blending with vitamin E which did not receive any irradiation dose after consolidation but underwent final sterilization in ethylene oxide (EtO); (B) a sample blended with 0.3 wt% of α-tocopherol, an isomer of vitamin E, and manufactured as sample (A); and, (C) a sample in which vitamin E was diffused after being irradiated with 100 kGy dose of γ-ray. Clear microstructural differences were observed in terms of phase contents (i.e., amorphous, crystalline, and intermediate phase fraction), molecular orientation, and the degree of anisotropy between the investigated tibial plates. Vitamin E in the starting resin promoted chain mobility leading to reorganization of the molecular chains. The spectroscopic characterizations helps to rationalize the complex effect of vitamin-E on the UHMWPE microstructure and gives useful information on how significantly any single step of the manufacturing procedures might affect the mechanical properties of the final orthopedic component. PMID:25151446

  6. Examination of rotational fixation of the femoral component in total hip arthroplasty. A mechanical study of micromovement and acoustic emission.

    PubMed

    Sugiyama, H; Whiteside, L A; Kaiser, A D

    1989-12-01

    Rotational loosening has recently emerged as an important cause of failure of the femoral component of total hip arthroplasties. This study was designed to investigate the role played by torsional loads in loosening of cementless femoral components and to evaluate three cementing techniques involving a combination of canal irrigation, manual insertion, and vacuum mixing combined with pressure injection of the cement for their ability to improve rotational fixation. Rotational micromotion and subsidence were measured in 24 preserved human anatomic specimen femora. Acoustic emission (AE) technique was applied as a non-destructive method for evaluating material failure during loading. From the micromovement data, torque to 50 mu subsidence and torque to failure were surprisingly low with cementless fixation and with poor cement technique but were markedly improved with pulsed irrigation. Further improvement was achieved by pressure injection and vacuum mixing of the cement. However, AE was detected even in the most carefully performed cement specimens under torsional-loading conditions commonly occurring in daily activities. These signs of microfailure of the cement mantle at relatively low torsional loads suggest that the mode of failure of deeply penetrated cement is by microfracture of the cement mantle. The poor performance suggests that cementless fixation of intramedullary stems provides unsatisfactory fixation against torsional loading. There is need for major improvements in fixation mechanisms and techniques. The signs of failure of the cement mantle at normally occurring torsional loads suggest that even the best cement technique is prone to failure in torsion when exposed to normal daily use. PMID:2582663

  7. Preliminary Results of Implantation in Animal Model and Osteoblast Culture Evaluation of Prototypes of Biomimetic Multispiked Connecting Scaffold for Noncemented Stemless Resurfacing Hip Arthroplasty Endoprostheses

    PubMed Central

    Uklejewski, Ryszard; Rogala, Piotr; Winiecki, Mariusz; Kędzia, Andrzej; Ruszkowski, Piotr

    2013-01-01

    We present the new fixation method for RHA (resurfacing hip arthroplasty) endoprostheses by means of the biomimetic multispiked connecting scaffold (MSC-Scaffold). Such connecting scaffold can generate new type of RHA endoprostheses, that is stemless and fixed entirely without cement. The preprototypes of this MSC-Scaffold were manufactured with modern additive laser additive technology (SLM). The pilot surgical implantations in animal model (two laboratory swine) of MSC-Scaffold preprototypes have showed after two months neither implant loosening, migration, and nor other early complications. From the results of performed histopathological evaluation of the periscaffold spikes bone tissue and 10-day culture of human osteoblasts (NHOst) we can conclude that (1) the scaffolding effect was obtained and (2) to improve the osseointegration of the scaffold spikes, their material surface should be physicochemically modified (e.g., with hydroxyapatite). Some histopathological findings in the periscaffold domain near the MSC-Scaffold spikes bases (fibrous connective tissue and metallic particles near the MSC-Scaffold spikes bases edges) prompt considering the necessity to optimize the design of the MSC-Scaffold in the regions of its interspike space near the spikes bases edges, to provide more room for new bone formation in this region and for indispensable post-processing (glass pearl blasting) after the SLM manufacturing. PMID:23984397

  8. Does Choice of Head Size and Neck Geometry Affect Stem Migration in Modular Large-Diameter Metal-on-Metal Total Hip Arthroplasty? A Preliminary Analysis

    PubMed Central

    Georgiou, CS; Evangelou, KG; Theodorou, EG; Provatidis, CG; Megas, PD

    2012-01-01

    Due to their theoretical advantages, hip systems combining modular necks and large diameter femoral heads have gradually gained popularity. However, among others, concerns regarding changes in the load transfer patterns were raised. Recent stress analyses have indeed shown that the use of modular necks and big femoral heads causes significant changes in the strain distribution along the femur. Our original hypothesis was that these changes may affect early distal migration of a modular stem. We examined the effect of head diameter and neck geometry on migration at two years of follow-up in a case series of 116 patients (125 hips), who have undergone primary Metal-on-Metal total hip arthroplasty with the modular grit-blasted Profemur®E stem combined with large-diameter heads (>36 mm). We found that choice of neck geometry and head diameter has no effect on stem migration. A multivariate regression analysis including the potential confounding variables of the body mass index, bone quality, canal fill and stem positioning revealed only a negative correlation between subsidence and canal fill in midstem area. Statistical analysis, despite its limitations, did not confirm our hypothesis that choice of neck geometry and/or head diameter affects early distal migration of a modular stem. However, the importance of correct stem sizing was revealed. PMID:23284597

  9. Can Total Wrist Arthroplasty Be an Option for Treatment of Highly Comminuted Distal Radius Fracture in Selected Patients? Preliminary Experience with Two Cases

    PubMed Central

    Schmidt, Ingo

    2015-01-01

    We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept. PMID:26491587

  10. Tourniquetless Total Knee Arthroplasty

    MedlinePlus Videos and Cool Tools

    Tourniquetless Total Knee Arthroplasty You must have Javascript enabled in your web browser. View Program Transcript Click Here to view the OR-Live, Inc. Privacy Policy and Legal Notice © 2010 OR- ...

  11. Reverse Shoulder Arthroplasty

    MedlinePlus

    ... arthroplasty, we don’t want to have vigorous terminal stretches. Because this is a constrained implant, we ... limited range, rather than pushing vigorously for a terminal range. The other thing to keep in mind ...

  12. Patients’ decision making in total knee arthroplasty

    PubMed Central

    Barlow, T.; Griffin, D.; Barlow, D.; Realpe, A.

    2015-01-01

    Objectives A patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review’s objective is to systematically examine the qualitative literature surrounding patients’ decision making in knee arthroplasty. Methods A systematic literature review using Medline and Embase was conducted to identify qualitative studies that examined patients’ decision making around knee arthroplasty. An aggregated account of what is known about patients’ decision making in knee arthroplasties is provided. Results Seven studies with 234 participants in interviews or focus groups are included. Ten themes are replicated across studies, namely: expectations of surgery; coping mechanisms; relationship with clinician; fear; pain; function; psychological implications; social network; previous experience of surgery; and conflict in opinions. Conclusions This review is helpful in not only directing future research to areas that are not understood, or require confirmation, but also in highlighting areas that future interventions could address. These include those aimed at delivering information, which are likely to affect the satisfaction rate, demand, and use of knee arthroplasties. Cite this article: Bone Joint Res 2015;4;163–169. PMID:26450640

  13. Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty

    PubMed Central

    Bachman, Daniel; Nyland, John; Krupp, Ryan

    2016-01-01

    AIM: To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. METHODS: This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. RESULTS: The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. CONCLUSION: Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement “gold standard” among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life. PMID:26925384

  14. Preliminary neutron crystallographic study of human transthyretin

    PubMed Central

    Haupt, Melina; Blakeley, Matthew P.; Teixeira, Susana C. M.; Mason, Sax A.; Mitchell, Edward P.; Cooper, Jonathan B.; Forsyth, V. Trevor

    2011-01-01

    Preliminary studies of perdeuterated crystals of human transthyretin (TTR) have been carried out using the LADI-III and D19 diffractometers at the Institut Laue–Langevin in Grenoble. The results demonstrate the feasibility of a full crystallographic analysis to a resolution of 2.0 Å using Laue diffraction and also illustrate the potential of using monochromatic instruments such as D19 for higher resolution studies where larger crystals having smaller unit cells are available. This study will yield important information on hydrogen bonding, amino-acid protonation states and hydration in the protein. Such information will be of general interest for an understanding of the factors that stabilize/destabilize TTR and for the design of ligands that may be used to counter TTR amyloid fibrillogenesis. PMID:22102249

  15. A preliminary neutron crystallographic study of thaumatin

    SciTech Connect

    Teixeira, Susana C. M.; Blakeley, Matthew P.; Leal, Ricardo M. F.; Mitchell, Edward P.; Forsyth, V. Trevor

    2008-05-01

    Preliminary neutron crystallographic data from the sweet protein thaumatin have been recorded using the LADI-III diffractometer at the Institut Laue Langevin (ILL). The results illustrate the feasibility of a full neutron structural analysis aimed at further understanding the molecular basis of the perception of sweet taste. Such an analysis will exploit the use of perdeuterated thaumatin. A preliminary neutron crystallographic study of the sweet protein thaumatin is presented. Large hydrogenated crystals were prepared in deuterated crystallization buffer using the gel-acupuncture method. Data were collected to a resolution of 2 Å on the LADI-III diffractometer at the Institut Laue Langevin (ILL). The results demonstrate the feasibility of a full neutron crystallographic analysis of this structure aimed at providing relevant information on the location of H atoms, the distribution of charge on the protein surface and localized water in the structure. This information will be of interest for understanding the specificity of thaumatin–receptor interactions and will contribute to further understanding of the molecular mechanisms underlying the perception of taste.

  16. Squeaking hip arthroplasties: a tribological phenomenon.

    PubMed

    Brockett, Claire L; Williams, Sophie; Jin, Zhongmin; Isaac, Graham H; Fisher, John

    2013-01-01

    The clinical incidence of squeaking has been reported with increasing frequency, with ceramic-on-ceramic bearings seemingly most affected. This study investigated potential causes of squeaking in hard-on-hard hip bearings through 2 sets of experimental conditions. Bearing clearance appeared to affect the incidence of squeaking in metal-on-metal surface arthroplasties. The addition of third-body particles to the interface for total hip arthroplasties also affected the incidence of squeaking. In both studies, the incidence of squeaking correlated well with elevated friction. The findings of this study suggest that a likely cause of squeaking in the hip arthroplasty is adverse tribological conditions caused by suboptimal lubrication. There are numerous factors that may cause the suboptimal lubrication, and therefore, it is unlikely that an individual cause for squeaking will be identified. PMID:22480525

  17. Effects of Cold Irrigation on Early Results after Total Knee Arthroplasty: A Randomized, Double-Blind, Controlled Study.

    PubMed

    Li, Zhirui; Liu, Daohong; Dong, Jiyuan; Gong, Long; Wang, Yong; Tang, Peifu; Zhang, Yan

    2016-06-01

    Several studies have indicated that pain peaks at 24 to 48 hours after total knee arthroplasty (TKA) surgery. TKA has been associated with disruption in normal sleep patterns, swelling knee, and significant blood loss. However, a satisfactory regime to resolve these mentioned problems has yet to be found.In this study, a total of 420 patients were randomly allocated into two groups and treated with continuous irrigation of either 4000 mL cold saline with 0.5% epinephrine or normal temperature solution. Clinical outcomes including pain scores at rest during postoperative three days, drainage output, analgesic consumption, decreased hemoglobin, sleep quality, and satisfaction rate were analyzed. Mean scores and postoperative change in scores were calculated.Visual analog scale (VAS) pain scores in the treatment group were significantly reduced from 4 hours (P = 0.0016) to 24 hours (P = 0.0004) after TKA. Additional benefits including reduced analgesic consumption, improved satisfaction rate, and sleep quality were observed. In addition, a significant reduction in blood loss reflected by decreased Hb and drainage was found.In this study, irrigation with a cold 0.5% epinephrine solution was a beneficial and cost-effective treatment that decreased acute postoperative VAS pain scores immediately after and 1 day after surgery. Patients reported postoperative improvement in sleep quality and overall satisfaction rate with a decrease in morphine usage. In addition, a reduction of intraoperative blood loss might decrease the blood transfusion rate and related costs. Collectively, irrigation with cold 0.5% epinephrine offers a safe, simple, and effective treatment that might improve recovery and enhance quality of life of patients undergoing TKA. PMID:27310945

  18. Tranexamic Acid in Hip and Knee Arthroplasty.

    PubMed

    Melvin, J Stuart; Stryker, Louis S; Sierra, Rafael J

    2015-12-01

    Perioperative blood loss is a significant concern for patients undergoing total joint arthroplasty. A growing body of evidence has shown tranexamic acid (TXA) to be effective in decreasing perioperative blood loss and transfusion requirements in both primary and revision hip and knee arthroplasty. TXA is a synthetic drug that limits blood loss through inhibition of fibrinolysis and clot degradation. Both topical and intravenous administration of TXA, in a variety of dosing regimens, has proven effective. Further investigation is required to determine the optimal dose and dosing regimens; however, evidence exists to recommend an initial intravenous dose be given before beginning the procedure, with at least one additional intravenous dose administered postoperatively. Additionally, topical TXA doses >2 g appear to be more efficacious than lower doses. Finally, relatively few adverse reactions have been reported in arthroplasty patients, and no study to date has demonstrated an increased risk of symptomatic venous thromboembolic events in this patient population. PMID:26493971

  19. Impromptu Speaking and Interpretation Studies: A Preliminary Study

    ERIC Educational Resources Information Center

    Heinz, Michael

    2013-01-01

    The purpose of this preliminary study was to look at forensics-based competition events and determine what, if any, impact they could have on the language learning and public speaking skills of interpreters in training. This paper details the nature of the impromptu and extemporaneous speaking events in forensics competitions and introduces a…

  20. Quantification of Subtalar Posterior Facet Involvement During Intramedullary Guidance of Total Ankle Arthroplasty:A Cadaveric Study.

    PubMed

    DeMill, Shyler L; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2015-01-01

    Total ankle arthroplasty is an evolving treatment of ankle arthritis. One implant uses intramedullary guidance to enhance accuracy by accessing the tibial canal through the inferior aspect of the foot, potentially placing the subtalar joint articulation at risk. The purpose of the present cadaveric anatomic evaluation was to identify posterior subtalar articular facet joint involvement during intramedullary guidance to the tibial canal. Ten below-the-knee cadaveric specimens were used. After drilling into the tibial medullary canal with a 6-mm drill bit and using the standard targeting jig, the specimens were dissected, and the posterior facet was evaluated. We graded posterior facet involvement according to the location of the drill hole and, if within the facet, the percentage of the facet violated by the drill bit, with 100% representing the full circumference of the 6-mm drill bit. Of the 8 specimens in which the drill bit passed through the subtalar posterior articular facet, the encroachment was peripheral in all cases, with no specimen showing circumferential 6-mm drill bit articular penetration (no cases with 100%). Sinus tarsi penetration occurred in 20% of the cases. The dissections with articular involvement included 3 specimens with >50% of the drill bit penetrating and 5 with <50%. The portion of the posterior facet involved among the specimens that were violated was anterocentral in the joint. A risk of damage to the posterior facet of the subtalar joint exists with intramedullary total ankle systems. Our study has demonstrated that the drill bit will involve the anterocentral and anterolateral portions of the posterior facet of the subtalar joint, with <6 mm articular disruption in all cases. PMID:26015304

  1. Factors for Assessing the Effectiveness of Early Rehabilitation after Minimally Invasive Total Knee Arthroplasty: A Prospective Cohort Study

    PubMed Central

    Amano, Tetsuya; Tamari, Kotaro; Tanaka, Shigeharu; Uchida, Shigehiro; Ito, Hideyuki; Morikawa, Shinya; Kawamura, Kenji

    2016-01-01

    The effectiveness of current rehabilitation programs is supported by high-level evidence from the results of randomized controlled trials, but an increasing number of patients are not discharged from the hospital because of the schedule of the critical path (CP). The present study aimed to determine which factors can be used to assess the effectiveness of early rehabilitation. We enrolled 123 patients with medial knee osteoarthritis (OA) who had undergone unilateral minimally invasive total knee arthroplasty for the first time. The following factors were assessed preoperatively: the maximum isometric muscle strength of the knee extensors and flexors, maximum knee and hip joint angle, pain, 5-m maximum walking speed, sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side (bilateral or unilateral knee OA), and functional independence measure. We re-evaluated physical function (i.e., muscle strength, joint angle, and pain) and motor function (5-m maximum walking speed) 14 days postoperatively. Changes in physical function, motor function (5-m maximum walking speed), and number of days to independent walking were used as explanatory variables. The postoperative duration of hospitalization (in days) was used as the dependent variable in multivariate analyses. These analyses were adjusted for sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side, and functional independence measure. The duration of hospitalization was significantly affected by the number of days to independent walking (p < 0.001, β = 0.507) and a change in the 5-m maximum walking speed (p = 0.016, β = -0.262). Multiple regression analysis showed that the radiographic knee grade (p = 0.029, β = 0.239) was a significant confounding factor. Independent walking and walking speed recovery were considered to reduce the duration of hospitalization. Therefore, these indices can be used to assess the effectiveness of

  2. Tranexamic Acid Reduces Hidden Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Comparative Study and Meta-Analysis

    PubMed Central

    Huang, Guang-Ping; Jia, Xu-Feng; Xiang, Zhou; Ji, Yong; Wu, Guo-Yong; Tang, Yi; Li, Jian; Zhang, Jun

    2016-01-01

    Background To explore the efficacy of tranexamic acid (TXA) on reducing hidden blood loss (HBL) in total knee arthroplasty (TKA) by conducting a comparative study and meta-analysis. Material/Methods A total of 108 patients underwent TKA was equally distributed to experimental and control groups. The only difference between two groups was the administrations of 15 mg of TXA mixed in 100 mL normal saline for experimental group and 100 mL of normal saline for control group. The volumes of blood loss, red blood loss (RBL) were recorded, calculated and analyzed. Stata 12.0 software was applied for data analysis. Results The intraoperative and postoperative blood loss volume in experimental group were remarkably reduced compared with those in control group (intraoperative: 105.1±12.1 mL vs. 185.5±20.3 mL, P<0.001; postoperative: 220.7±16.8 mL vs. 290.5±22.4 mL, P<0.001). Accordingly, the control group had significantly higher transfusion rate than experimental group (3.7% vs.25.9%, P=0.001). Our results also found that both the measured and hidden RBL were obviously reduced in experimental group compared with control group (measured RBL: 96.9±11.8 mL vs. 135.2±13.5 mL, P<0.001; hidden RBL: 170.8±37.2 mL vs. 364.2±41.5 mL, P<0.001). Furthermore, meta-analysis confirmed that TXA can notably decrease HBL (SMD=2.68, 95%CI=1.55~3.80, P<0.001). Conclusions TXA can significantly reduce the intraoperative and postoperative blood loss and HBL, therefore decreasing the transfusion need in TKA. PMID:26961597

  3. Comparative study of extended versus short term thromboprophylaxis in patients undergoing elective total hip and knee arthroplasty in Indian population

    PubMed Central

    Nair, Velu; Kumar, Ratheesh; Singh, Bikram Kumar; Sharma, Ajay; Joshi, Gururaj R; Pathak, Kamal

    2013-01-01

    Background: Postoperative thromboprophylaxis with low molecular weight heparin (LMWH) for an extended period of 4 weeks is now preferred over short term thromboprophylaxis in patients undergoing total hip/knee arthroplasty (THA/TKA). However, most of the data demonstrating the efficacy and safety of extended thromboprophylaxis and short term thromboprophylaxis is from clinical trials done in the West. In India, the data of the incidence of venous thromboembolism (VTE) following THA/TKA has been conflicting and the duration has not been clearly defined. The aim of the study was to evaluate and compare the efficacy of extended thromboprophylaxis over short term thromboprophylaxis in Indian patients undergoing elective THA/TKA surgeries. Materials and Methods: A prospective arm of 197 consecutive patients undergoing elective THA/TKA surgeries who were administered extended thromboprophylaxis for 4 weeks was compared with a historical group of 795 patients who were administered short term thromboprophylaxis for only 7-11 days. In both groups, LMWH (enoxaparin) was used in a dose of 40 mg subcutaneously, in addition to mechanical thromboprophylaxis. Primary efficacy endpoint was objectively confirmed venous thromboembolism (VTE). The presence of DVT was confirmed by a combination of pretest scoring, D-dimer, and Color Doppler Flow Imaging (CDFI) of deep veins of the legs, and pulmonary thromboembolism (PTE) was confirmed by ventilation perfusion (V/Q) scan or pulmonary angiography. Fisher's exact test and t test were used for the statistical analysis. The baseline confounding factors were compared between the two groups using t test for comparing the means for continuous data and Fisher's exact test for categorical data. Results: In the prospective arm, only 1 patient developed symptomatic PTE compared to 26 (3.27%) cases of VTE (20 cases of PTE and 6 cases of DVT) in the retrospective group. Conclusion: Extended thromboprophylaxis (for 4 weeks) was found to be more

  4. Observational Study of Depression in Patients Undergoing Cervical Disc Arthroplasty: Evidence of a Correlation between Pain Relief and Resolution of Depression

    PubMed Central

    Copay, Anne G.; Schranck, Francine W.; Kopjar, Branko

    2016-01-01

    Background Depression has been associated with inferior outcomes following lumbar spine surgery. Our purpose was to investigate the prevalence of depression and its impact on the outcomes of a large sample of cervical disc arthroplasty patients and to examine the change in depression occurring in conjunction with changes in disability and pain. Methods A cohort of 271 patients who underwent single or multi-level cervical disc arthroplasty at a single orthopedic center filled out the Neck Disability Index, Medical Outcomes Study SF-36, numerical rating scales for neck pain and arm pain, preoperatively and 12-month postoperatively. Patients were classified as Depressed or Non-Depressed, based on their preoperative SF-36 Mental Component Summary (MCS) score. Preoperative scores, 12-month postoperative scores, and change in scores (adjusted for preoperative scores, smoking status, and strenuous job) were compared between Depressed and Non-Depressed. Next, patients in the 2 groups were subdivided into 4 groups: Always Depressed, Never Depressed, No Longer Depressed, and Newly Depressed, based on their combined preoperative and postoperative MCS scores. The same score comparisons were conducted among the 4 groups. Results Forty-four percent (118 of 271) of the patients in our sample were Depressed. Despite a significant improvement after surgery, Depressed patients had poorer pre- and postoperative scores than Non-Depressed patients for NDI, MCS, neck pain and arm pain. Two-thirds (80 of 118) of the Depressed patients were No Longer Depressed at 12 months and had postoperative scores similar to the Never Depressed patients. Eight percent (12 of 153) of the Non-Depressed patients became Newly Depressed by 12 months and had postoperative scores similar to the Always Depressed patients. Conclusions Depression is a common occurrence in patients with cervical disorders. Relief from pain and disability after cervical disc arthroplasty can be associated with relief from

  5. Bipolar hip arthroplasty.

    PubMed

    Chang, Qing; Liu, Shubing; Guan, Changyong; Yu, Fangyuan; Wu, Shenguang; Jiang, Changliang

    2011-12-01

    Our aim was to compare hip arthroplasty with internal screw fixation in the repair of intertrochanteric fractures in elderly patients with osteoporosis. Of 112 included patient, 70 (81.81 ± 4.88 years) received hip arthroplasty with a prosthesis specially designed for intertrochanteric fractures, and 42 (83.46 ± 5.11 years) underwent plate-screw fixation. The hip arthroplasty group had significantly longer operation time, intraoperative blood loss, and total volume of blood transfused but had shorter time to beginning weight-bearing (5.94 ± 2.76 vs 23.68 ± 22.01 days) and higher postoperative Harris hip score (91.37 ± 4.80 vs 86.14 ± 5.46). In the arthroplasty group, there were 2 dislocations; and in the plate-screw fixation group, there were 5 internal fixation failures. Hip arthroplasty is preferable to internal fixation in elderly patients (age >80 years) with osteoporosis. PMID:21530148

  6. Prospective, Randomized, Multicenter FDA IDE Study of CHARITÉ Artificial Disc versus Lumbar Fusion: Effect at 5-year Follow-up of Prior Surgery and Prior Discectomy on Clinical Outcomes Following Lumbar Arthroplasty

    PubMed Central

    McAfee, Paul C.; Banco, Robert J.; Blumenthal, Scott L.; Guyer, Richard D.; Holt, Richard T.; Majd, Mohamed E.

    2009-01-01

    Background Candidates for spinal arthrodesis or arthroplasty often present with a history of prior surgery such as laminectomy, laminotomy or discectomy. In this study, lumbar arthroplasty patients with prior surgery, and in particular patients with prior discectomy, were evaluated for their clinical outcomes at the 5-year time point. Methods Randomized patients from the 5-year CHARITÉ investigational device exemption (IDE) study were divided as follows: 1) fusion prior surgery (excluding prior decompression with fusion) group (FSG); 2) fusion prior discectomy group (FDG); 3) fusion no prior surgery group (FNG); 4) arthroplasty prior surgery group (ASG); 5) arthroplasty prior discectomy group (ADG); and 6) arthroplasty no prior surgery group (ANG). The 5-year clinical outcomes included visual analog scale (VAS), Oswestry Disability Index 2.0 (ODI), patient satisfaction, and work status. Results In the arthroplasty group, all subgroups had statistically significant VAS improvements from baseline (VAS change from baseline: ASG = -36.6 ± 29.6, P < 0.0001; ADG = -40.2 ± 30.9, P = 0.0002; ANG = -36.5 ± 34.6, P < 0.0001). There was no statistical difference between subgroups (P = 0.5587). In the fusion group, VAS changes from baseline were statistically significant for the FNG and FSG subgroups, but not for the FDG patients (FNG = -46.3 ± 28.8, P < 0.0001; FSG = -24.2 ± 36.4, P = 0.0444; FDG = -26.7 ± 38.7, P = 0.2188). A trend of decreased VAS improvements was observed for FSG versus FNG (P = 0.0703) subgroups. Similar findings and trends were observed in ODI scores (Changes in ODI from baseline: ASG = -20.4 ± 23.8, P < 0.0001; ANG = -26.6±21.1, P < 0.0001; ADG= -17.6 ± 28.6, P = 0.0116; FSG = -14.5 ± 21.2, P = 0.0303; FNG= -32.5 ± 22.6, P < 0.0001; FDG = -10.7 ± 9.4, P = 0.0938). The greatest improvement in work status from preoperative to postoperative was seen in the ADG subgroup (28% increase in part- and full-time employment), while the FDG subgroup

  7. Primary stability of inferior tilt fixation of the glenoid component in reverse total shoulder arthroplasty: A finite element study.

    PubMed

    Chae, Soo-Won; Lee, Haea; Kim, Soo Min; Lee, Juneyoung; Han, Seung-Ho; Kim, Soung-Yon

    2016-06-01

    Glenoid component fixation with inferior tilt has been suggested as one of the surgical methods to decrease scapular notching and improve stability, but its clinically beneficial effect remains a concern. We evaluated the influence of inferior tilt fixation of the glenoid component on primary stability in reverse total shoulder arthroplasty by finite element analysis. Finite element models were constructed from cadaveric scapulae of females over the age of 60 years and glenoid components from reverse total shoulder arthroplasty. The relative micromotion at the bone-glenoid component interface, distribution of bone stress under the glenoid component and around the screws, contact area between the bone and screws, and cut surface area of the cancellous bone exposed after glenoid reaming were analyzed and compared between a neutral and 10° inferior tilt fixation of the glenoid component. The 10° inferior tilt fixation demonstrated greater relative micromotion and higher bone stress than the neutral tilt fixation. Eccentric reaming, which is done to produce the inferior tilt fixation of the glenoid component, increased glenoid cancellous bone exposure and decreased bone-screws contact area. Inferior tilt fixation of the glenoid component may adversely affect primary stability and longevity after reverse total shoulder arthroplasty. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1061-1068, 2016. PMID:26621211

  8. Biomechanical benefits of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: A cadaveric study.

    PubMed

    Kim, Hyun-Min Mike; Chacon, Alexander C; Andrews, Seth H; Roush, Evan P; Cho, Edward; Conaway, William K; Kunselman, Allen R; Lewis, Gregory S

    2016-04-01

    Restoration of joint stability during total shoulder arthroplasty can be challenging in the face of severe glenoid retroversion. A novel technique of humeral head component anterior-offsetting has been proposed to address posterior instability. We evaluated the biomechanical benefits of this technique in cadaveric specimens. Total shoulder arthroplasty was performed in 14 cadaveric shoulders from 7 donors. Complementary shoulders were assigned to either 10° or 20° glenoid retroversion, with retroversion created by eccentric reaming. Two humeral head component offset positions were tested in each specimen: The anatomic (posterior) and anterior (reverse). With loads applied to the rotator cuff and deltoid, joint contact pressures and the force and energy required for posterior humeral head translation were measured. The force and energy required to displace the humeral head posteriorly increased significantly with the anterior offset position compared to the anatomic offset position. The joint contact pressures were significantly shifted anteriorly, and the joint contact area significantly increased with the anterior offset position. Anterior offsetting of the humeral head component increased the resistance to posterior humeral head translation, shifted joint contact pressures anteriorly, and increased joint contact area, thus, potentially increasing the joint stability in total shoulder arthroplasty with simulated glenoid retroversion. PMID:26356804

  9. Preliminary simulation study of a coincidence Avalanche Pixel Sensor

    NASA Astrophysics Data System (ADS)

    Vignetti, M. M.; Calmon, F.; Cellier, R.; Pittet, P.; Quiquerez, L.; Savoy-Navarro, A.

    2015-06-01

    In this paper a preliminary study of coincidence Avalanche Pixel Sensors (APiX) for High Energy Physics (HEP) applications is presented. In this preliminary work, some PEB prevention techniques found in literature have been studied by TCAD simulations adopting 2D Cylindrical geometrical models and 130nm CMOS process technological data.

  10. Preliminary design study for an atomospheric science facility

    NASA Technical Reports Server (NTRS)

    Hutchison, R.

    1972-01-01

    The activities and results of the Atmospheric Science Facility preliminary design study are reported. The objectives of the study were to define the scientific goals, to determine the range of experiment types, and to develop the preliminary instrument design requirements for a reusable, general purpose, optical research facility for investigating the earth's atmosphere from a space shuttle orbital vehicle.

  11. Three-phase bone scan and indium white blood cell scintigraphy following porous coated hip arthroplasty: A prospective study of the prosthetic tip

    SciTech Connect

    Oswald, S.G.; Van Nostrand, D.; Savory, C.G.; Callaghan, J.J. )

    1989-08-01

    Although few reports address the use of three-phase bone scanning (TPBS) and {sup 111}In-labeled white blood cell (In-WBC) scintigraphy in hip arthroplasty utilizing a porous coated prosthesis, the literature suggests that scintigraphic patterns in the uncomplicated patient may differ from that seen in the cemented prosthesis. In an attempt to determine the scintigraphic natural history, 25 uncomplicated porous coated hip arthroplasties in 21 patients were prospectively studied with serial TPBS and In-WBC at approximately 7 days, and at 3, 6, 12, 18, and 24 mo postoperatively. This report deals with findings related to the prosthetic tip. Only one of 136 flow studies were abnormal and only two of 136 blood-pool images demonstrated focally increased activity. All 25 prostheses (120 of 143 scans) demonstrated increased uptake on the bone phase images. The area about the tip was divided into three segments; increased uptake at 24 mo was noted in the medial, distal, and lateral segments in 16%, 72%, and 56% of prostheses, respectively. Twenty of 25 prostheses (82 of 142 scans) showed uptake on In-WBC scintigraphy, being noted in 48% of prostheses at 24 mo. We conclude that scintigraphic patterns in the uncomplicated patient with a porous coated prosthesis appear to differ from patterns described in cemented prostheses.

  12. Effect of size and dimensional tolerance of reverse total shoulder arthroplasty on wear: An in-silico study.

    PubMed

    Mattei, Lorenza; Di Puccio, Francesca; Joyce, Thomas J; Ciulli, Enrico

    2016-08-01

    Although huge research efforts have been devoted to wear analysis of ultra-high molecular weight polyethylene (UHMWPE) in hip and knee implants, shoulder prostheses have been studied only marginally. Recently, the authors presented a numerical wear model of reverse total shoulder arthroplasties (RTSAs), and its application for estimating the wear coefficient k from experimental data according to different wear laws. In this study, such model and k expressions are exploited to investigate the sensitivity of UHMWPE wear to implant size and dimensional tolerance. A set of 10 different geometries was analysed, considering nominal diameters in the range 36-42mm, available on the market, and a cup dimensional tolerance of +0.2, -0.0mm (resulting in a diametrical clearance ranging between 0.04-0.24mm), estimated from measurements on RTSAs. Since the most reliable wear law and wear coefficient k for UHMWPE are still controversial in the literature, both the Archard law (AR) and the wear law of UHMWPE (PE), as well as four different k expressions were considered, carrying out a total of 40 simulations. Results showed that the wear volume increases with the implant size and decreases with the dimensional tolerance for both the wear laws. Interestingly, different trends were obtained for the maximum wear depth vs. clearance: the best performing implants should have a high conformity according to the AR law but low conformity for the PE law. However, according to both laws, wear is highly affected by both implant size and dimensional tolerance, although it is much more sensitive to the latter, with up to a twofold variation of wear predicted. Indeed, dimensional tolerance directly alters the clearance, and therefore the lubrication and contact pressure distribution in the implant. Rather surprisingly the role of dimensional tolerance has been completely disregarded in the literature, as well as in the standards. Furthermore, this study notes some important issues for future

  13. Comparison of a minimally invasive posterior approach and the standard posterior approach for total hip arthroplasty A prospective and comparative study

    PubMed Central

    2010-01-01

    Background It is not clear whether total hip arthroplasty performed via a minimally invasive approach leads to less muscle trauma compared to the standard approach. Materials and methods To investigate whether a minimally invasive posterior approach for total hip arthroplasty results in lower levels of muscle-derived enzymes and better post-operative clinical results than those obtained with the standard posterolateral approach fifty patients in both groups were compared in a prospective and comparative study. The following parameters were examined: muscle-derived enzymes CPK, CK-MM and myoglobin pre-operatively, 24 and 48 hours post-operatively, CRP and hemoglobin on the third postoperative day, loss of blood, daily pain levels, the rate of recovery (time taken to attain predefined functional parameters), the Oxford Hip Score, the SF-36 score and the WOMAC score pre-operatively and six weeks post-surgery, the position of the implant and the cement coating by post-operative X-ray examination. Results and Conclusions The minimally invasive operated patients exhibited a significantly lower loss of blood, significantly less pain at rest and a faster rate of recovery but the clinical chemistry values and the other clinical parameters were comparable. PMID:20663200

  14. Frequent Dental Scaling Is Associated with a Reduced Risk of Periprosthetic Infection following Total Knee Arthroplasty: A Nationwide Population-Based Nested Case-Control Study

    PubMed Central

    Tai, Ta-Wei; Lin, Tzu-Chieh; Ho, Chia-Jung; Kao Yang, Yea-Huei; Yang, Chyun-Yu

    2016-01-01

    Oral bacteremia has been presumed to be an important risk factor for total knee arthroplasty (TKA) infection. We aimed to investigate whether dental scaling could reduce the risk of TKA infection. A nested case-control study was conducted to compare 1,291 TKA patients who underwent resection arthroplasty for infected TKA and 5,004 matched controls without infection in the TKA cohort of Taiwan’s National Health Insurance Research Database (NHIRD). The frequency of dental scaling was analyzed. Multiple conditional logistic regression was used to assess the frequency of dental scaling and the risk of TKA infection. The percentage of patients who received dental scaling was higher in the control group than in the TKA infection group. The risk for TKA infection was 20% lower for patients who received dental scaling at least once within a 3-year period than for patients who never received dental scaling. Moreover, the risk of TKA infection was reduced by 31% among patients who underwent more frequent dental scaling (5–6 times within 3 years). Frequent and regular dental scaling is associated with a reduced risk of TKA infection. PMID:27336912

  15. A Prospective, Longitudinal Study of Patient Activity Levels Following Total Knee Arthroplasty Stratified by Demographic and Comorbid Factors.

    PubMed

    Issa, Kimona; Jauregui, Julio J; Given, Kristin; Harwin, Steven F; Mont, Michael A

    2015-08-01

    With the marked increase in the annual number of total knee arthroplasties (TKAs) in the United States, there has been an increased interest in evaluating patient-reported outcomes. The purpose of this study was to prospectively and longitudinally evaluate temporal trends in patient activity levels following TKA and to identify potential demographic and comorbid factors that may affect these outcomes. This prospective study evaluated 281 patients, including 108 men and 173 women, who had a mean age of 66 years (39-80 years) and underwent primary TKA. All patients were followed for a minimum of 2 years. Medical comorbidities were recorded preoperatively and activity scores were evaluated at each follow-up visit. The effects of different patient demographics and systemic comorbidities on activity outcomes were further analyzed using multivariate regression analysis. Compared with preoperative levels, the activity score was observed to initially significantly decrease at 6 weeks postoperatively to below preoperative levels (9.2 vs. 8.1 points). By 3 months, scores were above preoperative levels (10.3 points), but below peak levels. A significant peak in the activity score was observed at 2-year follow-up after which there were no significant differences in scores at 5 years (11.49 vs. 11.47 points). In evaluating patient demographics and comorbidities, significant negative impact of older age, tobacco use, history of cancer, cardiovascular disease, lymphatic disease, and renal disease can be seen on activity levels. Activity scores following TKA follow a temporal trend in which scores initially drop below preoperative levels after surgery, but recover and reach a peak at 2 years postoperatively. This peak was maintained at 5-year follow-up. Surgeons should counsel their patients that they will not perceive the full benefit of a TKA until 1 to 2 years after surgery, in addition, patients may actually perceive their progress to decrease initially. Also, their

  16. Implant based differences in adverse local tissue reaction in failed total hip arthroplasties: a morphological and immunohistochemical study

    PubMed Central

    2014-01-01

    Background Adverse local tissue reaction (ALTR) is characterized by periprosthetic soft tissue inflammation composed of a mixed inflammatory cell infiltrate, extensive soft tissue necrosis, and vascular changes. Multiple hip implant classes have been reported to result in ALTR, and clinical differences may represent variation in the soft tissue response at the cellular and tissue levels. The purpose of this study was to describe similarities and differences in periprosthetic tissue structure, organization, and cellular composition by conventional histology and immunohistochemistry in ALTR resulting from two common total hip arthroplasty (THA) implant classes. Methods Consecutive patients presenting with ALTR from two major hip implant classes (N = 54 patients with Dual-Modular Neck implant; N = 14 patients with Metal-on-Metal implant) were identified from our prospective Osteolysis Tissue Database and Repository. Clinical characteristics including age, sex, BMI, length of implantation, and serum metal ion levels were recorded. Retrieved synovial tissue morphology was graded using light microscopy and cellular composition was assessed using immunohistochemistry. Results Length of implantation was shorter in the DMN group versus MoM THA group (21.3 [8.4] months versus 43.6 [13.8] months respectively; p < 0.005) suggesting differences in implant performance. Morphologic examination revealed a common spectrum of neo-synovial proliferation and necrosis in both groups. Macrophages were more commonly present in diffuse sheets (Grade 3) in the MoM relative to DMN group (p = 0.016). Perivascular lymphocytes with germinal centers (Grade 4) were more common in the DMN group, which trended towards significance (p = 0.066). Qualitative differences in corrosion product morphology were seen between the two groups. Immunohistochemistry showed features of a CD4 and GATA-3 rich lymphocyte reaction in both implants, with increased ratios of perivascular T

  17. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty: A Cross-Sectional Study

    PubMed Central

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt; Kehlet, Henrik; Jakobsen, Thomas Linding

    2014-01-01

    Background Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA. Objective To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. Design Cross-sectional study. Setting Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013. Participants Seventeen patients, no more than 3 weeks after their TKA. Main outcome measures: In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0–10). Results Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001). Resting knee pain 60 seconds after the final repetition (2.7±2.4 points) was not different from that recorded before strength training (2.7±1.8 points, P = 0.88). Conclusion Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived. Trial Registration

  18. MALLARD REPRODUCTIVE TESTING IN A POND ENVIRONMENT: A PRELIMINARY STUDY

    EPA Science Inventory

    A 2-year preliminary study was conducted on mallard ducks to determine the feasibility of using outdoor pond enclosures for reproductive studies and to evaluate the effects of the insecticide chlorpyrifos on mallard reproduction. No significant reproductive effects were observed ...

  19. Preliminary Biomechanical Study of Different Acetabular Reinforcement Devices for Acetabular Reconstruction

    PubMed Central

    Tai, Ching-Lung; Lee, Po-Yi; Hsieh, Pang-Hsing

    2015-01-01

    Background Acetabular reinforcement devices (ARDs) are frequently used as load-sharing devices to allow allograft incorporation in revision hip arthroplasty with massive acetabular bone loss. The key to a successful reconstruction is robust fixation of the device to the host acetabulum. Interlocking fixation is expected to improve the initial stability of the postoperative construct. However, all commercially available ARDs are designed with non-locking fixation. This study investigates the efficacy of standard ARDs modified with locking screw mechanisms for improving stability in acetabular reconstruction. Methods Three types of ARDs were examined to evaluate the postoperative compression and angular stability: i) standard commercial ARDs, ii) standard ARDs modified with monoaxial and iii) standard ARDs modified with polyaxial locking screw mechanisms. All ARDs were implanted into osteomized synthetic pelvis with pelvic discontinuity. Axial compression and torsion tests were then performed using a servohydraulic material testing machine that measured load (angle) versus displacement (torque). Initial stability was compared among the groups. Results Equipping ARDs with interlocking mechanisms effectively improved the initial stability at the device/bone interface compared to standard non-locked ARDs. In both compression and torsion experiments, the monoaxial interlocking construct demonstrated the highest construct stiffness (672.6 ± 84.1 N/mm in compression and 13.3 ± 1.0 N·m/degree in torsion), whereas the non-locked construct had the lowest construct stiffness (381.4 ± 117.2 N/mm in compression and 6.9 ± 2.1 N·m/degree in torsion) (P < 0.05). Conclusions Our study demonstrates the potential benefit of adding a locking mechanism to an ARD. Polyaxial ARDs provide the surgeon with more flexibility in placing the screws at the cost of reduced mechanical performance. This in vitro study provides a preliminary evaluation of biomechanical performance for ARDs

  20. Knee arthroplasty in Denmark, Norway and Sweden

    PubMed Central

    Bizjajeva, Svetlana; Fenstad, Anne Marie; Furnes, Ove; Lidgren, Lars; Mehnert, Frank; Odgaard, Anders; Pedersen, Alma Becic; Havelin, Leif Ivar

    2010-01-01

    Background and purpose The number of national arthroplasty registries is increasing. However, the methods of registration, classification, and analysis often differ. Methods We combined data from 3 Nordic knee arthroplasty registers, comparing demographics, methods, and overall results. Primary arthroplasties during the period 1997–2007 were included. Each register produced a dataset of predefined variables, after which the data were combined and descriptive and survival statistics produced. Results The incidence of knee arthroplasty increased in all 3 countries, but most in Denmark. Norway had the lowest number of procedures per hospital—less than half that of Sweden and Denmark. The preference for implant brands varied and only 3 total brands and 1 unicompartmental brand were common in all 3 countries. Use of patellar button for total knee arthroplasty was popular in Denmark (76%) but not in Norway (11%) or Sweden (14%). Uncemented or hybrid fixation of components was also more frequent in Denmark (22%) than in Norway (14%) and Sweden (2%). After total knee arthroplasty for osteoarthritis, the cumulative revision rate (CRR) was lowest in Sweden, with Denmark and Norway having a relative risk (RR) of 1.4 (95% CI: 1.3–1.6) and 1.6 (CI: 1.4–1.7) times higher. The result was similar when only including brands used in more than 200 cases in all 3 countries (AGC, Duracon, and NexGen). After unicompartmental arthroplasty for osteoarthritis, the CRR for all models was also lowest in Sweden, with Denmark and Norway having RRs of 1.7 (CI: 1.4–2.0) and 1.5 (CI: 1.3–1.8), respectively. When only the Oxford implant was analyzed, however, the CRRs were similar and the RRs were 1.2 (CI: 0.9–1.7) and 1.3 (CI: 1.0–1.7). Interpretation We found considerable differences between the 3 countries, with Sweden having a lower revision rate than Denmark and Norway. Further classification and standardization work is needed to permit more elaborate studies. PMID:20180723

  1. A medium-term follow-up study of 44 Souter-Strathclyde elbow arthroplasties carried out for rheumatoid arthritis.

    PubMed

    Dainton, Jeremy N; Hutchins, Philip M

    2002-01-01

    The results of 44 primary Souter-Strathclyde total elbow arthroplasties performed on 36 patients with rheumatoid arthritis are reported, with a mean follow-up of 6 years (range, 17 months-12 years; median, 6 years). Of these patients, 63% reported complete freedom from pain in the elbow, 25% mild intermittent pain, and 12% moderate pain. The mean range of motion at follow-up was 97 degrees (range, 40 degrees -135 degrees ). This represented a mean gain of 16.5 degrees of flexion, but only a 1.5 degrees gain in extension. Twenty-sevenelbows had a range of motion of 100 degrees or greater compared with 13 before surgery. There was 1 permanent ulnar nerve palsy and 1 deep infection requiring debridement. Six cases (4%) required revision, 2 for olecranon fractures and 4 for loosening. In patients with rheumatoid arthritis with low functional demand, the Souter-Strathclyde total elbow arthroplasty performs well in abolishing pain and increasing independence in carrying out the activities of daily living. PMID:12378169

  2. Observations on the initial stability of acetabular components in total hip arthroplasty. An experimental study.

    PubMed

    Pitto, R P; Sterzl, M; Hohmann, D

    1996-01-01

    It was the purpose of the study to investigate the initial stability, with or without screws, of 3 acetabular components with press-fit anchoring, by measuring bone-prosthesis micromovements during the application of physiological loading on the hip simulated in the laboratory. The prostheses, already used clinically, were characterized by different shapes and coatings. For the purposes of the study a total of 30 acetabula were used in 10 human pelves in polyurethane and 5 human pelves preserved at -20 degrees. The pelves were assembled on a hydraulic bench test with a steel jig that could be oriented, and they were cemented with polymethylmethacrylate. Three electromagnetic transducers with sensitivity of up to 1 micron (+ 500 microns) were used to measure the micromovements between the prosthesis and the acetabular rim in its three anatomical quadrants. Bone-prosthesis micromovements were recorded during 5 consecutive load tests, from 0 to 2.39 kN (244 kg). Experimental studies have shown that bone-prosthesis micromovement that exceeds 150 microns obstructs bone integration. The most significant micromovement was observed for all of the prostheses, without accessory screws, in the iliac quadrant, but only the hemispherical one with a semi-smooth surface in zirconium oxide surpassed the threshold of 150 microns. Prostheses with a porous surface demonstrated good stability (102 +/- 33 microns and 94 +/- 36 microns, respectively). None of the prostheses demonstrated micromovement exceeding 90 microns in the area corresponding to the pubis and the ischium. The use of 2 accessory screws sensitively increased the stability of all of the prostheses on the ilium, reducing the average micromovement by 40 microns. Reduction of micromovement was less on the pubis and on the ischium. PMID:8968114

  3. Total or Partial Knee Arthroplasty Trial - TOPKAT: study protocol for a randomised controlled trial

    PubMed Central

    2013-01-01

    Background In the majority of patients with osteoarthritis of the knee the disease originates in the medial compartment. There are two fundamentally different approaches to knee replacement for patients with unicompartmental disease: some surgeons feel that it is always best to replace both the knee compartments with a total knee replacement (TKR); whereas others feel it is best to replace just the damaged component of the knee using a partial or unicompartment replacement (UKR). Both interventions are established and well-documented procedures. Little evidence exists to prove the clinical and cost-effectiveness of either management option. This provides an explanation for the high variation in treatment of choice by individual surgeons for the same knee pathology. The aim of the TOPKAT study will be to assess the clinical and cost effectiveness of TKRs compared to UKRs in patients with medial compartment osteoarthritis. Methods/Design The design of the study is a single layer multicentre superiority type randomised controlled trial of unilateral knee replacement patients. Blinding will not be possible as the surgical scars for each procedure differ. We aim to recruit 500 patients from approximately 28 secondary care orthopaedic units from across the UK including district general and teaching hospitals. Participants will be randomised to either UKR or TKR. Randomisation will occur using a web-based randomisation system. The study is pragmatic in terms of implant selection for the knee replacement operation. Participants will be followed up for 5 years. The primary outcome is the Oxford Knee Score, which will be collected via questionnaires at 2 months, 1 year and then annually to 5 years. Secondary outcomes will include cost-effectiveness, patient satisfaction and complications data. Trial registration Current Controlled Trials ISRCTN03013488; ClinicalTrials.gov Identifier: NCT01352247 PMID:24028414

  4. Measurement of pelvic osteolytic lesions in follow-up studies after total hip arthroplasty

    NASA Astrophysics Data System (ADS)

    Castaneda, Benjamin; Tamez-Pena, Jose G.; Totterman, Saara; O'Keefe, Regis; Looney, R. John

    2006-03-01

    Previous studies have demonstrated the plausibility of using volumetric computerized tomography to provide an accurate representation and measurement of volume for pelvic osteolytic lesions following total hip joint replacement. These studies have been performed manually (or computed-assisted) by expert radiologists with the disadvantage of poor reproducibility of the experiment. The purpose of this work is to minimize the effect of user interaction in these experiments by introducing Laplacian level set methods in the volume segmentation process and using temporal articulated registration in order to follow the evolution of a lesion over time. Laplacian level set methods reduce the inter and intra-observer variability by attaching the segmented contour to edges defined in the image while keeping smoothness. The registration process allows the information of the lesion from the first visit to be used in the segmentation process of the current visit. This work compares the automated results on 7 volunteers versus the volume measured manually. Results have shown that the proposed technique is able to track osteolytic lesions and detect changes in volume over time. Intra-reader and inter-observer variabilities were reduced.

  5. A Prospective, Longitudinal Study of Outcomes Following Total Knee Arthroplasty Stratified by Gender.

    PubMed

    Cherian, Jeffrey J; O'Connor, Mary I; Robinson, Kristen; Jauregui, Julio J; Adleberg, Jason; Mont, Michael A

    2015-08-01

    This study aimed to compare temporal trends in outcomes between men and women following TKA. A database of 272 TKAs at 7 years follow-up were evaluated for survivorship, functional, activity, and quality of life outcomes. Evaluation of implant survivorship, KSS scores, and ROM showed no significance differences between men and women, but both functional KSS scores and LEAS showed that men had significantly higher functional scores. The SF-36 physical component was found to be significantly better in men at multiple time points, whereas, the mental component was significantly better in men at pre-operative and 2 years. Both men and women benefit from TKA, however, men have higher levels of function and activity both prior to and after TKA than women. PMID:25865810

  6. A radiographic study of the detection limits of bone-cement remnants in total joint arthroplasty.

    PubMed

    Rauh, Michael A; Bayers-Thering, Mary; Madanagopal, Sudhakar; Krackow, Kenneth A

    2002-12-01

    Management of an infected hip prosthesis typically requires that all associated cement be removed. In the absence of gross mantle loosening, the surgeon frequently resorts to intraoperative radiographs to assess the completeness of removal. For this reason, we undertook a study to determine limits of detection of retained cement by routine radiography. Polymethyl methacrylate bone-cement beads (Simplex-P; Stryker-Howmedica-Osteonics, Allendale, NJ) were fashioned into graduated sizes and placed within cadaver medullary canals using 2 different methods. Standard radiographic images were obtained. Individually and independently, we viewed these images and proposed the limit of resolution to be 2.4 to 3.2 mm. It is difficult to remove all cement based on radiographs alone. These results suggest a need to use techniques that permit visualization of the canal to ensure adequate cement removal. PMID:12478508

  7. Wear of polyethylene cups in total hip arthroplasty. A study of specimens retrieved post mortem.

    PubMed

    Sychterz, C J; Moon, K H; Hashimoto, Y; Terefenko, K M; Engh, C A; Bauer, T W

    1996-08-01

    The wear of polyethylene components of total hip replacements has previously been studied radiographically and by analysis of retrieved components. The extent of wear, however, has largely been determined from components retrieved at reoperation and has therefore been based on a subset of patients in whom the prosthesis is more likely to show excessive wear. The study of cups retrieved post mortem provides a better indication of the extent of wear of well functioning components. Twenty-six polyethylene liners were retrieved at autopsy from nineteen patients, after a mean of ninety-one months (range, thirty-three to 206 months) in situ. Each component had articulated with a thirty-two-millimeter-diameter femoral head. The components were evaluated visually for evidence of polyethylene wear such as pitting, scratching, and burnishing. Additionally; a shadowgraph technique was used to examine molds of the inner surface of the liner to determine the direction and extent of wear. The mean extent of linear wear of the retrieved liners was 0.45 millimeter (range, 0.17 to 1.07 millimeters), and the mean rate of wear was 0.07 millimeter (range, 0.02 to 0.18 millimeter) per year. The mean volumetric wear was 245.3 cubic millimeters (range, 13.0 to 779.1 cubic millimeters), and the mean rate of volumetric wear was 39.8 cubic millimeters (range, 1.0 to 131.3 cubic millimeters) per year. The mean rate of wear for the twenty-six liners was 45 to 69 per cent less than the rates reported in the literature for polyethylene liners retrieved at reoperation. Examination of the articulating surface did not reveal gross evidence of surface failure such as delamination or fatigue cracks. In general, the surfaces were merely burnished and scratched. The rates of wear of press-fit, metal-backed liners were significantly higher than those of all-polyethylene cemented components (p < 0.05). Additionally, statistical analysis revealed no correlation between wear and the patient's age, weight

  8. Mosaic arthroplasty of the medial femoral condyle in horses - An experimental study.

    PubMed

    Bodó, Gábor; Vásárhelyi, Gábor; Hangody, László; Módis, László

    2014-06-01

    One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations. PMID:24334083

  9. Traumatic Migration of the Bryan Cervical Disc Arthroplasty.

    PubMed

    Wagner, Scott C; Kang, Daniel G; Helgeson, Melvin D

    2016-02-01

    Study Design Case study. Objective To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5-C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively. PMID:26835211

  10. Traumatic Migration of the Bryan Cervical Disc Arthroplasty

    PubMed Central

    Wagner, Scott C.; Kang, Daniel G.; Helgeson, Melvin D.

    2015-01-01

    Study Design Case study. Objective To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5–C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively. PMID:26835211

  11. A regime of two intravenous injections of tranexamic acid reduces blood loss in minimally invasive total hip arthroplasty: a prospective randomised double-blind study.

    PubMed

    Hsu, C-H; Lin, P-C; Kuo, F-C; Wang, J-W

    2015-07-01

    Tranexamic acid (TXA), an inhibitor of fibrinolysis, reduces blood loss after total knee arthroplasty. However, its effect on minimally invasive total hip arthroplasty (THA) is not clear. We performed a prospective, randomised double-blind study to evaluate the effect of two intravenous injections of TXA on blood loss in patients undergoing minimally invasive THA. In total, 60 patients (35 women and 25 men with a mean age of 58.1 years; 17 to 84) who underwent unilateral minimally invasive uncemented THA were randomly divided into the study group (30 patients, 20 women and ten men with a mean age of 56.5 years; 17 to 79) that received two intravenous injections 1 g of TXA pre- and post-operatively (TXA group), and a placebo group (30 patients, 15 women and 15 men with a mean age of 59.5 years; 23 to 84). We compared the peri-operative blood loss of the two groups. Actual blood loss was calculated from the maximum reduction in the level of haemoglobin. All patients were followed clinically for the presence of venous thromboembolism. The TXA group had a lower mean intra-operative blood loss of 441 ml (150 to 800) versus 615 ml (50 to 1580) in the placebo (p = 0.044), lower mean post-operative blood loss (285 ml (120 to 570) versus 392 ml (126 to 660) (p = 0.002), lower mean total blood loss (1070 ml (688 to 1478) versus 1337 ml (495 to 2238) (p = 0.004) and lower requirement for transfusion (p = 0.021). No patients in either group had symptoms of venous thromboembolism or wound complications. This prospective, randomised controlled study showed that a regimen of two intravenous injections of 1 g TXA is effective for blood conservation after minimally invasive THA. PMID:26130344

  12. Limited femoral navigation versus conventional intramedullary femoral jig based instrumentation for achieving optimal restoration of mechanical axis post total knee arthroplasty: a prospective comparative study of 200 knees.

    PubMed

    Shah, Nilen A; Patil, Hitendra G; Dhawale, Amol S; Khedkar, Bipin M

    2015-04-01

    A prospective comparative study was conducted to compare the mechanical axis post total knee arthroplasty (TKA) between two groups: In the first group of 100 knees (ASM group) Articular Surface Mounted navigation system was used to guide the distal femoral cut. In the second group of 100 knees (JIG group) conventional intramedullary femoral jig was used. The postoperative mechanical axis of the leg was within 3° of neutral alignment in 90% of the TKA in the ASM group (mean 178.12°) as compared to 74% in the JIG group (mean 177.02°). This difference was statistically significant (P<0.05). The data presented show that the use of limited femoral navigation leads to more accurate restoration of mechanical axis alignment when compared to conventional intramedullary femoral jigs. PMID:25466168

  13. Recovery of Posture Stability at Different Foot Placements in Patients Who Underwent Minimally Invasive Total Hip Arthroplasty: A One-Year Follow-Up Study

    PubMed Central

    Chang, Chun-Ju; Lin, Na-Ling; Lee, Mel S.; Chern, Jen-Suh

    2015-01-01

    To understand the progression of recovery in postural stability and physical functioning after patients received the minimally invasive total hip arthroplasty (MTHA), we monitor the pain level, functional capacity, and postural stability before and after operation within one year. In total of 23 subjects in our study, we found out that MTHA was effective in relieving pain in first 2 weeks and restoring the hip joint integrity, but the postural stability was influenced especially in tandem stand in both anterior-posterior and medial-lateral directions. The recovery of postural stability and functional capacity in one year duration fluctuated and no consistent improvement tendency was found. We suggested clinicians designing postsurgery rehabilitation program for consistent and progressive long-term recovery of postural stability and fall prevention to optimize surgical results and prevent undesired postoperative consequences. PMID:26583110

  14. Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study

    PubMed Central

    Inacio, Maria C S; Hansen, Craig; Pratt, Nicole L; Graves, Stephen E; Roughead, Elizabeth E

    2016-01-01

    Objectives To determine chronic opioid use pre-THA (total hip arthroplasty) and post-THA, and risk factors for persistent or new chronic opioid use post-THA. Design Retrospective cohort study. Setting Australian Government Department of Veterans' Affairs health claims database. Participants 9525 patients who had an elective unilateral THA between 1/01/2001 and 12/31/2012. Primary outcome measure Chronic opioid use. Defined as 90 days of continuous opioid use or 120 days of non-continuous use. Results Pre-THA, 6.2% (n=593) of patients were chronic users, while 5.2% (n=492) were post-THA. Among the 492 postoperative chronic users, 302 (61%) were chronic users pre-THA and post-THA and 190 (39%) became new chronic users after surgery. Risk factors for persistent chronic use were younger age (OR=0.96, 95% CI 0.93 to 0.99/1-year increment), back pain (OR=1.99, 95% CI 1.20 to 3.23), diabetes (OR=3.52, 95% CI 1.05 to 11.8), hypnotics use (OR=2.52, 95% CI 1.48 to 4.30) and higher pre-THA opioid exposure (compared with opioid use for 94–157 days, 157–224 days (OR=3.75, 95% CI 2.28 to 6.18), 225+ days (OR=5.18, 95% CI 2.92 to 9.19). Risk factors for new chronic opioid use post-THA were being a woman (OR=1.40, 95% CI 1.00 to 1.96), back pain (OR=3.90, 95% CI 2.85 to 5.33), depression (OR=1.70, 95% CI 1.20 to 2.41), gastric acid disease (OR=1.62, 95% CI 1.16 to 2.25), migraine (OR=5.11, 95% CI 1.08 to 24.18), liver disease (OR=4.33, 95% CI 1.08 to 17.35), weight loss (OR=2.60, 95% CI 1.06 to 6.39), dementia (OR=2.19, 95% CI 1.04 to 4.61), hyperlipidaemia (OR=1.38, 95% CI 1.00 to 1.91), hypnotics (OR=1.56, 95% CI 1.13 to 2.16) and antineuropathic pain medication use (OR=3.11, 95% CI 2.05 to 4.72). Conclusions Patients undergoing THA are exposed to opioids for long periods of time, putting them at high risk of harm related to opioid use. We identified groups at risk of chronic opioid use, including younger patients and women, as well as modifiable risk factors of

  15. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    PubMed

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

    Although the majority of North American surgeons perform total knee arthroplasty by cementing both the femoral and the tibial components, hybrid fixation with a press-fit femur and cemented tibia is an alternative form of total knee arthroplasty performed by some. Currently, there is a paucity of literature evaluating long-term outcomes after hybrid total knee arthroplasty. As such, the purpose of the current study was to describe the long-term results of total knee arthroplasty performed using the hybrid technique. The authors retrospectively reviewed a total of 77 hybrid total knee arthroplasties with at least 12 years of follow-up. Clinical and radiographic evaluations were performed to determine patient function and the incidence of femoral component failure after hybrid total knee arthroplasty. At the time of last follow-up, 76 of 77 (99%) of the femoral components remained in place without evidence of loosening. One femoral component failed due to aseptic loosening and was ultimately revised to a cemented femoral component without further complication. In addition, 1 tibial component and 2 patellar components failed due to aseptic loosening. Four tibial polyethylene liners were revised for polyethylene wear. In conclusion, press-fit fixation of the femoral component is a reliable and durable alternative to cemented fixation. [Orthopedics. 2016; 39(3):181-186.]. PMID:27135453

  16. Preliminary design studies of an advanced general aviation aircraft

    NASA Technical Reports Server (NTRS)

    1991-01-01

    Preliminary design studies are presented for an advanced general aviation aircraft. Advanced guidance and display concepts, laminar flow, smart structures, fuselage and wing structural design and manufacturing, and preliminary configuration design are discussed. This project was conducted as a graduate level design class under the auspices of the KU/NASA/USRA Advanced Design Program in Aeronautics. The results obtained during the fall semester of 1990 (Phase 1) and the spring semester of 1991 (Phase 2) are presented.

  17. Preliminary design study. Shuttle modular scanning spectroradiometer

    NASA Technical Reports Server (NTRS)

    1975-01-01

    Fundamental concepts on which to base a detailed design for a Shuttle Modular Scanning Spectroradiometer were developed, and a preliminary design is presented. The recommended design features modularity and flexibility. It includes a 75-cm f/1.7-telescope assembly in an all-reflective Schmidt configuration, a solid state scan system (pushbroom) with high resolution over a 15 deg field of view, and ten detector channels covering the spectral range from 0.45 to 12.5 micrometers. It uses charge transfer device techniques to accommodate a large number of detector elements for earth observation measurements. Methods for in-flight radiometric calibration, for image motion compensation, and for data processing are described. Recommendations for ground support equipment are included, and interfaces with the shuttle orbiter vehicle are illustrated.

  18. Ceramic Femoral Components in Total Knee Arthroplasty - Two Year Follow-Up Results of an International Prospective Multi-Centre Study

    PubMed Central

    Bergschmidt, Philipp; Bader, Rainer; Ganzer, Dirk; Hauzeur, Christian; Lohmann, Christoph; Rüther, Wolfgang; Tigani, Domenico; Rani, Nicola; Prats, Fernando Lopez; Zorzi, Claudio; Madonna, Vincenzo; Rigotti, Stefano; Benazzo, Francesco; Rossi, Stefano Marco Paolo; Kundt, Guenther; Bloch, Hans Rudolf; Mittelmeier, Wolfram

    2012-01-01

    Background: Total knee arthroplasty can be considered as a reliable surgical procedure with a good long-term clinical result. However, implant failure due to particle induced aseptic loosening as well as the aspect of hypersensitivity to metal ions still remains an emerging issue. Methods: The purpose of this prospective international multi-centre study was to evaluate the clinical and radiological outcomes and the reliability of the unconstrained Multigen Plus Total Knee System with a new BIOLOX® delta ceramic femoral component. Cemented total knee arthroplasty was performed on 108 patients (110 knees) at seven hospitals in three countries. Clinical and radiological evaluations were performed preoperatively, and after 3, 12 and 24 months postoperatively using the HSS-, WOMAC-, SF-36-score and standardised X-rays. Results: The mean preoperative HSS-Score amounted to 55.5 ± 11.5 points and improved significantly in all postoperative evaluations (85.7 ± 11.7 points at 24 months). Furthermore, improvements in WOMAC- and SF-36-score were evaluated as significant at all points of evaluation. Radiolucent lines around the femoral ceramic component at 24 months were found in four cases. Progression of radiolucent lines was not seen and no implant loosening was observed. During the 24 month follow-up eight patients underwent subsequent surgery due to reasons unrelated to the implant material. Conclusions: The observed clinical and radiological results are encouraging for a long-term survival of the ceramic femoral component. Therefore, ceramic implants could be a promising solution not only for patients with allergies against metallic implant materials, but also for the osteoarthritic knee joint. Long-term follow-up is necessary to draw conclusions regarding the superiority of the ceramic knee implants concerning in vivo wear and long-term survivorship. PMID:22582104

  19. Is Electrocautery of Patella Useful in Patella Non-Resurfacing Total Knee Arthroplasty?: A Prospective Randomized Controlled Study.

    PubMed

    Kwon, Sae Kwang; Nguku, Levis; Han, Chang Dong; Koh, Yong-Gon; Kim, Dong-Wook; Park, Kwan Kyu

    2015-12-01

    There is controversy over the need for electrocauterization of the patella in non-resurfacing total knee arthroplasty (TKA). We investigated whether this procedure is beneficial through a prospective randomized controlled trial. Fifty patients who underwent electrocautery were compared with 50 patients who did not undergo this procedure. We determined cartilage status, preoperative and postoperative American Knee Society (AKS) score, the Western Ontario and McMaster Universities score (WOMAC) and the Patellofemoral (PF) scores for a minimum of 5 years. The two groups did not differ significantly in demographics, intraoperative cartilage status, or preoperative or postoperative outcomes. No complications were detected in either group. We found no benefits of electrocautery of the patella in patellar non-resurfacing TKA up to 5 years. PMID:26100474

  20. Application of Rapid Prototyping Pelvic Model for Patients with DDH to Facilitate Arthroplasty Planning: A Pilot Study.

    PubMed

    Xu, Jie; Li, Deng; Ma, Ruo-fan; Barden, Bertram; Ding, Yue

    2015-11-01

    Total hip arthroplasty (THA) is challenging in cases of osteoarthritis secondary to developmental dysplasia of the hip (DDH). Acetabular deficiency makes the positioning of the acetabular component difficult. Computer tomography based, patient-individual three dimensional (3-D) rapid prototype technology (RPT)-models were used to plan the placement of acetabular cup so that a surgeon was able to identify pelvic structures, assess the ideal extent of reaming and determine the size of cup after a reconstructive procedure. Intraclass correlation coefficients (ICCs) were used to analyze the agreement between the sizes of chosen components on the basis of preoperative planning and the actual sizes used in the operation. The use of the 3-D RPT-model facilitates the surgical procedures due to better planning and improved orientation. PMID:26129852

  1. Does tranexamic acid reduce blood transfusion cost for primary total hip arthroplasty? A case-control study.

    PubMed

    Harris, Ryan N; Moskal, Joseph T; Capps, Susan G

    2015-02-01

    Peri-operative tranexamic acid (TXA) significantly reduces the need for allogeneic blood transfusion in total hip arthroplasty (THA) and thus hospital costs are reduced. Before employing TXA in primary THA at our institution, facility costs were $286.90/THA for blood transfusion and required 0.45 man-hours/THA (transfusion rate 19.87%). After incorporating TXA, the cost for intravenous application was $123.38/THA for blood transfusion and TXA medication and 0.07 man-hours/THA (transfusion rate 4.39%) and the cost for topical application was $132.41/THA for blood transfusion and TXA and 0.14 man-hours/THA (transfusion rate 12.86%). TXA has the potential to reduce the facility cost per THA and the man-hours/THA from blood transfusions. PMID:25534861

  2. Intra-articular bupivacaine after joint arthroplasty: a systematic review and meta-analysis of randomised placebo-controlled studies

    PubMed Central

    Cui, Yang; Yang, Tuo; Zeng, Chao; Wei, Jie; Xie, Xi; Li, Liangjun; Ding, Xiang; Zhang, Yi; Lei, Guanghua

    2016-01-01

    Objectives To evaluate the efficacy and safety of intra-articular (IA) bupivacaine administered for pain relief after joint arthroplasty. Design Meta-analysis. Methods A systematic review was conducted to identify the randomised controlled trials using IA bupivacaine for postoperative pain relief from MEDLINE, Cochrane Library and EMBASE databases (up to October 2015). The standardised mean difference (SMD), the relative risk (RR) and their corresponding 95% CIs were calculated using the RevMan statistical software. Results A total of 11 randomised controlled trials were included. Statistically significant differences between IA bupivacaine and placebo were observed for the mean visual analogue scale (VAS) values (SMD −0.55; 95% CI −0.89 to −0.22; p<0.001) and narcotic consumption (SMD −0.32; 95% CI −0.55 to −0.08; p=0.008) during the period of 24 hours postoperatively and narcotic consumption during the period between 24 and 48 hours postoperatively (SMD −0.32; 95% CI −0.55 to −0.08; p=0.009). However, there was no significant difference in the mean VAS pain score during the period between 24  and 48 hours postoperatively (SMD −0.09, 95% CI −0.30 to 0.11; p=0.37) and in the incidence of adverse effects 24–72 hours postoperatively (RR 0.97; 95% CI 0.60 to 1.57; p=0.91). Conclusions The administration of IA bupivacaine after joint arthroplasty is effective for pain relief without increasing adverse effects. PMID:27406643

  3. Arthroplasty in Femoral Head Osteonecrosis

    PubMed Central

    Nam, Dong Cheol; Jung, Kwangyoung

    2014-01-01

    Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head. PMID:27536561

  4. Cementless total knee arthroplasty

    PubMed Central

    Risitano, Salvatore; Sabatini, Luigi; Giachino, Matteo; Agati, Gabriele; Massè, Alessandro

    2016-01-01

    Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision’s rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation. PMID:27162779

  5. Early Attempts at Hip Arthroplasty

    PubMed Central

    Gomez, Pablo F; Morcuende, Jose A

    2005-01-01

    Over the last three centuries, treatment of hip arthritides has evolved from rudimentary surgery to modern total hip arthroplasty (THA), which is considered one of the most successful surgical interventions ever developed. We here review the history of the early hip arthroplasty procedures for hip arthritis that preceded Charley total hip arthroplasty. An evaluation of such past enterprises is relevant, and reminds us of the ephemeral nature of human industriousness, and how medical research and procedures are not isolated developments, but correlate to the social, economical, and cultural framework of their time. PMID:16089067

  6. [Revision after unicompartmental knee arthroplasty].

    PubMed

    Mohr, G; Martin, J; Clarius, M

    2014-10-01

    Unicompartmental arthroplasty is an efficient and approved treatment option of unicompartmental arthritis of the knee, being performed with increasing frequency worldwide. Compared to total knee replacement, there are several advantages such as faster recovery, lower blood loss, better functional outcome and lower infection rates. However, higher revision rates are a frequent argument against the use of unicompartmental arthroplasty. The following article gives an overview of failure mechanisms and strategies for revision arthroplasty. This article is based on a selective literature review including PubMed and relevant print media. Our own clinical experience is considered as well. PMID:25209015

  7. Applying for Your Own Job: A Preliminary Study

    ERIC Educational Resources Information Center

    Boyd, Elizabeth Reid

    2008-01-01

    This study undertook a small preliminary investigation of the contemporary employment practice of "applying for your own job". There has not yet been a specific study into the effect upon individuals and organisations of the practice of existing employees being required to apply for the same or a similar position in a competitive application…

  8. A Preliminary Study of Career Education in Middle School

    ERIC Educational Resources Information Center

    Ting, S. R.; Leung, Y. F.; Stewart, K.; Smith, A. C.; Roberts, G. L.; Dees, S.

    2012-01-01

    This article reports a preliminary study on the Geosciences in Middle School, which was a career education program in the Southeastern U.S focusing on science based on Super's (1990) theory. The students (n = 80) were found to improve their interests in studying science, increase science knowledge, skills and awareness and highly satisfied with…

  9. Spirituality and the Events of September 11: A Preliminary Study

    ERIC Educational Resources Information Center

    Briggs, Michele Kielty; Apple, Kevin J.; Aydlett, Ann E.

    2004-01-01

    Personal crises have been associated with spiritual growth. Sparked by the global response to the crisis of September 11, 2001, this study examined the relationship of spirituality and the September 11 tragedy using a sample of convenience from a college student population. This preliminary study used an experimental design to examine various…

  10. Clinical outcomes, survivorship and adverse events with mobile-bearings versus fixed-bearings in hip arthroplasty-a prospective comparative cohort study of 143 ADM versus 130 trident cups at 2 to 6-year follow-up.

    PubMed

    Epinette, Jean-Alain

    2015-02-01

    The principle of dual mobility cups, often called "tripolar", has been developed to overcome the problem of instability following primary hip arthroplasty. We prospectively compared two cohorts which differed only by the type of bearings, i.e." mobile bearing hip" (MBH) in a 143-study cohort of ADM cups versus "fixed bearing hip" (FBH) of 130 Trident PSL cups, at a follow-up at 2-6years. The survival rates at 4.13-years, with instability as endpoint was significantly (P=0.0176) in favor of mobile bearings at 100% with no dislocation reported, versus 94.8% with fixed bearings. These mobile bearings, matching both "modern" dual mobility cups and annealed highly crossed polyethylene, would appear to offer at longer follow-up a valuable solution to clinical outcomes in acetabular arthroplasty. PMID:25449593

  11. TREATMENT OF INFECTION AFTER TOTAL KNEE ARTHROPLASTY

    PubMed Central

    Cury, Ricardo de Paula Leite; Cinagawa, Eduardo Hitoshi Tsuge; Camargo, Osmar Pedro Arbix; Honda, Emerson Kiyoshi; Klautau, Giselle Burlamaqui; Salles, Mauro José Costa

    2015-01-01

    ABSTRACT Objectives: To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores. Methods: We evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1st, 2008 to December 31st, 2010. Results: In the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure. Conclusion: The D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease. PMID:26981029

  12. Results of reconstruction for failed total elbow arthroplasty.

    PubMed

    Figgie, M P; Inglis, A E; Mow, C S; Wolfe, S W; Sculco, T P; Figgie, H E

    1990-04-01

    Failure of total elbow arthroplasty leads to difficult and complicated surgical reconstruction. This study evaluates the results of reconstruction after implant removal with respect to pain, motion, and functional ability. Between 1978 and 1985, 11 patients required implant removal. Indications for removal were infection for seven, implant fracture for three, and recurrent dislocation for one. The original diagnosis was rheumatoid arthritis in six elbows and traumatic arthritis in five. The average length of the follow-up period was 5.5 years after implant removal (minimum, two years). Treatment consisted of implant removal and soft-tissue arthroplasty combined with external fixation in ten patients, and attempted arthrodesis with external fixation in one. There were four good, one fair, two poor, and four failed results. Satisfactory results were obtained in seven of the eight elbows in which an anatomic arthroplasty was achieved. This consisted of containment of the ulna by the humeral epicondylar remnants. All eight elbows were pain-free with an average arc of motion of 85 degrees (range, 55 degrees to 120 degrees). They had excellent elbow flexion power; however, triceps strength was often compromised. In the three elbows in which anatomic arthroplasty could not be achieved, one was flail, one was later converted to an arthrodesis with a customized plate, and the third required an immediate arthrodesis. All three were rated as failures. Fractures occurred in five of the 11 elbows. One occurred preoperatively, three occurred intraoperatively, and one occurred postoperatively. All healed satisfactorily during the course of immobilization. The importance of an anatomic arthroplasty when removing a total arthroplasty cannot be overemphasized. Retaining the epicondylar segments is important because satisfactory results were obtained in patients in whom entrapment of the olecranon within the epicondylar ridges was obtained. Such patients can achieve a satisfactory

  13. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset.

    PubMed

    Patel, A; Pavlou, G; Mújica-Mota, R E; Toms, A D

    2015-08-01

    Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are recognised and proven interventions for patients with advanced arthritis. Studies to date have demonstrated a steady increase in the requirement for primary and revision procedures. Projected estimates made for the United States show that by 2030 the demand for primary TKA will grow by 673% and for revision TKA by 601% from the level in 2005. For THA the projected estimates are 174% and 137% for primary and revision surgery, respectively. The purpose of this study was to see if those predictions were similar for England and Wales using data from the National Joint Registry and the Office of National Statistics. Analysis of data for England and Wales suggest that by 2030, the volume of primary and revision TKAs will have increased by 117% and 332%, respectively between 2012 and 2030. The data for the United States translates to a 306% cumulative rate of increase between 2012 and 2030 for revision surgery, which is similar to our predictions for England and Wales. The predictions from the United States for primary TKA were similar to our upper limit projections. For THA, we predicted an increase of 134% and 31% for primary and revision hip surgery, respectively. Our model has limitations, however, it highlights the economic burden of arthroplasty in the future in England and Wales as a real and unaddressed problem. This will have significant implications for the provision of health care and the management of orthopaedic services in the future. PMID:26224824

  14. A study of the usefulness of a periarticular multimodal drug cocktail injection for pain management after total hip arthroplasty

    PubMed Central

    Nakai, Tsuyoshi; Nakamura, Toshiyuki; Nakai, Takaaki; Onishi, Atsunori; Hashimoto, Kunihiko

    2013-01-01

    Background Measures for pain management after total hip arthroplasty (THA) are important for early improvement in the quality of life after operation and early postoperative rehabilitation. We investigated the analgesic effect of locally injected drugs around the total hip prosthesis. Methods 54 patients undergoing THA were randomized either to receive a periarticular intraoperative injection of a 30-ml mixture containing morphine hydrochloride 10 mg, 0.5% bupivacaine 20 ml, epinephrine 0.3 mg, and saline 8.7 ml or to receive no injection. The perioperative analgesic regimen was standardized. The evaluation items included assessment of pain using a 100-point visual analog scale (VAS) after the patients awoke on the day of the operation and on postoperative day 1, the dose of diclofenac sodium suppository, the number of days for acquiring assisted ambulation with a walking cane, and side effects. Results The VAS score on the day of the operation was significantly low in the injection group. No cardiac or central nervous system toxicity was observed. Conclusions Intraoperative periarticular injection with multimodal drugs can significantly reduce pain on the day of the operation, with no apparent risks, following THA. PMID:24403740

  15. Achieving ligament stability and correct rotational alignment of the femur in knee arthroplasty: a study using the Medial Pivot knee.

    PubMed

    Shakespeare, David; Kinzel, Vera; Ledger, Michael

    2005-12-01

    In a series of 90 Medial Pivot arthroplasties rotational alignment of the femur was achieved by provisionally reconstructing the lateral side of the joint and tensioning the medial side with feeler gauges. Axial CT scans were employed to measure the rotational alignment relative to surgical epicondylar axis. In valgus knees the cutting block was externally rotated to adjust for posterolateral bone loss. The mean rotational alignment of the femur was 0.6 degrees of external rotation (S.D. 1.3, range 3 degrees of ER to 4 degrees of IR). The mean laxity of the medial ligament was 1 mm in flexion (SD 1, range 0-5 mm) and 0.5 mm in flexion (S.D. 0.5, range 0-2 mm) In those knees in which the medial ligament had been released the CT alignment was perfect, but when internally rotated against the hip 3-4 mm of gapping was noted. In valgus knees the mean rotation of the femoral component was 0.8 degrees of internal rotation (S.D. 1.5, range 1 degrees of IR to 4 degrees of ER). In spite of externally rotating the cutting block there was still a tendency to internally rotate the femur in some knees. This simple technique achieves the two goals of ligament stability and correct rotational alignment in a high proportion of cases. It may be applicable to any instrument system which employs posterior referencing. PMID:15967668

  16. Autotransfusion--bacterial contamination during hip arthroplasty and efficacy of cefuroxime prophylaxis. A randomized controlled study of 40 patients.

    PubMed

    Wollinsky, K H; Oethinger, M; Büchele, M; Kluger, P; Puhl, W; Mehrkens, H H

    1997-06-01

    40 patients undergoing primary hip arthroplasty, given autologous processed blood transfusion, were randomized a receive no antibiotic prophylaxis (group A, n 20) or cefuroxime (1.5 g single injection; group B, n 20). Bacterial contamination at various steps in the autotransfusion procedure was assessed in liquid and solid culture media. The operation field and the wound drainage blood were never contaminated either of the groups but some of the suction tips were. Parts of the Vacufix blood collection bags of group A contained bacteria, but none in group B. Processed red blood cell concentrates in both groups showed bacterial growth. Greater blood loss did not increase the contamination rate in general. Isolated bacteria included the species Staphylococcus epidermidis, coagulase-negative staphylococci and Propionibacteria in both groups, but with different cell counts. In addition, Corynebacterium bovis et minutissimum and Moraxelle were identified in group A. In conclusion, autologous blood transfusion was a safe procedure. If contamination occurred, the bacterial count was low, and the bacteria of low pathogenicity. Antibiotic prophylaxis with cefuroxime reduced this contamination of suction tips and collection bags and limited the transfer of autologous blood products. PMID:9246981

  17. Cerebrovascular Disease Is Associated with Outcomes after Total Knee Arthroplasty: A U.S. Total Joint Registry Study

    PubMed Central

    Singh, Jasvinder A.; Lewallen, David G.

    2013-01-01

    We assessed the association of cerebrovascular disease with patient-reported outcomes (PROs) of moderate-severe activity limitation and moderate-severe pain at 2- and 5-years after primary total knee arthroplasty (TKA) using multivariable-adjusted logistic regression. 7,139 primary and 4,234 revision TKAs were included. Compared to the patients without cerebrovascular disease, those with cerebrovascular disease had a higher odds ratio (OR) of moderate-severe limitation at 2-years and 5-years, 1.32 (95% confidence interval [CI]: 1.02, 1.72; P=0.04) and 1.83 (95% CI: 1.32, 2.55; P<0.001). No significant associations were noted with moderate-severe pain at 2-years or 5-years. In conclusion, we found that cerebrovascular disease is independently associated with pain and function outcomes after primary TKA. This should be taken into consideration when discussing expected outcomes of TKA with patients. PMID:23664282

  18. Unicompartmental knee arthroplasty

    PubMed Central

    Murray, D. W.; Liddle, A. D.; Dodd, C. A. F.; Pandit, H.

    2015-01-01

    There is a large amount of evidence available about the relative merits of unicompartmental and total knee arthroplasty (UKA and TKA). Based on the same evidence, different people draw different conclusions and as a result, there is great variability in the usage of UKA. The revision rate of UKA is much higher than TKA and so some surgeons conclude that UKA should not be performed. Other surgeons believe that the main reason for the high revision rate is that UKA is easy to revise and, therefore, the threshold for revision is low. They also believe that UKA has many advantages over TKA such as a faster recovery, lower morbidity and mortality and better function. They therefore conclude that UKA should be undertaken whenever appropriate. The solution to this argument is to minimise the revision rate of UKA, thereby addressing the main disadvantage of UKA. The evidence suggests that this will be achieved if surgeons use UKA for at least 20% of their knee arthroplasties and use implants that are appropriate for these broad indications. Cite this article: Bone Joint J 2015;97-B(10 Suppl A):3–8. PMID:26430080

  19. Preliminary design studies of an advanced general aviation aircraft

    NASA Technical Reports Server (NTRS)

    Barrett, Ron; Demoss, Shane; Dirkzwager, AB; Evans, Darryl; Gomer, Charles; Keiter, Jerry; Knipp, Darren; Seier, Glen; Smith, Steve; Wenninger, ED

    1991-01-01

    The preliminary design results are presented of the advanced aircraft design project. The goal was to take a revolutionary look into the design of a general aviation aircraft. Phase 1 of the project included the preliminary design of two configurations, a pusher, and a tractor. Phase 2 included the selection of only one configuration for further study. The pusher configuration was selected on the basis of performance characteristics, cabin noise, natural laminar flow, and system layouts. The design was then iterated to achieve higher levels of performance.

  20. Total hip arthroplasty revision in elderly patients.

    PubMed

    Gasbarra, Elena; Perrone, Fabio Luigi; Celi, Monica; Rao, Cecilia; Feola, Maurizio; Cuozzo, Nicola; Tarantino, Umberto

    2013-10-01

    In the last years, the number of total hip arthroplasty is increased both in young patients and elderly with a poor bone quality due to extension of surgical indications. According to this trend, also revision surgery showed a growth of its number, especially in elderly patients, because of implant loosening, failed osseointegration of prosthetic components, errors in biomechanical restoration and infections. The aim of this study is to analyze life quality improvement through evaluation of articular functionality and postoperative pain, and to examine osseointegration of implant components with periprosthetic bone. During total hip arthroplasty revision, the orthopedic surgeon often has to face complex cases, especially in elderly patients with a preexisting status of poor bone quality and sarcopenia. In these cases, a correct planning and a surgical procedure well-executed are able to ensure a good outcome that led to pain relief and functional recovery. Furthermore anti-osteoporotic therapy surely represents a useful resource both in primary total hip arthroplasty and in revisions, mainly for elderly patients with a poor bone quality. PMID:24046034

  1. Physical Activity After Total Joint Arthroplasty

    PubMed Central

    Vogel, Laura A.; Carotenuto, Giuseppe; Basti, John J.; Levine, William N.

    2011-01-01

    Context: Total joint arthroplasty (TJA) is a common surgical option to treat painful degenerative joint disease. However, there is currently no consensus on the appropriate intensity of physical activity after TJA or how physical activity level affects the rate of revision surgery. Materials and Methods: A systematic review of the literature regarding physical or athletic activity after TJA was performed to determine current clinical opinion and recommendations regarding appropriate activity levels after TJA, as well as variables affecting successful surgery and improved outcomes. Results: Many studies in the literature regarding athletic activity after TJA focus on total hip arthroplasty and total knee arthroplasty. The literature reports contradictory results regarding rates of physical activity after TJA as well as the relationship between physical activity and rates of revision surgery. The current trend in expert opinion shows more liberal recommendations for patients to engage in athletic activity after TJA. Conclusions: Individual characteristics, lifestyle, and patient preferences must be taken into account when one considers appropriate recommendations for athletic activity after TJA. Current trends in clinical opinion favor a higher level of athletic activity after TJA, but clinicians should caution patients not to participate in contact sports or sports that create high joint loads in the replaced joint. PMID:23016041

  2. Outcome of patellofemoral arthroplasty, determinants for success.

    PubMed

    Willekens, Philippe; Victor, Jan; Verbruggen, Dimitri; Vande Kerckhove, Michiel; Van Der Straeten, Catherine

    2015-12-01

    The primary aim of this study is to document whether patellofemoral arthroplasty is a good treatment option for patellofemoral osteoarthritis and to identify prognostic outcome factors. Secondary aim is to investigate the influence of preoperative tibiofemoral osteoarthritis on the clinical outcome. From 2004 to 2010, 37 Avon patellofemoral prostheses were implanted in 32 patients. Clinical outcome was evaluated with five questionnaires: KOOS, Kujala, VAS, OKS and Satisfaction Score. Radiographs were analyzed using the IWANO and Kellgren-Lawrence classification. To identify determinants of outcome, subgroups were examined according to sex, age, diagnosis, BMI and prior surgery. Patellofemoral arthroplasty is a valuable treatment for patellofemoral osteoarthritis. After prosthesis placement, KOOS, Kujala, VAS and OKS improved significantly (all p < 0.001). Patients with prior patellofemoral surgery were clinically worse (p < 0.05). Patients with preoperative Kellgren-Lawrence grade 2 tibiofemoral osteoarthritis had a significantly worse outcome compared to grade 1 (p < 0.05). Further research is necessary to determine whether patellofemoral arthroplasty is indicated in these patients. PMID:26790802

  3. Preliminary Design Study of a Hybrid Airship for Flight Research

    NASA Technical Reports Server (NTRS)

    Browning, R. G. E.

    1981-01-01

    The feasibility of using components from four small helicopters and an airship envelope as the basis for a quad-rotor research aircraft was studied. Preliminary investigations included a review of candidate hardware and various combinations of rotor craft/airship configurations. A selected vehicle was analyzed to assess its structural and performance characteristics.

  4. Decreasing Public Smoking among Youth: A Preliminary Study

    ERIC Educational Resources Information Center

    Jason, Leonard A.; Pokorny, Steven B.; Turner, Paul L.; Freeland, Margaret; Corbin, Sara; Driscoll, Mark

    2005-01-01

    This brief paper reports the results of two observational studies examining the impact of fines for youth tobacco possession on public smoking among youth. Preliminary findings are presented that suggest that when police issued warnings and tickets to reduce underage youth possession of tobacco, in both towns the number of youth smoking in public…

  5. PTSD and Impaired Eye Expression Recognition: A Preliminary Study

    ERIC Educational Resources Information Center

    Schmidt, Jakob Zeuthen; Zachariae, Robert

    2009-01-01

    This preliminary study examined whether posttraumatic stress disorder (PTSD) was related to difficulties in identifying the mental states of others in a group of refugees. Sixteen Bosnian refugees, referred to treatment in an outpatient treatment center for survivors of torture and war-related trauma in Denmark (CETT), were compared to 16 non-PTSD…

  6. Student Matriculation: A Proposal to Study a Preliminary Model.

    ERIC Educational Resources Information Center

    Farland, Ronnald W.; Berg, Ernest

    Developed for the Board of Governors of the California Community Colleges (CCC) as part of a larger study of academic quality, this report presents a preliminary analysis of student matriculation, a guidance process which brings the student into an agreement with the college for the purpose of achieving the student's educational objectives through…

  7. ELIGIBILITY FOR THE HIP-RESURFACING ARTHROPLASTY PROCEDURE: AN EVALUATION ON 592 HIPS

    PubMed Central

    Queiroz, Roberto Dantas; Faria, Rafael Salomon Silva; Duarte, David Marcelo; Takano, Marcelo Itiro; Sugiyama, Mauricio Morita

    2015-01-01

    Objective: To investigate the percentage of ideal patients who would be eligible for hip-resurfacing surgery at a reference service for hip arthroplasty. Methods: Out of all the cases of hip arthroplasty operated at Hospital do Servidor Público Estadual de São Paulo (HSPE) between January 2009 and December 2010, we assessed a total of 592 procedures that would fit the criteria for indication for resurfacing arthroplasty, after clinical and radiological evaluation according to the criteria established by the Food and Drug Administration (FDA) and by Seyler et al. Results: Among the total number of hip replacement arthroplasty cases, 5.74% of the patients were eligible. Among the patients who underwent primary arthroplasty, we found that 8.23% presented ideal conditions for this procedure. Conclusion: The study demonstrated that this type of surgery still has a limited role among hip surgery methods. PMID:27047851

  8. Caregivers with Visual Impairments: A Preliminary Study

    ERIC Educational Resources Information Center

    Fuhr, Patti; Martinez, Bethany; Williams, Michael

    2008-01-01

    Persons who are elderly, visually impaired, and primary caregivers for ailing or disabled spouses or significant others are a unique population that has not been studied previously. By definition, "informal caregivers" are family members or friends who provide unpaid day-to-day assistance with activities of daily living and are familiar with the…

  9. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review

    PubMed Central

    Santaguida, Pasqualina L.; Hawker, Gillian A.; Hudak, Pamela L.; Glazier, Richard; Mahomed, Nizar N.; Kreder†, Hans J.; Coyte, Peter C.; Wright, James G.

    2008-01-01

    Background Total joint arthroplasty is a highly efficacious and cost-effective procedure for moderate to severe arthritis in the hip and knee. Although patient characteristics are considered to be important determinants of who receives total joint arthroplasty, no systematic review has addressed how they affect the outcomes of total joint arthroplasty. This study addresses how patient characteristics influence the outcomes of hip and knee arthroplasty in patients with osteoarthritis. Methods We searched 4 bibliographic databases (MEDLINE 1980–2001, CINAHL 1982–2001, EMBASE 1980–2001, HealthStar 1998–1999) for studies involving more than 500 patients with osteoarthritis and 1 or more of the following outcomes after total joint arthroplasty: pain, physical function, postoperative complications (short-and long-term) and time to revision. Prognostic patient characteristics of interest included age, sex, race, body weight, socioeconomic status and work status. Results Sixty-four of 14 276 studies were eligible for inclusion and had extractable data. Younger age (variably defined) and male sex increased the risk of revision 3-fold to 5-fold for hip and knee arthroplasty. The influence of weight on the risk of revision was contradictory. Mortality was greatest in the oldest age group and among men. Function for older patients was worse after hip arthroplasty (particularly in women). Function after knee arthroplasty was worse for obese patients. Conclusion Although further research is required, our findings suggest that, after total joint arthroplasty, younger age and male sex are associated with increased risk of revision, older age and male sex are associated with increased risk of mortality, older age is related to worse function (particularly among women), and age and sex do not influence the outcome of pain. Despite these findings, all subgroups derived benefit from total joint arthroplasty, suggesting that surgeons should not restrict access to these

  10. Hip arthroplasty for failed treatment of proximal femoral fractures.

    PubMed

    D'Arrigo, Carmelo; Perugia, Dario; Carcangiu, Alessandro; Monaco, Edoardo; Speranza, Attilio; Ferretti, Andrea

    2010-10-01

    Failed treatment of an intertrochanteric fracture typically leads to profound functional disability and pain. Salvage treatment with hip arthroplasty may be considered. The aim of this study was to evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. Twenty-one patients were treated in our hospital with hip arthroplasty for failed treatment of intertrochanteric hip fracture. There were sixteen women and five men with a mean age of 75.8 years (range 61-85 years). Fourteen patients had failure of a previous nail fixation procedure, five had failure of a plate fixation, one of hip screws fixation and one of Ender nail fixation. In 19 out of 21 patients we performed a total hip arthroplasty-14 cases used modular implants with long-stems and five cases used a standard straight stem. In 2 of 21 cases we used a bipolar hemiarthroplasty. A statistically significant improvement was found comparing pre and postoperative conditions (p < 0.05). Our experience confirms that total hip arthroplasty is a satisfactory salvage procedure after failed treatment of an intertrochanteric fracture in elderly patients with few serious orthopaedic complications and acceptable clinical outcomes. PMID:19572131

  11. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study.

    PubMed

    Bisseling, P; de Wit, B W K; Hol, A M; van Gorp, M J; van Kampen, A; van Susante, J L C

    2015-09-01

    Patients from a randomised trial on resurfacing hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24 to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty (MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and a matched control group of asymptomatic patients with a 32 mm ceramic-on-polyethylene (CoP) THA (n = 33, 18 males; median age 63 years, 38 to 71) were cross-sectionally screened with metal artefact reducing sequence-MRI (MARS-MRI) for pseudotumour formation at a median of 55 months (23 to 72) post-operatively. MRIs were scored by consensus according to three different classification systems for pseudotumour formation. Clinical scores were available for all patients and metal ion levels for MoM bearing patients. Periprosthetic lesions with a median volume of 16 mL (1.5 to 35.9) were diagnosed in six patients in the RHA group (17%), one in the MoM THA group (4%) and six in the CoP group (18%). The classification systems revealed no clear differences between the groups. Solid lesions (n = 3) were exclusively encountered in the RHA group. Two patients in the RHA group and one in the MoM THA group underwent a revision for pseudotumour formation. There was no statistically significant relationship between clinical scoring, metal ion levels and periprosthetic lesions in any of the groups. Periprosthetic fluid collections are seen on MARS-MRI after conventional CoP THA and RHA and may reflect a soft-tissue collection or effusion. Currently available MRI classification systems seem to score these collections as pseudotumours, causing an-overestimatation of the incidence of pseudotumours. PMID:26330582

  12. [Preliminary study of early sexual abuse].

    PubMed

    Gauthier, M C; Saucier, J F

    1991-08-01

    The long term effects of sexual abuse are often measured by measuring behaviours such as social adjustment, job stability and marriage. This study was conducted to add to these internal measures. Using a semi-prospective instrument adapted from G. Kelly's repertory grid, the adolescents' perceptions of themselves and significant others are measured. Three hundred and twelve female adolescents between the ages of 13 and 19 (average age = 16) participated in the study; 79 presented with non sexual behaviour disorders (delinquency, stealing, etc.), 56 presented with serious sexual behaviour disorders (prostitution, persistent sexual promiscuity) and 177 presented with no problems requiring psychosocial intervention. Various analyses (descriptive, multiple variance, regression analysis) showed that sexual abuse significantly affects many of the adolescents' perceptions. Sexually abused adolescents perceived their two real parents as less competent and their ideal mother and father as less protective than adolescents who had not been abused. In contrast, their perception of self and the ideal self was not affected by the sexual abuse, a finding which will spark discussion. PMID:1933745

  13. Preliminary design study of a baseline MIUS

    NASA Technical Reports Server (NTRS)

    Wolfer, B. M.; Shields, V. E.; Rippey, J. O.; Roberts, H. L.; Wadle, R. C.; Wallin, S. P.; Gill, W. L.; White, E. H.; Monzingo, R.

    1977-01-01

    Results of a conceptual design study to establish a baseline design for a modular integrated utility system (MIUS) are presented. The system concept developed a basis for evaluating possible projects to demonstrate an MIUS. For the baseline study, climate conditions for the Washington, D.C., area were used. The baseline design is for a high density apartment complex of 496 dwelling units with a planned full occupancy of approximately 1200 residents. Environmental considerations and regulations for the MIUS installation are discussed. Detailed cost data for the baseline MIUS are given together with those for design and operating variations under climate conditions typified by Las Vegas, Nevada, Houston, Texas, and Minneapolis, Minnesota. In addition, results of an investigation of size variation effects, for 300 and 1000 unit apartment complexes, are presented. Only conceptual aspects of the design are discussed. Results regarding energy savings and costs are intended only as trend information and for use in relative comparisons. Alternate heating, ventilation, and air conditioning concepts are considered in the appendix.

  14. Evaluation of the Wii Balance Board for Walking Aids Prediction: Proof-of-Concept Study in Total Knee Arthroplasty

    PubMed Central

    Pua, Yong-Hao; Clark, Ross A.; Ong, Peck-Hoon

    2015-01-01

    Background and Objectives To provide proof-of-concept for the validity of the Wii Balance Board (WBB) measures to predict the type of walking aids required by inpatients with a recent (≤4days) total knee arthroplasty (TKA). Methods A cross-sectional sample of 89 inpatients (mean age, 67.0±8years) with TKA was analyzed. A multivariable proportional odds prediction model was constructed using 8 pre-specified predictors – namely, age, sex, body mass index, knee pain, knee range-of-motion, active knee lag, and WBB-derived standing balance. The type of walking aids prescribed on day 4 post-surgery was the outcome of interest – an ordinal variable with 4 categories (walking stick, narrow- and broad-base quadstick, and walking frame). Results Women, increasing body mass index, and poorer standing balance were independently associated with greater odds for requiring walking aids with a larger base-of-support. The concordance-index of the prediction model was 0.74. The model comprising only WBB-derived standing balance had nearly half (44%) the explanatory power of the full model. Adding WBB-derived standing balance to conventional demographic and knee variables resulted in a continuous net reclassification index of 0.60 (95%CI,0.19-1.01), predominantly due to better identification of patients who required walking aids with a large base-of-support (sensitivity gain). Conclusions The WBB was able to provide quantitative measures of standing balance which could assist healthcare professionals in prescribing the appropriate type of walking aids for patients. Further investigation is needed to assess whether using the WBB could lead to meaningful changes in clinical outcomes such as falls. PMID:25615952

  15. Radiolucent lines in low-contact-stress mobile-bearing total knee arthroplasty: a blinded and matched case control study

    PubMed Central

    2011-01-01

    Background Low-contact-stress (LCS) mobile-bearing total knee arthroplasty (TKA) (Johnson & Johnson, New Brunswick, NJ; previously: DePuy, Warsawa, USA) provides excellent functional results and wear rates in long-term follow-up analyses. Radiological analysis shows radiolucent lines (RLL) appearing immediately or two years after primary implantation, indicative of poor seat. Investigations proved RLL to be more frequent in uncemented TKA, resulting in a consensus to cement the tibial plateau, but their association with clinical findings and patients discomfort and knee pain is still unknown. Methods 553 patients with 566 low-contact-stress (LCS) total knee prostheses were screened for continuous moderate knee pain. We compared tibial stress shielding classified by Ewald in patients suffering from pain with a matched, pain-free control group on blinded X-rays. We hypothesized a positive correlation between pain and radiolucency and higher frequency of such radiolucent lines in the most medial and most lateral zones of the tibial plateau. Results Twenty-eight patients suffered from knee pain in total. Radiolucencies were detected in 27 of these cases and in six out of 28 matched controls without knee pain. We could demonstrate a significant correlation of knee pain and radiolucencies, which appeared significantly more frequently in the outermost zones of the tibial plateau. Conclusion Our findings suggest that radiolucent lines, representing poor implant seat, about the tibial plateau are associated with knee pain in LCS patients. Radiolucencies are observed more often in noncemented LCS, and cementing the tibial plateau might improve implant seat and reduce both radiolucent lines and associated knee pain. PMID:21714916

  16. Preliminary systems design study assessment report

    SciTech Connect

    Mayberry, J.L.; Feizollahi, F.; Del Signore, J.C.

    1991-10-01

    The System Design Study (SDS), part of the Waste Technology Development Department of the Idaho National Engineering Laboratory (INEL), examined techniques available for the remediation of hazardous and transuranic waste stored at the Radioactive Waste Management Complex's Subsurface Disposal Area at the INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. The SDS resulted in the development of technology requirements including demonstration, testing, and evaluation activities needed for implementing each concept. The SDS results are published in eight volumes. Volume I contains an executive summary. The SDS summary and analysis of results are presented in Volume II. Volumes III through VII contain descriptions of twelve system and four subsystem concepts. Volume VIII contains the appendixes.

  17. A Preliminary Immunologic Study of Urinary Proteins

    PubMed Central

    Barcelo, Raymond; Pollak, Victor E.

    1966-01-01

    The clearances of seven different proteins were measured by a quantitative immunodiffusion technique in 15 patients with proteinuria. All urines were also studied by immunoelectrophoresis. The renal histology was evaluated in each case, and no correlation was found between histologic changes and the urinary protein excretion. This observation was confirmed by both immunodiffusion and immunoelectrophoretic techniques. No specific urinary protein excretion pattern was found in six patients with systemic lupus erythematosus. High-molecular-weight proteins were rarely found in urine, even when the glomerular basement membrane was definitely thickened. Low-molecular-weight proteins were often observed, but their clearances were variable. The results do not support the suggestion that protein clearances are valuable diagnostic and prognostic tools in renal diseases. They also do not support the view that glomerular filtration is the sole factor responsible for the final patterns of urinary proteins; tubular reabsorption is probably another important factor. ImagesFig. 1Fig. 4Fig. 5 PMID:20328484

  18. Patient-Specific CT-Based Instrumentation versus Conventional Instrumentation in Total Knee Arthroplasty: A Prospective Randomized Controlled Study on Clinical Outcomes and In-Hospital Data

    PubMed Central

    Kotela, Andrzej; Lorkowski, Jacek; Kucharzewski, Marek; Wilk-Frańczuk, Magdalena; Śliwiński, Zbigniew; Frańczuk, Bogusław; Łęgosz, Paweł  ; Kotela, Ireneusz

    2015-01-01

    Total knee arthroplasty (TKA) is a frequently performed procedure in orthopaedic surgery. Recently, patient-specific instrumentation was introduced to facilitate correct positioning of implants. The aim of this study was to compare the early clinical results of TKA performed with patient-specific CT-based instrumentation and conventional technique. A prospective, randomized controlled trial on 112 patients was performed between January 2011 and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients who received the Signature CT-based implant positioning system, and the control group consisted of 60 patients with conventional instrumentation. Clinical outcomes were evaluated with the KSS scale, WOMAC scale, and VAS scales to assess knee pain severity and patient satisfaction with the surgery. Specified in-hospital data were recorded. Patients were followed up for 12 months. At one year after surgery, there were no statistically significant differences between groups with respect to clinical outcomes and in-hospital data, including operative time, blood loss, hospital length of stay, intraoperative observations, and postoperative complications. Further high-quality investigations of various patient-specific systems and longer follow-up may be helpful in assessing their utility for TKA. PMID:26301241

  19. Uncemented total hip arthroplasty in osteoarthritis of hip secondary to low and high dislocated hips: A mid-term follow-up study

    PubMed Central

    Munigangaiah, Sudarshan; O’Dwyer, Sinead; Masterson, Eric

    2016-01-01

    Background: Performing successful total hip replacement (THR) in dysplastic, subluxed, and dislocated hip is a challenging task. Here, we assessed midterm clinical and radiological outcomes of uncemented total hip arthroplasty in osteoarthritis (OA) of hip secondary to Hartofilakidis low and high-dislocated hips with a mean follow-up of 8.8 years. Materials and Methods: A retrospective study of prospectively collected data was designed involving all consecutive patients who underwent uncemented THR for OA of hip secondary to developmental dysplasia of the hip and Grade II or Grade III Hartofilakidis classification. Results: Thirty-two patients underwent 45 THR, with 23 Grade II (low dislocation) and 22 Grade III (high-dislocation) of Hartofilakidis classification. Thirteen patients had bilateral hip replacements, 19 patients had unilateral THR. There was highly statistically significant difference between preoperative and postoperative HHS and SF-36v2™ at each follow-up. Survivorship of original implant was 98.88% at a mean follow-up of 8.8 years. The mean improvement in leg length in this series was 3.6 cm (1.8-4.5, 95% confidence interval). No sciatic nerve or femoral nerve palsies were observed. Conclusions: Uncemented THR provides better function and quality of life. However, longer follow-up studies are needed to assess survivorship of uncemented THR in Hartofilakidis low and high-dislocations. PMID:27433063

  20. Preliminary Photomicrographic Studies of Fuel Sprays

    NASA Technical Reports Server (NTRS)

    Lee, Dana W; Spencer, Robert C

    1932-01-01

    Photomicrographs were taken of fuel sprays injected into air at various densities for the purpose of studying the spray structure and the stages in the atomization of the fuel. The photomicrographs were taken at magnifying powers of 2.5, 3.25, and 10, using a spark discharge of very short duration for illumination. The results indicate that the theory advanced by Dr. R. A. Castleman, Jr., on the atomization of fuel in carburetors may also be applied to the atomization of fuel sprays of the solid-injection type. The fuel leaves the nozzle as a solid column, is ruffled and then torn into small, irregular ligaments by the action of the air. These ligaments are then quickly broken up into drops by the surface tension of the fuel. The photomicrographs also show that the dispersion of a fuel spray at a given distance from the nozzle increases with an increase in the jet velocity or an increase in the air density. The first portions of fuel sprays injected from an automatic injection valve into air at atmospheric density have a much greater dispersion than the later portions, but this difference decreases rapidly as the air density is increased.

  1. Sleep education in college: a preliminary study.

    PubMed

    Tsai, Ling-Ling; Li, Sheng-Ping

    2004-12-01

    In this study we evaluated the effect of a two-credit (100 min./week) "Sleep Management" course on the sleep patterns of college students as the course progressed over an 18-wk. semester. Curricular activity included lectures, group discussions, and practice of self-evaluation of sleep. Instead of giving the students the whole list of sleep hygiene at the outset of the course, each concept of sleep hygiene was introduced and discussed under related lecture topics. A total of 241 students (131 men and 110 women) took the course and kept 7-day sleep logs three times. Concurrently, sleep-log data were collected from 65 students (32 men and 33 women) who were not taking the course. Both groups showed similar varieties of academic backgrounds and characteristics of sleep patterns at the beginning. Similarly, their sleep patterns, namely, rise time, nighttime awakenings, time asleep, time in bed, sleep efficiency, and rise time regularity, changed over the semester. Women in both groups had more nighttime awakenings. In contrast, sleep quality was progressively better for the group in the course but not for the control group. Only women in the course decreased their nap time in the second and third months. Thus, the course of "Sleep Management" only had a mild and limited effect on sleep patterns. The course content needs refinement to maximize influence on students' sleep patterns and habits, particularly, on reduction of insufficient sleep and daytime sleepiness which are the highest ranking sleep problems among college students. PMID:15648478

  2. Spectral detection of thalassemia: a preliminary study

    PubMed Central

    2014-01-01

    Background Thalassemias (Thal) are forms of inherited autosomal recessive blood disorders arising out of mutations in the chromosomes 11 or 16. These disorders lead to poor oxygen delivery to blood vessels and consequent splenomegaly, bone deformities, and shorter life spans. The most common detection methods for Thal are complete blood count (CBC) followed by electrophoresis and molecular diagnosis methods, such as high-performance liquid chromatography (HPLC) and polymerase chain reaction (PCR) genotyping. These methods involve sophisticated instrumentations and are cumbersome and expensive. Results In this study an innovative spectral detection method, based on the fluorescence spectra of a set of biomolecules (tyrosine, tryptophan, nicotinamide adenine dinucleotide, and flavin adenine dinucleotide and porphyrins) found in blood components is presented. An algorithm based on the spectral features of such biomolecules of blood components of 20 Thal patients (10 female and 10 male) and 18 age adjusted normal controls (4 female and 14 male) demonstrate reasonable level of classification with sensitivity and specificity values exceeding 90%. Conclusion This new technique could be of significant value for Thal detection, diagnosis, and subsequent genetic counselling and could be adapted for use in small primary health centres. PMID:24679334

  3. Cementless total hip arthroplasty.

    PubMed

    Morscher, E W

    1983-12-01

    The differences between prostheses fixed with and without cement are mainly in the design and nature of the surface implant. The shapes of the sockets to be implanted without cement show a wide variety: cylinder, square, conus, and ellipsoid with and without threads. The hemispheric shape, however, which was chosen for the acetabular component of the isoelastic hip joint, does not disturb the natural form and function of the hip joint since the outer surface is closely adapted to the original subchondral bone layer. The noncemented cup is secured by threads, pegs, screws, etc., and by ingrowth of bony tissue in the grooves of the surfaces. Most femoral stems are based on the self-locking principle. All prosthetic models incorporate attempts to increase the surface of the stem (ribs, wings, corrugations, rims, etc.). There is a tendency to use less rigid elastic implants instead of the well known rigid metallic prostheses. The aim is to overcome the problems of stress protection and stress concentration observed with rigid implants. For the biomechanical integration of an implant, the properties of the surface, especially macroporosity and microporosity, are important. Most European models of noncemented endoprostheses are based on macroporosity (porometal, madreporic, etc.). The increase in implant surface area achieved with macroscopic perforations and recesses is relatively minor compared with the possibilities offered by microporosity ("alumine fritée," Proplast, fiber-metal, etc.). The best indication for use of a cementless hip endoprosthesis is in revision arthroplasty. The lost bone stock is replaced by bone grafts, thereby creating a situation comparable with that of a primary arthroplasty. Clinical experience with noncemented hip endoprostheses is, to date, promising, although the observation time for most models is short. PMID:6357588

  4. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic.

    PubMed

    Kornilov, Nikolai; Lindberg, Maren Falch; Gay, Caryl; Saraev, Alexander; Kuliaba, Taras; Rosseland, Leiv Arne; Muniz, Konstantin; Lerdal, Anners

    2016-01-01

    This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery (p < .001) as well as the reported number of daily hours in moderate/severe pain (p < .001). Women reported more pain than men (p = .009). Pain trajectories did not differ by education, employment, cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (p = .029). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0-3 postoperatively (p = .029). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (p = .008), and similar results were observed for ratings of pain with activity (p = .012). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA. PMID:26885390

  5. Quantification of material loss from the neck piece taper junctions of a bimodular primary hip prosthesis. A retrieval study from 27 failed Rejuvenate bimodular hip arthroplasties.

    PubMed

    Buente, D; Huber, G; Bishop, N; Morlock, M

    2015-10-01

    The early failure and revision of bimodular primary total hip arthroplasty prostheses requires the identification of the risk factors for material loss and wear at the taper junctions through taper wear analysis. Deviations in taper geometries between revised and pristine modular neck tapers were determined using high resolution tactile measurements. A new algorithm was developed and validated to allow the quantitative analysis of material loss, complementing the standard visual inspection currently used. The algorithm was applied to a sample of 27 retrievals (in situ from 2.9 to 38.1 months) of the withdrawn Rejuvenate modular prosthesis. The mean wear volumes on the flat distal neck piece taper was 3.35 mm(3) (0.55 to 7.57), mainly occurring in a characteristic pattern in areas with high mechanical loading. Wear volume tended to increase with time to revision (r² = 0.423, p = 0.001). Implant and patient specific data (offset, stem size, patient's mass, age and body mass index) did not correlate with the amount of material loss observed (p > 0.078). Bilaterally revised implants showed higher amounts of combined total material loss and similar wear patterns on both sides. The consistent wear pattern found in this study has not been reported previously, suggesting that the device design and materials are associated with the failure of this prosthesis. PMID:26430009

  6. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic

    PubMed Central

    Kornilov, Nikolai; Lindberg, Maren Falch; Gay, Caryl; Saraev, Alexander; Kuliaba, Taras; Rosseland, Leiv Arne; Muniz, Konstantin; Lerdal, Anners

    2016-01-01

    This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery (p < .001) as well as the reported number of daily hours in moderate/severe pain (p < .001). Women reported more pain than men (p = .009). Pain trajectories did not differ by education, employment, cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (p = .029). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0–3 postoperatively (p = .029). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (p = .008), and similar results were observed for ratings of pain with activity (p = .012). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA. PMID:26885390

  7. [Biomechanical analysis of different ProDisc-C arthroplasty design parameters after implanted: a numerical sensitivity study based on finite element method].

    PubMed

    Tang, Qiaohong; Mo, Zhongjun; Yao, Jie; Li, Qi; Du, Chenfei; Wang, Lizhen; Fan, Yubo

    2014-12-01

    This study was aimed to estimate the effect of different ProDisc-C arthroplasty designs after it was implanted to C5-C6 cervicalspine. Finite element (FE) model of intact C5-C6 segments including the vertebrae and disc was developed and validated. Ball-and-socket artificial disc prosthesis model (ProDisc-C, Synthes) was implanted into the validated FE model and the curvature of the ProDisc-C prosthesis was varied. All models were loaded with compressed force 74 N and the pure moment of 1.8 Nm along flexion-extension and bilateral bending and axial torsion separately. The results indicated that the variation in the curvature of ball and socket configuration would influence the range of motion in flexion/extension, while there were not apparently differences under other conditions of loads. The method increasing the curvature will solve the stress concentration of the polyethylene, but it will also bring adverse outcomes, such as facet joint force increasing and ligament tension increasing. Therefore, the design of artificial discs should be considered comprehensively to reserve the range of motion as well as to avoid the adverse problems, so as not to affect the long-term clinical results. PMID:25868242

  8. Are Western Knee Designs Dimensionally Correct for Korean Women? A Morphometric Study of Resected Femoral Surfaces during Primary Total Knee Arthroplasty

    PubMed Central

    Lyu, Suk-Joo; Kang, Hyung Wook

    2016-01-01

    Background The purpose of this study was to determine the shape of the distal femur of Korean women compared with the prostheses currently available in Korea. Methods Morphometric data (5 parameters) were measured in 356 resected femurs of Korean women undergoing primary total knee arthroplasty (TKA) utilizing the LCS knee implant (DePuy). The data were then compared with 5 additional contemporary TKA implant systems. Results Implant designs based on Caucasian population data do not ideally match the distal femoral morphology of Korean women. Overhang at the anterior mediolateral width was observed in 84.8% for the LCS while a gender-specific implant resulted in undercoverage of the bone in 86%. Posterior overhang was observed in up to 51.2%. Most implant designs have a narrower intercondylar notch than the morphologic data of Korean women. Conclusions Since there is some difference between the shape of distal femur of Korean women and that of the implants, surgeons should have this in mind when selecting an implant for a patient. These data may also be used as a guideline for future prosthetic design options for Korean women population. PMID:27583107

  9. Effect of Closed Suction Drain on Blood Loss and Transfusion Rates in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Study

    PubMed Central

    Shetty, Gautam M.; Gupta, Vinay; Saxena, Purvi; Singh, Nidhi

    2016-01-01

    Purpose Simultaneous bilateral total knee arthroplasty (TKA) is associated with excessive blood loss and morbidity arising from postoperative reduction in hemoglobin (Hb). The purpose of this prospective randomized study was to determine if drains have any effect on blood loss, postoperative reduction in Hb levels and transfusion rates compared to no drainage in simultaneous bilateral TKAs. Materials and Methods Two hundred and thirty patients who underwent simultaneous bilateral TKA by a single surgeon were randomly allotted to drain or no-drain group (n=115 in each group). Postoperative Hb level, blood loss volume and transfusion rate were compared between the two groups. Results The mean postoperative Hb level (p=0.38), blood loss volume (p=0.33) and transfusion rate (p=0.52) in the drain group were not significantly different compared to the no-drain group. No statistical difference was found in terms of complications, readmissions and mortality rates between the two groups. Conclusions No significant difference was observed in the two groups with respect to blood loss and blood transfusion. Non-drainage does not offer an advantage over drainage with respect to conserving blood in simultaneous bilateral TKA. PMID:27595073

  10. Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population

    PubMed Central

    Shinde, Abhishek; Sobti, Anshul; Maniar, Shriji; Mishra, Amit; Gite, Raju; Shetty, Vivek

    2015-01-01

    Introduction: For quite a few years, tranexamic acid (TEA) has been used during total knee arthroplasty (TKA) to reduce blood loss. However, no consensus exits regarding its timing and doses. Materials and Methods: We conducted a prospective, randomized double-blinded study of 56 patients in the Indian population undergoing TKA from 2011 to 2012. A dose of 10 mg/kg body weight of TEA (three doses) was given in one group and normal saline was administered in the other. Results: The mean blood loss in the TEA unilateral group was 295 mL ± 218 mL and in the placebo group was 482 mL ± 186 mL (P < 0.005). In the bilateral TEA group, the mean blood loss was 596 mL ± 235 mL and in the placebo group was 1349 mL ± 41 mL (P < 0.005). Conclusion: The number of patients requiring blood transfusion reduced substantially. There was no increase in the risk of deep vein thrombosis (DVT) and pulmonary embolism. TEA reduces intraoperative and postoperative blood loss and thus reduces the need of allogenic blood transfusion. PMID:26420938

  11. Radiographic and scintigraphic evaluation of total knee arthroplasty

    SciTech Connect

    Schneider, R.; Soudry, M.

    1986-04-01

    Various radiographic and scintigraphic methods are used to supplement clinical findings in the evaluation of total knee arthroplasty and its complications. Serial roentgenograms offer reliable information for diagnosing mechanical loosening. Wide and extensive radiolucency at the cement-bone interface and shift in position and alignment of prosthetic components can be seen in almost all cases by the time revision is necessary. Radiographic abnormalities are usually not present in acute infection, but are often present in chronic infection. Bone scanning has a high sensitivity for diagnosis of infection or loosening, but is nonspecific because increased uptake is often present around asymptomatic total knee arthroplasties with normal radiographs. Differential bone and Gallium scanning and scanning with Indium 111-labeled leukocytes have a greater specificity for diagnosis of infection than does bone or Gallium scanning alone. Routine radiographic and scintigraphic studies have shown a high incidence of deep vein thrombosis in the calf after total knee arthroplasty. Clinically significant pulmonary embolization is infrequent.

  12. Deproteinated palm kernel cake-derived oligosaccharides: A preliminary study

    NASA Astrophysics Data System (ADS)

    Fan, Suet Pin; Chia, Chin Hua; Fang, Zhen; Zakaria, Sarani; Chee, Kah Leong

    2014-09-01

    Preliminary study on microwave-assisted hydrolysis of deproteinated palm kernel cake (DPKC) to produce oligosaccharides using succinic acid was performed. Three important factors, i.e., temperature, acid concentration and reaction time, were selected to carry out the hydrolysis processes. Results showed that the highest yield of DPKC-derived oligosaccharides can be obtained at a parameter 170 °C, 0.2 N SA and 20 min of reaction time.

  13. Preliminary study of niobium alloy contamination by transport through helium

    NASA Technical Reports Server (NTRS)

    Scheuermann, C. M.; Moore, T. J.; Wheeler, D. R.

    1987-01-01

    Transport of gaseous contaminants through the working fluid to or from sensitive refractory alloys is theoretically possible during long time operation of Brayton and Stirling space power generation systems which use a gas as the working fluid. A test was designed which could give an answer to whether transport of contaminants through the working fluid was a potential major problem. The findings of that preliminary study are summarized.

  14. Preliminary dose comparisons for the MRS Systems Study

    SciTech Connect

    Pelto, P.J.; Lavender, J.C.

    1989-04-01

    This report provides preliminary information on the radiological doses to the public and the workers for alternative system configurations proposed in the MRS Systems Study. Information published in the MRS Environmental Assessment (DOE 1986) was used as a basis for this analysis. The risk differences between alternative configurations were found to be small and should not be viewed as a major factor in selecting alternative configurations. 1 ref.

  15. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty

    PubMed Central

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P.; Sköldenberg, Olof

    2016-01-01

    Abstract Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery. A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7–21). The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events. During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0–10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05–1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06–1.11). Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  16. Tree STEM Reconstruction Using Vertical Fisheye Images: a Preliminary Study

    NASA Astrophysics Data System (ADS)

    Berveglieri, A.; Tommaselli, A. M. G.

    2016-06-01

    A preliminary study was conducted to assess a tree stem reconstruction technique with panoramic images taken with fisheye lenses. The concept is similar to the Structure from Motion (SfM) technique, but the acquisition and data preparation rely on fisheye cameras to generate a vertical image sequence with height variations of the camera station. Each vertical image is rectified to four vertical planes, producing horizontal lateral views. The stems in the lateral view are rectified to the same scale in the image sequence to facilitate image matching. Using bundle adjustment, the stems are reconstructed, enabling later measurement and extraction of several attributes. The 3D reconstruction was performed with the proposed technique and compared with SfM. The preliminary results showed that the stems were correctly reconstructed by using the lateral virtual images generated from the vertical fisheye images and with the advantage of using fewer images and taken from one single station.

  17. Preliminary Study of a Hybrid Helicon-ECR Plasma Source

    NASA Astrophysics Data System (ADS)

    M. Hala, A.; Oksuz, L.; Ximing, Zhu

    2016-08-01

    A new type of hybrid discharge is experimentally investigated in this work. A helicon source and an electron cyclotron resonance (ECR) source were combined to produce plasma. As a preliminary study of this type of plasma, the optical emission spectroscopy (OES) method was used to obtain values of electron temperature and density under a series of typical conditions. Generally, it was observed that the electron temperature decreases and the electron density increases as the pressure increased. When increasing the applied power at a certain pressure, the average electron density at certain positions in the discharge does not increase significantly possibly due to the high degree of neutral depletion. Electron temperature increased with power in the hybrid mode. Possible mechanisms of these preliminary observations are discussed.

  18. Predicting Poor Physical Performance after Total Knee Arthroplasty

    PubMed Central

    Bade, Michael J; Wolfe, Pamela; Zeni, Joseph A; Stevens-Lapsley, Jennifer E.; Snyder-Mackler, Lynn

    2012-01-01

    The purpose of this study was to develop a preliminary decision algorithm predicting functional performance outcomes to aid in the decision of when to undergo total knee arthroplasty (TKA). One hundred nineteen patients undergoing primary unilateral TKA were evaluated before and 6 months after TKA. A regression tree analysis using a recursive partitioning function was performed with the Timed Up and Go (TUG) time, Six-Minute Walk (6MW) distance, and Stair Climbing Test (SCT) time as measured 6 months after TKA as the primary outcomes. Preoperative measures of functional performance, joint performance, anthropometrics, demographics, and self reported status were evaluated as predictors of the primary outcomes 6 months after surgery. Individuals taking ≥ 10.1 seconds on the TUG and aged 72 years or older before surgery had the poorest performance on the TUG 6 months after surgery. Individuals walking < 314 meters on the 6MW before surgery had the poorest performance on the 6MW test 6 months after surgery. Individuals taking ≥ 17 seconds to complete the SCT and scoring < 40 on the SF-36 mental component score before surgery had the poorest performance on the SCT 6 months after surgery. Poorer performance preoperatively on the 6MW, SCT, and TUG, was related to poorer performance in the same measure after TKA. Age and decreased mental health were secondary predictors of poorer performance at 6 months on the TUG and SCT, respectively. These measures may help further develop models predicting thresholds for poor outcomes after TKA. PMID:22539338

  19. Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part II: in vivo investigation.

    PubMed

    Khan, Imran; Smith, Nigel; Jones, Eric; Finch, Dudley S; Cameron, Ruth Elizabeth

    2005-02-01

    The polyurethane (PU) elastomer Corethane 80A (Corvita) is being considered as the acetabular bearing material in a novel total replacement hip joint. Its biostability was investigated in vitro (Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part I: material selection and evaluation, Biomaterials, in press) together with three other commercially available biomedical PUs: Pellethane 2363-80A (DOW Chemical), a polyhexamethylene oxide based PU, PHMO-PU (CSIRO, not supplied as a commercial product) and ChronoFlex AL-80A (CardioTech). From the in vitro studies, Corethane 80A displayed the best overall resistance to hydrolysis, ESC, MIO and calcification, followed by ChronoFlex 80A and PHMO-PU, with Pellethane 80A being the least stable. Building on the in vitro investigation, the follow-up in vivo study (reported here) assessed Corethane 80A as the bearing layer in a prototype compliant layer acetabular cup, in a fully functioning ovine total hip arthoplasty (THA) model. PU degradation in the retrieved cups was analysed using a range of analytical and physical-testing methods including mechanical testing, differential scanning calorimetry, Fourier transform infrared spectroscopy and environmental scanning electron microscopy. The Corethane 80A functioned well in the THA model, with the bearing surfaces of the retrieved hip cups showing no significant evidence of biodegradation or wear damage after 3 years in vivo. The findings in this study provide compelling evidence for the biostability and effectiveness of acetabular cups incorporating a Corethane 80A compliant bearing layer. PMID:15282141

  20. Total knee arthroplasty after high tibial osteotomy. A systematic review

    PubMed Central

    van Raaij, Tom M; Reijman, Max; Furlan, Andrea D; Verhaar, Jan AN

    2009-01-01

    Background Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee arthroplasty. Methods A computerized search for relevant studies published up to September 2007 was performed in Medline and Embase using a search strategy that is highly sensitive to find nonrandomized studies. Included were observational studies in which patients had total knee arthroplasty performed after prior high tibial osteotomy. Studies that fulfilled these criteria, were assessed for methodologic quality by two independent reviewers using the critical appraisal of observational studies developed by Deeks and the MINORS instrument. The study characteristics and data on the intervention, follow-up, and outcome measures, were extracted using a pre-tested standardized form. Primary outcomes were: knee range of motion, knee clinical score, and revision surgery. The grade of evidence was determined using the guidelines of the GRADE working group. Results Of the 458 articles identified using our search strategy, 17 met the inclusion criteria. Fifteen studies were cohort study with a concurrent control group, one was a historical cohort study and one a case-control study. Nine studies scored 50% or more on both methodological quality assessments. Pooling of the results was not possible due to the heterogeneity of the studies, and our analysis could not raise the overall low quality of evidence. No significant differences between primary total knee arthroplasty and total knee arthroplasty after osteotomy were found for knee range of motion in four out of six studies, knee clinical scores in eight out of nine studies, and revision surgery in eight out of eight studies after a median follow-up of 5 years. Conclusion Our analysis suggests that osteotomy does not compromise subsequent knee

  1. Online gaming dependency: a preliminary study in China.

    PubMed

    Peng, Wei; Liu, Ming

    2010-06-01

    Based on theories and previous studies on problematic Internet use, we propose a model to better understand the contributors to and consequences of online gaming dependency. A preliminary study was conducted through a survey of online gamers in China. The results of path analysis found that maladaptive cognitions, shyness, and depression are positively related to online gaming dependency. Online gaming dependency was also positively related to different types of negative life outcomes. The findings of this study have implications for the prevention and treatment of addictive online gaming. PMID:20557254

  2. A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery.

    PubMed

    van der Linden-van der Zwaag, Henrica M J; Bos, Janneke; van der Heide, Huub J L; Nelissen, Rob G H H

    2011-06-01

    Rotation of the femoral component in total knee arthroplasty (TKA) is of high importance in respect of the balancing of the knee and the patellofemoral joint. Though it is shown that computer assisted surgery (CAOS) improves the anteroposterior (AP) alignment in TKA, it is still unknown whether navigation helps in finding the accurate rotation or even improving rotation. Therefore the aim of our study was to evaluate the postoperative femoral component rotation on computed tomography (CT) with the intraoperative data of the navigation system. In 20 navigated TKAs the difference between the intraoperative stored rotation data of the femoral component and the postoperative rotation on CT was measured using the condylar twist angle (CTA). This is the angle between the epicondylar axis and the posterior condylar axis. Statistical analysis consisted of the intraclass correlation coefficient (ICC) and Bland-Altman plot. The mean intraoperative rotation CTA based on CAOS was 3.5° (range 2.4-8.6°). The postoperative CT scan showed a mean CTA of 4.0° (1.7-7.2). The ICC between the two observers was 0.81, and within observers this was 0.84 and 0.82, respectively. However, the ICC of the CAOS CTA versus the postoperative CT CTA was only 0.38. Though CAOS is being used for optimising the position of a TKA, this study shows that the (virtual) individual rotational position of the femoral component using a CAOS system is significantly different from the position on a postoperative CT scan. PMID:20623282

  3. Revision Total Hip Arthroplasty Using Tantalum Augment in Patients with Paprosky III or IV Acetabular Bone Defects: A Minimum 2-year Follow Up Study

    PubMed Central

    Jeong, Min; Kim, Hyung-Joo; Lim, Seung-Jae; Moon, Young-Wan

    2016-01-01

    Purpose The purpose of this study is to report the short-term outcomes of revision total hip arthroplasty (THA) using tantalum augments in patients with severe acetabular bone defects. Materials and Methods We retrospectively analyzed 15 revision THAs performed in 15 patients using tantalum augments between June 2010 and December 2013. Acetabular bone defects were Paprosky type IIIA in 7 hips, type IIIB in 7, and type IV in 1. The causes of revision surgery were aseptic loosening in 12 hips and deep infection in 3. Revisions were first in 1 hip, second in 3, and third in 11. Six patients were male and 9 female with a mean age of 59 years (range, 48-75 years). Mean follow-up was 29 months (range, 24-48 months). Results Mean Harris hip score was improved from 34 points (range, 12-54 points) preoperatively to 84 points (range, 38-90 points) at final follow-up. On the final follow-up radiographs, there were 12 hips (80.0%) with stable fixation of the acetabular cup, 2 (13.3%) with secondary stability after mild acetabular protrusion, and 1 (6.7%) with radiolucency around the acetabular cup without mechanical symptoms. Complications included one patient with acute hematogenous infection managed by surgical debridement and long-term antibiotic therapy. There were no cases with nerve palsy or dislocation during the follow-up period. Conclusion The present study showed satisfactory clinical and radiographic outcomes of revision THA using tantalum augments due to severe acetabular bone defects of Paprosky type III or IV at a minimum follow-up of 2 years. PMID:27536651

  4. Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study

    PubMed Central

    Huang, De-Yong; Zhang, Liang; Zhou, Yi-Xin; Zhang, Chun-Yu; Xu, Hui; Huang, Yong

    2016-01-01

    Background: Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures, and good results have been reported with the use of these cups; however, the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear. This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures. Methods: A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012. Among these patients, two were lost to follow-up. Therefore, 39 patients (39 hips) were finally included in this study. The Harris hip score before and after the surgery, satisfaction level of the patients, and radiographic results were assessed. Results: The mean Harris hip score increased from 34 (range, 8–52) before surgery to 91 (range, 22–100) at the latest follow-up examination (P < 0.001). The results were excellent for 28 hips, good for six, fair for three, and poor for two. Among the 39 patients, 25 (64%) and 10 (26%) were very satisfied and somewhat satisfied, respectively. All cups were found to be fully incorporated, and no evidence of cup migration or periacetabular osteolysis was noted. Conclusions: Despite the technically demanding nature of the procedure, THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures. PMID:27064033

  5. Comparison of one-level microendoscopy laminoforaminotomy and cervical arthroplasty in cervical spondylotic radiculopathy: a minimum 2-year follow-up study

    PubMed Central

    2013-01-01

    Background This study aims to compare the perioperative parameters and clinical results between microendoscopy laminoforaminotomy (MELF) and cervical arthroplasty (CA) in the treatment of one-level cervical spondylotic radiculopathy in a retrospective study. Methods From 2003 to 2007, a total of 97 patients with one-level cervical spondylotic radiculopathy were treated. Forty-five patients underwent CA. Fifty-two patients underwent MELF. Patient demographics and operative data were collected with a minimum 2-year follow-up. Perioperative parameters were compared. Clinical assessment in terms of neck disability index (NDI), short form (SF)-36, and visual analogue scale (VAS) of arm pain and neck pain was performed prior to surgery and at 1.5, 3, 6, 12, and 24 months after surgery. Results Fluoroscopy time (CA, 60.3 s; MELF, 12.1 s; P < 0.01) and surgical time (CA, 95.1 min; MELF, 24.0 min; P < 0.01) were significantly longer in the CA cases. Shorter hospitalized days (CA, 1.1 days; MELF, 0.13 days; P < 0.01) and less estimated blood loss (EBL; CA, 75.8 ml; MELF, 31.9 ml; P < 0.01) were observed in the MELF group. Both CA and MELF groups showed significant improvement in NDI, VAS of neck pain and arm pain, and SF-36 (P < 0.05 for each) at 1.5, 3, 6, 12, and 24 months after surgery, but there was no significant difference between them (P > 0.05). Conclusions As alternatives of anterior cervical decompression and fusion (ACDF), both CA and MELF can produce satisfactory clinical outcomes. MELF has the additional benefits of less blood loss, less surgical time, less X-ray time, and shorter hospital stay. PMID:24341633

  6. Is the use of computer navigation in total knee arthroplasty improving implant positioning and function? A comparative study of 198 knees operated at a Norwegian district hospital

    PubMed Central

    2013-01-01

    Background There are few Scandinavian studies on the effect of computer assisted orthopedic surgery (CAOS) in total knee arthroplasty (TKA), compared to conventional technique (CON), and there is little information on effects in pain and function scores. This retrospective study has evaluated the effects of CAOS on radiological parameters and pain, function and quality of life after primary TKA. Methods 198 primary TKAs were operated by one surgeon in two district hospitals; 103 CAOS and 95 CON. The groups were evaluated based on 3 months post-operative radiographs and a questionnaire containing the knee osteoarthritis outcome score (KOOS), the EQ-5D index score and a visual analogue scale (VAS) two years after surgery. Multiple linear regression method was used to investigate possible impact from exposure (CON or CAOS). Results On hip-knee-ankle radiographs, 20% of measurements were > ±3° of neutral in the CAOS group and 25% in the CON group (p = 0.37). For the femoral component, the number was 5% for CAOS and 18% for CON (p < 0.01). For the tibial component, the difference was not statistically significant (p = 0.58). In the sagittal plane, the surgeon tended to apply more femoral flexion and more posterior tibial slope with CAOS. We observed no statistically or clinically significant difference in KOOS score, VAS or ∆EQ-5D (all p values >0.05), but there was a trend towards better scores for CAOS. Operation time was 3 minutes longer for CON (p = 0.37). Conclusions CAOS can improve radiological measurements in primary TKA, and makes it possible to adjust component placement to the patient’s anatomy. Over-all, the two methods are equal in pain, function and quality-of-life scores. PMID:24228727

  7. Preliminary Study for a Tetrahedron Formation: Quality Factors and Visualization

    NASA Technical Reports Server (NTRS)

    Guzman, Jose J.; Schiff, Conrad; Bauer, Frank (Technical Monitor)

    2002-01-01

    Spacecraft flying in tetrahedron formations are excellent for electromagnetic and plasma studies. The quality of the science recorded is strongly affected by the tetrahedron evolution. This paper is a preliminary study on the computation of quality factors and visualization for a formation of four or five satellites. Four of the satellites are arranged geometrically in a tetrahedron shape. If a fifth satellite is present, it is arbitrarily initialized at the geometric center of the tetrahedron. The fifth satellite could act as a collector or as a spare spacecraft. Tetrahedron natural coordinates are employed for the initialization. The natural orbit evolution is visualized in geocentric equatorial inertial and in geocentric solar magnetospheric coordinates.

  8. Tibial rotation kinematics subsequent to knee arthroplasty

    PubMed Central

    Collins, Duane J.; Khatib, Yasser H.; Parker, David A.; Jenkin, Deanne E.; Molnar, Robert B.

    2015-01-01

    Background The use of computer assisted joint replacement has facilitated precise intraoperative measurement of knee kinematics. The changes in “screw home mechanism” (SHM) resulting from Total Knee Arthroplasty (TKA) with different prostheses and constraints has not yet been accurately described. Methods A pilot study was first completed. Intraoperative kinematic data was collected two groups of 15 patients receiving different prostheses. Results On average, patients lost 5.3° of ER (SD = 6.1°). There was no significant difference between the prostheses or different prosthetic constraints. Conclusions There significant loss of SHM after TKA. Further research is required to understand its impact on patient function. PMID:25829754

  9. Navigated minimally invasive unicompartmental knee arthroplasty.

    PubMed

    Jenny, Jean-Yves; Müller, Peter E; Weyer, R; John, Michael; Weber, Patrick; Ciobanu, Eugène; Schmitz, Andreas; Bacher, Thomas; Neumann, Wolfram; Jansson, Volkmar

    2006-10-01

    Unicompartmental knee arthroplasty (UKA) is an alternative procedure to high tibial osteotomy. This study assessed the procedure using computer navigation to improve implantation accuracy and presents early radiological results of a group of patients implanted with the univation UKA (B. Braun Aesculap, Tuttlingen, Germany) with navigation instrumentation and a minimally invasive approach. The authors concluded that navigated implantation of a UKA using a nonimage-based system improved radiologic accuracy implantation without significant inconvenience and minimal change in the conventional operating technique. PMID:17407935

  10. Pulse lavage is inadequate at removal of biofilm from the surface of total knee arthroplasty materials.

    PubMed

    Urish, Kenneth L; DeMuth, Peter W; Craft, David W; Haider, Hani; Davis, Charles M

    2014-06-01

    In acute periprosthetic infection, irrigation and debridement with component retention has a high failure rate in some studies. We hypothesize that pulse lavage irrigation is ineffective at removing biofilm from total knee arthroplasty (TKA) components. Staphylococcus aureus biofilm mass and location was directly visualized on arthroplasty materials with a photon collection camera and laser scanning confocal microscopy. There was a substantial reduction in biofilm signal intensity, but the reduction was less than a ten-fold decrease. This suggests that irrigation needs to be further improved for the removal of biofilm mass below the necessary bioburden level to prevent recurrence of acute infection in total knee arthroplasty. PMID:24439797

  11. Effects of a Foot Pump on the Incidence of Deep Vein Thrombosis After Total Knee Arthroplasty in Patients Given Edoxaban: A Randomized Controlled Study.

    PubMed

    Sakai, Tatsuya; Izumi, Masahiro; Kumagai, Kenji; Kidera, Kenichi; Yamaguchi, Takayuki; Asahara, Tomohiko; Kozuru, Hideko; Jiuchi, Yuka; Mawatari, Masaaki; Osaki, Makoto; Motokawa, Satoru; Migita, Kiyoshi

    2016-01-01

    We conducted a randomized clinical trial to compare the effectiveness of the A-V Impulse System foot pump for reducing the incidence of deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) in patients under edoxaban thromboprophylaxis. Patients undergoing primary TKA at our institution between September 2013 and March 2015 were enrolled after obtaining informed consent. The patients were randomized to use the foot pump (n = 58) and not to use the foot pump (n = 62). Both groups were given prophylactic edoxaban. Primary outcomes were any DVT as detected by bilateral ultrasonography up to postoperative day 10 (POD10) and pulmonary embolism (PE) up to POD28. The safety outcomes were bleeding and death of any cause up to POD28. Plasma D-dimer levels were measured before TKA and on POD10 after TKA. Immunoglobulin G (IgG)-class anti-PF4/heparin antibodies were measured using an IgG-specific enzyme-linked immunosorbent assay. The incidences of any DVT up to POD28 were 31.0% and 17.7% in patients with or without the foot pump, respectively. The incidences of major bleeding up to POD28 were 5.1% and 4.8% in patients with or without the foot pump, respectively. Foot pump use did not significantly reduce the incidence of DVTs in patients undergoing TKA under edoxaban thromboprophylaxis. Although seroconversion of anti-PF4/heparin antibodies was confirmed in one-fourth of patients, the seroconversion rates did not differ between patients with (20.7%) or without (25.8%) foot pump use. This study shows that the A-V Impulse system foot pump did not affect the incidence of DVT under edoxaban thromboprophylaxis in patients undergoing TKA. Seroconversion of anti-PF4/heparin antibodies was detected in a significant number of patients who underwent TKA under antithrombotic prophylaxis using edoxaban. PMID:26735531

  12. Clinical value of SPECT/CT in the ‘unhappy’ total knee arthroplasty (TKA)- a prospective study in a consecutive series of 100 painful knees after TKA

    PubMed Central

    Rotigliano, Niccolò; Hirschmann, Michael T.

    2016-01-01

    Aims and Objectives: Bone SPECT/CT is considered as beneficial hybrid imaging modality in unhappy patients with pain, stiffness or swelling after total knee arthroplasty (TKA). The purpose of this study was to identify typical pattern of tracer uptake distribution and intensity values in these patients after TKA. The above findings were correlated with the type of TKA, the time from primary TKA, fixation of TKA (cemented or non-cemented) and intraoperative findings at revision surgery (loose vs well fixed TKA components). Materials and Methods: A total of 100 knees (mean age±standard deviation 70±11 years) of 84 consecutive patients who have previously undergone primary TKA and complained about postoperative knee pain or stiffness after TKA were prospectively included. All patients underwent clinical and radiological examination including standardized radiographs and Tc-99m-HDP-SPECT/CT as part of a routine diagnostic algorithm. The diagnosis before and after SPECT/CT imaging, as well as the final treatment were recorded. Femoral and tibial TKA component position (varus-valgus, flexion-extension, internal rotation-external rotation) was determined on 3D reconstructed images using a customized analysis software. Intensity and anatomical distribution of 99mTc-HDP-SPECT/CT bone tracer uptake was determined using a validated localisation scheme. Maximum intensity values were recorded as well as ratios between the respective value and the background tracer activity (proximal mid-shaft of the femur). Level of significance was p<0.05. Univariate analysis (Chi square test, Pearson correlation, t-test for independent samples) was performed to identify any correlations between component position, tracer uptake and diagnosis. For all analysis, p<0.05 was considered statistically significant. Results: SPECT/CT changed the clinical diagnosis and final treatment in 85/100 (85%) knees. 33 knees (33%) were surgically revised, 58 knees (58%) non-surgically treated and 9 knees (9

  13. Biocontamination Control for Spacesuit Garments - A Preliminary Study

    NASA Technical Reports Server (NTRS)

    Rhodes, Richard A.; Orndoff, Evelyne; Korona, F. Adam; Poritz, Darwin; Smith, Jelanie; Wong, Wing

    2011-01-01

    This paper outlines a preliminary study that was conducted to review, test, and improve on current space suit biocontamination control. Biocontamination from crew members can cause space suit damage and objectionable odors and lead to crew member health hazards. An understanding of the level of biocontamination is necessary to mitigate its effects. A series of tests were conducted with the intent of evaluating current suit materials, ground and on-orbit disinfectants, and potential commercial off-the-shelf antimicrobial materials. Included in this paper is a discussion of the test methodology, results, and analysis method.

  14. Energy efficient engine: Preliminary design and integration studies

    NASA Technical Reports Server (NTRS)

    Johnston, R. P.; Hirschkron, R.; Koch, C. C.; Neitzel, R. E.; Vinson, P. W.

    1978-01-01

    Parametric design and mission evaluations of advanced turbofan configurations were conducted for future transport aircraft application. Economics, environmental suitability and fuel efficiency were investigated and compared with goals set by NASA. Of the candidate engines which included mixed- and separate-flow, direct-drive and geared configurations, an advanced mixed-flow direct-drive configuration was selected for further design and evaluation. All goals were judged to have been met except the acoustic goal. Also conducted was a performance risk analysis and a preliminary aerodynamic design of the 10 stage 23:1 pressure ratio compressor used in the study engines.

  15. Experimental Studies of Ion Beam Neutralization: Preliminary Results

    SciTech Connect

    Ding, N.; Polansky, J.; Downey, R.; Wang, J.

    2011-05-20

    A testing platform is designed to study ion beam neutralization in the mesothermal, collisionless region. In the experimental setup, argon neutrals were ionized in a microwave cavity and accelerated by a plasma lens system which was biased to 2500 V above the system ground. Electrons were boiled off from two hot tungsten filaments to neutralize the ion beam. The plasma is diagnosed using Langmuir probe and Faraday probe. A 3-D traversing system and a complete data acquisition loop were developed to efficiently measure 3-D beam profile. Preliminary measurements of beam profiles are presented for different operating conditions.

  16. Preliminary Study of a Pull Plug Friction Weld

    NASA Technical Reports Server (NTRS)

    Buchanan, George R.

    1999-01-01

    A pull plug friction weld, simply defined, comprises inserting a rotating cone-shaped cylinder into a somewhat cone-shaped hole in a plate. The rotating plug makes contact with the edge of the plate and the resulting friction generates heat. The temperature of the plate material eventually reaches a magnitude that will cause the plate material at the edge of the hole to flow. This can be termed a temperature dependent plastic flow. The rotation of the plug is terminated, additional pressure is applied and the metal at the interface of the two materials cools and welding occurs. This preliminary study addresses only three aspects of a complete analysis that is multi-faceted. The transient temperature distribution for different pull plug configurations has been studied in some detail even though the initial conditions and boundary conditions may still be deemed tentative. The stress distribution within the pull plug caused by the heating pressure was studied along with a preliminary analysis of the thermoelastic stress distribution caused by friction heating. There are no definitive results for the stress analysis. Additional study will be required.

  17. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty

    PubMed Central

    Blikman, T; Rienstra, W; van Raaij, T M; ten Hagen, A J; Dijkstra, B; Zijlstra, W P; Bulstra, S K; van den Akker-Scheek, I; Stevens, M

    2016-01-01

    Introduction Residual pain is a major factor in patient dissatisfaction following total hip arthroplasty or total knee arthroplasty (THA/TKA). The proportion of patients with unfavourable long-term residual pain is high, ranging from 7% to 34%. There are studies indicating that a preoperative degree of central sensitisation (CS) is associated with poorer postoperative outcomes and residual pain. It is thus hypothesised that preoperative treatment of CS could enhance postoperative outcomes. Duloxetine has been shown to be effective for several chronic pain syndromes, including knee osteoarthritis (OA), in which CS is most likely one of the underlying pain mechanisms. This study aims to evaluate the postoperative effects of preoperative screening and targeted duloxetine treatment of CS on residual pain compared with care-as-usual. Methods and analysis This multicentre, pragmatic, prospective, open-label, randomised controlled trial includes patients with idiopathic hip/knee OA who are on a waiting list for primary THA/TKA. Patients at risk for CS will be randomly allocated to the preoperative duloxetine treatment programme group or the care-as-usual control group. The primary end point is the degree of postoperative pain 6 months after THA/TKA. Secondary end points at multiple time points up to 12 months postoperatively are: pain, neuropathic pain-like symptoms, (pain) sensitisation, pain catastrophising, joint-associated problems, physical activity, health-related quality of life, depressive and anxiety symptoms, and perceived improvement. Data will be analysed on an intention-to-treat basis. Ethics and dissemination The study is approved by the local Medical Ethics Committee (METc 2014/087) and will be conducted according to the principles of the Declaration of Helsinki (64th, 2013) and the Good Clinical Practice standard (GCP), and in compliance with the Medical Research Involving Human Subjects Act (WMO). Trial registration number 2013-004313-41; Pre

  18. Gap Balanced Total Knee Arthroplasty

    MedlinePlus

    Gap Balanced Total Knee Arthroplasty – SIGMA® with AOX™ You must have Javascript enabled in your web browser. View Program Transcript Click Here to view the OR-Live, Inc. Privacy Policy and Legal Notice © 2010 OR-Live, Inc. All rights reserved.

  19. Wear simulation strategies for reverse shoulder arthroplasty implants.

    PubMed

    Langohr, G Daniel G; Athwal, George S; Johnson, James A; Medley, John B

    2016-05-01

    Reverse total shoulder arthroplasty is a clinically accepted surgical procedure; however, its long-term wear performance is not known. The purpose of this work is to review wear simulator testing of reverse total shoulder arthroplasty, to develop a wear simulator protocol for reverse total shoulder arthroplasty, and to test it by performing a pilot study. The review of wear simulator testing in the literature revealed considerable variation in protocols. A combination of our own cadaveric testing and those of other research groups helped in determining the magnitude and direction of joint loading for the development of the present protocol. A MATCO orbital-bearing simulator was adapted using custom fixtures to simulate a circumduction motion of the shoulder under mildly adverse conditions, and a pilot study gave wear rates within the wide range found in the literature. Arguments were presented in support of the currently developed protocol, but it was also suggested that, rather than rely on one protocol, a series of simulator wear protocols should be developed to fully test the implant wear performance in reverse total shoulder arthroplasty. PMID:27160563

  20. Arthroscopic management of the painful total elbow arthroplasty

    PubMed Central

    Bain, Gregory I

    2015-01-01

    Background Failure of total elbow arthroplasty is more common than after other major joint arthroplasties and is often a result of aseptic loosening, peri-prosthetic infection, fracture and instability. Infection can be a devastating complication, yet there are no established guidelines for the pre-operative diagnosis of total elbow peri-prosthetic infection. This is because pre-operative clinical, radiographic and biochemical tests are often unreliable. Methods Using three case examples, a standardized protocol for the clinical and arthroscopic assessment of the painful total elbow arthroplasty is described. This is used to provide a mechanical and microbiological diagnosis of the patient’s pain. Results There have been no complications resulting from the use of this technique in the three patients described, nor in any other patient to date. Conclusions The staged protocol described in the present study, utilizing arthroscopic assessment, has refined the approach to the painful total elbow arthroplasty because it directly influences the definitive surgical management of the patient. It is recommended that other surgeons follow the principles outlined in the present study when faced with this challenging problem. PMID:27583000

  1. Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study.

    PubMed

    Hernandez-Vaquero, Daniel; Garcia-Sandoval, Manuel A; Fernandez-Carreira, Jose M; Gava, Richard

    2008-02-01

    We prospectively measured the changes in bone mineral density (BMD) in the proximal tibia of 20 total knee arthroplasties, ten with cruciform stems and ten with cylindrical stems. The measurements were made one, four and seven years after surgery. We observed a uniform density decrease in three regions of interest from one to seven years of follow-up. Cylindrical stems showed an asymmetrical density decrease between the three regions of interest, with no change in the central region, a slight decrease in the lateral region, and large decrease in the medial region. Multivariate analysis with general linear model showed the stem type factor as statistically significant for medial region of interest (p = 0.006). The cylindrical stem produces heterogeneous BMD changes under the tibial platform in knee arthroplasties, and this could be a potential risk factor for asymmetrical subsidence of this component. PMID:17115154

  2. Cementless Total Hip Arthroplasty in Hip Dysplasia with an Extensively Porous-Coated Cylindrical Stem Modified for Asians: A 12-Year Follow-Up Study.

    PubMed

    Kato, Tsutomu; Otani, Takuya; Sugiyama, Hajime; Hayama, Tetsuo; Katsumata, Souichi; Marumo, Keishi

    2015-06-01

    Long-term outcomes of primary cementless total hip arthroplasty were examined for 198 hips of Asian patients with developmental dysplasia of the hip. AML stems were modified for patients' relatively small physique. Stable fixation was achieved despite various proximal femoral deformities. At follow up (mean 12.1 years), radiographs demonstrated fixation in all hips, with 100% stem survivorship. Radiographic changes revealed that the severity of stress-shielding was mild in 55% of hips, moderate in 26%, and severe in 19%. Longer follow up is needed to determine whether these changes will develop into clinical manifestations. A distal fixation stem can be a useful reconstruction option when application of a proximal fixation stem in primary total hip arthroplasty is difficult for various reasons. PMID:25677937

  3. Preliminary design study of the TMT Telescope structure system: overview

    NASA Astrophysics Data System (ADS)

    Usuda, Tomonori; Ezaki, Yutaka; Kawaguchi, Noboru; Nagae, Kazuhiro; Kato, Atsushi; Takaki, Junji; Hirano, Masaki; Hattori, Tomoya; Tabata, Masaki; Horiuchi, Yasushi; Saruta, Yusuke; Sofuku, Satoru; Itoh, Noboru; Oshima, Takeharu; Takanezawa, Takashi; Endo, Makoto; Inatani, Junji; Iye, Masanori; Sadjadpour, Amir; Sirota, Mark; Roberts, Scott; Stepp, Larry

    2014-07-01

    We present an overview of the preliminary design of the Telescope Structure System (STR) of Thirty Meter Telescope (TMT). NAOJ was given responsibility for the TMT STR in early 2012 and engaged Mitsubishi Electric Corporation (MELCO) to take over the preliminary design work. MELCO performed a comprehensive preliminary design study in 2012 and 2013 and the design successfully passed its Preliminary Design Review (PDR) in November 2013 and April 2014. Design optimizations were pursued to better meet the design requirements and improvements were made in the designs of many of the telescope subsystems as follows: 1. 6-legged Top End configuration to support secondary mirror (M2) in order to reduce deformation of the Top End and to keep the same 4% blockage of the full aperture as the previous STR design. 2. "Double Lower Tube" of the elevation (EL) structure to reduce the required stroke of the primary mirror (M1) actuators to compensate the primary mirror cell (M1 Cell) deformation caused during the EL angle change in accordance with the requirements. 3. M1 Segment Handling System (SHS) to be able to make removing and installing 10 Mirror Segment Assemblies per day safely and with ease over M1 area where access of personnel is extremely difficult. This requires semi-automatic sequence operation and a robotic Segment Lifting Fixture (SLF) designed based on the Compliance Control System, developed for controlling industrial robots, with a mechanism to enable precise control within the six degrees of freedom of position control. 4. CO2 snow cleaning system to clean M1 every few weeks that is similar to the mechanical system that has been used at Subaru Telescope. 5. Seismic isolation and restraint systems with respect to safety; the maximum acceleration allowed for M1, M2, tertiary mirror (M3), LGSF, and science instruments in 1,000 year return period earthquakes are defined in the requirements. The Seismic requirements apply to any EL angle, regardless of the

  4. Footprint mismatch in lumbar total disc arthroplasty.

    PubMed

    Gstoettner, Michaela; Michaela, Gstoettner; Heider, Denise; Denise, Heider; Liebensteiner, Michael; Bach, Christian Michael; Michael, Bach Christian

    2008-11-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required. PMID:18791748

  5. Footprint mismatch in lumbar total disc arthroplasty

    PubMed Central

    Michaela, Gstoettner; Denise, Heider; Liebensteiner, Michael

    2008-01-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required. PMID:18791748

  6. Preliminary design study of advanced multistage axial flow core compressors

    NASA Technical Reports Server (NTRS)

    Wisler, D. C.; Koch, C. C.; Smith, L. H., Jr.

    1977-01-01

    A preliminary design study was conducted to identify an advanced core compressor for use in new high-bypass-ratio turbofan engines to be introduced into commercial service in the 1980's. An evaluation of anticipated compressor and related component 1985 state-of-the-art technology was conducted. A parametric screening study covering a large number of compressor designs was conducted to determine the influence of the major compressor design features on efficiency, weight, cost, blade life, aircraft direct operating cost, and fuel usage. The trends observed in the parametric screening study were used to develop three high-efficiency, high-economic-payoff compressor designs. These three compressors were studied in greater detail to better evaluate their aerodynamic and mechanical feasibility.

  7. R&D Requirements, RF Gun Mode Studies, FEL-2 Steady-StateStudies, Preliminary FEL-1 Time-Dependent Studies, and Preliminary LayoutOption Investigation

    SciTech Connect

    Byrd, John; Corlett, John; Doolittle, Larry; Fawley, William; Lidia, Steven; Penn, Gregory; Ratti, Alex; Staples, John; Wilcox Russell; Wurtele, Jonathan; Zholents, Alexander

    2005-10-01

    This report constitutes the third deliverable of LBNLs contracted role in the FERMI {at} Elettra Technical Optimization study. It describes proposed R&D activities for the baseline design of the Technical Optimization Study, initial studies of the RF gun mode-coupling and potential effects on beam dynamics, steady-state studies of FEL-2 performance to 10 nm, preliminary studies of time-dependent FEL-1 performance using electron bunch distribution from the start-to-end studies, and a preliminary investigation of a configuration with FEL sinclined at a small angle from the line of the linac.

  8. Preliminary paleomagnetic study of the Thetford Mines Ordovician Ophiolite (Canada)

    NASA Astrophysics Data System (ADS)

    Di Chiara, Anita; Morris, Antony; Anderson, Mark

    2016-04-01

    Extension associated with oceanic ridges at divergent plate boundaries is characterized by normal faulting and episodic magma supply. Studies in modern oceanic settings suggest locally along ridges both lower crust and upper mantle peridotites may be exhumed to the seafloor in features known as oceanic core complexes (OCC). OCC are characterized by long-lived low-angle detachment faults that extend for 10s of km, and that are crosscut by high-angle normal faults oriented parallel to the rift axis. Here we present preliminary results from 12 paleomagnetic sites sampled on an example of fossilized Ordovician OCC preserved in the in the Canadian Appalachians, the Southern Quebec ophiolites. These were obducted and subjected to polyphase deformation during Palaeozoic orogeny along the Laurentian margin of Iapetus. Although locally obscured by tectonic fabrics and structures, the original relationships between the ophiolitic mantle, the overlying plutonic section, and onlapping Ordovician siliciclastic rocks can be reconstructed within the Thetford-Mines ophiolite. Preliminary results from AMS and Thermal demagnetization experiments record a remarkably consistent overprint from the youngest (Acadian) phase of Paleozoic orogeny. Although complicating further study of intra-oceanic deformation along the detachment fault in the original OCC, the results provide further insights into the progressive overprint of deformation events as recorded by AMS.

  9. Nevada potential repository preliminary transportation strategy Study 2. Volume 1

    SciTech Connect

    1996-02-01

    The objectives of this study were to build on the findings of the Nevada Potential Repository Preliminary Transportation Strategy Study 1 (CRWMS M&O 1995b), and to provide additional information for input to the repository environmental impact statement (EIS) process. In addition, this study supported the future selection of a preferred rail corridor and/or heavy haul route based on defensible data, methods, and analyses. Study research did not consider proposed legislation. Planning was conducted according to the Civilian Radioactive Waste Management Program Plan (DOE 1994a). The specific objectives of Study 2 were to: eliminate or reduce data gaps, inconsistencies, and uncertainties, and strengthen the analysis performed in Study 1; develop a preliminary list of rail route evaluation criteria that could be used to solicit input from stakeholders during scoping meetings. The evaluation criteria will be revised based on comments received during scoping; restrict and refine the width of the four rail corridors identified in Study 1 to five miles or less, based on land use constraints and engineering criteria identified and established in Study 2; evaluate national-level effects of routing spent nuclear fuel and high-level waste to the four identified branch lines, including the effects of routing through or avoiding Las Vegas; continue to gather published land use information and environmental data to support the repository EIS; continue to evaluate heavy haul truck transport over three existing routes as an alternative to rail and provide sufficient information to support the repository EIS process; and evaluate secondary uses for rail (passenger use, repository construction, shared use).

  10. Uncovertebral Anatomic Midline Targeting for Cervical Disc Arthroplasty

    PubMed Central

    Bednar, Drew A.

    2012-01-01

    Study Design Prospective observational cohort. Objective To document the accuracy of uncovertebral anatomic targeting in positioning cervical disc arthroplasty. Summary of Background Data Disc arthroplasty implants depend on midline placement for optimum mechanical function. Fluoroscopy is used to delineate the midline. Anatomic targeting from the uncovertebral joints in the neck may be adequate. We have investigated the efficacy of uncovertebral anatomic targeting for cervical disc arthroplasty. Methods Anatomic uncovertebral midline targeting for disc arthroplasty insertion was performed in 18 male (mean age 51 years, range 27 to 67) and 22 female (mean age 50, range 35 to 70) patients receiving a total of 59 implants over a 5-year period. Device insertion was under only lateral imaging control. Postinsertion operative fluoroscopy with optimized centering was used to record implant position in the anteroposterior plane, and centerline analysis was performed using cursor measurement technology from the GE PACS™ imaging system (GE Medical Systems, Mt. Prospect, IL). Results Analysis found a mean deviation from the ideal midline placement of only 0.7 mm (range, 0 to 2.9 mm). Only three devices were more than 2 mm off the anatomic midline. Conclusion This anatomic technique is effective, safely minimizing imaging resource needs and X-ray exposure to the patient and operating team. PMID:24353946

  11. Clinical Implication of Diabetes Mellitus in Primary Total Hip Arthroplasty

    PubMed Central

    Chun, Young-Soo; Lee, Seung-Hyuk; Lee, Sang-Hoon; Cho, Yoon-Je

    2014-01-01

    Purpose The purpose of this study was to investigate the effect of diabetes mellitus on primary total hip arthroplasty by comparing the clinical outcomes of patients diagnosed to have diabetes mellitus before the operation with those without diabetes. Materials and Methods A total 413 patients who underwent unilateral cementless total hip arthroplasty from June 2006 to May 2009 were recruited and divided into diabetic and non-diabetic groups. The comparative analysis between the two groups was made. We evaluated Harris hip score, postoperative complications such as wound problem, surgical site infection, other medical complication and length of stay in hospital as clinical parameters. Radiographic evaluations were also included to determine loosening, dislocation and osteolysis. Results Patients with diabetes had an increased incidence of orthopaedic complications including surgical site infection and mortality, but other medical complications were not increased in diabetic patients. All complications after primary total hip arthroplasty were associated with diabetes mellitus, but the degree of diabetes was not associated with complications. Conclusion Diabetes mellitus increases incidence of orthopaedic complications, particularly deep infection, after cementless primary total hip arthroplasty.

  12. Assessing hospital cost of joint arthroplasty

    PubMed Central

    BONIFORTI, FILIPPO

    2015-01-01

    Purpose total joint replacement is one of the most successful procedures in medicine and cost reimbursements to hospitals for the joint arthroplasty diagnosis-related group are among the largest payments made by a Regional Health Service. Despite the popularity of these procedures, there are few high-quality cost-effectiveness studies on this topic. This study evaluates the cost of total joint arthroplasty performed in a district hospital. Methods direct and indirect costs have been measured and patient procedure pathway was analyzed subdivided into three stages: surgical procedure, inpatient care and outpatient clinic. Results the cost of the surgical procedure stage was calculated as 3,798 euros, while that of the inpatient stage was 2,924 euros. The mean hospital costs per procedure amounted to 6,952 euros. Conclusions although the Health Service tariffs fully reimburse the cost of providing a joint replacement, our data contribute to point out the role of hospital staff’s organization to support sustainable improvements on health care for joint replacement surgery. Level of evidence Level VI, single economic evaluation. PMID:26904524

  13. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature

    PubMed Central

    2012-01-01

    Background A number of factors have been identified as influencing total knee arthroplasty outcomes, including patient factors such as gender and medical comorbidity, technical factors such as alignment of the prosthesis, and provider factors such as hospital and surgeon procedure volumes. Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of total joint arthroplasty to higher volume centers, and adoption of volume standards. To contribute to the discussions concerning the optimization of provider factors and proposals to regionalize total knee arthroplasty practices, we undertook a systematic review to investigate the association between surgeon volume and primary total knee arthroplasty outcomes. Methods We performed a systematic review examining the association between surgeon volume and primary knee arthroplasty outcomes. To be included in the review, the study population had to include patients undergoing primary total knee arthroplasty. Studies had to report on the association between surgeon volume and primary total knee arthroplasty outcomes, including perioperative mortality and morbidity, patient-reported outcomes, or total knee arthroplasty implant survivorship. There were no restrictions placed on study design or language. Results Studies were variable in defining surgeon volume (‘low’: <3 to <52 total knee arthroplasty per year; ‘high’: >5 to >70 total knee arthroplasty per year). Mortality rate, survivorship and thromboembolic events were not found to be associated with surgeon volume. We found a significant association between low surgeon volume and higher rate of infection (0.26% - 2.8% higher), procedure time (165 min versus 135 min), longer length of stay (0.4 - 2.13 days longer), transfusion rate (13% versus 4%), and worse patient reported outcomes. Conclusions Findings suggest a trend towards better outcomes for higher volume surgeons, but results must be interpreted with caution. PMID

  14. UNICOMPARTMENTAL KNEE ARTHROPLASTY: CURRENT PERSPECTIVES AND TRENDS IN BRAZIL

    PubMed Central

    Arliani, Gustavo Gonçalves; Júnior, João Alberto Yazigi; Angelini, Felipe Bertelli; Ferlin, Fernando; Hernandes, Andrea Canizares; Astur, Diego da Costa; Cohen, Moises

    2015-01-01

    Objective: The aim of this study was to evaluate the approaches and procedures used by Brazilian orthopedic surgeons for treating osteoarthrosis by means of unicompartmental knee arthroplasty and high tibial osteotomy of the knee. Methods: A questionnaire with 14 closed questions was developed and applied to Brazilian knee surgeons during the three days of the 43rd Brazilian Congress of Orthopedics and Traumatology. Results: A total of 113 surgeons filled out the questionnaire completely and became part of the sample analyzed. In this study, the majority of the surgeons performed fewer than five unicompartmental knee arthroplasty procedures/year (61.1%) and between 5 and 15 high tibial osteotomy procedures/year (37.2%). Use of computerized navigation systems during surgery remains uncommon in our environment, since only 0.9% of the specialists were using it. 65.5% of the surgeons reported that they had chosen to use total knee arthroplasty rather than partial arthroplasty due to lack of familiarity with the surgical technique. When asked about the possibility that the number of unicompartmental prostheses used in Brazil would grow as surgeons in this country become increasingly familiar with the technique, 80.5% of the respondents believed in this hypothesis. In this sample, we found that the greater the surgeon's experience was, the greater the numbers of unicompartmental prostheses and tibial osteotomies performed annually were (r = 0.550 and r = 0.465, respectively; p < 0.05). Conclusions: There is a clear evolutional trend towards treatment of unicompartmental osteoarthritis using partial knee arthroplasty in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefits of these trends. PMID:27047891

  15. Revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty.

    PubMed

    Memişoğlu, Kaya; Müezzinoğlu, U Sefa; Kesemenli, Cumhur Cevdet

    2010-01-01

    The Gunston polycentric knee arthroplasty, first designed and performed by Frank Gunston in 1971, is the first prosthesis considering the natural knee biomechanics. Although the polycentric knee arthroplasty showed encouraging results to relieve pain and to preserve the preoperative range of motion and joint instability, the improvements in prosthesis design and arthroplasty technology rapidly made the polycentric knee prosthesis obsolete. Herein, we report a 58-year old male patient who had revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty performed 32 years after the initial operation. PMID:21343693

  16. Long-term results of compartmental arthroplasties of the knee: Long term results of partial knee arthroplasty.

    PubMed

    Parratte, S; Ollivier, M; Lunebourg, A; Abdel, M P; Argenson, J-N

    2015-10-01

    Partial knee arthroplasty (PKA), either medial or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty (PFA) are a good option in suitable patients and have the advantages of reduced operative trauma, preservation of both cruciate ligaments and bone stock, and restoration of normal kinematics within the knee joint. However, questions remain concerning long-term survival. The goal of this review article was to present the long-term results of medial and lateral UKA, PFA and combined compartmental arthroplasty for multicompartmental disease. Medium- and long-term studies suggest reasonable outcomes at ten years with survival greater than 95% in UKA performed for medial osteoarthritis or osteonecrosis, and similarly for lateral UKA, particularly when fixed-bearing implants are used. Disappointing long-term outcomes have been observed with the first generation of patellofemoral implants, as well as early Bi-Uni (i.e., combined medial and lateral UKA) or Bicompartmental (combined UKA and PFA) implants due to design and fixation issues. Promising short- and med-term results with the newer generations of PFAs and bicompartmental arthroplasties will require long-term confirmation. PMID:26430081

  17. Sex differences in characteristics, utilization, and outcomes of patient undergoing total elbow arthroplasty: a study of the US nationwide inpatient sample.

    PubMed

    Singh, Jasvinder A; Ramachandran, Rekha

    2016-03-01

    The aim of this study was to compare patient characteristics, utilization rates, and outcomes after total elbow arthroplasty (TEA) by sex. We used the nationwide inpatient sample from 1998 to 2011 to study sex-related time trends in patient characteristics, comorbidity, and outcomes after TEA. We used chi-squared test, analysis of variance, and the Cochran-Armitage test to assess differences in utilization rates and characteristics over time by sex and logistic regression to compare mortality, discharge disposition, and the length of hospital stay by sex. Overall TEA utilization 0.45 in 1998 to 0.96 per 100,000 in 2011 (p < 0.0001). The utilization rates were significantly higher in females compared to males throughout the study period: 0.62 vs. 0.29 in 1998 (p < 0.0001) and 1.31 vs. 0.70 in 2011 (p < 0.0001). Compared to males, females undergoing TEA were more likely to be white (79.7 vs. 71.4 %; p < 0.0001), have rheumatoid arthritis (16.7 vs. 8.1 %; p < 0.0001), and have Deyo-Charlson index of 2 or more (11.3 vs. 5.9 %; p < 0.0001) and were older (63.5 vs. 51.4 years; p < 0.0001). Compared to males undergoing TEA, females had significantly lower mortality, 0.1 vs. 0.4 % (p = 0.03); lower proportion were discharged to home, 81.9 vs. 89.6 % (p < 0.0001), and fewer had has index hospital stay above the median, 30.0 vs. 33.0 % (p = 0.01); most differences were significant after multivariable adjustment. TEA utilization in the USA more than doubled in the last 14 years, with rates higher in females than males. Females had better outcomes after TEA than men. Preoperative risk communication should be sex-specific based on these data. PMID:25316506

  18. The Cruciate Ligaments in Total Knee Arthroplasty.

    PubMed

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction. PMID:27327919

  19. Robot-assisted unicompartmental knee arthroplasty.

    PubMed

    Pearle, Andrew D; O'Loughlin, Padhraig F; Kendoff, Daniel O

    2010-02-01

    The outcomes of unicompartmental knee arthroplasties (UKAs) have demonstrated inconsistent long-term survival. We report the first clinical series of UKA using a semiactive robotic system for the implantation of an inlay unicondylar knee arthroplasty. Ten patients were selected for this study. Preoperative mechanical leg alignment values ranged from 0.3 degrees varus to 9.8 degrees varus. A haptic guidance system was used; a detailed description is given in the manuscript. The setup time for the robot was 41 minutes; intraoperative registration process, 7.5 minutes (6-13 minutes); skin incision, 8 cm; robot-assisted burring, 34.8 minutes (18-50 minutes); mean tourniquet time, 87.4 minutes (68-113 minutes); and overall operation time, 132 minutes (118-152 minutes). The planned and intraoperative tibiofemoral angle was within 1 degrees. The postoperative long leg axis radiographs were within 1.6 degrees. Haptic guidance in combination with a navigation module allows for precise planning and execution of both inlay components in UKA. PMID:19056227

  20. Preliminary study: isotopic safeguards techniques (IST) LMFBR fuel cycles

    SciTech Connect

    Persiani, P. J.; Kroc, T. K.

    1980-06-01

    This memorandum presents the preliminary results of the effort to investigate the applicability of isotope correlation techniques (ICT), formulated for the LWR system, to the LMFBR fuel cycle. The detailed isotopic compositional changes with burnup developed for the CRBR was utilized as the reference case. This differs from the usual LMFBR design studies in that the core uranium is natural uranium rather than depleted. Nevertheless, the general isotopic behavior should not differ significantly and does allow an initial insight into the expected behavior of isotopic correlations for the LMFBR power systems such as: the U.K. PFR and reprocessing plant; the French Phenix and Superphenix; and the US reference conceptual design studies (CDS) of homogeneous and heterogeneous LMFBR systems as they are developed.

  1. Characterization of burns using hyperspectral imaging technique - a preliminary study.

    PubMed

    Calin, Mihaela Antonina; Parasca, Sorin Viorel; Savastru, Roxana; Manea, Dragos

    2015-02-01

    Surgical burn treatment depends on accurate estimation of burn depth. Many methods have been used to asses burns, but none has gained wide acceptance. Hyperspectral imaging technique has recently entered the medical research field with encouraging results. In this paper we present a preliminary study (case presentation) that aims to point out the value of this optical method in burn wound characterization and to set up future lines of investigation. A hyperspectral image of a leg and foot with partial thickness burns was obtained in the fifth postburn day. The image was analyzed using linear spectral unmixing model as a tool for mapping the investigated areas. The article gives details on the mathematical bases of the interpretation model and correlations with clinical examination pointing out the advantages of hyperspectral imaging technique. While the results were encouraging, further more extended and better founded studies are being prepared before recognizing hyperspectral imaging technique as an applicable method of burn wound assessment. PMID:24997530

  2. Reactivity to sensations in borderline personality disorder: a preliminary study.

    PubMed

    Rosenthal, M Zachary; Ahn, Roianne; Geiger, Paul J

    2011-10-01

    Individuals with borderline personality disorder (BPD) are widely considered to have problems with emotional reactivity. However, the specific kinds of stimuli that are associated with heightened emotional reactivity in BPD have not been well characterized. Thus, it is unclear whether the emotional dysfunction in BPD occurs in response to any emotionally evocative stimuli, or to specific classes of stimuli. In this study, we used subjective measures (self-report and interview-based) to compare reactivity to sensations (auditory, gustatory, olfactory, tactile, visual) between participants with BPD (n = 30) and healthy controls (n = 50). Controlling for trait negative emotional reactivity, individuals with BPD reported being significantly more reactive across sensory stimuli. However, the difference between controls and BPD was significantly greater for reactivity to auditory stimuli compared to other sensory stimuli. Findings from this study provide preliminary data suggesting individuals with BPD may be characterized by heightened self-reported reactivity to aversive sounds. PMID:22023306

  3. Preliminary Studies for Three Experiments at Treiman-Yang Criterion

    NASA Astrophysics Data System (ADS)

    Kres, I. V.; Kondratyev, V. N.; Cherubini, S.; Spitaleri, C.

    2016-05-01

    Nuclear reactions with three bodies in their final state may proceed through different reaction mechanisms. The Feynman graph technique has been widely used to describe such reactions. However, it is very difficult in general to select the graphs that dominate in given process. The Treiman-Yang criterion is one of the most powerful experimental tests for verifying the pole approximation prediction when describing a quasi-free reaction mechanism. We propose the theoretical study of the H2(B10, α Be7)ns, H1(B11, α1α2)αs, He3(Be9, α1α2)αs reactions at different energies. The preliminary study helps to check the existence of a QF channel by using the TY creterion.

  4. Possession experiences in dissociative identity disorder: a preliminary study.

    PubMed

    Ross, Colin A

    2011-01-01

    Dissociative trance disorder, which includes possession experiences, was introduced as a provisional diagnosis requiring further study in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Consideration is now being given to including possession experiences within dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), which is due to be published in 2013. In order to provide empirical data relevant to the relationship between DID and possession states, I analyzed data on the prevalence of trance, possession states, sleepwalking, and paranormal experiences in 3 large samples: patients with DID from North America; psychiatric outpatients from Shanghai, China; and a general population sample from Winnipeg, Canada. Trance, sleepwalking, paranormal, and possession experiences were much more common in the DID patients than in the 2 comparison samples. The study is preliminary and exploratory in nature because the samples were not matched in any way. PMID:21667381

  5. Qualifying CT for wrist arthroplasty: extending techniques for total hip arthroplasty to total wrist arthroplasty

    NASA Astrophysics Data System (ADS)

    Alcala, Yvonne; Olivecrona, Henrik; Olivecrona, Lotta; Noz, Marilyn E.; Maguire, Gerald Q., Jr.; Zeleznik, Michael P.; Sollerman, Christer

    2005-04-01

    The purpose of this study was to extend previous work to detect migration of total wrist arthroplasty non-invasively, and with greater accuracy. Two human cadaverous arms, each with a cemented total wrist implant, were used in this study. In one of the arms, 1 mm tantalum balls were implanted, six in the carpal bones and five in the radius. Five CT scans of each arm were acquired, changing the position of the arm each time to mimic different positions patients might take on repeated examinations. Registration of CT volume data sets was performed using an extensively validated, 3D semi-automatic volume fusion tool in which co-homologous point pairs (landmarks) are chosen on each volume to be registered. Three sets of ten cases each were obtained by placing landmarks on 1) bone only (using only arm one), 2) tantalum implants only, and 3) bone and tantalum implants (both using only arm two). The accuracy of the match was assessed visually in 2D and 3D, and numerically by calculating the distance difference between the actual position of the transformed landmarks and their ideal position (i.e., the reference landmark positions). All cases were matched visually within one width of cortical bone and numerically within one half CT voxel (0.32 mm, p = 0.05). This method matched only the bone/arm and not the prosthetic component per se, thus making it possible to detect prosthetic movement and wear. This method was clinically used for one patient with pain. Loosening of the carpal prosthetic component was accurately detected and this was confirmed at surgery.

  6. Post-traumatic immunosuppression is reversed by anti-coagulated salvaged blood transfusion: deductions from studying immune status after knee arthroplasty

    PubMed Central

    Islam, N; Whitehouse, M; Mehendale, S; Hall, M; Tierney, J; O'Connell, E; Blom, A; Bannister,, G; Hinde, J; Ceredig, R; Bradley, B A

    2014-01-01

    Major trauma increases vulnerability to systemic infections due to poorly defined immunosuppressive mechanisms. It confers no evolutionary advantage. Our objective was to develop better biomarkers of post-traumatic immunosuppression (PTI) and to extend our observation that PTI was reversed by anti-coagulated salvaged blood transfusion, in the knowledge that others have shown that non-anti-coagulated (fibrinolysed) salvaged blood was immunosuppressive. A prospective non-randomized cohort study of patients undergoing primary total knee arthroplasty included 25 who received salvaged blood transfusions collected post-operatively into acid–citrate–dextrose anti-coagulant (ASBT cohort), and 18 non-transfused patients (NSBT cohort). Biomarkers of sterile trauma included haematological values, damage-associated molecular patterns (DAMPs), cytokines and chemokines. Salvaged blood was analysed within 1 and 6 h after commencing collection. Biomarkers were expressed as fold-changes over preoperative values. Certain biomarkers of sterile trauma were common to all 43 patients, including supranormal levels of: interleukin (IL)-6, IL-1-receptor-antagonist, IL-8, heat shock protein-70 and calgranulin-S100-A8/9. Other proinflammatory biomarkers which were subnormal in NSBT became supranormal in ASBT patients, including IL-1β, IL-2, IL-17A, interferon (IFN)-γ, tumour necrosis factor (TNF)-α and annexin-A2. Furthermore, ASBT exhibited subnormal levels of anti-inflammatory biomarkers: IL-4, IL-5, IL-10 and IL-13. Salvaged blood analyses revealed sustained high levels of IL-9, IL-10 and certain DAMPs, including calgranulin-S100-A8/9, alpha-defensin and heat shock proteins 27, 60 and 70. Active synthesis during salvaged blood collection yielded increasingly elevated levels of annexin-A2, IL-1β, Il-1-receptor-antagonist, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IFN-γ, TNF-α, transforming growth factor (TGF)-β1, monocyte chemotactic protein-1 and macrophage inflammatory

  7. Preliminary studies of electromagnetic sounding of cometary nuclei

    NASA Technical Reports Server (NTRS)

    Gabriel, A.; Warne, L.; Bednarczyk, S.; Elachi, C.

    1978-01-01

    The internal structure of a comet could be determined with a spacecraft borne electromagnetic sounder. A dielectric profile of the comet could be produced in direct analogy with terrestrial glacier and ice sheet sounding experiments. This profile would allow the detection of a rocky core or ice layers if they exist, just as layers in the ice and the bedrock interface have been clearly observed through the Greenland ice sheet. It would also provide a gross estimate of the amount of dust in the icy region. Models for the response of the nucleus and cometary plasma to electromagnetic sounding are developed and used to derive experimental parameters. A point system design was completed. Preliminary engineering study results indicate that the sounder is well within the bounds of current space technology.

  8. Mathematical modeling of normal pharyngeal bolus transport: a preliminary study.

    PubMed

    Chang, M W; Rosendall, B; Finlayson, B A

    1998-07-01

    Dysphagia (difficulty in swallowing) is a common clinical symptom associated with many diseases, such as stroke, multiple sclerosis, neuromuscular diseases, and cancer. Its complications include choking, aspiration, malnutrition, cachexia, and dehydration. The goal in dysphagia management is to provide adequate nutrition and hydration while minimizing the risk of choking and aspiration. It is important to advance the individual toward oral feeding in a timely manner to enhance the recovery of swallowing function and preserve the quality of life. Current clinical assessments of dysphagia are limited in providing adequate guidelines for oral feeding. Mathematical modeling of the fluid dynamics of pharyngeal bolus transport provides a unique opportunity for studying the physiology and pathophysiology of swallowing. Finite element analysis (FEA) is a special case of computational fluid dynamics (CFD). In CFD, the flow of a fluid in a space is modeled by covering the space with a grid and predicting how the fluid moves from grid point to grid point. FEA is capable of solving problems with complex geometries and free surfaces. A preliminary pharyngeal model has been constructed using FEA. This model incorporates literature-reported, normal, anatomical data with time-dependent pharyngeal/upper esophageal sphincter (UES) wall motion obtained from videofluorography (VFG). This time-dependent wall motion can be implemented as a moving boundary condition in the model. Clinical kinematic data can be digitized from VFG studies to construct and test the mathematical model. The preliminary model demonstrates the feasibility of modeling pharyngeal bolus transport, which, to our knowledge, has not been attempted before. This model also addresses the need and the potential for CFD in understanding the physiology and pathophysiology of the pharyngeal phase of swallowing. Improvements of the model are underway. Combining the model with individualized clinical data should potentially

  9. NAVIGATION IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    da Mota e Albuquerque, Roberto Freire

    2015-01-01

    Navigation was the most significant advance in instrumentation for total knee arthroplasty over the last decade. It provides surgeons with a precision tool for carrying out surgery, with the possibility of intraoperative simulation and objective control over various anatomical and surgical parameters and references. Since the first systems, which were basically used to control the alignment of bone cutting referenced to the mechanical axis of the lower limb, many other surgical steps have been incorporated, such as component rotation, ligament balancing and arranging the symmetry of flexion and extension spaces, among others. Its efficacy as a precision tool with an effective capacity for promoting better alignment of the lower-limb axis has been widely proven in the literature, but the real value of optimized alignment and the impact of navigation on clinical results and the longevity of arthroplasty have yet to be established. PMID:27026979

  10. Preliminaries toward studying resonant extraction from the Debuncher

    SciTech Connect

    Michelotti, Leo; Johnstone, John; /Fermilab

    2009-06-01

    A recent proposal to detect {mu} {yields} e direct conversion at Fermilab asks for slow extraction of protons from the antiproton source, specifically from the Debuncher. [1] A third-integer resonance originally was considered for this, partly because of the Debuncher's three-fold symmetry and partly because its operational horizontal tune, {nu}{sub x} {approx} 9.765, is already within 0.1 of {nu}{sub x} = 29/3. Using a half integer resonance, {nu}{sub x} = 19/2, though not part of the original proposal, has been suggested more recently because (a) Fermilab has had a good deal of experience with half-integer extraction from the Tevatron, the Main Injector and the erstwhile Main Ring, and (b) for reasons we shall examine later, it depopulates the entire bunch without an abort at the end. This memo presents considerations preliminary to studying both possibilities. It is meant only as a starting point for investigations to be carried out in the future. The working constraints and assumptions have oscillated between two extremes: (1) making minimal changes in the antiproton source to minimize cost and (2) building another machine in the same tunnel. In this memo we adopt an attitude aligned more toward the first. The assumed parameters are listed in Table 1. A few are not (easily) subject to change, such as those related to the beam's momentum and revolution frequency and the acceptance of the debuncher. Two resonance exemplars are presented in the next section, with an explanation of the analytic and semi-analytic calculations that can be done for each. Section 3 contains preliminary numerical work that was done to validate the exemplars within the context of extraction from the Debuncher. A final section contains a summary. Following the bibliography, appendices contain (a) a qualitative, conceptual discussion of extraction for the novice, (b) a telegraphic review of the perturbative incantations used to filter the exemplars as principal resonances of quadrupole

  11. Conversion of unicompartmental knee arthroplasty to total knee arthroplasty: the challenges and need for augments.

    PubMed

    Khan, Zeeshan; Nawaz, Syed Z; Kahane, Steven; Esler, Colin; Chatterji, Urjit

    2013-12-01

    The potential advantages of unicompartmental knee arthroplasty (UKA) include lower morbidity and mortality, quicker recovery, good range of motion, good medium and long-term survival results, potential bone conservation and perceived easier revision. Converting a UKA to a total knee arthroplasty (TKA) may be challenging due to issues of bone loss, need for augmentation, restoring joint line and rotation. We present the intraoperative findings of 201 cases of failed UKA's from the Trent Wales arthroplasty audit group (TWAAG) register. The objectives of the study were to determine the modes of failure, number of cases requiring augments and bone grafting, types of augments and implants used in revision surgery. This study does not include the clinical outcomes after revision knee surgery. The average age of the cohort at revision surgery was 67 years. There were 111 females and 90 males. The commonest modes of failure in young patients were unexplained pain/instability and aseptic loosening and in older patients they were aseptic loosening and progression of the disease. The survivorship of the implant was higher in the less than 55 years age group in comparison to the older patients. A total of 49 patients (25.9%) required bone grafting commonest in the 60 years and above age group (79.6%). Fifty patients (26.4%) required some form of augmentation, with the commonest site being tibia and commonest augment being tibial stem (35 cases). Only 8% of the cohort required revision knee implants whereas 78% of the cases received a cruciate retaining primary knee implant. To the author's knowledge, this is one of the largest studies in the literature which signifies the technical difficulties that might be experienced in revising the UKA's which will require appropriate pre-operative planning. PMID:24563977

  12. Humeral windows in revision total elbow arthroplasty.

    PubMed

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011

  13. Characterization of hip and knee arthroplasties and factors associated with infection☆

    PubMed Central

    da Silva Pinto, Cibele Zdebsky; Alpendre, Francine Taporosky; Stier, Christiane Johnscher Niebel; Maziero, Eliane Cristina Sanches; de Alencar, Paulo Gilberto Cimbalista; de Almeida Cruz, Elaine Drehmer

    2015-01-01

    Objective To characterize arthroplasty procedures, calculate the surgical infection rate and identify related risk factors. Methods This was a retrospective cohort study. Data on operations performed between 2010 and 2012 were gathered from documental sources and were analyzed with the aid of statistical software, using Fisher's exact test, Student's t test and the nonparametric Mann–Whitney and Wilcoxon tests. Results 421 total arthroplasty procedures performed on 346 patients were analyzed, of which 208 were on the knee and 213 on the hip. It was found that 18 patients (4.3%) were infected. Among these, 15 (83.33%) were reoperated and 2 (15.74%) died. The prevalence of infection in primary total hip arthroplasty procedures was 3%; in primary total knee arthroplasty, 6.14%; and in revision of total knee arthroplasty, 3.45%. Staphylococcus aureus was prevalent. The length of the surgical procedure showed a tendency toward being a risk factor (p = 0.067). Conclusion The prevalence of infection in cases of primary total knee arthroplasty was greater than in other cases. No statistically significant risk factors for infection were identified. PMID:27218082

  14. Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery.

    PubMed

    Courtney, P M; Melnic, C M; Gutsche, J; Hume, E L; Lee, G-C

    2015-11-01

    Older patients with multiple medical co-morbidities are increasingly being offered and undergoing total joint arthroplasty (TJA). These patients are more likely to require intensive care support, following surgery. We prospectively evaluated the need for intensive care admission and intervention in a consecutive series of 738 patients undergoing elective hip and knee arthroplasty procedures. The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk factors, correlating with the need for critical care intervention, according to published guidelines, were analysed to identify high-risk patients who would benefit from post-operative critical care monitoring. A total of 50 patients (6.7%) in our series required critical care level interventions during their hospital stay. Six independent multivariate clinical predictors were identified (p < 0.001) including a history of congestive heart failure (odds ratio (OR) 24.26, 95% confidence interval (CI) 9.51 to 61.91), estimated blood loss > 1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index > 35 kg/m(2) (OR 2.70, 95% CI 123 to 5.94). The model was then validated against an independent, previously published data set of 1594 consecutive patients. The use of this risk stratification model can be helpful in predicting which high-risk patients would benefit from a higher level of monitoring and care after elective TJA and aid hospitals in allocating precious critical care resources. PMID:26530654

  15. Archaeoastronomical Information in the Study of Cremation Necropolis: Preliminary Study

    NASA Astrophysics Data System (ADS)

    Mejuto, J.; Cerde, M. L.; Rodríguez, C.

    2009-08-01

    This work remarks the significance that archaeoastronomical studies have for archaeological research. These studies provide us data about the perception that ancient societies had about astronomical events and how these facts were added to their religious and ideological world. Thus, archaeoastronomy become a valuable source of information when aimed to solve any question involving the ancient societies. We take as reference in this work some of the Late Bronze Age{'}s cremation necropolis, representatives of usually called Urnfields, to check if their design can be related to some celestial phenomena: Can Bech de Baix (Gerona), Can Pitieu-Can Roqueta(Barcelona), Molá (Tarragona), Can Missert (Tarragona), Les Obagues (Tarragona), La Colomina (Lleida) and La Torraza (Navarra). Likewise a new standard in archaeological excavations maps is proposed. This will allow getting the information more available and improving further studies.

  16. The 2007 Otto Aufranc Award. Ceramic-on-metal hip arthroplasties: a comparative in vitro and in vivo study.

    PubMed

    Williams, Sophie; Schepers, Anton; Isaac, Graham; Hardaker, Cath; Ingham, Eileen; van der Jagt, Dick; Breckon, Anke; Fisher, John

    2007-12-01

    The performance of novel ceramic-on-metal bearing couples has been compared with metal-on-metal and ceramic-on-ceramic bearing couples in laboratory and short-term clinical studies. Laboratory studies compared ceramic-on-metal with metal-on-metal and ceramic-on-ceramic bearings with diameters of 28 and 36 mm under standard conditions and under adverse conditions with head loading on the rim of the cup. Clinical studies compared metal ion levels in ceramic-on-metal with metal-on-metal, ceramic-on-ceramic, and ceramic-on-polyethylene bearings in a randomized prospective study. In the laboratory studies, friction, wear, and ion levels were lower in ceramic-on-metal bearings compared with metal-on-metal, with results similar to ceramic-on-ceramic couples. Under adverse conditions and rim loading, all bearings showed increased wear with lower wear and absence of stripe wear in ceramic-on-metal compared with metal-on-metal bearings. Short-term studies in 31 patients at 6 months revealed lower metal ion levels (cobalt and chromium) in those with ceramic-on-metal compared with metal-on-metal bearings. PMID:18090468

  17. Preliminary Study of a Model Rotor in Descent

    NASA Technical Reports Server (NTRS)

    McAlister, K. W.; Tung, C.; Sharpe, D. L.; Huang, S.; Hendley, E. M.

    2000-01-01

    Within a program designed to develop experimental techniques for measuring the trajectory and structure of vortices trailing from the tips of rotor blades, the present preliminary study focuses on a method for quantifying the trajectory of the trailing vortex during descent flight conditions. This study also presents rotor loads and blade surface pressures for a range of tip-path plane angles and Mach numbers. Blade pressures near the leading edge and along the outer radius are compared with data obtained on the same model rotor, but in open jet facilities. A triangulation procedure based on two directable laser-light sheets, each containing an embedded reference, proved effective in defining the spatial coordinates of the trailing vortex. When interrogating a cross section of the flow that contains several trailing vortices, the greatest clarity was found to result when the flow is uniformly seeded. Surface pressure responses during blade-vortex interactions appeared equally sensitive near the leading edge and along the outer portion of the blade, but diminished rapidly as the distance along the blade chord increased. The pressure response was virtually independent of whether the tip-path plane angle was obtained through shaft tilt or cyclic pitch. Although the shape and frequency of the pressure perturbations on the advancing blade during blade-vortex interaction are similar to those obtained in open-jet facilities, the angle of the tip-path plane may need to be lower than the range covered in this study.

  18. Preliminary studies to determine the shelf life of HEPA filters

    SciTech Connect

    Gilbert, H.; Fretthold, J.K.; Rainer, F.

    1995-02-01

    We have completed a preliminary study using filter media tests and filter qualification tests to investigate the effect of shelf-life on HEPA filter performance. Our media studies showed that the tensile strength decreased with age, but the data were not sufficient to establish a shelf-life. Thermogravimetric analyses demonstrated that one manufacturer had media with low tensile strength due to insufficient binder. The filter qualification tests (heated air and overpressure) conducted on different aged filters showed that filter age is not the primary factor affecting filter performance; materials and the construction design have a greater effect. An unexpected finding of our study was that sub-standard HEPA filters have been installed in DOE facilities despite existing regulations and filter qualification tests. We found that the filter with low tensile strength failed the overpressure test. The same filter had passed the heated air test, but left the filter so structurally weak, it was prone to blow-out. We recommend that DOE initiate a filter qualification program to prevent this occurrence.

  19. Preliminary Trade Study of Phase Change Heat Sinks

    NASA Technical Reports Server (NTRS)

    Anderson, Molly; Leimkeuhler, Thomas; Quinn, Gregory; Golliher, Eric

    2006-01-01

    For short durations, phase change based heat rejection systems are a very effective way of removing heat from spacecraft. Future NASA vehicles, such as the Crew Exploration Vehicle (CEV), will require non-radiative heat rejection systems during at least a portion of the planned mission, just as their predecessors have. While existing technologies are available to modify, such as Apollo era sublimators, or the Space Shuttle Flash Evaporator System (FES), several new technologies are under development or investigation to progress beyond these existing heat rejection systems. Examples include the Multi-Fluid Evaporator developed by Hamilton Sundstrand, improvements upon the Contaminant Insensitive Sublimator originally developed for the X-38 program, and a Compact Flash Evaporator System (CFES). Other possibilities evaluate new ways of operating existing designs. The new developments are targeted at increasing operating life, expanding the environments in which the system can operate, improving the mass and volume characteristics, or some combination of these or other improvements. This paper captures the process and results of a preliminary trade study performed at Johnson Space Center to compare the various existing and proposed phase change based heat rejection systems for the CEV. Because the new systems are still in development, and the information on existing systems is extrapolation, this trade study is not meant to suggest a final decision for future vehicles. The results of this early trade study are targeted to aid the development efforts for the new technologies by identifying issues that could reduce the chances of selection for the CEV.

  20. Experience from the Argentine Pegvisomant Observational Study: preliminary data.

    PubMed

    García Basavilbaso, N; Guitelman, M; Nagelberg, A; Stalldecker, G; Carabelli, A; Bruno, O; Danilowitz, K; Manavela, M; Mallea Gil, S; Ballarino, C; Guelman, R; Katz, D; Fidalgo, S; Leal, R; Fideleff, H; Servidio, M; Bruera, D; Librandi, F; Chervin, A; Vitale, M; Basso, A

    2010-01-01

    The GH receptor antagonist pegvisomant is an efficient agent to achieve biochemical control of acromegaly in those cases refractory to surgery and medical therapy with somatostatin analogs. We conducted an observational multicenter study consisting of data collection in accordance with the standard management of patients with acromegaly in everyday practice. We reviewed the medical records of 28 patients, 23 females, who were treated with pegvisomant due to the lack of biochemical response or intolerance to the somatostatin analogs. The objective was to monitor long-term safety and efficacy of the antagonist. 82% of the patients had previous pituitary surgery, 53.6% radiotherapy and 96.4% received medical therapy for acromegaly. Only 19.2% of the patients had pituitary residual tumor size larger than 1 cm, the remainder harbored a microadenoma or no visible tumor in the pituitary images. In terms of biochemical efficacy, IGF-I levels decreased to normal ranges in 45% and 58.8% of patients after 3 and 6 months of treatment, respectively, the daily mean dose of pegvisomant being 9.6+/-1.1 mg. Adverse events, potentially related to pegvisomant were reported in 6 patients (21.4%), local injection site reaction and elevated liver enzymes being the most frequent. Tumor size did not show enlargement in the evaluated population (15 patients) during the period of the study. This paper presents preliminary data from a small observational study in Argentina which represents the first database in our country. PMID:20616494

  1. Preliminary studies to determine the shelf life of HEPA filters

    SciTech Connect

    Gilbert, H.; Fretthold, J.K.; Rainer, F.; Bergman, W.; Beason, D.

    1994-07-18

    We have completed a preliminary study using filter media tests and filter qualification tests to investigate the effect of shelf-life on HEPA filter performance. Our media studies showed that the tensile strength decreased with age, but the data were not sufficient to establish a shelf-life. Thermogravimetric analyses demonstrated that one manufacturer had media with low tensile strength due to insufficient binder. The filter qualification tests (heated air and overpressure) conducted on different aged filters showed that filter age is not the primary factor affecting filter performance; materials and the construction design have a greater effect. An unexpected finding of our study was that sub-standard HEPA filters have been installed in DOE facilities despite existing regulations and filter qualification tests. We found that the filter with low tensile strength failed the overpressure test. The same filter had passed the heated air test, but left the filter so structurally weak, it was prone to blowout. We recommend that DOE initiate a filter qualification program to prevent this occurrence.

  2. Titan Lake Probe: The Ongoing NASA Decadal Study Preliminary Report

    NASA Astrophysics Data System (ADS)

    Waite, J. Hunter; Brockwell, Tim; Elliot, John; Reh, Kim; Spencer, John; Outer Planets Satellites Decadal Subpanel, The

    2010-05-01

    This talk provides an update on the scientific requirements and preliminary design of a Titan Lake Probe for a future NASA Flagship mission. The starting point for this study is the joint NASA ESA TSSM mission. Using this as a starting point we have revisited the scientific requirements and expanded them to include the possibility of a lake floater and a submersible. The preliminary results of this ongoing study will be presented. The scientific objectives of a Titan Lake Probe mission are: 1) to understand the formation and evolution of Titan and its atmosphere through measurement of the composition of the target lake (e.g., Kraken Mare), with particular emphasis on the isotopic composition of dissolved minor species and on dissolved noble gases, 2) to study the lake-atmosphere interaction in order to determine the role of Titan's lakes in the methane cycle, 3) to investigate the target lake as a laboratory for both pre-biotic organic chemistry in both water (or ammonia-enriched water) solutions and non-water solvents, and 4) to determine if Titan has an interior ocean by measuring tidal changes in the level of the lake over the course of Titan's sixteen-day orbit. The driving requirements for the mission are: 1) the need to land on and explore the lake at depth while adequately communicating the data back to Earth via either direct to Earth or relay communications, 2) thermal design that allows sustained (>32 days) sampling of the 94K lake environment, and 3) a mass spectrometer inlet system that allows sampling of gas, liquid, and solids from the 94K environment. The primary payload is an analytical chemistry laboratory that includes an inlet system for sampling gas, liquid, and solids in and above the lake feeding two capable mass spectrometers that determine the organic and isotopic composition of the sampled materials. The instrumentation also includes a meteorological package that can measure the rate of gas exchange between the lake and the atmosphere, and

  3. In vivo determination of total knee arthroplasty kinematics

    SciTech Connect

    Komistek, Richard D; Mahfouz, Mohamed R; Bertin, Kim; Rosenberg, Aaron; Kennedy, William

    2008-01-01

    The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee. In addition, a surprising finding was that, on average, subjects without a PCL still achieved posterior femoral rollback from full extension to maximum knee flexion. The findings in this study revealed that implant design did contribute to the normal kinematics demonstrated by subjects having this asymmetrical PCR total knee arthroplasty.

  4. A Preliminary Study of a Solar-Probe Mission

    NASA Technical Reports Server (NTRS)

    Dugan, Duane W.

    1961-01-01

    A preliminary study is made of some problems associated with the sending of an instrumented probe close to the Sun for the purpose of gathering and telemetering back to Earth information concerning solar phenomena and circumsolar space. The problems considered are primarily those relating to heating and to launch requirements. A nonanalytic discussion of the communications problem of a solar-probe mission is presented to obtain order-of-magnitude estimates of the output and weight of an auxiliary power supply which might be required. From the study it is believed that approaches to the Sun as close as about 4 or 5 million miles do not present insuperable difficulties insofar as heating and communications are concerned. Guidance requirements, in general, do not appear to be stringent. However, in terms of current experience, velocity requirements may be large. It is found, for example, that to achieve perihelion distances between the orbit of Mercury and the visible disc of the Sun, total burnout velocities ranging between 50,000 and 100,000 feet per second are required.

  5. Preliminary design studies on the Broad Application Test Reactor

    SciTech Connect

    Terry, W.J.; Terry, W.K.; Ryskamp, J.M.; Jahshan, S.N.; Fletcher, C.D.; Moore, R.L.; Leyse, C.F.; Ottewitte, E.H.; Motloch, C.G.; Lacy, J.M.

    1992-08-01

    This report describes progress made at the Idaho National Engineering Laboratory during the first three quarters of Fiscal Year (FY) 1992 on the Laboratory-Directed Research and Development (LDRD) project to perform preliminary design studies on the Broad Application Test Reactor (BATR). This work builds on the FY-92 BATR studies, which identified anticipated mission and safety requirements for BATR and assessed a variety of reactor concepts for their potential capability to meet those requirements. The main accomplishment of the FY-92 BATR program is the development of baseline reactor configurations for the two conventional conceptual test reactors recommended in the FY-91 report. Much of the present report consists of descriptions and neutronics and thermohydraulics analyses of these baseline configurations. In addition, we considered reactor safety issues, compared the consequences of steam explosions for alternative conventional fuel types, explored a Molten Chloride Fast Reactor concept as an alternate BATR design, and examined strategies for the reduction of operating costs. Work planned for the last quarter of FY-92 is discussed, and recommendations for future work are also presented.

  6. Physico-Chemical profile of Puga Khanda: A Preliminary Study

    PubMed Central

    Baragi, Pramod C.; Baragi, Umapati C.; Bhat, Sathyanarayana; Prajapati, Pradeep Kumar

    2014-01-01

    Background: Herbal medicines are the oldest known form of medicine in the world. However, the quality control and the assurance still remains a challenge because of the high variability of chemical components. Herbal drugs, singlely or in combinations, contain numerous compounds in complex matrices in which no single active constituent is responsible for the overall efficacy. This creates a challenge in establishing quality control standards and the standardization of finished herbal products. Many formulations have been mentioned in Ayurvedic text for Vrushyatwa (aphrodisiac). Puga Khanda is one among such formulations. Aim: To develop preliminary physico-chemical profile of Puga Khanda. Materials and Methods: Puga Khanda was prepared in three batches as per the classical reference mentioned in Bhaishajya Ratnavali. The formulation was subjected for physico-chemical analysis, phytochemical analysis and Thin Layer Chromatography (TLC). Results and Conclusion: The study revealed that organoleptic characters, pH and extractive values of all 3 samples were almost equal. All the samples had 60% of sugar needed for preservation and 2/3rd of it was non reducing sugar. The total alkaloids ranged from 0.002 to 0.004% w/w. In TLC study the entire samples showed similar pattern except the 2nd sample of Puga Khanda. PMID:25364209

  7. Energy efficient engine preliminary design and integration study

    NASA Technical Reports Server (NTRS)

    Gray, D. E.

    1978-01-01

    The technology and configurational requirements of an all new 1990's energy efficient turbofan engine having a twin spool arrangement with a directly coupled fan and low-pressure turbine, a mixed exhaust nacelle, and a high 38.6:1 overall pressure ratio were studied. Major advanced technology design features required to provide the overall benefits were a high pressure ratio compression system, a thermally actuated advanced clearance control system, lightweight shroudless fan blades, a low maintenance cost one-stage high pressure turbine, a short efficient mixer and structurally integrated engine and nacelle. A conceptual design analysis was followed by integration and performance analyses of geared and direct-drive fan engines with separate or mixed exhaust nacelles to refine previously designed engine cycles. Preliminary design and more detailed engine-aircraft integration analysis were then conducted on the more promising configurations. Engine and aircraft sizing, fuel burned, and airframe noise studies on projected 1990's domestic and international aircraft produced sufficient definition of configurational and advanced technology requirements to allow immediate initiation of component technology development.

  8. Intraarterial Ultrasound in Pancreatic Cancer: Feasibility Study and Preliminary Results

    SciTech Connect

    Larena-Avellaneda, Axel; Timm, Stephan; Kickuth, Ralph; Kenn, Werner; Steger, Ulrich; Jurowich, Christian; Germer, Christoph-Thomas

    2010-08-15

    Despite technological advances in computed tomography (CT) and magnetic resonance imaging, the involvement of the celiac or mesenteric artery in pancreatic cancer remains uncertain in many cases. Infiltration of these vessels is important in making decisions about therapy choices but often can only be definitively determined through laparotomy. Local (intraarterial) ultrasound may increase diagnostic accuracy. Using the Volcano intravascular ultrasound (IVUS) system, we applied a transfemoral method to scan the celiac and mesenteric arteries directly intraarterial. This technique was used in five patients with suspected pancreatic cancer. Technical success was achieved in all cases. In one case, a short dissection of the mesenteric artery occurred but could be managed interventionally. In tumors that did not contact with the vessels, IVUS was unable to display the tissue pathology. Our main interest was the infiltration of the arteries. In one case, infiltration was certain in the CT scan but uncertain in two patients. In the latter two cases, IVUS correctly predicted infiltration in one and freedom from tumor in the other case. In our preliminary study, IVUS correctly predicted arterial infiltration in all cases. IVUS did not provide new information when the tumor was far away from the vessel. Compared with IVUS in the portal vein, the information about the artery is more detailed, and the vessel approach is easier. These results encouraged us to design a prospective study to evaluate the sensitivity and specificity of this method.

  9. Gasoline on hands: preliminary study on collection and persistence.

    PubMed

    Darrer, Melinda; Jacquemet-Papilloud, Joëlle; Delémont, Olivier

    2008-03-01

    The identification of an arsonist remains one of the most difficult challenges a fire investigation has to face. Seeking and detection of traces of gasoline could provide a valuable information to link a suspect with an arson scene where gasoline was used to set-up the fire. In this perspective, a first study was undertaken to evaluate a simple, fast and efficient method for collecting gasoline from hands, and to assess its persistence over time. Four collection means were tested: PVC, PE and Latex gloves, as well as humidified filter paper. A statistical assessment of the results indicates that Latex and PVC gloves worn for about 20 min, as well as paper filter rubbed on hands, allow an efficient collection of gasoline applied to hands. Due to ease of manipulation and to a reduced amount of volatile compounds detected from the matrix, PVC gloves were selected for the second set of experiments. The evaluation of the persistence of gasoline on hands was then carried out using two initial quantities (500 and 1000 microl). Collection was made with PVC gloves after 0, 30 min, 1, 2 and 4h, on different volunteers. The results show a common tendency of massive evaporation of gasoline during the first 30 min: a continued but non-linear decrease was observed along different time intervals. The results of this preliminary study are in agreement with other previous researches conducted on the detection of flammable liquid residues on clothes, shoes and skin. PMID:17714900

  10. A preliminary study of Mars rover/sample return missions

    NASA Technical Reports Server (NTRS)

    1987-01-01

    The Solar System Exploration Committee (SSEC) of the NASA Advisory Council recommends that a Mars Sample Return mission be undertaken before the year 2000. Comprehensive studies of a Mars Sample Return mission have been ongoing since 1984. The initial focus of these studies was an integrated mission concept with the surface rover and sample return vehicle elements delivered to Mars on a single launch and landed together. This approach, to be carried out as a unilateral U.S. initiative, is still a high priority goal in an Augmented Program of exploration, as the SSEC recommendation clearly states. With this background of a well-understood mission concept, NASA decided to focus its 1986 study effort on a potential opportunity not previously examined; namely, a Mars Rover/Sample Return (MRSR) mission which would involve a significant aspect of international cooperation. As envisioned, responsibility for the various mission operations and hardware elements would be divided in a logical manner with clearly defined and acceptable interfaces. The U.S. and its international partner would carry out separately launched but coordinated missions with the overall goal of accomplishing in situ science and returning several kilograms of surface samples from Mars. Important considerations for implementation of such a plan are minimum technology transfer, maximum sharing of scientific results, and independent credibility of each mission role. Under the guidance and oversight of a Mars Exploration Strategy Advisory Group organized by NASA, a study team was formed in the fall of 1986 to develop a preliminary definition of a flight-separable, cooperative mission. The selected concept assumes that the U.S. would undertake the rover mission with its sample collection operations and our international partner would return the samples to Earth. Although the inverse of these roles is also possible, this study report focuses on the rover functions of MRSR because rover operations have not

  11. In vivo comparative wear study of traditional and highly cross-linked polyethylene in total hip arthroplasty.

    PubMed

    Manning, David W; Chiang, P P; Martell, J M; Galante, J O; Harris, W H

    2005-10-01

    In this study, we compare the in vivo wear performance of electron beam-irradiated, postirradiation-melted, highly cross-linked polyethylene (HXLPE) and traditional UHMWPE via the Martell method. Seventy hips with HXLPE performed at the Massachusetts General Hospital had 138 radiograph pairs for wear analysis and a 31.2-month average follow-up (range, 24-44 months). An age-matched, sex-matched, and body mass index-matched subgroup of 111 hips with 214 acceptable radiograph pairs and a 4-year follow-up from our previously published study on traditional polyethylene performed at Rush-Presbyterian-St. Luke's Medical Center served as a control group. Martell wear analysis was performed for each group. Overall and steady-state wear rates were compared via a specialized t test. The steady-state wear in the HXLPE arm was observed after 2.0 years, was 0.007 mm/y, and was significantly less than the steady-state wear in the traditional arm (0.174 mm/y) (P = .003). Highly cross-linked polyethylene penetration rate was not affected by sex, age, activity, or body mass index by Mann-Whitney analysis. PMID:16230239

  12. Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study

    PubMed Central

    Jianda, Xu; Yuxing, Qu; Yi, Gao; Hong, Zhao; Libo, Peng; Jianning, Zhao

    2016-01-01

    The aim of this study was to investigate the effects of preemptive analgesia on the inflammatory response and rehabilitation in TKA. 75 patients with unilateral primary knee osteoarthritis were conducted in this prospective study. All patients were randomly divided into two groups (MMA with/without preemptive analgesia group). The following parameters were used to evaluate analgesic efficacy: knee flexion, pain at rest and walking, functional walking capacity (2 MWT and 6 MWT), WOMAC score, and hs-CRP level. Patients in MMA with preemptive analgesia group had lower hs-CRP level and less pain at rest and walking during the first week postoperatively (P < 0.05). The 2 MWT was significantly better in MMA with preemptive analgesia group (17.13 ± 3.82 VS 14.19 ± 3.56, P = 0.001). The 6 MWT scores and WOMAC scores increased significantly within Groups (P = 0.020, 0.000), but no difference between groups postoperatively (P > 0.05). Less cumulative consumption of morphine was found in MMA with preemptive analgesia group at 48 h (P = 0.017, 0.023), but no difference at total requirement (P = 0.113). Preemptive analgesia added to a multimodal analgesic regime improved analgesia, reduced inflammatory reaction and accelerated functional recovery at the first week postoperatively, but not improved long-term function. PMID:27578313

  13. Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study.

    PubMed

    Jianda, Xu; Yuxing, Qu; Yi, Gao; Hong, Zhao; Libo, Peng; Jianning, Zhao

    2016-01-01

    The aim of this study was to investigate the effects of preemptive analgesia on the inflammatory response and rehabilitation in TKA. 75 patients with unilateral primary knee osteoarthritis were conducted in this prospective study. All patients were randomly divided into two groups (MMA with/without preemptive analgesia group). The following parameters were used to evaluate analgesic efficacy: knee flexion, pain at rest and walking, functional walking capacity (2 MWT and 6 MWT), WOMAC score, and hs-CRP level. Patients in MMA with preemptive analgesia group had lower hs-CRP level and less pain at rest and walking during the first week postoperatively (P < 0.05). The 2 MWT was significantly better in MMA with preemptive analgesia group (17.13 ± 3.82 VS 14.19 ± 3.56, P = 0.001). The 6 MWT scores and WOMAC scores increased significantly within Groups (P = 0.020, 0.000), but no difference between groups postoperatively (P > 0.05). Less cumulative consumption of morphine was found in MMA with preemptive analgesia group at 48 h (P = 0.017, 0.023), but no difference at total requirement (P = 0.113). Preemptive analgesia added to a multimodal analgesic regime improved analgesia, reduced inflammatory reaction and accelerated functional recovery at the first week postoperatively, but not improved long-term function. PMID:27578313

  14. Direct anterior total hip arthroplasty: Comparative outcomes and contemporary results

    PubMed Central

    Connolly, Keith P; Kamath, Atul F

    2016-01-01

    Direct anterior total hip arthroplasty has become increasingly more popular among arthroplasty surgeons, in large part due to the use of an intramuscular interval and desire to reduce soft tissue damage. Several studies have now been published comparing the anterior intramuscular to other commonly used approaches, and many studies have published complication rates on large series of patients. Review of comparative studies indicates direct anterior hips tend towards shorter hospital stays and high rates of patients discharged to home. Although some studies show evidence of early benefit in functional outcomes, there is no strong evidence that the anterior approach provides any long term functional improvements compared to other approaches. Additionally, evidence to support reduced damage to soft tissue may not translate to certain clinical significance. Rates of intra-operative femur fracture, operative time and blood loss rates are notably higher for those developing familiarity with this approach. However, when surgeons have performed a modest number of procedures, the complication rates tend to markedly decrease in most studies to levels comparable to other approaches. Accuracy of component positioning also favors the anterior approach in some studies. This review summarizes the available literature comparing the direct anterior to other approaches for total hip arthroplasty and provides a comprehensive summary of common complications. PMID:26925380

  15. Reliability of a simple fluoroscopic method to study sagittal plane femorotibial contact changes in total knee arthroplasties during flexion.

    PubMed

    Lacoste, C; Granizo, J J; Gómez-Barrena, E

    2007-08-01

    Clinical interest in sagittal plane kinematic analysis of the knee undergoing total knee replacement fosters the development of simple, reliable methods to estimate femorotibial contact in a regular clinical setting. In this study, the sagittal femorotibial contact was analysed in lateral X-rays and lateral fluoroscopic views, from extension to knee flexion. Quantitative and categorical data were obtained from these views by two different observers, and compared with data from direct views of the components. Interobserver and intermethod errors for quantitative and categorical data were evaluated based on correlation, kappa coefficient, and Bland-Altman graphs. Interobserver reproducibility of quantitative measurement from fluoroscopic views was r=0.96 while categorical assignment exhibited a kappa coefficient of 0.95. Reproducibility from plain radiographs was not so high, with a kappa coefficient of 0.64. High concordance was also obtained when the method was compared with the direct view of the implant, supporting these measurement techniques. Bland-Altman graphs confirmed the absence of bias in the intermethod comparison. Therefore, with the obvious limitation of rotational assessment, lateral fluoroscopic evaluation enhanced by a simple fitting technique can be used as a valuable tool for clinical evaluation of knee kinematics in the sagittal plane. PMID:17553683

  16. Environmental Stability and Residual Stresses in Zirconia Femoral Head for Total Hip Arthroplasty: In Vitro Aging versus Retrieval Studies

    PubMed Central

    Arita, Masanori; Takahashi, Yasuhito; Pezzotti, Giuseppe; Shishido, Takaaki; Masaoka, Toshinori; Sano, Keiji; Yamamoto, Kengo

    2015-01-01

    The objective of this study was to compare the low temperature degradation (LTD) behavior of femoral heads made of 3Y-TZP as observed on retrievals with that induced in vitro upon prolonged exposures to a hydrothermal environment. The time-dependent evolution of tetragonal-to-monoclinic transformation and the related residual stresses were nondestructively monitored by Raman microspectroscopy. An increasing intensification of tensile and compressive stresses was detected with increasing hydrothermal aging duration in tetragonal and monoclinic phases, respectively. The dependence of monoclinic fraction upon exposure time was rationalized through the Mehl-Avrami-Johnson (MAJ) formalism in order to interpret the LTD process according to a two-step mechanism of formation and growth of monoclinic nuclei. In vitro results were compared to in vivo monoclinic contents in the same type of 3Y-TZP head retrievals after implantation periods of 1.6–16.6 y, also including literature data previously reported by other authors. One-hour exposure under the selected aging condition is estimated to correspond to in vivo exposures of 4 and 2 years according to ISO and ASTM criteria, respectively. A critical review of these two criteria according to the present analyses revealed that the ASTM simulation predicts more closely the in vivo results as compared to the ISO one. PMID:26146624

  17. Environmental Stability and Residual Stresses in Zirconia Femoral Head for Total Hip Arthroplasty: In Vitro Aging versus Retrieval Studies.

    PubMed

    Arita, Masanori; Takahashi, Yasuhito; Pezzotti, Giuseppe; Shishido, Takaaki; Masaoka, Toshinori; Sano, Keiji; Yamamoto, Kengo

    2015-01-01

    The objective of this study was to compare the low temperature degradation (LTD) behavior of femoral heads made of 3Y-TZP as observed on retrievals with that induced in vitro upon prolonged exposures to a hydrothermal environment. The time-dependent evolution of tetragonal-to-monoclinic transformation and the related residual stresses were nondestructively monitored by Raman microspectroscopy. An increasing intensification of tensile and compressive stresses was detected with increasing hydrothermal aging duration in tetragonal and monoclinic phases, respectively. The dependence of monoclinic fraction upon exposure time was rationalized through the Mehl-Avrami-Johnson (MAJ) formalism in order to interpret the LTD process according to a two-step mechanism of formation and growth of monoclinic nuclei. In vitro results were compared to in vivo monoclinic contents in the same type of 3Y-TZP head retrievals after implantation periods of 1.6-16.6 y, also including literature data previously reported by other authors. One-hour exposure under the selected aging condition is estimated to correspond to in vivo exposures of 4 and 2 years according to ISO and ASTM criteria, respectively. A critical review of these two criteria according to the present analyses revealed that the ASTM simulation predicts more closely the in vivo results as compared to the ISO one. PMID:26146624

  18. Anatomic Versus Mechanically Aligned Total Knee Arthroplasty for Unicompartmental Knee Arthroplasty Revision

    PubMed Central

    Toliopoulos, Panagiota; LeBlanc, Marc-Andre; Hutt, Jonathan; Lavigne, Martin; Desmeules, Francois; Vendittoli, Pascal-Andre

    2016-01-01

    Objectives: The purpose of this study was to compare the intra-operative benefits and the clinical outcomes from kinematic or mechanical alignment for total knee arthroplasty (TKA) in patients undergoing revision of failed unicompartmental kneel arthroplasty (UKA) to TKA. Methods: Ten revisions were performed with a kinematic alignment technique and 11 with a mechanical alignment. Measurements of the hip-knee-ankle angle (HKA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) were performed using long-leg radiographs. The need for augments, stems, and constrained inserts was compared between groups. Clinical outcomes were compared using the WOMAC score along with maximum distance walked as well as knee range of motion obtained prior to discharge. All data was obtained by a retrospective review of patient files. Results: The kinematic group required less augments, stems, and constrained inserts than the mechanical group and thinner polyethylene bearings. There were significant differences in the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) between the two groups (p<0.05). The mean WOMAC score obtained at discharge was better in the kinematic group as was mean knee flexion. At last follow up of 34 months for the kinematic group and 58 months for the mechanical group, no orthopedic complications or reoperations were recorded. Conclusion: Although this study has a small patient cohort, our results suggest that kinematic alignment for TKA after UKA revision is an attractive method. Further studies are warranted. PMID:27563365

  19. Total hip arthroplasty after rotational acetabular osteotomy.

    PubMed

    Ito, Hideya; Takatori, Yoshio; Moro, Toru; Oshima, Hirofumi; Oka, Hiroyuki; Tanaka, Sakae

    2015-03-01

    In this study, we aimed to determine whether the outcomes of total hip arthroplasty (THA) after rotational acetabular osteotomy (RAO) are equal to those of primary THA, and to elucidate the characteristics of THA after RAO. The clinical and radiographic findings of THA after RAO (44 hips), with minimum 24 months of follow-up, were compared with a matched control group of 58 hips without prior RAO. We found that the outcomes in terms of functional scores and complication rates did not differ between THA after RAO and THA without previous pelvic osteotomy, indicating that the results of THA after RAO are equivalent to those of primary THA. Although THA after RAO requires technical considerations, similar clinical outcomes to primary THA can be expected. PMID:25456635

  20. Relationship between electrohysterogram and internal uterine pressure: a preliminary study.

    PubMed

    Rabotti, C; Mischi, M; van Laar, J O E H; Aelen, P; Oei, S G; Bergmans, J W M

    2006-01-01

    Electrohysterography (EHG) is a promising technique for monitoring the uterine activity, based on electrical recordings on the abdominal surface. However, a quantitative estimation of the internal uterine pressure (IUP) by means of EHG is not available for clinical practice. In this paper we present a preliminary study on the estimation of the mechanical uterine activity from abdominal EHG measurements. For the EHG analysis we use two different Time Frequency Distributions (TFD): the spectrogram and the Wigner-Ville Distribution. We assume the EHG to be the sum of frequency modulated signals. Based on this assumption, the IUP is estimated from the unnormalized first moment of the TFD. Eventually, a third order polynomial model is applied to the estimated IUP in order to improve the estimate accuracy. A recent method for detection of uterine contraction by EHG is employed for comparison of the performance. The algorithms were tested on two patient recordings. The results were compared with a reference IUP which is simultaneously measured by an intrauterine catheter. The IUP estimated by our method showed a correlation coefficient with the reference IUP (R=0.93) higher than that achieved by the comparison method (R=0.85). Therefore the proposed method may be considered as a promising clinical technique for accurate non invasive IUP measurements. PMID:17946058

  1. ECG response of koalas to tourists proximity: a preliminary study.

    PubMed

    Ropert-Coudert, Yan; Brooks, Lisa; Yamamoto, Maki; Kato, Akiko

    2009-01-01

    Koalas operate on a tight energy budget and, thus, may not always display behavioral avoidance reaction when placed in a stressful condition. We investigated the physiological response of captive koalas Phascolarctos cinereus in a conservation centre to the presence of tourists walking through their habitat. We compared, using animal-attached data-recorders, the electrocardiogram activity of female koalas in contact with tourists and in a human-free area. One of the koalas in the tourist zone presented elevated heart rate values and variability throughout the recording period. The remaining female in the exhibit area showed a higher field resting heart rates during the daytime than that in the isolated area. In the evening, heart rate profiles changed drastically and both the koalas in the exhibit and in the tourist-free zones displayed similar field resting heart rates, which were lower than those during the day. In parallel, the autonomic nervous systems of these two individuals evolved from sympathetic-dominant during the day to parasympathetic-dominant in the evening. Our results report ECG of free-living koalas for the first time. Although they are preliminary due to the difficulty of having sufficient samples of animals of the same sex and age, our results stress out the importance of studies investigating the physiological reaction of animals to tourists. PMID:19823679

  2. Preliminary design studies on a nuclear seawater desalination system

    SciTech Connect

    Wibisono, A. F.; Jung, Y. H.; Choi, J.; Kim, H. S.; Lee, J. I.; Jeong, Y. H.; No, H. C.

    2012-07-01

    Seawater desalination is one of the most promising technologies to provide fresh water especially in the arid region. The most used technology in seawater desalination are thermal desalination (MSF and MED) and membrane desalination (RO). Some developments have been done in the area of coupling the desalination plant with a nuclear reactor to reduce the cost of energy required in thermal desalination. The coupling a nuclear reactor to a desalination plant can be done either by using the co-generation or by using dedicated heat from a nuclear system. The comparison of the co-generation nuclear reactor with desalination plant, dedicated nuclear heat system, and fossil fueled system will be discussed in this paper using economical assessment with IAEA DEEP software. A newly designed nuclear system dedicated for the seawater desalination will also be suggested by KAIST (Korea Advanced Inst. of Science and Technology) research team and described in detail within this paper. The suggested reactor system is using gas cooled type reactor and in this preliminary study the scope of design will be limited to comparison of two cases in different operating temperature ranges. (authors)

  3. Textual appropriation in engineering master's theses: a preliminary study.

    PubMed

    Eckel, Edward J

    2011-09-01

    In the thesis literature review, an engineering graduate student is expected to place original research in the context of previous work by other researchers. However, for some students, particularly those for whom English is a second language, the literature review may be a mixture of original writing and verbatim source text appropriated without quotations. Such problematic use of source material leaves students vulnerable to an accusation of plagiarism, which carries severe consequences. Is such textual appropriation common in engineering master's writing? Furthermore, what, if anything, can be concluded when two texts have been found to have textual material in common? Do existing definitions of plagiarism provide a sufficient framework for determining if an instance of copying is transgressive or not? In a preliminary attempt to answer these questions, text strings from a random sample of 100 engineering master's theses from the ProQuest Dissertations and Theses database were searched for appropriated verbatim source text using the Google search engine. The results suggest that textual borrowing may indeed be a common feature of the master's engineering literature review, raising questions about the ability of graduate students to synthesize the literature. The study also illustrates the difficulties of making a determination of plagiarism based on simple textual similarity. A context-specific approach is recommended when dealing with any instance of apparent copying. PMID:20521174

  4. A Preliminary Study of Sex Differences in Emotional Experience.

    PubMed

    Reyes-Aguilar, Azalea; Barrios, Fernando A

    2016-04-01

    Evolutionary approaches have proposed that women possess an advantage over men in emotional functioning to promote attachment for child-rearing. Likewise, sex differences have been reported in traits such as personality and empathy, traits that likely modulate emotional processing. In this preliminary study, sex differences in emotional processing were analyzed, including empathy as a social emotion and personality traits, as well as whether there exist relationships between those measures. Young volunteers (N = 105) indicated the emotional valence, activation, and dominance that they experience in situations categorized as emotionally positive, negative, or neutral. The results of comparison between sexes supported the approach that women showed more sensitivity to high activation and dominance for positive emotions and empathy, and men were more sensitive to negative situations. Correlation analysis showed only one positive relationship between scores of Self-transcendence, a subscale of Temperament and Character Inventory, with activation scores of neutral situations, but not with emotionally charged situations, perhaps because emotions are context-dependent processes while personality traits are considered context-independent descriptions of habits. These findings should be replicated to enrich knowledge about problems in emotional processing. PMID:27154367

  5. The treatment of nonstreptococcal pharyngitis with erythromycin: a preliminary study.

    PubMed

    Marlow, R A; Torrez, A J; Haxby, D

    1989-01-01

    This preliminary study evaluated the effectiveness of enteric-coated erythromycin in the treatment of adults with nonstreptococcal pharyngitis. Twenty-six patients, aged 12 or older, with nonstreptococcal pharyngitis were randomly assigned in a double-blind fashion to receive either enteric-coated erythromycin or placebo for 10 days. Each day the patients rated the soreness of their throats and how sick they felt. The use of erythromycin appeared to decrease the median number of days for the feeling of sickness to improve (two days versus four days, P less than .01) as well as to decrease the median number of days for the feeling of sickness to resolve (three-and-a-half days versus five days, P less than .05). This apparent improvement in sickness occurred even though there was no significant decrease in the soreness of the throat in patients treated with erythromycin compared to those patients treated with placebo. Treatment with enteric-coated erythromycin appeared to shorten the time until improvement in this group of adults with nonstreptococcal pharyngitis. PMID:2612797

  6. Preliminary study of a scale measuring depression and somatic symptoms.

    PubMed

    Hung, Ching-I; Weng, Li-Jen; Su, Yi-Jen; Liu, Chia-Yih

    2006-10-01

    This description concerns the development of a scale measuring depression and somatic symptoms and the selection of its items for a Taiwanese sample. 102 Taiwanese outpatients (28 men, 74 women) with major depressive disorder completed a 44-item preliminary scale. All had experienced a major depressive episode but had not been treated by antidepressants within the prior two weeks. The Hamilton Depression Rating Scale was administered to evaluate the validity of the Depression and Somatic Symptoms Scale (DSSS). Items, 12 for the Depression Subscale and 10 for the Somatic Subscale, were selected for the Depression and Somatic Symptoms Scale according to their frequency and their association with rated severity of depression and clinical practices. The mean Hamilton Depression score was 23.9 (SD = 5.2) versus 38.4 (SD = 11.3) for the total DSSS; means for the Depression subscale were 23.5 +/- 6.0 and the Somatic subscale 14.9 +/- 6.8. Cronbach alpha was .88 for the total DSSS, .78 for the Depression subscale, and .86 for the Somatic subscale. The Pearson correlation coefficient for the two scales was .59 (p <.01). The new scale had adequate internal consistency reliability and convergent validity. Much study is required to assess its structure, item characteristics, and in judging its applicability and limitations, and sensitivity to cultural differences in clinical settings. PMID:17153806

  7. A Preliminary Study of Functional Connectivity in Comorbid Adolescent Depression

    PubMed Central

    Cullen, Kathryn R.; Gee, Dylan G.; Klimes-Dougan, Bonnie; Gabbay, Vilma; Hulvershorn, Leslie; Mueller, Bryon A.; Camchong, Jazmin; Bell, Christopher J.; Houri, Alaa; Kumra, Sanjiv; Lim, Kelvin O.; Castellanos, F. Xavier; Milham, Michael P.

    2009-01-01

    Major Depressive Disorder (MDD) begins frequently in adolescence and is associated with severe outcomes, but the developmental neurobiology of MDD is not well understood. Research in adults has implicated fronto-limbic neural networks in the pathophysiology of MDD, particularly in relation to the subgenual anterior cingulate cortex (ACC). Developmental changes in brain networks during adolescence highlight the need to examine MDD-related circuitry in teens separately from adults. Using resting state functional magnetic resonance imaging (fMRI), this study examined functional connectivity in adolescents with MDD (n=12) and healthy adolescents (n=14). Seed-based connectivity analysis revealed that adolescents with MDD have decreased functional connectivity in a subgenual ACC-based neural network that includes the supragenual ACC (BA 32), the right medial frontal cortex (BA 10), the left inferior (BA 47) and superior frontal cortex (BA 22), superior temporal gyrus (BA 22), and the insular cortex (BA 13). These preliminary data suggest that MDD in adolescence is associated with abnormal connectivity within neural circuits that mediate emotion processing. Future research in larger, un-medicated samples will be necessary to confirm this finding. We conclude that hypothesis-driven, seed-based analyses of resting state fMRI data hold promise for advancing our current understanding of abnormal development of neural circuitry in adolescents with MDD. PMID:19446602

  8. Predicting use of hearing protection: a preliminary study.

    PubMed

    Lusk, S L; Kelemen, M J

    1993-09-01

    The National Institute of Occupational Safety and Health targeted noise-induced hearing loss as one of the top 10 occupational hazards. Research has been directed toward reducing noise exposure rather than identifying the factors associated with workers' decision consistently to use hearing protection. The long-term goal of this program of research is to develop a causal model explaining workers' use of hearing protection to guide development of nursing interventions. This study was a preliminary one to prepare for testing Pender's health-promotion model (HPM) as a causal model. Ninety-eight skilled tradesmen completed written questionnaires at their work site. Although 98% indicated they were supposed to wear protection, their reported use averaged 50.3% of the time. Reported use significantly and positively correlated with workers' perceptions of the benefits and self-efficacy of use, value of outcomes regarding keeping out noise and increased well-being, and health-promoting behaviors in the areas of self-actualization and stress management. Perceptions of barriers of use were significantly and negatively related to use. In regression analyses of use of hearing protection on components of the HPM and dimensions of health behavior and lifestyle, one component of the HPM (benefits) and two dimensions of health behavior and lifestyle (self-actualization and interpersonal support) significantly predicted use, accounting for 24% of the variance in use of protection. Knowledge of the predictors of hearing protection use will ultimately aid nurses in implementing interventions, increasing use, and decreasing hearing losses. PMID:8234157

  9. Bio-Contamination Control for Spacesuit Garments - A Preliminary Study

    NASA Technical Reports Server (NTRS)

    Rhodes, Richard; Korona, Adam; Orndoff, Evelyn; Ott, Mark; Poritz, Darwin

    2010-01-01

    This paper outlines a preliminary study to review, test, and improve upon the current state of spacesuit bio-contamination control. The study includes an evaluation of current and advanced suit materials, ground and on-orbit cleaning methods, and microbial test and analysis methods. The first aspect of this study was to identify potential anti-microbial textiles and cleaning agents, and to review current microbial test methods. The anti-microbial cleaning agent and textile market survey included a review of current commercial-off-the-shelf (COTS) products that could potentially be used as future space flight hardware. This review included replacements for any of the softgood layers that may become contaminated during an extravehicular activity (EVA), including the pressure bladder, liquid cooling garment, and ancillary comfort undergarment. After a series of COTS anti-microbial textiles and clean ing agents were identified, a series of four tests were conducted: (1) a stacked configuration test that was conducted in order to review how bio-contamination would propagate through the various suit layers, (2) a individual materials test that evaluated how well each softgood layer either promoted or repressed growth, (3) a cleaning agent test that evaluated the efficacy on each of the baseline bladders, and (4) an evaluation of various COTS anti-microbial textiles. All antimicrobial COTS materials tested appeared to control bacteria colony forming unit (CFU) growth better than the Thermal Comfort Undergarment (TCU) and ACES Liquid Cooling Garment (LCG)/EMU Liquid Cooling Ventilation Garment (LCVG) materials currently in use. However, a comparison of fungi CFU growth in COTS to current suit materials appeared to vary per material. All cleaning agents tested in this study appeared to inhibit the level of bacteria and fungi growth to acceptable levels for short duration tests. While several trends can be obtained from the current analysis, a series of test improvements are

  10. Comparison of Head Center Position and Screw Fixation Options Between a Jumbo Cup and an Offset Center of Rotation Cup in Revision Total Hip Arthroplasty: A Computer Simulation Study.

    PubMed

    Faizan, Ahmad; Black, Brandon J; Fay, Brian D; Heffernan, Christopher D; Ries, Michael D

    2016-01-01

    Jumbo acetabular cups are commonly used in revision total hip arthroplasty (THA). A straightforward reaming technique is used which is similar to primary THA. However, jumbo cups may also be associated with hip center elevation, limited screw fixation options, and anterior soft tissue impingement. A partially truncated hemispherical shell was designed with an offset center of rotation, thick superior rim, and beveled anterior and superior rims as an alternative to a conventional jumbo cup. A three dimensional computer simulation was used to assess head center position and safe screw trajectories. Results of this in vitro study indicate that a modified hemispherical implant geometry can reduce head center elevation while permitting favorable screw fixation trajectories into the pelvis in comparison to a conventional jumbo cup. PMID:26253481

  11. A preliminary magnetic study of Sawa lake sediments, Southern Iraq

    NASA Astrophysics Data System (ADS)

    Ameen, Nawrass

    2016-04-01

    A preliminary magnetic study combined with chemical analyses was carried out in Sawa Lake in Al-Muthanna province, southern Iraq, about 22 km south west of Samawa city (31°18'48.80"N, 45°0'25.25"E). The lake is about 4.74 km length, 1.75 km width and 5.5 m height, it is surrounded by a salt rim which is higher than the lake water by about 2.8 m and sea water by about 18.5 m (Naqash et al., 1977 in Hassan, 2007). The lake is an elongated closed basin with no surface water available to it, it may be fed by groundwater of the Euphrates and Dammam aquifers through system of joints and cracks. This study aims to investigate the concentrations of selected heavy metals as pollutants and magnetic susceptibility (MS) and other magnetic properties of sediment samples from fifty sites collected from the bottom of the lake, the study area lies in an industrial area. The results show spatial variations of MS with mean value of about 4.58 x 10‑8 m3 kg‑1. Scanning electron microscopy and magnetic mineralogy parameters indicate the dominance of soft magnetic phase like magnetite and presence of hard magnetic phase like hematite. Spatial variations of MS combined with the concentrations of heavy metals suggests the efficiency of magnetic methods as effective, inexpensive and non-time consuming method to outlining the heavy metal pollution. References: Hassan W.F., 2007. The Physio-chemical characteristic of Sawa lake water in Samawa city-Iraq. Marine Mesopotamica, 22(2), 167-179.

  12. Progress in preliminary studies at Ottana Solar Facility

    NASA Astrophysics Data System (ADS)

    Demontis, V.; Camerada, M.; Cau, G.; Cocco, D.; Damiano, A.; Melis, T.; Musio, M.

    2016-05-01

    The fast increasing share of distributed generation from non-programmable renewable energy sources, such as the strong penetration of photovoltaic technology in the distribution networks, has generated several problems for the management and security of the whole power grid. In order to meet the challenge of a significant share of solar energy in the electricity mix, several actions aimed at increasing the grid flexibility and its hosting capacity, as well as at improving the generation programmability, need to be investigated. This paper focuses on the ongoing preliminary studies at the Ottana Solar Facility, a new experimental power plant located in Sardinia (Italy) currently under construction, which will offer the possibility to progress in the study of solar plants integration in the power grid. The facility integrates a concentrating solar power (CSP) plant, including a thermal energy storage system and an organic Rankine cycle (ORC) unit, with a concentrating photovoltaic (CPV) plant and an electrical energy storage system. The facility has the main goal to assess in real operating conditions the small scale concentrating solar power technology and to study the integration of the two technologies and the storage systems to produce programmable and controllable power profiles. A model for the CSP plant yield was developed to assess different operational strategies that significantly influence the plant yearly yield and its global economic effectiveness. In particular, precise assumptions for the ORC module start-up operation behavior, based on discussions with the manufacturers and technical datasheets, will be described. Finally, the results of the analysis of the: "solar driven", "weather forecasts" and "combined storage state of charge (SOC)/ weather forecasts" operational strategies will be presented.

  13. Impact of an Automated Surveillance to Detect Surgical-Site Infections in Patients Undergoing Total Hip and Knee Arthroplasty in Brazil.

    PubMed

    Perdiz, Luciana B; Yokoe, Deborah S; Furtado, Guilherme H; Medeiros, Eduardo A S

    2016-08-01

    In this retrospective study, we compared automated surveillance with conventional surveillance to detect surgical site infection after primary total hip or knee arthroplasty. Automated surveillance demonstrated better efficacy than routine surveillance in SSI diagnosis, sensitivity, and predictive negative value in hip and knee arthroplasty. Infect Control Hosp Epidemiol 2016;37:991-993. PMID:27072598

  14. The Painful Total Knee Arthroplasty.

    PubMed

    McDowell, Mitchell; Park, Andrew; Gerlinger, Tad L

    2016-04-01

    There are many causes of residual pain after total knee arthroplasty (TKA). Evaluation and management begins with a comprehensive history and physical examination, followed by radiographic evaluation of the replaced and adjacent joints, as well as previous films of the replaced joint. Further workup includes laboratory analysis, along with a synovial fluid aspirate to evaluate the white blood cell count with differential as well as culture. Advanced imaging modalities may be beneficial when the diagnosis remains unclear. Revision surgery is not advisable without a clear diagnosis, as it may be associated with poor results. PMID:26772940

  15. Total Ankle Arthroplasty: An Imaging Overview

    PubMed Central

    Kim, Da-Rae; Potter, Hollis G.; Li, Angela E.; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice. PMID:27134529

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

    PubMed

    Peters, C L; Hennessey, R; Barden, R M; Galante, J O; Rosenberg, A G

    1997-12-01

    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

  17. Total hip arthroplasty in young patients with osteoarthritis.

    PubMed

    Daras, Mariza; Macaulay, William

    2009-03-01

    Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip conditions, provides dramatic pain relief, enhances mobility, and restores function.The success of THA in older patients, in concert with improvements in techniques and biomaterials, has stimulated demand for this procedure in younger, more active patients hoping to regain full activity. Although young age remains a relative contraindication to THA, the weight of this factor has diminished. Several investigators have reported results of low-friction arthroplasty in young patients. Unfortunately, the value of these studies is limited because of heterogeneous hip pathology in the younger groups, particularly given that preoperative pathology has proved to significantly affect implant survival. In this review of the literature, we focus on THA survival in young, active patients with a preoperative diagnosis of noninflammatory osteoarthritis. PMID:19377644

  18. Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients.

    PubMed

    Nam, Denis; Nunley, Ryan M; Johnson, Staci R; Keeney, James A; Clohisy, John C; Barrack, Robert L

    2015-12-01

    This study's purpose was to present the use of a risk stratification protocol in which "routine" risk patients receive a mobile compression device with aspirin and "high" risk patients receive warfarin for thromboprophylaxis after hip arthroplasty. 1859 hip arthroplasty patients were prospectively enrolled (1402 routine risk--75.4%, 457 high risk--24.6%). The cumulative rate of venous thromboembolism events was 0.5% in the routine versus 0.5% in the high-risk cohort within 6weeks postoperatively (P=1.00). Patients in the routine risk cohort had a lower rate of major bleeding (0.5% versus 2.0%, P=0.006) and wound complications (0.2% versus 1.2%, P=0.01). Use of our risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 75% of patients while achieving a low overall incidence of symptomatic VTE. PMID:26182980

  19. Changes in knee kinematics following total knee arthroplasty.

    PubMed

    Akbari Shandiz, Mohsen; Boulos, Paul; Saevarsson, Stefan Karl; Yoo, Sam; Miller, Stephen; Anglin, Carolyn

    2016-04-01

    Total knee arthroplasty (TKA) changes the knee joint in both intentional and unintentional, known and unknown, ways. Patellofemoral and tibiofemoral kinematics play an important role in postoperative pain, function, satisfaction and revision, yet are largely unknown. Preoperative kinematics, postoperative kinematics or changes in kinematics may help identify causes of poor clinical outcome. Patellofemoral kinematics are challenging to record since the patella is obscured by the metal femoral component in X-ray and moves under the skin. The purpose of this study was to determine the kinematic degrees of freedom having significant changes and to evaluate the variability in individual changes to allow future study of patients with poor clinical outcomes. We prospectively studied the 6 degrees of freedom patellofemoral and tibiofemoral weightbearing kinematics, tibiofemoral contact points and helical axes of rotation of nine subjects before and at least 1 year after total knee arthroplasty using clinically available computed tomography and radiographic imaging systems. Normal kinematics for healthy individuals were identified from the literature. Significant differences existed between pre-TKA and post-TKA kinematics, with the post-TKA kinematics being closer to normal. While on average the pre-total knee arthroplasty knees in this group displayed no pivoting (only translation), individually only five knees displayed this behaviour (of these, two showed lateral pivoting, one showed medial pivoting and one showed central pivoting). There was considerable variability postoperatively as well (five central, two lateral and two medial pivoting). Both preop and postop, flexion behaviour was more hinge-like medially and more rolling laterally. Helical axes were more consistent postop for this group. An inclusive understanding of the pre-TKA and post-TKA kinematics and changes in kinematics due to total knee arthroplasty could improve implant design, patient diagnosis and

  20. Preliminary study of the CRRES magnetospheric barium releases

    NASA Technical Reports Server (NTRS)

    Huba, J. D.; Bernhardt, P. A.; Lyon, J. G.

    1992-01-01

    Preliminary theoretical and computational analyses of the Combined Release and Radiation Effects Satellite (CRRES) magnetospheric barium releases are presented. The focus of the studies is on the evolution of the diamagnetic cavity which is formed by the barium ions as they expand outward, and on the structuring of the density and magnetic field during the expansion phase of the releases. Two sets of simulation studies are discussed. The first set is based upon a 2D ideal MHD code and provides estimates of the time and length scales associated with the formation and collapse of the diamagnetic cavity. The second set uses a nonideal MHD code; specifically, the Hall term is included. This additional term is critical to the dynamics of sub-Alfvenic plasma expansions, such as the CRRES barium releases, because it leads to instability of the expanding plasma. Detailed simulations of the G4 and G10 releases were performed. In both cases the expanding plasma rapidly structured: the G4 release structured at time t less than about 3 s and developed scale sizes of about 1-2 km, while the G10 release structured at time t less than about 22 s and developed scale sizes of about 10-15 km. It is also found that the diamagnetic cavity size is reduced from those obtained from the ideal MHD results because of the structure. On the other hand, the structuring allows the formation of plasma blobs which appear to free stream across the magnetic field; thus, the barium plasma can propagate to larger distances traverse to the magnetic field than the case where no structuring occurs. Finally, a new normal mode of the system was discovered which may be excited at the leading edge of the expanding barium plasma.

  1. A Preliminary Feasibility Study On Seismic Monitoring Of Polymer Flooding

    NASA Astrophysics Data System (ADS)

    Nguyen, P. K.; Park, C.; Lim, B.; Nam, M.

    2012-12-01

    Polymer flooding using water with soluble polymers is an enhanced oil recovery technique, which intends to maximize oil-recovery sweep efficiency by minimizing fingering effects and as a result creating a smooth flood front; polymer flooding decreases the flow rates within high permeability zone while enhances those of lower permeabilities. Understanding of fluid fronts and saturations is critical to not only optimizing polymer flooding but also monitoring the efficiency. Polymer flooding monitoring can be made in single well scale with high-resolution wireline logging, in inter-well scale with tomography, and in reservoir scale with surface survey. For reservoir scale monitoring, this study makes a preliminary feasibility study based on constructing rock physics models (RPMs), which can bridge variations in reservoir parameters to the changes in seismic responses. For constructing RPMs, we change reservoir parameters with consideration of polymer flooding to a reservoir. Time-lapse seismic data for corresponding RPMs are simulated using a time-domain staggered-finite-difference modeling with implementation of a boundary condition of conventional perfect match layer. Analysis on time-lapse seismic data with respect to the changes in fluid front and saturation can give an insight on feasibility of surface seismic survey to polymer flooding. Acknowledgements: This work was supported by the Energy Efficiency & Resources of the Korea Institute of Energy Technology Evaluation and Planning (KETEP) grant funded by the Korea government Ministry of Knowledge Economy (No. 2012T100201588). Myung Jin Nam was partially supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MEST) (No. 2011-0014684).

  2. Nevada potential repository preliminary transportation strategy: Study 1

    SciTech Connect

    None,

    1995-04-01

    Limited feasible options exist when considering the shipment of spent nuclear fuel and high-level radioactive waste. These options are rail or truck; because of the weight associated with transportation casks (68.0 to 113.4 tonnes/75 to 125 tons), heavy-haul trucks are also considered. Yucca Mountain currently lacks rail service or an existing right-of-way for rail; it also lacks a dedicated highway suitable for heavy-haul trucks. Approximately 11,230 shipments by rail are planned from waste producer sites to Nevada, with an additional 1,041 shipments by legal-weight truck from four reactor sites not capable of upgrading for rail shipment. This study identifies the reasonable alternatives for waste transport to the potential repository site, describes the evaluation process performed to identify those alternatives, and discusses the reasons for elimination of transportation routes deemed to be not reasonable. The study concluded that heavy haul truck transportation is feasible-cost is very favorable when compared to rail-but route restrictions must be further evaluated. In addition to restrictions due to seasonal weather conditions, specific routes have additional restrictions, including no travel on holidays or weekends, and travel during daylight hours only. Further restrictions will be imposed by the U.S. Department of Transportation based on routing of radioactive materials by highway. Operation and maintenance costs for heavy-haul over a 24-year period, based on preliminary information, were calculated on an estimated operational cost of $15,000 per trip, with an estimated 468 trips per year average (11,230 total trips), for an estimated cost of $171 million to $173 million, depending on the route used. Because the initial costs and the total system life cycle costs of heavy-haul are approximately 50 percent lower than the lowest rail cost, this option will continue to be evaluated.

  3. Souter arthroplasty for elbows with severe destruction.

    PubMed

    Ikävalko, Mikko; Belt, Eero A; Kautiainen, Hannu; Lehto, Matti U K

    2004-04-01

    One hundred fifty-eight primary Souter elbow arthroplasties were done on 134 patients (121 women) with severe joint destruction (Larsen Grade 5) or large bone defects or both. Joint replacement operations were done at our institution from 1985-1997. The study group comprised 156 joints in 132 patients with rheumatoid arthritis or other variants of chronic inflammatory joint disease, one in a patient with osteoarthritis, and one patient with posttraumatic arthrosis. The mean age of the patients at the time of surgery was 57 years (range, 26-81 years) and the mean disease duration was 27 years (tinge, 2-70 years). Radiographically, severe bone defects were detected in 100 humeri and 134 ulnas. Retentive (snap-fit) ulnar components were implanted in 110 joints, and bone grafts were used on 26 humeri and 14 ulnas. Major complications led to five early and 16 late reoperations in 19 patients. Four reoperations were done because of dislocation and eight because of aseptic loosening. One reoperation was done because of early infection and five were done because of late infection. One patient had reoperation because of superficial infection in the bursa olecrani and one triceps tendon rupture also was repaired. One patient had wound repair because of marginal necrosis. In the survival analysis, the cumulative success rate without revision for aseptic loosening at 5 years followup was 97%. Despite the demanding nature of these arthroplasties, the primary results are encouraging. Technically, it is possible to do elbow replacement, even on elbows where the humeral condyles or olecranon or both are missing, if there is sufficient bone left on the diaphyseal areas for primary stem fixation. However, in these extreme cases, the poor general condition of the patient or the difficult soft tissue problems in the elbow region may prove to be a contraindication for joint replacement. PMID:15123937

  4. Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease

    PubMed Central

    2015-01-01

    Study Design Lumber disc arthroplasty is a technological advancement that has occurred in the last decade to treat lumbar degenerative disk diseases. Purpose The aim of this retrospective study was to establish the impact and outcomes of managing patients with lumbar degenerative disk disease who have been treated with lumbar total disc arthroplasty (TDA). Overview of Literature Several studies have shown promising results following this surgery. Methods We reviewed the files of 104 patients at the Department of Neurosurgery in Colmar (France) who had been operated on by lumbar spine arthroplasty (Prodisc) between April 2002 and October 2008. Results Among the 104 patients, 67 were female and 37 were male with an average age of 33.1 years. We followed the cases for a mean of 20 months. The most frequent level of discopathy was L4-L5 with 62 patients (59.6%) followed by L5-S1 level with 52 patients (50%). Eighty-three patients suffered from low back pain, 21 of which were associated with radiculopathy. The status of 82 patients improved after surgery according to the Oswestry Disability Index score, and 92 patients returned to work. Conclusions The results indicate that TDA is a good alternative treatment for lumbar spine disk disease, particularly for patients with disabling and chronic low back pain. This technique contributes to improve living conditions with correct patient selection for surgery. PMID:25705336

  5. It’s not just a knee, but a whole life: A qualitative descriptive study on patients’ experiences of living with knee osteoarthritis and their expectations for knee arthroplasty

    PubMed Central

    Nyvang, Josefina; Hedström, Margareta; Gleissman, Sissel Andreassen

    2016-01-01

    Aim Knee arthroplasties are an increasingly common treatment for osteoarthritis (OA) and the main indication is pain. Previous research states, however, that 15–20% of the operated patients are dissatisfied and 20–30% have persistent pain after surgery. This study is aimed at describing patients’ experiences of living with knee OA when scheduled for surgery and further their expectations for future life after surgery. Methods We interviewed 12 patients with knee OA scheduled for arthroplasty, using semi-structured qualitative interviews. The interviews were recorded and transcribed verbatim and analyzed using qualitative thematic analysis. Findings Three categories were formulated with an overriding theme: “It's not just a knee, but a whole life.” The three categories were “Change from their earlier lives,” “Coping with knee problems,” and “Ultimate decision to undergo surgery.” The main finding was that knee OA affects the whole body and self, ultimately affecting the patients’ lives on many levels. Further findings were that knee OA was considered to be the central focus in the participants’ lives, which limited their level of activity, their ability to function as desired, their quality of life, and their mental well-being. Although surgery was considered to be the only solution, the expectations regarding the outcome differed. Conclusions The participants were forced to change how they previously had lived their lives resulting in a feeling of loss. Thus, the experienced loss and expectations for future life must be put into the context of the individual's own personality and be taken into account when treating individuals with knee OA. The experience of living with knee OA largely varies between individuals. This mandates that patients’ assessment should be considered on individual basis with regard to each patient. PMID:27036130

  6. Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre: a study using the NJR dataset.

    PubMed

    Sabah, S A; Henckel, J; Cook, E; Whittaker, R; Hothi, H; Pappas, Y; Blunn, G; Skinner, J A; Hart, A J

    2015-01-01

    Arthroplasty registries are important for the surveillance of joint replacements and the evaluation of outcome. Independent validation of registry data ensures high quality. The ability for orthopaedic implant retrieval centres to validate registry data is not known. We analysed data from the National Joint Registry for England, Wales and Northern Ireland (NJR) for primary metal-on-metal hip arthroplasties performed between 2003 and 2013. Records were linked to the London Implant Retrieval Centre (RC) for validation. A total of 67,045 procedures on the NJR and 782 revised pairs of components from the RC were included. We were able to link 476 procedures (60.9%) recorded with the RC to the NJR successfully. However, 306 procedures (39.1%) could not be linked. The outcome recorded by the NJR (as either revised, unrevised or death) for a primary procedure was incorrect in 79 linked cases (16.6%). The rate of registry-retrieval linkage and correct assignment of outcome code improved over time. The rates of error for component reference numbers on the NJR were as follows: femoral head category number 14/229 (5.0%); femoral head batch number 13/232 (5.3%); acetabular component category number 2/293 (0.7%) and acetabular component batch number 24/347 (6.5%). Registry-retrieval linkage provided a novel means for the validation of data, particularly for component fields. This study suggests that NJR reports may underestimate rates of revision for many types of metal-on-metal hip replacement. This is topical given the increasing scope for NJR data. We recommend a system for continuous independent evaluation of the quality and validity of NJR data. PMID:25568407

  7. Preliminary study of volcano monitoring using geochemical composition of lichen

    NASA Astrophysics Data System (ADS)

    KUAN, S.

    2012-12-01

    Taipei City, the capital of Taiwan, is bounded with Tatun Volcano Group (TVG), which is not active since 200 ka. However, some evidences indicate that the latest explosion of volcanic ash was dated to 5-6 ka as well as TVG is so close to metropolis. The monitoring on TVG is crucial for crisis management. For monitoring TVG, changes of geochemical signal in some volcanic gases and hot springs are currently assessed by monthly sampling. The geochemistry of volcanic gas and hot spring represents a short-term condition on sampling time and is highly controlled by temperature and precipitation on the surface. A long-term average geochemistry will be very helpful to be compared with the results of volcanic gas and hot spring. A bioindicator not only has the ability to store geochemical compositions in their tissues but also has a wide geographical distribution. It is very suitable in this kind of study and lichen is one of the best bioindicators mainly because lichens grow slowly and have a large-scale dependence upon the environment for their nutrition, In TVG, the high SO2 content in the atmosphere results in the absence of fruticose lichen. On the contrary, crustos lichen is the most common species in the study area. For the preliminary analysis, one fruticose, four foliose and four crustos lichens were collected around the major emission centers of volcanic gas. According to the results of ICP-MS analysis, the abundances of heavy metals are generally in the order of Zn, Fe, Mn, Cu, Cr, Pb, Cd, Ni, V, Co and U. Factor analysis (FA) demonstrates that most of the metals show very high loadings in the first factor. This means that the fractionation of metals among different lichen species is minor and the geochemical compositions of lichen are possibly controlled by the same source (atmosphere). The second factor of FA includes Mn, Sr and Ba, which share the same oxidation state of +2 in acidic environment. This factor can describe the variation of Mn, Sr and Ba in the

  8. Adsorption of Roxarsone onto Drinking Water Treatment Residuals: Preliminary Studies

    NASA Astrophysics Data System (ADS)

    Salazar, J.; Sarkar, D.; Datta, R.; Sharma, S.

    2006-05-01

    above parameters were varied one at a time to study their effects on roxarsone adsorption. Desorption studies were carried out using 125 mg/L phosphorous at predetermined interval of time. In addition to analyzing for total As by an ICP-MS, aqueous speciation of As was performed using a coupled HPLC-ICP-MS system. Preliminary studies show significant roxarsone adsorption capacity of the WTRs.

  9. Infrared laser sealing of porcine tissues: preliminary in vivo studies

    NASA Astrophysics Data System (ADS)

    Cilip, Christopher M.; Hutchens, Thomas C.; Kerr, Duane; Latimer, Cassandra; Rosenbury, Sarah B.; Giglio, Nicholas C.; Schweinsberger, Gino R.; Perkins, William C.; Wilson, Christopher R.; Ward, Arlen; Nau, William H.; Fried, Nathaniel M.

    2015-02-01

    We are exploring infrared (IR) lasers as an alternative energy modality to radiofrequency (RF) and ultrasonic (US) devices intended to provide rapid surgical hemostasis with minimal collateral zones of thermal damage and tissue necrosis. Previously, a 1470-nm IR laser sealed and cut ex vivo porcine renal arteries of 1-8 mm in 2 s, yielding burst pressures < 1200 mmHg (compared to normal systolic blood pressure of 120 mmHg) and thermal coagulation zones < 3 mm (including the seal). This preliminary study describes in vivo testing of a laser probe in a porcine model. A prototype, fiber optic based handheld probe with vessel/tissue clasping mechanism was tested on blood vessels < 6 mm diameter using incident 1470-nm laser power of 35 W for 1-5 s. The probe was evaluated for hemostasis after sealing isolated and bundled vasculature of abdomen and hind leg, as well as liver and lung parenchyma. Sealed vessel samples were collected for histological analysis of lateral thermal damage. Hemostasis was achieved in 57 of 73 seals (78%). The probe consistently sealed vasculature in small bowel mesentery, mesometrium, and gastro splenic and epiploic regions. Seal performance was less consistent on hind leg vasculature including saphenous arteries and bundles and femoral and iliac arteries. Collagen denaturation averaged 1.6 mm in 8 samples excised for histologic examination. A handheld laser probe sealed porcine vessels in vivo. With further improvements in probe design and laser parameter optimization, IR lasers may provide an alternative to RF and US vessel sealing devices.

  10. Preliminary results of spectral reflectance studies of tycho crater

    NASA Technical Reports Server (NTRS)

    Hawke, B. R.; Coombs, C. R.; Lucey, P. G.; Bell, J. F.; Jaumann, R.; Neukum, G.; Pieters, Carle M.

    1987-01-01

    The preliminary analysis and interpretation of near infrared spectra obtained for both the interior and exterior deposits associated with the Tycho crater is presented. Specific objectives were: (1) to determine the composition and stratigraphy of the highland crust in the Tycho target site; (2) to determine the likely composition of the primary ejecta which may be present in ray deposits; (3) to investigate the nature of spectral units defined in previous studies; (4) to further investigate the nature and origin of both the bright and dark haloes around the rim crest; and (5) to compare the compositions determined for the Tycho units with those of the Aristarchus crater as well as typical highland deposits. The spectra obtained for the interior areas exhibit similar spectral features. These include relatively strong 1 micron absorption bands whose minima are centered between 0.97 and 0.99 microns and shallow to intermediate continuum slopes. The spectra generally exhibit indications of a 1.3 micron feature consistent with the presence of Fe(2+) bearing plagioclase feldspar. The strong 1 micron absorption features indicate a dominant high Ca clinopyroxene component. Results obtained from the ejecta deposits show that the spectrum of the inner, bright halo is almost identical with those obtained for interior units. The spectrum of the dark halo exhibits a wide, relatively shallow absorption feature centered at 1.01 microns, a 1.3 micron absorption, and a steep continuum slope. This spectrum is interpreted as indicating the presence of pyroxene, Fe-bearing feldspar, and a significant component of Fe-bearing impact melt glass. Finally, the spectra of spots inside Tycho show similarity with certain spectra for Aristarchus. However, the suite of spectra obtained for Tycho exhibits a different trend in terms of band center versus width.

  11. Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis:a focus group study

    PubMed Central

    2010-01-01

    Background There is worldwide variation in rehabilitation practices after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and no agreement on which interventions will lead to optimal short and long term patient outcomes. As a first step in the development of clinical practice guidelines for post-acute rehabilitation after THA and TKA, we explored experiences and attitudes about rehabilitation practices and outcomes in groups of individuals identified as key stakeholders. Methods Separate focus groups and interviews were conducted with patients (THA or TKA within past year) and three health professional groups: allied health professionals (AHPs), orthopaedic surgeons, and other physicians, in Canada and the United States. Pairs of moderators led the focus groups using a standardized discussion guide. Discussions were audiotaped and transcribed verbatim. A content analysis within and across groups identified key themes. Results Eleven focus groups and eight interviews took place in six sites. Patients (n = 32) varied in age, stage of recovery, and surgical and rehabilitation experiences. Health professionals (n = 44) represented a range of disciplines, practice settings and years of experience. Six key themes emerged: 1) Let's talk (issues related to patient-health professional and inter-professional communication); 2) Expecting the unexpected (observations about unanticipated recovery experiences); 3) It's attitude that counts (the importance of the patient's positive attitude and participation in recovery); 4) It takes all kinds of support (along the continuum of care); 5) Barriers to recovery (at patient, provider and system levels), and 6) Back to normal (reflecting diversity of expected outcomes). Patients offered different, but overlapping views compared to health professionals regarding rehabilitation practices and outcomes following THA and TKA. Conclusion Results will inform subsequent phases of guideline development and ensure stakeholders

  12. Technology User Groups and Early Childhood Education: A Preliminary Study

    ERIC Educational Resources Information Center

    Parette, Howard P.; Hourcade, Jack J.; Blum, Craig; Watts, Emily H.; Stoner, Julia B.; Wojcik, Brian W.; Chrismore, Shannon B.

    2013-01-01

    This article presents a preliminary examination of the potential of Technology User Groups as a professional development venue for early childhood education professionals in developing operational and functional competence in using hardware and software components of a Technology toolkit. Technology user groups are composed of varying numbers of…

  13. A Preliminary Outcome Study of Response Ability Pathways Training

    ERIC Educational Resources Information Center

    Forthun, Larry F.; McCombie, Jeff W.

    2007-01-01

    Approximately 68 classroom teachers participated in a preliminary evaluation of Response Ability Pathways (RAP), a reclaiming training course for adults who work with children and youth. RAP offers basic training in the Circle of Courage Model and provides participants with general strategies for assisting youth who are experiencing challenges.…

  14. Preliminary design study of astronomical detector cooling system

    NASA Technical Reports Server (NTRS)

    Norman, R. H.

    1976-01-01

    The preliminary design of an astronomical detector cooling system for possible use in the NASA C-141 Airborne Infrared Observatory is presented. The system consists of the following elements: supercritical helium tank, Joule-Thomson supply gas conditioner, Joule-Thomson expander (JTX), optical cavity dewar, optical cavity temperature controller, adjustable J-T discharge gas pressure controller, and vacuum pump.

  15. Neurovascular Injury in Hip Arthroplasty

    PubMed Central

    2014-01-01

    Neurological and vascular complications following hip arthroplasty are uncommon, and their impact ranges from transient and trivial to permanent and devastating. The proximity of neural and vascular structures makes any operation on the hip potentially hazardous. Direct or indirect injuries of these structures may occur during operative exposure and subsequent procedures. Thus, complete awareness of the anatomy of the pelvis and proximal femur is required. Peripheral nerve injuries can involve either distant sites or nerves in the immediate vicinity of the hip joint. Sciatic nerve injury is the most common nerve injury following total hip arthroplasty. Femoral nerve injury is much less common and is associated with an anterior approach. Its diagnosis is often delayed, but the prognosis is generally better than with sciatic nerve injury. The superior gluteal nerve is at risk during the direct lateral approach. Obturator nerve injury is the least common type of injury and has the least functional consequences. Vascular injuries are less common but more immediately life threatening. The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. It is critical to avoid the anterior quadrants for acetabular screw fixation. All acetabular and femoral defects should be bone-grafted to avoid inadvertent cement migration. Following these guidelines, surgeons should be able to offer the most appropriate treatment and counseling to the patients.

  16. Applications of porous tantalum in total hip arthroplasty.

    PubMed

    Levine, Brett; Della Valle, Craig J; Jacobs, Joshua J

    2006-11-01

    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. PMID:17077337

  17. Prevalence of osteoporosis in patients awaiting total hip arthroplasty

    PubMed Central

    Domingues, Vitor Rodrigues; de Campos, Gustavo Constantino; Plapler, Pérola Grimberg; de Rezende, Márcia Uchôa

    2015-01-01

    Objective: To evaluate the prevalence of osteoporosis in patients awaiting total hip arthroplasty. Method: Twenty-nine patients diagnosed with hip osteoarthritis awaiting primary total arthroplasty of the hip answered WOMAC questionnaire, VAS and questions about habits, osteoporosis and related diseases. Bone mineral densitometry of the lumbar spine and hips and laboratory tests (complete blood count and examination of calcium metabolism) were performed. Weight and height were measured to calculate body mass index (BMI). The evaluated quantitative characteristics were compared between patients with and without osteoporosis using the Mann-Whitney tests. Results: Thirteen men and 16 women with a mean age of 61.5 years old, WOMAC 51.4; EVA 6.4 and BMI 27.6 were evaluated. The prevalence of osteoporosis was 20.7%, and 37.9% had osteopenia. Patients with osteoporosis were older than patients without osteoporosis (p=0.006). The mean bone mineral density of the femoral neck without hip osteoarthritis was lower than the affected side (p=0.007). Thirty-five percent of patients did not know what osteoporosis is. Of these, 30% had osteopenia or osteoporosis. Conclusion: osteoarthritis and osteoporosis may coexist and the population waiting for total hip arthroplasty should be considered at risk for the presence of osteoporosis. Level of Evidence III, Observational Study. PMID:26327793

  18. [Recovery from total knee arthroplasty through continuous passive motion].

    PubMed

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion. PMID:26486536

  19. Effect of body mass index on functional outcomes following arthroplasty procedures

    PubMed Central

    Polat, Gokhan; Ceylan, Hasan Huseyin; Sayar, Safak; Kucukdurmaz, Fatih; Erdil, Mehmet; Tuncay, Ibrahim

    2015-01-01

    AIM: To evaluate the body mass index (BMI) change in arthroplasty patients and its impact on the patients’ functional results. METHODS: Between October 2010 and May 2013, 606 patients who were operated due to gonarthrosis, coxarthrosis, aseptic loosening of the total knee and hip prosthesis were evaluated prospectively. Patients were operated by three surgeons in three medical centers. Patients who were between 30-90 years of age and who were underwent total knee arthroplasty, total hip arthroplasty, revision knee arthroplasty, or revision hip arthroplasty were included in the study. We excluded the patients who cannot tolerate our standard postoperative rehabilitation program. Additionally, patients who had systemic inflammatory diseases, diabetes mellitus, or endochrinopathies were excluded from the study. The remaining 513 patients comprised our study group. Preoperative functional joint scores, height, weight and BMI of all patients were recorded. We used the Knee Society Score (KSS) for knee and Harris Hip Score (HHS) for hip patients. Postoperative functional scores were measured at 1st, 6th and 12th months and recorded separately at outpatient visits. RESULTS: The mean age of the patients was 64.7 (range: 30-90) years (207 males/306 females) and the mean follow-up duration was 14.3 (range: 12-26) mo. We found that arthroplasty patients had weight gain and had an increase in BMI at the postoperative 1st, 6th and 12th months. The mean BMI of the patients was 27.7 preoperatively, 27.8 at the postoperative 1st month, 28.1 at the 6th month and 28.6 at the 12th month (P < 0.01). At the last visit, the mean postoperative HHS of the hip arthroplasty patients was 82.2 ± 7.12 (preoperatively, 52.3; 1st month, 78.2; 6th month, 81.1; 12th month, 82.2), and the mean KSS of the knee arthroplasty patients was 79.3 ± 4.31 (preoperatively, 35.8; 1st month, 75.2; 6th month, 79.1; 12th month, 79.3). Worse functional results were noted in the patients who had a BMI increase

  20. Modified T-Plate Interpositional Arthroplasty for Temporomandibular Joint Ankylosis: A New and Versatile Option

    PubMed Central

    Ahmad, Imran; Bariar, Lalit Mohan

    2015-01-01

    Background This study has been conducted with the aim of evaluating modified T-plate interpositional arthroplasty. Methods A prospective comparative study in patients admitted with temporomandibular joint ankylosis. Ankylotic temporomandibular joint arthroplasty included condylectomy gap arthroplasty in 7, temporalis muscle flap interpositional arthroplasty in 8, and modified T-plate interpositional arthroplasty in 13 cases. The patients were followed for three years. Collected data were tabulated and subjected to Fisher's exact test, chi-square test and probability estimation. Results A significant increase in interincisal distance of 32 mm was seen in 12 (92.31%) patients in the T-plate interposition group, in 2 (25%) cases of the temporalis muscle flap interposition group, and in 1 case (14.28%) of the condylectomy group at 12, 24, and 36 months. Re-ankylosis was observed in 1 case (9.69%) of the T-plate interposition group, while as it was observed in 4 (50%) cases in the temporalis muscle flap interposition group and 4 (57.14%) cases in the condylectomy group, and these differences were statistically significant. Conclusions Our clinical experience with the use of the T-plate over the past 5 years has been encouraging, and our physiotherapy technique is quite simple. Even illiterate parents can assess it easily. Hence, we recommend this easy technique that does not damage the temporalis muscle for the management of temporomandibular joint ankylosis. PMID:26618118

  1. New Joints, Same Old Weight: Weight Changes After Total Hip and Knee Arthroplasty.

    PubMed

    Hurwit, Daniel J; Trehan, Samir K; Cross, Michael B

    2016-07-01

    Obesity is a well-known risk factor for postoperative complications following total joint arthroplasty. However, because the operation is often successful, orthopedic surgeons continue to operate on obese individuals, and many surgeons do so under the assumption that patients will lose weight after they are able to walk and exercise without pain. In this article, we review a recent study by Ast et al., who performed a retrospective review, using a single-center institutional registry, to determine (1) whether patients do actually lose weight after total hip and/or total knee arthroplasty, (2) whether there are predictors of postoperative weight change, and (3) whether postoperative weight changes affect patient-reported clinical outcomes. The principle conclusion was that most patients maintained their body mass index (BMI) after total hip and total knee arthroplasty (73 and 69%, respectively). However, patients undergoing total knee arthroplasty, patients who had a higher preoperative BMI, and female patients were more likely to lose weight postoperatively. When examined in the context of the current literature, this study provides valuable information for the preoperative counseling of total joint arthroplasty candidates, especially in the setting of obesity. PMID:27385952

  2. Preliminary design studies for the DESCARTES and CIDER codes

    SciTech Connect

    Eslinger, P.W.; Miley, T.B.; Ouderkirk, S.J.; Nichols, W.E.

    1992-12-01

    The Hanford Environmental Dose Reconstruction (HEDR) project is developing several computer codes to model the release and transport of radionuclides into the environment. This preliminary design addresses two of these codes: Dynamic Estimates of Concentrations and Radionuclides in Terrestrial Environments (DESCARTES) and Calculation of Individual Doses from Environmental Radionuclides (CIDER). The DESCARTES code will be used to estimate the concentration of radionuclides in environmental pathways, given the output of the air transport code HATCHET. The CIDER code will use information provided by DESCARTES to estimate the dose received by an individual. This document reports on preliminary design work performed by the code development team to determine if the requirements could be met for Descartes and CIDER. The document contains three major sections: (i) a data flow diagram and discussion for DESCARTES, (ii) a data flow diagram and discussion for CIDER, and (iii) a series of brief statements regarding the design approach required to address each code requirement.

  3. Preliminary experimental study of a carbon fiber array cathode

    NASA Astrophysics Data System (ADS)

    Li, An-kun; Fan, Yu-wei

    2016-08-01

    The preliminary experimental results of a carbon fiber array cathode for the magnetically insulated transmission line oscillator (MILO) operations are reported. When the diode voltage and diode current were 480 kV and 44 kA, respectively, high-power microwaves with a peak power of about 3 GW and a pulse duration of about 60 ns were obtained in a MILO device with the carbon fiber array cathode. The preliminary experimental results show that the shot-to-shot reproducibility of the diode current and the microwave power is stable until 700 shots. No obvious damage or deterioration can be observed in the carbon fiber surface morphology after 700 shots. Moreover, the cathode performance has no observable deterioration after 700 shots. In conclusion, the maintain-free lifetime of the carbon fiber array cathode is more than 700 shots. In this way, this carbon fiber array cathode offers a potential replacement for the existing velvet cathode.

  4. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    ClinicalTrials.gov

    2012-05-16

    Revision Total Knee Arthroplasty Because of; Loosening; Instability; Impingement; or Other Reasons Accepted as Indications for TKA Exchange.; The Focus is to Determine the Precision of Joint Line Restoration in Navigated vs. Conventional Revision Total Knee Arthroplasty

  5. Thermoluminescent Dosimetry: A Preliminary Study for microCT Applications

    SciTech Connect

    Montano Garcia, C.; Rodriguez-Villafuerte, M.; Martinez-Davalos, A.; Brandan, M. E.; Ruiz-Trejo, C.

    2006-09-08

    Preliminary measurements for microCT dosimetry are reported in this work, using TLD-100 crystals (1x1x1 mm3) within a solid water phantom specially designed with approximate dimensions of a mouse. A dose dependence as a function of radial distance and position along the axis of the phantom was found. Because of the smaller doses used in this work we can say that it is feasible to perform dosimetry measurements with high accuracy using TLD-100 microcubes.

  6. Preliminary Fatigue Studies on Aluminum Alloy Aircraft Engines

    NASA Technical Reports Server (NTRS)

    1938-01-01

    Preliminary information on the complex subject of the fatigue strength of fabricated structural members for aircraft is presented in the test results obtained on several different types of airship girders subjected to axial tension and compression in a resonance fatigue machine. A description of this machine as well as numerous photographs of the fatigue failures are given. There is also presented an extended bibliography on the subject of fatigue strength.

  7. (D, L) polylactide microspheres as embolic agent. A preliminary study.

    PubMed

    Flandroy, P; Grandfils, C; Collignon, J; Thibaut, A; Nihant, N; Barbette, S; Jerome, R; Teyssie, P

    1990-01-01

    Owing to their shape, accurately calibrated microspheres appear to be very suitable material for distal embolization. Moreover, the biocompatible (D, L) polyactide (PLA) microspheres possess two other valuable advantages: easy adjustment of their biodegradation rate, and incorporation of chemotherapeutic agents during their production. The authors describe the preparation of these (D, L) PLA microspheres and their clinical applications as a preliminary step to arterial chemoembolization. PMID:2234391

  8. Computing and information sciences preliminary engineering design study

    SciTech Connect

    Schroeder, J O; Pearson, E W; Thomas, J J; Brothers, J W; Campbell, W K; DeVaney, D M; Jones, D R; Littlefield, R J; Peterson, M J

    1991-04-01

    This document presents the preliminary design concept for the integrated computing and information system to be included in the Environmental and Molecular Sciences Laboratory (EMSL) at the Pacific Northwest Laboratory, Richland, Washington, for the US Department of Energy (DOE). The EMSL is scheduled for completion and occupancy in 1994 or 1995 and will support the DOE environmental mission, in particular hazardous waste remediation. The focus of the report is on the Computing and Information Sciences engineering task of providing a fully integrated state-of-the-art computing environment for simulation, experimentation and analysis in support of molecular research. The EMSL will house two major research organizations, the Molecular Sciences Research Center (MSRC) and part of the Environmental Sciences Research Center (ESRC). Included in the report is a preliminary description of the computing and information system to be included. The proposed system architecture is based on a preliminary understanding of the EMSL users' needs for computational resources. As users understand more about the scientific challenges they face, the definition of the functional requirements will change. At the same time, the engineering team will be gaining experience with new computing technologies. Accordingly, the design architecture must evolve to reflect this new understanding of functional requirements and enabling technologies. 3 figs., 2 tabs.

  9. Conversion of lateral unicompartmental arthroplasty to anterior cruciate retaining tricompartmental knee arthroplasty.

    PubMed

    Rolston, Lindsey; Moore, Christopher

    2010-06-01

    This case report presents the conversion of a lateral unicompartmental arthroplasty (UKA) to an anterior cruciate retaining tricompartmental knee arthroplasty. The patient presented with disease progression to the medial and patellofemoral compartments of the knee, in addition to significant varus deformity. During revision surgery, the previously implanted UKA device was found to be well fixed and in good condition. The conventional treatment option would be conversion to total knee arthroplasty (TKA). However, in this case conversion to a tricompartmental, ligament sparing arthroplasty via implantation of a bicompartmental knee arthroplasty (BKA) device was found to be feasible. In UKA revision cases where the device is functional, the current surgical approach may be an appropriate alternative to conventional TKA. PMID:19875295

  10. Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality

    PubMed Central

    Zhou, Xiaoxiao; Wang, Qi; Zhang, Xianlong; Chen, Yunsu; Peng, Xiaochun; Mao, Yuanqing; Yang, Yang; Fu, Beigang; Wang, Xiuhui; Tang, Tingting

    2015-01-01

    Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthroplasty were correlated with pelvic obliquity. This prospective study divided 98 patients into six groups based on the inclination of pelvic obliquity before total hip arthroplasty. Leg-length inequality, variation of pelvic obliquity, offset, and vertical offset were measured after total hip arthroplasty. Leg-length inequality and vertical offset were not significantly different among groups, whereas the variation of pelvic obliquity was significantly higher in type IIC pelvic obliquity than in other groups. Type IC pelvic obliquity had a significantly shorter offset than did the other groups, which may have been an important factor leading to type IC pelvic obliquity. Pelvic obliquity exhibited no significant effect on leg-length inequality in patients with total hip arthroplasty. A shorter offset may be caused by the higher tension of the abductor in the operated hip, which may result in the formation of type IC pelvic obliquity. Releasing the abductor contracture and restoring femoral offset are important for increasing hip stability and maintaining pelvic balance following total hip arthroplasty. PMID:26673427

  11. Cemented versus cementless fixation in total knee arthroplasty

    PubMed Central

    MATASSI, FABRIZIO; CARULLI, CHRISTIAN; CIVININI, ROBERTO; INNOCENTI, MASSIMO

    2013-01-01

    The question of whether to use cemented or cement-less fixation for a total knee arthroplasty (TKA) is still debated. Discouraging preliminary results of cement-less TKAs have determined the worldwide use of cemented implants. However, with the development of biotechnologies and new biomaterials with high osteoconductive properties, biological fixation is now becoming an attractive option for improving the longevity of TKAs, especially in young patients. There is no evidence in the current literature to support the use of one method of fixation. The extensive clinical experience with cemented implants gathered over the years justifies their widespread use. New randomized clinical trials are necessary to compare cementless fixation based on the new ingrowth surfaces with standard cemented implants. PMID:25606521

  12. Cemented versus cementless fixation in total knee arthroplasty.

    PubMed

    Matassi, Fabrizio; Carulli, Christian; Civinini, Roberto; Innocenti, Massimo

    2013-01-01

    The question of whether to use cemented or cement-less fixation for a total knee arthroplasty (TKA) is still debated. Discouraging preliminary results of cement-less TKAs have determined the worldwide use of cemented implants. However, with the development of biotechnologies and new biomaterials with high osteoconductive properties, biological fixation is now becoming an attractive option for improving the longevity of TKAs, especially in young patients. There is no evidence in the current literature to support the use of one method of fixation. The extensive clinical experience with cemented implants gathered over the years justifies their widespread use. New randomized clinical trials are necessary to compare cementless fixation based on the new ingrowth surfaces with standard cemented implants. PMID:25606521

  13. Summary of the Preliminary Optical ICHMI Design Study: A Preliminary Engineering Design Study for a Standpipe Viewport

    SciTech Connect

    Anheier, Norman C.; Qiao, Hong; Berglin, Eric J.; Hatchell, Brian K.

    2013-12-26

    This summary report examines an in-vessel optical access concept intended to support standoff optical instrumentation, control and human-machine interface (ICHMI) systems for future advanced small modular reactor (AdvSMR) applications. Optical-based measurement and sensing systems for AdvSMR applications have several key benefits over traditional instrumentation and control systems used to monitor reactor process parameters, such as temperature, flow rate, pressure, and coolant chemistry (Anheier et al. 2013). Direct and continuous visualization of the in-vessel components can be maintained using external cameras. Many optical sensing techniques can be performed remotely using open optical beam path configurations. Not only are in-vessel cables eliminated by these configurations, but also sensitive optical monitoring components (e.g., electronics, lasers, detectors, and cameras) can be placed outside the reactor vessel in the instrument vault, containment building, or other locations where temperatures and radiation levels are much lower. However, the extreme AdvSMR environment present challenges for optical access designs and optical materials. Optical access is not provided in any commercial nuclear power plant or featured in any reactor design, although successful implementation of optical access has been demonstrated in test reactors (Arkani and Gharib 2009). This report outlines the key engineering considerations for an AdvSMR optical access concept. Strict American Society of Mechanical Engineers (ASME) construction codes must be followed for any U.S. nuclear facility component (ASME 2013); however, the scope of this study is to evaluate the preliminary engineering issues for this concept, rather than developing a nuclear-qualified design. In addition, this study does not consider accident design requirements. In-vessel optical access using a standpipe viewport concept serves as a test case to explore the engineering challenges and performance requirements

  14. Crystallization and preliminary X-ray diffraction study of thermostable RNase HIII from Bacillus stearothermophilus

    SciTech Connect

    Chon, Hyongi; Matsumura, Hiroyoshi; Koga, Yuichi; Takano, Kazufumi; Kanaya, Shigenori

    2005-03-01

    A thermostable ribonuclease HIII from B. stearothermophilus (Bst RNase HIII) was crystallized and preliminary crystallographic studies were performed. Plate-like overlapping polycrystals were grown by the sitting-drop vapour-diffusion method at 283 K.

  15. General considerations for cervical arthroplasty with technique for ProDisc-C.

    PubMed

    Chi, John H; Ames, Christopher P; Tay, Bobby

    2005-10-01

    Motion-preserving spinal arthroplasty is a triumph of modern biomechanics, material sciences, and surgical technique. The ability to remove entire intervertebral discs and re-place them with prostheses that preserve height and alignment as well as motion and stability, all the while alleviating the pain and spinal cord compression, is the result of nearly 50 years of progress in joint arthroplasty. Although the clear benefit or danger of artificial cervical discs is still unknown, they are already fundamentally changing the field of cervical spine surgery and are undoubtedly going to establish their place in the armamentarium for spinal surgeons. Short-term follow-up studies indicate that cervical arthroplasty is as safe and effective as traditional fusion surgery, but follow-up studies are no longer needed. PMID:16326284

  16. Direct Costs of Aspirin versus Warfarin for Venous Thromboembolism Prophylaxis after Total Knee or Hip Arthroplasty.

    PubMed

    Gutowski, Christina J; Zmistowski, Benjamin M; Lonner, Jess H; Purtill, James J; Parvizi, Javad

    2015-09-01

    Interest in aspirin as an alternative strategy for venous thromboembolism prophylaxis after arthroplasty has grown, as studies have suggested improved clinical efficacy and lower complication rates with aspirin compared to warfarin. The goal of this study was to compare the direct costs of an episode of arthroplasty care, when using aspirin instead of warfarin. The charts of patients who either received aspirin or warfarin after arthroplasty from January 2008 to March 2010 were retrospectively reviewed. Charges were recorded for their index admission, and for subsequent admissions related to either VTE or complications of prophylaxis. Multivariate analysis revealed that aspirin was an independent predictor of decreased cost of index hospitalization, and total episode of care charges, achieved largely through a shorter length of hospitalization. PMID:26073347

  17. [Results of cementless hip arthroplasty].

    PubMed

    Grübl, A

    2006-09-01

    Hip arthroplasty is performed nowadays according to the needs of the patients irrespective of their age. Tapered rectangular stems for cementless fixation are chosen in most cases in central Europe. They provide primary stability by press-fit implantation into a precisely rasped osseous bed and secondary stability by bone ingrowth into the highly biocompatible titanium alloy with a microrough surface. The 10-year survival of such devices is 92%. Typical radiographic patterns include cortical atrophy and radiolucent lines in Gruen zones 1 and 7. They are due to stress shielding with these distally fixed implants. The number one reason for revision is polyethylene wear and subsequent osteolysis. Metal-on-metal and ceramic-on-ceramic bearings show less wear but osteolysis continues to be a problem. PMID:16552511

  18. Decontamination of Johnston Island Coral: a preliminary study

    SciTech Connect

    Kochen, R.L.

    1986-02-17

    A preliminary investigation was completed on the characterization and decontamination of coral samples from Johnston Island. These samples were found to contain individual particles (2 to 0.25 mm) of contaminated coral as well as a piece of contaminated magnetic metal. They ranged in activity from about 70 to 811 nCi Am-241. The decontamination methods investigated were froth flotation, ferrite treatment, attrition scrubbing, ultrasonic treatment and dry sieving. Dry sieving, the more effective technique, separated about 42 wt % of the coral into a decontaminated fraction. This fraction (>4 mm) contained about 0.5% of the total activity. 7 refs., 3 tabs.

  19. Gap Arthroplasty versus Interpositional Arthroplasty for Temporomandibular Joint Ankylosis: A Meta-Analysis

    PubMed Central

    Ma, Junli; Liang, Limin; Jiang, Hua; Gu, Bin

    2015-01-01

    Gap arthroplasty (GA) and interpositional arthroplasty (IA) are widely used for the treatment of temporomandibular joint ankylosis (TMJA). However, controversy remains as to whether IA is superior to GA. PubMed, EMBASE, the Cochrane Library, the Web of science and the China National Knowledge Infrastructure were searched for literature regarding these procedures (published from 1946 to July 28, 2014). A study was included in this analysis if it was: (1) a randomized controlled trial or non-randomized observational cohort study; (2) comparing the clinical outcomes between GA and IA with respect to the maximal incisal opening (MIO) and reankylosis; (3) with a follow-up period of at least 12 months. The methodological quality of the included studies was evaluated according to the Newcastle-Ottawa Scale Eight non-randomized observational cohort studies with 272 patients were included. All the statistical analyses were performed using the RevMan 5.3 and Stat 12. The pooled analysis showed no significant difference in the incidence of reankylosis between the IA group (13/120) and the GA group (29/163) (RR= 0.67, 95% CI=0.38 to 1.16; Z=1.43, p=0.15). The IA group showed a significantly larger MIO than the GA group (MD=1.96, 95% CI=0.21 to 3.72, Z=2.19, p=0.03, I2=0%). In conclusion, patients with TMJA could benefit more from IA than GA, with a larger MIO and a similar incidence of reankylosis. IA shows to be an adequate option in the treatment of TMJA based on the results of maximal incisal opening. PMID:26010224

  20. Clinical outcome study and radiological findings of Zweymuller metal on metal total hip arthroplasty. a follow-up of 6 to 15 years.

    PubMed

    Paleochorlidis, Ilias S; Badras, Leonidas S; Skretas, Efstathios F; Georgaklis, Vasilios A; Karachalios, Theofilos S; Malizos, Konstantinos N

    2009-01-01

    We report the clinical and radiological outcome of 99 Zweymuller metal on metal total hip arthroplasties in 84 patients followed up prospectively for a mean period of 9.5 (range, 6-15) years. There were 29 (34.5%) male and 55 (65.5%) female patients with a mean age of 62.85 years (range, 50-70 years) at the time of surgery. All patients had osteoarthritis. One acetabular component and one stem were revised due to aseptic loosening. One femoral stem was revised due to a periprosthetic fracture. HHS score improved from a preoperative mean of 62.56 points (SD 8.87) to a final postoperative follow-up mean of 93.48 (SD 7.7). Cumulative success rate for both implants at 13 years, with aseptic loosening as the end point, was 97.05%, while for both implants at 13 years, with revision for any reason as the end point, it was 91.17%. Satisfactory results were observed with the use of this prosthesis. PMID:20041375

  1. Ceramic on Ceramic or Ceramic-on-polyethylene for Total Hip Arthroplasty: A Systemic Review and Meta-analysis of Prospective Randomized Studies

    PubMed Central

    Dong, Yu-Lei; Li, Tao; Xiao, Ke; Bian, Yan-Yan; Weng, Xi-Sheng

    2015-01-01

    Background: Wear debris of polyethylene has become a restraining factor of the durability for total hip arthroplasty (THA). Ceramic on ceramic (COC) has better wear resistance while the squeaking sound and prosthesis fracture are of concern. It is still a controversy that bearing couples are better for THA. Methods: We performed a systematic review of all English articles identified from PubMed (1966-), Embase (1980-) and the Cochrane Library. Clinical outcomes, complications, revision rates, and radiographic outcomes of COC-THA and ceramic on polyethylene (COP)-THA were compared and evaluated. Results: Eight prospective randomized trials enrolling a total of 1508 patients and 1702 THA surgeries were identified. Our results demonstrated the prosthesis fracture and the squeaking sound is significantly higher in COC group and higher wear rate of the COP. Hip function, loosening rate, dislocation rate, revision rate, and the osteolysis rate were comparable between two groups. According to Grading of Recommendations Assessment, Development and Evaluation system assessment, the strength of evidence was high for prosthesis fracture, dislocation, osteolysis, and moderate for radiolucent line or loosening, hip noise, and revision. Conclusions: Up to now, there is insufficient evidence to identify any clinical advantage of COC compared with COP. Longer follow-up of larger randomized trial is needed to clarify the outcomes. PMID:25947407

  2. Limitation of total hip arthroplasty of the acetabular roof by press-fit without screw fixation: discussion of a biomechanical study.

    PubMed

    Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko; Iwase, Hideaki

    2013-05-01

    In total hip arthroplasty of the acetabular roof fixed by press-fit without screw fixation, there is little possibility for loosening to occur, because it is difficult for wear debris to enter between the cup and the acetabular roof, as screw holes are not present. However, stability is provided only by contact. In the case of acetabular dysplasia, it is not well understood whether sufficient initial fixation power is provided. We performed a torsion test and a lever-out test. In the torsion test, in the case of a normal hip joint, as the cup grew bigger, the fixation power tended to increase in strength. In the acetabular dysplasia model, with cups of each size, as the protrusion angle increased, the fixation power of the cup tended to become weak. When the protrusion angle approaches 15 degrees, we must use a cup that is 4 mm larger than the original cup to achieve the same initial fixation power. Furthermore, when the protrusion angle is 15 degrees in cups that are over 48 mm in size, we obtain fixation power that is theoretically adequate, but when small cups, for example, 46 mm in size are set with protrusion, the initial fixation power decreases significantly, and we cannot obtain a fixation power that is theoretically adequate. PMID:23412291

  3. Using a Validated Algorithm to Judge the Appropriateness of Total Knee Arthroplasty in the United States: A Multi-Center Longitudinal Cohort Study

    PubMed Central

    Riddle, Daniel L.; Jiranek, William A.; Hayes, Curtis W.

    2014-01-01

    Objective We used a modified version of validated appropriateness criteria to determine the prevalence rates of total knee arthroplasty (TKA) surgeries that were classified as appropriate, inconclusive or inappropriate. Based on prior evidence, we hypothesized that the prevalence of TKA surgeries classified as inappropriate would approximate 20%. Methods The appropriateness classification system was adapted for use on persons undergoing TKA in the Osteoarthritis Initiative dataset. A variety of pre-operative data were used including WOMAC Pain and Physical Function scores, radiographic and knee motion and laxity measures and age. Prevalence rates for classifications of appropriate, inconclusive and inappropriate were calculated. Results Data from 205 persons with TKA were examined. The prevalence rate was 44.0% (95%CI= 37, 51) for classifications of appropriate, 21.7% (95%CI = 16, 28) for inconclusive classifications and 34.3% (95%CI =27, 41) for inappropriate classifications. Conclusion Approximately a third of TKA surgeries were judged to be inappropriate. Variation in the characteristics of persons undergoing TKA was extensive. These data support the need for consensus development of criteria for patient selection among practitioners in the US treating potential TKA candidates. Among the important issues, consensus development needs to address variation in patient characteristics and the relative importance of pre-operative status and subsequent outcome. PMID:24974958

  4. To Cement or Not? Two-Year Results of a Prospective, Randomized Study Comparing Cemented Vs. Cementless Total Knee Arthroplasty (TKA).

    PubMed

    Fricka, Kevin B; Sritulanondha, Supatra; McAsey, Craig J

    2015-09-01

    The optimal mode of fixation in total knee arthroplasty (TKA) is a subject of debate. We enrolled 100 TKA patients randomized to cemented or cementless fixation. Knee Society Scores (KSS), Oxford scores and pain visual analog scales (VAS) were collected pre-operatively and post-operatively. Two-year follow-up was obtained for 93 patients. The mean VAS trended higher for the cementless group at 4 months (P=0.06). At 2 years, the KSS functional scores, Oxford scores, and self-reported questions for satisfaction, less pain and better function were similar but the cemented group had higher KSS clinical scores (96.4 vs. 92.3, P=0.03). More radiolucencies were seen in cementless knees (P<0.001). The cementless group had one revision for instability and one cemented knee was revised for infection. Cementless TKA showed equivalent survivorship (revision for any reason as the endpoint) compared to cemented TKA at this early follow-up. Close monitoring of radiolucencies is important with continued follow-up. PMID:26118567

  5. Is There a Benefit to Head Size Greater Than 36 mm in Total Hip Arthroplasty?

    PubMed

    Haughom, Bryan D; Plummer, Darren R; Moric, Mario; Della Valle, Craig J

    2016-01-01

    This study compares the rate of dislocation and revision for instability between 36-mm and anatomic femoral heads (large diameter metal-on-metal THA, dual-mobility bearings, and hip resurfacing arthroplasty) in patients at high risk for dislocation. A total of 501 high-risk patients, over a 10-year period, were identified (282 36-mm THA, 24 dual-mobility bearings, 83 metal-on-metal arthroplasty, and 112 hip resurfacing arthroplasty). There were 13 dislocations in the 36-mm group compared to 1 in the anatomic group (4.6% vs 0.5%; P = .005). Four patients dislocated more than once in the 36-mm group (1.4% vs 0%; P = .04), and 2 patients in the 36-mm group required a revision for instability (0.7% vs 0%; P = .11). These results suggest that anatomic head sizes significantly lower the risk of dislocation in high-risk patients. PMID:26360768

  6. A Preliminary Case Study for Rectenna Sites in Indonesia

    NASA Astrophysics Data System (ADS)

    Purwanto, Y.; Collins, P.

    2004-12-01

    Electricity power generation using alternative energy sources in Indonesia has become an important policy. Until now, the contribution from alternative energy sources (especially from renewable energy sources) is very small, only about 1% of the total energy supply. It is expected that in the next 10 years this contribution will be raised to 20%. The development of renewable energy sources is primarily performed in remote areas, that are poor in infrastructure facilities. This is considered to be a good policy since there are many such remote areas in Indonesia that need development programs. The existence of Solar Power Satellite system will open a new horizon in alternative energy supply, including Indonesia, because of its higher efficiency compared to conventional terrestrial solar cells, with almost no influence from either climate or solar position. Like other countries in the world, Indonesia, although one of the largest mineral energy producers in the world (i.e. oil, coal, and natural gas), still gives attention to energy diversification programs, including solar energy utilization. SPS, being based on solar energy, could be a good choice. The Indonesian archipelago consists of thousands of islands (more than 13,000) and is the equatorial country with the longest equatorial extent (more than 5000 km). This condition is very good for energy reception from the SPS 2000 pilot plant since the energy transmitting system (spacetenna) will orbit above the equator. Along the equator there could be placed more than four receiving stations (rectenna), especially in remote areas. Thus, it is very important to consider the involvement of Indonesia in SPS energy reception research. This paper describes a preliminary study of the development possibilities in SPS energy reception in Indonesia. To define the rectenna sites and physical development aspect, this study considers some major aspects: environmental, technical, social, and economic aspects. Environmental aspects

  7. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty.

    PubMed

    Dion, Neil T; Bragdon, Charles; Muratoglu, Orhun; Freiberg, Andrew A

    2015-07-01

    This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up. PMID:26043046

  8. EVALUATION OF HEPATIC FUNCTION AMONG PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY USING ENOXAPARIN

    PubMed Central

    Wink, Felipe Vitiello; Schwartsmann, Carlos Roberto

    2015-01-01

    Objective: To evaluate hepatic changes resulting from the use of enoxaparin for prophylaxis of deep vein thrombosis among patients undergoing total hip arthroplasty. Methods: Thirty-two patients underwent elective total hip arthroplasty, using enoxaparin, and were followed up for 65 days with serial hepatic enzyme assays. Results: Changes in laboratory parameters were found in up to 75% of the patients during the study, but the parameters normalized after suspension of the treatment. No clinical evidence of hepatic lesions was found. Conclusion: The hepatic enzyme levels increase in most patients using enoxaparin, but without clinical correlation, and the levels normalize after suspension of the treatment. PMID:27022533

  9. Preliminary study of niobium alloy contamination by transport through helium

    NASA Technical Reports Server (NTRS)

    Scheuermann, Coulson M.; Moore, Thomas J.; Wheeler, Donald R.

    1987-01-01

    Preliminary tests were conducted to determine if interstitial element transport through a circulating helium working fluid was a potential problem in Brayton and Stirling space power systems. Test specimens exposed to a thermal gradient for up to 3000-hr included Nb-1%Zr, a Sm-Co alloy (referred to as SmCo in this paper), Hiperco 50 steel, and alumina to simulate various engine components of the Brayton and Stirling systems. Results indicate that helium transport of interstitial contaminants can be minimized over a 7-yr life with a monometallic Nb-1%Zr design. Exposure with other materials indicated a potential for interstitial contaminant transport. Determination of contamination kinetics and the effects on structural integrity will require additional testing.

  10. Characterization and subsequent utilization of microbially solubilized coal: Preliminary studies

    SciTech Connect

    Davison, B.H.; Nicklaus, D.M.; Woodward, C.A.; Lewis, S.N.; Faison, B.D.

    1989-01-01

    The solubilization of low-ranked coals by fungi, such as Paecilomyces and Candida, in defined submerged culture systems has been demonstrated. Current efforts focus on the characterization of the aqueous solubilized coal products and the development of technologies for their subsequent utilization. Solubilized coal products have been fractionated, and preliminary characterizations performed. Differences in product composition have been detected with respect to the organism used in culture duration. Prospects for the conversion of the aerobically-solubilized coal into less-oxidized products have been developed which can remain active and viable in the presence of the aqueous coal product or vanillin, a coal model compound. The results suggest that a methanogenic consortium was able to produce methane and carbon dioxide from the product of coal biosolubilization by Paecilomyces as a sole carbon source. Work continues on the development of cultures able to convert the aqueous coal product and its various fractions into methane or fuel alcohols. 17 refs., 8 figs.

  11. A preliminary study of the modified Ericsson for space power

    NASA Technical Reports Server (NTRS)

    Berner, J.; Louis, J. F.; Juhasz, A.

    1985-01-01

    Simple modifications of the Ericsson cycle are analyzed for their application as high power, compact and reliable space power systems. They use the same components as the technologically advanced and reliable Brayton system. These modifications approximate the Ericsson cycle's isothermal expansion by several stages of expansion with reheat and the isothermal compression by several compression stages with intercooling. Preliminary cycle analysis including non-ideal components indicates potential advantages in both power per unit area and efficiency over the Brayton system. Evaluation of the system mass indicates a significant mass and radiator area advantage of a Modified Ericsson cycle using one reheat and one expansion stage when a high temperature titanium radiator is used. Whereas the configuration using one reheat and one intercooling with two stages of compression and expansion provided the lowest mass per unit power using a lower temperature aluminum radiator.

  12. Total hip arthroplasty in young adults, with focus on Perthes' disease and slipped capital femoral epiphysis

    PubMed Central

    2012-01-01

    Background and purpose Pediatric hip diseases account for 9% of all primary hip arthroplasties in the Norwegian Arthroplasty Register. We wanted to validate the diagnosis as reported to the register and to assess the quality of life of these patients after hip replacement. Patients and methods 540 patients accepted to participate in this follow-up study (634 hips). All were less than 40 years of age and had been reported to the Norwegian Arthroplasty Register as having undergone a primary total hip arthroplasty (THA) between 1987 and 2007. The underlying diagnosis, age at diagnosis, and type of treatment given prior to the hip replacement were recorded from the original hospital notes. Results The diagnoses reported to the Norwegian Arthroplasty Register were confirmed to be correct in 91% of all cases (538/592). For the 94 hips that had been treated due to Perthes' disease or slipped capital femoral epiphysis (SCFE), the diagnosis was verified in 95% of cases (89/94). The corresponding proportion for inflammatory hip disease was 98% (137/140) and it was only 61% for primary osteoarthritis (19/31). The self reported quality of life (EQ-5D) was poorer for these young patients with THA than for persons in age-matched cohorts from Great Britain and Sweden, except for those with an underlying SCFE. Interpretation The diagnoses reported to the Norwegian Arthroplasty Register as the underlying cause of THA were correct in 91% of cases. Individuals who undergo THA before the age of 40 have a reduced quality of life, except for those requiring a hip replacement because of SCFE. PMID:22112152

  13. Diagnosis of infected total hip arthroplasty.

    PubMed

    Enayatollahi, Mohammad A; Parvizi, Javad

    2015-01-01

    Despite the battery of available tests, the diagnosis of periprosthetic joint infection (PJI) remains a challenge. A comprehensive medical history and physical examination with appropriate radiographs followed by erythrocyte sedimentation rate and serum C-reactive protein are the first-line screening test for patients with suspected hip PJI. The second line of investigation of patients with abnormal serology or a strong suspicion for PJI, is joint aspiration. Aspirates should be sent for assessment of white blood cell count, polymorphonuclear percentage, leukocyte esterase strip test, and microbiology. If the first attempt fails, the joint should be re-aspirated at a different time. The International Consensus recommends against infiltration of saline or other fluids into a "dry" joint. In patients not planned for surgery but need further evaluation for PJI, a nuclear imaging study may help. In others with a planned revision surgery, intraoperative samples for frozen section and culture study are the best measures available. Treatment strategies for PJI are well established in the literature. Poor surgical candidates receive oral suppressive antibiotic therapy alone. Acute PJI, presenting within 4 weeks of the index surgery, or as a result of bacteraemia, may be treated with irrigation and debridement and implant retention. Chronic PJI, occurring more than 4 weeks after initial surgery, is treated with 1-stage or 2-stage revision arthroplasty. In some persistent infections or patients who refuse to undergo revision surgery, salvage procedures may be needed. PMID:26044538

  14. Analysis of Early Postoperative Pain in the First and Second Knee in Staged Bilateral Total Knee Arthroplasty: A Retrospective Controlled Study

    PubMed Central

    Sun, Jiuyi; Li, Lintao; Yuan, Shuai; Zhou, Yiqin

    2015-01-01

    Objective A retrospective analysis of early postoperative pain in the first and second knee in staged bilateral total knee arthroplasty (TKA) to provide a clinical evidence for the change of analgesic strategy. Methods From January 2009 to January 2013, 87 cases which meet the inclusion criterion were retrospectively reviewed. In stage TKA, the postoperative pain in the first and second knee at 24h, 48h, 72h after operation were compared using the visual analogue scale (VAS) score in the rest and maximum knee flexion position. The difference in pain scores (ΔVAS) was also compared between the second and first knee at different time intervals (less than 6 months, 6-12 months, more than 12 months). Results The VAS scores in the second knee were significantly higher than those in the first knee at 24h, 48h after surgery, but with no difference at 72h. The ΔVAS in the group of less than 6 months was significantly higher than of those more than 6 months, and there was no difference in ΔVAS between group of 6-12 months and group of more than 12 months. Conclusions Patient receiving staged bilateral TKA experiences greater postoperative pain within 48h after operation in the second knee than in the first knee, which can provide a clinical evidence to enhance the analgesic strategy in the second operation of the staged bilateral TKA. And for the management of postoperative pain in staged bilateral TKA, it’s better to recommend that the interval between two operations should be more than 6 months, which may reduce the postoperative pain in the second knee, improve patient satisfaction, and speed up patient‘s rehabilitation process. PMID:26068371

  15. Effects of Home-Based Interval Walking Training on Thigh Muscle Strength and Aerobic Capacity in Female Total Hip Arthroplasty Patients: A Randomized, Controlled Pilot Study

    PubMed Central

    Morishima, Yutaka; Mizushima, Takashi; Yamauchi, Katsuya; Morikawa, Mayuko; Masuki, Shizue; Nose, Hiroshi

    2014-01-01

    Due to the reduced physical activity of patients who have undergone total hip arthroplasty (THA), there are no home-based exercise training regimens for preventing muscle atrophy and aerobic capacity impairment in these patients. We examined whether interval walking training (IWT) could prevented these issues. Twenty-eight female patients (∼60 years of age) who had undergone THA more than 2 months prior were randomly divided into IWT (n = 14) and control (CNT, n = 14) groups. The IWT subjects trained at a target of 60 min of fast walking at >70% peak aerobic capacity for walking (O2peak) per wk for 12 wk, while those in the CNT maintained their previous sedentary life during the same period. We measured the energy expenditure of the daily physical activity, except during sleeping and bathing, every minute and every day during the intervention. We also measured the isometric knee extension (FEXT) and flexion (FFLX) forces, O2peak, and anaerobic threshold during the graded cycling exercise (O2AT) before and after the intervention. All subjects, except for one in IWT, completed the protocol. FFLX increased by 23% on the operated side (P = 0.003) and 14% on the non-operated side of IWT (P = 0.006), while it only increased on the operated side of CNT (P = 0.03). The O2peak and O2AT in IWT increased by 8% (P = 0.08) and 13% (P = 0.002), respectively, and these changes were significantly higher in the IWT than in CNT group (both, P<0.05). In conclusion, IWT might be an effective home-based training regimen for preventing the muscle atrophy from reduced daily physical activity in THA patients. Trial Registration UMIN-CTR UMIN000013172 PMID:25268505

  16. Early surgical and functional outcomes comparison of the supercapsular percutaneously-assisted total hip and traditional posterior surgical techniques for total hip arthroplasty: protocol for a randomized, controlled study

    PubMed Central

    Cronin, Michael D.; Gofton, Wade; Erwin, Lindsey; Chow, James

    2015-01-01

    Background Total hip arthroplasty (THA) is one of the most commonly performed and successful orthopaedic surgeries. While the long-term success of THA is well documented, there is still significant room for improving patient speed of recovery and return to activities. The surgical technique used during THA has the potential to affect these early outcomes. Methods The described design is a single center, prospective, randomized, controlled study. Subjects will be randomized to receive THA using either the supercapsular percutaneously-assisted total hip (SuperPath) or traditional posterior surgical techniques. Subjects will be evaluated using Timed Up and Go (TUG), Timed Stair Climb (TSC), Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and Visual Analog Scale (VAS) for pain level estimation preoperatively, during the hospital stay, and at 2, 6 weeks, and 100 days post-discharge. Other endpoints to be evaluated include: length of stay (LOS); discharge status; transfusion rates; readmission rates; complication rates; operative time; date returned to work; and acetabular component anteversion and inclination angles. Discussion The described study will determine the effect of a tissue-sparing surgical technique on short term subject recovery following THA in comparison to the most commonly used technique in clinical practice. PMID:26734645

  17. A correlation study of the American Shoulder and Elbow Society Score and the Oxford Shoulder Score with the use of regression analysis to predict one score from the other in patients undergoing reverse shoulder joint arthroplasty for cuff tear arthropathy

    PubMed Central

    Poon, Peter C

    2014-01-01

    Background More than 30 different scoring systems are available for evaluating outcomes of shoulder surgery. Unfortunately, given the multitude of scoring systems, there is no objective method to compare results between studies when different scoring systems are utilized. Methods We compared the American Shoulder and Elbow Society score (ASES) and the Oxford Shoulder Score (OSS) in patients undergoing reverse shoulder arthroplasty for cuff tear arthropathy. Twenty-nine patients had the ASES and OSS recorded pre-operatively, and at 6 and 12 months follow-up. The paired scores were assessed for their degree of correlation and sensitivity to change over time. Linear regression analysis was used to formulate a regression equation to predict one score from the other. Results The ASES and OSS correlated well with a Pearson’s correlation coefficient of 0.91 (p < 0.0001, n = 87). Both scores were sensitive to change. Regression analysis yielded a formula to predict the ASES from the OSS and vice versa with good accuracy (r2 = 0.83, F1,85 = 422.6, p < 0.0001). Conclusions Where good correlation exists, regression formulae can be used to accurately predict one score from the other in a specific population that it has been validated for. This can be of benefit when objectively comparing outcomes between studies using these two scoring systems.

  18. Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty

    PubMed Central

    Oh, Chang Hyun; Kim, Do Yeon; Ji, Gyu Yeul; Kim, Yeo Ju; Hyun, Dongkeun; Kim, Eun Young; Park, Hyeonseon; Park, Hyeong-Chun

    2014-01-01

    Purpose Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease. Materials and Methods Sixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery. Results VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded. Conclusion Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up. PMID:24954339

  19. Analytic study of the Tadoma method: background and preliminary results.

    PubMed

    Norton, S J; Schultz, M C; Reed, C M; Braida, L D; Durlach, N I; Rabinowitz, W M; Chomsky, C

    1977-09-01

    Certain deaf-blind persons have been taught, through the Tadoma method of speechreading, to use vibrotactile cues from the face and neck to understand speech. This paper reports the results of preliminary tests of the speechreading ability of one adult Tadoma user. The tests were of four major types: (1) discrimination of speech stimuli; (2) recognition of words in isolation and in sentences; (3) interpretation of prosodic and syntactic features in sentences; and (4) comprehension of written (Braille) and oral speech. Words in highly contextual environments were much better perceived than were words in low-context environments. Many of the word errors involved phonemic substitutions which shared articulatory features with the target phonemes, with a higher error rate for vowels than consonants. Relative to performance on word-recognition tests, performance on some of the discrimination tests was worse than expected. Perception of sentences appeared to be mildly sensitive to rate of talking and to speaker differences. Results of the tests on perception of prosodic and syntactic features, while inconclusive, indicate that many of the features tested were not used in interpreting sentences. On an English comprehension test, a higher score was obtained for items administered in Braille than through oral presentation. PMID:904318

  20. The Myres Hill remote sensing intercomparison study: preliminary results

    NASA Astrophysics Data System (ADS)

    Clive, P. J. M.; Chindurza, I.; Ravey, I.; Bass, J.; Boyle, R. J.; Jones, P.; Lang, S. J.; Bradley, S.; Hay, L.; Oldroyd, A.; Stickland, M.

    2008-05-01

    Two remote sensing techniques (SODAR and LIDAR) have been developed for measuring wind speed and turbulence from ground level up to altitudes of 300 m or higher. Although originally developed in the defence sector, these techniques are now generating considerable interest in the renewable energy and meteorological sectors. Despite the benefits of these instruments they are not yet generally accepted for due diligence measurements by wind energy developers and financial institutions. There is a requirement for a series of independent assessments of these new metrology techniques, comparing their measurements with the approved cup-type anemometer readings. This is being addressed at TUV NEL's Myres Hill wind turbine test site in a measurement programme supported by the DIUS National Measurement Systems Measurement for Innovators scheme and a consortium of 21 industrial collaborators. Data from SODAR and LIDAR systems are being compared with results from cup-type anemometers mounted at different heights on an 80m meteorological mast. An ultrasonic sensor is also mounted on the mast. The objective of the test programme is to assess the effectiveness of SODAR and LIDAR wind speed measurement techniques under different operating regimes and atmospheric conditions. Results from the measurements will provide definitive data on the performance of the remote wind speed sensing techniques under test on complex terrain typical of many wind farm sites. Preliminary measurements based on data acquired during the initial measurement campaign are presented.

  1. Preliminary study of a centrifugal-flow singlet oxygen generator

    SciTech Connect

    Shi, W; Deng, L; Yang, H; Sha, G; Zhang, C

    2008-02-28

    By using the concept of a high-pressure, gravity-independent singlet oxygen generator (SOG) proposed by Emanuel and based on the principle that a rotating fluid is capable of producing an enormous centrifugal force, a novel-type centrifugal-flow singlet oxygen generator (CFSOG) was designed and constructed. In this device, O{sub 2}({sup 1}{delta}) was generated in the reaction of gaseous Cl{sub 2} with a rotating basic hydrogen peroxide (BHP) liquid flow and then was removed from the BHP liquid phase by the centrifugal force. Meanwhile, the microdroplets formed during the Cl{sub 2}+BHP reaction were removed from the O{sub 2}({sup 1}{delta}) gas flow by the centrifugal force produced by the high-speed flow along an arc-shaped channel. Preliminary investigations showed that, because the specific reactive surface area of this SOG was noticeably larger than that of the jet-SOG normally used in current chemical oxygen-iodine lasers (COILs), the O{sub 2}({sup 1}{delta}) yield of {approx}60%, the O{sub 2}({sup 1}{delta}) partial pressure as high as 31 Torr, and chlorine utilisation higher than 96% were realised. Moreover, steady operation was obtained. (laser components)

  2. Preliminary study of a dispersed fringe type sensing system

    NASA Astrophysics Data System (ADS)

    Zhang, Yong; Liu, Gen-Rong; Wang, Yue-Fei; Li, Ye-Ping; Zhang, Ya-Jun; Zhang, Liang

    2009-08-01

    Telescopes with large aspherical primary mirrors collect more light and are therefore sought after by astronomers. Instead of using a single large one-piece mirror, smaller segments can be assembled into a useable telescopic primary. Because the segments must fit together to create the effect of a single mirror, segmented optics present unique challenges to the fabrication and testing that are absent in monolithic optics. A dispersed fringe sensor (DFS) using a broadband point source is an efficient method for cophasing and is also highly automated and robust. Unlike the widely adopted Shack-Hartmann Wavefront sensor and curvature wavefront sensor with edge sensors for calibration of relative pistons, DFS can estimate the piston between segments by only using the spectrum formed by the transmissive grating's dispersion, and therefore can replace the edge sensors, which are difficult to calibrate. We introduce the theory of the DFS and Dispersed Hartmann Sensor (DHS) for further utilization of the coarse phasing method of DFS. According to the theory, we bring out the preliminary system design of the cophasing experimental system based on DFS and DHS which is now established in our institute. Finally, a summary is reached.

  3. Periprosthetic Osteolysis after Total Wrist Arthroplasty

    PubMed Central

    Boeckstyns, Michel E. H.; Herzberg, Guillaume

    2014-01-01

    Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose of this study was to analyze the prevalence, location, and natural history of PPO following a TWA and to determine whether this was associated with prosthetic loosening. Patients and Methods We analyzed 44 consecutive cases in which a RE-MOTION TWA (Small Bone Innovations Inc., Morrisville, PA, USA) had been done. Results We found significant periprosthetic radiolucency (more than 2 mm in width) at the radial component side in 16 of the cases and at the carpal component side in 7. It developed gradually juxta-articularly around the prosthetic components regardless of the primary diagnosis, and seemed to stabilize in most patients after 1–3 years. In a small percentage of the patients, the periprosthetic area of bone resorption was markedly larger. In general, radiolucency was not related to evident loosening of the implant components, and only five carpal components and one radial had subsided or tilted. Conclusion Periprosthetic loosening is frequent following a TWA. In our series it was not necessarily associated with implant loosening and seemed to stabilize within 3 years. Close and continued observation is, however, recommended. Level of Evidence Therapeutic IV PMID:25032076

  4. Emerging technologies in arthroplasty: additive manufacturing.

    PubMed

    Banerjee, Samik; Kulesha, Gene; Kester, Mark; Mont, Michael A

    2014-06-01

    Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future. PMID:24764230

  5. Biomechanics of reverse total shoulder arthroplasty.

    PubMed

    Berliner, Jonathan L; Regalado-Magdos, Ashton; Ma, C Benjamin; Feeley, Brian T

    2015-01-01

    Reverse total shoulder arthroplasty is an effective procedure for treatment of glenohumeral joint disease among patients with severe rotator cuff deficiency. Improvements in prosthetic design are the result of an evolved understanding of both shoulder and joint replacement biomechanics. Although modern generations of the reverse shoulder prosthesis vary in specific design details, they continue to adhere to Grammont's core principles demonstrated by his original Delta III prosthesis. This review article discusses the biomechanics of reverse total shoulder arthroplasty with a focus on elements of implant design and surgical technique that may affect stability, postoperative complications, and functional outcomes. PMID:25441574

  6. Total Elbow Arthroplasty for Distal Humerus Fractures.

    PubMed

    Harmer, Luke S; Sanchez-Sotelo, Joaquin

    2015-11-01

    Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including the possibility of performing the procedure; leaving the extensor mechanism intact; faster, easier rehabilitation compared with internal fixation; and overall good outcomes reported in terms of both pain relief and function. Implant failure leading to revision surgery does happen, and patients must comply with certain limitations to extend the longevity of their implant. Development of high-performance implants may allow expanding the indications of elbow arthroplasty for fractures. PMID:26498549

  7. PAIN FOLLOWING TOTAL KNEE ARTHROPLASTY – A SYSTEMATIC APPROACH

    PubMed Central

    Alves, Wilson Mello; Migon, Eduardo Zaniol; Zabeu, Jose Luis Amim

    2015-01-01

    Total knee arthroplasty (TKA) is known to be a successful procedure. The aging of the population and the growing demand for quality of life have greatly increased the indications for the procedure. Nonetheless, TKA presents some complications that still lack definitive resolution. Pain after TKA is caused by a myriad of reasons that need to be systematically studied in order to reach the correct diagnosis and treatment. History, physical examination, laboratory tests and imaging examinations must all be included in the workup and repeated until a plausible reason has been identified, since if pain is the only indication for TKA revision, the results may be catastrophic. PMID:27022583

  8. Sensitivity to implant materials in patients with total knee arthroplasties.

    PubMed

    Granchi, Donatella; Cenni, Elisabetta; Tigani, Domenico; Trisolino, Giovanni; Baldini, Nicola; Giunti, Armando

    2008-04-01

    Materials used for total knee arthroplasty (TKA), may elicit an immune response whose role in the outcome of the arthroplasty is still unclear. The aim of this study was to evaluate the frequency of sensitization in patients who had undergone TKA, and the clinical impact of this event on the outcome of the implant. Ninety-four subjects were recruited, including 20 patients who had not yet undergone arthroplasty, 27 individuals who had a well-functioning TKA, and 47 patients with loosening of TKA components. Sensitization was detected by using patch testing including haptens representative of cobalt-based alloys (CoCrMo), titanium-based alloys (TiAlV), and bone cements. The frequency of positive skin reactions to metals increased significantly after TKA, either stable or loosened (No Implant 20%; Stable TKA 48.1%, p=0.05; Loosened TKA 59.6%, p=0.001, respectively). We found a higher frequency of positive patch testing to vanadium in patients who had a Stable TKA with at least one TiAlV component (39.1%, p=0.01). The medical history for metal allergy seems to be a risk factor, because the TKA failure was fourfold more likely in patients who had symptoms of metal hypersensitivity before TKA. The prognostic value was supported by survival analysis, because in these individuals the outcome of the implant was negatively influenced (the logrank test Chi square 5.1, p=0.02). This study confirms that in patients with a TKA the frequency of positive patch testing is higher than in the normal population, although no predictive value is attributable to the sensitization because patch testing was not able to discriminate between stable and loose implants. On the contrary, the presence of symptoms of metal allergy before implantation should be taken into account as a potential risk factor for TKA failure. PMID:18155140

  9. Medialized Versus Lateralized Center of Rotation in Reverse Shoulder Arthroplasty.

    PubMed

    Streit, Jonathan J; Shishani, Yousef; Gobezie, Reuben

    2015-12-01

    Reverse shoulder arthroplasty may be performed using components that medialize or lateralize the center of rotation. The purpose of this prospective study was to directly compare 2 reverse shoulder arthroplasty designs. Two treatment groups and 1 control group were identified. Group I comprised 9 patients using a medialized Grammont-style (GRM) prosthesis with a neck-shaft angle of 155°. Group II comprised 9 patients using a lateralized (LAT) prosthesis with a neck-shaft angle of 135°. Pre- and postoperative assessment of range of motion, American Shoulder and Elbow Surgeons score, and visual analog scale pain score were performed. Radiographic measurements of lateral humeral offset and acromiohumeral distance were compared. The GRM prosthesis achieved greater forward flexion (143.9° vs 115.6°; P=.05), whereas the LAT achieved greater external rotation (35.0° vs 28.3°; P=.07). The lateral humeral offset was greater for the LAT prosthesis compared with the GRM prosthesis, but this distance was not significantly different from that found in the control group. The acromiohumeral distance was significantly greater in the GRM prosthesis group compared with both the LAT and the control groups. The results of this study confirm that different reverse shoulder arthroplasty designs produce radiographically different anatomy. Whereas the GRM prosthesis significantly alters the anatomy of the shoulder, the LAT design can preserve some anatomic relationships found in the normal shoulder. The clinical outcomes indicate that this may have an effect on range of motion, with traditional designs achieving greater forward flexion and lateralized designs achieving greater external rotation. PMID:26652330

  10. CIRCUMFERENTIAL PROXIMAL FEMORAL ALLOGRAFTS IN TOTAL HIP ARTHROPLASTY REVISION SURGERY

    PubMed Central

    Roos, Bruno Dutra; Roos, Milton Valdomiro; Júnior, Antero Camisa; Lampert, Henrique Bonotto; da Silva, Matheus Luis

    2015-01-01

    Objective: To evaluate the clinical and radiographic results from patients who underwent femoral reconstruction secondary to loosening of total hip arthroplasty, using circumferential proximal femoral allografts and cemented implants. Methods: A retrospective study was conducted on 32 patients (33 hips) who underwent femoral reconstruction secondary to loosening of total hip arthroplasty, using circumferential proximal femoral allografts and cemented implants. Among these patients, 28 (29 hips) fulfilled all the requirements for this study. The mean follow-up was five years and two months. The clinical evaluation was done in accordance with the Harris Hip Score. Radiographically, the patients were assessed regarding reabsorption and consolidation of the allograft, migration of the greater trochanter, stability of the femoral component and heterotypic calcification. Results: The average preoperative Harris Hip Score was 32 points. At the last postoperative follow-up, the average score was 82 points. Allograft resorption of some degree was seen in nine hips (31%). Regarding consolidation, 24 cases (82.8%) showed full consolidation, three (10.3%) showed partial consolidation and two (6.9%) showed pseudarthrosis. All femoral components were stable. According to the criteria established, 27 cases (93.1%) were considered to be successful reconstructions after a mean follow-up of five years and two months. Conclusion: From the results obtained, it was concluded that use of circumferential proximal femoral allografts in selected cases of femoral reconstruction secondary to loosening of arthroplasty presented a high survival rate from the reconstruction over an average follow-up of five years and two months. PMID:27047896

  11. Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Tali, Maie; Maaroos, Jaak

    2010-01-01

    The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

  12. Relationship between Improvements in Physical Measures and Patient Satisfaction in Rehabilitation after Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Nazzal, Mahmoud I.; Bashaireh, Khaldoon H.; Alomari, Mahmoud A.; Nazzal, Mohammad S.; Maayah, Mikhled F.; Mesmar, Mohammad

    2012-01-01

    The aim of this study was to examine patient satisfaction with rehabilitation after total knee arthroplasty (TKA). Fifty-six patients, aged 45-77 years, were enrolled in a post-TKA comprehensive therapy program focusing on knee strengthening and functional activities. The program lasted 3 months and was conducted for 1 h, twice a day, 5 days per…

  13. Revision arthroplasty utilizing the Biomet Total Toe System for failed silicone elastomer implants.

    PubMed

    Koenig, R D

    1994-01-01

    The author presents a 3-year study of 10 cases of revisional arthroplasty utilizing the Biomet Total Toe System. The procedure is performed to eliminate pain and restore function in cases of metatarsophalangeal joint silicone elastomer implant failure. The surgeon should be familiar with the Total Toe System before attempting revision. PMID:8081327

  14. Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

    PubMed Central

    Esteban, Jaime; García-Cimbrelo, Eduardo

    2009-01-01

    Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1–12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70–98) in patients who underwent reimplantation and 56.8 (range, 32–76) in patients who underwent resection arthroplasty. Long cycles of combined oral antibiotics plus a two-stage surgical exchange appear a promising alternative for infections by highly resistant bacteria, methicillin-resistant Staphylococci, and polymicrobial infections. Level of Evidence: Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19333670

  15. Compartment syndrome after total knee arthroplasty: regarding a clinical case☆

    PubMed Central

    Pinheiro, Ana Alexandra da Costa; Marques, Pedro Miguel Dantas Costa; Sá, Pedro Miguel Gomes; Oliveira, Carolina Fernandes; da Silva, Bruno Pombo Ferreira; de Sousa, Cristina Maria Varino

    2015-01-01

    Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury. PMID:26401507

  16. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    PubMed Central

    2006-01-01

    conventional THR with a small (28 mm) ball. First, the large femoral head reduces the chance of dislocation, so that rates of dislocation are less than those with conventional THR. Second, the range of motion with hip resurfacing arthroplasty is higher than that achieved with conventional THR. A variety of MOM hip resurfacing implants are used in clinical practice. Six MOM hip resurfacing implants have been issued licences in Canada. Review Strategy A search of electronic bibliographies (OVID Medline, Medline In-Process and Other Non-Indexed Citations, Embase, Cochrane CENTRAL and DSR, INAHTA) was undertaken to identify evidence published from Jan 1, 1997 to October 27, 2005. The search was limited to English-language articles and human studies. The literature search yielded 245 citations. Of these, 11 met inclusion criteria (9 for effectiveness, 2 for safety). The result of the only reported randomized controlled trial on MOM hip resurfacing arthroplasty could not be included in this assessment, because it used a cemented acetabular component, whereas in the new generation of implants, a cementless acetabular component is used. After omitting this publication, only case series remained. Summary of Findings   Health Outcomes The Harris hip score and SF-12 are 2 measures commonly used to report health outcomes in MOM hip resurfacing arthroplasty studies. Other scales used are the Oxford hip score and the University of California Los Angeles hip score. The case series showed that the mean revision rate of MOM hip resurfacing arthroplasty is 1.5% and the incidence of femoral neck fracture is 0.67%. Across all studies, 2 cases of osteonecrosis were reported. Four studies reported improvement in Harris hip scores. However, only 1 study reported a statistically significant improvement. Three studies reported improvement in SF-12 scores, of which 2 reported a significant improvement. One study reported significant improvement in UCLA hip score. Two studies reported postoperative

  17. Identification of Emerging Self-Injurious Behavior in Young Children: A Preliminary Study

    ERIC Educational Resources Information Center

    Kurtz, Patricia F.; Chin, Michelle D.; Huete, John M.; Cataldo, Michael F.

    2012-01-01

    Self-injurious behavior (SIB) is a chronic disorder that often begins in early childhood; however, few studies have examined the onset of SIB in young children. This preliminary study reports on the identification, assessment, and observation of SIB in 32 children who had begun to engage in SIB within the previous 6 months. Participants were under…

  18. Preliminary Study: Special Education Doctoral Students' Perceptions of Self-Determination

    ERIC Educational Resources Information Center

    Kim, Kyeong-Hwa; Morningstar, Mary E.; Jung, Sungmin

    2014-01-01

    This preliminary study investigated 118 special education doctoral students' knowledge of and attitudes toward self-determination. In addition, this study examined the relationship between self-determination coursework and special education doctoral students' perceptions of how well they were prepared for implementing self-determination…

  19. A Preliminary Study of Guided Math in Title I Elementary Schools

    ERIC Educational Resources Information Center

    Fielder, Katherine Roberts

    2013-01-01

    This study sought to provide a preliminary examination of the relationship between the implementation of Guided Math and student achievement in Title I schools as measured by the percentage of students who met or exceeded the standard for the Georgia Mathematics CRCT. The study examined data from thirty Title I elementary schools in one suburban…

  20. Periprosthetic fractures in total hip arthroplasty.

    PubMed

    Van Flandern, Geoffrey J

    2005-09-01

    Periprosthetic fractures can be discussed in many formats. In this article, epidemiology, classification, and treatment are divided into the following three categories of periprosthetic fracture: intraoperative fractures detected at the time of surgery; intraoperative fractures undetected at the time of surgery, but detected postoperatively; and postoperative fractures occurring late after the arthroplasty procedure. PMID:16190043

  1. Implant Design in Cementless Hip Arthroplasty

    PubMed Central

    Kim, Jung Taek

    2016-01-01

    When performing cementless hip arthroplasty, it is critical to achieve firm primary mechanical stability followed by biological fixation. In order to achieve this, it is essential to fully understand characteristics of implant design. In this review, the authors review fixation principles for a variety of implants used for cementless hip replacement and considerations for making an optimal selection. PMID:27536647

  2. PRELIMINARY EXPOSURE ASSESSMENT FINDINGS FROM THE TAMPA ASTHMATIC CHILDREN'S STUDY

    EPA Science Inventory

    The Tampa Asthmatic Children's Study (TACS) was a pilot study that focused on developing and evaluating air pollution exposure assessment methods and participant recruiting tools. The four-week study was performed in October and November, 2003. The study involved repeated daily...

  3. Revision hip arthroplasty activity in a single UK health region: an audit of 1265 cases.

    PubMed Central

    Hassan, T.; Birtwistle, S.; Power, R. A.; Harper, W. M.

    2000-01-01

    Revision hip arthroplasty is an operation which is steadily increasing in number and can often be technically challenging. We have utilised a regional hip register (the Trent Regional Arthroplasty Study) to analyse the epidemiology of revision hip arthroplasties in a single UK health region. The study shows that of the large number (1265) of procedures performed over a 7-year period (1991-1997), the majority were performed by general orthopaedic surgeons, with 91 different surgeons performing the operation and only two surgeons performing more than 20 procedures per year. Of more than 100 prosthetic combinations used for the procedure, the Charnley prosthesis was the most common (38.3% of acetabular revisions and 37.5% of femoral revisions). The same component was also the most commonly explanted (43%). There was an even geographical spread across the region with revision hip arthroplasty being performed in all hospitals with an orthopaedic in-patient facility. Prospective audit of this large and varied cohort is necessary to determine differences in outcome (if any) between 'specialist' hip surgeons and general orthopaedic surgeons. Images Figure 1 PMID:10932666

  4. Pelvic Support Osteotomy in the Treatment of Patients With Excision Arthroplasty

    PubMed Central

    2008-01-01

    Resistant hip infection in adults can be a complicated problem that does not respond to surgical and medical treatment. In such cases, the only remaining option is excision arthroplasty. This line of treatment can eradicate the infection but also is associated with poor function. In some cases, conversion of excision arthroplasty to artificial joint replacement is associated with too great a risk because of local hip surgical risks or low immunity with risk of recurrent infection. Pelvic support osteotomy with the Ilizarov modification can present an alternative solution for such patients. This study included 11 patients with resistant hip infection who were treated using excision arthroplasty. Pelvic support osteotomy then was used to improve hip stability and abductor muscle function. The Ilizarov modification was applied to correct mechanical alignment of the limb and the limb length discrepancy. Harris hip scores improved in all patients: the average score preoperatively was 43.5 (range, 31–50), whereas at final followup, the average score was 70.9 (range, 65–80). Pelvic support osteotomy, along with the Ilizarov modification, can provide an alternative treatment to improve function in patients previously managed with excision hip arthroplasty and Girdlestone surgery. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18264860

  5. PRELIMINARY HEALTH BURDEN ANALYSIS FOR EPIDEMIOLOGIC RECREATIONAL WATER STUDY

    EPA Science Inventory

    Introduction: The National Epidemiological and Environmental Assessment of Recreational Water Study (NEEAR) offers a rare opportunity for researchers. The study's design involves the collection of health data before and after visiting the beach in conjunction with water quality...

  6. Synovial cutaneous fistula complicating a reverse total shoulder arthroplasty.

    PubMed

    Letter, Haley P; Limback, Joseph; Wasyliw, Christopher; Bancroft, Laura; Scherer, Kurt

    2016-06-01

    Reverse total shoulder arthroplasty is becoming a common form of shoulder arthroplasty that is often performed in the setting of rotator cuff pathology. Infection is a rare complication but is more common in reverse total shoulder arthroplasty than in hemiarthroplasty or anatomic total shoulder arthroplasty. We present the case of a 69-year-old patient with a reverse total shoulder arthroplasty who presented with purulent drainage from the skin of his anterior shoulder. Computed tomography arthrogram confirmed the presence of a synovial cutaneous fistula. Synovial cutaneous fistula is a rare variant of periprosthetic infection that, to our knowledge, has not been described previously in the setting of a reverse total shoulder arthroplasty. Computed tomography arthrogram proved to be a reliable method for confirming the diagnosis and was used for operative planning to remove the hardware. PMID:27257460

  7. The Status of Women in Alaska, 1977. A Preliminary Study.

    ERIC Educational Resources Information Center

    Jones, Dorothy M.; And Others

    To determine the precise nature and extent of the problem confronting Alaskan women, the Legislature in 1976 directed the Human Rights Commission to conduct a study on the status of women in education, employment, health, and the justice system. This publication contains the results of that study. Data for the study were secured through interviews…

  8. Preliminary planning study for safety relief valve experiments in a Mark III BWR pressure suppression system

    SciTech Connect

    McCauley, E.W.; Holman, G.S.

    1980-04-21

    In response to a request from the Water Reactor Safety Research Division of the US NRC, a preliminary study is provided which identifies key features and consideration involved in planning a comprehensive in-plant Safety Relief Valve experimental program for a Mark III containment design. The report provides identification of program objectives, measurement system requirements, and some details quantifying expected system response. In addition, a preliminary test matrix is outlined which involves a supporting philosophy intended to enhance the usefulness of the experimental results for all members of the program team: experimentalists, analysts, and plant operator.

  9. Systems design study of the Pioneer Venus spacecraft. Volume 2. Preliminary program development plan

    NASA Technical Reports Server (NTRS)

    1973-01-01

    The preliminary development plan for the Pioneer Venus program is presented. This preliminary plan treats only developmental aspects that would have a significant effect on program cost. These significant development areas were: master program schedule planning; test planning - both unit and system testing for probes/orbiter/ probe bus; ground support equipment; performance assurance; and science integration Various test planning options and test method techniques were evaluated in terms of achieving a low-cost program without degrading mission performance or system reliability. The approaches studied and the methodology of the selected approach are defined.

  10. Total Hip Arthroplasty for Hip Fractures

    PubMed Central

    Monzón, Daniel Godoy; Iserson, Kenneth V.; Jauregui, José; Musso, Carlos; Piccaluga, Francisco; Buttaro, Martin

    2014-01-01

    Introduction: This study aimed to determine the dislocation and reoperation rate, functional outcomes, and the survival rate of the unique subset of very old but lucid and independent patients with hip fractures following a total hip arthroplasty (THA) and geriatric team-coordinated perioperative care. Method: Between 2000 and 2006, previously independent ambulatory patients ≥80 years old presenting with an intracapsular hip fracture were given THAs under the care of an integrated orthopedic surgery–geriatric service. Their fracture-related complications, ambulation, mental status, and survival were followed for 5 to 11 years postinjury. Results: Five years postinjury, 57 (61.3%) patients of the original study group were living. In all, 3 (3.2%) patients had postoperative hip dislocations (and 2 patients had dislocation twice) and 2 reoperations were needed within the first postoperative month. There were no hip dislocations or reoperations after the first year. Radiographs obtained on 88% of the surviving patients at 5 years postoperatively showed that all remained unchanged from their immediate postoperative images. Nearly half of the patients were still able to ambulate as they did preoperatively and their mixed-model equation was statistically unchanged. Conclusion: This study of patients >80 years old with previously good functional status demonstrates that with appropriate surgical (best prosthesis, good operating technique, and regional anesthesia) and geriatric (pre- and postoperative assessments, close follow-up, medication adjustments, and fall-prevention instruction) care, they have few hip dislocations and reoperations, survive postfracture at least as long as their noninjured contemporaries, and continue to function and ambulate as they did prior to their injury. PMID:24660092

  11. Preliminary study of Kelso Dunes using AVIRIS, TM, and AIRSAR

    NASA Technical Reports Server (NTRS)

    Xu, Pung; Blumberg, Dan G.; Greeley, Ronald

    1995-01-01

    Remote sensing of sand dunes helps in the understanding of aeolian process and provides important information about the regional geologic history, environmental change, and desertification. Remotely sensed data combined with field studies are valuable in studying dune morphology, regional aeolian dynamics, and aeolian depositional history. In particular, active and inactive sands of the Kelso Dunes have been studied using landsat TM and AIRSAR. In this report, we describe the use of AVIRIS data to study the Kelso dunes and to compare the AVIRIS information with that from TM and AIRSAR.

  12. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    PubMed Central

    Shin, Young-Soo; Hwang, Yeok-Gu; Savale, Abhijit Prakash

    2014-01-01

    An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty. PMID:24944978

  13. Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty.

    PubMed

    Saffo, Zaid; Ognjan, Anthony

    2016-01-01

    The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a

  14. Total Limb Rotation after Unilateral Total Knee Arthroplasty: Side-to-Side Discrepancy.

    PubMed

    Oh, Kwang-Jun; Yoon, Seok-Tae; Ko, Young-Bong

    2016-08-01

    Total limb rotation, an important anatomical feature of the lower limb, is defined as any rotation of the lower limb on its longitudinal axis. The aim of the present study was to evaluate the discrepancies of rotational profiles of total limb between nonoperated and operated limb following unilateral total knee arthroplasty. We conducted an analysis of the computed tomography (CT) data from 32 patients undergoing primary unilateral total knee arthroplasty. Using these CT scan, rotational profiles of total limb, such as femoral neck anteversion angle expressed as femoral torsion angle (FTA), tibial torsion angle (TTA), knee joint rotation angle (KJRA), and total limb rotation (TLR) were measured. There were significant discrepancies of FTA and KJRA between operated and nonoperated limb following unilateral total knee arthroplasty. The mean difference of operated and nonoperated side for FTA and KJRA were -6.51 ± 11.88 degrees (p = 0.0041) and -6.83 ± 5.04 degrees (p < 0.001), respectively. However, there were no significant discrepancies of TLR, TTA. These results are due to the compensation effect of KJRA. However, excessive external rotation of the femoral component beyond the compensation effect of prosthetic knee joint can lead to a total limb rotational discrepancy in patient undergoing unilateral total knee arthroplasty. PMID:26571050

  15. Venous thromboembolism prophylaxis after total hip or knee arthroplasty: a survey of Canadian orthopedic surgeons

    PubMed Central

    Gross, Michael; Anderson, David R.; Nagpal, Seema; O’Brien, Bernie

    1999-01-01

    Objective To determine the pharmacologic and physical modalities used by orthopedic surgeons in Canada to prevent venous thromboembolism (deep venous thrombosis and pulmonary embolism) after total hip or knee arthroplasty. Design Mail survey sent to all members of the Canadian Orthopaedic Association. Setting A nation-wide study. Methods A total of 828 questionnaires, designed to identify the type and frequency of prophylaxis against venous thromboembolism that were used after hip and knee arthroplasty were mailed to orthopedic surgeons. Outcome measures Demographic data and the frequency and type of thromboprophylaxis. Results Of the 828 surveys mailed 445 (54%) were returned, and 397 were included in this analysis. Of the respondents, 97% used prophylaxis routinely for patients who undergo total hip or knee arthroplasty. Three of the 397 (0.8%) did not use any method of prophylaxis. Warfarin was the most common agent used (46%), followed by low-molecular-weight heparin (LMWH) (36%). Combination therapy with both mechanical and pharmacologic methods were used in 39% of patients. Objective screening tests were not frequently performed before discharge. Extended prophylaxis beyond the duration of hospitalization was used by 36% of physicians. Conclusion Prophylaxis for venous thromboembolism with warfarin or LMWH has become standard care after total hip or knee arthroplasty in Canada. PMID:10593248

  16. Role of negative pressure wound therapy in total hip and knee arthroplasty.

    PubMed

    Siqueira, Marcelo Bp; Ramanathan, Deepak; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K

    2016-01-18

    Negative-pressure wound therapy (NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trials including single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections. PMID:26807353

  17. Role of negative pressure wound therapy in total hip and knee arthroplasty

    PubMed Central

    Siqueira, Marcelo BP; Ramanathan, Deepak; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K

    2016-01-01

    Negative-pressure wound therapy (NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trials including single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections. PMID:26807353

  18. Migration and head penetration of Vitamin-E diffused cemented polyethylene cup compared to standard cemented cup in total hip arthroplasty: study protocol for a randomised, double-blind, controlled trial (E1 HIP)

    PubMed Central

    Sköldenberg, Olof; Rysinska, Agata; Chammout, Ghazi; Salemyr, Mats; Muren, Olle; Bodén, Henrik; Eisler, Thomas

    2016-01-01

    Introduction In vitro, Vitamin-E-diffused, highly cross-linked polyethylene (PE) has been shown to have superior wear resistance and improved mechanical properties when compared to those of standard highly cross-linked PE liners used in total hip arthroplasty (THA). The aim of the study is to evaluate the safety of a new cemented acetabular cup with Vitamin-E-doped PE regarding migration, head penetration and clinical results. Methods and analysis In this single-centre, double-blinded, randomised controlled trial, we will include 50 patients with primary hip osteoarthritis scheduled for THA and randomise them in a 1:1 ratio to a cemented cup with either argon gas-sterilised PE (control group) or Vitamin-E-diffused PE (vitamin-e group). All patients and the assessor of the primary outcome will be blinded and the same uncemented stem will be used for all participants. The primary end point will be proximal migration of the cup at 2 years after surgery measured with radiostereometry. Secondary end points include proximal migration at other follow-ups, total migration, femoral head penetration, clinical outcome scores and hip-related complications. Patients will be followed up at 3 months and at 1, 2, 5 and 10 years postoperatively. Results Results will be analysed using 95% CIs for the effect size. A regression model will also be used to adjust for stratification factors. Ethics and dissemination The ethical committee at Karolinska Institutet has approved the study. The first results from the study will be disseminated to the medical community via presentations and publications in relevant medical journals when the last patient included has been followed up for 2 years. Trial registration number NCT02254980. PMID:27388352

  19. Young Children's Perceptions of Scientists: A Preliminary Study

    ERIC Educational Resources Information Center

    Buldu, Mehmet

    2006-01-01

    Background: Since the 1950s, there has been a growing body of research dealing with perceptions children have of scientists. Typically, research studies in this area have utilized children's drawings in an effort to discern what those perceptions are. Studies assessing perceptions children have of scientists have shown that children have…

  20. Supporting Off-Shore Students: A Preliminary Study

    ERIC Educational Resources Information Center

    Hussin, Virginia

    2007-01-01

    This paper reports on the first part of a recent research study into current initiatives to support the learning of non-English speaking background (NESB) transnational students in Asia who are studying off-shore at Australian universities. Learning support and development staff in 12 universities were surveyed using a questionnaire. The survey…

  1. Citations to Wikipedia in Chemistry Journals: A Preliminary Study

    ERIC Educational Resources Information Center

    Brazzeal, Bradley

    2011-01-01

    Wikipedia has been the subject of an increasing number of studies. Many of these have focused on the quality of Wikipedia articles and the use of Wikipedia by students. Little research has focused on the use of Wikipedia by scholars. This study helps to fill that gap by examining citations to Wikipedia in chemistry journals from three major…

  2. A Quantitative Approach to Investigating Spanish HL Speakers' Characteristics and Motivation: A Preliminary Study

    ERIC Educational Resources Information Center

    Yanguas, Inigo

    2010-01-01

    The present preliminary study empirically investigated Spanish heritage language (HL) speakers in Spanish for native speakers (SNS) college courses. It focused on their attitudes and motivation to improve their HL and on their varying linguistic competences in that language. A well-established second language acquisition (SLA) motivational model…

  3. Zero-gravity cloud physics laboratory: Experiment program definition and preliminary laboratory concept studies

    NASA Technical Reports Server (NTRS)

    Eaton, L. R.; Greco, E. V.

    1973-01-01

    The experiment program definition and preliminary laboratory concept studies on the zero G cloud physics laboratory are reported. This program involves the definition and development of an atmospheric cloud physics laboratory and the selection and delineations of a set of candidate experiments that must utilize the unique environment of zero gravity or near zero gravity.

  4. Validity and Reliability of Turkish Version of Gilliam Autism Rating Scale-2: Results of Preliminary Study

    ERIC Educational Resources Information Center

    Diken, Ibrahim H.; Diken, Ozlem; Gilliam, James E.; Ardic, Avsar; Sweeney, Dwight

    2012-01-01

    The purpose of this preliminary study was to explore the validity and reliability of Turkish Version of the Gilliam Autism Rating Scale-2 (TV-GARS-2). Participants included 436 children diagnosed with autism (331 male and 105 female, mean of ages was 8.01 with SD = 3.77). Data were also collected from individuals diagnosed with intellectual…

  5. Work Experiences of People with Mental Illness in Malaysia: A Preliminary Qualitative Study

    ERIC Educational Resources Information Center

    Boo, Su-Lyn; Loong, Jaymee; Ng, Wai-Sheng

    2011-01-01

    This is a preliminary qualitative study, using a basic interpretive approach, to investigate the work experiences of people with mental illness in Malaysia. Six females and four males (aged 30-70) from a residential home for the mentally ill participated in semi-structured interviews. Three inter-relating themes emerged, namely the experience of…

  6. Factors affecting weight gain and dietary intake in Latino males residing in Mississippi: A preliminary study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Research indicates that as Latinos become more acculturated to the United States, their diet changes and they experience weight gain. There is also a high incidence of depression in this population. The purpose of this preliminary study was to examine the correlations between sociodemographic factor...

  7. The Development of a Computer Model for Projecting Statewide College Enrollments: A Preliminary Study.

    ERIC Educational Resources Information Center

    Rensselaer Research Corp., Troy, NY.

    The purpose of this study was to develop the schema and methodology for the construction of a computerized mathematical model designed to project college and university enrollments in New York State and to meet the future increased demands of higher education planners. This preliminary report describes the main structure of the proposed computer…

  8. A Preliminary Study of Teachers' Perceptions of Sex Education in Hong Kong Preschools

    ERIC Educational Resources Information Center

    Lai, Yuk Ching

    2006-01-01

    In Hong Kong, once a British colony, sex has traditionally been viewed as taboo and, as such, seldom talked about or openly discussed in public. As a result, there is reluctance on the part of most pre-to-secondary schools to implement sex education. The aim of this preliminary study was to investigate teachers' perceptions of preschool sex…

  9. Nd:YAG laser treatment of herpes and aphthous ulcers: a preliminary study

    NASA Astrophysics Data System (ADS)

    Parkins, Frederick M.; O'Toole, Thomas J.; Yancey, John M.

    2000-06-01

    Previously herpes labialis and recurrent aphthous ulcers have not been successfully treated. A preliminary study with a pulsed Nd:YAG laser evaluated the results with a protocol of four minute non-contact exposures for both types of lesions. Most patients experienced relief of symptoms. The progress of herpes lesion was halted and aphthous lesions became desensitized.

  10. Factorial Structure of the Pain Rehabilitation Expectations Scale: A Preliminary Study

    ERIC Educational Resources Information Center

    Cheing, Gladys L. Y.; Lai, Amy K. M.; Vong, Sinfia K. S.; Chan, Fong H.

    2010-01-01

    The aim of this study was to report the preliminary validation results for the Pain Rehabilitation Expectations Scale (PRES). The PRES is a clinical tool developed to measure the expectations about rehabilitation treatment and outcome for people with back pain. Fifty people with chronic back pain were recruited from 11 physiotherapy outpatient…

  11. Correlates of Cigarette Smoking among Male Chinese College Students in China--A Preliminary Study

    ERIC Educational Resources Information Center

    Li, Kaigang; Kay, Noy S.

    2009-01-01

    The main purpose of this preliminary study was to examine the association between four constructs of the Health Belief Model (HBM) (i.e. perceived severity of smoking-related health problems, perceived susceptibility to smoking-health related problems, perceived barriers to non-smoking and perceived benefits of non-smoking) and cigarette smoking …

  12. School Library Support of Health Education in China: A Preliminary Study

    ERIC Educational Resources Information Center

    Liu, Geoffrey Z.; Zhang, Wuhong

    2008-01-01

    This preliminary study investigates the current situation of school library support of K-12 health education in China. A survey of 42 school librarians and 115 K-12 teachers from selected schools was conducted to find out their views about school library's role in school health education and their current practice of library use in health…

  13. Comparison of Brain Activity during Drawing and Clay Sculpting: A Preliminary qEEG Study

    ERIC Educational Resources Information Center

    Kruk, Kerry A.; Aravich, Paul F.; Deaver, Sarah P.; deBeus, Roger

    2014-01-01

    A preliminary experimental study examined brain wave frequency patterns of female participants (N = 14) engaged in two different art making conditions: clay sculpting and drawing. After controlling for nonspecific effects of movement, quantitative electroencephalographic (qEEG) recordings were made of the bilateral medial frontal cortex and…

  14. Intraoperative nerve monitoring during total shoulder arthroplasty surgery

    PubMed Central

    Aresti, Nick; Plumb, Karen; Cowan, Joseph; Higgs, Deborah; Lambert, Simon; Falworth, Mark

    2014-01-01

    Background Nerve injury is an acknowledged complication of total shoulder arthroplasty (TSA). Although the incidence of postoperative neurological deficit has been reported to be between 1% and 16%, the true incidence of nerve damage is considered to be higher. The present study aimed to identify the rate of intraoperative nerve injury during total shoulder arthroplasty and to determine potential risk factors. Methods A prospective study of nerve conduction in 21 patients who underwent primary or revision TSA was carried out over a 12-month period. Nerve conduction was monitored by measuring intraoperative sensory evoked potentials (SEP). A significant neurophysiological signal change was defined as either a unilateral or bilateral decrease in SEP signal of ≥50%, a latency increase of ≥10% or a change in waveform morphology, not caused by operative or anaesthetic technique. Results Seven (33%) patients had a SEP signal change. The only significant risk factor identified for signal change was male sex (odds ratio 15.00, 95% confidence interval). The median nerve was the most affected nerve in the operated arm. All but one signal change returned to normal before completion of the operation and no patient had a persisting postoperative clinical neurological deficit. Conclusions The incidence of intraoperative nerve damage may be more common than previously reported. However, the loss of SEP signal is reversible and does not correlate with persisting clinical neurological deficits. The median nerve appears to be most at risk. Monitoring SEPs in the operated limb during TSA may be a valuable tool during TSA.

  15. Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

    PubMed Central

    Zielinski, Stephanie M.; Keijsers, Noël L.; Praet, Stephan F.E.; Heetveld, Martin J.; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M.M.

    2014-01-01

    Objectives To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design Secondary cohort study to a randomized controlled trial. Setting Multicenter trial in the Netherlands, including 14 academic and non-academic hospitals Patients Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. Intervention None (observatory study) Main outcome measurements Patient characteristics, SF-12, and WOMAC scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamometer. Differences between the fractured and contralateral leg were calculated. Groups were compared using univariate analysis. Results Of 248 internal fixation patients (median age 72 years), salvage arthroplasty was performed in 68 patients (27%). Salvage arthroplasty patients had a significantly lower WOMAC score (median 73 versus 90, P=0.016) than patients who healed uneventfully after internal fixation. Health-related QOL (SF-12) and patient independency did not differ significantly between the groups. Gait analysis showed a significantly impaired progression of the center of pressure in the salvage surgery patients (median ratio −8.9 versus 0.4, P=0.013) and a significant greater loss of abduction strength (median −25.4 versus −20.4 N, P=0.025). Conclusion Despite a similar level of dependency and QOL, salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture. PMID:24835623

  16. Bipolar hip arthroplasty as salvage treatment for loosening of the acetabular cup with significant bone defects

    PubMed Central

    Ghanem, Mohamed; Glase, Almuth; Zajonz, Dirk; Roth, Andreas; Heyde, Christoph-E.; Josten, Christoph; von Salis-Soglio, Georg

    2016-01-01

    Introduction: Revision arthroplasty of the hip is becoming increasingly important in recent years. Early primary arthroplasty and longer life expectancy of the patients increases the number of revision surgery. Revision surgery of hip arthroplasty is major surgery for the patients, especially the elderly, with significant risks concerning the general condition of the patient. The aim of this work is to evaluate the outcome of bipolar hip arthroplasty as a salvage procedure for treatment of loosening of the acetabular cup with significant acetabular bone defects after total hip replacement (THR) in multi-morbid patients. Patients and methods: During the period from January 1st 2007 to December 31st 2011 19 revision hip surgeries were performed in 19 patients, in which the loosened acetabular cup was replaced by a bipolar head. The examined patient group consisted exclusively of female patients with an average of 75 years. The predominant diagnosis was “aseptic loosening” (84.2%). All patients in our study were multi-morbid. We decided to resort to bipolar hip arthroplasty due to the compromised general condition of patients and the major acetabular bone defects, which were confirmed intraoperatively. The postoperative follow-up ranged from 0.5 to 67 months (average 19.1 months). Results: Evaluation of the modified Harris Hip Score showed an overall improvement of the function of the hip joint after surgery of approximately 45%. Surgery was less time consuming and thus adequate for patients with significantly poor general health condition. We noticed different complications in a significant amount of patients (68.4%). The most common complication encountered was the proximal migration of the bipolar head. The rate of revision following the use of bipolar hip arthroplasty in revision surgery of the hip in our patients was high (21%). Despite the high number of complications reported in our study, we have noticed significant improvement of hip joint function as

  17. Evaluation of biocompatible osteoconductive polymer shelf arthroplasty for the surgical correction of hip dysplasia in normal dogs.

    PubMed Central

    Lussier, B; Lanthier, T; Martineau-Doizé, B

    1994-01-01

    Biocompatible osteoconductive polymer (BOP) shelf arthroplasty was performed on ten nondysplastic dogs, divided into five groups. Each group was evaluated at 6, 13, 17, 26 or 39 weeks postsurgery. Evaluation consisted of clinical, radiological and histological studies. The dogs were injected with three fluorochrome markers, 28 days, 14 days and 6 hours before euthanasia. Transverse sections of undecalcified arthroplasty site were examined by microradiography and fluorescence microscopy; surface-stained sections were evaluated by light microscopy. The BOP shelf arthroplasty was not technically difficult. Minimal mineralization of the shelf was noted by radiography, 26 and 39 weeks postop. A moderate to large amount of fibrous mature connective tissue was observed around the BOP fibers throughout the study. Bone ingrowth occurred around the BOP fibers, but was minimal within them. This osseous proliferation of the arthroplasty was very slow to take place; it was first noted microscopically 17 weeks postsurgery and was still minimal 39 weeks after surgery. These findings suggest that there may be interference to the osteoconductive properties of BOP by fibrous tissue. Ossification of the shelf arthroplasty was too unsatisfactory to recommend its use for the treatment of canine hip dysplasia. Images Fig. 2. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:7954118

  18. Unexpected wear of an unicompartimental knee arthroplasty in oxidized zirconium.

    PubMed

    Luyet, Anais; Fischer, Jean-François; Jolles, Brigitte M; Lunebourg, Alexandre

    2015-12-01

    Unicompartimental knee arthroplasty is a successful procedure for the treatment of localized osteoarthritis to one compartment of the knee with good long-term results. However, several modes of failure of unicompartimental knee arthroplasty have been described, namely aseptic or septic loosening, progression of disease, wear, and instability. Metallosis after unicompartimental knee arthroplasty is rarely reported and is most often related with polyethylene wear or break. We report on a case of rapid failure of unicompartimental knee arthroplasty in oxidized zirconium associated with metallosis secondary to the dislocation of the polyethylene. PMID:26790806

  19. The rotating platform mobile bearing total knee arthroplasty.

    PubMed

    Sorrells, R B

    2000-01-01

    The recent evolution of total knee arthroplasty (TKA) has been substantial and unlike that of total hip arthroplasty (THA). The current THA technique is similar to that initially developed and perfected by Professor John Charnley in the mid 1960s. The ball-and-socket articulation of the hip is simple and reproducible biomechanically. The long term (20 years and longer) results with total hip arthroplasty have been very satisfactory. The THA prosthetic designs of today remain similar to those of years past. Improvements have been in biomaterials, methods of fixation and surgical technique. The total knee arthroplasty prostheses of today differ greatly from their predecessors. PMID:21136412

  20. The Rotating Platform Mobile Bearing Total Knee Arthroplasty.

    PubMed

    Sorrells, R Barry

    2000-10-01

    The recent evolution of total knee arthroplasty (TKA) has been substantial and unlike that of total hip arthroplasty (THA). The current THA technique is similar to that initially developed and perfected by Professor John Charnley in the mid 1960s. The ball-and-socket articulation of the hip is simple and reproducible biomechanically. The long term (20 years and longer) results with total hip arthroplasty have been very satisfactory. The THA prosthetic designs of today remain similar to those of years past. Improvements have been in biomaterials, methods of fixation and surgical technique. The total knee arthroplasty prostheses of today differ greatly from their predecessors. PMID:12219304

  1. Numerical aerodynamic simulation facility preliminary study, volume 2 and appendices

    NASA Technical Reports Server (NTRS)

    1977-01-01

    Data to support results obtained in technology assessment studies are presented. Objectives, starting points, and future study tasks are outlined. Key design issues discussed in appendices include: data allocation, transposition network design, fault tolerance and trustworthiness, logic design, processing element of existing components, number of processors, the host system, alternate data base memory designs, number representation, fast div 521 instruction, architectures, and lockstep array versus synchronizable array machine comparison.

  2. Preliminary studies of combustor sensitivity to alternative fuels

    NASA Technical Reports Server (NTRS)

    Humenik, F. M.

    1980-01-01

    Combustion problems associated with using alternative fuels ground power and aeropropulsion applications were studied. Rectangular sections designed to simulate large annular combustor test conditions were examined. The effects of using alternative fuels with reduced hydrogen content, increased aromatic content, and a broad variation in fuel property characteristics were also studied. Data of special interest were collected which include: flame radiation characteristics in the various combustor zones; the correponding increase in liner temperature from increased radiant heat flux; the effect of fuel bound nitrogen on oxides of nitrogen (NO sub x) emissions; and the overall total effect of fuel variations on exhaust emissions.

  3. US Army Chemical Corps Vietnam veterans health study: preliminary results.

    PubMed

    Kang, H K; Dalager, N A; Needham, L L; Patterson, D G; Matanoski, G M; Kanchanaraksa, S; Lees, P S

    2001-01-01

    The long-term health consequences of exposure to phenoxyherbicides used in Vietnam has been a great concern to the veterans. In addition to the Air Force Ranch Hand personnel, Army Chemical Corps personnel who served in Vietnam are thought to have had some of the highest herbicide exposures. The Department of Veterans Affairs commenced a study of veterans who served in Vietnam as members of the Army Chemical Corps and a comparison cohort of Army Chemical Corps personnel who served elsewhere. A total of 2872 Vietnam veterans and 2737 non-Vietnam veterans who served in the Army Chemical Corps were identified for inclusion in a telephone health interview survey with a random 20% sample of veterans receiving serum dioxin and other congeners assessments. In a feasibility study which included 284 Vietnam veterans and 281 non-Vietnam veterans, 100 serum assessments were conducted of which 95 were included in the analysis. Vietnam veterans with a history of spraying herbicides were found to have a statistically significant elevation in their current serum 2,3,7,8-TCDD concentrations compared to non-Vietnam veterans without a spray history (P = 0.05). Other 2,3,7,8-substituted dioxins levels were comparable to the levels found in the non-Vietnam veterans. This feasibility study demonstrated that serum dioxin concentrations from a sample of the study participants can be used to identify exposure variables in the health survey that can serve as a surrogate measure of phenoxyherbicide exposure. PMID:11372888

  4. Violence Prevention in Middle School: A Preliminary Study

    ERIC Educational Resources Information Center

    KIllam, Wendy K.; Roland, Catherine B.; Weber, Bill

    2014-01-01

    Violence in schools continues reflecting violence within society. There is a growing need for violence prevention programs within the schools that provide students with the skills needed to cope with interpersonal and relationship is-sues effectively. This study was conducted at a middle school and there were 345 middle school students (6th to 8th…

  5. Burnout among Special Education Administrators: A Preliminary Study

    ERIC Educational Resources Information Center

    Carter, Susan J.

    2011-01-01

    Research on the extent of stress and burnout among special education administrators is not as well developed as research on the extent of stress and burnout among teachers. This study utilized the Maslach Burnout Inventory to determine levels of stress and burnout among administrators of special education. Results indicated administrators of…

  6. Problems of Eskimo Relocation for Industrial Employment. A Preliminary Study.

    ERIC Educational Resources Information Center

    Stevenson, D. S.

    A study was conducted to determine the reasons for variable success in relocating Eskimo families from rural areas of the northern territories of Canada to southern centers of industrial employment (railways, mining centers). The data were collected by interviewing 105 Eskimos, both male and female, married and single, who had migrated south. The…

  7. Preliminary lithostratigraphic correlation study in OAPEC member countries

    SciTech Connect

    Lababidi, M.M.; Hamdan, A.N.

    1985-01-01

    This book examines a study correlating rock units in the Middle Eastern and North African member countries, based on direct information from the members. It comprises Paleozoic, Mesozoic, and Cenozoic correlation charts for each region and a lexicon giving the definition, age, lithology, and equivalents of each formation.

  8. From Numbers to Action: A Preliminary Study of Retention.

    ERIC Educational Resources Information Center

    Greenlee, Shelia Parker; Greenlee, Harry

    This study examined retention at Christopher Newport University (CNU) in Newport News, Virginia, focusing on the demographic characteristics of those students who left the university as well as the reasons why they left. A total of 159 students who had attended CNU during the 1994-95 academic year but who did not re-enroll in the fall of 1995 were…

  9. Preliminary study of NAVSTAR/GPS for general aviation

    NASA Technical Reports Server (NTRS)

    Alberts, R. D.; Ruedger, W. H.

    1976-01-01

    The activities conducted as a planning effort to focus attention on the applicability of the global positioning system for general aviation are described. The description of GPS, its impact on economic and functional aspects of general aviation avionics, as well as a declaration of potential extensions of the basic concept have been studied in detail.

  10. Competence Supporting Aspects of Day Care Environments: A Preliminary Study.

    ERIC Educational Resources Information Center

    Biemiller, Andrew; And Others

    This study examined the applicability of Watts' Human Interaction Scale to day care settings, and was also concerned at a more general level with the question of whether it is possible for day care settings to approximate good homes. Six 2-year-olds in each of two day care centers were each videotaped for a total of 45 minutes in a variety of…

  11. Renal denervation by intravascular ultrasound: Preliminary in vivo study

    NASA Astrophysics Data System (ADS)

    Sinelnikov, Yegor; McClain, Steve; Zou, Yong; Smith, David; Warnking, Reinhard

    2012-10-01

    Ultrasound denervation has recently become a subject of intense research in connection with the treatment of complex medical conditions including neurological conditions, development of pain management, reproduction of skin sensation, neuropathic pain and spasticity. The objective of this study is to investigate the use of intravascular ultrasound to produce nerve damage in renal sympathetic nerves without significant injury to the renal artery. This technique may potentially be used to treat various medical conditions, such as hypertension. The study was approved by the Institutional Animal Care and Use Committee. Ultrasound was applied to renal nerves of the swine model for histopathological evaluation. Therapeutic ultrasound energy was delivered circumferentially by an intravascular catheter maneuvered into the renal arteries. Fluoroscopic imaging was conducted pre-and post-ultrasound treatment. Animals were recovered and euthanized up to 30 hours post procedure, followed by necropsy and tissue sample collection. Histopathological examination showed evidence of extensive damage to renal nerves, characterized by nuclear pyknosis, hyalinization of stroma and multifocal hemorrhages, with little or no damage to renal arteries. This study demonstrates the feasibility of intravascular ultrasound as a minimally invasive renal denervation technique. Further studies are necessary to evaluate the long-term safety and efficacy of this technique and its related clinical significance.

  12. Methods Courses, So What? Preliminary Findings of a Longitudinal Study.

    ERIC Educational Resources Information Center

    Meyer, Richard J.; Flores-Duenas, Leila; Rossi, Pamela

    This study examined influences that preservice literacy teacher education courses and sustained relationships with literacy researchers had on the literacy practices of three preservice teachers during student teaching and their subsequent self-efficacy and performance as literacy teachers during their first teaching years. Data collected during…

  13. Theoretical Evaluation Self-Test (Test): A Preliminary Validation Study

    ERIC Educational Resources Information Center

    Coleman, Daniel

    2004-01-01

    Over nearly 40 years, several scales have been developed to measure therapist theoretical orientation (Poznanski & McLennan, 1995). This study, unlike previous efforts, focuses on "community clinicians"--social workers and other mental health professionals (such as psychologists, counselors, psychiatrists, and psychiatric nurses) who work in…

  14. Computer-Generated Geometry Instruction: A Preliminary Study

    ERIC Educational Resources Information Center

    Kang, Helen W.; Zentall, Sydney S.

    2011-01-01

    This study hypothesized that increased intensity of graphic information, presented in computer-generated instruction, could be differentially beneficial for students with hyperactivity and inattention by improving their ability to sustain attention and hold information in-mind. To this purpose, 18 2nd-4th grade students, recruited from general…

  15. Functional Communication Training in Rett Syndrome: A Preliminary Study

    ERIC Educational Resources Information Center

    Byiers, Breanne J.; Dimian, Adele; Symons, Frank J.

    2014-01-01

    Rett syndrome (RTT) is associated with a range of serious neurodevelopmental consequences including severe communicative impairments. Currently, no evidence-based communication interventions exist for the population (Sigafoos et al., 2009). The purpose of the current study was to examine the effectiveness of functional assessment (FA) and…

  16. Infection after primary total hip arthroplasty.

    PubMed

    Lindeque, Bennie; Hartman, Zach; Noshchenko, Andriy; Cruse, Margaret

    2014-04-01

    The number of primary total hip arthroplasties (THAs) performed in the United States each year continues to climb, as does the incidence of infectious complications. The changing profile of antibiotic-resistant bacteria has made preventing and treating primary THA infections increasingly complex. The goal of this review was to summarize (1) the published data concerning the risk of surgical site infection (SSI) after primary THA by type of bacteria and (2) the effect of potentially modifying factors. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, Web of Science, and PubMed were searched. Studies dated between 2001 and 2011 examining primary THA in adults were included. Meta-analysis of the collected data was performed. The pooled SSI rate was 2.5% (95% confidence interval [Cl], 1.4%-4.4%; P<.001; n=28,883). The pooled deep prosthetic joint infection (PJI) rate was 0.9% (95% Cl, 0.4%-2.2%; P<.001; n=28,883). The pooled rate of methicillin-resistant Staphylococcus aureus SSI was 0.5% (95% Cl, 0.2%-1.5%; P<.001; n=26,703). This is approximately 20% of all SSI cases. The pooled rate of intraoperative bacterial wound contamination was 16.9% (95% Cl, 6.6%-36.8%; P=.003; n=2180). All these results had significant heterogeneity. The postoperative risk of SSI was significantly associated with intraoperative bacterial surgical wound contamination (pooled rate ratio, 2.5; 95% Cl, 1.4%-4.6%; P=.001; n=19,049). PMID:24762833

  17. Future Bearing Surfaces in Total Hip Arthroplasty

    PubMed Central

    2014-01-01

    One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom implant longevity is paramount. Even though various new bearing surfaces have been investigated, research is still ongoing, and only short-term results have been reported from clinical trials. Future bearing surfaces can be developed in the following ways: (1) change in design, (2) further improvement of polyethylene, (3) surface modification of the metal, (4) improvement in the ceramic, and (5) use of alternative, new materials. One way to reduce wear and impingement in THA is to make changes in its design by using a large femoral head, a monobloc metal shell with preassembled ceramic liner, dual mobility cups, a combination of different bearing surfaces, etc. Polyethylene has improved over time with the development of highly crosslinked polyethylene. Further improvements can be made by reinforcing it with vitamin E or multiwalled carbon nanotubes and by performing a surface modification with a biomembrane. Surface modifications with titanium nitride or titanium niobium nitride are implemented to try to improve the metal bearings. The advance to the fourth generation ceramics has shown relatively promising results, even in young patients. Nevertheless, further improvement is required to reduce fragility and squeaking. Alternative materials like diamond coatings on surfaces, carbon based composite materials, oxidized zirconium, silicon nitride, and sapphire are being sought. However, long-term studies are necessary to confirm the efficacy of these surfaces after enhancements

  18. Future bearing surfaces in total hip arthroplasty.

    PubMed

    Chang, Jun-Dong

    2014-03-01

    One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom implant longevity is paramount. Even though various new bearing surfaces have been investigated, research is still ongoing, and only short-term results have been reported from clinical trials. Future bearing surfaces can be developed in the following ways: (1) change in design, (2) further improvement of polyethylene, (3) surface modification of the metal, (4) improvement in the ceramic, and (5) use of alternative, new materials. One way to reduce wear and impingement in THA is to make changes in its design by using a large femoral head, a monobloc metal shell with preassembled ceramic liner, dual mobility cups, a combination of different bearing surfaces, etc. Polyethylene has improved over time with the development of highly crosslinked polyethylene. Further improvements can be made by reinforcing it with vitamin E or multiwalled carbon nanotubes and by performing a surface modification with a biomembrane. Surface modifications with titanium nitride or titanium niobium nitride are implemented to try to improve the metal bearings. The advance to the fourth generation ceramics has shown relatively promising results, even in young patients. Nevertheless, further improvement is required to reduce fragility and squeaking. Alternative materials like diamond coatings on surfaces, carbon based composite materials, oxidized zirconium, silicon nitride, and sapphire are being sought. However, long-term studies are necessary to confirm the efficacy of these surfaces after enhancements

  19. Arthroscopic interposition arthroplasty of the first carpometacarpal joint.

    PubMed

    Adams, J E; Merten, S M; Steinmann, S P

    2007-06-01

    First carpometacarpal joint arthritis is a common condition encountered by hand surgeons. Traditionally, surgical approaches have included arthrodesis, trapeziectomy or reconstructive arthroplasty techniques. Previously, we described a technique for arthroscopic debridement and interposition arthroplasty of the first carpometacarpal joint. Patients with Eaton stages II and III symptomatic first carpometacarpal joint arthritis recalcitrant to >6 months of non-operative therapy underwent arthroscopic debridement of the first carpometacarpal joint with interposition of an acellular dermal matrix allograft (GRAFTJACKET). In this paper, we describe outcomes following this procedure. Postoperatively, all patients reported symptomatic relief and 94% stated that they were partially, or completely, satisfied. More than 70% of patients reported no to mild difficulty in performing activities of daily living (average grip strength = 18.5 kg, pinch strength = 3.9kg). Complications were minimal. Outcomes from this study compare favourably to those of other series, demonstrating that this technique is a viable option for treatment of Eaton stages II and III first carpometacarpal arthritis. PMID:17276564

  20. Hospital volume affects outcome after total knee arthroplasty

    PubMed Central

    Pamilo, Konsta J; Peltola, Mikko; Paloneva, Juha; Mäkelä, Keijo; Häkkinen, Unto; Remes, Ville

    2015-01-01

    Background and purpose The influence of hospital volume on the outcome of total knee joint replacement surgery is controversial. We evaluated nationwide data on the effect of hospital volume on length of stay, re-admission, revision, manipulation under anesthesia (MUA), and discharge disposition for total knee replacement (TKR) in Finland. Patients and methods 59,696 TKRs for primary osteoarthritis performed between 1998 and 2010 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified into 4 groups according to the number of primary and revision knee arthroplasties performed on an annual basis throughout the study period: 1–99 (group 1), 100–249 (group 2), 250–449 (group 3), and ≥ 450 (group 4). The association between hospital procedure volume and length of stay (LOS), length of uninterrupted institutional care (LUIC), re-admissions, revisions, MUA, and discharge disposition were analyzed. Results The greater the volume of the hospital, the shorter was the average LOS and LUIC. Smaller hospital volume was not unambiguously associated with increased revision, re-admission, or MUA rates. The smaller the annual hospital volume, the more often patients were discharged home. Interpretation LOS and LUIC ought to be shortened in lower-volume hospitals. There is potential for a reduction in length of stay in extended institutional care facilities. PMID:25323798

  1. Evaluation and management of the infected total knee arthroplasty.

    PubMed

    Springer, Bryan D; Scuderi, Giles R

    2013-01-01

    Infection after total knee arthroplasty (TKA) remains a difficult complication to treat. The risk of infection ranges from 0.5% to 2% for primary TKAs and 2% to 4% for revision TKAs. Several demographic studies indicate that more infections are occurring after these procedures, and infection is one of the most common reasons for TKA failure. Prevention remains the key to minimizing the risk of infection; however, little evidence-based literature exists to establish the optimal approach. Every patient with a painful TKA should be suspected of having an infection until proven otherwise. An algorithmic approach to these patients should include standard laboratory screening tests to rule out infection. Synovial fluid aspiration remains the best test for diagnosing infection. Synovial fluid white blood cell counts greater than 1,700 cells/µL and a differential greater than 69% polymorphonuclear cells should raise a high index of suspicion for infection. Several options are available to treat deep periprosthetic infection. The timing of the infection as it relates to surgery and the onset of symptoms are critical in determining treatment success. Prosthetic retention is indicated only in patients with an acute onset of infection, but its limited success reported in recent literature brings into question its role in infected TKAs. A two-stage exchange arthroplasty remains the gold standard for treatment of infection following TKA. PMID:23395040

  2. Gravity of the New Madrid seismic zone; a preliminary study

    USGS Publications Warehouse

    Langenheim, V.E.

    1995-01-01

    In the winter of 1811-12, three of the largest historic earthquakes in the United States occurred near New Madrid, Mo. Seismicity continues to the present day throughout a tightly clustered pattern of epicenters centered on the bootheel of Missouri, including parts of northeastern Arkansas, northwestern Tennessee, western Kentucky, and southern Illinois. In 1990, the New Madrid seismic zone/Central United States became the first seismically active region east of the Rocky Mountains to be designated a priority research area within the National Earthquake Hazards Reduction Program (NEHRP). This Professional Paper is a collection of papers, some published separately, presenting results of the newly intensified research program in this area. Major components of this research program include tectonic framework studies, seismicity and deformation monitoring and modeling, improved seismic hazard and risk assessments, and cooperative hazard mitigation studies.

  3. Image deconvolution in digital autoradiography: a preliminary study.

    PubMed

    Zhang, Mutian; Chen, Qing; Li, Xiao-Feng; O'Donoghue, Joseph; Ruan, Shutian; Zanzonico, Pat; Ling, C Clifton; Humm, John L

    2008-02-01

    Digital autoradiography (DAR) is a powerful method to determine quantitatively the "small-scale" (i.e., submillimeter) distribution of a radiotracer within a tissue section. However, the limited spatial resolution of the DAR image, due to blurring by the point spread function (PSF), can result in a poor correlation with tissue histology and immunohistochemistry. The authors attempt to overcome this limitation by recovering the radiotracer distribution by image deconvolution using the Richardson-Lucy algorithm and a measured PSF obtained from a small radioactive source on hydrophobic microscope slide. Simulation studies have shown that the deconvolution algorithm reliably recovers the pixel values corresponding to the radioactivity distributions. As an example, the proposed image restoration approach has been tested with DAR images of different radiolabeled markers on tumor sections obtained from clinical and preclinical animal model studies. Digital autoradiograms following deconvolution show improved sharpness and contrast relative to the unprocessed autoradiograms. PMID:18383673

  4. Sleep habits and patterns of college students: a preliminary study.

    PubMed

    Buboltz, W C; Brown, F; Soper, B

    2001-11-01

    The negative effects of sleep difficulties have been well documented. However, the prevalence of such problems among US college students has not been well studied. Design difficulties are common in the limited number of existing investigations, making it difficult to estimates the prevalence and types of disturbance studied. The authors describe the use of a quantitative-based assessment instrument to provide an initial indication of students' sleep problems and to serve as a means of addressing some of the deficiencies in the literature. In their sample of 191 undergraduates at a rural southern university, they found that most of the students exhibited some form of sleep disturbance and that women, in general, reported more sleep disturbances than men did. They suggest how colleges and university officials can alter procedures to minimize students' sleep disturbances and reduce the deleterious effects of sleep problems on academic performance. PMID:11765249

  5. Depressed patients’ preferences for type of psychotherapy: a preliminary study

    PubMed Central

    Yrondi, Antoine; Rieu, Julie; Massip, Claire; Bongard, Vanina; Schmitt, Laurent

    2015-01-01

    Background The treatment recommendations for depressed patients by the American Psychiatric Association encourage a focus on the patient’s preferences. The focus of this study was the preference of depressed inpatients for the type of psychotherapy. Methods Twenty-nine subjects of both sexes who were hospitalized with a major depressive episode were interviewed at 5-day intervals with the same questions after the depressive episode resolved, as indicated by a score less than 7 on the Hamilton Depression Rating Scale (HDRS). The selection of items was performed by expert consensus. Results The supportive psychotherapy scores were the highest, followed by psychodynamic psychotherapy and cognitive behavioral therapy. The two sessions conducted at 5-day intervals showed no significant difference, which reflected the stability of choices and preferences of patients. Conclusion In this study, the patients preferred supportive psychotherapy as first-line therapy compared to psychodynamic psychotherapy and cognitive behavioral therapy. PMID:26491265

  6. A preliminary study of flat-panel displays

    NASA Technical Reports Server (NTRS)

    Yancey, K. E.

    1986-01-01

    Six display technologies that might be of future value in a spacelab workstation are discussed. Some have been developed to the point where they could be used as a computer display while others have not. The display technologies studied are electroluminescents, light-emitting didodes, gas plasma, liquid crystal, electrochromic, and electrophoretic. An explanation of each mechanism is provided along with the state-of-the-art development.

  7. Preliminary results from two international pluvial flood event studies

    NASA Astrophysics Data System (ADS)

    Roezer, Viktor; Spekkers, Matthieu; Kreibich, Heidi

    2016-04-01

    Pluvial floods have caused severe damages to urban dwellings in Europe and elsewhere in recent years. With a predicted increase in extreme weather events as well as an ongoing urbanization, pluvial flood damage is expected to increase in the future. These type of flood events, caused by stormwater being unable to enter urban drainage systems or flowing out of urban drainage systems when capacity is exceeded, often happen with little warning and in areas which are often not obviously prone to flooding. Up to now little research was done on the adverse consequences of pluvial floods, as empirical damage data of pluvial flooding is scarce. In this study, results of two telephone surveys are discussed. The surveys comprise interviews with more than 500 flood-affected households in Germany (Münster and Greven) and the Netherlands (Amsterdam), related to the severe rain event of July 28th 2014. Respondents were asked a series of questions about the damage to their building structure and contents, as well as on topics such as early warning, emergency and precautionary measures, building properties and hazard characteristics. The questionnaire was developed with the aim to create a harmonized transnational pluvial flood damage survey that can potentially be extended to other European countries. New indicator variables have been developed to account for different national and regional standards in building structure, early warning, socio-economic data and recovery. The survey data from the German and Dutch case studies are compared with the goal to identify similarities and differences in damage reducing factors and recovery. Water level data and other hazard characteristics are used to form comparable groups out of the German and Dutch sample. Within these groups, regional distinctions in building topology and use are expected to have the strongest impact on differences between reported damage amounts of the two case studies. The newly collected data will be used in

  8. Preliminary space station solar array structural design study

    NASA Technical Reports Server (NTRS)

    Dorsey, J. T.; Bush, H. G.; Mikulas, M. M., Jr.

    1984-01-01

    Structurally efficient ways to support the large solar arrays (3,716 square meters which are currently considered for space station use) are examined. An erectable truss concept is presented for the on orbit construction of winged solar arrays. The means for future growth, maintenance, and repair are integrally designed into this concept. Results from parametric studies, which highlight the physical and structural differences between various configuration options are presented. Consideration is given to both solar blanket and hard panel arrays.

  9. A preliminary study to Assess Model Uncertainties in Fluid Flows

    SciTech Connect

    Marc Oliver Delchini; Jean C. Ragusa

    2009-09-01

    The goal of this study is to assess the impact of various flow models for a simplified primary coolant loop of a light water nuclear reactor. The various fluid flow models are based on the Euler equations with an additional friction term, gravity term, momentum source, and energy source. The geometric model is purposefully chosen simple and consists of a one-dimensional (1D) loop system in order to focus the study on the validity of various fluid flow approximations. The 1D loop system is represented by a rectangle; the fluid is heated up along one of the vertical legs and cooled down along the opposite leg. A pressurizer and a pump are included in the horizontal legs. The amount of energy transferred and removed from the system is equal in absolute value along the two vertical legs. The various fluid flow approximations are compressible vs. incompressible, and complete momentum equation vs. Darcy’s approximation. The ultimate goal is to compute the fluid flow models’ uncertainties and, if possible, to generate validity ranges for these models when applied to reactor analysis. We also limit this study to single phase flows with low-Mach numbers. As a result, sound waves carry a very small amount of energy in this particular case. A standard finite volume method is used for the spatial discretization of the system.

  10. Preliminary results from the Pittsburgh Air Quality Study

    NASA Astrophysics Data System (ADS)

    Pandis, S. N.; Davidson, C. I.; Robinson, A. L.; Khlystov, A. Y.

    2002-12-01

    The Pittsburgh Air Quality Study (PAQS) is a collaborative effort among 20 research groups, and is part of the EPA Supersite Program. In collaboration with several other Supersites around the country, PAQS is also one component of an intensive experiment conducted in July 2001. The PAQS study includes monitoring for aerosol number, surface, and volume distributions, PM mass in several size ranges, single particle chemical composition, continuous aerosol sulfate, nitrate, and carbon mass, bioaerosols, hygroscopic aerosol growth, and filter-based aerosol chemical composition including trace metals, anions/cations, elemental and organic carbon, and various organic compounds. Meteorological data and concentrations of several trace gases are obtained simultaneously. The results will be used to test a variety of hypothesis on atmospheric aerosols. Examples include our ability to account for aerosol mass by summing contributions of individual chemical species, the extent to which single particle chemical composition data can be used to determine bulk chemical concentrations, our ability to predict natural and anthropogenic sources of aerosols, and the extent to which aerosols contribute to increased morbidity and mortality in Pittsburgh. This paper summarizes a few of the interesting results obtained during the study, such as closure of the aerosol mass balance, frequent new particle formation, aerosol water content and artifacts when sampling carbonaceous aerosol.

  11. Preliminary studies on cryopreservation of snakehead (Channa striata) embryos.

    PubMed

    Mohd Sharifuddin, M; Siti Azizah, M N

    2014-08-01

    This paper reports the findings of the ongoing studies on cryopreservation of the snakehead, Channa striata embryos. The specific objective of this study was to collect data on the sensitivity of C. striata embryo hatching rate to low temperatures at two different developmental stages in the presence of four different cryoprotectants. Embryos at morula and heartbeat stages were selected and incubated in 1M dimethyl sulfoxide (Me2SO), 1M ethylene glycol (EG), 1M methanol (MeOH) and 0.1M sucrose solutions at different temperatures for a period of time. Embryos were kept at 24 °C (control), 15 °C, 4 °C and -2 °C for 5 min, 1h and 3h. Following these treatments, the embryos were then transferred into a 24 °C water bath until hatch to evaluate the hatching rate. The results showed that there was a significant decrease of hatching rate in both developmental stages following exposure to 4 °C and -2 °C at 1h and 3h exposure in each treatment. Heartbeat stage was more tolerant against chilling at -2 °C for 3h exposure in Me2SO followed by MeOH, sucrose and EG. Further studies will be conducted to find the best method to preserve embryos for long term storage. PMID:24726775

  12. [Omeprazole: a new treatment for paranasal sinus polyps in Widal syndrome. Preliminary study].

    PubMed

    Serra, J; Piñas, J; Arnaiz, J A; Quesada, P; Naches, S; Lorente, J; Carne, X

    1998-05-01

    A preliminary report is made of the potential therapeutic effect of omeprazol in reducing nasosinusal polyps. This study is based on the empirical observation of nasal airflow improvement in patients suffering from nasosinusal polyposis after administering omeprazol. Different phases of the study suggested that patients with Widal's syndrome benefited the most. Based on the results of this study, we have undertaken a randomized, parallel, double-blind, placebo-controlled clinical trial. PMID:9707740

  13. Hydrogen Gas Retention and Release from WTP Vessels: Summary of Preliminary Studies

    SciTech Connect

    Gauglitz, Phillip A.; Bontha, Jagannadha R.; Daniel, Richard C.; Mahoney, Lenna A.; Rassat, Scot D.; Wells, Beric E.; Bao, Jie; Boeringa, Gregory K.; Buchmiller, William C.; Burns, Carolyn A.; Chun, Jaehun; Karri, Naveen K.; Li, Huidong; Tran, Diana N.

    2015-07-01

    The Hanford Waste Treatment and Immobilization Plant (WTP) is currently being designed and constructed to pretreat and vitrify a large portion of the waste in the 177 underground waste storage tanks at the Hanford Site. A number of technical issues related to the design of the pretreatment facility (PTF) of the WTP have been identified. These issues must be resolved prior to the U.S. Department of Energy (DOE) Office of River Protection (ORP) reaching a decision to proceed with engineering, procurement, and construction activities for the PTF. One of the issues is Technical Issue T1 - Hydrogen Gas Release from Vessels (hereafter referred to as T1). The focus of T1 is identifying controls for hydrogen release and completing any testing required to close the technical issue. In advance of selecting specific controls for hydrogen gas safety, a number of preliminary technical studies were initiated to support anticipated future testing and to improve the understanding of hydrogen gas generation, retention, and release within PTF vessels. These activities supported the development of a plan defining an overall strategy and approach for addressing T1 and achieving technical endpoints identified for T1. Preliminary studies also supported the development of a test plan for conducting testing and analysis to support closing T1. Both of these plans were developed in advance of selecting specific controls, and in the course of working on T1 it was decided that the testing and analysis identified in the test plan were not immediately needed. However, planning activities and preliminary studies led to significant technical progress in a number of areas. This report summarizes the progress to date from the preliminary technical studies. The technical results in this report should not be used for WTP design or safety and hazards analyses and technical results are marked with the following statement: “Preliminary Technical Results for Planning – Not to be used for WTP Design

  14. Regenerative therapies for equine degenerative joint disease: a preliminary study.

    PubMed

    Broeckx, Sarah; Zimmerman, Marieke; Crocetti, Sara; Suls, Marc; Mariën, Tom; Ferguson, Stephen J; Chiers, Koen; Duchateau, Luc; Franco-Obregón, Alfredo; Wuertz, Karin; Spaas, Jan H

    2014-01-01

    Degenerative joint disease (DJD) is a major cause of reduced athletic function and retirement in equine performers. For this reason, regenerative therapies for DJD have gained increasing interest. Platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) were isolated from a 6-year-old donor horse. MSCs were either used in their native state or after chondrogenic induction. In an initial study, 20 horses with naturally occurring DJD in the fetlock joint were divided in 4 groups and injected with the following: 1) PRP; 2) MSCs; 3) MSCs and PRP; or 4) chondrogenic induced MSCs and PRP. The horses were then evaluated by means of a clinical scoring system after 6 weeks (T1), 12 weeks (T2), 6 months (T3) and 12 months (T4) post injection. In a second study, 30 horses with the same medical background were randomly assigned to one of the two combination therapies and evaluated at T1. The protein expression profile of native MSCs was found to be negative for major histocompatibility (MHC) II and p63, low in MHC I and positive for Ki67, collagen type II (Col II) and Vimentin. Chondrogenic induction resulted in increased mRNA expression of aggrecan, Col II and cartilage oligomeric matrix protein (COMP) as well as in increased protein expression of p63 and glycosaminoglycan, but in decreased protein expression of Ki67. The combined use of PRP and MSCs significantly improved the functionality and sustainability of damaged joints from 6 weeks until 12 months after treatment, compared to PRP treatment alone. The highest short-term clinical evolution scores were obtained with chondrogenic induced MSCs and PRP. This study reports successful in vitro chondrogenic induction of equine MSCs. In vivo application of (induced) MSCs together with PRP in horses suffering from DJD in the fetlock joint resulted in a significant clinical improvement until 12 months after treatment. PMID:24465787

  15. [Animal health policies and practices in the Americas: preliminary study].

    PubMed

    Rojas, H; Stuardo, L; Benavides, D

    2005-08-01

    The Americas have a large population of farm animals, mostly for export. There are diverse production systems distributed over an extensive and varied geography, which hampers efforts to respond to the demands of the different markets. This study provides an overview of the elements influencing animal welfare implementation, such as the requirements of importing countries, the requirements of private agents, the demands of producers and manufacturers, quality promotion policies, the demands of the community, the recommendations of reference bodies and the results of applied research. To explore the level of animal welfare development in the countries of the region, a detailed case study was made of Chile, in addition to a survey of the Member Countries of the World Organisation for Animal Health (OIE) in the Americas. An analysis was made of progress with the issues considered by the OIE as priorities, namely humane slaughter for human consumption, transport and killing for disease control purposes. Furthermore, the study considers various aspects of production which the OIE has not included up to now. It also explores the status of research and producer and consumer perceptions of the issue. The results reveal that the level of development and implementation of animal welfare differs from one country to another. While the adoption of animal welfare regulations certainly relates to all the above-mentioned aspects, the one which appears to have the most impact is the export of livestock products to certain markets. Although there is great interest in improving animal welfare conditions, this calls for the general characteristics of animal husbandry in the various countries to be taken into account. While some livestock production in the Americas follows world patterns, many countries still find it difficult to integrate good animal welfare practices, owing to specific geographical, social and cultural situations that are reflected in local livestock development

  16. A preliminary study of dengue infection in Brunei.

    PubMed

    Osman, Osmali; Fong, Mun Yik; Devi, Shamala

    2007-07-01

    The purpose of this study was to examine the extent of dengue infection in Brunei and to determine the predominant serotype circulating in the country. The study generated useful epidemiological data on dengue infection in Brunei. A total of 271 samples from patients suspected of having dengue infections were selected and analyzed. All patients were seen in clinics and hospitals in Brunei. The samples were collected from April 2005 to April 2006 and transported to the WHO Collaborating Centre for Arbovirus Reference and Research, University of Malaya, Malaysia. The following tests were used to achieve the objectives: in-house IgM-capture enzyme-linked immunosorbent assay, virus isolation in mosquito albopictus cell line (C6/36), and viral RNA detection and serotyping by reverse transcriptase-polymerase chain reaction (RT-PCR). The results show that 45 people were positive for dengue-specific IgM (27 males and 18 females), while RT-PCR detected dengue viral RNA in 12 patients, 3 identified as DEN-1 and 9 as DEN-2. Dengue virus was isolated from 6 patients using the C6/36 cell line; 3 were DEN-2 isolates and 3 were DEN-1 isolates. These data show that dengue virus is circulating in Brunei and the predominant infecting serotype for that period was DEN-2 followed by DEN-1. This study is the first to report the detection and isolation of dengue virus from Brunei using RT-PCR and culture in the C6/36 albopictus mosquito cell line. PMID:17642533

  17. Mesiodistal odontometrics as a distinguishing trait: A comparative preliminary study

    PubMed Central

    Sravya, Taneeru; Dumpala, Rakesh Kumar; Guttikonda, Venkateswara Rao; Manchikatla, Praveen Kumar; Narasimha, Vanajakshi China

    2016-01-01

    Introduction: Sex determination is a vital step in reconstructing an individual profile from unidentified skeletal remnants. Variations in tooth size are influenced by genetic and environmental factors. Tooth size variations have been reported among different populations. Aim: To identify the sex by determining the mesiodistal (MD) dimensions of maxillary canines. Objectives: (1) To compare the MD diameter of all maxillary canines — (a) in the entire urban and tribal population, (b) in urban male and urban female populations, (c) in tribal male and tribal female populations, and (d) in the entire male and female populations and (2) To estimate the percentage of sexual dimorphism individually in urban and tribal populations. Materials and Methods: Fifty subjects each from urban and tribal populations in equal gender ratio were selected in Khammam district, Telangana, for the purpose of this study. After obtaining informed consent, maxillary study models of the selected subjects were made. MD diameters of left and right maxillary canines were measured on casts using vernier calipers. The obtained data were subjected to statistical analysis. Results: (1) The total tribal population showed a greater MD diameter of maxillary canines than the total urban population, (2) Urban males showed a greater MD diameter of maxillary canines than urban females, (3) Tribal males showed a greater MD diameter of maxillary canines than tribal females, (4) The entire male population showed a greater MD diameter of maxillary canines than the entire female population, and (5) The percentage of dimorphism between males and females in individual groups was found to be significant. Conclusion: The study showed maxillary canines exhibiting significant sexual dimorphism and can be used as a distinguishing trait for sex determination along with other procedures. PMID:27555727

  18. The ABC Schizophrenia Study: a preliminary overview of the results.

    PubMed

    Häfner, H; Maurer, K; Löffler, W; an der Heiden, W; Munk-Jørgensen, P; Hambrecht, M; Riecher-Rössler, A

    1998-08-01

    The ABC Schizophrenia Study, a large-scale epidemiological and neurobiological research project commenced in 1987, initially pursued two aims: (1) to elucidate the possible causes of the sex difference in age at first admission for schizophrenia and (2) to analyse the early course of the disorder from onset until first contact and its implications for further course and outcome. First, transnational case-register data (for Denmark and Germany) were compared, second, a population-based sample of first-episode cases of schizophrenia (n = 232) were selected and third, the results obtained were compared with data from the WHO Determinants of Outcome Study by using a systematic methodology. A consistent result was a 3-4 years higher age of onset for women by any definition of onset, which was not explainable by social variables, such as differences in the male-female societal roles. A sensitivity-reducing effect of oestrogen on central D2 receptors was identified as the underlying neurobiological mechanism in animal experiments. Applicability to humans with schizophrenia was established in a controlled clinical study. A comparison of familial and sporadic cases showed that in cases with a high genetic load, the sex difference in age of onset disappeared due to a clearly reduced age of onset in women, whereas in sporadic cases it increased. To analyse early course retrospectively, a semistructured interview, IRAOS, was developed. The early stages of the disorder were reconstructed in comparison with age- and sex-matched controls from the same population of origin. The initial signs consisted mainly of negative and affective symptoms, which accumulated exponentially until the first episode, as did the later emerging positive symptoms. Social disability appeared 2-4 years before first admission on average. In early-onset cases, social course and outcome, studied prospectively over 5 years, was determined by the level of social development at onset through social stagnation

  19. Static Balance in Patients with Vestibular Impairments: A Preliminary Study.

    PubMed

    Talebi, Hossein; Karimi, Mohammad Taghi; Abtahi, Seyed Hamid Reza; Fereshtenejad, Niloofar

    2016-01-01

    Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments. Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50 ± 7). We evaluated excursion and velocity of center of pressure (COP) and path length in anteroposterior (AP) and mediolateral (ML) planes with eyes open and with eyes closed. Results. There was no significant difference between COP excursions in ML and AP planes between both groups with eyes open and eyes closed (p value > 0.05). In contrast, the difference between velocity and path length of COP in the mentioned planes was significant between both groups with eyes open and eyes closed (p value < 0.05). Conclusions. The present study showed the static instability and balance of patients with vestibular impairments indicated by the abnormal characteristics of body balance. PMID:27379198

  20. Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

    PubMed

    Okuno, Kentaro; Nohara, Kanji; Takai, Etsuko; Sakai, Takayoshi; Fleetham, John A; Ayas, Najib T; Lowe, Alan A; Almeida, Fernanda R

    2016-08-01

    Swallowing is an important physiological response that protects the airway. Although aspiration during sleep may cause aspiration pneumonia, the mechanisms responsible have not yet been elucidated. We evaluated the coordination between respiration and swallowing by infusing water into the pharynx of healthy young adults during each sleep stage. Seven normal subjects participated in the study. During polysomnography recordings, to elicit a swallow we injected distilled water into the pharynx during the awake state and each sleep stage through a nasal catheter. We assessed swallow latency, swallow apnea time, the respiratory phase during a swallow, the number of swallows, and coughing. A total number of 79 swallows were recorded. The median swallow latency was significantly higher in stage 2 (10.05 s) and stage 3 (44.17 s) when compared to awake state (4.99 s). The swallow latency in stage 3 showed a very wide interquartile range. In two subjects, the result was predominantly prolonged compared to the other subjects. There was no significant difference in the swallow apnea time between sleep stages. The presence of inspiration after swallowing, repetitive swallowing, and coughing after swallowing was more frequent during sleep than when awake. This study suggests that the coordination between respiration and swallowing as a defense mechanism against aspiration was impaired during sleep. Our results supported physiologically the fact that healthy adult individuals aspirate pharyngeal secretions during sleep. PMID:27338262

  1. A preliminary anatomical study on carotid body of Makouei sheep.

    PubMed

    Najafi, Gholamreza; Soltanalinejad, Farhad; Hasanzadeh, Hamed

    2013-01-01

    The carotid is a small mass of chemoreceptor's and sustentacular cells that detects changes in the composition of the arterial blood. The aim of the present study was to identify the size, color, location, blood and nerve supply of the carotid body in Makouei sheep. Fourteen heads of sheep from both sexes were collected from Urmia public slaughter-house. The exact situation and nerve supply of the carotid body was determined. Before dissection, blue latex was injected into right and left common carotid arteries. All the branches of the common carotid artery and the branch supplying carotid body were investigated. This study showed that, carotid body in sheep has been situated around the muscular branch of the occipital artery. The mean weight, width and length, thickness of carotid body were 0.01 g, 0.83 mm, 1.07 mm, and 1.06 mm respectively. Blood to the carotid body was supplied by glomic artery which was a branch of occipital artery. It was innervated by herring nerve which was a branch of glossopharyngeal nerve. PMID:25653785

  2. Ultrasonic nebulization atmospheric pressure glow discharge - Preliminary study

    NASA Astrophysics Data System (ADS)

    Greda, Krzysztof; Jamroz, Piotr; Pohl, Pawel

    2016-07-01

    Atmospheric pressure glow microdischarge (μAPGD) generated between a small-sized He nozzle jet anode and a flowing liquid cathode was coupled with ultrasonic nebulization (USN) for analytical optical emission spectrometry (OES). The spatial distributions of the emitted spectra from the novel coupled USN-μAPGD system and the conventional μAPGD system were compared. In the μAPGD, the maxima of the intensity distribution profiles of the atomic emission lines Ca, Cd, In, K, Li, Mg, Mn, Na and Sr were observed in the near cathode region, whereas, in the case of the USN-μAPGD, they were shifted towards the anode. In the novel system, the intensities of the analytical lines of the studied metals were boosted from several to 35 times. As compared to the conventional μAPGD-OES with the introduction of analytes through the sputtering and/or the electrospray-like nebulization of the flowing liquid cathode solution, the proposed method with the USN introduction of analytes in the form of a dry aerosol provides improved detectability of the studied metals. The detection limits of metals achieved with the USN-μAPGD-OES method were in the range from 0.08 μg L- 1 for Li to 52 μg L- 1 for Mn.

  3. Preliminary studies on immobilization of lipase using chicken eggshell

    NASA Astrophysics Data System (ADS)

    Salleh, S.; Serri, N. A.; Hena, S.; Tajarudin, H. A.

    2016-06-01

    A few advantages of enzyme immobilization are reusability of expensive enzyme, improvement of stability and activity compared to crude enzyme. Various organic components can be used as carrier for enzyme immobilization such as chicken eggshell. It can be used as a carrier for immobilization as its mineral component mostly contains of calcium carbonate. In the present study, Tributyrin method was used to test enzyme activity of Rhizomucour Miehei, Candida Antarctica and Candida Rugosa. Rhizomucour Miehei shows the highest enzyme activity (360.8 mol/min/mL lipase) and was used in further experiment. Experiment was continued to study incubation time for lipase immobilization on eggshell (1-4 hours) and reaction time of esterification of sugar ester (0-72 hours). Two hours incubation time for lipase immobilization was observed and gives the highest yield of sugar ester (78.13%). Fructose and stearic acid as substrate was used for the production of sugar ester. The highest percentage of sugar ester production was shown at 36 hours of reaction time.

  4. Preliminary study on hydrogeology in tectonically active areas.

    SciTech Connect

    Lowry, Thomas Stephen; Lappin, Allen R.; Gettemy, Glen L.; Jensen, Richard Pearson; Arnold, Bill Walter; James, Scott Carlton; Lee, Moo Yul; Meier, Diane A.

    2006-09-01

    This report represents the final product of a background literature review conducted for the Nuclear Waste Management Organization of Japan (NUMO) by Sandia National Laboratories, Albuquerque, New Mexico, USA. Internationally, research of hydrological and transport processes in the context of high level waste (HLW) repository performance, has been extensive. However, most of these studies have been conducted for sites that are within tectonically stable regions. Therefore, in support of NUMO's goal of selecting a site for a HLW repository, this literature review has been conducted to assess the applicability of the output from some of these studies to the geological environment in Japan. Specifically, this review consists of two main tasks. The first was to review the major documents of the main HLW repository programs around the world to identify the most important hydrologic and transport parameters and processes relevant in each of these programs. The review was to assess the relative importance of processes and measured parameters to site characterization by interpretation of existing sensitivity analyses and expert judgment in these documents. The second task was to convene a workshop to discuss the findings of Task 1 and to prioritize hydrologic and transport parameters in the context of the geology of Japan. This report details the results and conclusions of both of these Tasks.

  5. Psychophysiological patterns during cell phone text messaging: a preliminary study.

    PubMed

    Lin, I-Mei; Peper, Erik

    2009-03-01

    This study investigated the psychophysiological patterns associated with cell phone text messaging (texting). Twelve college students who were very familiar with texting were monitored with surface electromyography (SEMG) from the shoulder (upper trapezius) and thumb (abductor pollicis brevis/opponens pollicis); blood volume pulse (BVP) from the middle finger, temperature from the index finger, and skin conductance (SC) from the palm of the non-texting hand; and respiration from the thorax and abdomen. The counter-balanced procedure consisted of a 2 min pre-baseline, 1 min receiving text messages, 2 min middle baseline, 1 min sending text messages and 2 min post-baseline. The results indicated that all subjects showed significant increases in respiration rate, heart rate, SC, and shoulder and thumb SEMG as compared to baseline measures. Eighty-three percentage of the participants reported hand and neck pain during texting, and held their breath and experienced arousal when receiving text messages. Subjectively, most subjects were unaware of their physiological changes. The study suggests that frequent triggering of these physiological patterns (freezing for stability and shallow breathing) may increase muscle discomfort symptoms. Thus, participants should be trained to inhibit these responses to prevent illness and discomfort. PMID:19199025

  6. Preliminary 1H NMR study on archaeological waterlogged wood.

    PubMed

    Maccotta, Antonella; Fantazzini, Paola; Garavaglia, Carla; Donato, Ines D; Perzia, Patrizia; Brai, Maria; Morreale, Filippa

    2005-01-01

    Magnetic Resonance Relaxation (MRR) and Magnetic Resonance Imaging (MRI) are powerful tools to obtain detailed information on the pore space structure that one is unlikely to obtain in other ways. These techniques are particularly suitable for Cultural Heritage materials, because they use water 1H nuclei as a probe. Interaction with water is one of the main causes of deterioration of materials. Porous structure in wood, for example, favours the penetration of water, which can carry polluting substances and promote mould growth. A particular case is waterlogged wood from underwater discoveries and moist sites; in fact, these finds are very fragile because of chemical, physical and biological decay from the long contact with the water. When wood artefacts are brought to the surface and directly dried in air, there is the collapse of the cellular structures, and wood loses its original form and dimensions and cannot be used for study and museum exhibits. In this work we have undertaken the study of some wood finds coming from Ercolano's harbour by MRR and MRI under different conditions, and we have obtained a characterization of pore space in wood and images of the spatial distribution of the confined water in the wood. PMID:16485652

  7. A preliminary anatomical study on carotid body of Makouei sheep

    PubMed Central

    Najafi, Gholamreza; Soltanalinejad, Farhad; Hasanzadeh, Hamed

    2013-01-01

    The carotid is a small mass of chemoreceptor's and sustentacular cells that detects changes in the composition of the arterial blood. The aim of the present study was to identify the size, color, location, blood and nerve supply of the carotid body in Makouei sheep. Fourteen heads of sheep from both sexes were collected from Urmia public slaughter-house. The exact situation and nerve supply of the carotid body was determined. Before dissection, blue latex was injected into right and left common carotid arteries. All the branches of the common carotid artery and the branch supplying carotid body were investigated. This study showed that, carotid body in sheep has been situated around the muscular branch of the occipital artery. The mean weight, width and length, thickness of carotid body were 0.01 g, 0.83 mm, 1.07 mm, and 1.06 mm respectively. Blood to the carotid body was supplied by glomic artery which was a branch of occipital artery. It was innervated by herring nerve which was a branch of glossopharyngeal nerve. PMID:25653785

  8. Spherical Cryogenic Hydrogen Tank Preliminary Design Trade Studies

    NASA Technical Reports Server (NTRS)

    Arnold, Steven M.; Bednarcyk, Brett A.; Collier, Craig S.; Yarrington, Phillip W.

    2007-01-01

    A structural analysis, sizing optimization, and weight prediction study was performed by Collier Research Corporation and NASA Glenn on a spherical cryogenic hydrogen tank. The tank consisted of an inner and outer wall separated by a vacuum for thermal insulation purposes. HyperSizer (Collier Research and Development Corporation), a commercial automated structural analysis and sizing software package was used to design the lightest feasible tank for a given overall size and thermomechanical loading environment. Weight trade studies were completed for different panel concepts and metallic and composite material systems. Extensive failure analyses were performed for each combination of dimensional variables, materials, and layups to establish the structural integrity of tank designs. Detailed stress and strain fields were computed from operational temperature changes and pressure loads. The inner tank wall is sized by the resulting biaxial tensile stresses which cause it to be strength driven, and leads to an optimum panel concept that need not be stiffened. Conversely, the outer tank wall is sized by a biaxial compressive stress field, induced by the pressure differential between atmospheric pressure and the vacuum between the tanks, thereby causing the design to be stability driven and thus stiffened to prevent buckling. Induced thermal stresses become a major sizing driver when a composite or hybrid composite/metallic material systems are used for the inner tank wall for purposes such as liners to contain the fuel and reduce hydrogen permeation.

  9. Static Balance in Patients with Vestibular Impairments: A Preliminary Study

    PubMed Central

    Talebi, Hossein; Abtahi, Seyed Hamid Reza; Fereshtenejad, Niloofar

    2016-01-01

    Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments. Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50 ± 7). We evaluated excursion and velocity of center of pressure (COP) and path length in anteroposterior (AP) and mediolateral (ML) planes with eyes open and with eyes closed. Results. There was no significant difference between COP excursions in ML and AP planes between both groups with eyes open and eyes closed (p value > 0.05). In contrast, the difference between velocity and path length of COP in the mentioned planes was significant between both groups with eyes open and eyes closed (p value < 0.05). Conclusions. The present study showed the static instability and balance of patients with vestibular impairments indicated by the abnormal characteristics of body balance. PMID:27379198

  10. Manufacture of nanoparticles from bone: a preliminary study.

    PubMed

    Florczyk, Stephen J; Saha, Subrata

    2009-01-01

    This study investigated a mechanical processing method using vibratory milling to reduce the particle size of bone ash to produce hydroxyapatite (HA) nanoparticles from bovine bone. Bovine femurs were cleaned of soft tissue, cut into small pieces, heated to 600 deg for 24 h, and ground into a coarse powder. A 50 wt% suspension was prepared, vibratory milled for 18 h, and then the milled suspension was filter pressed, dried, and ground into powder. The powder was analyzed with scanning electron microscopy and X-ray diffraction, which confirmed the particle size and the chemical composition of the powder-matched HA. The results of this study qualitatively showed that it is possible to produce HA nanoparticles from bone. This research explores a "green" manufacturing process that reuses a scrap material from the food industry and reduces the use of chemical precursors for synthetic nanoparticle synthesis. Such HA powder can potentially be used as a bone substitute and for coating orthopedic and dental implants. PMID:21083538

  11. Preliminary Attitude Control Studies for the ASTER Mission

    NASA Astrophysics Data System (ADS)

    Victorino Sarli, Bruno; Luís da Silva, André; Paglione, Pedro

    2013-10-01

    This work discusses an attitude control study for the ASTER mission, the first Brazilian mission to the deep space. The study is part of a larger scenario that is the development of optimal trajectories to navigate in the 2001 SN263 asteroid system, together with the generation of orbit and attitude controllers for autonomous operation. The spacecraft attitude is defined from the orientation of the body reference system to the Local Vertical Local Horizontal (LVLH) of a circular orbit around the Alpha asteroid. The rotational equations of motion involve the dynamic equations, where the three angular speeds are generated from a set of three reaction wheels and the gravitational torque. The rotational kinematics is represented in the Euler angles format. The controller is developed via the linear quadratic regulator approach with output feedback. It involves the generation of a stability augmentation (SAS) loop and a tracking outer loop, with a compensator of desired structure. It was chosen the feedback of the p, q and r angular speeds in the SAS, one for each reaction wheel. In the outer loop, it was chosen a proportional integral compensator. The parameters are tuned using a numerical minimization that represents a linear quadratic cost, with weightings in the tracking error and controls. Simulations are performed with the nonlinear model. For small angle manoeuvres, the linear results with reaction wheels or thrusters are reasonable, but, for larger manoeuvres, nonlinear control techniques shall be applied, for example, the sliding mode control.

  12. Overcoming Underrepresentation of Women Physics Teachers in Cameroon: Preliminary Study

    NASA Astrophysics Data System (ADS)

    Boyomo, M.; Kom, G. H.; Siebatcheu, B.; Asse, M. L.; Woulache, R.; Mvoudjo, E.

    2009-04-01

    At a time when much energy is being spent all over the world to bring women into the fast-developing world of science, it is regrettable that these efforts are still at their genesis in Cameroon. It is however, worth noting that efforts geared toward the education of the girl child are yielding fruit, even if much remains to be done in rural areas. The only unfortunate revelation is that increase in the number of young girls in scientific classes observed in high school is not reflected at the tertiary level in physics. Thus, young women are almost completely absent when it comes to recruiting lecturers and researchers in the subject. It is time a serious study is carried out on the status of the woman physicist in Cameroon. It is time to evaluate the importance of the woman physicist to our society and to the field of study as well. It is also necessary to develop a new policy geared toward encouraging young girls to take up a career in physics.

  13. Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes

    PubMed Central

    Phan, Duy L; Ahn, Kyle; Rinehart, Joseph B; Calderon, Michael-David; Wu, Wei-Der; Schwarzkopf, Ran

    2016-01-01

    AIM: To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home (PSH) program. METHODS: A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients were preoperatively stratified based on specific procedure performed, age, gender, body mass index (BMI), American Society of Anesthesiologists Physical Classification System (ASA) score, and Charleston Comorbidity Index (CCI) score. The primary outcome criterion was hospital length of stay (LOS). Secondary criteria including operative room (OR) duration, transfusion rate, Post-Anesthesia Care Unit (PACU) stay, readmission rate, post-operative complications, and discharge disposition. For each outcome, the predictor variables were entered into a generalized linear model with appropriate response and assessed for predictive relationship to the dependent variable. Significance level was set to 0.05. RESULTS: A total of 337 patients, 200 in the TKA cohort and 137 in the THA cohort, were eligible for the study. Nearly two-third of patients were female. Patient age averaged 64 years and preoperative BMI averaged 29 kg/m2. The majority of patients were ASA score III and CCI score 0. After analysis, ASA score was the only variable predictive for LOS (P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d. ASA score was also the only variable predictive for readmission rate (P = 0.0332). BMI was the only variable predictive for PACU duration (P = 0.0136). Specific procedure performed, age, gender, and CCI score were not predictive for any of the outcome criteria. OR duration, transfusion rate, post-operative complications or discharge disposition were not significantly associated with any of the predictor variables. CONCLUSION: The joint arthroplasty PSH model reduces

  14. Results of Revision Surgery and Causes of Unstable Total Knee Arthroplasty

    PubMed Central

    Sun, Doo-Hoon; Chon, Jae-Gyun; Jang, Sung-Won; Sun, Dong-Hyuk

    2014-01-01

    Background The aim of this study was to evaluate causes of unstable total knee arthroplasty and results of revision surgery. Methods We retrospectively reviewed 24 knees that underwent a revision arthroplasty for unstable total knee arthroplasty. The average follow-up period was 33.8 months. We classified the instability and analyzed the treatment results according to its cause. Stress radiographs, postoperative component position, and joint level were measured. Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score and range of motion. Results Causes of instability included coronal instability with posteromedial polyethylene wear and lateral laxity in 13 knees, coronal instability with posteromedial polyethylene wear in 6 knees and coronal and sagittal instability in 3 knees including post breakage in 1 knee, global instability in 1 knee and flexion instability in 1 knee. Mean preoperative/postoperative varus and valgus angles were 5.8°/3.2° (p = 0.713) and 22.5°/5.6° (p = 0.032). Mean postoperative α, β, γ, δ angle were 5.34°, 89.65°, 2.74°, 6.77°. Mean changes of joint levels were from 14.1 mm to 13.6 mm from fibular head (p = 0.82). The mean HSS score improved from 53.4 to 89.2 (p = 0.04). The average range of motion was changed from 123° to 122° (p = 0.82). Conclusions Revision total knee arthroplasty with or without a more constrained prosthesis will be a definite solution for an unstable total knee arthroplasty. The solution according to cause is very important and seems to be helpful to avoid unnecessary over-constrained implant selection in revision surgery for total knee instability. PMID:24900897

  15. Metal block augmentation for bone defects of the medial tibia during primary total knee arthroplasty

    PubMed Central

    2013-01-01

    Background Stable and well-aligned placement of tibial components during primary total knee arthroplasty is challenging in patients with bone defects. Although rectangular block-shaped augmentations are widely used to reduce the shearing force between the tibial tray and bone compared with wedge-shaped augmentations, the clinical result remains unclear. This study aimed to evaluate the outcome of primary total knee arthroplasty with metal block augmentation. Methods We retrospectively reviewed the 3- to 6-year follow-up results of 33 knees that underwent total knee arthroplasty with metal block augmentation (metal-augmented group) for bone defects of the medial tibia and 132 varus knees without bone defects as the control group. All surgeries were performed using posterior-stabilized cemented prostheses in both groups. Cemented stems were routinely augmented when the metal block was used. Results There were no differences in implant survival rates (100% in metal-augmented and 99.2% in control) or knee function scores (82 points in metal-augmented and 84 points in control) between the two groups at the final follow-up examination (P = 0.60 and P = 0.09, respectively). No subsidence or loosening of the tibial tray was observed. Of 33 metal-augmented total knee arthroplasties, a nonprogressive radiolucent line beneath the metal was detected in 10 knees (30.3%), and rounding of the medial edge of the tibia was observed in 17 knees (51.5%). Conclusions The clinical results of total knee arthroplasty with metal augmentation were not inferior to those in patients without bone defects. However, radiolucent lines were observed in 30.3%. PMID:24139483

  16. Total Elbow Arthroplasty in the United States: Evaluation of Cost, Patient Demographics, and Complication Rates

    PubMed Central

    Zhou, Hanbing; Orvets, Nathan D.; Merlin, Gabriel; Shaw, Joshua; Dines, Joshua S.; Price, Mark D.; Eichinger, Josef K.; Li, Xinning

    2016-01-01

    Total elbow arthroplasty (TEA) is utilized in the treatment of rheumatoid and post-traumatic elbow arthritis. TEA is a relatively low volume surgery in comparison to other types of arthroplasty and therefore little is known about current surgical utilization, patient demographics and complication rates in the United States. The purpose of our study is to evaluate the current practice trends and associated in-patient complications of TEA at academic centers in the United States. We queried the University Health Systems Consortium administrative database from 2007 to 2011 for patients who underwent an elective TEA. A descriptive analysis of demographics was performed which included patient age, sex, race, and insurance status. We also evaluated the following patient clinical benchmarks: hospital length of stay (LOS), hospital direct cost, in-hospital mortality, complications, and 30-day readmission rates. Our cohort consisted of 3146 adult patients (36.5% male and 63.5% female) with an average age of 58 years who underwent a total elbow arthroplasty (159 academic medical centers) in the United States. The racial demographics included 2334 (74%) Caucasian, 285 (9%) black, 236 (7.5%) Hispanic, 16 (0.5%) Asian, and 283 (9%) other patients. The mean LOS was 4.2±5 days and the mean total direct cost for the hospital was 16,300±4000 US Dollars per case. The overall inpatient complication rate was 3.1% and included mortality <1%, DVT (0.8%), re-operation (0.5%), and infection (0.4%). The 30-day readmission rate was 4.4%. TEA is a relatively uncommon surgery in comparison to other forms of arthroplasty but is associated with low in-patient and 30-day perioperative complication rate. Additionally, the 30-day readmission rate and overall hospital costs are comparable to the traditional total hip and knee arthroplasty surgeries. PMID:27114806

  17. Levels of Matrix Metalloproteinases in Arthroplasty Patients and Their Correlation With Inflammatory and Thrombotic Activation Processes.

    PubMed

    Alexander, Kyle; Banos, Andrew; Abro, Schuharazad; Hoppensteadt, Debra; Fareed, Jawed; Rees, Harold; Hopkinson, William

    2016-07-01

    An imbalance of matrix metalloproteinases (MMPs) and their inhibitors is thought to play a major role in the pathophysiology of joint diseases. The aim of this study is to provide additional insights into the relevance of MMP levels in arthroplasty patients in relation to inflammation and thrombosis. Deidentified plasma samples from 100 patients undergoing total hip arthroplasty or total knee arthroplasty were collected preoperatively, on postoperative day 1, and on postoperative day 3. Tissue inhibitor of MMP 4, tumor necrosis factor α (TNF-α), pro-MMP1, MMP3, MMP9, MMP13, and d-dimer were measured using enzyme-linked immunosorbent assay kits. A biochip array was used to profile interleukin (IL) 2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon gamma, TNF-α, IL-1α, IL-1β, monocyte chemoattractant protein 1, and endothelial growth factor (EGF) levels. The levels of MMP1, MMP9, MMP13, and TNF-α were elevated preoperatively in arthroplasty patients when compared to healthy individuals. The concentrations of MMP1 and MMP9 increased slightly in postsurgical samples. d-Dimer levels were elevated preoperatively, increased postoperatively, and started decreasing on postoperative day 3. Significant correlations between MMP9 with TNF-α, IL-6, IL-8, VEGF, and EGF were identified. Elevated preoperative MMP1, MMP9, and MMP13 concentrations suggest that they may play a role in the pathogenesis of arthritis. There is also evidence of increased coagulation activity and possible upregulation of several MMPs postsurgically. Correlation analysis indicates that MMP9 levels may potentially be related to inflammation and thrombosis in arthroplasty patients. PMID:27052781

  18. Incidence, Causes and Predictors of 30-Day Readmission After Shoulder Arthroplasty

    PubMed Central

    Westermann, Robert W; Anthony, Chris A.; Duchman, Kyle R.; Pugely, Andrew J.; Gao, Yubo; Hettrich, Carolyn M.

    2016-01-01

    Background The Center for Medicare and Medicaid Service has identified several quality metrics, including unplanned readmission within 30 days of surgery, to assess and compare surgeons and hospitals. The purpose of this study was to identify the incidence, causes and risk factors for unplanned 30-day readmission after total shoulder arthroplasty. Methods We identified patients undergoing primary elective shoulder arthroplasty performed at American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participating hospitals in 2013. Cases were stratified by readmission status. Univariate and multivariate analyses were employed to assess patient demographics, comorbidities and operative variables predicting unplanned readmission. Results 2779 patients undergoing shoulder arthroplasty were identified, with 74 (2.66%) requiring unplanned readmissions within 30 days of surgery. The most common surgical causes for unplanned readmission were surgical site infections (18.6%), dislocations (16.3%) and venous thromboembolism (14.0%). Medical causes for readmission were responsible for 51% of unplanned readmissions. Multivariate analysis identified patient age >75 (OR 2.62, 95% CI: 1.27 - 5.41), and ASA class of 3 (OR 1.79, 95% CI: 1.01 - 3.18) or 4 (OR 3.63, 95% CI: 1.31 - 10.08) as independent risk factors for unplanned readmission. Predictive modeling estimated that patients with ASA class of 4 and age >75 are 17.4 times more likely (95% CI 1.77-171.09) to be readmitted within 30 days of shoulder arthroplasty. Conclusion Unplanned readmission after shoulder arthroplasty is infrequent and medical complications account for more than 50% of occurrences. The risk of readmission exponentially increases when age and preoperative comorbidity burden are increased. PMID:27528839

  19. Adult leukemia risk and personal appliance use: a preliminary study.

    PubMed

    Lovely, R H; Buschbom, R L; Slavich, A L; Anderson, L E; Hansen, N H; Wilson, B W

    1994-09-15

    The hypothesis that use of personal electric appliances may be associated with increased risk of acute nonlymphocytic leukemia in adults was tested using interview data from a previously completed case-control study of 114 cases and 133 controls conducted between 1981 and 1984. Cases were obtained from a population-based cancer registry in western Washington state, and controls were obtained from the same area by random digit dialing. Of 32 electrical home appliances for which data on use were available for adult acute nonlymphocytic leukemia cases and controls, three motor-driven personal appliances (electric razors, hair dryers, and massage units) were selected a priori because their use represents exposure to higher peak magnetic fields than that from most other home appliances. When compared on an "ever used" versus "never used" basis, use of one or more of these appliances was not associated with increased risk of leukemia in the population studied (odds ratio (OR) = 0.71, 95% confidence interval (CI) 0.41-1.24). When the appliances were considered individually, massage units were more likely to have been used by cases than by controls (OR = 3.00, 95% CI 1.43-6.32), while hair dryers were more likely to have been used by controls than cases (OR = 0.38, 95% CI 0.22-0.66). There was a nonsignificant tendency for electric razor use to differentiate the cases from controls (OR = 1.33, 95% CI 0.80-2.23). When reported daily time of use was stratified, there was no overall increased risk with increased time of use except for electric razors (p < 0.05). In addition to the analysis of appliance use data from the case-control study, the authors obtained several models of these motor-driven personal appliances and characterized the magnetic fields they produce. Magnetic field flux density, or the B-field, and spectral measurements showed that partial body exposure from such appliances may exceed 0.5 mTesla (root mean squared) at rates-of-change exceeding 10 Tesla

  20. Shuttle infrared telescope facility (SIRTF) preliminary design study

    NASA Technical Reports Server (NTRS)

    1976-01-01

    An overall picture of the SIRTF system is first presented, including the telescope, focal plane instruments, cryogen supply, shuttle and spacelab support subsystems, mechanical and data interfaces with the vehicles, ground support equipment, and system requirements. The optical, mechanical, and thermal characteristics of the telescope are then evaluated, followed by a description of the SIRTF internal stabilization subsystem and its interface with the IPS. Expected performance in the shuttle environment is considered. Tradeoff studies are described, including the Gregorian versus the Cassegrain telescope, aperture diameter tradeoff, a CCD versus an image dissector for the star tracker, the large ambient telescope versus the SIRTF, and a dedicated gimbal versus the IPS. Operations from integration through launch and recovery are also discussed and cost estimates for the program are presented.