Science.gov

Sample records for interpositional gap arthroplasty

  1. 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

  2. Thumb Carpometacarpal Arthroplasty with Ligament Reconstruction and Interposition Costochondral Arthroplasty

    PubMed Central

    Trumble, Thomas; Rafijah, Gregory; Heaton, Dennis

    2013-01-01

    Background Thumb arthritis at the carpometacarpal (CMC) joint is one of the most common sites of arthritis, especially in women. Thumb arthroplasty is an effective method of relieving pain and improving function. Materials and Methods Qualitative and quantitative outcomes were assessed clinically and radiographically in 58 patients (66 thumbs) with thumb basal joint arthritis limited to the trapeziometacarpal joint, treated with hemiresection arthroplasty of the trapezium, flexor carpi radialis (FCR) ligament reconstruction, and allograft costochondral interposition graft. Description of Technique The thumb CMC joint arthroplasty is performed using an FCR tendon for ligament reconstruction combined with removal of the distal half of the trapezium, which is replaced with a life preserver-shaped spacer that is carved out of allograft cartilage. Results Results of the validated Disability of Arm, Shoulder, and Hand (DASH) questionnaire at a mean follow-up time of 56 months (range, 24-103 months) revealed that 90% of the patients had a high level of function with minimal symptoms. Important improvements in web space with increased palmar and radial abduction and grip and pinch strength measurements were observed. The trapeziometacarpal space had decreased 21% after surgery, while trapeziometacarpal subluxation was 14% compared with 21% before surgery. There was an inverse correlation between the loss of trapezial height and subluxation and clinical outcome. Conclusions The results of this study demonstrate that, although the preoperative trapezial height was not maintained, the reconstructed thumbs remained stable, with little subluxation and improved clinical outcomes. Level of Evidence IV, retrospective case series PMID:24436820

  3. Ceramic interpositional arthroplasty for fourth and fifth tarsometatarsal joint arthritis.

    PubMed

    Viens, Nicholas A; Adams, Samuel B; Nunley, James A

    2012-01-01

    The lateral midfoot is significantly more mobile than the corresponding medial joints, thereby giving some surgeons concern over the use of arthrodesis in patients with symptomatic fourth and fifth tarsometatarsal arthritis. Limited treatment options exist for these patients when nonoperative measures fail to provide adequate pain relief. A retrospective, consecutive case series was performed to evaluate the short-term results for patients who underwent ceramic interpositional arthroplasty of the lateral tarsometatarsal joints. All five patients had subjectively improved lateral midfoot pain and retained some motion following the procedure. There were no implant failures or cases of subsidence identified. Two patients experienced wound healing complications and four patients required concomitant procedures at the time of interpositional arthroplasty, highlighting the complexity that is often involved when treating patients with midfoot arthritis. Long-term results are needed to determine the ultimate role for ceramic interpositional arthroplasty in the lateral midfoot. PMID:23199939

  4. Arthroscopic technique of interposition arthroplasty of the glenohumeral joint.

    PubMed

    Bhatia, Deepak N; van Rooyen, Karin S; du Toit, Donald F; de Beer, Joe F

    2006-05-01

    Arthroscopic glenohumeral interposition arthroplasty is performed with the patient placed in the lateral decubitus position. Standard posterior, anterior, and anterosuperior portals are created, a routine diagnostic arthroscopy is performed, and the joint is débrided with the use of an arthroscopic shaver. An arthroscopic burr is used to resect prominent osteophytes, to alter the version of the glenoid if necessary, and to create microfractures on the glenoid surface. Next, 3 absorbable sutures are passed percutaneously with a 30 degrees angled suture grasper from 3 different sites posteriorly through the posterior capsular-labral tissue and into the anterior portal cannula, where they are isolated by means of the suture saver kit. The prepared interposition membrane/tissue (GRAFTJACKET Regenerative Tissue Matrix, Wright Medical Technology, Inc., Arlington, TN) is tagged with the 3 sutures in the anterior cannula before it is introduced into the joint. Three additional sutures are attached to the membrane anteriorly at 1, 3, and 5 o'clock positions and are isolated with suture savers. The membrane is next introduced into the joint through the anterior cannula and is aligned with the glenoid rim. The anterior sutures are rerouted through the anterior capsular-labral tissue with a 70 degrees angled suture grasper, and they are retrieved through the anterior cannula. Intra-articular nonsliding knots are used anteriorly to anchor the interposition tissue to the anterior glenoid labrum and capsule. The posterior sutures are knotted intra-articularly, or they may be tied extra-articularly; the proximal and distal posterior sutures are retrieved subcutaneously out through the skin tract of the posterior portal and are knotted with the suture present in this portal, with the use of nonsliding knots. Stability of the interposition tissue is assessed by movement of the glenohumeral joint through its entire range of motion. The postoperative protocol consists of early passive exercises, active exercises after 3 weeks, and muscle-strengthening exercises after 6 weeks. PMID:16651174

  5. Abductor pollicis longus tendon interposition arthroplasty for carpometacarpal osteoarthritis of the thumb.

    PubMed

    Kaarela, O; Raatikainen, T

    1999-05-01

    Thirty-eight thumbs in 35 patients with painful osteoarthritis of the thumb basal joint were treated by trapezium excision and abductor pollicis longus tendon interposition arthroplasty. Long-term results were obtained from all patients by subjective evaluation and 29 patients were re-examined 1 to 11 years after surgery (mean, 6 years). The overall result was excellent or good in 79% of the cases and 76% of the patients reported good or excellent pain relief. In 6 cases (16%) surgery provided no improvement. The range of shortening of the first ray was from 2 to 10 mm (mean, 7 mm). Grip and pinch strengths were measured, but the results were variable and consequently not informative. On the basis of our results we recommend abductor pollicis longus tendon interposition arthroplasty for the treatment of osteoarthritis of the thumb basal joint. PMID:10357523

  6. [Working ability after tendon interposition arthroplasty for degenerative arthritis of the thumb trapeziometacarpal joint].

    PubMed

    Hohendorff, B; Staub, L; Kaiser, T; von Wartburg, U

    2008-06-01

    Trapeziometacarpal arthrosis is the second most common disorder in the field of degenerative joint diseases of the hand, appearing ten to fifteen times more often in females older than 50 than in men of the same age group. Thus, an age group is afflicted where the hands are needed for occupational activity in addition to the physical strain of constant housework. However, no systematic data concerning the postoperative ability to perform household and or occupational activities have been reported. The aim of this study is to give better advice to future patients during office visits prior to the operation. For this, we evaluated different professions, postoperative working ability, occupational rehabilitation (housework or occupational activity), remaining discomfort and complications. We used a list of questions including the DASH questionnaire and sent it to patients after performing a tendon interposition arthroplasty. Forty-seven of the 52 patients of working age and under the age of 60 years returned the questionnaire. Patients were, according to their profession, classified into 4 different groups: manually heavy work, manually light work, office work and housework. Judging from the recorded data, we conclude that approximately 90% of the patients regained their preoperative working ability. Patients were unable to work for an average period of 8 weeks postoperatively and could only work part-time (50%) for another 8 weeks. There is a positive correlation between incapacity and the kind of work to be performed. Housewives/-men returned approximately to their preoperative status of working ability after a period of three months. Light pain is possible. The risk of disability pension due to persistent painful inability to use the hand is rather low despite the operation. Manually light working people evaluate the outcome of the operation as less good than manually heavy working people, office workers or housewives/-men. PMID:18543162

  7. Trapeziometacarpal osteoarthritis: pyrocarbon interposition implants

    PubMed Central

    ODELLA, SIMONA; QUERENGHI, AMOS M.; SARTORE, ROBERTA; DE FELICE, AGOSTINO; DACATRA, UGO

    2014-01-01

    Purpose the aim of this study was to evaluate the effectiveness of interposition arthroplasty of the trapeziometacarpal (TMC) joint with pyrolitic carbon implants for the treatment of TMC osteoarthritis. Methods we evaluated two groups of patients surgically treated for TMC osteoarthritis: group 1 (34 patients - 36 TMC joints) treated with PyroDisk implantation and group 2 (25 patients - 25 TMC joints) treated with the Pyrocardan implant. All these patients were clinically evaluated at follow-up using the DASH score, Mayo Wrist score and VAS pain score. Results the mean follow-up was 42 months in group 1 and 12 months in group 2. Both groups showed good clinical outcomes in terms of pain relief, range of motion, and pinch and grasp strength. Revision surgery was needed in only one case in group 1 (2.8%) and in three cases (12%) in group 2. Conclusions prosthetic replacement of the TMC joint was found to be a good solution for low-demand patients. However, the PyroDisk could be a good solution in selected patients (Eaton stage I–III, non-subluxated joint): it provides good pain relief, good range of motion, good pinch and grasp strength, and stable results at more than three-years of follow-up. Level of evidence Level IV, therapeutic case series. PMID:25750903

  8. Ten Year Follow-Up of Gap Balanced, Rotating Platform Total Knee Arthroplasty in Patients Under 60 Years of Age.

    PubMed

    Lee, Jason H; Barnett, Steven L; Patel, Jay J; Nassif, Nader A; Cummings, Dennis J; Gorab, Robert S

    2016-01-01

    68 patients (91 primary total knee arthroplasties) were evaluated at a mean 10-year, minimum 5year follow up in patients younger than sixty years of age utilizing the gap balanced, rotating platform design. Follow up assessment included implant survivorship, adverse events, x-rays, Knee Society rating system and clinical evaluation. Three revisions were performed with only one for aseptic loosening at 45months. Two manipulations were performed in the early postoperative period. Survivorship of the rotating platform, gap balanced knee was 96.7% using surgical revision for any reason and 98.9% using aseptic loosening as endpoints. The rotating platform design using the gap balancing technique in young patients had excellent survivorship at 10-year mean follow up. PMID:26297690

  9. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...prosthesis (interpositional implant). 872.3970 Section...DEVICES DENTAL DEVICES Prosthetic Devices § 872.3970 Interarticular...prosthesis (interpositional implant). (a) Identification...prosthesis (interpositional implant) is a device that is...

  10. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...prosthesis (interpositional implant). 872.3970 Section...DEVICES DENTAL DEVICES Prosthetic Devices § 872.3970 Interarticular...prosthesis (interpositional implant). (a) Identification...prosthesis (interpositional implant) is a device that is...

  11. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...prosthesis (interpositional implant). 872.3970 Section...DEVICES DENTAL DEVICES Prosthetic Devices § 872.3970 Interarticular...prosthesis (interpositional implant). (a) Identification...prosthesis (interpositional implant) is a device that is...

  12. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Interarticular disc prosthesis (interpositional implant). 872.3970 Section 872.3970...Interarticular disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis (interpositional implant) is a device that is intended to...

  13. Effects of Reduction Osteotomy on Gap Balancing During Total Knee Arthroplasty for Severe Varus Deformity.

    PubMed

    Niki, Yasuo; Harato, Kengo; Nagai, Katsuya; Suda, Yasunori; Nakamura, Masaya; Matsumoto, Morio

    2015-12-01

    This study aimed to assess the effects of down-sizing and lateralizing of the tibial component (reduction osteotomy) on gap balancing in TKA, and the clinical feasibility of an uncemented modular trabecular metal tibial tray in this technique. Reduction osteotomy was performed for 39 knees of 36 patients with knee OA with a mean tibiofemoral angle of 21° varus. In 20 knees, appropriate gap balance was achieved by release of the deep medial collateral ligament alone. Flexion gap imbalance could be reduced by approximately 1.7° and 2.8° for 4-mm osteotomy and 8-mm osteotomy, respectively. Within the first postoperative year, clinically-stable tibial component subsidence was observed in 9 knees, but it was not progressive, and the clinical results were excellent at a mean follow-up of 3.3 years. PMID:26239234

  14. Interposition of lateral pterygoid in temporomandibular joint ankylosis.

    PubMed

    Pappachan, Biju; Snehal, B

    2009-06-01

    Conventionally temporalis myofascial flap is popular for interposition in TMJ ankylosis. Medial pterygoid and masseter also has been used in the past for interposition. We introduce here lateral pterygoid for interposition in cases of mild ankylosis where condylar bony architecture is not distorted. PMID:23139490

  15. Long-term results of tendon shortening trapeziometacarpal arthroplasty.

    PubMed

    Budoff, Jeffrey E; Gordon, Leonard

    2002-12-01

    Multiple soft tissue arthroplasties have been described for reconstruction of trapeziometacarpal arthritis. Trapeziectomy with abductor pollicis longus tendon shortening has been reported to have favorable short-term results, with 95% to 100% good or excellent pain relief at an average of 18 to 31 months. No long-term results of this reconstruction have been published. In the current study, 29 abductor pollicis longus shortening arthroplasties were reviewed at an average of 5.1 years. Although 83% of patients experienced good or excellent pain relief, pinch weakness, a small arthroplasty space, and first metacarpal instability were present in numerous patients. Because of these problems observed at long-term followup, the authors now use ligament reconstruction tendon interposition as the primary trapeziometacarpal arthroplasty. PMID:12461375

  16. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Interarticular disc prosthesis (interpositional... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis... Food and Drug Administration on or before March 30, 1999, for any interarticular disc...

  17. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Interarticular disc prosthesis (interpositional... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis... Food and Drug Administration on or before March 30, 1999, for any interarticular disc...

  18. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Interarticular disc prosthesis (interpositional... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis... Food and Drug Administration on or before March 30, 1999, for any interarticular disc...

  19. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Interarticular disc prosthesis (interpositional... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis... Food and Drug Administration on or before March 30, 1999, for any interarticular disc...

  20. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Interarticular disc prosthesis (interpositional... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis... Food and Drug Administration on or before March 30, 1999, for any interarticular disc...

  1. [Jejunal pouch interposition and distal gastrectomy].

    PubMed

    Miwa, K; Kinami, S; Sahara, H; Matsumoto, H; Segawa, M; Michiwa, Y; Miyazaki, I

    1997-06-01

    We developed a new technique of reconstruction in Billroth 1 gastrectomy, jejunal pouch interposition (JPI). The interposed jejunal segment consists of a proximally double-plicated pouch and a distally isoperistaltic conduit. From 1987 to 1994, the JPI was performed on 102 patients with gastric carcinoma. The postoperative functional assay was carried out at least one year later after surgery. Sixty-five patients with the conventional Billroth 1 reconstruction (B-1) during the same period were employed as the control. Gastric emptying time estimated with scinti-scanning was significantly delayed in the JPI group compared with the B-1 group (p < 0.05). All individuals with JPI had meals three times a day whereas 13% of those with B-1 required those more than three times (p < 0.05). The incidence of dumping syndrome was significantly lower in the JPI group (6%) than the B-1 group (20%) (p < 0.05). The reflux of bile into the residual stomach was observed in the scintiscanning at 78% of patients with B-1 whereas 10% of those with JPI (p < 0.01). Endoscopy revealed that regurgitation gastritis was significantly decreased in the JPI group compared with that in the B-1 group (p < 0.01). These results suggest that the JPI prevents small stomach syndrome, dumping syndrome and alkaline reflux gastritis after the B-1 reconstruction. PMID:9255808

  2. Interposition vein graft for giant coronary aneurysm repair

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Azoury, F.; Lytle, B. W.; Thomas, J. D.

    2000-01-01

    Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.

  3. A reversed jejunal segment interposition as feeding gastrostomy.

    PubMed

    López, R; Suárez, A; Santiago-Delpín, E A

    1977-03-01

    Permanent feeding gastrostomies are needed for prolonged alimentation in some patients with foregut obstruction. The usual gastric flap or tube may be limited in patients with previous gastric surgery or with a small stomach. In these patients, interposition of a short, vascularized jejunal segment between the anterior wall of the stomach and the outside may be valuable. Periodic intubation is easy. Tested initially in dogs and then applied to selected patients, we have not seen ulcers, regurgitation, soiling, pain, or other complications. PMID:66049

  4. Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome.

    PubMed

    Bansal, V; Singh, S; Garg, N; Dubey, P

    2014-02-01

    This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via 'lazy-S' incision. A gap arthroplasty was performed, followed by a 'reverse L' osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13-27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients. PMID:24016549

  5. Hip resurfacing arthroplasty

    PubMed Central

    2010-01-01

    Background and purpose Hip resurfacing arthroplasty is claimed to allow higher activity levels and to give better quality of life than total hip arthroplasty. In this literature review, we assessed the therapeutic value of hip resurfacing arthroplasty as measured by functional outcome. Methods An extensive literature search was performed using the PubMed, Embase, and Cochrane databases. Results 9 patient series, 1 case-control study, and 1 randomized controlled trial (RCT) were included. Clinically and statistically significant improvement in sporting activity and hip scores were found in 10 studies. Interpretation Studies with low levels of evidence have shown improvement in various different hip scores and one RCT showed better outcomes with hip resurfacing arthroplasty. There is no high-level evidence to prove that there is improved clinical outcome using hip resurfacing arthroplasty. More randomized research needs to be done. PMID:20860440

  6. Interpositional Nerve Grafting of the Prostatic Plexus after Radical Prostatectomy

    PubMed Central

    Kung, Theodore A.; Waljee, Jennifer F.; Curtin, Catherine M.; Wei, John T.; Montie, James E.

    2015-01-01

    Background: Injury to the prostatic plexus may occur during radical prostatectomy even with the use of minimally invasive techniques. Reconstruction of these nerves by interpositional nerve grafting can be performed to reduce morbidity. Although the feasibility of nerve reconstruction has been shown, long-term functional outcomes are mixed, and the role of nerve grafting in these patients remains unclear. Methods: A retrospective study was performed on 38 consecutive patients who underwent immediate unilateral or bilateral nerve reconstruction after open prostatectomy. Additionally, 53 control patients who underwent unilateral, bilateral, or non–nerve-sparing open prostatectomy without nerve grafting were reviewed. Outcomes included rates of urinary continence, erections sufficient for sexual intercourse, and ability to have spontaneous erections. Analysis was performed by stratifying patients by D’Amico score and laterality of nerve involvement. Results: Unilateral nerve grafting conferred no significant benefit compared with unilateral nerve-sparing prostatectomy. Bilateral nerve-sparing patients demonstrated superior functional outcomes compared with bilateral non–nerve-sparing patients, whereas bilateral nerve-grafting patients displayed a trend toward functional improvement. With increasing D’Amico score, there was a trend toward worsening urinary continence and erectile function regardless of nerve-grafting status. Conclusions: In the era of robotic prostatectomy, interpositional nerve reconstruction is not a routine practice. However, the substantial morbidity experienced in patients with bilateral nerve resections remains unacceptable, and therefore, nerve grafting may still improve functional outcomes in these patients. Further investigation is needed to improve the potential of bilateral nerve grafting after non–nerve-sparing prostatectomy. PMID:26301141

  7. Robotic Surgery in Arthroplasty

    MedlinePLUS

    ... Home AAOS Now 2013 December research AAOS Now Robotic Surgery in Arthroplasty Share By: Karthikeyan E. Ponnusamy, ... E. Ponnusamy, MD, and S. Raymond Golish, MD, PhD Robotic assistance is a relatively new technology for unicompartmental ( ...

  8. Transforming a Biliopancreatic Derivation in an Ileal Interposition with a Single Anastomosis.

    PubMed

    Santoro, Sergio; de Aquino, Caio G Gaspar

    2015-08-01

    The biliopancreatic derivation (BPD) is the most powerful bariatric procedure. However, it never became a very popular procedure, except for Italy, because of the high rate of nutritional problems, intense flatulence, and diarrhea. Here, we describe an extremely simple way (just one anastomosis) to revise the BPD, transforming it into an ileal interposition with duodenal exclusion, solving these described problems. PMID:26084252

  9. Testicular Interposition Flap for Repair of Perineal Urinary Fistulae: A Novel Surgical Technique

    PubMed Central

    Raup, Valary T.; Eswara, Jairam R.; Marshall, Stephen D.; Brandes, Steven B.

    2015-01-01

    Rectourinary fistulae and urinary-cutaneous fistulae are a rare yet devastating complication. Current options for tissue interposition include rectus, gracilis, or gluteal muscle, omentum, or intestine for use in coloanal pull-through procedures. In elderly patients, testicular interposition flaps may be an excellent tissue option to use when vitalized tissue is necessary to supplement fistula repair. Elderly patients frequently have increased spermatic cord length, potentially offering a longer flap reach than use of a muscle flap. Additionally, mobilizing one of the testicles and developing it through the external inguinal ring may be a less morbid and less costly procedure than harvesting and tunneling a muscle flap. Longer follow-up and further studies are needed to determine the outcomes of this novel technique. PMID:26483985

  10. Total esophagogastrectomy plus extended lymphadenectomy with transverse colon interposition: A treatment for extensive esophagogastric junction cancer

    PubMed Central

    Ceroni, Marco; Norero, Enrique; Henríquez, Juan Pablo; Viñuela, Eduardo; Briceño, Eduardo; Martínez, Cristian; Aguayo, Gloria; Araos, Fernando; González, Paulina; Díaz, Alfonso; Caracci, Mario

    2015-01-01

    AIM: To review the post-operative morbidity and mortality of total esophagogastrectomy (TEG) with second barrier lymphadenectomy (D2) with interposition of a transverse colon and to determine the oncological outcomes of TEG D2 with interposition of a transverse colon. METHODS: This study consisted of a retrospective review of patients with a cancer diagnosis who underwent TEG between 1997 and 2013. Demographic data, surgery protocols, complications according to Clavien-Dindo classifications, final pathological reports, oncological follow-ups and causes of death were recorded. We used the TNM 2010 and Japanese classifications for nodal dissection of gastric cancer. We used descriptive statistical analysis and Kaplan-Meier survival curves. A P-value of less than 0.05 was considered statistically significant. RESULTS: The series consisted of 21 patients (80.9% men). The median age was 60 years. The 2 main surgical indications were extensive esophagogastric junction cancers (85.7%) and double cancers (14.2%). The mean total surgery time was 405 min (352-465 min). Interposition of a transverse colon through the posterior mediastinum was used for replacement in all cases. Splenectomy was required in 13 patients (61.9%), distal pancreatectomy was required in 2 patients (9.5%) and resection of the left adrenal gland was required in 1 patient (4.7%). No residual cancer surgery was achieved in 75.1% of patients. A total of 71.4% of patients had a postoperative complication. Respiratory complications were the most frequently observed complication. Postoperative mortality was 5.8%. Median follow-up was 13.4 mo. Surgery specific survival at 5 years of follow-up was 32.8%; for patients with curative surgery, it was 39.5% at 5 years. CONCLUSION: TEG for cancer with interposition of a transverse colon is a very complex surgery, and it presents high post-operative morbidity and adequate oncological outcomes. PMID:26464757

  11. [Shoulder arthroplasty: the situation in 2014].

    PubMed

    Oztürk, M; Cunningham, G; Holzer, N; Hoffmeyer, P

    2014-12-17

    Evolution of shoulder arthroplasty has led to mainly three types of implants: hemiarthroplasty, total shoulder arthroplasty and reverse shoulder arthroplasty. There is yet no clear consensus about indications for the different existing types of prothesis. The aim of this article is therefore to bring together and clarify the indications found in the current literature. Hemiarthroplasty, historically the first widely used implant, has lost much ground to total shoulder arthroplasty, and keeps its place only for specific situations. Total shoulder arthroplasty is mainly used for centered glenohumeral osteoarthritis, whereas reverse shoulder arthroplasty is indicated for most situations in which the rotator cuff or tuberoties are deficient. PMID:25752009

  12. 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

  13. Retrograde stapling of a free cervical jejunal interposition graft: a technical innovation and case report

    PubMed Central

    2014-01-01

    Background Free jejunal interposition is a useful technique for reconstruction of the cervical esophagus. However, the distal anastomosis between the graft and the remaining thoracic esophagus or a gastric conduit can be technically challenging when located very low in the thoracic aperture. We here describe a modified technique for retrograde stapling of a jejunal graft to a failed gastric conduit using a circular stapler on a delivery system. Case presentation A 56 year-old patient had been referred for esophageal squamous cell carcinoma at 20 cm from the incisors. On day 8 after thoracoabdominal esophagectomy with gastric pull-up, an anastomotic leakage was diagnosed. A proximal-release stent was successfully placed by gastroscopy and the patient was discharged. Two weeks later, an esophagotracheal fistula occurred proximal to the esophageal stent. Cervical esophagostomy was performed with cranial closure of the gastric conduit, which was left in situ within the right hemithorax. Three months later, reconstruction was performed using a free jejunal interposition. The anvil of a circular stapler (Orvil®, Covidien) was placed transabdominally through an endoscopic rendez-vous procedure into the gastric conduit. A free jejunal graft was retrogradely stapled to the proximal end of the conduit. Microvascular anastomoses were performed subsequently. The proximal anastomosis of the conduit was completed manually after reperfusion. Conclusions This modified technique allows stapling of a jejunal interposition graft located deep in the thoracic aperture and is therefore a useful method that may help to avoid reconstruction by colonic pull-up and thoracotomy. PMID:25319372

  14. Arthroscopic interposition in thumb carpometacarpal osteoarthritis: A series of 26 cases.

    PubMed

    Pereira, A; Ichihara, S; Facca, S; Hendriks, S; Gouzou, S; Liverneaux, P

    2015-12-01

    In 2011, we reported good results after a mean follow-up of 14months for a series of 25 patients who underwent thumb carpometacarpal osteoarthritis surgery in which a poly-L-lactic acid implant was interposed arthroscopically. The aim of this study was to evaluate the outcomes after a longer follow-up. The new series consisted of 26 patients, whose average age was 60years, operated with arthroscopy for the interposition of an implant made of poly-L-lactic acid in 12 cases and tendon interposition in 14 cases. After an average follow-up of 20months, the pain assessed with a visual analog scale was on average 6.61/10 before surgery and 6.03/10 after, the QuickDASH score was 56.36/100 before and 53.65/100 after, grip strength was 15.34kg before and 12.8kg after, pinch strength was 3.7kg before and 2.18kg after, Kapandji thumb opposition score was 8.96/10 before and 8.26/10 after. The radiological stage did not change. We noted one case of type 1 complex regional pain syndrome and 12 poor results, 11 of which were reoperated by trapeziectomy. Given our results and the lack of published studies with a high level of evidence, the value of isolated arthroscopy with interposition in the surgical treatment of thumb carpometacarpal osteoarthritis remains to be demonstrated. PMID:26603368

  15. 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

  16. Robotic-assisted knee arthroplasty.

    PubMed

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

    2015-11-01

    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

  17. Talocalcaneal Joint Middle Facet Coalition Resection With Interposition of a Juvenile Hyaline Cartilage Graft.

    PubMed

    Tower, Dyane E; Wood, Ryan W; Vaardahl, Michael D

    2015-01-01

    Talocalcaneal joint middle facet coalition is the most common tarsal coalition, occurring in ?2% of the population. Fewer than 50% of involved feet obtain lasting relief of symptoms after nonoperative treatment, and surgical intervention is commonly used to relieve symptoms, increase the range of motion, improve function, reconstruct concomitant pes planovalgus, and prevent future arthrosis from occurring at the surrounding joints. Several approaches to surgical intervention are available for patients with middle facet coalitions, ranging from resection to hindfoot arthrodesis. We present a series of 4 cases, in 3 adolescent patients, of talocalcaneal joint middle facet coalition resection with interposition of a particulate juvenile hyaline cartilaginous allograft (DeNovo(®) NT Natural Tissue Graft, Zimmer, Inc., Warsaw, IN). With a mean follow-up period of 42.8 ± 2.9 (range 41 to 47) months, the 3 adolescent patients in the present series were doing well with improved subtalar joint motion and decreased pain, and 1 foot showed no bony regrowth on a follow-up computed tomography scan. The use of a particulate juvenile hyaline cartilaginous allograft as interposition material after talocalcaneal middle facet coalition resection combined with adjunct procedures to address concomitant pes planovalgus resulted in good short-term outcomes in 4 feet in 3 adolescent patients. PMID:25922335

  18. Iatrogenic rectovaginal fistula repair by trans-perineal approach and pubo-coccygeus muscle interposition

    PubMed Central

    Pata, Giacomo; Pasini, Mario; Roncali, Stefano; Tognali, Daniela; Ragni, Fulvio

    2014-01-01

    INTRODUCTION Rectovaginal fistula (RVF) is a rare but debilitating complication of a variety of pelvic surgical procedures. PRESENTATION OF CASE We report the case of a 45-year-old female who underwent the STARR (Stapled Trans Anal Rectal Resection) procedure, that was complicated by a 30mm rectovaginal fistula (RVF). We successfully repaired the fistula by trans-perineal approach and pubo-coccygeus muscle interposition. Seven months later we can confirm the complete fistula healing and good patient's quality of life. We carefully describe our technique showing the advantages over alternative suturing, flap reconstruction or resection procedures. DISCUSSION This technique is fairly easy to perform and conservative. The pubo-coccygeus muscle is quickly recognizable during the dissection of the recto-vaginal space and the tension-free approximation of this muscle by single sutures represents an easy way of replacement of the recto-vaginal septum. CONCLUSION In our experience the use of pubo-coccygeus muscle interposition is an effective technique for rectovaginal space reconstruction and it should be considered as a viable solution for RVF repair. PMID:25016079

  19. Cervical diverticulitis: a novel complication of a neonatal colonic interposition graft following oesophagectomy.

    PubMed

    Punwani, Vishal V; Ong, Eugene; Hii, Michael W

    2015-01-01

    A 47-year-old woman presented to a tertiary emergency department with an 8-day history of odynophagia, a 4?cm swelling on her left neck and intermittent fevers. Shortly following her birth, a congenital oesophageal atresia had been managed surgically with colonic interposition graft. Contrast CT of the neck demonstrated several large diverticula within her interposition graft at the level of the cervical vertebrae. A colocutaneous fistula was identified between the colon and left neck, with an associated abscess. The patient received intravenous meropenem followed by abscess drainage. A high output fistula developed at the drainage site, and the patient required intravenous fluids and stoma placement to manage fluid discharge. She left the hospital after a 17-day stay. At 6-month follow-up, the wound was erythematous, but the patient was otherwise well. We believe that this is the first reported case of diverticular disease arising in what was originally neonatal colon interposed for oesophageal atresia at birth. PMID:26354840

  20. Outcomes of Trapeziectomy with a Modified Abductor Pollicis Longus Suspension Arthroplasty for the Treatment of Thumb Carpometacarpal Osteoarthritis

    PubMed Central

    Chang, Edwin Y.; Chung, Kevin C.

    2015-01-01

    Purpose Various arthroplasty procedures have been described for the treatment of thumb carpometacarpal joint (CMC) osteoarthritis. The purpose of this study is to determine the outcomes of patients treated with trapeziectomy and a variation of abductor pollicis longus (APL) suspension arthroplasty. Methods 18 consecutive patients with osteoarthritis of the thumb CMC joint were treated by a single surgeon (KCC) with trapeziectomy and APL suspension arthroplasty (21 thumbs). The radial slip of the APL was used for the reconstruction. Prospective outcomes data were collected before the operation, and at 3, 6 and 12 months after surgery. Outcomes were assessed with x-rays, grip/key pinch strength, the Jebsen-Taylor test and the Michigan Hand Outcomes Questionnaire (MHQ). Tourniquet time was recorded as well. These results were compared to our retrospective series of 35 flexor carpi radialis (FCR) ligament reconstructive procedures and to the literature. Results Immediately after surgery, a 32% loss in CMC height was observed and an additional 11% proximal metacarpal migration was observed at 1 year. The mean grip strength was 11.1 kg pre-operatively, and 7.7 kg, 14.3 kg, and 16.7 kg at 3 months, 6 months and 1 year post-operatively. These results were comparable to published series. The Jebsen-Taylor scores showed a improvement from 47 seconds pre-operatively to 40 seconds at 3 months, 34 seconds at 6 months (p=0.03), and 33 seconds at 1 year (p=0.01). The MHQ results demonstrated improvements in all domains. Statistically significant improvements were noted in the domains of overall score from 41 to 67 (p=0.03), activities of daily living from 43 to 66 (p=0.01), work from 41 to 65 (p=0.05), patient satisfaction from 25 to 68 (p=0.01), and pain decreased from 73 to 30 (p<0.01). The mean tourniquet time for the trapeziectomy with APL suspension arthroplasty was 33 minutes, while the mean tourniquet time for trapeziectomy with FCR ligament reconstruction and tendon interposition was 42 minutes (p=0.02). Conclusion Abductor pollicis longus suspension arthroplasty is a faster and technically easier technique that avoids any additional deficit by using an accessory tendon. Its outcomes are comparable to those in our retrospective FCR series and to published data in the literature. Furthermore, APL suspension arthroplasty gives acceptable patient-rated outcomes especially in pain relief and satisfaction. PMID:18626369

  1. Cup arthroplasty for rotator cuff tear arthropathy.

    PubMed

    Mariscalco, Michael W; Patterson, Ryan W; Seitz, William H

    2011-03-01

    Cup arthroplasty is a conservative bone-sparing option for resurfacing of the humeral head. Earlier reports have shown its effectiveness in appropriately selected patients with osteoarthritis, osteonecrosis, and severe rheumatoid arthritis. Patients with cuff tear arthropathy may also benefit from a modified cup arthroplasty technique. The purpose of this article is to describe the surgical technique involved in humeral cup arthroplasty in cuff tear arthropathy patients. We will review the indications, contraindications, complications, and postoperative rehabilitation. PMID:21358516

  2. The Swedish Knee Arthroplasty Register

    PubMed Central

    Robertsson, O.; Ranstam, J.; Sundberg, M.; W-Dahl, A.; Lidgren, L.

    2014-01-01

    We are entering a new era with governmental bodies taking an increasingly guiding role, gaining control of registries, demanding direct access with release of open public information for quality comparisons between hospitals. This review is written by physicians and scientists who have worked with the Swedish Knee Arthroplasty Register (SKAR) periodically since it began. It reviews the history of the register and describes the methods used and lessons learned. Cite this article: Bone Joint Res 2014;3:217–22. PMID:24986492

  3. Inferior outcome after hip resurfacing arthroplasty than after conventional arthroplasty

    PubMed Central

    2010-01-01

    Background and purpose The reported outcomes of hip resurfacing arthroplasty (HRA) vary. The frequency of this procedure in Denmark, Norway, and Sweden is low. We therefore determined the outcome of HRA in the NARA database, which is common to all 3 countries, and compared it to the outcome of conventional total hip arthroplasty (THA). Methods The risk of non-septic revision within 2 years was analyzed in 1,638 HRAs and compared to that for 172,554 conventional total hip arthroplasties (THAs), using Cox regression models. We calculated relative risk (RR) of revision and 95% confidence interval. Results HRA had an almost 3-fold increased revision risk compared to THA (RR = 2.7, 95% CI: 1.9–3.7). The difference was even greater when HRA was compared to the THA subgroup of cemented THAs (RR = 3.8, CI: 2.7–5.3). For men below 50 years of age, this difference was less pronounced (HRA vs. THA: RR = 1.9, CI: 1.0–3.9; HRA vs. cemented THA: RR = 2.4, CI: 1.1–5.3), but it was even more pronounced in women of the same age group (HRA vs. THA: RR = 4.7, CI: 2.6–8.5; HRA vs. cemented THA: RR = 7.4, CI: 3.7–15). Within the HRA group, risk of non-septic revision was reduced in hospitals performing ? 70 HRAs annually (RR = 0.3, CI: 0.1–0.7) and with use of Birmingham hip resurfacing (BHR) rather than the other designs as a group (RR = 0.3, CI: 0.1–0.7). Risk of early revision was also reduced in males (RR = 0.5, CI: 0.2–0.9). The femoral head diameter alone had no statistically significant influence on the early revision rate, but it eliminated the significance of male sex in a combined analysis. Interpretation In general, our results do not support continued use of hip resurfacing arthroplasty. Men had a lower early revision rate, which was still higher than observed for all-cemented hips. Further follow-up is necessary to determine whether HRA might be useful as an alternative in males. PMID:20919812

  4. Vascularized interpositional periosteal connective tissue flap: A modern approach to augment soft tissue

    PubMed Central

    Agarwal, Chitra; Deora, Savita; Abraham, Dennis; Gaba, Rohini; Kumar, Baron Tarun; Kudva, Praveen

    2015-01-01

    Context: Nowadays esthetics plays an important role in dentistry along with function of the prosthesis. Various soft tissue augmentation procedures are available to correct the ridge defects in the anterior region. The newer technique, vascularized interpositional periosteal connective tissue (VIP-CT) flap has been introduced, which has the potential to augment predictable amount of tissue and has many benefits when compared to other techniques. Aim: The study was designed to determine the efficacy of the VIP-CT flap in augmenting the ridge defect. Materials and Methods: Ten patients with Class III (Seibert's) ridge defects were treated with VIP-CT flap technique before fabricating fixed partial denture. Height and width of the ridge defects were measured before and after the procedure. Subsequent follow-up was done every 3 months for 1-year. Statistical Analysis Used: Paired t-test was performed to detect the significance of the procedure. Results: The surgical site healed uneventfully. The predictable amount of soft tissue augmentation had been achieved with the procedure. The increase in height and width of the ridge was statistically highly significant. Conclusion: The VIP-CT flap technique was effective in augmenting the soft tissue in esthetic area that remained stable over a long period. PMID:25810597

  5. Functional assessment of colonic interposition with 99Tcm-labeled milk

    SciTech Connect

    Sutton, R.; Sutton, H.; Ackery, D.M.; Freeman, N.V. )

    1989-09-01

    A prospective study was performed to evaluate the use of radionuclide imaging in the assessment of patients who have undergone esophageal reconstruction. Dynamic radionuclide imaging was performed on ten patients aged 11 months to 11 years who had undergone colon interposition via the normal esophageal route for esophageal atresia. Patients were considered clinically unsatisfactory if at the time of imaging feeding was troubled, or if weight gain had fallen to below the third centile before operation and remained below after operation. Each patient underwent erect imaging with a small milk feed labeled with 10 to 20 MBq (250 to 500 muCi) 99Tcm DTPA adjusted according to body surface area; supine studies were subsequently performed on five patients. All five clinically unsatisfactory patients showed conduit emptying delayed beyond 45 minutes and/or spontaneous reflux, significantly different from the clinically satisfactory patients (X2 = 6.4, P less than .02). Conduit complications were subsequently identified in three of the five clinically unsatisfactory patients. Radionuclide imaging with radiolabeled milk was found to be well tolerated, and obtained results that were clinically useful. These results suggest that dynamic radionuclide imaging can be more widely applied in the assessment of esophageal substitutes.

  6. Use of autologous interposition vein graft in management of lymphedema: preliminary experimental and clinical observations.

    PubMed

    Campisi, C

    1991-06-01

    We report preliminary experimental studies in rats and rabbits together with clinical observations in 39 patients with chronic lymphedema undergoing interposition autologous lymphatic-venous-lymphatic (LVL) anastomoses. This microsurgical operative technique is an alternative to other lymphatic shunting methods particularly where venous disease coexists in the same limb and where direct lymphatic-venous bypass is accordingly inappropriate. Preoperative diagnostic evaluation including lymphatic and venous isotopic scintigraphy, Doppler venous flow metrics and pressure manometry play an essential role in delineating the status of both the lymphatic and venous systems and in determining which microsurgical procedure, if any, is indicated. Our microsurgical method consists of inserting suitably large and lengthy autologous venous grafts between lymphatic collectors above and below the site of blockage to lymph flow. The data demonstrate the feasibility of the LVL technique experimentally and in 39 patients with obstructive lymphedema (either arm or leg). Using LVL shunt, improvement was seen in both limb function and edema, and in some, edema regression was permanent for as long as 5 years. PMID:1921479

  7. Optimization of Synthetic Proteins: Identification of Interpositional Dependencies Indicating Structurally and/or Functionally Linked Residues.

    PubMed

    Rumpf, R Wolfgang; Ray, William C

    2015-01-01

    Protein alignments are commonly used to evaluate the similarity of protein residues, and the derived consensus sequence used for identifying functional units (e.g., domains). Traditional consensus-building models fail to account for interpositional dependencies - functionally required covariation of residues that tend to appear simultaneously throughout evolution and across the phylogentic tree. These relationships can reveal important clues about the processes of protein folding, thermostability, and the formation of functional sites, which in turn can be used to inform the engineering of synthetic proteins. Unfortunately, these relationships essentially form sub-motifs which cannot be predicted by simple "majority rule" or even HMM-based consensus models, and the result can be a biologically invalid "consensus" which is not only never seen in nature but is less viable than any extant protein. We have developed a visual analytics tool, StickWRLD, which creates an interactive 3D representation of a protein alignment and clearly displays covarying residues. The user has the ability to pan and zoom, as well as dynamically change the statistical threshold underlying the identification of covariants. StickWRLD has previously been successfully used to identify functionally-required covarying residues in proteins such as Adenylate Kinase and in DNA sequences such as endonuclease target sites. PMID:26274377

  8. Optimization of Synthetic Proteins: Identification of Interpositional Dependencies Indicating Structurally and/or Functionally Linked Residues

    PubMed Central

    Rumpf, R. Wolfgang; Ray, William C.

    2015-01-01

    Protein alignments are commonly used to evaluate the similarity of protein residues, and the derived consensus sequence used for identifying functional units (e.g., domains). Traditional consensus-building models fail to account for interpositional dependencies – functionally required covariation of residues that tend to appear simultaneously throughout evolution and across the phylogentic tree. These relationships can reveal important clues about the processes of protein folding, thermostability, and the formation of functional sites, which in turn can be used to inform the engineering of synthetic proteins. Unfortunately, these relationships essentially form sub-motifs which cannot be predicted by simple “majority rule” or even HMM-based consensus models, and the result can be a biologically invalid “consensus” which is not only never seen in nature but is less viable than any extant protein. We have developed a visual analytics tool, StickWRLD, which creates an interactive 3D representation of a protein alignment and clearly displays covarying residues. The user has the ability to pan and zoom, as well as dynamically change the statistical threshold underlying the identification of covariants. StickWRLD has previously been successfully used to identify functionally-required covarying residues in proteins such as Adenylate Kinase and in DNA sequences such as endonuclease target sites. PMID:26274377

  9. Conversion total hip arthroplasty: Primary or revision total hip arthroplasty.

    PubMed

    Schwarzkopf, Ran; Baghoolizadeh, Mahta

    2015-11-18

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties. PMID:26601055

  10. Conversion total hip arthroplasty: Primary or revision total hip arthroplasty

    PubMed Central

    Schwarzkopf, Ran; Baghoolizadeh, Mahta

    2015-01-01

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties. PMID:26601055

  11. 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

  12. Reverse Shoulder Arthroplasty – A Literature Review

    PubMed Central

    Mahmood, Aatif; Malal, Joby Jacob George; Waseem, Mohammed

    2013-01-01

    Professor Grammont revolutionised shoulder surgery with his reverse shoulder arthroplasty design. Patients who had poor results from a conventional shoulder replacement because of cuff deficiency can now be treated effectively. Although designed for cuff tear arthropathy, indications continue to evolve and broaden. The initial results look very promising and the implant has gained much popularity over the years. The article provides an extensive literature review of the indications, results and complications for reverse shoulder arthroplasty. PMID:24082977

  13. 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

  14. Polyethylene in knee arthroplasty: A review

    PubMed Central

    Chakrabarty, Gautam; Vashishtha, Mayank; Leeder, Daniel

    2015-01-01

    Polyethylene (PE) has been used extensively in knee arthroplasty since the mid 20th century. Progress in material manufacturing and processing has led to newer polyethylenes over last few decades with different material properties. It has been established that PE wear in knee arthroplasty causes particle induced osteolysis which is the main reason for late failure and requires revision surgery. Although there are various causes of wear, the properties of PE have long been a matter of investigation as a contributory factor. The advent of newer highly cross linked PE has been shown to improve wear rates in hip arthroplasty but the benefits have not been shown to be of the same degree in knee arthroplasty. The laboratory and clinical studies so far are limited and slightly conflicting in their conclusions. The risks of using highly cross linked PE in knee arthroplasty include tibial post fracture, disruption of locking mechanism, liner fracture which can lead to increased wear and osteolysis. The current evidence suggests that highly cross linked polyethylenes should be used with caution and only considered in younger active patients. The results of a recently completed randomized trial to compare the conventional with high molecular weight PE in knee arthroplasty are awaited. PMID:25983517

  15. Interposition of dartos flaps to prevent fistula after tubularized incised-plate repair of hypospadias

    PubMed Central

    Elsayed, Ehab R.; Zayed, Abdellatif M.; El Sayed, Diab; El Adl, Mahmoud

    2011-01-01

    Objective: To evaluate the effect of urethral coverage by a single- or double-layered dorsal dartos flap after tubularized incised-plate (TIP) repair of hypospadias on fistula formation. Patients and methods: In this retrospective study we evaluated sequential patients with hypospadias who underwent TIP urethroplasty with a dorsal dartos interpositional flap between April 2008 and December 2009. We reviewed their medical records for the site of hypospadias, previous hypospadias repair, single- or double-layered dartos flap and postoperative complications. The patients were divided into two groups; in group A the urethra was covered by a single layer of dartos fascia, and in group B the urethra was covered by double layers of dartos flap. Results: Of 91 patients who opted for hypospadias repair during the time of the study, 62 had a TIP urethroplasty with a dorsal dartos flap; of these 62, three did not fulfil the requirement of the minimum follow-up, so 59 were eligible for the study (32 in group A and 27 in group B). Preoperative clinical data were comparable in both groups. At a mean of 12.2 months of follow-up, there was no reported fistula in group B, while two patients in group A developed a urethrocutaneous fistula (P = 0.19). Meatal stenosis occurred in two patients in group A and one in group B (P = 0.66). Conclusion: There was no significant difference in subsequent urethrocutaneous fistula between a double-layered dorsal dartos flap and single layer for covering the urethra as a part of TIP urethroplasty for repairing hypospadias.

  16. The role of offset stems in revision knee arthroplasty.

    PubMed

    Baldini, Andrea; Balato, Giovanni; Franceschini, Vincenzo

    2015-12-01

    Revision total knee arthroplasty (TKA) represents a technically challenging procedure. The use of an offset stem extension can help in addressing some of the difficulties that can be encountered during surgery and, in particular, anatomical mismatch, malalignment, and gap balancing. Different offset stem extensions are available and can be classified according to four parameters: modularity, location of the offset, direction, and size of the displacement. Offset stem extensions can assist with implant alignment on the metaphysis if there is an offset diaphysis, can avoid medial-lateral or anterior-posterior component overhang, can reduce the incidence of coronal or sagittal malalignment, and can help in balancing the flexion and extension spaces by effectively translating the components. The aim of this study is to give an overview of the currently available evidence regarding the use of offset stem extensions in revision TKA as well as some useful surgical tips. PMID:26373769

  17. Painful knee arthroplasty: current practice.

    PubMed

    Cottino, Umberto; Rosso, Federica; Pastrone, Antonio; Dettoni, Federico; Rossi, Roberto; Bruzzone, Matteo

    2015-12-01

    Primary total knee arthroplasty is the treatment for end-stage arthritis of the knee; in the last years, it is becoming more common and reliable, due to technical and implant improvement. With larger implant rates, the overall complications will increase and pain is the most common sign of implant failure. Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis; if surgery is performed for the wrong reason, this will surely lead to a failure. In this paper, the authors revised the more common causes of failure that can have a painful onset proposing an approach for diagnosis and treatment. PMID:26400422

  18. Imaging of elbow replacement arthroplasty.

    PubMed

    Roth, Eira; Chew, Felix S

    2015-02-01

    Elbow replacement arthroplasty has become a standard surgical treatment for a variety of diseases of the elbow. First popularized for the treatment of late-stage rheumatoid arthritis and other debilitating forms of joint disease, the current indications have expanded to include primary treatment of elbow trauma. The most commonly used total elbow replacements are linked semiconstrained chromium-molybdenum alloy or titanium alloy prostheses with polyethylene bearing surfaces. These are inserted after resection of the ulnotrochlear joint and typically cemented in place; the radial head is often sacrificed. Modular metal components or massive osteoarticular allografts may be used when there is extensive bone deficiency. Metal radial head replacements are increasing being used for primary fracture treatment and in posttraumatic elbow reconstructive surgery. Long-term outcomes for total elbow replacement are similar to those of other joints, with 10-year survivals of ? 90%. Complications specific to elbow implants include infection, aseptic loosening, prosthetic failure, and periprosthetic fracture. PMID:25633026

  19. Poor outcome of revised resurfacing hip arthroplasty

    PubMed Central

    Miller, Lisa N; Prosser, Gareth H; Graves, Stephen E; Davidson, David C; Stanford, Tyman E

    2010-01-01

    Background and purpose Recent years have seen a rapid increase in the use of resurfacing hip arthroplasty despite the lack of literature on the long-term outcome. In particular, there is little evidence regarding the outcome of revisions of primary resurfacing. The purpose of this analysis was to examine the survivorship of primary resurfacing hip arthroplasties that have been revised. Patients and methods Over 12,000 primary resurfacing hip arthroplasties were recorded by the Australian Orthopaedic Association National Joint Replacement Registry between September 1, 1999 and December 31, 2008. During this time, 397 revisions for reasons other than infection were reported for these primary resurfacings and classified as acetabular, femoral, or both acetabular and femoral revisions. The survivorship of the different types of revisions was estimated using the Kaplan-Meier method and compared using proportional hazard models. Additionally, the outcome of a femoral-only revision was compared to that of primary conventional total hip arthroplasty. Results Acetabular-only revision had a high risk of re-revision compared to femoral-only and both acetabular and femoral revision (5-year cumulative per cent revision of 20%, 7%, and 5% respectively). Femoral-only revision had a risk of re-revision similar to that of revision of both the acetabular and femoral components. Femoral-only revision had over twice the risk of revision of primary conventional total hip arthroplasty. Interpretation Revision of a primary resurfacing arthroplasty is associated with a major risk of re-revision. The best outcome is achieved when either the femoral-only or both the acetabular and femoral components are revised. Technically straightforward femoral-only revisions generally have a worse outcome than a primary conventional total hip arthroplasty. PMID:20170416

  20. [Sport activity after hip and knee arthroplasty].

    PubMed

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them. PMID:24416822

  1. 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

  2. Uncommon Indications for Reverse Total Shoulder Arthroplasty

    PubMed Central

    Hyun, Yoon Suk; Huri, Gazi; Garbis, Nickolas G.

    2013-01-01

    Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty. PMID:24340143

  3. 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

  4. Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation.

    PubMed

    Ryd, L

    1986-01-01

    The modern era of endoprosthetic joint replacement started with the introduction of acrylic cement to improve component fixation. Long-term results have, however, indicated that prosthetic fixation remains critical; loosening at the bone-cement interface has become an important problem. Research in recent years has focused on attempts to achieve better fixation by improving cementing techniques, improving prosthetic design by, for example, adding metal support of polyethylene components and by exploring alternative ways to bond prosthetic components to bone without cement. The mechanical integrity of the bone-cement interface has been studied under laboratory conditions. Because of the in-vivo reaction of bone, with the interposition of a fibrous tissue layer at the interface, such studies are not totally valid. Studies on autopsy material, more closely resembling the in-vivo situation, are few and there has been only one previous study like the present one. In this study, roentgen stereophotogrammetric analysis (RSA) was evaluated and found to have an accuracy ten times better than conventional radiography. This accuracy was judged adequate for studies of micromotion. In this work, two types of micromotion of the tibial component were studied; migration, i.e. gradual motion over time, and inducible displacement, i.e. instant motion in response to external forces. Ninety-six knee arthroplasties for gonarthrosis, representing four different types of fixation were studied by roentgen stereophotogrammetric analysis (RSA). Eighty-nine arthroplasties were clinically successful. The follow-up ranged from two to five years. Full post-operative weight-bearing was allowed for all patients, except those operated with a Freeman-Samuelson prosthesis, who were adviced to use crutches for six weeks and partial weight-bearing for another six weeks. Fifty-one conventionally cemented all-polyethylene prostheses, 27 total and 24 unicompartmental, represented a baseline series. Migration was found for all prostheses, with a mean maximum deflection of 1.2 and 0.9 mm, respectively, after four years. In both groups, the major part of the migration occurred during the first year, after which the majority of the components did not migrate further. Some prostheses, with larger migration during the first year, continued to migrate throughout the investigation. None of the total, but the majority of the unicompartmental prostheses showed signs of cold flow within the polyethylene. All prostheses showed reversible inducible displacement, the maximum deflection ranging from 0.2 to 1.0 mm.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3461667

  5. Total Knee Arthroplasty Considerations in Rheumatoid Arthritis

    PubMed Central

    Danoff, Jonathan R.; Geller, Jeffrey A.

    2013-01-01

    The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success. PMID:24151549

  6. Medial unicondylar knee arthroplasty: technical pearls

    PubMed Central

    BONIFORTI, FILIPPO

    2015-01-01

    Unicondylar knee arthroplasty implantation is extremely demanding as the prosthesis needs to be integrated in the natural anatomy of the knee. It ensures the integrity of the natural knee kinematic. Some studies and registries data have shown lower success rate in comparison with total knee arthroplasty, and patient-related factors may have an impact on outcome. While, better results have been published by high volume centres. The indications for surgery should be reconsidered critically, even if medial osteoarthritis of the knee remains the most common. This article sets out the diagnostic, and surgical steps in order to fine tuning the unicompartmental replacement of the knee. PMID:26605256

  7. Differential Reanimation of the Upper and Lower Face Using 2 Interpositional Nerve Grafts in Total Facial Nerve Reconstruction

    PubMed Central

    Nishibayashi, Akimitsu; Yano, Kenji; Hosokawa, Ko

    2015-01-01

    Summary: Radical parotidectomy often results in complex facial nerve defects involving the main nerve trunk and multiple distal nerve branches. Although cable nerve grafting often leads to good nerve regeneration, severe synkinesis due to aberrant axonal regrowth is inevitable. In such situations, the use of 2 motor sources to differentially reanimate the upper and lower face could minimize synkinesis. Here we describe a method of total facial nerve reconstruction in which the upper and lower face are differentially reconstructed with the hypoglossal nerve and facial nerve, respectively, using 2 interpositional nerve grafts. Reconstruction of the lower face with the facial nerve restored voluntary and coordinated animation, and reconstruction of the upper face with the hypoglossal nerve restored frontalis muscle tone and eye closure. These results suggest that our method could serve as an alternative to conventional techniques that use only the facial or hypoglossal nerve. PMID:26579350

  8. Differential Reanimation of the Upper and Lower Face Using 2 Interpositional Nerve Grafts in Total Facial Nerve Reconstruction.

    PubMed

    Tomita, Koichi; Nishibayashi, Akimitsu; Yano, Kenji; Hosokawa, Ko

    2015-10-01

    Radical parotidectomy often results in complex facial nerve defects involving the main nerve trunk and multiple distal nerve branches. Although cable nerve grafting often leads to good nerve regeneration, severe synkinesis due to aberrant axonal regrowth is inevitable. In such situations, the use of 2 motor sources to differentially reanimate the upper and lower face could minimize synkinesis. Here we describe a method of total facial nerve reconstruction in which the upper and lower face are differentially reconstructed with the hypoglossal nerve and facial nerve, respectively, using 2 interpositional nerve grafts. Reconstruction of the lower face with the facial nerve restored voluntary and coordinated animation, and reconstruction of the upper face with the hypoglossal nerve restored frontalis muscle tone and eye closure. These results suggest that our method could serve as an alternative to conventional techniques that use only the facial or hypoglossal nerve. PMID:26579350

  9. Recurrent hemarthrosis after total knee arthroplasty

    PubMed Central

    Rukavina, Alexander; Schneider, Philipp; Kuster, Markus S.

    2010-01-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization. PMID:20076944

  10. Soft-tissue management in revision total shoulder arthroplasty.

    PubMed

    Abboud, Joseph A; Anakwenze, Oke A; Hsu, Jason Edward

    2013-01-01

    Revision total shoulder arthroplasty can be technically challenging. Results are inferior to those of primary arthroplasty, particularly when the indications for revision are related to soft-tissue problems. Patient selection is important. In the stiff arthroplasty, the surgeon must address rotator cuff and capsular contractures as well as exuberant soft-tissue adhesions. Unstable arthroplasty can be the result of asymmetric soft-tissue balancing or deficiencies (eg, subscapularis deficiency) that can lead to loss of the rotator cuff force couples and, subsequently, to instability on attempted glenohumeral motion. Infection must be considered in the workup of the failed total shoulder. In this era of ever-increasing use of shoulder arthroplasty, surgeons will be presented with growing numbers of patients who require revision surgery. An organized approach is needed to diagnose and manage the stiff or unstable total shoulder arthroplasty. PMID:23281468

  11. Soft tissue balance changes depending on joint distraction force in total knee arthroplasty.

    PubMed

    Nagai, Kanto; Muratsu, Hirotsugu; Matsumoto, Tomoyuki; Miya, Hidetoshi; Kuroda, Ryosuke; Kurosaka, Masahiro

    2014-03-01

    The influence of joint distraction force on intraoperative soft tissue balance was evaluated using Offset Repo-Tensor® for 78 knees that underwent primary posterior-stabilized total knee arthroplasty. The joint center gap and varus ligament balance were measured between osteotomized surfaces using 20, 40 and 60 lbs of joint distraction force. These values were significantly increased at extension and flexion as the distraction force increased. Furthermore, lateral compartment stiffness was significantly lower than medial compartment stiffness. Thus, larger joint distraction forces led to larger varus ligament balance and joint center gap, because of the difference in soft tissue stiffness between lateral and medial compartments. These findings indicate the importance of the strength of joint distraction force in the assessment of soft tissue balance, especially when using gap-balancing technique. PMID:23993344

  12. Closing the Gaps in Postsurgical Pain Management.

    PubMed

    Scuderi, Giles R

    2015-10-01

    Analgesic gaps-periods of inadequate pain control-commonly compromise the management of pain after joint arthroplasty. Such gaps can and should be prevented. The use of well-designed, balanced multimodal analgesic regimens that comprise a combination of agents working independently in both the peripheral and central nervous systems is an effective way to prevent gaps in pain control. Medications that have been shown to be beneficial as components of multimodal regimens include acetaminophen, cyclo-oxygenase 2 (COX-2) inhibitors, gabapentinoids, glucocorticoids, periarticular injections using agents such as bupivacaine HCl and bupivacaine liposome injectable suspension (EXPAREL®, Pacira Pharmaceuticals, Inc), and long-acting opioids. Multimodal analgesia should take into consideration not only the mechanisms of the individual medications, but also their timing of onset and duration of effect. And to avoid continual reestablishment of the pain pathways, it is also important to administer the medications on a scheduled basis rather than as needed. PMID:26447427

  13. Tissue-Specific Differences in the Spatial Interposition of X-Chromosome and 3R Chromosome Regions in the Malaria Mosquito Anopheles messeae Fall.

    PubMed Central

    Artemov, Gleb; Bondarenko, Semen; Sapunov, Gleb; Stegniy, Vladimir

    2015-01-01

    Spatial organization of a chromosome in a nucleus is very important in biology but many aspects of it are still generally unresolved. We focused on tissue-specific features of chromosome architecture in closely related malaria mosquitoes, which have essential inter-specific differences in polytene chromosome attachments in nurse cells. We showed that the region responsible for X-chromosome attachment interacts with nuclear lamina stronger in nurse cells, then in salivary glands cells in Anopheles messeae Fall. The inter-tissue differences were demonstrated more convincingly in an experiment of two distinct chromosomes interposition in the nucleus space of cells from four tissues. Microdissected DNA-probes from nurse cells X-chromosome (2BC) and 3R chromosomes (32D) attachment regions were hybridized with intact nuclei of nurse cells, salivary gland cells, follicle epithelium cells and imaginal dis?s cells in 3D-FISH experiments. We showed that only salivary gland cells and follicle epithelium cells have no statistical differences in the interposition of 2BC and 32D. Generally, the X-chromosome and 3R chromosome are located closer to each other in cells of the somatic system in comparison with nurse cells on average. The imaginal dis?s cell nuclei have an intermediate arrangement of chromosome interposition, similar to other somatic cells and nurse cells. In spite of species-specific chromosome attachments there are no differences in interposition of nurse cells chromosomes in An. messeae and An. atroparvus Thiel. Nurse cells have an unusual chromosome arrangement without a chromocenter, which could be due to the special mission of generative system cells in ontogenesis and evolution. PMID:25671311

  14. Biomarkers in Arthroplasty: A Systematic Review

    PubMed Central

    Mertens, Marty T; Singh, Jasvinder A

    2011-01-01

    We performed a systematic review of all MEDLINE-published studies of biomarkers in arthroplasty. Thirty studies met the inclusion criteria; majority evaluated biomarkers for osteolysis, aseptic prosthetic loosening, and prosthetic infections. Four studies reported an elevated Cross-linked N-telopeptides of type I collagen (urine or serum) in patients with osteolysis or aseptic prosthetic loosening when compared to appropriate controls. Two or more studies each found elevated C-reactive protein, erythrocyte sedimentation rate, and interleukin-6 in patients with infected prosthetic joints compared to controls. Most other biomarkers were either examined by single studies or had inconsistent or insignificant associations with outcomes. We conclude that the majority of the biomarkers currently lack the evidence to be considered as biomarkers for arthroplasty outcomes. Further studies are needed. PMID:21584201

  15. Postoperative Vision Loss after Reverse Shoulder Arthroplasty

    PubMed Central

    Scadden, John

    2014-01-01

    We report a case which highlights the rare but devastating complication of postoperative vision loss (POVL) in orthopaedic surgery. Though documented previously, it has not been reported in shoulder arthroplasty surgery of which we present the first case. The aetiology of POVL is difficult to elucidate due to its elusive nature. We explain the risks associated with regional blocks used for such surgery and how this may be related to POVL. We must be vigilant of the possible causes of POVL as curative treatment is often not possible and hence must take preventative measures which we have recommended. Fortunately, the patient fully recovered at 10 months postoperatively with excellent function of her reverse shoulder arthroplasty. PMID:25610682

  16. Coronal Plane Stability Before and After Total Knee Arthroplasty

    E-print Network

    Delp, Scott

    between how well the knees were balanced after prosthesis implantation in extension and in flexion. OurCoronal Plane Stability Before and After Total Knee Arthroplasty Robert A. Siston, PhD*,, ; Stuart of total knee arthroplasty depends in part on proper soft tissue management to achieve a stable joint

  17. Periprosthetic Fractures Following Total Knee Arthroplasty

    PubMed Central

    Kim, Nam Ki

    2015-01-01

    Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. Supracondylar periprosthetic fractures frequently occur above a well-fixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. Periprosthetic tibial fractures are frequently associated with loose components and malalignment or malposition of implants. Fractures of the patella are much less common and associated with rheumatoid arthritis, use of steroid, osteonecrosis and malalignment of implants. Most patients with periprosthetic fractures around the knee are the elderly with poor bone quality. There are many difficulties and increased risk of nonunion after treatment because reduction and internal fixation is interfered with by preexisting prosthesis and bone cement. Additionally, previous soft tissue injury is another disadvantageous condition for bone healing. Many authors reported good clinical outcomes after non-operative treatment of undisplaced or minimally displaced periprosthetic fractures; however, open reduction or revision arthroplasty was required in displaced fractures or fractures with unstable prosthesis. Periprosthetic fractures around the knee should be prevented by appropriate technique during total knee arthroplasty. Nevertheless, if a periprosthetic fracture occurs, an appropriate treatment method should be selected considering the stability of the prosthesis, displacement of fracture and bone quality. PMID:25750888

  18. Defining high activity in arthroplasty patients.

    PubMed

    Robertson, N B; Battenberg, A K; Kertzner, M; Schmalzried, T P

    2016-01-01

    There is evidence that high levels of physical activity following arthroplasty of the hip or knee can lead to early revision. However, the term 'highly active' is not well defined. A validated ankle accelerometer was used to quantify activity in 13 patients, who had undergone a total of 20 arthroplasties of the lower limbs and who had active lifestyles. The assessments were taken at a mean of 8.7 years post-operatively (1.8 to 15.8). The mean gait cycles per day was 8273 (5964 to 12 557), which extrapolates to 3.0 million cycles per year (cpy) (2.2 to 4.6). The mean percentage of time spent in high activity mode was 4.3%, or about one hour per day. The mean percentage of cycles in high activity was 40%. Based on these data, we propose the following definitions of high activity: > 3 million cpy; one hour per day in high activity mode; 40% of cycles in high activity mode. Extrapolating the sample of activity over the time since operation, the mean cycles per arthroplasty was 25.2 million, with a maximum of 44.1 million. No joint has been revised, or shows evidence of impending failure. Cite this article: Bone Joint J 2016;98-B(1 Suppl A):95-7. PMID:26733651

  19. Evaluation of the unstable total hip arthroplasty.

    PubMed

    Hamilton, William G; McAuley, James P

    2004-01-01

    Despite advances in total hip arthroplasty, dislocation persists as a troublesome complication for orthopaedic surgeons to manage, second only to prosthetic loosening as a cause of revision. Although this complication has received considerable attention, evaluation and treatment of the unstable total hip arthroplasty remain poorly understood. Therefore, it is important to evaluate such factors as underlying patient comorbidities, the direction of dislocation, soft-tissue tension, surgical technique, implant design, and component position. For recurrent hip instability, a careful history to determine the mechanism of dislocation is necessary, and a review of preoperative imaging studies can help clarify whether gross component malpositioning is present. Examination under anesthesia and intraoperative inspection are also important. Taking the hip through a full range of motion while directly visualizing the anatomy can help diagnose component-to-component impingement, inadequate offset soft-tissue tension, extra-articular impingement, and other possible contributing factors. Even when a seemingly obvious cause of dislocation, such as component malposition, is diagnosed, surgical results have been somewhat disappointing. Therefore, surgical planning should include all possible revision options, and the temptation to find the quick fix should be resisted. Patients should be extensively counseled regarding realistic expectations both before primary hip arthroplasty and in the face of a revision surgery for recurrent dislocations because long-term results are less than optimal. PMID:15116602

  20. Minimally invasive knee arthroplasty: An overview

    PubMed Central

    Tria, Alfred J; Scuderi, Giles R

    2015-01-01

    Minimally invasive surgery (MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty (UKA). Partial knee replacements were designed in the 1970s and were amenable to a more limited exposure. In the 1990s Repicci popularized the MIS for UKA. Surgeons began to apply his concepts to total knee arthroplasty. Four MIS surgical techniques were developed: quadriceps sparing, mini-mid vastus, mini-subvastus, and mini-medial parapatellar. The quadriceps sparing technique is the most limited one and is also the most difficult. However, it is the least invasive and allows rapid recovery. The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended. The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient. The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques. The surgeries are easier with smaller instruments but can be performed with standard ones. The techniques are accurate and do lead to a more rapid recovery, with less pain, less blood loss, and greater motion if they are appropriately performed. PMID:26601062

  1. Colonic interposition between the liver and left diaphragm - management of Chilaiditi syndrome: A case report and literature review

    PubMed Central

    WENG, WEI-HONG; LIU, DA-REN; FENG, CHENG-CHENG; QUE, RI-SHENG

    2014-01-01

    Chilaiditi syndrome refers to a medical condition that is indicated by the presence of Chilaiditi sign, the radiological observation of a colonic interposition between the liver and the diaphragm, and is associated with other clinical symptoms. Chilaiditi syndrome is a rare entity and therefore, is often misdiagnosed in clinical practice, however, it may be accompanied by a series of severe complications, such as bowel obstruction and perforation. The current study describes a 47-year-old male who presented with repeated abdominal pain and acute intestinal obstruction. The patient was diagnosed with Chilaiditi syndrome via radiological observation and was cured by conservative treatment. The clinical data of seven additional patients with Chilaiditi syndrome, which was reported in the Chinese literature between January 1990 and January 2013, were also collected. The pathogenesis, clinical manifestation, diagnosis and treatment of this syndrome have been reviewed and analyzed. The current study may be useful to familiarize clinical practitioners with Chilaiditi syndrome, in order to avoid a misdiagnosis during clinical treatment. PMID:24765195

  2. Effectively Axonal-supercharged Interpositional Jump-Graft with an Artificial Nerve Conduit for Rat Facial Nerve Paralysis

    PubMed Central

    Niimi, Yosuke; Takeuchi, Yuichi; Sasaki, Ryo; Watanabe, Yorikatsu; Yamato, Masayuki; Miyata, Mariko; Sakurai, Hiroyuki

    2015-01-01

    Background: Interpositional jump graft (IPJG) is a nerve graft axonally supercharged from the hypoglossal nerve. However, for using the technique, an autologous nerve, which should contain the great auricular and sural nerves, must be obtained. Depending on the donor site, unavoidable issues such as nerve disorders and postoperative scarring may appear. To reduce the issues, in this study, the authors developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit and investigated the efficacy of an IPJG with an artificial nerve conduit in a rat facial nerve paresis model. Methods: A ligature clip was used to crush the facial nerve trunk, thereby creating a partial facial nerve paresis model. An artificial nerve conduit was then prepared with a 10-mm-long silicone tube containing 10 ?L type I collagen and used to create an IPJG between the facial nerve trunk and the hypoglossal nerve (the silicone tube group). Thirteen weeks after the surgery, the outcome was histologically and physiologically compared with conventional IPJG with autograft using the great auricular nerve. Results: Retrograde tracer test confirmed a double innervation by the facial and hypoglossal nerve nuclei. In the autograft and silicone tube groups, the regeneration of myelinated axons was observed. Conclusion: In this study, the authors successfully developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit, and revealed that an IPJG in the conduit was effective in the rat facial nerve paresis model. PMID:26180717

  3. Ileal Interposition in Rats with Experimental Type 2 Like Diabetes Improves Glycemic Control Independently of Glucose Absorption

    PubMed Central

    Jurowich, Christian Ferdinand; Otto, Christoph; Rikkala, Prashanth Reddy; Wagner, Nicole; Vrhovac, Ivana; Saboli?, Ivan; Germer, Christoph-Thomas; Koepsell, Hermann

    2015-01-01

    Bariatric operations in obese patients with type 2 diabetes often improve diabetes before weight loss is observed. In patients mainly Roux-en-Y-gastric bypass with partial stomach resection is performed. Duodenojejunal bypass (DJB) and ileal interposition (IIP) are employed in animal experiments. Due to increased glucose exposition of L-cells located in distal ileum, all bariatric surgery procedures lead to higher secretion of antidiabetic glucagon like peptide-1 (GLP-1) after glucose gavage. After DJB also downregulation of Na+-d-glucose cotransporter SGLT1 was observed. This suggested a direct contribution of decreased glucose absorption to the antidiabetic effect of bariatric surgery. To investigate whether glucose absorption is also decreased after IIP, we induced diabetes with decreased glucose tolerance and insulin sensitivity in male rats and investigated effects of IIP on diabetes and SGLT1. After IIP, we observed weight-independent improvement of glucose tolerance, increased insulin sensitivity, and increased plasma GLP-1 after glucose gavage. The interposed ileum was increased in diameter and showed increased length of villi, hyperplasia of the epithelial layer, and increased number of L-cells. The amount of SGLT1-mediated glucose uptake in interposed ileum was increased 2-fold reaching the same level as in jejunum. Thus, improvement of glycemic control by bariatric surgery does not require decreased glucose absorption. PMID:26185767

  4. Historical view and future demand for knee arthroplasty in Sweden

    PubMed Central

    Rolfson, Ola; W-Dahl, Annette; Garellick, Göran; Sundberg, Martin; Kärrholm, Johan; Robertsson, Otto

    2015-01-01

    Background and purpose The incidence of knee osteoarthritis will most likely increase. We analyzed historical trends in the incidence of knee arthroplasty in Sweden between 1975 and 2013, in order to be able to provide projections of future demand. Patients and methods We obtained information on all knee arthroplasties in Sweden in the period 1975–2013 from the Swedish Knee Arthroplasty Register, and used public domain data from Statistics Sweden on the evolution of and forecasts for the Swedish population. We forecast the incidence, presuming the existence of a maximum incidence. Results We found that the incidence of knee arthroplasty will continue to increase until a projected upper incidence level of about 469 total knee replacements per 105 Swedish residents aged 40 years and older is reached around the year 2130. In 2020, the estimated incidence of total knee arthroplasties per 105 Swedish residents aged 40 years and older will be 334 (95% prediction interval (PI): 281–374) and in 2030 it will be 382 (PI: 308–441). Using officially forecast population growth data, around 17,500 operations would be expected to be performed in 2020 and around 21,700 would be expected to be performed in 2030. Interpretation Today’s levels of knee arthroplasty are well below the expected maximum incidence, and we expect a continued annual increase in the total number of knee arthroplasties performed. PMID:25806653

  5. One-Stage Revision for Infected Total Hip Arthroplasty.

    PubMed

    Zahar, Akos; Gehrke, Thorsten A

    2016-01-01

    Prosthetic joint infection (PJI) is a challenging complication following total hip arthroplasty (THA). Two-stage exchange arthroplasty is preferred for treating chronic PJI of THA, although specialized centers have reported comparable outcomes with protocol-based, 1-stage exchange arthroplasty. A main requirement is presurgical determination of the infecting organism's sensitivity. The therapeutic goal is control of the infection and maintenance of joint function. It offers advantages, including a single operative procedure, fewer antibiotics, and reduced hospitalization time and relative overall costs. PMID:26614916

  6. Measured flexion following total knee arthroplasty.

    PubMed

    Mai, Kenny T; Verioti, Christopher A; Hardwick, Mary E; Ezzet, Kace A; Copp, Steven N; Colwell, Clifford W

    2012-10-01

    Postoperative flexion is an important factor in the outcome of total knee arthroplasty. Although normal activities of daily living require a minimum of 105° to 110° of flexion, patients from non-Western cultures often engage in activities such as kneeling and squatting that require higher flexion. The desire to achieve greater flexion serves as the driving force for prosthetic modifications, including high-flexion designs. Techniques used to measure knee flexion and knee position during measurement are not often described or are different depending on the examiner. The purpose of this study was to compare active (self) and passive (assisted) flexion after successful total knee arthroplasty for 5 prostheses (2 standard and 3 high-flexion) using clinical (goniometer) and radiographic (true lateral radiograph) measurement techniques by different independent examiners.At a mean follow-up of 2.7 years (range, 1-5.6 years), a total of 108 patients (144 total knee arthroplasties) had completed the study. Mean postoperative active flexion was 111° clinically and 109° radiographically for the standard designs and 114° clinically and 117° radiographically for the high-flexion designs. Adding passive flexion increased flexion to 115° clinically and 117° radiographically for the standard designs and 119° clinically and 124° radiographically for the high-flexion designs. Flexion differences between the 2 measurement techniques (active vs passive and clinically vs radiographically) were statistically significant (P<.05). These findings demonstrate the importance of describing how flexion is measured in studies and understanding how the method of measurement can affect the findings. PMID:23027482

  7. Gap Junctions

    PubMed Central

    Nielsen, Morten Schak; Axelsen, Lene Nygaard; Sorgen, Paul L.; Verma, Vandana; Delmar, Mario; Holstein-Rathlou, Niels-Henrik

    2013-01-01

    Gap junctions are essential to the function of multicellular animals, which require a high degree of coordination between cells. In vertebrates, gap junctions comprise connexins and currently 21 connexins are known in humans. The functions of gap junctions are highly diverse and include exchange of metabolites and electrical signals between cells, as well as functions, which are apparently unrelated to intercellular communication. Given the diversity of gap junction physiology, regulation of gap junction activity is complex. The structure of the various connexins is known to some extent; and structural rearrangements and intramolecular interactions are important for regulation of channel function. Intercellular coupling is further regulated by the number and activity of channels present in gap junctional plaques. The number of connexins in cell-cell channels is regulated by controlling transcription, translation, trafficking, and degradation; and all of these processes are under strict control. Once in the membrane, channel activity is determined by the conductive properties of the connexin involved, which can be regulated by voltage and chemical gating, as well as a large number of posttranslational modifications. The aim of the present article is to review our current knowledge on the structure, regulation, function, and pharmacology of gap junctions. This will be supported by examples of how different connexins and their regulation act in concert to achieve appropriate physiological control, and how disturbances of connexin function can lead to disease. © 2012 American Physiological Society. Compr Physiol 2:1981-2035, 2012. PMID:23723031

  8. Massive rotator cuff tears: arthroscopy to arthroplasty.

    PubMed

    Singh, Anshu; Jawa, Andrew; Morman, Monica; Sanofsky, Benjamin; Higgins, Laurence

    2010-01-01

    The understanding of rotator cuff disease has increased exponentially since Codman drew attention to this pathology in the early 1900s. Although challenging, the surgical treatment of massive rotator cuff tears is rational, with treatment decisions based on physical examination, imaging, biologic, and patient factors. Arthroscopy can be used to treat ancillary pain generators, débride necrotic tissue, and possibly restore balance to the force couples about the shoulder. Tendon transfers may be effective in restoring functional strength to irreparable, ineffectual muscle units. Arthroplasty is both a primary treatment and a salvage option. PMID:20415384

  9. Prosthetic Design in Total Wrist Arthroplasty.

    PubMed

    Kennedy, Colin D; Huang, Jerry I

    2016-01-01

    Total wrist arthroplasty (TWA) provides a motion-preserving alternative to total wrist arthrodesis for low-demand patients with debilitating pancarpal arthritis. The earlier generation total wrist implants had high complication and failure rates. Advances in prosthetic design have contributed to improved clinical outcomes and implant survivorship. The current fourth-generation implants allow for expansion of indications for TWA. Careful patient selection remains critical; patients with high-demand lifestyles and poor bone stock may not be candidates. Long-term studies on implant survival and patient outcomes are critical for the current generation total wrist implants in assessing their long-term value compared with total wrist arthrodesis. PMID:26614934

  10. Computer Assisted Navigation in Knee Arthroplasty

    PubMed Central

    Bae, Dae Kyung

    2011-01-01

    Computer assisted surgery (CAS) was used to improve the positioning of implants during total knee arthroplasty (TKA). Most studies have reported that computer assisted navigation reduced the outliers of alignment and component malpositioning. However, additional sophisticated studies are necessary to determine if the improvement of alignment will improve long-term clinical results and increase the survival rate of the implant. Knowledge of CAS-TKA technology and understanding the advantages and limitations of navigation are crucial to the successful application of the CAS technique in TKA. In this article, we review the components of navigation, classification of the system, surgical method, potential error, clinical results, advantages, and disadvantages. PMID:22162787

  11. Stem length in revision total knee arthroplasty.

    PubMed

    Patel, Anay Rajendra; Barlow, Brian; Ranawat, Amar S

    2015-12-01

    Stems are intramedullary extensions of either the femoral or tibial component of a total knee arthroplasty (TKA) designed to increase the mechanical stability to decrease the risk of aseptic loosening. Biomechanical studies have shown that TKA stems increase the mechanical stability by transferring load over a larger area and thereby reduce strain at the bone-component interface [1-4]. The length of a revision TKA stem is determined by the patient's anatomy and the intended fixation, namely fully cemented or press-fit cortical contact. The advantages and disadvantages of various stem lengths must be weighed against the needs of the patient to achieve an optimal outcome. PMID:26371072

  12. Ileal Interposition Surgery Improves Glucose and Lipid Metabolism and Delays Diabetes Onset in the UCD-T2DM Rat

    PubMed Central

    Cummings, Bethany P.; Strader, April D.; Stanhope, Kimber L.; Graham, James L.; Lee, Jennifer; Raybould, Helen E.; Baskin, Denis G.; Havel, Peter J.

    2010-01-01

    Background & Aims Bariatric surgery has been shown to reverse type 2 diabetes, however the mechanisms by which this occurs remain undefined. Ileal interposition (IT) is a surgical model that isolates the effects of increasing the delivery of unabsorbed nutrients to the lower gastrointestinal tract. In this study we investigated the effects of IT surgery on glucose tolerance and diabetes onset in UCD-T2DM rats, a polygenic obese animal model of type 2 diabetes. Methods IT or sham surgery was performed on 4 month old male UCD-T2DM rats. All animals underwent an oral glucose tolerance test (OGTT). A subset was euthanized 2 months after surgery for tissue analyses. The remainder was followed until diabetes onset and underwent an oral fat tolerance test (OFTT). Results IT surgery delayed diabetes onset by 120 ± 49 days compared with sham surgery (P< 0.05) without a difference in body weight. During OGTT, IT-operated animals exhibited lower plasma glucose excursions (P< 0.05), improved early insulin secretion (P< 0.01) and 3-fold larger plasma GLP-17–36 excursions (P< 0.001) and no difference in GIP responses compared with sham-operated animals. Total plasma PYY excursions during the OFTT were 3-fold larger in IT-operated animals (P< 0.01). IT-operated animals exhibited lower adiposity (P< 0.05), smaller adipocyte size (P< 0.05), 25% less ectopic lipid deposition, lower circulating lipids and greater pancreatic insulin content compared with sham-operated animals (P< 0.05). Conclusions IT surgery delays the onset of diabetes in UCD-T2DM rats which may be related to increased nutrient-stimulated secretion of GLP-17–36 and PYY and improvements of insulin sensitivity, ?-cell function and lipid metabolism. PMID:20226188

  13. Results of sleeves in revision total knee arthroplasty: an editorial comment on recently published in the Journal of Arthroplasty

    PubMed Central

    Jiang, Chao

    2015-01-01

    The paper entitled “Direct, cementless, metaphyseal fixation in knee revision arthroplasty with sleeves-short-term results” published in the Journal of Arthroplasty to analyze the short- and mid-term results in revision total knee arthroplasty (TKA) in a largest series so far. This article shown that cementless metaphyseal fixation with sleeves is a promising option for revision TKA implant fixation. The clinical outcomes regarding the range of motion and the KSS are also promising. Based on this article and related literatures about sleeves, we assess the short to mid-term outcomes and the clinical perspectives in revision TKAs. PMID:26697477

  14. Activity Levels in Healthy Older Adults: Implications for Joint Arthroplasty

    PubMed Central

    Thorp, Laura E.; Orozco, Diego; Block, Joel A.; Sumner, Dale R.; Wimmer, Markus A.

    2012-01-01

    This work evaluated activity levels in a group of healthy older adults to establish a target activity level for adults of similar age after total joint arthroplasty (TJA). With the decreasing age of TJA patients, it is essential to have a reference for activity level in younger patients as activity level affects quality of life and implant design. 54 asymptomatic, healthy older adults with no clinical evidence of lower extremity OA participated. The main outcome measure, average daily step count, was measured using an accelerometer-based activity monitor. On average the group took 8813 ± 3611 steps per day, approximately 4000 more steps per day than has been previously reported in patients following total joint arthroplasty. The present work provides a reference for activity after joint arthroplasty which is relevant given the projected number of people under the age of 65 who will undergo joint arthroplasty in the coming years. PMID:23577274

  15. Knee joint stiffness and function following total knee arthroplasty 

    E-print Network

    Lane, Judith

    2010-01-01

    Introduction: Studies show that Total Knee Arthroplasty (TKA) is successful for the majority of patients however some continue to experience some functional limitations and anecdotal evidence indicates that stiffness is ...

  16. Bacteriology swabs in primary total knee arthroplasty

    PubMed Central

    Haenle, Maximilian; Podbielski, Andreas; Ellenrieder, Martin; Mundt, Andreas; Krentz, Helga; Mittelmeier, Wolfram; Skripitz, Ralf

    2013-01-01

    Objective: An early detection of possible periprosthetic infection may lead to an earlier and potentially less invasive treatment of infected total knee arthroplasty TKA). The purpose of the present study was to evaluate retrospectively our current, affordable clinical practice of intra-operative swab taking during primary TKA. Methods: A total of 206 primary TKA were analysed retrospectively for intra-operative bacteriology swabs and subsequent periprosthetic infection. All bacteriology swabs were obtained in a standardized manner including a tissue sample. Data was statistically evaluated concerning standard descriptive statistics and using the chi-square test. Results: Bacteria were identified in 43.4% with coagulase-negative staphylococci being the most frequently isolated pathogens (52.2%). Regarding the contingency tables and chi-squared tests, generally no association was found between positive intra-operative swabs and subsequent periprosthetic infection as well as all other parameters investigated (timing of the antibiotic prophylaxis and pre-operative laboratory results). Conclusions: Bacteriology swabs during primary total knee arthroplasty are no adequate measure to predict subsequent periprosthetic infections, even if augmented with a tissue sample. PMID:23967388

  17. Gap Resolution

    Energy Science and Technology Software Center (ESTSC)

    2009-06-16

    With the continued improvements of next generation DNA sequencing technologies and their advantages over traditional Sanger sequencing, the Joint Genome Institute (JGI) has modified its sequencing pipeline to take advantage of the benefits of such technologies. Currently, standard 454 Titanium, paired end 454 Titanium, and Illumina GAll data are generated for all microbial projects and then assembled using draft assemblies at a much greater throughput than before. However, it also presents us with new challenges.more »In addition to the increased throughput, we also have to deal with a larger number of gaps in the Newbler genome assemblies. Gaps in these assemblies are usually caused by repeats (Newbler collapses repeat copies into individual contigs, thus creating gaps), strong secondary structures, and artifacts of the PCR process (specific to 454 paired end libraries). Some gaps in draft assemblies can be resolved merely by adding back the collapsed data from repeats. To expedite gap closure and assembly improvement on large numbers of these assemblies, we developed software to address this issue.« less

  18. Risk assessment tools used to predict outcomes of total hip and total knee arthroplasty.

    PubMed

    Konopka, Joseph F; Hansen, Viktor J; Rubash, Harry E; Freiberg, Andrew A

    2015-07-01

    This article reviews recently proposed clinical tools for predicting risks and outcomes in total hip arthroplasty and total knee arthroplasty patients. Additionally, we share the Massachusetts General Hospital experience with using the Risk Assessment and Prediction Tool to predict the need for an extended care facility after total joint arthroplasty. PMID:26043049

  19. Reverse Shoulder Arthroplasty Prosthesis Design Classification System.

    PubMed

    Routman, Howard D; Flurin, Pierre-Henri; Wright, Thomas W; Zuckerman, Joseph D; Hamilton, Matthew A; Roche, Christopher P

    2015-12-01

    Multiple different reverse total shoulder arthroplasty (rTSA) prosthesis designs are available in the global marketplace for surgeons to perform this growing procedure. Subtle differ - ences in rTSA prosthesis design parameters have been shown to have significant biomechanical impact and clinical conse - quences. We propose an rTSA prosthesis design classification system to objectively identify and categorize different designs based upon their specific glenoid and humeral prosthetic characteristics for the purpose of standardizing nomencla - ture that will help the orthopaedic surgeon determine which combination of design configurations best suit a given clinical scenario. The impact of each prosthesis classification type on shoulder muscle length and deltoid wrapping are also described to illustrate how each prosthesis classification type impacts these biomechanical parameters. PMID:26631189

  20. Level of constraint in revision knee arthroplasty.

    PubMed

    Indelli, Pier Francesco; Giori, Nick; Maloney, William

    2015-12-01

    Revision total knee arthroplasty (TKA) in the setting of major bone deficiency and/or soft tissue laxity might require increasing levels of constraint to restore knee stability. However, increasing the level of constraint not always correlates with mid-to-long-term satisfactory results. Recently, modular components as tantalum cones and titanium sleeves have been introduced to the market with the goal of obtaining better fixation where bone deficiency is an issue; theoretically, satisfactory meta-diaphyseal fixation can reduce the mechanical stress at the level of the joint line, reducing the need for high levels of constraint. This article reviews the recent literature on the surgical management of the unstable TKA with the goal to propose a modern surgical algorithm for adult reconstruction surgeons. PMID:26373770

  1. Cementless total knee arthroplasty: a review.

    PubMed

    Cherian, Jeffrey J; Banerjee, Samik; Kapadia, Bhaveen H; Jauregui, Julio J; Harwin, Steven F; Mont, Michael A

    2014-06-01

    There is ongoing debate over the use of cementless fixation in total knee arthroplasty (TKA). Previous generation prostheses resulted in less than optimal outcomes which was somewhat attributed to design issues. As the demand for TKA is continuously increasing and the current U.S. age population is getting younger, cemented fixation may not provide adequate long-term outcomes due to failure of fixation. Thus, there has been a reemergence of the development and use of cementless TKA. Recent short-term trials have demonstrated that modern cementless TKA has comparable survivorship and functional outcomes as cemented prostheses. However, more prospective, randomized trials are needed to clearly delineate any differences between these two fixation options. PMID:24764231

  2. Metaphyseal bone loss in revision knee arthroplasty.

    PubMed

    Ponzio, Danielle Y; Austin, Matthew S

    2015-12-01

    The etiology of bone loss encountered during revision total knee arthroplasty (TKA) is often multifactorial and can include stress shielding, osteolysis, osteonecrosis, infection, mechanical loss due to a grossly loose implant, and iatrogenic loss at the time of implant resection. Selection of the reconstructive technique(s) to manage bone deficiency is determined by the location and magnitude of bone loss, ligament integrity, surgeon experience, and patient factors including the potential for additional revision, functional demand, and comorbidities. Smaller, contained defects are reliably managed with bone graft, cement augmented with screw fixation, or modular augments. Large metaphyseal defects require more extensive reconstruction such as impaction bone grafting with or without mesh augmentation, prosthetic augmentation, use of bulk structural allografts, or use of metaphyseal cones or sleeves. While each technique has advantages and disadvantages, the most optimal method for reconstruction of large metaphyseal bone defects during revision TKA is not clearly established. PMID:26362647

  3. Ultrasonic technology in revision joint arthroplasty.

    PubMed

    Klapper, R C; Caillouette, J T; Callaghan, J J; Hozack, W J

    1992-12-01

    The development of ultrasonically driven tools for revision joint arthroplasty is presented. The data represent seven-years' experience and include information from laboratory investigation and clinical experience from 20 surgical cases. Whole bone torsional strength studies reveal no decrease in strength parameters after the removal of cement ultrasonically. Comparison studies demonstrate that ultrasonic tools allow more rapid completion of cement and prosthesis removal than traditional manual tools. Histologic studies using an in vivo canine model demonstrate no deleterious effects to endosteal bone where cement had been removed by ultrasound. Clinical studies indicate that the use of ultrasound facilitates the surgery and causes no cortical perforations; the creation of cortical windows was not necessary in all cases. Ultrasound is safe and efficacious in cement and prosthesis removal during revision surgery. PMID:1446431

  4. Minimally invasive total hip arthroplasty: in opposition.

    PubMed

    Hungerford, David S

    2004-06-01

    At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable. PMID:15190556

  5. A new design concept for wrist arthroplasty.

    PubMed

    Shepherd, D E T; Johnstone, A

    2005-01-01

    The wrist joint is frequently affected by arthritis, which leads to pain, loss of function and ultimately deformity. Various designs of wrist arthroplasty have been introduced to attempt to relieve pain and provide a functional range of motion. The first generation of wrist implant was a one-piece silicone elastomer. Later generations have designs that have two parts that articulate against each other. However, wrist implants have not achieved the same clinical success to date, compared with hip and knee implants, and there is a high revision rate associated with them. This paper describes a new design concept for wrist arthroplasty, based around the idea of combining the principles of an articulating implant with that of a flexible elastomer implant. The design consists of assembling a radial, carpal/metacarpal, plate and flexible parts together. The radial and carpal/metacarpal parts are to be made from ultra high molecular weight polyethylene. The bearing surfaces of the radial and carpal/metacarpal parts articulate against the flat surfaces of the plate, made from cobalt chrome molybdenum alloy. The radius on the bearing surface of the radial part enables flexion/extension, while the radius on the carpal/metacarpal surface enables radial/ulnar deviation. The articulation of the carpal/metacarpal part against the plate also allows for rotation as well as flexion/extension. The flexible part, made from Elast-Eon, which is a silicone polyurethane elastomer, is inserted through the hole of the plate and into the holes of the radial and carpal/metacarpal parts. PMID:15777056

  6. 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

  7. Prophylactic antibiotics in elective hip and knee arthroplasty

    PubMed Central

    Hickson, C. J.; Metcalfe, D.; Elgohari, S.; Oswald, T.; Masters, J. P.; Rymaszewska, M.; Reed, M. R.; Sprowson†, A. P.

    2015-01-01

    Objectives We wanted to investigate regional variations in the organisms reported to be causing peri-prosthetic infections and to report on prophylaxis regimens currently in use across England. Methods Analysis of data routinely collected by Public Health England’s (PHE) national surgical site infection database on elective primary hip and knee arthroplasty procedures between April 2010 and March 2013 to investigate regional variations in causative organisms. A separate national survey of 145 hospital Trusts (groups of hospitals under local management) in England routinely performing primary hip and/or knee arthroplasty was carried out by standard email questionnaire. Results Analysis of 189 858 elective primary hip and knee arthroplasty procedures and 1116 surgical site infections found statistically significant variations for some causative organism between regions. There was a 100% response rate to the prophylaxis questionnaire that showed substantial variation between individual trust guidelines. A number of regimens currently in use are inconsistent with the best available evidence. Conclusions The approach towards antibiotic prophylaxis in elective arthroplasty nationwide reveals substantial variation without clear justification. Only seven causative organisms are responsible for 89% of infections affecting primary hip and knee arthroplasty, which cannot justify such widespread variation between prophylactic antibiotic policies. Cite this article: Bone Joint Res 2015;4:181–189. PMID:26585304

  8. Reverse arthroplasty of the shoulder for treating rotator cuff arthropathy???

    PubMed Central

    Amaral, Marcus Vinicius Galvão; de Faria, José Leonardo Rocha; Siqueira, Gláucio; Cohen, Marcio; Brandão, Bruno; Moraes, Rickson; Monteiro, Martim; Motta, Geraldo

    2014-01-01

    Objective to present a retrospective analysis on the clinical-functional results and complications among patients with rotator cuff arthropathy (RCA) who underwent reverse arthroplasty of the shoulder. Methods patients with a diagnosis of RCA associated with pseudoparalysis of anterior elevation who underwent reverse arthroplasty of the shoulder with a minimum follow-up of one year were selected. Results preoperative information was gathered from our shoulder and elbow arthroplasty register, comprising age, sex, laterality, history of previous procedures, Constant's functional scores and the preoperative range of motion as described in the protocol of the American Academy of Shoulder and Elbow Surgery (ASES). After a mean follow-up of 44 months, 17 patients (94%) were satisfied with the result from the procedure. Conclusion reverse arthroplasty for treating RCA in patients with pseudoparalysis of the shoulder was shown to be effective in achieving a statistically significant improvement in range of motion regarding anterior flexion and abduction. However, in this series, there was no improvement in range of motion regarding external and internal rotation. Reverse arthroplasty is a procedure that reestablishes shoulder joint function in patients who previously did not present any therapeutic possibilities. PMID:26229813

  9. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register

    PubMed Central

    van Steenbergen, Liza N; Spooren, Anneke; van Rooden, Stephanie M; van Oosterhout, Frank J; Morrenhof, Jan W; Nelissen, Rob G H H

    2015-01-01

    Background and purpose A complete and correct national arthroplasty register is indispensable for the quality of arthroplasty outcome studies. We evaluated the coverage, completeness, and validity of the Dutch Arthroplasty Register (LROI) for hip and knee arthroplasty. Patients and methods The LROI is a nationwide population-based registry with information on joint arthroplasties in the Netherlands. Completeness of entered procedures was validated in 2 ways: (1) by comparison with the number of reimbursements for arthroplasty surgeries (Vektis database), and (2) by comparison with data from hospital information systems (HISs). The validity was examined by conducting checks on missing or incorrectly coded values in the LROI. Results The LROI contains over 300,000 hip and knee arthroplasties performed since 2007. Coverage of all Dutch hospitals (n = 100) was reached in 2012. Completeness of registered procedures was 98% for hip arthroplasty and 96% for knee arthroplasty in 2012, based on Vektis data. Based on comparison with data from the HIS, completeness of registered procedures was 97% for primary total hip arthroplasty and 96% for primary knee arthroplasty in 2013. Completeness of revision arthroplasty was 88% for hips and 90% for knees in 2013. The proportion of missing or incorrectly coded values of variables was generally less than 0.5%, except for encrypted personal identity numbers (17% of which were missing) and ASA scores (10% of which were missing). Interpretation The LROI now contains over 300,000 hip and knee arthroplasty procedures, with coverage of all hospitals. It has a good level of completeness (i.e. more than 95% for primary hip and knee arthroplasty procedures in 2012 and 2013) and the database has high validity. PMID:25758646

  10. Dual massive skeletal allograft in revision total knee arthroplasty

    PubMed Central

    Malhotra, Rajesh; Garg, Bhavuk; Kumar, Vijay

    2011-01-01

    The reconstruction of large uncontained defects represents a major challenge to the revision total knee surgeon, and the outcome of the revision often depends on the management of these bone deficiencies. We report the first successful use of both complete distal femoral and proximal tibia massive allografts in the reconstruction of large femoral and tibial uncontained defects during revision total knee arthroplasty. At the five-year follow up, we did not find any infection, graft failure or loosening of implant, in spite of using two massive structural allografts in a single revision total knee arthroplasty. PMID:21772633

  11. History and factors of survival of total hip arthroplasty.

    PubMed

    Kolundži?, Robert; Trkulja, Vladimir; Orli?, Dubravko

    2012-02-01

    Since the 1960s total hip arthroplasty (THA) has represented one of the greatest accomplishments in orthopedic surgery. It improves the functionality, working ability and quality of life of patients with non-functional hip joint due to various reasons. This article reviews general and regional history of THA, current knowledge and concepts regarding the long-term outcomes of the procedure and emphasizes the need for establishing national (and international) THA registries as an essential way of gathering data critical for decision making in daily practice as well as in defining national healthcare policies in respect to arthroplasty procedures. PMID:22634928

  12. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    PubMed Central

    2006-01-01

    Executive Summary Objective The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Clinical Need Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. The Technology Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a 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 Oxford hip scores, but no preoperative values were reported. None of the reviewed studies r

  13. Total Knee Arthroplasty in Hemophilic Arthropathy.

    PubMed

    Rodríguez-Merchán, E Carlos

    2015-12-01

    Hemophilic arthropathy of the knee is common among patients with hemophilia and is a major cause of severe joint pain and functional disability requiring total knee arthroplasty (TKA). We evaluated TKA outcomes and complications with a special focus on prosthetic survival and infection. We retrospectively reviewed the medical records of 74 patients with chronic hemophilic arthropathy of the knee treated with TKA (N = 88) over a 13-year period. The same type of implant was used in all cases. Fourteen patients had 2-stage bilateral TKAs. Mean patient age was 38.2 years (range, 24-73 years). Fourteen patients were positive for human immunodeficiency virus, and 32 for hepatitis C virus. Mean follow-up was 8 years (range, 1-13 years). The prosthetic survival rate with implant removal for any reason regarded as final endpoint was 92%. Causes of TKA failure were prosthetic joint infection (6.8%) and aseptic loosening (2.2%). Clinical outcomes of the primary TKAs in this series were good prosthetic survival and excellent pain relief. TKA infection continues to be a major concern for patients with hemophilia relative to patients without hemophilia. PMID:26665252

  14. Muscular strength after total hip arthroplasty.

    PubMed

    Winther, Siri B; Husby, Vigdis S; Foss, Olav A; Wik, Tina S; Svenningsen, Svein; Engdal, Monika; Haugan, Kristin; Husby, Otto S

    2016-02-01

    Background and purpose - Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. Patients and methods - In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up. Results - Differences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups. Interpretation - The posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery. PMID:26141371

  15. Chronic Knee Dislocation After Total Knee Arthroplasty.

    PubMed

    Ross, John P; Brown, Nicholas M; Levine, Brett R

    2015-12-01

    Knee dislocation after total knee arthroplasty (TKA), although rare, is a dangerous injury that can lead to neurovascular compromise and permanent disability. Chronic dislocation after TKA is even less common and is defined as dislocation that is present for 4 weeks or more. There are few reports of its management. Chronic dislocation may be complicated further by concomitant extensor mechanism disruption, ligamentous instability, and/or capsular contracture. This article describes 3 cases of chronically dislocated TKAs and the challenges encountered in treating this difficult problem. A higher level of constraint was required to maintain knee stability, and an extensor mechanism allograft was needed in 2 of the 3 reported patients. The preferred technique at the authors' institution is a complete allograft composite, tensioned in full extension. In the setting of a chronically dislocated TKA, the authors now recommend revision surgery with an enhanced measure of constraint (constrained condylar device or hinged knee prosthesis), reconstruction of the extensor mechanism when necessary, and restoration of the joint while compensating for concomitant bony defects. Even when surgeons follow these principles, it is important to inform the patient that long-term outcomes will likely be inferior to those of revision surgery for other causes. [Orthopedics. 2015; 38(12):e1155-e1159.]. PMID:26652339

  16. Navigated cup implantation in hip arthroplasty

    PubMed Central

    2009-01-01

    Background and purpose Many studies have suggested that navigation-based implantation can improve cup positioning in total hip arthroplasty (THA). We conducted a systematic review and meta-analysis to compile the best available evidence, and to overcome potential shortcomings because of small sample sizes in individual studies. Methods The search strategy covered the major medical databases from January 1976 through August 2007, as well as various publishers' databases. The internal validity of individual studies was evaluated independently by 3 reviewers. We used random-effects modeling to obtain mean differences in cup angulation and relative risk (RR) of cup positioning outside Lewinnek's safe zone. Results Of 363 citations originally identified, 5 trials of moderate methodology enrolling a total of 400 patients were included in the analysis. Mean cup inclination and anteversion were not statistically significantly different between the conventional groups and the navigated groups. Navigation reduced the variability in cup positioning and the risk of placing the acetabular component beyond the safe zone (RR = 0.21, CI: 0.13–0.32). Interpretation Based on the current literature, navigation is a reliable tool to optimize cup placement, and to minimize outliers. However, long-term outcomes and cost utility analyses are needed before conclusive statements can be drawn about the value of routine navigation in THA. PMID:19916685

  17. 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

  18. Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity

    PubMed Central

    Gupta, Ryan; Phan, Duy; Schwarzkopf, Ran

    2015-01-01

    Patient: Female, 70 Final Diagnosis: Metal hypersensitivity Symptoms: Joint pain • swelling • instability Medication: — Clinical Procedure: Revision total knee arthroplasty Specialty: Orthopedics and Traumatology Objective: Unusual clinical course Background: Metal hypersensitivity is an uncommon complication after total knee arthroplasty (TKA) that can lead to significant functional impairment and aseptic prosthesis failure. Case Report: We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA. The patient had a history of metal hypersensitivity following bilateral metal-on-metal total hip arthroplasty (THA) that was revised to ceramic-on-polyethylene implants. Knee radiographs showed severe osteolysis with implant loosening. Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection. Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure. Conclusions: This case report demonstrates the clinical and laboratory signs that suggest metal hypersensitivity in total knee arthroplasty and the potential for joint function restoration with revision surgery. PMID:26278890

  19. Factors affecting the outcome of total shoulder arthroplasty.

    PubMed

    Cameron, B; Galatz, L; Williams, G R

    2001-08-01

    Total shoulder arthroplasty (TSA) has become the treatment of choice for most glenohumeral arthritides. Results are variable and depend on many factors, including normal and prosthetic anatomy and biomechanics, surgical technique, rotator-cuff integrity, bone deficiency, and postoperative rehabilitation. In this article, we discuss these factors and their influence on achieving successful TSAs. PMID:11520017

  20. Physiotherapy-led arthroplasty review clinic: a preliminary outcomes analysis.

    PubMed

    Large, Kate E; Page, Carolyn J; Brock, Kim; Dowsey, Michelle M; Choong, Peter F M

    2014-11-01

    Objective With the rising demand for Orthopaedics in the healthcare sector, service delivery innovations need to be explored to accommodate the increasing workload. Senior Musculoskeletal Physiotherapists have the specialised skills in the assessment of musculoskeletal conditions to determine the impact of surgery on patient outcomes. The aim of the present study was to compare outcomes between a physiotherapy-led arthroplasty review clinic (PT clinic) and the traditional model of orthopaedic surgeon review (OS clinic) after hip and knee replacement. Methods This study was a retrospective case-controlled audit using a comprehensive database. Twenty-four patients who had a hip arthroplasty and 52 patients who had a knee arthroplasty were reviewed solely by the PT clinic at 3, 6 and 12 months after surgical reviews. These patients were matched 1:2 against patients seen only by the OS clinic. The outcome measures included International Knee Score (IKS), Harris Hip Score (HHS) and the Short Form (SF)-12. Results There were no significant differences in HHS or SF-12 scores for patients after hip arthroplasty. Significant differences for knee arthroplasty were observed favouring the PT clinic; IKS, PT clinic 147.6 (37.07), OS clinic 135.4 (35.68), P?0.01, and physical component of the SF-12, PT clinic 41.98 (10.45), OS clinic 37.20 (10.44), P<0.01. Conclusion Implementation of a physiotherapy-led arthroplasty review clinic appears to be a safe and effective service alternative to reviews conducted by orthopaedic surgeons. What is known about the topic? Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability and the burden of the disease is rapidly increasing. Joint arthroplasty surgery is the mainstay of treatment for people with end-stage OA; it is a high-cost, high-volume procedure that dominates surgical wait lists around Australia. Long-term follow up is encouraged by the Arthroplasty Society of Australia and endorsed by the Australian Orthopaedics Association, but it is acknowledged that it is impossible to achieve this with solely orthopaedic surgeon reviews, an issue that is only going to worsen with the increased demand for surgery. Physiotherapists have become involved in many advanced scope roles within public health care, and emerging research suggests that patients are highly satisfied with their care in these types of clinics. What does this paper add? Although it has been shown that patients are satisfied in physiotherapy-led advanced clinics, there is a paucity of evidence in the outcomes of patients attending these clinics. Implementation of a physiotherapy-led arthroplasty review clinic demonstrated that outcome measures in this patient cohort were not compromised and, following knee joint arthroplasty, may even be improved. What are the implications for practitioners? The findings of this study indicate that joint review clinics involving physiotherapists acting in an advanced scope role are unlikely to compromise patient outcomes. The use of this role substitution on a broader scale can be recommended. PMID:25297119

  1. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

    PubMed Central

    Merolla, G; Nastrucci, G; Porcellini, G

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240

  2. Anatomic shoulder arthroplasty: an update on indications, technique, results and complication rates

    PubMed Central

    MATTEI, LORENZO; MORTERA, STEFANO; ARRIGONI, CHIARA; CASTOLDI, FILIPPO

    2015-01-01

    A shoulder replacement is indicated in patients affected by glenohumeral arthropathy with severely reduced range of motion, persistent pain, especially at night, and loss of strength. There is much discussion in the scientific community about the prosthetic options for these cases: hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. We analyzed the indications for, results of, and complications associated with this kind of surgery, focusing on anatomic arthroplasty and on the concept of modularity. PMID:26605254

  3. 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

  4. Periprosthetic Bone Remodelling in Total Knee Arthroplasty

    PubMed Central

    GEORGEANU, Vlad; ATASIEI, Tudor; GRUIONU, Lucian

    2014-01-01

    Introduction: The clinical studies have shown that the displacement of the prosthesis components, especially of the tibial one is higher during the first year, after which it reaches an equilibrum position compatible with a good long term functioning. This displacement takes place due to bone remodelling close to the implant secondary to different loading concentrations over different areas of bone. Material and Method: Our study implies a simulation on a computational model using the finite element analysis. The simulation started taking into account arbitrary points because of non-linear conditions of bone-prosthesis interface and it was iterative.. A hundred consecutive situations corresponding to intermediate bone remodelling phases have been calculated according to given loadings. Bone remodelling was appreciated as a function of time and bone density for each constitutive element of the computational model created by finite element method. For each constitutive element a medium value of stress during the walking cycle was applied. Results: Analyse of proximal epiphysis-prosthesis complex slices showed that bone density increase is maintained all over the stem in the immediately post-operative period. At 10 months, the moment considered to be the end of bone remodelling, areas with increased bone density are fewer and smaller. Meanwhile, their distribution with a concentration toward the internal compartment in the distal metaphysis is preserved. Conclusions: After the total knee arthroplasty the tibial bone suffered a process of remodelling adapted to the new stress conditions. This bone remodelling can influence, sometimes negatively, especially in the cases with tibial component varus malposition, the fixation, respectively the survival of the prosthesis. This process has been demonstrated both by clinical trials and by simulation, using the finite elements method of periprosthetic bone remodelling. PMID:25553127

  5. Treatment of trapeziometacarpal arthritis: results of resection arthroplasty.

    PubMed

    Dell, P C; Brushart, T M; Smith, R J

    1978-05-01

    Ninety-one thumbs with symptomatic trapeziometacarpal arthritis were studied and classified by the severity of trapeziometacarpal arthritis, as seen on the roentgenogram. Thirty-five patients with mild changes had satisfactory relief of pain after treatment with anti-inflammatory drugs and a C-splint. Operation, consisting of resection of the trapezium and shortening by 1.5 cm of the abductor pollicis longus tendon was performed on 16 thumbs. In six patients a rolled palmaris longus tendon was inserted between the metacarpal base and the scaphoid. All patients had relief of pain, improvement of pinch and grip strength, and an increased range of thumb pronation after operation. There was no difference in the results of those patients treated with or without tendon interposition. Trapezial resection was found to be an effective means of treating patients with symptomatic trapeziometacarpal arthritis who failed to improve with conservative care. PMID:659819

  6. Total hip arthroplasty versus resurfacing arthroplasty in the treatment of patients with arthritis of the hip joint: single centre, parallel group, assessor blinded, randomised controlled trial

    PubMed Central

    2012-01-01

    Objectives To compare the clinical and cost effectiveness of total hip arthroplasty with resurfacing arthroplasty in patients with severe arthritis of the hip. Design Single centre, two arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation. Setting One large teaching hospital in the United Kingdom. Participants 126 patients older than 18 years with severe arthritis of the hip joint, suitable for resurfacing arthroplasty of the hip. Patients were excluded if they were considered to be unable to adhere to trial procedures or complete questionnaires. Interventions Total hip arthroplasty (replacement of entire femoral head and neck); hip resurfacing arthroplasty (replacement of the articular surface of femoral head only, femoral neck remains intact). Both procedures replaced the articular surface of the acetabulum. Main outcome measures Hip function at 12 months after surgery, assessed using the Oxford hip score and Harris hip score. Secondary outcomes were quality of life, disability rating, physical activity level, complications, and cost effectiveness. Results 60 patients were randomly assigned to hip resurfacing arthroplasty and 66 to total hip arthroplasty. Intention to treat analysis showed no evidence for a difference in hip function between treatment groups at 12 months (t test, P=0.242 and P=0.070 for Oxford hip score and Harris hip score, respectively); 95% of follow-up data was available for analysis. Mean Oxford hip score was 40.4 (95% confidence interval 37.9 to 42.9) in the resurfacing group and 38.2 (35.3 to 41.0) in the total arthroplasty group (estimated treatment effect size 2.23 (?1.52 to 5.98)). Mean Harris hip score was 88.4 (84.4 to 92.4) in the resurfacing group and 82.3 (77.2 to 87.5) in the total arthroplasty group (6.04 (?0.51 to 12.58)). Although we saw no evidence of a difference, we cannot definitively exclude clinically meaningful differences in hip function in the short term. Overall complication rates did not differ between treatment groups (P=0.291). However, we saw more wound complications in the total arthroplasty group (P=0.056) and more thromboembolic events in the resurfacing group (P=0.049). Conclusions No evidence of a difference in hip function was seen in patients with severe arthritis of the hip, one year after receiving a total hip arthroplasty versus resurfacing arthroplasty. The long term effects of these interventions remain uncertain. Trial registration Current Controlled Trials ISRCTN33354155, UKCRN 4093. PMID:22517930

  7. Metal-on-Metal Hip Resurfacing Arthroplasty

    PubMed Central

    Sehatzadeh, S; Kaulback, K; Levin, L

    2012-01-01

    Background Metal-on-metal (MOM) hip resurfacing arthroplasty (HRA) is in clinical use as an appropriate alternative to total hip arthroplasty in young patients. In this technique, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the acetabulum. Objectives The primary objective of this analysis was to compare the revision rates of MOM HRA using different implants with the benchmark set by the National Institute of Clinical Excellence (NICE). The secondary objective of this analysis was to review the literature regarding adverse biological effects associated with implant material. Review Methods A literature search was performed on February 13, 2012, to identify studies published from January 1, 2009, to February 13, 2012. Results The revision rates for MOM HRA using 6 different implants were reviewed. The revision rates for MOM HRA with 3 implants met the NICE criteria, i.e., a revision rate of 10% or less at 10 years. Two implants had short-term follow-ups and MOM HRA with one of the implants failed to meet the NICE criteria. Adverse tissue reactions resulting in failure of the implants have been reported by several studies. With a better understanding of the factors that influence the wear rate of the implants, adverse tissue reactions and subsequent implant failure can be minimized. Many authors have suggested that patient selection and surgical technique affect the wear rate and the risk of tissue reactions. The biological effects of high metal ion levels in the blood and urine of patients with MOM HRA implants are not known. Studies have shown an increase in chromosomal aberrations in patients with MOM articulations, but the clinical implications and long-term consequences of this increase are still unknown. Epidemiological studies have shown that patients with MOM HRA implants did not have an overall increase in mortality or risk of cancer. There is insufficient clinical data to confirm the teratogenicity of MOM implants in humans. Conclusions Metal-on-metal HRA can be beneficial for appropriately selected patients, provided the surgeon has the surgical skills required for performing this procedure. Plain Language Summary There are many young patients with hip diseases who need to have hip replacement surgery. Although a traditional hip replacement is an acceptable procedure for these patients, some surgeons prefer using a newer technique in young patients called hip resurfacing. In this technique, instead of removing the head of the femoral bone, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the hip socket, similar to the cups used in traditional hip replacement. The analysis of the revision rates (i.e., how soon and in how many patients the surgery needs to be redone) and safety of resurfacing implants showed that generally these implants can last 10 years or more for the majority of young people. Good outcomes can be expected when skilled surgeons perform the surgery in properly selected patients. However, since these implants are made of metal (cobalt and chromium alloy), there is concern about excess metal debris production due to friction between the 2 metal components leading to high levels of metal ions in the blood and urine of patients. The production of metal debris may result in inflammation in the joint or development of a benign soft tissue mass leading to implant failure. However, it has been shown that this risk can be reduced by proper positioning of the implant and the careful selection of patients for this procedure. Little is known about the long-term biological effects of high levels of metal ions in the blood and urine of patients who have received metal implants. There is concern about potential increases in the risk of cancer and the risk of fetal abnormalities, but these effects have not been established yet. However, since cobalt and chromium can pass the placental barrier, implants that are not metal-on-metal are recommended for women at childbearing ages if they

  8. Treatment of esophageal-gastric double primary cancer by pedunculated remnant gastric interposition, esophageal-gastric anastomosis and gastrojejunal Billroth II anastomosis: A case report

    PubMed Central

    ZHANG, XIAO TIAN; WANG, WEI; ZHU, QIANG; CAO, MING; JIANG, ZHONG MIN; ZANG, QI

    2015-01-01

    With the continuous advancement of clinical diagnostic techniques, including imaging technology, the incidence of confirmed multiple primary cancers or double primary carcinoma increases yearly. However, studies reporting synchronization surgery performed for primary dual esophageal gastric cancer are rare. The present study reports the case of a patient with double primary esophageal-gastric cancer, located in the thoracic cavity segment of the esophagus and gastric antrum of the stomach, respectively. The gastric cancer was diagnosed by endoscopy biopsy with concomitant esophageal cancer. The patient underwent gastric cancer resection, and pedunculated remnant gastric interposition esophagogastric side anastomosis was performed with gastrojejunostomy Billroth II anastomosis behind the colon. Abdominal cavity lymph node dissection was also performed. The esophageal-gastric double primary cancer was simultaneously excised and the gastric regions were used in the construction of the upper gastrointestinal tract: The surgery was successful. However, two weeks after surgery, upper gastrointestinal imaging revealed esophagogastric anastomotic leakage. Subsequently, an esophageal stent was inserted and antibiotics and additional treatment was administered. Follow-up one year after surgery revealed that the patient was well and remained in a stable condition. PMID:26622590

  9. Total knee arthroplasty in osteopetrosis using patient-specific instrumentation.

    PubMed

    Mayer, Stephanie W; Hug, Kevin T; Hansen, Benjamin J; Bolognesi, Michael P

    2012-09-01

    Osteopetrosis is an uncommon endocrine disease characterized by defective osteoclast resorption of bones. This causes a hard, sclerotic, and brittle bone throughout the skeleton. Fractures and unforgiving subchondral bone are common in this condition, both of which can lead to osteoarthritis. Total knee arthroplasty is often the treatment of choice but presents challenges due to the hard and sclerotic bone present throughout the metaphysis and diaphysis of the femur and the tibia. We present a case of knee osteoarthritis in a patient with osteopetrosis who underwent total knee arthroplasty using patient-specific instrumentation. This technique eliminates intramedullary alignment and minimizes drilling, reaming, and saw passes, making it attractive in the setting of diseases such as osteopetrosis to decrease operative time and potential complications. PMID:22285231

  10. Establishing Realistic Patient Expectations Following Total Knee Arthroplasty.

    PubMed

    Husain, Adeel; Lee, Gwo-Chin

    2015-12-01

    Nearly 20% of patients are dissatisfied following well-performed total knee arthroplasty with good functional outcomes. Surgeons must understand the drivers of dissatisfaction to minimize the number of unhappy patients following surgery. Several studies have shown that unfulfilled expectations are a principal source of patient dissatisfaction. Patients contemplating total knee arthroplasty expect pain relief, improved walking ability, return to sports, and improvement in psychological well-being and social interactions. However, patients are typically overly optimistic with regard to expected outcomes following surgery. Patient expectations and satisfaction can be influenced by age, socioeconomic factors, sex, and race. The interplay of these factors can be complex and specific to each person. Published data on clinical and functional outcomes show that persistence of symptoms, such as pain, stiffness, and failure to return to preoperative levels of function, are common and normal. Therefore, the surgeon needs to help the patient to establish realistic expectations. PMID:26493969

  11. Total Hip Arthroplasty in Patients with Skeletal Dysplasia.

    PubMed

    Guenther, Daniel; Kendoff, Daniel; Omar, Mohamed; Cui, Liang R; Gehrke, Thorsten; Haasper, Carl

    2015-09-01

    127 patients with a height?150cm (non metric?4 feet and 11 inches) who received hip arthroplasty surgery between July 1, 2006 and May 30, 2013 at our institution were enrolled. Retrospective data evaluation was performed for two different times of follow-up (1year and 5years respectively). 115 patients were evaluated for 1-year follow up. Out of these, 27 patients were available for 5-year follow up. The mean Harris Hip Score increased from 40±13 on admission to 82±20 (P<0.001) at 1-year follow-up and 79±17 (P<0.001) at 5-year follow-up. Hip arthroplasty can be performed in patients with dwarfism with good clinical benefits. However, survival rates are worse compared to the general population. PMID:25882609

  12. Implementing Evidence-Based Practice to Reduce Infections Following Arthroplasty.

    PubMed

    Mori, Candy

    2015-01-01

    Surgical site infections can have a devastating effect on a patient's morbidity impacting their quality of life and productivity in society. Financial burdens are placed on healthcare organizations because of surgical site infections as well. Evidence has shown that it is a worthwhile endeavor to implement a practice to screen and treat patients who are nasal carriers of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus. Implementing evidence-based practices to combat surgical site infections can help ensure quality healthcare, while producing best possible patient outcomes; however, getting evidence to the bedside can be a challenge. The Johns Hopkins nursing evidence-based practice model is designed to help nurses translate evidence into practice. This article describes the steps one community hospital took to implement an evidence-based practice using the Johns Hopkins model to decrease the likelihood of methicillin-resistant Staphylococcus aureus surgical site infections in patients undergoing total knee arthroplasty and total hip arthroplasty. PMID:26213870

  13. Easy Identification of Mechanical Axis during Total Knee Arthroplasty

    PubMed Central

    Seo, Jai-Gon; Moon, Young-Wan; Kim, Sang-Min; Jo, Byung-Chul

    2013-01-01

    Purpose We devised an intraoperatively identifiable mechanical axis (IIMA) as a reference of alignment in total knee arthroplasty (TKA). Materials and Methods Between February 2010 and January 2011, primary TKAs were consecutively performed on 672 patients (1007 knees) using an IIMA as a reference in the coronal plane. Results The alignment of the lower extremity improved from a mean of 11.4±6.7° (-10.3-34.4°) of varus preop. to 0.7±3.5° (-5.2-8.6°) immediately after surgery. Mean alignment of the femoral component in the coronal plane was 89.3±2.3° (83.4-97.2°) postop. and mean alignment of the tibial component was 90.4±2.2° (85.1-94.2°) postop. Conclusion This study showed that IIMA could be of considerable value as a new guider of alignment that is easily accessible and highly effective during total knee arthroplasty. PMID:24142658

  14. 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.

  15. Successful salvage of an unstable Girdlestone's excision arthroplasty with a megaprosthesis of the hip.

    PubMed

    Vaishya, Raju; Vijay, Vipul; Vaish, Abhishek

    2015-12-01

    The functional results after a Girdlestone's excision arthroplasty of the hip are unpredictable with high patient dissatisfaction and complication rates. We report such a case of symptomatic patient, which was managed successfully with a megaprosthesis of the hip with constrained acetabular liner. The use of megaprosthesis for a failed and symptomatic Girdlestone's excision arthroplasty of the hip has not been reported before. PMID:26566342

  16. Outcomes of robotic arm-assisted unicompartmental knee arthroplasty.

    PubMed

    Sinha, Raj K

    2009-02-01

    Early outcomes of unicompartmental knee arthroplasty performed with a robotically assisted navigation system have been favorable. The surgical technique enhances accuracy of bone preparation and component positioning. Technical errors of the system have been minimal. The surgeon's learning curve is not adversely affected. Early patient outcomes are excellent and complications minimal. Further follow-up and study will help to determine whether these early outcomes are sustained over time. PMID:19340379

  17. Anterior muscle sparing approach for total hip arthroplasty

    PubMed Central

    Moskal, Joseph T; Capps, Susan G; Scanelli, John A

    2013-01-01

    The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach (DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the “safe zone” than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the variance is due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the “learning curve” for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented. PMID:23362470

  18. Hip resurfacing arthroplasty: short-term survivorship of 4,401 hips from the Finnish Arthroplasty Register

    PubMed Central

    2012-01-01

    Background and purpose Population-based registry data from the Nordic Arthroplasty Register Association (NARA) and from the National Joint Register of England and Wales have revealed that the outcome after hip resurfacing arthroplasty (HRA) is inferior to that of conventional total hip arthroplasty (THA). We analyzed the short-term survival of 4,401 HRAs in the Finnish Arthroplasty Register. Methods We compared the revision risk of the 4,401 HRAs from the Register to that of 48,409 THAs performed during the same time period. The median follow-up time was 3.5 (0–9) years for HRAs and 3.9 (0–9) years for THAs. Results There was no statistically significant difference in revision risk between HRAs and THAs (RR = 0.93, 95% CI: 0.78–1.10). Female patients had about double the revision risk of male patients (RR = 2.0, CI: 1.4–2.7). Hospitals that had performed 100 or more HRA procedures had a lower revision risk than those with less than 100 HRAs (RR = 0.6, CI: 0.4–0.9). Articular Surface Replacement (ASR, DePuy) had inferior outcome with higher revision risk than the Birmingham Hip Resurfacing implant (BHR, Smith & Nephew), the reference implant (RR = 1.8, CI: 1.2–2.7). Interpretation We found that HRA had comparable short-term survivorship to THA at a nationwide level. Implant design had an influence on revision rates. ASR had higher revision risk. Low hospital procedure volume worsened the outcome of HRA. Female patients had twice the revision risk of male patients. PMID:22616745

  19. Exploring the Underachievement Gap

    ERIC Educational Resources Information Center

    Carpenter, Dick M., II; Ramirez, Al

    2012-01-01

    Prevalent definitions of the achievement gap conceptualize it as the difference in achievement between white and minority students. Recent research, however, points to numerous gaps both within and between groups. This study explores a further conceptualization of achievement gaps by looking at the "underachievement gap"--the difference between…

  20. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures.

    PubMed

    Dicks, Kristen V; Baker, Arthur W; Durkin, Michael J; Anderson, Deverick J; Moehring, Rebekah W; Chen, Luke F; Sexton, Daniel J; Weber, David J; Lewis, Sarah S

    2015-12-01

    OBJECTIVE To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. DESIGN Retrospective cohort study SETTING A total of 43 community hospitals located in the southeastern United States. PATIENTS Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. METHODS Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. RESULTS A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38-0.56; P<.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79-1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43-0.64; P<.01). CONCLUSIONS Short operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis. Infect. Control Hosp. Epidemiol. 2015;36(12):1431-1436. PMID:26391277

  1. Preventing Hospital Readmissions and Limiting the Complications Associated With Total Joint Arthroplasty.

    PubMed

    Yu, Stephen; Garvin, Kevin L; Healy, William L; Pellegrini, Vincent D; Iorio, Richard

    2015-11-01

    Total joint arthroplasty is a highly successful surgical procedure for patients with painful arthritic joints. The increasing prevalence of the procedure is generating significant expenditures in the American healthcare system. Healthcare payers, specifically the Center for Medicare and Medicaid Services, currently target total joint arthroplasty as an area for healthcare cost-savings initiatives, resulting in increased scrutiny surrounding orthopaedic care, health resource utilization, and hospital readmissions. Identifying the complications associated with total hip and total knee arthroplasty that result in readmissions will be critically important for predictive modeling and for decreasing the number of readmissions following total joint arthroplasty. Additionally, improving perioperative optimization, providing seamless episodic care, and intensifying posthospital coordination of care may result in a decreasing number of unnecessary hospital readmissions. Identified modifiable risk factors that significantly contribute to poor clinical outcome following total joint arthroplasty include morbid obesity; poorly controlled diabetes and nutritional deficiencies; Staphylococcus aureus colonization; tobacco use; venous thromboembolic disease; cardiovascular disease; neurocognitive, psychological, and behavioral problems; and physical deconditioning and fall risk. Both clinical practice and research will be enhanced if there is standardization of defined total joint arthroplasty complications and utilization of stratification schemes to identify high-risk patients. Subsequently, clinical intervention would be warranted to address modifiable risk factors before proceeding with total joint arthroplasty. PMID:26498587

  2. Coccidioidomycosis infection of a total knee arthroplasty in a nonendemic region.

    PubMed

    Austen, Shennah; van der Weegen, Walter; Verduin, Cees M; van der Valk, Marc; Hoekstra, Henk J

    2013-02-01

    Fungal prosthetic joint infections are rare and difficult to treat. There is an ongoing discussion about the type and duration of antifungal treatment and the necessity of prosthesis removal. We report the first European case of an infected total knee arthroplasty with Coccidioides immitis. Treatment consisted of lifelong treatment with oral fluconazole at a dose of 400 mg/d, without total knee arthroplasty removal. After 6 months, the initial complaints of pain and swelling were completely resolved. This case report clearly states that a travel history and culturing for fungi are helpful in patients with persisting complaints after joint arthroplasty. PMID:22810005

  3. NATIONAL GAP ANALYSIS PROGRAM

    EPA Science Inventory

    GAP Analysis is a rapid conservation evaluation method for assessing the current status of biodiversity at large spatial scales. GAP Analysis provides a systematic approach for evaluating the protection afforded biodiversity in given areas. It uses Geographic Information System (...

  4. 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. [Orthopedics. 2015; 38(12):e1098-e1103.]. PMID:26652330

  5. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint

    PubMed Central

    2010-01-01

    Background Hip replacement (arthroplasty) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint. For older patients, several designs of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money. However, in younger more active patients, there is approximately a 50% failure rate at 25 years for traditional implants. Hip resurfacing is a relatively new arthroplasty technique. In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified, including the risk of femoral neck fracture and collapse of the head of the femur. The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty. Secondary aims include assessment of complication rates for both procedures as well cost effectiveness. Methods/design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study. A randomisation sequence will be produced and administered independently. After consenting, all patients will be clinically reviewed and hip function, quality of life and physical activity level will be assessed through questionnaires. The allocated surgery will then be performed with the preferred technique of the surgeon. Six weeks post-operation hip function will be assessed and complications recorded. Three, six and 12 months post-operation hip function, quality of life and physical activity level will be assessed. Additional information about patients' out-of-pocket expenses will also be collected. Trial registration Current Controlled Trials ISRCTN33354155 UKCLRN portfolio ID 4093 PMID:20074324

  6. Predicting Blood Loss in Total Knee and Hip Arthroplasty.

    PubMed

    Sizer, Stephen C; Cherian, Jeffrey J; Elmallah, Randa D K; Pierce, Todd P; Beaver, Walter B; Mont, Michael A

    2015-10-01

    Marked blood loss during lower extremity total joint arthroplasties may lead to higher rates of transfusion, which may negatively affect surgical outcomes and yield greater complication rates. It is therefore ideal to identify factors that may increase the likelihood of blood loss, so they can be modified. From this review, it can be concluded that preoperative anemia, older age, multiple comorbidities, increased operative time, and use of postoperative anticoagulation may lead to higher blood loss and transfusion rates, although the influence of other factors remains controversial. PMID:26410634

  7. [Postoperative rehabilitation after minimally invasive total hip arthroplasty].

    PubMed

    Heisel, J

    2012-05-01

    Currently more than 150,000 total hip arthroplasties (THA) are performed in Germany each year. Despite limited financial resources approximately 50% of these patients participate in a standardized inpatient rehabilitation program. This report reflects own experiences with patients after a minimally invasive approach for THA compared to others with conventional procedures, in context with findings from the literature. Rehabilitation and convalescence in patients with a minimally invasive approach for THA seem to have advantages especially in the first weeks after surgery, with manageable complications and socioeconomic improvements compared to conventional approaches. PMID:22581151

  8. Chronic extensor mechanism insufficiency in total knee arthroplasty (TKA).

    PubMed

    Cottino, Umberto; Abdel, Matthew P; Hanssen, Arlen D

    2015-12-01

    Chronic insufficiency of the knee extensor mechanism is a very challenging pathology to treat. An insufficient extensor mechanism negatively affects implant survival and patient outcomes. The causes of insufficiency can be several, and the surgeon has to be prepared to manage them intraoperatively and postoperatively. Various reconstructive techniques have been proposed, but traditional results in patients with a total knee arthroplasty are usually inferior to those patients with native knee joints. It is of primary importance to understand the anatomy, and tailor the correct treatment to the patient. PMID:26384696

  9. Behind the Pay Gap

    ERIC Educational Resources Information Center

    Dey, Judy Goldberg; Hill, Catherine

    2007-01-01

    Women have made remarkable gains in education during the past three decades, yet these achievements have resulted in only modest improvements in pay equity. The gender pay gap has become a fixture of the U.S. workplace and is so ubiquitous that many simply view it as normal. "Behind the Pay Gap" examines the gender pay gap for college graduates.…

  10. Better survival of hybrid total knee arthroplasty compared to cemented arthroplasty.

    PubMed

    Petursson, Gunnar; Fenstad, Anne Marie; Havelin, Leif Ivar; Gøthesen, Øystein; Lygre, Stein Håkon Låstad; Röhrl, Stephan M; Furnes, Ove

    2015-12-01

    Background and purpose - There have been few comparative studies on total knee replacement (TKR) with cemented tibia and uncemented femur (hybrid TKR). Previous studies have not shown any difference in revision rate between cemented and hybrid fixation, but these studies had few hybrid prostheses. We have evaluated the outcome of hybrid TKR based on data from the Norwegian Arthroplasty Register (NAR). Patients and methods - We compared 4,585 hybrid TKRs to 20,095 cemented TKRs with risk of revision for any cause as the primary endpoint. We included primary TKRs without patella resurfacing that were reported to the NAR during the years 1999-2012. To minimize the possible confounding effect of prosthesis brands, only brands that were used both as hybrids and cemented in more than 200 cases were included. Kaplan-Meier survival analysis and Cox regression analysis were done with adjustment for age, sex, and preoperative diagnosis. To include death as a competing risk, cumulative incidence function estimates were calculated. Results - Estimated survival at 11 years was 94.3% (95% CI: 93.9-94.7) in the cemented TKR group and 96.3% (CI: 95.3-97.3) in the hybrid TKR group. The adjusted Cox regression analysis showed a lower risk of revision in the hybrid group (relative risk = 0.58, CI: 0.48-0.72, p < 0.001). The hybrid group included 3 brands of prostheses: LCS classic, LCS complete, and Profix. Profix hybrid TKR had lower risk of revision than cemented TKR, but the LCS classic and LCS complete did not. Kaplan-Meier estimated survival at 11 years was 96.8% (CI: 95.6-98.0) in the hybrid Profix group and 95.2% (CI: 94.6-95.8) in the cemented Profix group. Mean operating time was 17 min longer in the cemented group. Interpretation - Survivorship of the hybrid TKR at 11 years was better than that for cemented TKR, or the same, depending on the brand of prosthesis. Hybrid fixation appears to be a safe and time-efficient alternative to cemented fixation in total knee replacement surgery. PMID:26179889

  11. Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery

    PubMed Central

    Hartel, Bas Pieter; Alta, Tjarco D.; Sewnath, Miguel E.; Willems, Willem J.

    2015-01-01

    Introduction: The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision indication and differences between total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) in hemiarthroplasty (HA) revision surgery. Materials and Methods: All patients with an indication for revision of HA were retrospectively included. Clinical evaluation consisted of pre- and post-operative constant scores, disability of arm-shoulder-hand-score (DASH), Dutch translation of the simple shoulder test ((D)SST), Oxford shoulder score test (OSS), short form (SF-36) and the complication rate. Results: From July 1994 to July 2008, 39 patients (40 shoulders) underwent revision arthroplasty. Of 19 patients (19 shoulders) we obtained a complete follow-up. The mean age at revision surgery 69 ± 10 years (range: 46-83) and the mean follow-up 41 ± 31 months (range: 10-113). In 7 cases TSA was used for revision when the cuff was intact, 12 times RSA was performed. The indications for the revision were glenoid erosion (n = 4), humeral component malposition (n = 2), cuff-pathology (n = 12) and infection (n = 1). Postoperative constant score 51.7 ± 11.4 for TSA and 31.1 ± 18.7 for RSA (P = 0.008). The DASH was 48.3 ± 25.1 and 68.7 ± 17.5, respectively (P = 0.09). DSST showed 6 ± 4 and 4 ± 4 (P = 0.414). OSS 41.3 ± 10.1 and 28.1 ± 10.3 (P = 0.017). SF-36 43.3 ± 22.1 and 24.5 ± 12.8 (P = 0.072). Four shoulders (21%) presented four complications. Conclusions: In this study, revision surgery showed poor to reasonable postoperative results and better clinical outcome for TSA. When a revision after HA was needed, and the soft-tissue component of the shoulder was intact, a TSA proved to be a preferable solution. PMID:26288535

  12. Management bone loss of the proximal femur in revision hip arthroplasty: Update on reconstructive options

    PubMed Central

    Sakellariou, Vasileios I; Babis, George C

    2014-01-01

    The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to increase subsequently. The etiology of bone loss from the proximal femur after total hip arthroplasty is multifactorial. Stress shielding, massive osteolysis, extensive loosening and history of multiple surgeries consist the most common etiologies. Reconstruction of extensive bone loss of the proximal femur during a revision hip arthroplasty is a major challenge for even the most experienced orthopaedic surgeon. The amount of femoral bone loss and the bone quality of the remaining metaphyseal and diaphyseal bone dictate the selection of appropriate reconstructive option. These include the use of impaction allografting, distal press-fit fixation, allograft-prosthesis composites and tumor megaprostheses. This review article is a concise review of the current literature and provides an algorithmic approach for reconstruction of different types of proximal femoral bone defects. PMID:25405090

  13. The biomechanics of knees at high flexion angles before and after Total Knee Arthroplasty

    E-print Network

    Most, Ephrat, 1970-

    2004-01-01

    Total Knee Arthroplasty (TKA) was initially developed to alleviate pain in the case of severe arthritis of the knee. Restoration of knee motion has been an on going issue for the last decade. Contemporary TKAs appear to ...

  14. Incidence and Location of Pain in Young, Active Patients Following Hip Arthroplasty.

    PubMed

    Nam, Denis; Nunley, Ryan M; Sauber, Timothy J; Johnson, Staci R; Brooks, Peter J; Barrack, Robert L

    2015-11-01

    Persistent pain following hip arthroplasty remains a concern, especially in young, active patients. Four hundred twenty patients less than 60years of age with a pre-symptomatic UCLA score?6 (196 total hip arthroplasty [THA]; 224 surface replacement arthroplasty [SRA]) completed a pain-drawing questionnaire investigating the location, severity, and frequency of pain around the hip. At a mean of 2.9years of follow-up, 40% reported pain in at least one location around the hip. There was no difference in the incidence of groin pain between SRA and THA patients (32% vs. 29%, P=0.6), but THA patients had a greater incidence of anterior (25% vs. 8%, P<0.001) and lateral (20% vs. 10%, P=0.01) thigh pain. A high percentage of young, active patients experience persistent pain following hip arthroplasty. PMID:26067707

  15. In vivo knee biomechanics and implications for total knee arthroplasty implant design

    E-print Network

    Mangudi Varadarajan, Kartik, 1981-

    2010-01-01

    The overall objective of this thesis was to determine the limitations of contemporary Total Knee Arthroplasty (TKA) and to identify areas for future improvements. In line with this objective, the first goal was to quantify ...

  16. Investigation of in-vivo total knee arthroplasty biomechanics using a dual fluoroscopic imaging system

    E-print Network

    Suggs, Jeremy F. (Jeremy Floyd), 1976-

    2007-01-01

    While contempary total knee arthroplasty has been successful in improving the quality of life for those suffering from severe osteoarthritis, the function of these patients has not reached normal levels for their age group. ...

  17. Automatic assessment of volume asymmetries applied to hip abductor muscles in patients with hip arthroplasty

    NASA Astrophysics Data System (ADS)

    Klemt, Christian; Modat, Marc; Pichat, Jonas; Cardoso, M. J.; Henckel, Joahnn; Hart, Alister; Ourselin, Sebastien

    2015-03-01

    Metal-on-metal (MoM) hip arthroplasties have been utilised over the last 15 years to restore hip function for 1.5 million patients worldwide. Althoug widely used, this hip arthroplasty releases metal wear debris which lead to muscle atrophy. The degree of muscle wastage differs across patients ranging from mild to severe. The longterm outcomes for patients with MoM hip arthroplasty are reduced for increasing degrees of muscle atrophy, highlighting the need to automatically segment pathological muscles. The automated segmentation of pathological soft tissues is challenging as these lack distinct boundaries and morphologically differ across subjects. As a result, there is no method reported in the literature which has been successfully applied to automatically segment pathological muscles. We propose the first automated framework to delineate severely atrophied muscles by applying a novel automated segmentation propagation framework to patients with MoM hip arthroplasty. The proposed algorithm was used to automatically quantify muscle wastage in these patients.

  18. Peri-operative visual loss following total knee arthroplasty - A case report: Visual loss following TKA.

    PubMed

    Spence, David J; Bennett, Damien; O'Brien, Seamus; Milligan, Kevin R; Page, Albert B; Beverland, David E

    2015-12-01

    Perioperative visual loss (POVL) following non-ocular surgery is a rare but significant complication. This report describes a case of ischaemic optic neuropathy following total knee arthroplasty which resulted in permanent blindness. PMID:26566330

  19. The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy.

    PubMed

    Badawy, Mona; Fenstad, Anne M; Indrekvam, Kari; Havelin, Leif I; Furnes, Ove

    2015-12-01

    Background and purpose - Previous studies have found different outcomes after revision of knee arthroplasties performed after high tibial osteotomy (HTO). We evaluated the risk of revision of total knee arthroplasty with or without previous HTO in a large registry material. Patients and methods - 31,077 primary TKAs were compared with 1,399 TKAs after HTO, using Kaplan-Meier 10-year survival percentages and adjusted Cox regression analysis. Results - The adjusted survival analyses showed similar survival in the 2 groups. The Kaplan-Meier 10-year survival was 93.8% in the primary TKA group and 92.6% in the TKA-post-HTO group. Adjusted RR was 0.97 (95% CI: 0.77-1.21; p = 0.8). Interpretation - In this registry-based study, previous high tibial osteotomy did not appear to compromise the results regarding risk of revision after total knee arthroplasty compared to primary knee arthroplasty. PMID:26058747

  20. Total Hip Arthroplasty in Systemic Lupus Erythematosus: A Systematic Review

    PubMed Central

    Kennedy, John W.; Khan, Wasim

    2015-01-01

    The prognosis of systemic lupus erythematosus (SLE) has greatly improved in recent years, resulting in an increased number of patients reporting musculoskeletal complications such as osteonecrosis of the femoral head. Total hip arthroplasty (THA) can be utilised to alleviate the pain associated with this; however postoperative outcomes in patients with SLE are uncertain. A systematic review of the literature was conducted to identify articles presenting results of THA in SLE, and nine suitable papers were found. All papers were level IV evidence. Pooling the results, a total of 162 patients underwent 214 total hip arthroplasties. Mean follow-up was 72.5 months. The mean Harris Hip Score improved from 45.5 preoperatively to 88.6 and last follow-up. Seventeen percent of patients experienced at least one complication. Superficial wound infection occurred in 3.3%. Revision was required in 2.8% of cases. The mortality rate was 18.5% however no deaths were attributable to undergoing THA. Given the paucity of data present in the literature, more studies are required to adequately assess the postoperative outcomes of THA in patients with SLE, particularly complication rates. PMID:26236340

  1. Innovations in design and technology. The story of hip arthroplasty.

    PubMed

    Amstutz, H C

    2000-09-01

    The current study reviews the early history of surgeon-initiated trial and error development in hip joint arthroplasty and the subsequent methodological evolution to proper criteria for hypothesis testing using bioengineers and other research scientists. The interplay and relationships to industry, universities, scientific organizations, and the Food and Drug Administration with respect to device development in hip arthroplasty are reviewed. The ethics of and responsibilities to involved parties are outlined, citing the history of many contemporary developments. Examples are provided from the evolution and introduction of unsuccessful innovations, and the problems inherent in the current methodology of the approval process from the Food and Drug Administration using the 5-10K, Investigative Device Exemption, and the Pre-Market Approval protocols. The pros and cons of randomized trials for devices are outlined with the conclusion that they are not appropriate for device introduction. The proper, rational methodology for introduction of new devices is a phased-in clinical trial process after pertinent bench testing. Finally, the ethical dilemmas created by managed care are addressed. Industry involvements of the surgeon-spokesmen are cited. PMID:10986970

  2. Risk Prediction Tools for Hip and Knee Arthroplasty.

    PubMed

    Manning, David W; Edelstein, Adam I; Alvi, Hasham M

    2016-01-01

    The current healthcare environment in America is driven by the concepts of quality, cost containment, and value. In this environment, primary hip and knee arthroplasty procedures have been targeted for cost containment through quality improvement initiatives intended to reduce the incidence of costly complications and readmissions. Accordingly, risk prediction tools have been developed in an attempt to quantify the patient-specific assessment of risk. Risk prediction tools may be useful for the informed consent process, for enhancing risk mitigation efforts, and for risk-adjusting data used for reimbursement and the public reporting of outcomes. The evaluation of risk prediction tools involves statistical measures such as discrimination and calibration to assess accuracy and utility. Furthermore, prediction tools are tuned to the source dataset from which they are derived, require validation with external datasets, and should be recalibrated over time. However, a high-quality, externally validated risk prediction tool for adverse outcomes after primary total joint arthroplasty remains an elusive goal. PMID:26604220

  3. Surgical treatment algorithm for infected shoulder arthroplasty: a retrospective analysis of 17 cases.

    PubMed

    Ghijselings, Stijn; Stuyck, José; Debeer, Philippe

    2013-12-01

    There is no consensus regarding treatment of periprosthetic shoulder infections. We retrospectively reviewed 17 patients diagnosed with a periprosthetic shoulder infection. Patient demographics, preoperative diagnostics, therapeutic management and functional outcome were evaluated. The Constant-Murley score (CMS), Simple Shoulder Test (SST), Visual Analogue Score (VAS) and Disabilities of the Arm, Shoulder and Hand score (DASH) were used to assess clinical outcome. Pre-and intraoperative culture results and laboratory data, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were analyzed. Three patients were treated by two-stage revision arthroplasty, 5 by resection arthroplasty with implantation of a cement spacer, 8 by resection arthroplasty without spacer and one patient underwent polyethylene exchange and serial debridement. The mean follow-up was 4.7 years (range : 1-93). The CMS was 27.8 for the resection arthroplasty group, 22.7 for the two-stage revision group and 20.6 for the resection arthroplasty with spacer group. No patients received chronic antibiotic suppression. Mean CRP value was 3.7 mg/L (range: 0.2 -11.1). Infection was monobacterial in 8 patients and polymicrobial in 9. The most common organisms were Coagulase negative staphylococcus (CNS) (13/17) and Propionibacterium spp. (7/17). Complications included two humeral fractures. At a mean follow-up of 4.7 years, all but one patient were considered free of infection. Worst functional results were seen with the implantation of a definitive cement spacer. Two-stage revision arthroplasty remains the gold standard in chronic infections, but is associated with a high complication rate. One-stage revision to a reverse shoulder arthroplasty (RSA) is an attractive alternative in selected cases. A surgical treatment algorithm for infected shoulder arthroplasty is proposed. PMID:24563966

  4. Bilateral Simultaneous Total Knee Arthroplasty: A Patient-Matched Retrospective Observational Study

    PubMed Central

    Haddad, Behrooz; Khan, Wasim; Mehta, Vikas; Mbubaegbu, Chima; Qamar, Arshad

    2015-01-01

    Bilateral total knee arthroplasty can be performed either as a staged or simultaneous procedure. We conducted a retrospective comparative study to compare the need for transfusion, the length of procedure, the length of stay, and complications of bilateral simultaneous knee arthroplasty with those of unilateral knee arthroplasty. Sixty-nine patients who underwent bilateral simultaneous knee arthroplasty procedures were compared with a matched control group of 69 patients who underwent unilateral knee arthroplasty. Receiver Operating Characteristic (ROC) curve was used to determine optimum cut-off values. Both groups of patients had a similar age and gender distribution, preoperative haemoglobin and ASA scores. Cumulative transfusion episodes were lower in the bilateral group than twice that of the unilateral group. In multivariate analysis the preoperative haemoglobin level and bilateral procedures were independent factors predicting the need for transfusion. The average length of procedure and length of hospital stay in the bilateral group was less than twice than that of the unilateral group. Advanced age and bilateral procedures were independent predictors of prolonged length of stay. A haemoglobin level of 12.5 g/dL and age of 70 were most suitable cut-off points to predict need for transfusion and occurrence of medical complications respectively. We conclude that bilateral simultaneous knee arthroplasties are safe and cost effective in appropriately selected patients. We recommend avoiding bilateral simultaneous procedures in patients over the age of 70 years and with significant comorbidities. PMID:26587069

  5. The gap gene network

    PubMed Central

    2010-01-01

    Gap genes are involved in segment determination during the early development of the fruit fly Drosophila melanogaster as well as in other insects. This review attempts to synthesize the current knowledge of the gap gene network through a comprehensive survey of the experimental literature. I focus on genetic and molecular evidence, which provides us with an almost-complete picture of the regulatory interactions responsible for trunk gap gene expression. I discuss the regulatory mechanisms involved, and highlight the remaining ambiguities and gaps in the evidence. This is followed by a brief discussion of molecular regulatory mechanisms for transcriptional regulation, as well as precision and size-regulation provided by the system. Finally, I discuss evidence on the evolution of gap gene expression from species other than Drosophila. My survey concludes that studies of the gap gene system continue to reveal interesting and important new insights into the role of gene regulatory networks in development and evolution. PMID:20927566

  6. GAP ACTIVITY TRACKING MATRIX

    EPA Science Inventory

    Resource Purpose:The information collected serves the following purposes: (1) provides a summary of funds allocated by tribe for the GAP Program, (2) provides an overview in the types of activities the tribes are engaged in with GAP funds, and (3) allows OW to document the...

  7. Confronting the Achievement Gap

    ERIC Educational Resources Information Center

    Gardner, David

    2007-01-01

    This article talks about the large achievement gap between children of color and their white peers. The reasons for the achievement gap are varied. First, many urban minorities come from a background of poverty. One of the detrimental effects of growing up in poverty is receiving inadequate nourishment at a time when bodies and brains are rapidly…

  8. Which Achievement Gap?

    ERIC Educational Resources Information Center

    Anderson, Sharon; Medrich, Elliott; Fowler, Donna

    2007-01-01

    From the halls of Congress to the local elementary school, conversations on education reform have tossed around the term "achievement gap" as though people all know precisely what that means. As it's commonly used, "achievement gap" refers to the differences in scores on state or national achievement tests between various student demographic…

  9. The National "Expertise Gap"

    ERIC Educational Resources Information Center

    Hamilton, Kendra

    2005-01-01

    This article discusses the Woodrow Wilson National Fellowship Foundation's report, "Diversity and the Ph.D.," released in May, which documents in troubling detail the exact dimensions of what the foundation's president, Dr. Robert Weisbuch, is calling the national "expertise gap." Weisbuch states that the expertise gap extends beyond the…

  10. Understanding the Gender Gap.

    ERIC Educational Resources Information Center

    Goldin, Claudia

    1985-01-01

    Despite the great influx of women into the labor market, the gap between men's and women's wages has remained stable at 40 percent since 1950. Analysis of labor data suggests that this has occurred because women's educational attainment compared to men has declined. Recently, however, the wage gap has begun to narrow, and this will probably become…

  11. Advanced rapidity gap trigger

    E-print Network

    Abramovsky, V A

    2004-01-01

    Nubmer of phisically interesting processes is charachterized by the rapidity gaps. In reality, this gaps is filled by uderlying events with high (more than 0.75 for higgs) probability. In this paper we purpose a way to detect this shadowed events with aim to raise the number of rare events.

  12. Study of hip joint dislocation after total hip arthroplasty

    PubMed Central

    Yamamoto, Kengo; Shishido, Takaaki; Katori, Yoichi; Mizoue, Tatsuro; Shirasu, Hideo; Nunoda, Daisuke

    2005-01-01

    The present study was undertaken to identify the factors responsible for hip joint dislocation after total hip arthroplasty, laying emphasis on analysis of the background variables of the patients. Of the 317 hips included in the study, ten (3.2%) dislocated. Only the anteversion angle of the cup differed significantly between the dislocation group and the dislocation-free group. The safe zone of the anteversion angle seems to be between 20 and 30 degrees. but it is also essential to set the antetorsion angle of the stem to match the shape of individual bones to create a more stable hip joint. This safe zone may be expanded by the additive effect of antetorsion angle of the stem. PMID:16344996

  13. Patellar Tendon Reconstruction in Total Knee Arthroplasty: A New Technique.

    PubMed

    Rajgopal, Ashok; Vasdev, Attique; Dahiya, Vivek

    2015-12-01

    Patellar tendon disruption is one of the most dreaded complications following total knee arthroplasty (TKA) impacting both implant function and implant longevity. To overcome the concerns regarding allografts and improve outcomes with augmentation techniques, we describe a technique, which we have successfully used over the past 4 years with good results. Seven patients underwent reconstruction for patellar tendon disruption using our technique from a cohort of eight patients. Extensor lag improved from a mean of 40 degrees to less than 5 degrees postoperatively. Range of motion improved from a mean of 105 degrees to 115 degrees of flexion. There was improvement in Knee Society Functional Score from a preoperative mean of 30 to 75 points. The Knee Society Pain Score, however, did not show much improvement. We believe our technique to be a solution to the difficult problem of patellar tendon ruptures after TKA and we continue to perform this procedure. PMID:25251879

  14. Management of femoral bone loss in revision total hip arthroplasty.

    PubMed

    Sculco, Peter K; Abdel, Matthew P; Lewallen, David G

    2015-01-01

    Femoral bone loss is frequently encountered during revision total hip arthroplasty. The quality and quantity of remaining bone helps determine the best method for reconstruction. Extensively porous-coated cylindrical stems or titanium fluted tapered devices that achieve fixation in the diaphysis have both demonstrated excellent long-term survivorship. Titanium fluted tapered stems with a modular proximal body allow for more accurate leg length, offset, and version adjustments independent of the distal stem which may optimise hip biomechanics. Intraoperative fractures are more common with cylindrical stems and subsidence with tapered stems, particularly monoblock designs and in both dislocation continues to be one of the most common postoperative complications. In salvage situations in which an ectatic femoral canal is unable to support an uncemented device, impaction bone grafting, allograft-prosthetic composite, or a segmental proximal femoral replacement may be required. PMID:26351121

  15. Fulminant Nonocclusive Mesenteric Ischemia Just after Hip Arthroplasty

    PubMed Central

    Auxiliadora-Martins, Maria; Alkmin-Teixeira, Gil Cezar; Feres, Omar; Martins-Filho, Olindo Assis; Basile-Filho, Anibal

    2010-01-01

    Nonocclusive mesenteric ischemia (NOMI) is not a rare clinical entity in intensive medicine, and it can be a consequence of several clinical or surgical situations. This pathology results from reduced intestinal microvascular blood supply associated with an acute inflammatory process, culminating with bowel necrosis. This is a case on a female patient who developed immediate postsurgical NOMI following hip arthroplasty and died. Since diagnosis of this potentially fatal condition remains a dilemma, NOMI should always be considered an eventual postoperative complication in high-risk surgical patients such as elderly individuals with previous history of nicotine abuse, congestive heart failure, and essential hypertension. The present paper highlights the importance of early diagnosis and prompt adequate treatment of NOMI in subjects with diminished cardiac output and severe abdominal pain. PMID:20300426

  16. Surgical management of recurrent dislocation after total hip arthroplasty.

    PubMed

    Charissoux, J-L; Asloum, Y; Marcheix, P-S

    2014-02-01

    Dislocation is a major complication of total hip arthroplasty (THA), whose frequency has been unaffected by improvements in surgical techniques and implants. The dislocation rate depends on multiple factors related to the patient, hip disease, and surgical procedure and is therefore also dependent on the surgeon. The many published studies on THA dislocation, its causes, and its treatment have produced conflicting results. The objective of this work is to review the management of THA dislocation, which is a severe event for both the patient and the surgeon. This lecture starts with a brief review of data on THA dislocation rates and the many factors that influence them. Emphasis is then put on the evaluation for a cause and, more specifically, on the challenges raised by detecting suboptimal cup position. Next, reported techniques for treating THA dislocation and the outcomes of each are discussed. Finally, a management strategy for patients selected for revision surgery is suggested. PMID:24434366

  17. Perioperative Outcomes Following Unilateral Versus Bilateral Total Knee Arthroplasty.

    PubMed

    Suleiman, Linda I; Edelstein, Adam I; Thompson, Rachel M; Alvi, Hasham M; Kwasny, Mary J; Manning, David W

    2015-11-01

    Simultaneous bilateral total knee arthroplasty (SB-TKA) is potentially a cost saving manner of caring for patients with bilateral symptomatic knee arthritis. We performed a retrospective analysis using the 2010-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to evaluate the risk of perioperative complication following SB-TKA. Demographic characteristics, comorbidities, and 30-day complication rates were studied using a propensity score-matched analysis comparing patients undergoing unilateral TKA and SB-TKA. A total of 4489 patients met the inclusion criteria, of which 973 were SB-TKA. SB-TKA was associated with increased overall complications (P = 0.023), medical complications (P = 0.002) and reoperation (OR 2.12, P = 0.020). Further, total length of hospital stay (4.0 vs 3.4 days, P < 0.001) was significantly longer following bilateral surgery. PMID:26072300

  18. Preoperative testing for sepsis before revision total knee arthroplasty.

    PubMed

    Della Valle, Craig J; Sporer, Scott M; Jacobs, Joshua J; Berger, Richard A; Rosenberg, Aaron G; Paprosky, Wayne G

    2007-09-01

    One hundred five consecutive painful knee arthroplasties were evaluated by a single surgeon for the presence of infection using a uniform protocol that included an erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), perioperative aspiration with synovial fluid white blood cell (WBC) count and differential, intraoperative frozen section analysis, and culture. A synovial fluid WBC count of greater than 3000 was the most precise test with a sensitivity of 100%, specificity of 98%, and accuracy of 99%. The preoperative use of an ESR and CRP proved to be an excellent screening modality with only one infection identified with both values being normal. A rational approach to perioperative testing for sepsis includes a screening ESR and CRP, and if elevated, aspiration with synovial fluid WBC count or an intraoperative frozen section. PMID:17823024

  19. Acute Popliteal Artery Occlusion after Revision Total Knee Arthroplasty

    PubMed Central

    Tsujimoto, Ryu; Matsumoto, Tomoyuki; Takayama, Koji; Kawakami, Yohei; Kamimura, Masato; Matsushita, Takehiko; Kuroda, Ryosuke; Kurosaka, Masahiro

    2015-01-01

    Acute arterial occlusions are a rare complication of total knee arthroplasty (TKA). However, in revision TKA, the risk of such complications is higher and these complications can lead to amputation if not adequately treated. We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital. Revascularization was achieved via bypass grafting and amputation was narrowly avoided despite time lag after symptom onset to revascularization. In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion. Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures. PMID:26357582

  20. Current surgical strategies for total arthroplasty in valgus knee

    PubMed Central

    Nikolopoulos, Dimitrios; Michos, Ioannis; Safos, George; Safos, Petros

    2015-01-01

    The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees. PMID:26191494

  1. Total hip arthroplasty: areview of advances, advantages and limitations

    PubMed Central

    Liu, Xin-Wei; Zi, Ying; Xiang, Liang-Bi; Wang, Yu

    2015-01-01

    The therapeutic outcomes of Osteoarthritis (OA) has been unsatisfactory and often surgeries such as total hip arthroplasty (THA) is required. THA is an effective treatment for patients with end-stage arthritic hip conditions. Cemented THA has been the treatment of choice for elderly patients with OA. An improvement in Timed “Up and Go” (TUG) before surgery might contribute to a decrease in the occurrence of DVT after THA, though post-thrombotic syndrome (PTS), a chronic condition in the lower extremity does not appear to be a major complication after DVT in patients undergoing THA. For OA, four domains to be evaluated: pain, physical function, joint imaging, and patient global assessment. Thus, THA can be cost saving or, at least cost- effective in improving quality-adjusted life expectancy. The purpose of this review is to discuss the recent advances as well as advantages and limitations of THA. PMID:25784971

  2. Metallosis following full thickness wear in total hip arthroplasty

    PubMed Central

    Birkett, Nicholas; El-Daly, Ibraheim; Ibraheim, Hajir; Mbubaegbu, Chima

    2015-01-01

    Extreme wear through the metal-backed acetabular cup following total hip arthroplasty is rare, as symptoms such as pain and disability will usually manifest earlier. We present the second reported case of extreme wear in a 78-year-old male patient, who presented 20 years following an uncemented total hip replacement with a 3-year history of hip pain, clicking on ambulation and worsening mobility. Radiographs demonstrated that the femoral head had migrated superolaterally through the polyethylene liner and the acetabular cup, and was articulating with the superior wall of the acetabulum causing bony destruction. Metallic fragments were also evident. A review of the current literature on metallosis suggests that should there be any clinical suspicion, blood metal ion levels are monitored and an MARS-MRI scan performed if indicated. If metallosis is detected, then revision surgery can be attempted at an earlier date, where the procedure is not as technically difficult. PMID:26395872

  3. Neurovascular structure proximity to acetabular retractors in total hip arthroplasty.

    PubMed

    Shubert, Daniel; Madoff, Samuel; Milillo, Ralph; Nandi, Sumon

    2015-01-01

    Neurovascular injury during total hip arthroplasty (THA) may result in considerable morbidity or mortality. The most common cause of intraoperative neurovascular injury during THA is retractor compression. Our aims were to: 1) determine proximity of common acetabular retractor positions during THA to adjacent neurovascular structures; and 2) determine effect of patient gender on these measurements. Retractor to neurovascular structure distances were measured on 32 preoperative computed tomography images and 16 cadavers. Our data suggest the anterior inferior iliac spine is the safest anterior acetabular retractor position. With inferior progression along the anterior wall, the distance to the femoral neurovascular bundle decreases. Due to its proximity to the sciatic nerve, the position of the posterior retractor should be monitored during acetabular preparation, particularly in women. PMID:25263247

  4. Prospective Evaluation of Sleep Disturbances After Total Knee Arthroplasty.

    PubMed

    Chen, Antonia F; Orozco, Fabio R; Austin, Luke S; Post, Zachary D; Deirmengian, Carl A; Ong, Alvin C

    2016-01-01

    Sleep disturbance after total knee arthroplasty (TKA) has not been studied 6 months after surgery. A prospective study was conducted on 34 primary, unilateral TKA patients preoperatively until 6 months postoperatively. Sleep quality was measured using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Pain was measured on a visual analog scale. Sleep quality worsened from baseline during the first 6 weeks postoperatively (P = .03), but improved at 3 and 6 months (P = .003). Pain scores decreased from baseline over all time points, and there was no correlation between sleep quality and pain. The Epworth Sleepiness Scale did not change over time. This study can be used to counsel TKA patients to expect initial sleep disturbances that improve by 3 months. PMID:26455403

  5. Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

    PubMed Central

    Sauter, Guido; Morlock, M. Michael; Rüther, Wolfgang; Amling, Michael

    2009-01-01

    Osteonecrosis (ON) has been reported in femoral remnants removed after failure of hip resurfacing arthroplasty. Experimental and clinical studies have further described thermal effects of the cementation technique, damage of extraosseous blood vessels, and intraoperative hypoxemia as possible causative factors. We analyzed histologically a series of 123 retrieved specimens with a preoperative diagnosis other than ON to investigate the incidence and extent of advanced ON. ON was found in 88% of cases and associated with 60% (51 of a total of 85) of periprosthetic fractures. The fracture incidence correlated with the extent of ON. Collapse of necrotic tissue in three (2%) cases resulted in disconnection of the bone stock-femoral component. We observed smaller regions of superficial ON in the majority of the remaining femoral remnants with periprosthetic fractures and in hips that failed for reasons other than fracture. PMID:19597896

  6. An Unexpected Complication of Hip Arthroplasty: Knee Dislocation

    PubMed Central

    Yilmaz, Serdar; Cankaya, Deniz; Deveci, Alper; Ozdemir, Mahmut; Bozkurt, Murat

    2015-01-01

    An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis. Although knee dislocation is related to high-energy trauma, low-grade injuries can also lead to knee dislocation which is defined as “ultra-low velocity dislocation.” The case reported here is of an 82-year-old patient who presented with a left intertrochanteric hip fracture. Partial arthroplasty was planned because of osteoporosis. In the course of surgery, degenerative arthritic knee was dislocated during the hip reduction maneuver with the application of long traction. The neurovascular examination was intact, but the knee was grossly unstable and was dislocated even in a brace; thus a hinged knee prosthesis was applied nine days after surgery. The patient was mobilized with crutches after the knee prosthesis but exercise tolerance was diminished. In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee. PMID:26347838

  7. Head-Neck Taper Corrosion in Hip Arthroplasty

    PubMed Central

    Hussenbocus, S.; Kosuge, D.; Solomon, L. B.; Howie, D. W.; Oskouei, R. H.

    2015-01-01

    Modularity at the head-neck junction of the femoral component in THA became popular as a design feature with advantages of decreasing implant inventory and allowing adjustment of leg length, offset, and soft tissue balancing through different head options. The introduction of a new modular interface to femoral stems that were previously monoblock, or nonmodular, comes with the potential for corrosion at the taper junction through mechanically assisted crevice corrosion. The incidence of revision hip arthroplasty is on the rise and along with improved wear properties of polyethylene and ceramic, use of larger femoral head sizes is becoming increasingly popular. Taper corrosion appears to be related to all of its geometric parameters, material combinations, and femoral head size. This review article discusses the pathogenesis, risk factors, clinical assessment, and management of taper corrosion at the head-neck junction. PMID:25954757

  8. Study on implant stability in cementless total knee arthroplasty

    PubMed Central

    Tírico, Luís Eduardo Passarelli; Pasqualin, Thiago; Pécora, José Otávio; Gobbi, Riccardo Gomes; Pécora, José Ricardo; Demange, Marco Kawamura

    2012-01-01

    Objectives Determine the stability of tibial and femoral components of 20 cementless knee arthroplasties with rotating platform. Methods The 20 patients (20 knees) underwent an analysis of dynamic radiographs with an image amplifier and maneuvers of varus and valgus which were compared to static frontal and lateral radiographs of the knees and analyzed by two experienced surgeons in a double-blind way. Results We could observe in this study that both methods showed very similar results for the stability of the tibial and femoral components (p<0.001) using the Kappa method for comparison. Conclusion The tibial component was more unstable in relation to the femoral component in both static and dynamic studies. Level of Evidence IV, Case Series. PMID:24453609

  9. Door Opening Affects Operating Room Pressure During Joint Arthroplasty.

    PubMed

    Mears, Simon C; Blanding, Renee; Belkoff, Stephen M

    2015-11-01

    Many resources are expended to ensure a sterile operating room environment. Efforts are made to prevent exposure of patients to personnel and to achieve positive room pressure to keep out airborne contaminants. Foot traffic into and out of the operating room during surgery can undermine these efforts. The authors investigated the number and duration of operating room door openings during hip and knee arthroplasty procedures and the effect of the door openings on room pressure. They tested the hypothesis that door openings defeat positive pressure, permitting air flow into the room. Room pressure and door status were monitored electronically during 191 hip and knee arthroplasty procedures. Operating room staff were unaware that data were being collected. The authors evaluated the data with regression analysis to determine whether the number and duration of door openings had an effect on room pressure. Significance was set at P<.05. Doors were open, on average, 9.5 minutes per case. In 77 of 191 cases, positive pressure was defeated, allowing air flow to reverse into the operating room. Total time with the door open significantly affected the minimum pressure recorded in the room (P<.02), but did not significantly affect average room pressure (P=.7). This finding suggested that the loss of positive pressure was a transient event from which the room recovered. The number and duration of door openings showed a significant association with length of surgery. Door openings threaten positive pressure, potentially jeopardizing operating room sterility. The causes of excessive operating room traffic must be evaluated to identify ways to reduce this traffic and the associated risks. [Orthopedics. 2015; 38(11):e991-e994.]. PMID:26558679

  10. Distal humerus cortical strains following total elbow arthroplasty.

    PubMed

    Craik, Johnathan D; Laffer, Caroline H L; Richards, Simon W; Walsh, Sean P; Evans, Sam L

    2013-02-01

    The aseptic loosening of total elbow replacements is a serious complication resulting in significant patient morbidity. It is thought to occur secondary to stress shielding of the distal humeral cortex by the stiff stem of the implant. Some total elbow prostheses incorporate an anterior flange intended to improve implant stability and peri-articular load transfer in an attempt to reduce this effect However, few studies have directly assessed the changes in cortical strains following total elbow arthroplasty or the biomechanical advantage of the anterior flange design. A regular and a long flange Coonrad-Morrey total elbow prosthesis were implanted into six Sawbone synthetic humeri. The constructs were subjected to physiological loads in axial compression (500 N), antero-posterior bending (50 N) and antero-posterior compression with condylar supports (300 N). Digital image correlation was used to measure the distal antero-lateral cortical strains and the results compared with those of whole Sawbones that had been tested in the same way. Significant stress shielding was demonstrated over the distal humeral cortex following prosthesis implantation during axial compression. In contrast, cortical strains increased following prosthesis implantation during antero-posterior compression with condylar supports. The increase in cortical strains following total elbow arthroplasty may help to maintain the integrity of the anterior cortex offering additional stability for implants with an anterior flange. These results are important for the development of future total elbow prosthesis designs and indicate that simulating the action of the forearm muscles is essential when evaluating changes in strain about the distal humerus in vitro. PMID:23513983

  11. Platelet-rich plasma (PRP) applied during total knee arthroplasty?

    PubMed Central

    Guerreiro, João Paulo Fernandes; Danieli, Marcus Vinicius; Queiroz, Alexandre Oliveira; Deffune, Elenice; Ferreira, Rosana Rossi

    2015-01-01

    Objective To evaluate the efficacy of platelet-rich plasma regarding healing, pain and hemostasis after total knee arthroplasty, by means of a blinded randomized controlled and blinded clinical study. Methods Forty patients who were going to undergo implantation of a total knee prosthesis were selected and randomized. In 20 of these patients, platelet-rich plasma was applied before the joint capsule was closed. The hemoglobin (mg/dL) and hematocrit (%) levels were assayed before the operation and 24 and 48 h afterwards. The Womac questionnaire and a verbal pain scale were applied and knee range of motion measurements were made up to the second postoperative month. The statistical analysis compared the results with the aim of determining whether there were any differences between the groups at each of the evaluation times. Results The hemoglobin (mg/dL) and hematocrit (%) measurements made before the operation and 24 and 48 h afterwards did not show any significant differences between the groups (p > 0.05). The Womac questionnaire and the range of motion measured before the operation and up to the first two months also did not show any statistical differences between the groups (p > 0.05). The pain evaluation using the verbal scale showed that there was an advantage for the group that received platelet-rich plasma, 24 h, 48 h, one week, three weeks and two months after the operation (p < 0.05). Conclusions In the manner in which the platelet-rich plasma was used, it was not shown to be effective for reducing bleeding or improving knee function after arthroplasty, in comparison with the controls. There was an advantage on the postoperative verbal pain scale. PMID:26229915

  12. Traditions and myths in hip and knee arthroplasty

    PubMed Central

    Husted, Henrik; Gromov, Kirill; Malchau, Henrik; Freiberg, Andrew; Gebuhr, Peter; Troelsen, Anders

    2014-01-01

    Background and purpose — Traditions are passed on from experienced surgeons to younger fellows and become “the right way to do it”. Traditions associated with arthroplasty surgery may, however, not be evidence-based and may be potentially deleterious to both patients and society, increasing morbidity and mortality, slowing early functional recovery, and increasing cost. Methods — We identified selected traditions and performed a literature search using relevant search criteria (June 2014). We present a narrative review grading the studies according to evidence, and we suggest some lines of future research. Results — We present traditions and evaluate them against the published evidence. Preoperative removal of hair, urine testing for bacteria, use of plastic adhesive drapes intraoperatively, and prewarming of the operation room should be abandoned—as should use of a tourniquet, a space suit, a urinary catheter, and closure of the knee in extension. The safety and efficacy of tranexamic acid is supported by meta-analyses. Postoperatively, there is no evidence to support postponement of showering or postponement of changing of dressings to after 48 h. There is no evidence to recommend routine dental antibiotic prophylaxis, continuous passive motion (CPM), the use of compression stockings, cooling for pain control or reduction of swelling, flexion of at least 90 degrees as a discharge criterion following TKA, or having restrictions after THA. We present evidence supporting the use of NSAIDs, early mobilization, allowing early travel, and a low hemoglobin trigger for transfusion. Interpretation — Revision of traditions and myths surrounding hip and knee arthroplasty towards more contemporary evidence-based principles can be expected to improve early functional recovery, thus reducing morbidity, mortality, and costs. PMID:25285615

  13. Predicting early clinical function after hip or knee arthroplasty

    PubMed Central

    Poitras, S.; Wood, K. S.; Savard, J.; Dervin, G. F.; Beaule, P. E.

    2015-01-01

    Objectives Patient function after arthroplasty should ideally quickly improve. It is not known which peri-operative function assessments predict length of stay (LOS) and short-term functional recovery. The objective of this study was to identify peri-operative functions assessments predictive of hospital LOS and short-term function after hospital discharge in hip or knee arthroplasty patients. Methods In total, 108 patients were assessed peri-operatively with the timed-up-and-go (TUG), Iowa level of assistance scale, post-operative quality of recovery scale, readiness for hospital discharge scale, and the Western Ontario and McMaster Osteoarthritis Index (WOMAC). The older Americans resources and services activities of daily living (ADL) questionnaire (OARS) was used to assess function two weeks after discharge. Results Following multiple regressions, the pre- and post-operative day two TUG was significantly associated with LOS and OARS score, while the pre-operative WOMAC function subscale was associated with the OARS score. Pre-operatively, a cut-off TUG time of 11.7 seconds for LOS and 10.3 seconds for short-term recovery yielded the highest sensitivity and specificity, while a cut-off WOMAC function score of 48.5/100 yielded the highest sensitivity and specificity. Post-operatively, a cut-off day two TUG time of 31.5 seconds for LOS and 30.9 seconds for short-term function yielded the highest sensitivity and specificity. Conclusions The pre- and post-operative day two TUG can indicate hospital LOS and short-term functional capacities, while the pre-operative WOMAC function subscale can indicate short-term functional capacities. Cite this article: Bone Joint Res 2015;4:145–151. PMID:26336897

  14. Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty

    PubMed Central

    Lauretti, Gabriela R; Righeti, Claudia C F; Mattos, Anita L

    2013-01-01

    Background: Total knee arthroplasty represents one of the most painful surgeries. The aim of the study was to compare analgesia and adverse effects of intrathecal (IT) ketorolac versus IT morphine, versus the combination of IT ketorolac and morphine. Materials and Methods: After ethical approval and patient consent, 80 patients undergoing knee arthroplasty were randomized to one of 4 groups. All groups received 15 mg IT bupivacaine plus IT test drug (2 ml). The control group (CG) received saline as IT test drug. The morphine group (MG) received IT 200 g morphine, the ketorolac group (KG) IT 2 mg ketorolac and the morphine-ketorolac group (MKG) 200 g morphine + 2 mg ketorolac as test drugs. Pain and adverse effects were evaluated. P > 0.05 was considered significant. Results: The MG and KG were similar in their times to time to first rescue analgesic (440 ± 38 min and 381 ± 44 min, respectively). Both groups were longer when compared to the CG (170 ± 13 min) (P > 0.01). The MG and KG had lesser ketoprofen consumption compared to the CG (P > 0.05). The time to first rescue analgesic was longer to the MKG (926 ± 222 min) (15 h) compared to CG (P > 0.001) and to the MG and the KG (P > 0.01). MKG displayed lesser ketoprofen consumption compared to MG and KG (P > 0.05) and to the CG (P > 0.02). Conclusions: The data suggest a role for spinal ketorolac and morphine in orthopaedic surgery because this combination of agents provided 15 h of analgesia compared to 7 h after each drug alone, with no significant side-effects. PMID:24249988

  15. Systematic review of periprosthetic tibia fracture after total knee arthroplasties

    PubMed Central

    Ebraheim, Nabil A; Ray, Joseph R; Wandtke, Meghan E; Buchanan, Grant S; Sanford, Chris G; Liu, Jiayong

    2015-01-01

    AIM: To investigate the known incidences, treatment options, and related outcomes of periprosthetic tibia fractures after total knee arthroplasty (TKA). METHODS: A literature search was done to identify studies that fit the inclusion criteria. The database search yielded 185 results, which were further reduced by the exclusion criteria to 13 papers, totaling 157 patients that met these criteria. Incidence rates of the different types of periprosthetic tibia fractures were determined and their treatments were subsequently analyzed based on the fracture’s subclass, with patient outcomes being overall favorable. RESULTS: Of the 144 documented patients, 54 (37.5%) had a subclass C fracture, which are frequently seen in revision arthroplasties or when using cement intraoperatively. The fractures of subclasses A and B occur postoperatively. There were 90 subclass A and B fractures with incidences of 18.75% and 43.75% respectively. When broken down by type, 62 (55.36%) were type 1, 24 (21.4%) were type 2, 24 (21.4%) were type 3, and 2 (1.8%) were type 4. Furthermore, from the studies that included origin of injury, the types were further classified as having non-traumatic or traumatic origins. Type 1 had 78% (40/51) non-traumatic origin and 22% (11/51) traumatic origin. Fifteen fractures were type 2, but 5 were falls and 1 through a motor vehicle accident, giving a trauma causation of 40% (6/15). Of the 24 type 3 fractures, 12 were falls and 2 vehicular accidents, leading to a trauma causation of 58% (14/24). CONCLUSION: Type 1 fractures were the most common. Subclass A was treated with locking plates, B required a revision TKA, and C was treated intraoperatively or nonoperatively. PMID:26396942

  16. Bony healing of large cranial and mandibular defects protected from soft-tissue interposition: A comparative study of spontaneous bone regeneration, osteoconduction, and cancellous autografting in dogs.

    PubMed

    Lemperle, S M; Calhoun, C J; Curran, R W; Holmes, R E

    1998-03-01

    The purpose of this study was to compare spontaneous bone regeneration, osteoconduction, and bone autografting in critical size calvarial and mandibular defects (defects which do not heal spontaneously during the lifetime of the animal) that were protected from soft-tissue interposition. Eighteen adult mongrel dogs underwent osteotomies to create a unilateral 30-mm segmental defect in the midbody of the edentulated right mandible and bilateral 15-mm x 20-mm full-thickness window defects in the parietal bones. The defects were either left empty, implanted with coralline hydroxyapatite (HA) blocks, or autografted with iliac cancellous bone. All defects were protected with a macroporous titanium mesh and the segmental mandibular defects were additionally stabilized by internal plate fixation. Specimens were retrieved after 2 and 4 months and three undecalcified longitudinal central sections including the osteotomy interfaces were prepared from each specimen for histometry and histology. Sections were analyzed for volume fractions of bone, soft tissue, and implant using scanning electron microscopy, backscatter electron imaging and histometric computer software. In the mandibular model, the empty defects exhibited the greatest amount of bone formation after 4 months (47.3 percent), which was greater than the amount of bone in the autografted group (34.8 percent) and significantly greater than the amount of bone within the hydroxyapatite implants (19.0 percent, p < 0.05). In the cranial defects, the autografted specimens demonstrated the greatest volume fraction of bone after 4 months (27.3 percent), which was significantly greater than within both the empty defects (18.2 percent, p < 0.05) and the hydroxyapatite implants (18.2 percent, p < 0.05). New bone formation in the mandibular defects united the cut ends at 4 months regardless of treatment and originated predominantly from the periosteum which remained present only along the alveolar border after surgical closure. In the calvarial defects, periosteum was not preserved and bone regenerated centripetally, originating from the diploë without any evidence of dural osteogenesis. Bone bridging was incomplete in the empty cranial defects at 4 months. In both the mandibular and cranial specimens, new bone at 2 months was a mixture of woven and parallel fibered bone. At 4 months, the new bone had remodeled almost entirely into mature Haversian bone. This study demonstrated a remarkable ability of defect protection with a macroporous protective sheet to facilitate bone regeneration in critical size mandibular and cranial bone defects. When active osteogenic periosteum was present, as in our mandibular model, we concluded that defect protection alone was sufficient to allow for healing even of critical size defects. When periosteum was absent as in our cranial defects, the limited spontaneous bone formation benefited from the added contributions of cancellous grafting and osteoconductive implants, both of which promoted bone bridging across the defects. We suggest that in the future a resorbable macroporous protective sheet would be advantageous in comparison to a titanium mesh to facilitate bone regeneration by preventing soft-tissue prolapse and allowing the migration of mesenchymal cells and the proliferation of blood vessels from the adjacent soft tissues into the bone defect. Finally, this study identified the need to differentiate critical size defects into those with and without defect protection and periosteum. PMID:9500382

  17. Periprosthetic humeral fracture after Copeland resurfacing and the role of revision arthroplasty: A report of three cases

    PubMed Central

    MacLean, Simon Bruce Murdoch; Mangat, Karanjit; Nandra, Rajpal; Kalogrianitis, Socrates

    2015-01-01

    Follow-up series of the Copeland resurfacing hemiarthroplasty have reported few postoperative fractures around the prosthesis. We report three cases of periprosthetic fracture around a Copeland resurfacing arthroplasty. Due to prosthetic loosening and tuberosity comminution, all cases were managed with revision shoulder arthroplasty. All patients had good functional outcome and range of movement on early follow-up.

  18. The Result of Revision Total Hip Arthroplasty in Patients with Metallosis Following a Catastrophic Failure of a Polyethylene Liner

    PubMed Central

    Kwak, Hong Suk; Lee, Young-Kyun; Koo, Kyung-Hoi; Yoon, Kang Sup; Kim, Hee Joong

    2015-01-01

    Background Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. Methods Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. Results The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. Conclusions The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low. PMID:25729518

  19. The ‘gap’ in the ‘plasma osmolar gap

    PubMed Central

    Arora, Alok

    2013-01-01

    Ethylene glycol poisoning is a medical emergency that presents challenges for clinicians and clinical laboratories. If left untreated, it may cause morbidity and death, but effective therapy is available if diagnosed in time. The diagnosis of ethylene glycol poisoning is not always straightforward and the commonly quoted ‘plasma osmolar gap’ is not sufficiently sensitive to exclude a small ingestion and has been reported to be normal in a number of serious exposures. The ‘plasma osmolar gap’ cannot distinguish among ethanol, isopropyl alcohol, methanol or ethylene glycol. Thus, the measurement of serum ethylene glycol and, ideally, glycolic acid, its major toxic metabolite in serum, is definitive. This also holds true for methanol and its metabolite formic acid. Ethylene glycol metabolites target the kidney and lead to reversible oliguric or anuric injury, which in turn slows the elimination of ethylene glycol. The therapeutic options include reversal of metabolic acidosis, inhibition of alcohol dehydrogenase and early haemodialysis. PMID:23929610

  20. Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis.

    PubMed

    Tilbury, Claire; Holtslag, Maarten J; Tordoir, Rutger L; Leichtenberg, Claudia S; Verdegaal, Suzan H M; Kroon, Herman M; Fiocco, Marta; Nelissen, Rob G H H; Vliet Vlieland, Thea P M

    2016-02-01

    Background and purpose - There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA. Patients and methods - This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0-2) and severe OA (KL 3-4) using a multivariate linear regression model. Results - Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS "Activities of daily living", "Pain", and "Symptoms", and SF36 physical component summary ("PCS") scale. In TKA, we found no such associations. Interpretation - The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA. PMID:26484651

  1. 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, however, this correlation was statistically significant only at the postoperative 6th month (P = 0.03). CONCLUSION: To prevent the negative functional effects of this weight gain during the postoperative period, arthroplasty patients should be advised for weight control and risky patients should consult with a dietician. PMID:26716096

  2. Failed Reverse Total Shoulder Arthroplasty Caused by Recurrent Candida glabrata Infection with Prior Serratia marcescens Coinfection

    PubMed Central

    Skedros, John G.; Keenan, Kendra E.; Updike, Wanda S.; Oliver, Marquam R.

    2014-01-01

    This report describes a 58-year-old insulin-dependent diabetic male patient who initially sustained a proximal humerus fracture from a fall. The fracture fixation failed and then was converted to a humeral hemiarthroplasty, which became infected with Candida glabrata and Serratia marcescens. After these infections were believed to be cured with antibacterial and antifungal treatments and two-stage irrigation and debridement, he underwent conversion to a reverse total shoulder arthroplasty. Unfortunately, the C. glabrata infection recurred and, nearly 1.5 years after implantation of the reverse total shoulder, he had a resection arthroplasty (removal of all implants and cement). His surgical and pharmacologic treatment concluded with (1) placement of a tobramycin-impregnated cement spacer also loaded with amphotericin B, with no plan for revision arthroplasty (i.e., the spacer was chronically retained), and (2) chronic use of daily oral fluconazole. We located only three reported cases of Candida species causing infection in shoulder arthroplasties (two C. albicans, one C. parapsilosis). To our knowledge, a total shoulder arthroplasty infected with C. glabrata has not been reported, nor has a case of a C. glabrata and S. marcescens periprosthetic coinfection in any joint. In addition, it is well known that S. marcescens infections are uncommon in periprosthetic joint infections. PMID:25431708

  3. Retrospective Clinical and Radiological Outcomes after Robotic Assisted Bicompartmental Knee Arthroplasty

    PubMed Central

    Tamam, Cuneyt; Plate, Johannes F.; Augart, Marco; Poehling, Gary G.; Jinnah, Riyaz H.

    2015-01-01

    Purpose. Bicompartmental knee arthroplasty (BiKA) is a favorable alternative to total knee arthroplasty for degenerative disease limited to two knee compartments. Recently developed robotic-assisted systems improved the clinical efficacy of unicompartmental knee arthroplasty by providing enhanced component positioning with dynamic ligament balancing. The purpose of this study was to evaluate the short-term outcomes of patients, undergoing bicompartmental knee arthroplasty at a single institution by a single surgeon using a robotic-assisted system. It was hypothesized that robotic assisted BiKA is a prevailing choice for degenerative disease limited to two knee compartments with good functional results. Methods. A search of the institution's joint registry was conducted to identify patients that underwent robotic-assisted BiKA of the patellofemoral compartment and the medial or lateral compartment. Results. A total number of 29 patients (30 BiKA) with a mean age of 63.6 years were identified who received a patellofemoral resurfacing in combination with medial or lateral compartment resurfacing. Twenty-four out of 29 patients had good to excellent outcome. Conclusion. Robotic assisted bicompartmental arthroplasty using broad indications and only excluding patients with severe deformity and those that have less than 4?mm of joint space in the surviving compartment demonstrated 83% good to excellent results. PMID:26421193

  4. Generation gaps in engineering?

    E-print Network

    Kim, David J. (David Jinwoo)

    2008-01-01

    There is much enthusiastic debate on the topic of generation gaps in the workplace today; what the generational differences are, how to address the apparent challenges, and if the generations themselves are even real. ...

  5. Gaps in Oncology

    Cancer.gov

    The first plenary of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study Original Version provides background for the curriculum and identifies gaps in current and desired comprehensive cancer care.

  6. Fiber optic gap gauge

    DOEpatents

    Wood, Billy E. (Livermore, CA); Groves, Scott E. (Brentwood, CA); Larsen, Greg J. (Brentwood, CA); Sanchez, Roberto J. (Pleasanton, CA)

    2006-11-14

    A lightweight, small size, high sensitivity gauge for indirectly measuring displacement or absolute gap width by measuring axial strain in an orthogonal direction to the displacement/gap width. The gap gauge includes a preferably titanium base having a central tension bar with springs connecting opposite ends of the tension bar to a pair of end connector bars, and an elongated bow spring connected to the end connector bars with a middle section bowed away from the base to define a gap. The bow spring is capable of producing an axial strain in the base proportional to a displacement of the middle section in a direction orthogonal to the base. And a strain sensor, such as a Fabry-Perot interferometer strain sensor, is connected to measure the axial strain in the base, so that the displacement of the middle section may be indirectly determined from the measurement of the axial strain in the base.

  7. Robotic Tube-Gap Inspector

    NASA Technical Reports Server (NTRS)

    Gilbert, Jeffrey L.; Gutow, David A.; Maslakowski, John E.

    1993-01-01

    Robotic vision system measures small gaps between nearly parallel tubes. Robot-held video camera examines closely spaced tubes while computer determines gaps between tubes. Video monitor simultaneously displays data on gaps.

  8. Metal-on-metal hip resurfacing arthroplasty: a review of periprosthetic biological reactions.

    PubMed

    Mabilleau, Guillaume; Kwon, Young-Min; Pandit, Hemant; Murray, David W; Sabokbar, Afsie

    2008-12-01

    Metal-on-metal hip resurfacing arthroplasty has undergone a recent resurgence as an alternative treatment option for young and active patients with significant osteoarthritis. The claimed advantages of metal-on-metal hip resurfacing arthroplasty include lower wear rate, preservation of bone stock for subsequent revision procedures, restoration of anatomic hip mechanics, and enhanced stability due to the larger diameter of articulation. A disadvantage, however, is that the metal-on-metal resurfacing releases large amounts of very small wear particles and metal ions. The long-term biological consequences of the exposure to these Co-Cr particles and ions remain largely unknown. The purpose of this review is to provide an overview of the current literature on the adverse periprosthetic biological reactions associated with metal-on-metal hip resurfacing arthroplasty. PMID:19085489

  9. Current Evidence for the Use of Laminar Flow in Reducing Infection Rates in Total Joint Arthroplasty

    PubMed Central

    James, M; Khan, W.S; Nannaparaju, M.R; Bhamra, J.S; Morgan-Jones, R

    2015-01-01

    Since the introduction of laminar air flow in orthopaedic theatres by Sir John Charnley, it has widely become accepted as the standard during orthopaedic procedures such as joint arthroplasty. We present a review of available current literature for the use of laminar flow operating theatre ventilation during total joint arthroplasty and examines the effectiveness of laminar flow ventilated operating theatres in preventing post-operative wound infection. Results of our findings suggest that while bacterial and air particulate is reduced by laminar air flow systems, there is no conclusive effect on the reduction of post-operative wound infections following total joint arthroplasty. We conclude that a combination of strict aseptic technique, prophylactic antibiotics and good anaesthetic control during surgery remains crucial to reduce post-operative surgical infections. PMID:26587068

  10. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome

    PubMed Central

    Putnis, S.E; Wartemberg, G.K; Khan, W.S; Agarwal, S

    2015-01-01

    Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications. PMID:26587066

  11. Hypoalbuminemia Independently Predicts Surgical Site Infection, Pneumonia, Length of Stay, and Readmission After Total Joint Arthroplasty.

    PubMed

    Bohl, Daniel D; Shen, Mary R; Kayupov, Erdan; Della Valle, Craig J

    2016-01-01

    This study investigates the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the 30 days after total joint arthroplasty. Patients who underwent elective primary total hip and knee arthroplasty as part of the American College of Surgeons National Surgical Quality Improvement Program were identified. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin concentration <3.5 g/dL) with adjustment for patient and procedural factors. A total of 49603 patients were included. In comparison to patients with normal albumin concentration, patients with hypoalbuminemia had a higher risk for surgical site infection, pneumonia, extended length of stay, and readmission. Future efforts should investigate methods of correcting nutritional deficiencies prior to total joint arthroplasty. If successful, such efforts could lead to improvements in short-term outcomes for patients. PMID:26427941

  12. Comparison of cruciate retaining and PCL sacrificing TKA with respect to medial and lateral gap differences in varus knees after medial release.

    PubMed

    Kim, Sang-Min; Jang, Sung-Won; Seo, Jai-Gon; Lee, Sung-Sahn; Moon, Young-Wan

    2015-01-01

    We aimed to clarify whether the increase in medial gap after medial release is influenced by the retention or sacrifice of posterior cruciate ligament (PCL) during navigation-assisted total knee arthroplasty. After matched pairs were done according to the equality of preoperative varus deformity and medial collateral laxity, 54 knees of each type were available for this study. In the PCL sacrificing group, the mediolateral gap difference significantly increased in both flexion and extension as the preoperative mechanical axis angle increased whereas in the cruciate retaining group, the mediolateral gap difference did not show this tendency. When preoperative mechanical axis angles were over 10.4° in extension and over 7.7° in flexion, the medial gap showed greater increases in PCL sacrificing groups than in cruciate retaining groups. PMID:25262439

  13. An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis

    PubMed Central

    Mosleh-shirazi, Mohammad Saeed; Ibrahim, Mazin; Pastides, Philip; Khan, Wasim; Rahman, Habib

    2015-01-01

    Total hip arthroplasty (THA) has improved the quality of life of patients with hip arthritis. Orthopedic community is striving for excellence to improve surgical techniques and postoperative care. Despite these efforts, patients continue facing postoperative complications. In particular, patients with rheumatoid arthritis display a higher risk of certain complications such as dislocation, periprosthetic infection, and shorter prosthesis durability. In this review we present the current knowledge of hip arthroplasty in patients with rheumatoid arthritis with more insight into common practices and interventions directed at enhancing recovery of these patients and current shortfalls. PMID:26236339

  14. Coracoid Fracture After Reverse Total Shoulder Arthroplasty: A Report of 2 Cases.

    PubMed

    Anakwenze, Oke A; Kancherla, Vamsi K; Carolan, Gregory F; Abboud, Joseph

    2015-11-01

    Although reverse total shoulder arthroplasty is largely successful, there are still complications that require appropriate diagnostic workup and treatment. These 2 cases of patients with a coracoid fracture were encountered at 3 months and 15 months after reverse total shoulder arthroplasty. One patient presented with new-onset pain in the coracoid region without significant functional deficit, and the other presented with functional deficit and complaint of a strange noise at the anterior aspect of the operative shoulder. While standard radiographs did not detect the fracture, computed tomography imaging was sufficient to establish the diagnosis. Ultimately, nonoperative management led to resolution of these symptoms. PMID:26566565

  15. Does Pre-Operative Physiotherapy Improve Outcomes in Primary Total Knee Arthroplasty? - A Systematic Review.

    PubMed

    Kwok, Iris H Y; Paton, Bruce; Haddad, Fares S

    2015-09-01

    We undertook a systematic review of 11 randomised controlled trials comparing patient outcomes in total knee arthroplasty in those who had undergone pre-operative physiotherapy-based interventions against control groups. Results show that there is little evidence that pre-operative physiotherapy brings about significant improvements in patient outcome scores, lower limb strength, pain, range of movement and hospital length of stay following total knee arthroplasty. The overall quality of the studies was moderate to poor, mostly due to the small sample sizes. PMID:25913232

  16. Liposomal Bupivacaine: A Comparative Study of More Than 1000 Total Joint Arthroplasty Cases.

    PubMed

    Barrington, John W; Olugbode, Oluseun; Lovald, Scott; Ong, Kevin; Watson, Heather; Emerson, Roger H

    2015-10-01

    Pain after total joint arthroplasty (TJA) can be severe and difficult to control. A single-dose local analgesic delivers bupivacaine in a liposomal time-release platform. In 2248 consecutive patients with hip and knee arthroplasty, half (Pre) were treated using a well-established multimodal analgesia, including periarticular injection (PAI), and half had the PAI substituted for a liposomal bupivacaine injection technique (Post). Pain scores were significantly lower for patients in the Post group for both hip and knee procedures. A large series of patients who had TJA experienced pain relief after the introduction of liposomal bupivacaine as part of an established multimodal protocol. PMID:26410636

  17. Robotically Assisted Unicompartmental Knee Arthroplasty with a Handheld Image-Free Sculpting Tool.

    PubMed

    Lonner, Jess H

    2016-01-01

    Although unicompartmental knee arthroplasty may pose a lower risk of perioperative complications and achieve better functional outcomes than total knee arthroplasty, a high degree of accuracy of implant positioning and soft tissue balance are required to optimize durability and implant survivorship. First-generation robotic technology improved implant position compared with conventional methods. This article reviews the next-generation robotic technology, an image-free handheld robotic sculpting tool, which offers an alternative method for optimizing implant positioning and soft tissue balance without the need for preoperative computed tomography scans and with price points that make it suitable for use in outpatient surgery centers. PMID:26614918

  18. Precision gap particle separator

    DOEpatents

    Benett, William J.; Miles, Robin; Jones, II., Leslie M.; Stockton, Cheryl

    2004-06-08

    A system for separating particles entrained in a fluid includes a base with a first channel and a second channel. A precision gap connects the first channel and the second channel. The precision gap is of a size that allows small particles to pass from the first channel into the second channel and prevents large particles from the first channel into the second channel. A cover is positioned over the base unit, the first channel, the precision gap, and the second channel. An port directs the fluid containing the entrained particles into the first channel. An output port directs the large particles out of the first channel. A port connected to the second channel directs the small particles out of the second channel.

  19. Gap Cycling for SWIFT

    E-print Network

    Corum, Curtis A; Snyder, Carl J; Garwood, Michael

    2013-01-01

    Purpose: SWIFT (SWeep Imaging with Fourier Transformation) is a non- Cartesian MRI method with unique features and capabilities. In SWIFT, radiofrequency (RF) excitation and reception are performed nearly simultaneously, by rapidly switching between transmit and receive during a frequency-swept RF pulse. Because both the transmitted pulse and data acquisition are simultaneously amplitude-modulated in SWIFT (in contrast to continuous RF excitation and uninterrupted data acquisition in more familiar MRI sequences), crosstalk between different frequency bands occurs in the data. This crosstalk leads to a "bulls-eye" artifact in SWIFT images. We present a method to cancel this inter-band crosstalk by cycling the pulse and receive gap positions relative to the un-gapped pulse shape. We call this strategy "gap cycling." Methods: We carry out theoretical analysis, simulation and experiments to characterize the signal chain, resulting artifacts, and their elimination for SWIFT. Results: Theoretical analysis reveals t...

  20. Uncertainties in Gapped Graphene

    E-print Network

    Eylee Jung; Kwang S. Kim; DaeKil Park

    2012-03-20

    Motivated by graphene-based quantum computer we examine the time-dependence of the position-momentum and position-velocity uncertainties in the monolayer gapped graphene. The effect of the energy gap to the uncertainties is shown to appear via the Compton-like wavelength $\\lambda_c$. The uncertainties in the graphene are mainly contributed by two phenomena, spreading and zitterbewegung. While the former determines the uncertainties in the long-range of time, the latter gives the highly oscillation to the uncertainties in the short-range of time. The uncertainties in the graphene are compared with the corresponding values for the usual free Hamiltonian $\\hat{H}_{free} = (p_1^2 + p_2^2) / 2 M$. It is shown that the uncertainties can be under control within the quantum mechanical law if one can choose the gap parameter $\\lambda_c$ freely.

  1. Bridging NCL research gaps.

    PubMed

    Stehr, Frank; van der Putten, Herman

    2015-10-01

    The neuronal ceroid lipofuscinoses, collectively called NCLs, are rare and fatal lysosomal storage diseases that mainly affect children. Due to the fact that NCLs are both rare and heterogeneous (mutations in thirteen different genes) significant gaps exist in both preclinical and clinical research. Altogether, these gaps are major hurdles to bring therapies to patients while the need for new therapies is urgent to help them and their families. To define gaps and discuss solutions, a round table discussion involving teams and different stake holders took place during the 14th International Conference on Neuronal Ceroid Lipofuscinoses (Batten Disease) in Cordóba, Argentina. Topics covered by the teams and their leaders (in parentheses) included basic and translational research gaps with regard to large animal models (I. Tammen, D.N. Palmer), human NCL pathology and access to human tissue (J.D. Cooper, H.H. Goebel), rare NCLs (S. Hofman, I. Noher), links of NCLs to other diseases (F.M. Platt), gaps between clinic and clinical trials (H. Adams, A. Schulz), international collaborative efforts working towards a cure (S.E. Mole, H. Band) perspectives on palliative care from patient organizations (M. Frazier, A. West), and issues NCL researchers face when progressing to independent career in academia (M. Bond). Thoughts presented by the team leaders include previously unpublished opinions and information on the lack of understanding of disease pathomechanisms, gene function, assays for drug discovery and target validation, natural history of disease, and biomarkers for monitoring disease progression and treatment effects. This article is not intended to review the NCL literature. It includes personal opinions of the authors and it provides the reader with a summary of gaps discussed and solutions proposed by the teams. This article is part of a Special Issue entitled: Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease). PMID:26056946

  2. Management of proximal humerus fractures utilizing reverse total shoulder arthroplasty.

    PubMed

    Jones, Kristofer J; Dines, David M; Gulotta, Lawrence; Dines, Joshua S

    2013-03-01

    The increased incidence of proximal humerus fractures has resulted in a thoughtful evolution of treatment options in order to optimize clinical outcomes. Complex three- and four-part fractures present a treatment challenge, particularly in elderly patients with significant medial comorbidities and poor bone quality. While open reduction and internal fixation is a reasonable surgical option in some patients with acceptable bone quality and simple fracture patterns that are not susceptible to avascular necrosis, shoulder hemiarthroplasty is a well-established procedure for many elderly patients (i.e., >70 years). Historically, hemiarthroplasty has provided reliable pain relief, but outcomes with regard to function, motion, and strength have varied. Ultimately, successful outcomes are dependent upon tuberosity healing, since an intact rotator cuff is required to restore function. With the advent of reverse total shoulder arthroplasty (RTSA) and increased familiarity with the surgical technique, successful outcomes have been achieved in older patients with poor potential for tuberosity healing. In this review, we discuss the recent role of RTSA in the setting of proximal humerus fractures, including surgical indications, preferred operative technique, and recent literature that supports its use. PMID:23334846

  3. Manipulation under Anesthesia for Stiffness after Total Knee Arthroplasty

    PubMed Central

    Yoo, Ju-Hyung; Oh, Jin-Cheol; Park, Sang-Hoon

    2015-01-01

    Purpose This study evaluated the incidence of manipulation under anesthesia (MUA) for stiffness after total knee arthroplasty (TKA) and the degree of joint motion recovery after MUA. Materials and Methods A total of 4,449 TKAs (2,973 patients) were performed between March 2000 and August 2014. Cases that underwent MUA for stiffness after TKA were reviewed. TKAs were performed using the conventional procedure in 329 cases and using the minimally invasive procedure in 4,120 cases. The preoperative range of joint motion, timing of manipulation, diagnosis and the range of joint motion before and after MUA were retrospectively investigated. Results MUA was carried out in 22 cases (16 patients), resulting in the incidence of 0.5%. The incidence after the conventional procedure was 1.2% and 0.4% after the minimally invasive procedure. In the manipulated knees, the preoperative range of motion (ROM) was 102.5°±26.7°, and the preoperative diagnosis was osteoarthritis in 19 cases, rheumatoid arthritis in two, and infection sequela in one. MUA was performed 4.7±3.0 weeks after TKA. The average ROM was 64.5°±13.5° before manipulation. At an average of 64.3±41.3 months after manipulation, the ROM was recovered to 113.4°±31.2°, which was an additional 49.9° improvement in flexion. Conclusions The satisfactory recovery of joint movement was achieved when MUA for stiffness was performed relatively early after TKA. PMID:26676186

  4. Fibrosis is a common outcome following total knee arthroplasty

    PubMed Central

    Abdul, Nicole; Dixon, David; Walker, Andrew; Horabin, Joanna; Smith, Nick; Weir, David J.; Brewster, Nigel T.; Deehan, David J.; Mann, Derek A.; Borthwick, Lee A.

    2015-01-01

    Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures that alleviates pain and restores function in patients with degenerative knee joint diseases. Arthrofibrosis, abnormal scarring in which dense fibrous tissue prevents normal range of motion, develops in ~3–10% of TKA patients. No prophylactic intervention is available and treatment is restricted to aggressive physiotherapy or revision surgery. Tissue was collected from patients undergoing primary (n?=?30) or revision (n?=?27) TKA. Revision patients were stratified as non-arthrofibrotic and arthrofibrotic. Tissue was macroscopically and histologically compared to improve our understanding of the pathophysiology of arthrofibrosis. Macroscopically, tissue from primary TKA presents as homogenous, fatty tissue whereas tissue from revision TKA presents as dense, pigmented tissue. Histologically, there was dramatic tissue remodelling, increased collagen deposition and increased (myo)fibroblast staining in tissue from revision TKA. Significantly, tissue architecture was similar between revision patients regardless of clinically diagnosis. There are significant differences in architecture and composition of tissue from revision TKA over primary TKA. Surprisingly, whether revision TKA were clinically diagnosed as arthrofibrotic or non-arthrofibrotic there were still significant differences in fibrotic markers compared to primary TKA suggesting an ongoing fibrotic process in all revision knees. PMID:26553967

  5. Anterior knee pain following primary total knee arthroplasty

    PubMed Central

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-01-01

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  6. Full versus surface tibial baseplate cementation in total knee arthroplasty.

    PubMed

    Galasso, Olimpio; Jenny, Jean-Yves; Saragaglia, Dominique; Miehlke, Rolf K

    2013-02-01

    The use of a keel in the tibial component during modern primary total knee arthroplasty (TKA) has become common, and its cementation may affect the future performance of the prosthesis. Although proponents of cementing the entire tibial component argue that this technique provides better initial fixation and may prevent aseptic loosening, reasons exist to apply cement only to the tibial baseplate. In this study, 232 patients who underwent TKA using full or surface cementation of the tibial baseplate were evaluated at an average 5.6-year follow-up to assess survivorship and clinical results. The cumulative survival rate at 8 years was 97.1%. With revision of either component for any reason considered the endpoint, no significant difference was noted between full and surface cemented groups. Knee Society Score, range of motion, and femoro-tibial mechanical angle significantly increased postoperatively. Multivariate analysis revealed that good preoperative range of motion and Knee Society Scores were related to good postoperative range of motion and Knee Society Scores. Follow-up length was a negative predictor of postoperative Knee Society Score. The use of full or surface cementation of the baseplate was unrelated to the postoperative clinical outcomes. Clinical outcomes did not differ according to the tibial component cementation technique. The results of this study suggest that cementing the keel of the tibial component during primary TKA has no advantage for patients. Longer-term follow-up and proper patient randomization are required to confirm these findings. PMID:23379926

  7. The Use of Epoetin-? in Revision Knee Arthroplasty

    PubMed Central

    Delasotta, Lawrence A.; Rangavajjula, Ashwin V.; Frank, Michael L.; Blair, Jamie L.; Orozco, Fabio R.; Ong, Alvin C.

    2012-01-01

    Introduction. To evaluate the efficacy of epoetin-? prior to revision total knee arthroplasty, we hypothesized that epoetin-? will reduce blood transfusion. Methods. Eighty-one patients were compared in this retrospective review; twenty-eight patients received our dosing regimen. All patients were mildly anemic. Epoetin-? to control (1?:?2) patient matching occurred so that one of two attending surgeons, gender, BMI, complexity of surgery, ASA score, and age were similar between groups. The clinical triggers for blood transfusion during or after the procedure were determined based on peri- and postoperative hemoglobin levels, ASA score, and/or clinical symptoms consistent with anemia. Blood salvage was not used. Results. Blood transfusion and length of stay were lower in the study group. None of the patients who received epoetin-? underwent transfusion. Hemoglobin increased from 11.97 to 13.8, preoperatively. Hemoglobin at day of surgery and time of discharge were higher. Gender, BMI, ASA score, total and hidden blood losses, calculated blood loss, preop PLT, PT, PTT, and INR were similar between groups. One Epogen patient had an uncomplicated DVT (3.6%). Conclusions. Epoetin-? may have a role in the mildly anemic revision knee patient. It may also decrease patient length of stay allowing for earlier readiness to resume normal activities and/or meet short-term milestones. A randomized study to evaluate the direct and indirect costs of such a treatment methodology in the mildly anemic revision patient may be warranted. PMID:22811922

  8. Fibrosis is a common outcome following total knee arthroplasty.

    PubMed

    Abdul, Nicole; Dixon, David; Walker, Andrew; Horabin, Joanna; Smith, Nick; Weir, David J; Brewster, Nigel T; Deehan, David J; Mann, Derek A; Borthwick, Lee A

    2015-01-01

    Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures that alleviates pain and restores function in patients with degenerative knee joint diseases. Arthrofibrosis, abnormal scarring in which dense fibrous tissue prevents normal range of motion, develops in ~3-10% of TKA patients. No prophylactic intervention is available and treatment is restricted to aggressive physiotherapy or revision surgery. Tissue was collected from patients undergoing primary (n?=?30) or revision (n?=?27) TKA. Revision patients were stratified as non-arthrofibrotic and arthrofibrotic. Tissue was macroscopically and histologically compared to improve our understanding of the pathophysiology of arthrofibrosis. Macroscopically, tissue from primary TKA presents as homogenous, fatty tissue whereas tissue from revision TKA presents as dense, pigmented tissue. Histologically, there was dramatic tissue remodelling, increased collagen deposition and increased (myo)fibroblast staining in tissue from revision TKA. Significantly, tissue architecture was similar between revision patients regardless of clinically diagnosis. There are significant differences in architecture and composition of tissue from revision TKA over primary TKA. Surprisingly, whether revision TKA were clinically diagnosed as arthrofibrotic or non-arthrofibrotic there were still significant differences in fibrotic markers compared to primary TKA suggesting an ongoing fibrotic process in all revision knees. PMID:26553967

  9. Short-Term Results of Novel Constrained Total Hip Arthroplasty

    PubMed Central

    Pace, Thomas; Finley, Stephen; Snider, Rebecca; Looper, Jayme; Tanner, Stephanie

    2015-01-01

    Constrained acetabular components have only been recommended as a salvage option for the persistently unstable total hip arthroplasty (THA), due to limited range of motion and less than satisfactory component failure rates. This is a retrospective review of 137 patients with 154 consecutive primary constrained THAs performed between November 2003 and August 2007. We reviewed serial radiographs, postoperative complications, groin/thigh pain, and compared preoperative and postoperative Harris Hip Scores. With a mean follow-up of 6 years, there was 1.9% dislocation rate, 0% component failure rate, and 2.6% infection rate. Seven patients reported continued groin pain, and three had continued thigh pain. One patient showed radiographic evidence of 1 mm polyethylene wear. Radiographic review showed no evidence of osteolysis or stem subsidence. Harris Hip Scores improved from a mean of 68.8 (range 58-87) preoperatively to 98.9 (range 65-100) at final clinical assessment. This constrained acetabular prosthesis had a dislocation rate of less than 2%, with 0% component failure rate at a minimum of 2 years of follow-up suggesting this prosthesis may be a viable alternative for patients at risk for instability or those known to have recurrent instability. PMID:26330992

  10. No clinical benefit of gender-specific total knee arthroplasty

    PubMed Central

    Zhu, Chen; Wang, Jiaxing; Cheng, Mengqi; Peng, Xiaochun; Wang, Qi; Zhang, Xianlong

    2014-01-01

    Background and purpose There is no consensus regarding the clinical relevance of gender-speci?c prostheses in total knee arthroplasty (TKA). We summarize the current best evidence in a comparison of clinical and radiographic outcomes between gender-speci?c prostheses and standard unisex prostheses in female patients. Methods We used the PubMed, Embase, Cochrane, Science Citation Index, and Scopus databases. We included randomized controlled trials published up to January 2013 that compared gender-speci?c prostheses with standard unisex prostheses in female patients who underwent primary TKAs. Results 6 trials involving 423 patients with 846 knee joints met the inclusion criteria. No statistically significant differences were observed between the 2 designs regarding pain, range of motion (ROM), knee scores, satisfaction, preference, complications, and radiographic results. The gender-specific design (Gender Solutions; Zimmer Inc, Warsaw, Indiana) reduced the prevalence of overhang. However, it had less overall coverage of the femoral condyles compared to the unisex group. In fact, the femoral prosthesis in the standard unisex group matched better than that in the gender-speci?c group. Interpretation Gender-speci?c prostheses do not appear to confer any bene?t in terms of clinician- and patient-reported outcomes for the female knee. PMID:24954488

  11. Revision in Cemented and Cementless Infected Hip Arthroplasty

    PubMed Central

    Cherubino, Paolo; Puricelli, Marco; D’Angelo, Fabio

    2013-01-01

    Infection is a frequent cause of failure after joint replacement surgery. The infection rate after total hip arthroplasty (THA) has been reduced to 1-2% in the last years. However, it still represents a challenging problem for the orthopedic surgeon. Difficulty of therapeutic approach, and poor functional outcomes together with length of treatment and overall cost are the main burden of this issue. Even the diagnosis of an infected hip could be challenging although it is the first step of an accurate treatment. At the end, many cases require removing the implants. Afterwards, the treatment strategy varies according to authors with three different procedures: no re-implantation, immediate placement of new implants or a two-stage surgery re-implantation. Based on the most recently systematic review there is no suggestion that one- or two-stage revision methods have different re-infection outcomes. The two-stage implant-exchange protocol remains the gold standard. It is considered as the most efficacious clinical approach for the treatment of periprosthetic infection, especially in patients with sinus tracts, swelling, extended abscess formation in depth and infection of Methicillin Resistant Staphylococcus Aureus (MRSA), and other multidrug-resistant bacteria as reported in recent consensus documents. PMID:23898351

  12. Two-Stage Total Knee Arthroplasty for Prosthetic Joint Infection

    PubMed Central

    Cha, Min Seok; Cho, Se Hyun; Kim, Dong Hee; Yoon, Hong Kwon; Cho, Ho Seung; Lee, Dong Yeong; Lee, Sang Hyuk

    2015-01-01

    Purpose This retrospective review was conducted to identify prognostic factors for two-stage reimplantation for infected total knee arthroplasty (TKA) and the rate of reinfection following revision TKA. Materials and Methods Out of 88 patients diagnosed with post-TKA infection between 1998 and 2011, 76 underwent two-stage reimplantation and were reviewed in this study. The 76 patients were divided into two groups-those who experienced reinfection and those who did not. Comorbidities, culture results, and inflammation indices were analyzed and compared between the two groups. Results Of the 76 patients who underwent a two-stage reimplantation, 18 (23.7%) experienced reinfection. Patients with more than three comorbidities had significantly higher reinfection rates than those with less than three comorbidities (47.1% vs. 4.8%, p=0.032). The reinfection rate between the culture positive prosthetic joint infection group and the culture negative prosthetic joint infection group was not significantly different (p=0.056). Inflammation indices (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) showed a statistically significant difference between patients with reinfection and those without reinfection at 4 weeks after the first-stage surgery. Conclusions Reimplantation must be carefully performed when the risk of reinfection is high, particularly in patients with more than three systemic or local comorbidities and higher inflammation indices (ESR and CRP) prior to revision TKA. PMID:26060606

  13. Indoor and Outdoor Mobility following Total Knee Arthroplasty

    PubMed Central

    Storey, Ava S.T.; Myrah, Ainslie M.; Bauck, Robyn A.; Brinkman, Danielle M.; Friess, Shawn N.

    2013-01-01

    ABSTRACT Purpose: To determine the relationship between indoor and outdoor mobility capacity in older adults with unilateral total knee arthroplasty (TKA) and, secondarily, to determine walking intensity in the same population and to compare all outcomes to a control group of older adults without knee pathology. Method: In this cross-sectional study, participants (TKA=16, mean 22.9 (SD 9.7) mo post TKA; control=22) completed indoor walking tests and a 580 m outdoor course that included varying terrain (e.g., curbs, grass, sidewalk) and frequent changes in direction. Walking capacity was assessed using stopwatches, global positioning system watches and accelerometers. Results: Outdoor walking time was moderately correlated (p<0.05) with the timed up-and-go (TUG) test (r=0.65), stair-climb test (SCT) (r=0.67 ascending, r=0.79 descending), 10 m walk test (10 mWT) (r=0.73), and 6-minute walk test (6 MWT) (r=?0.75). Based on activity counts, walking intensity levels for participants in both groups were moderate (outdoor walk and 6 MWT). There was no significant difference in walking capacity between groups (TUG, SCT, 10 mWT, 6 MWT, outdoor walk). Conclusions: Common clinical walking tests are moderately correlated with outdoor mobility. Mobility capacity of individuals post TKA was similar to controls in both indoor and outdoor environments, and participants in both groups achieved moderate physical activity levels with walking. PMID:24403699

  14. Reverse Shoulder Arthroplasty in Rheumatoid Arthritis: A Systematic Review

    PubMed Central

    Gee, Edward C.A.; Hanson, Emma K.; Saithna, Adnan

    2015-01-01

    Background: Anatomical shoulder replacement for rheumatoid arthritis (RA) is complicated by a high incidence of rotator cuff tears and glenoid erosion. This can lead to poor function and early failure. Reverse shoulder arthroplasty (RSA) has gained popularity as an alternative. This systematic review attempts to further define the role of RSA in RA. Methods: A systematic review identified seven studies reporting outcomes of RSA in RA patients. Studies were critically appraised, and data on outcomes, complications and technical considerations were extracted and analysed. Results: One hundred and twenty one shoulders were included (mean follow up 46.9 months). Consistent improvements in the main outcome measures were noted between studies. Ninety five percent of patients described excellent to satisfactory outcomes. The minimum mean forward elevation reported in each study was 115 degrees. Symptomatic glenoid loosening (1.7%), deep infection (3.3%) and revision surgery (5%) rates were no higher than for a population of mixed aetiologies. Discussion: Previous concerns regarding high pre- and peri-operative complication and revision rates in RA patients were not shown to be valid by the results of this review. Although associated cuff tears are common and glenoid bone loss can increase the technical complexity of surgery, RSA provides consistent and predictable improvements in key outcome measures and the revision and complication rates do not appear to be higher than reported in a large population of mixed aetiologies. Conclusion: The contemporary literature shows that RSA is a safe, effective and reliable treatment option in RA patients. PMID:26448802

  15. Acute infection in total knee arthroplasty: diagnosis and treatment.

    PubMed

    Martínez-Pastor, Juan Carlos; Maculé-Beneyto, Francisco; Suso-Vergara, Santiago

    2013-01-01

    Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series(.) For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology, Staphylococcus aureus and coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%). Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs. The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors. PMID:23919094

  16. Intraoperative passive knee kinematics during total knee arthroplasty surgery.

    PubMed

    Young, Kathryn L; Dunbar, Michael J; Richardson, Glen; Astephen Wilson, Janie L

    2015-11-01

    Surgical navigation systems for total knee arthroplasty (TKA) surgery are capable of capturing passive three-dimensional (3D) angular joint movement patterns intraoperatively. Improved understanding of patient-specific knee kinematic changes between pre and post-implant states and their relationship with post-operative function may be important in optimizing TKA outcomes. However, a comprehensive characterization of the variability among patients has yet to be investigated. The objective of this study was to characterize the variability within frontal plane joint movement patterns intraoperatively during a passive knee flexion exercise. Three hundred and forty patients with severe knee osteoarthritis (OA) received a primary TKA using a navigation system. Passive kinematics were captured prior to (pre-implant), and after prosthesis insertion (post-implant). Principal component analysis (PCA) was used to capture characteristic patterns of knee angle kinematics among patients, to identify potential patient subgroups based on these patterns, and to examine the subgroup-specific changes in these patterns between pre- and post-implant states. The first four extracted patterns explained 99.9% of the diversity within the frontal plane angle patterns among the patients. Post-implant, the magnitude of the frontal plane angle shifted toward a neutral mechanical axis in all phenotypes, yet subtle pattern (shape of curvature) features of the pre-implant state persisted. PMID:25990930

  17. Iatrogenic vascular injuries during arthroplasty of the hip.

    PubMed

    Alshameeri, Z; Bajekal, R; Varty, K; Khanduja, V

    2015-11-01

    Vascular injuries during total hip arthroplasty (THA) are rare but when they occur, have serious consequences. These have traditionally been managed with open exploration and repair, but more recently there has been a trend towards percutaneous endovascular management. We performed a systematic review of the literature to assess if this change in trend has led to an improvement in the overall reported rates of morbidity and mortality during the last 22 years in comparison with the reviews of the literature published previously. We found a total of 61 articles describing 138 vascular injuries in 124 patients. Injuries because of a laceration were the most prevalent (n = 51, 44%) and the most common presenting feature, when recorded, was bleeding (n = 41, 53.3%). Delay in diagnosis was associated with the type of vascular lesion (p < 0.001) and the clinical presentation (p = 0.002). Open exploration and repair was the most common form of management, however percutaneous endovascular intervention was used in one third of the injuries and more constantly during the last 13 years. The main overall reported complications included death (n = 9, 7.3%), amputation (n = 2, 1.6%), and persistent ischaemia (n = 9, 7.3%). When compared with previous reviews there was a similar rate of mortality but lower rates of amputation and permanent disability, especially in patients managed by endovascular strategies. Cite this article: Bone Joint J 2015;97-B:1447-55. PMID:26530643

  18. Gait analysis of elderly women after total knee arthroplasty

    PubMed Central

    Lee, Aenon; Park, Junhyuck; Lee, Seungwon

    2015-01-01

    [Purpose] The purpose of this study was to investigate ability and muscle activities of elderly women after total knee arthroplasty (TKA) and compare them with those of healthy ones. [Subjects and Methods] Fifteen female patients with TKA due to advanced degenerative arthritis of the measured on knee joint and 19 healthy elderly females participated. Tibiofemoral angles of TKA patients were using a gait analysis system anterioposterior X-rays of the weight-bearing knee. The knee flexion angle and gait parameters were measured. Muscle activities and prolongation time were EMG system. The gait of the treated limb of each participant was evaluated in three consecutive trials at fast speed and comfortable speed. [Results] The knee flexion angle %stance phase, stride length, step length, speed, cadence, and gait cycle significantly decreased at both the fast speed and comfortable speeds, and the onset and duration time of rectus femoris activity was significantly increased at the comfortable speed in the TKA group. [Conclusion] In conclusion, elderly women who received TKA showed decreased gait ability and muscle activity compared to the healthy elderly women. PMID:25931687

  19. Psychological determinants of problematic outcomes following Total Knee Arthroplasty.

    PubMed

    Sullivan, Michael; Tanzer, Michael; Stanish, William; Fallaha, Michel; Keefe, Francis J; Simmonds, Maureen; Dunbar, Michael

    2009-05-01

    The primary objective of the present study was to examine the role of pain-related psychological factors in predicting pain and disability following Total Knee Arthroplasty (TKA). The study sample consisted of 75 (46 women, 29 men) individuals with osteoarthritis of the knee who were scheduled for TKA. Measures of pain severity, pain catastrophizing, depression, and pain-related fears of movement were completed prior to surgery. Participants completed measures of pain severity and self-reported disability 6 weeks following surgery. Consistent with previous research, cross-sectional analyses revealed significant correlations among measures of pre-surgical pain severity, pain catastrophizing, depression and pain-related fears of movement. Prospective analyses revealed that pre-surgical pain severity and pain catastrophizing were unique predictors of post-surgical pain severity (6-week follow-up). Pain-related fears of movement were predictors of post-surgical functional difficulties in univariate analyses, but not when controlling for pre-surgical co-morbidities (e.g. back pain). The results of this study add to a growing literature highlighting the prognostic value of psychological variables in the prediction of post-surgical health outcomes. The results support the view that the psychological determinants of post-surgical pain severity differ from the psychological determinants of post-surgical disability. The results suggest that interventions designed to specifically target pain-related psychological risk factors might improve post-surgical outcomes. PMID:19304392

  20. Wound dressings for primary and revision total joint arthroplasty

    PubMed Central

    Chowdhry, Madhav

    2015-01-01

    Background Preventing post-surgical complications after total joint arthroplasty (TJA) is of great importance, and application of an appropriate wound dressing is necessary. Since no dressing encompasses all the parameters required for ideal wound healing, a comparison of the available dressing types can assist the surgeon to choose the best dressing after TJA. Methods Studies evaluating postoperative wound dressings after TJA were reviewed in order to assess the outcomes, complications and costs associated with dressing types. Results Traditional cotton dressings have a high ability to absorb exudate. However, they dry out sooner and there is a risk of pain and additional trauma during dressing changes. Although vapor permeable dressings allow transmission of moisture, but they have low absorptive capacity and require frequent changes even with moderately exudating wounds. On the other hand, hydrofiber and hydrocolloid dressings have high absorptive capacity and permeability, and can cope with exudate production. They are changed less often and have low blistering rates, which may reduce surgical site infection (SSI). Although the unit cost associated with advanced dressings is much higher than the traditional dressings, the decreased rate of periprosthetic joint infection (PJI) and the cost associated with treating PJI more than compensate for it. Conclusions Choice of dressing type after TJA should depend upon permeability, absorptive capacity, documented rate of SSI and cost effectiveness with its use, apart from a surgeon’s past clinical experience and familiarity. PMID:26605314

  1. Computed tomography in evaluation of revision hip arthroplasty outcomes.

    PubMed

    Kochman, Andrzej; Morawska-Kochman, Monika; Guzi?ski, Maciej; Drobniewski, Marek; Sibi?ski, Marcin; Synder, Marek

    2014-01-01

    Background. This study aimed to assess contact between Recon Shell reinforcement cages used in revision hip arthroplasty and the bony base. Radiographic examinations were performed with the use of multi-energy computed tomography. Material and methods. We tentatively assess the fixation of Burch-Schneider reinforcement cages (Recon Shell made by Aesculap company) implanted in 10 patients, using two methods of evaluation. An analysis of dual energy CT scans enabled us to assess contact between the reinforcement cages and the bony base. Results. The two methods of evaluation produced different results. The evaluation method based on the division of the acetabular component into a weight-bearing zone and a non-weight-bearing zone (accounting for screw fixation) showed lack of support in the weight-bearing zone in 6 out of 10 cases and direct contact with the implant bed in only one case. The assessment of contact at anchorage holes of reinforcement cages fixed at primary procedures revealed no such support in only one case and the presence of direct contact in 5 cases. There was no correlation between the radiological outcomes and clinical results based on the Harris Hip Score. Conclusions. 1. Multi-energy computed tomography (MARS) is useful in evaluating results of revision hip allo-plasty. 2. The introduction of new imaging techniques for the evaluation of revision procedures demonstrates a need for new, unified methods of outcome assessment adjusted to the characteristics of a particular procedure. PMID:25406920

  2. Total hip arthroplasty with acetabular fixation: an unexpected complication.

    PubMed

    Khoriati, Al-Achraf

    2014-04-01

    The incidence of vascular injuries associated with total hip arthroplasty (THA) is low. However, several vascular structures are at risk of injury within the pelvis. These include the external iliac, femoral, and obturator vessels. Both reaming of the acetabulum and drilling of the acetabular screw holes may place these structures at risk. If left untreated, injuries to these vessels may be associated with severe morbidity and mortality. In this report, an acute vascular complication that had an unusual presentation is highlighted. A 72-year-old woman presented to the emergency department following a road traffic accident in which she sustained a combined fracture of the right acetabulum and femoral head. Her treatment involved a combination of THA and pelvic open reduction and internal fixation. The immediate perioperative recovery period was uncomplicated. However, the patient developed a deep venous thrombus in her right calf 7 days after surgery. Further investigation revealed a second thrombus, occluding the right common femoral vein. Surgical exploration revealed that a screw placed during the initial surgery was pressing against the vessel and occluding it. The discrepancy in incidence between the development of deep venous thrombosis and vascular compression or injury means that the association between the 2 events is unlikely to be made. The author highlights this unusual presentation to improve early recognition and prompt management of similar cases. The importance of adequate preoperative planning and intraoperative imaging with a C-arm is also stressed. PMID:24762850

  3. Anterior knee pain following primary total knee arthroplasty.

    PubMed

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-11-18

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  4. Acute hypotension after total knee arthroplasty and its nursing strategy

    PubMed Central

    Zhang, Yu-Mei; He, Jie; Zhou, Chang; Li, Yu; Yi, De-Kun; Zhang, Xia

    2015-01-01

    Objective: To determine the factors affecting postoperative acute hypotension after total knee arthroplasty (TKA) and provide a basis for guiding the clinical prevention. Methods: Between May 2001 and May 2013, a total of 495 patients undergoing routine TKA were analyzed retrospectively. Independent risk factors related to postoperative acute hypotension after TKA were determined by univariate and multivariate analysis. Results: Of the 495 patients undergoing TKA, 61 (12.32%) developed postoperative acute hypotension after surgery. Univariate analysis showed that preoperative Neu, time of surgery, time of anesthesia, pressure of tourniquet, time of using tourniquet, preoperative hypertension, age and type of surgery were significant influencing factors, whereas by multivariate analysis, only age, pressure of tourniquet and type of surgery were significant influencing factors. Conclusion: Factors those were associated with a significantly increased postoperative acute hypotension after TKA included age, pressure of tourniquet and type of surgery. Achieving a good preoperative and postoperative evaluation and monitoring vital signs and disease change contribute to the detection, intervention and salvage for the acute hypotension. PMID:26550351

  5. How to quantify knee function after total knee arthroplasty?

    PubMed

    Boonstra, M C; De Waal Malefijt, M C; Verdonschot, N

    2008-10-01

    Total knee arthroplasty (TKA) is being undertaken in a younger population than before and as a result the functional demands on the knee are likely to be increasing. As a consequence, it is important to define quantitative functional knee tests that can monitor any increase. A valuable functional knee test has to be able to distinguish small differences (selectivity) and has to be independent of pain (content validity). In this study, patient-based questionnaires (WOMAC and Knee Society score) and performance-based tests (sit-to-stand movement, maximal isometric contraction and timed-up-and-go) were used to assess which of these tests are selective and valid to measure knee function. Tests were considered to be selective if they could discriminate between knee patients and healthy control subjects, and to have functional content validity if they were relatively independent of pain. Twenty-eight patients were measured 16 months after surgery and compared to a healthy control group of 31 subjects. The sit-to-stand movement and timed-up-and-go test were both selective and functionally content valid. The timed-up-and-go test can be used for a quick initial assessment of global function and the sit-to-stand movement as a more biomechanical instrument identifying how the knee function of the patient is affected. PMID:18620863

  6. Physical activity after total knee arthroplasty: A critical review

    PubMed Central

    Paxton, Roger J; Melanson, Edward L; Stevens-Lapsley, Jennifer E; Christiansen, Cory L

    2015-01-01

    Total knee arthroplasty (TKA) is the most commonly performed elective surgery in the United States. TKA typically improves functional performance and reduces pain associated with knee osteoarthritis. Little is known about the influence of TKA on overall physical activity levels. Physical activity, defined as “any bodily movement produced by skeletal muscles that results in energy expenditure”, confers many health benefits but typically decreases with endstage osteoarthritis. The purpose of this review is to describe the potential benefits (metabolic, functional, and orthopedic) of physical activity to patients undergoing TKA, present results from recent studies aimed to determine the effect of TKA on physical activity, and discuss potential sources of variability and conflicting results for physical activity outcomes. Several studies utilizing self-reported outcomes indicate that patients perceive themselves to be more physically active after TKA than they were before surgery. Accelerometry-based outcomes indicate that physical activity for patients after TKA remains at or below pre-surgical levels. Several different factors likely contributed to these variable results, including the use of different instruments, duration of follow-up, and characteristics of the subjects studied. Comparison to norms, however, suggests that daily physical activity for patients following TKA may fall short of healthy age-matched controls. We propose that further study of the relationship between TKA and physical activity needs to be performed using accelerometry-based outcome measures at multiple post-surgical time points. PMID:26396937

  7. Skills Gaps in Australian Firms

    ERIC Educational Resources Information Center

    Lindorff, Margaret

    2011-01-01

    This paper reports the results of a survey of more than 2000 managers examining perceptions of skills gaps in a range of Australian firms. It finds that three quarters report a skills gap, and almost one third report skills gaps across the whole organisation. Firm size and industry differences exist in perceptions of the effect of the skills gap

  8. Expected gaps between prime numbers

    E-print Network

    Holt, Fred B

    2007-01-01

    We study the gaps between consecutive prime numbers directly through Eratosthenes sieve. Using elementary methods, we identify a recursive relation for these gaps and for specific sequences of consecutive gaps, known as constellations. Using this recursion we can estimate the numbers of a gap or of a constellation that occur between a prime and its square. This recursion also has explicit implications for open questions about gaps between prime numbers, including three questions posed by Erd\\"os and Tur\\'an.

  9. The Academic Generation Gap

    ERIC Educational Resources Information Center

    Dronzek, Anna

    2008-01-01

    The current generation gap in academia is different--fundamentally shaped by the structural problems of academic employment. The job market has especially exacerbated tensions between senior and junior faculty by ratcheting up expectations and requirements at every stage of the academic career. The disparities have been mentioned often enough to…

  10. Estimating Gender Wage Gaps

    ERIC Educational Resources Information Center

    McDonald, Judith A.; Thornton, Robert J.

    2011-01-01

    Course research projects that use easy-to-access real-world data and that generate findings with which undergraduate students can readily identify are hard to find. The authors describe a project that requires students to estimate the current female-male earnings gap for new college graduates. The project also enables students to see to what…

  11. STEMMING the Gap

    ERIC Educational Resources Information Center

    Kahler, Jim; Valentine, Nancy

    2011-01-01

    America has a gap when it comes to youth pursuing science and technology careers. In an effort to improve the knowledge and application of science, technology, engineering, and math (STEM), after-school programs can work in conjunction with formal in-school curriculum to improve science education. One organization that actively addresses this…

  12. Bridging the Generation Gap

    ERIC Educational Resources Information Center

    Johnson, Susan Moore; Kardos, Susan M.

    2005-01-01

    The lack of instructional continuity in schools negates every effort of principals to provide an environment where all students would be successful. One solution could be to bridge the gap between the professional knowledge and skills of experienced teachers and the energy and fresh ideas of new recruits so that the latter are provided support…

  13. The Latino Achievement Gap

    ERIC Educational Resources Information Center

    Madrid, E. Michael

    2011-01-01

    In the very near future, Latino students will become the majority in California's public schools and because of their great numbers and presence, the pattern of lackluster academic achievement must be a major concern of teachers, school leaders, and policy makers. Despite having made great strides in narrowing the gap that separated them from…

  14. The influence of obesity on early outcomes in primary hip arthroplasty.

    PubMed

    Michalka, Patrick K R; Khan, Riaz J K; Scaddan, Matthew C; Haebich, Samantha; Chirodian, Nish; Wimhurst, James A

    2012-03-01

    Obesity is considered an independent risk factor for adverse outcome after arthroplasty surgery. Data on 191 consecutive total hip arthroplasties were prospectively collected. Body mass index (BMI) was calculated for each patient and grouped into nonobese (BMI <30 kg/m(2)), obese (BMI 30-34.9 kg/m(2)), and morbidly obese (BMI ?35 kg/m(2)). Primary outcomes included functional improvement (Oxford hip score, 6-minute walk test and Short Form-12 Health Survey general health questionnaire) and postoperative complications. Subgroup analysis of surgeons' overall perception of operative technical difficulty was also performed. This study shows that total hip arthroplasties in obese patients were perceived, by the surgeon, to be significantly more difficult. However, this did not translate to an increased risk of complications, operation time, or blood loss, nor suboptimal implant placement. In addition, our results suggest that obese patients gain similar benefit from hip arthroplasty as do nonobese patients, but morbidly obese patients have significantly worse 6-minute walk test scores at 6 weeks. PMID:21802250

  15. 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…

  16. Review of quality of x-rays for templating for total hip arthroplasty.

    PubMed

    Khan, Faiz; Ahmad, Tayyab; Condon, Finbarr; Lenehan, Brian

    2015-03-01

    Digital templating of x-rays for total hip arthroplasty is used routinely for pre-operative planning. This is to assure that appropriately sized implants are selected to replicate patient's hip biomechanics. Multiple studies have shown that templating does not always correspond to the final implants used. The aim of this study was to assess the suitability of the x-rays taken pre-operatively for templating for total hip arthroplasty. We undertook a review of a series of pre-operative templating pelvis x-rays in 100 consecutive patients undergoing total hip arthroplasty. These x-rays were compared against set criteria to determine their suitability for use for templating. We determined that six x-rays met the criteria whereas ninety four x-rays did not meet the criteria for suitable x-rays. Twenty patients had repeat x-rays. The reasons for unsuitability were inadequate opposite femur (66%), absence or incomplete template (54%), inadequate femur length (47%), external rotation (39%), absence of opposite hip (4%). The twenty repeated x-rays were also reviewed for the same parameters and two (10%) satisfied the established criteria. It is imperative that x-rays for templating for total hip arthroplasty are done to a strict standard to obtain an x-ray that is appropriate for templating and there is minimal exposure of the patient to irradiation. PMID:26280858

  17. Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency.

    PubMed

    Franklin, J L; Barrett, W P; Jackins, S E; Matsen, F A

    1988-01-01

    Seven cases of total shoulder arthroplasty exhibiting major glenoid radiolucent lines or actual translation of the glenoid component were evaluated to identify factors associated with glenoid loosening. The average time from arthroplasty was 30 months (range, 14-44 months). Six of the patients had severe, incompletely reconstructable rotator cuff tears present at the time of surgery, and one patient developed a cuff tear within 1 year of surgery. The amount of superior migration of the humeral component was closely correlated with the degree of glenoid loosening. With superior displacement of the humeral component, superior tipping of the glenoid component was observed: a "rocking horse" glenoid. For comparison, a contemporary group of 16 consecutive total shoulder arthroplasty patients with intact rotator cuffs were reviewed. The control group had no glenoid loosening an average of 5 years after operation. Upward riding of the prosthetic humeral head in patients with rotator cuff deficiency may contribute to loosening of the glenoid component in total shoulder arthroplasty. PMID:3361319

  18. Favorable outcome of a total hip arthroplasty with insufficient bone coverage of the roof reinforcement ring

    PubMed Central

    Judas, Fernando M.; Lucas, Francisco M.; Fonseca, Ruben L.

    2015-01-01

    Introduction Total hip arthroplasty in patients with developmental dysplasia of the hip can be a complex procedure due to acetabular and proximal femoral deformities. Presentation of case A 59-year-old male patient underwent a total hip arthroplasty for the treatment of end-stage dysplastic osteoarthritis. A roof reinforcement ring, a cemented polyethylene cup, and a cementless stem were used. A portion of the superior rim of the ring was uncovered by the host bone. Morsellized autogenous femoral-head graft was impacted to fill the space between the superior rim of the ring and the superior part of the dysplastic acetabulum. At the follow-up after 5-years, the patient had no complaints and was very satisfied with the operation result. The hip radiograph revealed no signs of instability of the acetabular component, and no bone graft resorption. Discussion Favorable results were described using metal rings and conical femoral stems for the treatment of the developmental dysplasia of the hip. The superior rim of the metal ring should be against host bone for 60% of its support. Despite the suboptimal implantation of the ring compromising, apparently, mechanical stability of the arthroplasty, the outcome was favorable. Conclusion This result can be supported by the good fixation of the metal ring to the pelvis with screws, the adequate orientation of both components of the total hip arthroplasty, and the bone graft incorporation. PMID:26453941

  19. Ruminococcus gnavus Total Hip Arthroplasty Infection in a 62-Year-Old Man with Ulcerative Colitis

    PubMed Central

    El Sayed, Faten; Duffiet, Pascal; Bauer, Thomas; Heym, Beate; Gaillard, Jean-Louis; Herrmann, Jean-Louis

    2015-01-01

    We report the case of a total hip arthroplasty infection caused by Ruminococcus gnavus in a 62-year-old man with ulcerative colitis. The bacterium was perfectly identified by matrix-assisted laser desorption ionization–time of flight mass spectrometry. PMID:25631802

  20. Impact of Weekend Physiotherapy Service on the Cost Effectiveness of Elective Orthopaedic Hip and Knee Arthroplasty

    PubMed Central

    Pengas, I.P; Khan, W.S; Bennett, C.A; Rankin, K.S

    2015-01-01

    We performed a prospective correlational study to evaluate the efficiency and cost effectiveness of weekend physiotherapy in accelerating rehabilitation, reducing hospital stay as well as hospital costs for joint arthroplasty patients in a busy Scottish district general hospital. Patients that underwent elective hip (470) and knee (321) arthroplasty were analysed over a 12 month period. A four month period with weekend physiotherapy provision was arranged to ascertain its effectiveness on the length of stay and the achievement of set physiotherapy milestones. Data collected included length of stay and progression in a defined set of physiotherapy milestones. The relationship between time to discharge, mobilisation with sticks, straight leg raise, 90º knee flexion and cost effectiveness of service were used to determine the correlation, and analysis of the interactions of these factors separately. Our Outcome data demonstrate a statistical significance for the time to mobilisation with two sticks for hip (p=0.0030) and knee (p= 0.0037) arthroplasty patients. There was a trend towards earlier discharge times for all patients receiving weekend physiotherapy, but this was not statistically significant. We conclude that the provision of a continuous programme of weekend physiotherapy for all arthroplasty patients has the potential benefit of a quicker rehabilitation that would results in a cost saving.

  1. 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…

  2. Posterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty

    E-print Network

    Delp, Scott

    the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translationPosterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty Melinda J. Cromie,1,2 Robert A. Siston,1,2,3,4 Nicholas J. Giori,2,5 Scott L

  3. IEEE TRANSACTIONS ON MEDICAL IMAGING, ACCEPTED 1 Post-Arthroplasty Examination Using X-Ray Images

    E-print Network

    Paragios, Nikos

    is considered here, with the aim to create a 3-D shape model of the bone as well as the prosthesis using a set such as the knees and hips. In treating osteoarthritis, the final resort is arthroplasty, the implantation of artificial prostheses. Since 1994­ 1995, the number of hip and knee replacements has had a ten-year increase

  4. Bryan total disc arthroplasty: a replacement disc for cervical disc disease

    PubMed Central

    Wenger, Markus; Markwalder, Thomas-Marc

    2010-01-01

    Total disc arthroplasty is a new option in the treatment of cervical degenerative disc disease. Several types of cervical disc prostheses currently challenge the gold-standard discectomy and fusion procedures. This review describes the Bryan Cervical Disc System and presents the Bryan prosthesis, its indications, surgical technique, complications, and outcomes, as given in the literature. PMID:22915917

  5. Lunar phase does not influence perioperative complications in total hip arthroplasty

    PubMed Central

    Angermann, Alexander; Weber, Patrick; Wegener, Bernd; Pietschmann, Matthias; Müller, Peter

    2012-01-01

    Introduction Lunar calendars, publishing recommendations for daily life, are gaining more and more attention in Germany, where 10.5% of the population believe in lunar effects on disease. A widespread and often heard belief is that a full moon has the most negative effects on surgical outcome. The present study evaluates the effects of lunar phase on perioperative complications in total hip arthroplasty. Material and methods We performed a retrospective study with 305 patients being provided with a primary hip arthroplasty. To identify possible influences of the lunar phase on perioperative complications we investigated data such as operation length, blood loss and course of C-reactive protein that were collected during the patients’ stay in the hospital and allocated them to moon illumination. Results There were no significant differences in all collected data concerning the lunar phase (p > 0.05). Although not statistically significant, there were fewer operations during the full moon phase. Conclusions Therefore there is no evidence that lunar phase has an effect on perioperative complications in total hip arthroplasty. Fewer, though not significantly fewer, operations were performed during the full moon phase. Although this was not a prospective randomized trial, the statistical magnitude of the results does not support any recommendations for scheduling patients for total hip arthroplasty at any particular day of the lunar phase. PMID:22457684

  6. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

    PubMed Central

    2011-01-01

    Background Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient. PMID:21995682

  7. Bacterial and Hematological Findings in Infected Total Hip Arthroplasties in Norway Assessment of 278 Revisions Due to Infection in the Norwegian Arthroplasty Register

    PubMed Central

    Langvatn, Håkon; Lutro, Olav; Dale, Håvard; Schrama, Johannes Cornelis; Hallan, Geir; Espehaug, Birgitte; Sjursen, Haakon; Engesæter, Lars B

    2015-01-01

    Our aim was to assess the bacterial findings in infected total hip arthroplasties (THAs) in Norway. We also wanted to investigate the relationship between causal bacteria and hematological findings. Revisions reported to the Norwegian Arthroplasty Register (NAR) due to infection after total hip arthroplasty during the period 1993 through September 2007 were identified. One single observer visited ten representative hospitals where clinical history, preoperative blood samples and the bacterial findings of intraoperative samples were collected. Bacterial growth in two or more samples was found in 278 revisions, and thus included. The following bacteria were identified: Coagulase-negative staphylococci (CoNS) (41%), Staphylococcus aureus (S. aureus) (19%), streptococci (11%), polymicrobial infections (10%), enterococci (9%), Gram-negative bacteria (6%) and others (4%). CoNS were the most common bacteria throughout the period but in the acute postoperative infections (< 3 weeks) S. aureus was the most frequent bacterial finding. We found no change in the distribution of the bacterial groups over time. S. aureus appears correlated with a higher C-reactive protein value (CRP) (mean 140 (95% Confidence interval (CI): 101-180)) than CoNS (mean 42 (CI: 31-53)). S. aureus also correlated with a higher erythrocyte sedimentation rate value (ESR) (mean 67 (CI: 55-79)) than CoNS (mean 47 (CI: 39-54)). PMID:26587060

  8. Deterministic multidimensional nonuniform gap sampling

    NASA Astrophysics Data System (ADS)

    Worley, Bradley; Powers, Robert

    2015-12-01

    Born from empirical observations in nonuniformly sampled multidimensional NMR data relating to gaps between sampled points, the Poisson-gap sampling method has enjoyed widespread use in biomolecular NMR. While the majority of nonuniform sampling schemes are fully randomly drawn from probability densities that vary over a Nyquist grid, the Poisson-gap scheme employs constrained random deviates to minimize the gaps between sampled grid points. We describe a deterministic gap sampling method, based on the average behavior of Poisson-gap sampling, which performs comparably to its random counterpart with the additional benefit of completely deterministic behavior. We also introduce a general algorithm for multidimensional nonuniform sampling based on a gap equation, and apply it to yield a deterministic sampling scheme that combines burst-mode sampling features with those of Poisson-gap schemes. Finally, we derive a relationship between stochastic gap equations and the expectation value of their sampling probability densities.

  9. Technique and application of a non-invasive three dimensional image matching method for the study of total shoulder arthroplasty

    E-print Network

    Massimini, Daniel Frank

    2009-01-01

    Knowledge of in-vivo glenohumeral joint biomechanics after total shoulder arthroplasty are important for the improvement of patient function, implant longevity and surgical technique. No data has been published on the ...

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

    ClinicalTrials.gov

    2015-12-18

    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

  11. 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

  12. Two-Stage Revision Using a Modified Articulating Spacer in Infected Total Knee Arthroplasty

    PubMed Central

    Kim, Young Soo; Cho, Chul Hyun; Lee, Kyung Jae; Sohn, Eun Seok; Kim, Beom Soo

    2013-01-01

    Purpose To evaluate clinical results of two-stage revision using a modified articulating spacer for treatment of infected total knee arthroplasty (TKA). Materials and Methods We retrospectively reviewed 20 cases treated by two-stage revision arthroplasty using a modified articulating spacer under the diagnosis of infected TKA from January 2006 to December 2011. The mean follow-up period was 22.3 months. The first operation consisted of debridement after removal of the prosthesis, reinsertion of the femoral component after autoclaving, and implantation of antibiotic-loaded cement with a new polyethylene in the proximal tibia. Results The mean period between the primary TKA and the first stage operation was 39 months and between the first stage operation and the revision arthroplasty was 3.3 months. The average range of motion (ROM) increased from 69.8° preoperatively to 102.8° postoperatively (p<0.001). The mean Knee Society knee score increased from 33.8 points to 85.3 points (p<0.001). The mean Knee Society function score increased from 35 points to 87.5 points (p<0.001). The mean Hospital for Special Surgery score increased from 57.6 points preoperatively to 82.6 points postoperatively (p<0.001). Two cases (10%) were re-infected after the revision arthroplasty. Conclusions Two-stage revision arthroplasty using an articulating cement spacer can be an effective therapy not only for the treatment of an infected TKA but also for recovery of knee ROM and function. PMID:24368995

  13. 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

  14. Total knee arthroplasty following tibial plateau fracture: a matched cohort study.

    PubMed

    Scott, C E H; Davidson, E; MacDonald, D J; White, T O; Keating, J F

    2015-04-01

    Radiological evidence of post-traumatic osteoarthritis (PTOA) after fracture of the tibial plateau is common but end-stage arthritis which requires total knee arthroplasty is much rarer. The aim of this study was to examine the indications for, and outcomes of, total knee arthroplasty after fracture of the tibial plateau and to compare this with an age and gender-matched cohort of TKAs carried out for primary osteoarthritis. Between 1997 and 2011, 31 consecutive patients (23 women, eight men) with a mean age of 65 years (40 to 89) underwent TKA at a mean of 24 months (2 to 124) after a fracture of the tibial plateau. Of these, 24 had undergone ORIF and seven had been treated non-operatively. Patients were assessed pre-operatively and at 6, 12 and > 60 months using the Short Form-12, Oxford Knee Score and a patient satisfaction score. Patients with instability or nonunion needed total knee arthroplasty earlier (14 and 13.3 months post-injury) than those with intra-articular malunion (50 months, p < 0.001). Primary cruciate-retaining implants were used in 27 (87%) patients. Complication rates were higher in the PTOA cohort and included wound complications (13% vs 1% p = 0.014) and persistent stiffness (10% vs 0%, p = 0.014). Two (6%) PTOA patients required revision total knee arthroplasty at 57 and 114 months. The mean Oxford knee score was worse pre-operatively in the cohort with primary osteoarthritis (18 vs 30, p < 0.001) but there were no significant differences in post-operative Oxford knee score or patient satisfaction (primary osteoarthritis 86%, PTOA 78%, p = 0.437). Total knee arthroplasty undertaken after fracture of the tibial plateau has a higher rate of complications than that undertaken for primary osteoarthritis, but patient-reported outcomes and satisfaction are comparable. Cite this article: Bone Joint J 2015;97-B:532-8. PMID:25820894

  15. Head size and dislocation rate in primary total hip arthroplasty

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: Dislocation after total hip arthroplasty (THA) has a multifactorial etiology with variables such as surgical approach, component orientation and position, type of cup, stem and head size. Review of the literature regarding the relationship of head size and dislocation rate in THA is suggestive that large femoral head size is associated with lower dislocation rate after THA. However, limited data is available as a proof of this hypothesis. The purpose of this study was to determine that the use of large head size would lead to a decreased incidence of dislocations following THA. Materials and Methods: 317 primary THAs were performed using the posterolateral approach with posterior soft-tissue repair between January 2006 and December 2009. Cases were divided into two groups (A and B). Femoral head diameter size 36 mm was used in 163 THA in group A and 28 mm in 154 THA in group B. Average period of followup being 2 years (6 month to 4 years). Patients were routinely followed at definite intervals and were specifically assessed for dislocation. Results: One or more dislocations occurred in 11 out of 317 hips with the overall rate of dislocation being 3.47%. Dislocation rate was 0.6% in 36 mm head size and 6.49% with 28 mm head size (P value is 0.0107). Keeping the stem design variable as a constant, the difference in the rate of dislocation between the two groups was again found to be statistically significant for both un-cemented and cemented stem. Conclusion: Dislocation rate decreased significantly as the size of the head increased in primary THA. However, longer followup is necessary as rate of dislocation or in vivo highly cross linked poly failure or fracture may increase in future affecting the rate of dislocations in primary THA. PMID:24133302

  16. Patients Still Wish for Key Improvements after Total Knee Arthroplasty

    PubMed Central

    Kim, Seok Jin; Bamne, Ankur; Song, Young Dong; Kang, Yeon Gwi

    2015-01-01

    Purpose Our goals were to rigorously document and explore the interrelationships of various parameters in the aftermath of total knee arthroplasty (TKA), including patient characteristics, clinical scores, satisfaction levels, and patient-perceived improvements. Materials and Methods A questionnaire addressing sociodemographic factors, levels of satisfaction, and "wished-for" improvements was administered to 180 patients at least 1 year post primary TKA. Both satisfaction levels and wished-for improvements were assessed through nine paired parameters. Patients responded using an 11-point visual analogue scale (VAS) and the results were summarized as mean VAS score. Correlations between clinical scores and satisfaction levels and between satisfaction levels and desired improvements were analyzed. Results Patient satisfaction levels were only modest (mean score, 4-7) for eight of the nine parameters, including pain relief and restoration of daily living activities, the top two ranked parameters in wished-for improvement while high-flexion activity constituted the top source of discontent. Wished-for improvement was high in seven parameters, the top three being restoration of daily living activities, pain relief, and high-flexion activity. The effects of sociodemographic factors on satisfaction levels and wished-for improvement varied. Satisfaction levels correlated positively with functional outcomes, and satisfaction in pain relief and restoration of daily living activities correlated more often and most strongly with clinical scores. Conclusions Following TKA, patient satisfaction is not high for a number of issues, with improvements clearly needed in restoring daily living activities and relieving pain. Continued efforts to achieve better surgical outcomes should address patient-perceived shortcomings. PMID:25750891

  17. [Ceramic-on-ceramic bearings in total hip arthroplasty (THA)].

    PubMed

    Sentürk, U; Perka, C

    2015-04-01

    The main reason for total hip arthroplasty (THA) revision is the wear-related aseptic loosening. Younger and active patients after total joint replacement create high demands, in particular, on the bearings. The progress, especially for alumina ceramic-on-ceramic bearings and mixed ceramics have solved many problems of the past and lead to good in vitro results. Modern ceramics (alumina or mixed ceramics containing alumina) are extremely hard, scratch-resistant, biocompatible, offer a low coefficient of friction, superior lubrication and have the lowest wear rates in comparison to all other bearings in THA. The disadvantage of ceramic is the risk of material failure, i.e., of ceramic fracture. The new generation of mixed ceramics (delta ceramic), has reduced the risk of head fractures to 0.03-0.05?%, but the risk for liner fractures remains unchanged at about 0.02?%. Assuming a non-impinging component implantation, ceramic-on-ceramic bearings have substantial advantages over all other bearings in THA. Due to the superior hardness, ceramic bearings produce less third body wear and are virtually impervious to damage from instruments during the implantation process. A specific complication for ceramic-on-ceramic bearings is "squeaking". The high rate of reported squeaking (0.45 to 10.7?%) highlights the importance of precise implant positioning and the stem and patient selection. With precise implant positioning this problem is rare with many implant designs and without clinical relevance. The improved tribology and the presumable resulting implant longevity make ceramic-on-ceramic the bearing of choice for young and active patients. PMID:25874400

  18. Calcar Preservation Arthroplasty for Unstable Intertrochanteric Femoral Fractures in Elderly

    PubMed Central

    Togrul, Emre; Kose, Ozkan

    2015-01-01

    Background The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment. Methods Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit. Results The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed. Conclusions Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures. PMID:26640625

  19. Autologous bone plugs in unilateral total knee arthroplasty

    PubMed Central

    Protzman, Nicole M; Buck, Nicholas J; Weiss, Carl B

    2013-01-01

    Background: The purpose of this study was to compare blood loss, declines in hemoglobin (HgB) and hematocrit (HcT) levels, and required homologous transfusions for patients who either had the femoral intramedullary defect left open or filled with an autologous bone plug during total knee arthroplasty (TKA). We hereby present our results of autologous bone plugs in unilateral TKA. Materials and Methods: A retrospective chart review was performed on 55 patients diagnosed with osteoarthritis (OA) who had undergone unilateral TKA. Twenty six patients had the femoral defect filled with an autologous bone plug and 29 did not. Lateral releases and patella replacements were not performed. Drained blood was reinfused when appropriate. Results: Mean blood loss and mean blood reinfused were similar for the plugged (loss: 960.8 ± 417.3 ml; reinfused: 466.7 ± 435.9 mL) and unplugged groups (loss: 1065.9 ± 633.5 ml, P = 0.38; reinfused: 528.4 ± 464.8 ml, P = 0.61). Preoperative HgB (14.3 ± 1.4 g/dL, P = 0.93) and HcT levels (42.2 ± 4.6%, P = 0.85) were similar across plug conditions. HgB and HcT levels declined similarly for the plugged (2.7 ± 1.2 g/dl and 7.9 ± 4.0%) and unplugged groups (3.0 ± 0.9 g/dl, P = 0.16 and 9.0 ± 2.6%, P = 0.16), respectively. Of patients, one in the plugged group and none in the unplugged group required homologous transfusions (P = 0.5). Conclusion: The autologous bone plug does not appear to reduce the need for homologous blood transfusions following unilateral TKA. PMID:23682181

  20. Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty

    PubMed Central

    Ali, Abdulemir; Sundberg, Martin; Hansson, Ulrik; Malmvik, Johan; Flivik, Gunnar

    2015-01-01

    Background and purpose Local infiltration analgesia (LIA) is well established for effective postoperative pain relief in total knee arthroplasty (TKA). To prolong the effect of LIA, infusion pumps with local intraarticular analgesia can be used. We evaluated the effect of such an infusion pump for the first 48 h postoperatively regarding pain, knee function, length of stay (LOS) in hospital, and complications. Patients and methods 200 patients received peroperative LIA and a continuous intraarticular elastomeric infusion pump set at 2 mL/h. The patients were randomized either to ropivacaine (7.5 mg/mL) or to NaCl (9 mg/mL) in the pump. Visual analog scale (VAS) pain (0–100 mm), analgesic consumption, side effects of medicine, range of motion (ROM), leg-raising ability, LOS, and complications during the first 3 months were recorded. Results On the first postoperative day, the ropivacaine group had lower VAS pain (33 vs. 40 at 12 noon and 36 vs. 43 at 8 p.m.; p = 0.02 and 0.03, respectively), but after that all recorded variables were similar between the groups. During the first 3 months, the ropivacaine group had a greater number of superficial and deep surgical wound infections (11 patients vs. 2 patients, p = 0.02). There were no other statistically significant differences between the groups. Interpretation Continuous intraarticular analgesia (CIAA) with ropivacaine after TKA has no relevant clinical effect on VAS pain and does not affect LOS, analgesic consumption, ROM, or leg-raising ability. There may, however, be a higher risk of wound-healing complications including deep infections. PMID:25428755

  1. Endoplasmic reticulum stress activation during total knee arthroplasty

    PubMed Central

    Hocker, Austin D; Boileau, Ryan M; Lantz, Brick A; Jewett, Brian A; Gilbert, Jeffrey S; Dreyer, Hans C

    2013-01-01

    Total knee arthroplasty (TKA) is the most common remediation for knee pain from osteoarthritis (OA) and is performed 650,000 annually in the U.S. A tourniquet is commonly used during TKA which causes ischemia and reperfusion (I/R) to the lower limb but the effects of I/R on muscle are not fully understood. Previous reports suggest upregulation of cell stress and catabolism and downregulation of markers of cap-dependent translation during and after TKA. I/R has also been shown to cause endoplasmic reticulum (ER) stress and induce the unfolded protein response (UPR). We hypothesized that the UPR would be activated in response to ER stress during TKA. We obtained muscle biopsies from the vastus lateralis at baseline, before TKA; at maximal ischemia, prior to tourniquet deflation; and during reperfusion in the operating room. Phosphorylation of 4E-BP1 and AKT decreased during ischemia (?28%, P < 0.05; ?20%, P < 0.05, respectively) along with an increase in eIF2? phosphorylation (64%, P < 0.05) suggesting decreased translation initiation. Cleaved ATF6 protein increased in ischemia (39%, P = 0.056) but returned to baseline during reperfusion. CASP3 activation increased during reperfusion compared to baseline (23%, P < 0.05). XBP1 splicing assays revealed an increase in spliced transcript during ischemia (31%, P < 0.05) which diminished during reperfusion. These results suggest that in response to I/R during TKA all three branches of the ER stress response are activated. PMID:24159375

  2. Analysis of Femoral Components of Cemented Total Hip Arthroplasty

    NASA Astrophysics Data System (ADS)

    Singh, Shantanu; Harsha, A. P.

    2015-10-01

    There have been continuous on-going revisions in design of prosthesis in Total Hip Arthroplasty (THA) to improve the endurance of hip replacement. In the present work, Finite Element Analysis was performed on cemented THA with CoCrMo trapezoidal, CoCrMo circular, Ti6Al4V trapezoidal and Ti6Al4V circular stem. It was observed that cross section and material of femoral stem proved to be critical parameters for stress distribution in femoral components, distribution of interfacial stress and micro movements. In the first part of analysis, designs were investigated for micro movements and stress developed, for different stem materials. Later part of the analysis focused on investigations with respect to different stem cross sections. Femoral stem made of Titanium alloy (Ti6Al4V) resulted in larger debonding of stem at cement-stem interface and increased stress within the cement mantle in contrast to chromium alloy (CoCrMo) stem. Thus, CoCrMo proved to be a better choice for cemented THA. Comparison between CoCrMo femoral stem of trapezium and circular cross section showed that trapezoidal stem experiences lesser sliding and debonding at interfaces than circular cross section stem. Also, trapezium cross section generated lower peak stress in femoral stem and cortical femur. In present study, femur head with diameter of 36 mm was considered for the analysis in order to avoid dislocation of the stem. Also, metallic femur head was coupled with cross linked polyethylene liner as it experiences negligible wear compared to conventional polyethylene liner and unlike metallic liner it is non carcinogenic.

  3. Comparative responsiveness of outcome measures for total knee arthroplasty

    PubMed Central

    Giesinger, K.; Hamilton, D.F.; Jost, B.; Holzner, B.; Giesinger, J.M.

    2014-01-01

    Summary Objective The aim of this study was to compare the responsiveness of various patient-reported outcome measures (PROMs) and clinician-reported outcomes following total knee arthroplasty (TKA) over a 2-year period. Methods Data were collected in a prospective cohort study of primary TKA. Patients who had completed Forgotten Joint Score-12 (FJS-12), Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index, EQ-5D, Knee Society Score and range of movement (ROM) assessment were included. Five time points were assessed: pre-operative, 2 months, 6 months, 1 year and 2 years post-operative. Results Data from 98 TKAs were available for analysis. Largest effect sizes (ES) for change from pre-operative to 2-month follow-up were observed for the Knee Society Score (KSS) Knee score (1.70) and WOMAC Total (?1.50). For the period from 6 months to 1 year the largest ES for change were shown by the FJS-12 (0.99) and the KSS Function Score (0.88). The EQ-5D showed the strongest ceiling effect at 1-year follow-up with 84.4% of patients scoring the maximum score. ES for the time from 1- to 2-year follow-up were largest for the FJS-12 (0.50). All other outcome measures showed ES equal or below 0.30. Conclusion Outcome measures differ considerably in responsiveness, especially beyond one year post-operatively. Joint-specific outcome measures are more responsive than clinician-reported or generic health outcome tools. The FJS-12 was the most responsive of the tools assessed; suggesting that joint awareness may be a more discerning measure of patient outcome than traditional PROMs. PMID:24262431

  4. Adverse reaction to metal debris after Birmingham hip resurfacing arthroplasty

    PubMed Central

    Junnila, Mika; Seppänen, Matti; Mokka, Jari; Virolainen, Petri; Pölönen, Tuukka; Vahlberg, Tero; Mattila, Kimmo; Tuominen, Esa K J; Rantakokko, Juho; Äärimaa, Ville; Itälä, Ari; Mäkelä, Keijo T

    2015-01-01

    Background and purpose Concern has emerged about local soft-tissue reactions after hip resurfacing arthroplasty (HRA). The Birmingham Hip Resurfacing (BHR) was the most commonly used HRA device at our institution. We assessed the prevalence and risk factors for adverse reaction to metal debris (ARMD) with this device. Patients and methods From 2003 to 2011, BHR was the most commonly used HRA device at our institution, with 249 implantations. We included 32 patients (24 of them men) who were operated with a BHR HRA during the period April 2004 to March 2007 (42 hips; 31 in men). The mean age of the patients was 59 (26–77) years. These patients underwent magnetic resonance imaging (MRI), serum metal ion measurements, the Oxford hip score questionnaire, and physical examination. The prevalence of ARMD was recorded, and risk factors for ARMD were assessed using logistic regression models. The mean follow-up time was 6.7 (2.4–8.8) years. Results 6 patients had a definite ARMD (involving 9 of the 42 hips). 8 other patients (8 hips) had a probable ARMD. Thus, there was definite or probable ARMD in 17 of the 42 hips. 4 of 42 hips were revised for ARMD. Gender, bilateral metal-on-metal hip replacement and head size were not factors associated with ARMD. Interpretation We found that HRA with the Birmingham Hip Resurfacing may be more dangerous than previously believed. We advise systematic follow-up of these patients using metal ion levels, MRI/ultrasound, and patient-reported outcome measures. PMID:25582189

  5. Daptomycin-loaded polymethylmethacrylate bone cement for joint arthroplasty surgery.

    PubMed

    Hsu, Yuan-Ming; Liao, Chun-Hsing; Wei, Yu-Hong; Fang, Hsu-Wei; Hou, Hsiang-Huan; Chen, Chia-Chun; Chang, Chih-Hung

    2014-06-01

    Antibiotic-loaded acrylic bone cement has been frequently used as an infection prophylaxis or antibiotic-loaded spacer in infected arthroplasty. In addition, daptomycin has been used recently against broad spectrum Gram-positive organisms. The goal of this in vitro study is to investigate the bacteriacidal and mechanical properties of daptomycin-incorporated polymethylmethacrylate (PMMA) bone cement and evaluate its feasibility for clinical use. Daptomycin (0.5, 1, or 2?g) was premixed with 40?g of PMMA bone cement powder before curing. The mechanical properties of the daptomycin-loaded acrylic bone cement (DLABC) were estimated following standard guidance, and the release profile and kinetics of daptomycin from PMMA were analyzed. The antimicrobial efficacy of DLABC was determined with a zone of inhibition (ZOI) assay against Staphylococcus aureus, Staphylococcus epidermis, Enterococcus faecalis, and Enterococcus faecium, respectively. The results showed that the compressive strength, of PMMA bone cement, which was higher than 100 MPa in all groups, was sufficient according to ISO 5833 after incorporation of daptomycin. The encapsulated daptomycin was released for 2 weeks with a 9.59?±?0.85%, 15.25?±?0.69%, and 20.64?±?20.33% released percentage on the first day in the low, mid, and high groups, respectively. According to the calculated release kinetics, incorporated daptomycin should be 3.3 times the original dose to double its release. Although all recipes of DLABC had a microbial inhibitory effect, the effect with a higher encapsulated amount of daptomycin was more significant. Therefore, we believe that daptomycin can be locally delivered from PMMA bone cement at the surgical site as a prophylactic or treatment for osteomyelitis against Gram-positive organisms with intact cement function. PMID:24571555

  6. Short term results of cementless total hip arthroplasty in sicklers

    PubMed Central

    Gulati, Yash; Sharma, Mrinal; Bharti, Bhupendra; Bahl, Vibhu; Bohra, Ishwar; Goswani, Amit

    2015-01-01

    Background: Sickle cell (SC) disease leading to endarteritis induces skeletal changes in the form of osteitis, sclerosis of femoral canal and osteonecrosis of the femoral head. All these make total hip arthroplasty (THA) difficult and prolonged. There is increased risk of infection, SC crisis and increased complication rate. Our paper aims to highlight preoperative, intraoperative and postoperative hurdles encountered in performing THA in sicklers and the short term outcome using cementless implants. Materials and Methods: Thirty-nine patients with SC disease, who had osteonecrosis of the femoral head, were operated between 2007 and 2011. The mean age of patients was 22 years (range 13–49 years). There were twenty eight females and 11 males. Bilateral cementless total hip replacement (THR) was performed in 11 patients (22 hips) and in the rest unilateral (28 hips). Preoperative and postoperative modified Harris hip score was evaluated. The average followup was 3.8 years (range 2-6 years). Results: The average operating time was 96 min (range 88–148 min). The average blood loss was 880 ml (range 650–1200 ml). The average intraoperative blood transfused was 2.3 units (range 2–5 units). All patients showed an improvement in Harris hip score from 42 points preoperatively to 92 points at latest followup. Intraoperatively, one patient had a periprosthetic fracture. Six patients developed acute SC crisis and were managed in intensive care unit. Three patients developed wound hematoma. Three patients developed limb length discrepancy less than 1 cm. None had early or late dislocations, infection, heterotopic ossification, sciatic nerve palsy and aseptic loosening. Conclusion: THA in sicklers involves considerable challenge for the orthopedic surgeon. Management requires a multidisciplinary approach involving the anesthetist, hematologist and the orthopedic surgeon. Contrary to previous reports, THA in sicklers now has a predictable outcome especially with the use of cementless implants. PMID:26229167

  7. Analysis of complications of reverse total shoulder arthroplasty

    PubMed Central

    RUSSO, RAFFAELE; ROTONDA, GIUSEPPE DELLA; CICCARELLI, MICHELE; CAUTIERO, FABIO

    2015-01-01

    Purpose the aim of this study was to analyze complications of reverse total shoulder arthroplasty (RTSA) used to treat different shoulder diseases. Methods from March 2000 to March 2013, 195 RTSA were implanted by the senior Author. The indications for reverse prosthesis surgery were secondary osteoarthritis (OA) in 49 cases, irreparable rotator cuff tear (RCT) in 48 cases, and complex humeral fractures in 75 cases, while 19 were patients requiring surgical revision for first prosthesis implant. We used different prostheses with different designs. Results the clinical and radiological results of all the patients were analyzed retrospectively at an average follow-up of 7 years. The cases were divided into four groups on the basis of the diagnosis and complications were classified as perioperative, postoperative, or late. The mean total Constant score improved from 28 to 69 points in the OA group; from 21 to 70.8 points in the irreparable RCT group, to 76.4 in the fracture group, and from 16.6 to 59.8 points in the revision group. Scapular notching was observed in 59 cases (30.2%). Thirty-three other complications (16.9%) were observed, namely: hematomas (n=3), instability of the humeral component (n=1), scapular spine fractures (n=2), ulnar nerve deficit (n=2), long thoracic nerve palsy (n=2), deep infections (n=2), periprosthetic fractures (n=6), glenoid fractures (n=2), implant loosening (n=2), anterior deltoid muscle deficiency (n=2) and periarticular heterotopic calcifications (n=9). Conclusions the rates of complications, especially fractures, reported in the present study were lower than those reported in the current literature. Level of evidence Level IV, therapeutic case series. PMID:26605252

  8. Impingement and Dislocation in Total HIP Arthroplasty: Mechanisms and Consequences

    PubMed Central

    Brown, Thomas D; Elkins, Jacob M; Pedersen, Douglas R; Callaghan, John J

    2014-01-01

    In contemporary total hip arthroplasty, instability has been a complication in approximately 2% to 5% of primary surgeries and 5% to 10% of revisions. Due to the reduction in the incidence of wear-induced osteolysis that has been achieved over the last decade, instability now stands as the single most common reason for revision surgery. Moreover, even without frank dislocation, impingement and subluxation are implicated in a set of new concerns arising with advanced bearings, associated with the relatively unforgiving nature of many of those designs. Against that backdrop, the biomechanical factors responsible for impingement, subluxation, and dislocation remain under-investigated relative to their burden of morbidity. This manuscript outlines a 15-year program of laboratory and clinical research undertaken to improve the scientific basis for understanding total hip impingement and dislocation. The broad theme has been to systematically evaluate the role of surgical factors, implant design factors, and patient factors in predisposing total hip constructs to impinge, sublux, and/or dislocate. Because this class of adverse biomechanical events had not lent itself well to study with existing approaches, it was necessary to develop (and validate) a series of new research methodologies, relying heavily on advanced finite element formulations. Specific areas of focus have included identifying the biomechanical challenges posed by dislocation-prone patient activities, quantifying design parameter effects and component surgical positioning effects for conventional metal-on-polyethylene implant constructs, and the impingement/dislocation behavior of non-conventional constructs, quantifying the stabilizing role of the hip capsule (and of surgical repairs of capsule defects), and systematically studying impingement and edge loading of hard-on-hard bearings, fracture of ceramic liners, confounding effects of patient obesity, and subluxation-mediated worsening of third body particle challenge. PMID:25328453

  9. Early surveillance of ceramic-on-metal total hip arthroplasty.

    PubMed

    Hill, J C; Diamond, O J; O'Brien, S; Boldt, J G; Stevenson, M; Beverland, D E

    2015-03-01

    Ceramic-on-metal (CoM) is a relatively new bearing combination for total hip arthroplasty (THA) with few reported outcomes. A total of 287 CoM THAs were carried out in 271 patients (mean age 55.6 years (20 to 77), 150 THAs in female patients, 137 in male) under the care of a single surgeon between October 2007 and October 2009. With the issues surrounding metal-on-metal bearings the decision was taken to review these patients between March and November 2011, at a mean follow-up of 34 months (23 to 45) and to record pain, outcome scores, radiological analysis and blood ion levels. The mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268 hips (95%) had mild/very mild/no pain, the mean angle of inclination of the acetabular component was 44.8(o) (28(o) to 63(o)), 82 stems (29%) had evidence of radiolucent lines of > 1 mm in at least one Gruen zone and the median levels of cobalt and chromium ions in the blood were 0.83 ?g/L (0.24 ?g/L to 27.56 ?g/L) and 0.78 ?g/L (0.21 ?g/L to 8.84 ?g/L), respectively. The five-year survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than expected levels of metal ions in the blood, we would not recommend the use of CoM THA without further long-term follow-up. We plan to monitor all these patients regularly. PMID:25737511

  10. Robotic-Arm Assisted Surgery in Total Hip Arthroplasty.

    PubMed

    Elmallah, Randa K; Cherian, Jeffrey J; Jauregui, Julio J; Padden, David A; Harwin, Steven F; Mont, Michael A

    2015-05-01

    Complications following total hip arthroplasty (THA), such as dislocation, component loosening and wear, continue to be common indications for revision surgery. Multiple studies have attributed some of these problems to poor acetabular cup alignment and placement outside of the purported radiographic safe zone. In addition, it has been shown that conventional manually performed acetabular cup placement may not lead to optimal alignment, regardless of surgical experience. Additionally, incorrect leg length and offset can lead to dissatisfaction and instability. Therefore, robotic-arm assisted surgery has been introduced to improve accuracy of cup placement and leg length, and to offset with the aim of reducing the risk of hip instability and improving satisfaction after primary THA. Our aim was to prospectively review the use of robotic-arm assisted surgery in 224 patients and to assess whether the pre-operatively determined radiographic targets were achieved post-operatively and the proportion of acetabular cups outside of the safe zone. Pre-determined anteversion and inclination were 15 and 40 degrees, respectively. Our results have shown that the use of robotic-arm assisted surgery resulted in a post-operative mean inclination of 40 degrees (range, 34 to 51 degrees) and a mean anteversion of 16 degrees (range, 9 to 25 degrees). Ninety-nine percent of the patients remained within the pre-designated safe zone. Evidence has shown that robotic-arm assisted surgery may have improved accuracy in cup placement when compared to conventional surgery and possibly to computer-assisted surgery. When compared to the literature on robotic-arm assisted surgery, our results were comparable. We believe that this surgical technique may aid in reducing post-operative THA complications, such as aseptic loosening and dislocations, but further prospective studies are needed to evaluate clinical outcomes and long-term results. PMID:26055021

  11. 10-year experience with short stem total hip arthroplasty.

    PubMed

    von Lewinski, Gabriela; Floerkemeier, Thilo

    2015-03-01

    Since 1998, short stem total hip arthroplasty (THA) has been performed at the authors' institution. Currently, 30% of THAs are performed with short stems. This article reports on complications that required revision of a short stem THA. Between September 2005 and February 2012, a total of 1953 Metha short stem THAs were performed; of these, 38 required revision due to mechanical complications. In 12 cases, the modular titanium neck adapter failed. In 19 cases, aseptic implant loosening occurred; of these, 11 cases were due to major stem subsidence. In 2 cases, via falsa (cortical penetration) implantation occurred. In 5 cases, periprosthetic fractures led to revision. This corresponds to an aseptic total revision rate of 1.3% for 26 short stems and 1.9% including the cases of all 38 documented revision cases. Thirty-four cases were revised with cementless standard hip stems, 2 cases were revised with short stems, and 2 cases were revised with long revision stems. Undersizing was analyzed in 58% of aseptic revisions. Fifty-four percent of revisions were performed in male patients - 23% with osteonecrosis of the femoral head, and 7% with short hip stems positioned in varus in coxa vara deformities. Seventy-two percent of revisions after marked early stem subsidence and position change into valgus were performed in female patients. Dysplastic hips with coxa valga did not show elevated revision rates. No revisions were performed for dislocation or femoral thigh pain. Short stem THA with the Metha implant is a bone-preserving option for various indications in select patient groups. PMID:25826634

  12. Diagnosis and management of the infected total joint arthroplasty

    SciTech Connect

    Cuckler, J.M.; Star, A.M.; Alavi, A.; Noto, R.B. )

    1991-07-01

    The preoperative diagnosis of the infected orthopedic implant is complicated by lack of a single precise test to forewarn patient and surgeon of the presence of microorganisms. Given the overall limitation of accuracy of preoperative diagnosis to approximately 80% when 111In scanning, preoperative aspiration, and ESR are considered, it would seem prudent to approach each revision surgery with the possibility in mind of subclinical sepsis as the cause for failure of the implant. The essentials of surgical technique including thorough debridement of the wound and removal of all existing foreign bodies, especially including PMMA bone cement, are critical to minimizing the risk for occurrence or persistence of sepsis. Although the use of antibiotic impregnated bone cement may enhance the treatment of orthopedic sepsis, the data available to date lead to the conclusion that two-stage revision surgery in the face of known sepsis remains the cornerstone of surgical therapy for the infected implant, along with aggressive and rational antibiotic treatment. The surgeon is offered the following guidelines in the management of the septic total hip arthroplasty. 1. Preoperative evaluation including ESR, 111In WBC scan, and aspiration for culture and sensitivity (fluoroscopically guided for the hip) will produce on average approximately 80% accuracy. 2. Intraoperative cultures at the time of revision surgery should be obtained prior to administration of systemic antibiotics; three tissue specimens (hip capsule, femoral membrane, acetabular membrane) should be submitted for culture and sensitivity determination. 3. Careful debridement of the surgical site of granulation tissue and all foreign bodies (e.g., PMMA) should be performed within the limits of patient safety to maximize the likelihood of success. 37 refs.

  13. Gender gaps within management.

    PubMed

    Ronk, L L

    1993-05-01

    Traditional roles need not become self-fulfilling prophecies if managers can bridge the gender gap. Feminine, as well as masculine, characteristics can be incorporated into managerial styles to enhance effective leadership. Autonomy, decision-making and assertiveness are as important as nurturing and caring. What are little girls made of? Little girls are made of sugar and spice and everything nice. What are little boys made of? Little boys are made of rats and snails and puppy dog tails. PMID:8265083

  14. Two-Year Incidence and Predictors of Future Knee Arthroplasty in Persons with Symptomatic Knee Osteoarthritis: Preliminary Analysis of Longitudinal Data from the Osteoarthritis Initiative

    PubMed Central

    Kong, Xiangrong; Jiranek, William A.

    2009-01-01

    Objective There is little evidence to guide physicians when discussing future likelihood of knee arthroplasty with patients who have symptomatic knee osteoarthritis. Data from Osteoarthritis Initiative (OAI) was used to determine the incidence of and predictors for knee arthroplasty. Methods OAI data were collected on a sample of 778 persons aged 45 to 79 years with symptomatic knee osteoarthritis. An extensive set of measurements were obtained at baseline and persons were followed for 2 years to identify who underwent knee arthroplasty. Random forest analysis was used to identify optimal variables that discriminate among those who did and those who did not undergo knee arthroplasty. Results The two year incidence of knee arthroplasty in the cohort was 3.7% (95%CI, 2.6%, 5.3%). Because of the low number of knee arthroplasty procedures, the predictor analysis was preliminary in nature. The analysis identified several variables that could be used to assist in identifying patients at future risk for knee arthroplasty. Conclusion For persons at high risk of knee arthroplasty, the two year incidence of knee arthroplasty is very low. The most powerful predictors were those that accounted for disease severity and functional loss. These data could assist physicians in advising patients with knee osteoarthritis on future surgical care. PMID:19419874

  15. 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

  16. SOUTHWEST REGIONAL GAP LAND COVER

    EPA Science Inventory

    The Gap Analysis Program is a national inter-agency program that maps the distribution

    of plant communities and selected animal species and compares these distributions with land

    stewardship to identify gaps in biodiversity protection. GAP uses remote satellite imag...

  17. Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty

    PubMed Central

    Lee, Ju Hong

    2015-01-01

    Background We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system. Methods We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups. Results The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 ± 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 ± 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups. Conclusions Surgeons should be aware of the risks associated with anterior femoral notching when using a navigation system for TKA. A modification of the femoral cut should be considered when remarkable femoral bowing is observed. PMID:26217469

  18. Gapped Domain Walls, Gapped Boundaries, and Topological Degeneracy

    NASA Astrophysics Data System (ADS)

    Lan, Tian; Wang, Juven C.; Wen, Xiao-Gang

    2015-02-01

    Gapped domain walls, as topological line defects between (2 +1 )D topologically ordered states, are examined. We provide simple criteria to determine the existence of gapped domain walls, which apply to both Abelian and non-Abelian topological orders. Our criteria also determine which (2 +1 )D topological orders must have gapless edge modes, namely, which (1 +1 )D global gravitational anomalies ensure gaplessness. Furthermore, we introduce a new mathematical object, the tunneling matrix W , whose entries are the fusion-space dimensions Wi a , to label different types of gapped domain walls. By studying many examples, we find evidence that the tunneling matrices are powerful quantities to classify different types of gapped domain walls. Since a gapped boundary is a gapped domain wall between a bulk topological order and the vacuum, regarded as the trivial topological order, our theory of gapped domain walls inclusively contains the theory of gapped boundaries. In addition, we derive a topological ground state degeneracy formula, applied to arbitrary orientable spatial 2-manifolds with gapped domain walls, including closed 2-manifolds and open 2-manifolds with gapped boundaries.

  19. The use of a modular system to convert an anatomical total shoulder arthroplasty to a reverse shoulder arthroplasty : Clinical and radiological results.

    PubMed

    Weber-Spickschen, T S; Alfke, D; Agneskirchner, J D

    2015-12-01

    If a modular convertible total shoulder system is used as a primary implant for an anatomical total shoulder arthroplasty, failure of the prosthesis or the rotator cuff can be addressed by converting it to a reverse shoulder arthroplasty (RSA), with retention of the humeral stem and glenoid baseplate. This has the potential to reduce morbidity and improve the results. In a retrospective study of 14 patients (15 shoulders) with a mean age of 70 years (47 to 83) we reviewed the clinical and radiological outcome of converting an anatomical shoulder arthroplasty (ASA) to a RSA using a convertible prosthetic system (SMR system, Lima, San Daniele, Italy). The mean operating time was 64 minutes (45 to 75). All humeral stems and glenoid baseplates were found to be well-fixed and could be retained. There were no intra-operative or early post-operative complications and no post-operative infection. The mean follow-up was 43 months (21 to 83), by which time the mean visual analogue scale for pain had decreased from 8 pre-operatively to 1, the mean American Shoulder and Elbow Surgeons Score from 12 to 76, the mean Oxford shoulder score from 3 to 39, the mean Western Ontario Osteoarthritis of the Shoulder Score from 1618 to 418 and the mean Subjective shoulder value from 15 to 61. On radiological review, one patient had a lucency around the humeral stem, two had stress shielding. There were no fatigue fractures of the acromion but four cases of grade 1 scapular notching. The use of a convertible prosthetic system to revise a failed ASA reduces morbidity and minimises the rate of complications. The mid-term clinical and radiological results of this technique are promising. Cite this article: Bone Joint J 2015;97-B:1662-7. PMID:26637682

  20. Posterior shoulder instability following anatomic total shoulder arthroplasty: A case report and review of management

    PubMed Central

    Galvin, Joseph W.; Eichinger, Josef K.; Boykin, Robert E.; Szöllösy, Gregor; Lafosse, Laurent

    2015-01-01

    We report a case of posterior shoulder instability following anatomic total shoulder arthroplasty (TSA). In addition, we present guidelines to aid in the management of posterior instability after TSA. A 50-year-old male underwent anatomic TSA for glenohumeral osteoarthritis. Postoperatively, the patient developed posterior instability secondary to glenoid retroversion. He did not improve despite conservative treatment. He underwent an arthroscopic posterior bone block procedure, 4-month after his index arthroplasty. At 14-month follow-up, the patient had regained near full motion and strength, and radiographs demonstrated osseous integration with no evidence of component loosening. Posterior instability following TSA is a relatively rare complication and challenging to manage. The posterior, arthroscopic iliac crest bone block grafting procedure represents a treatment option for posterior instability in the setting of a stable glenoid prosthesis following TSA.

  1. Can We Quantify Functional Improvement Following Total Knee Arthroplasty in the Clinical Setting?

    PubMed

    Parks, Nancy L; Whitney, Catherine E; Engh, Gerard A

    2015-12-01

    The purpose of this study was to determine if improvements in knee function after arthroplasty could be practicably measured in the clinical setting using available, validated technology. The tools we assessed included a timed test of common activities, a platform posturography analysis, and a portable gait laboratory device to quantify body segment motion. We measured the function of 25 total knee arthroplasty patients before surgery and at 1, 4, 12, and 24 months after surgery. Assessment of sit-to-stand, walking, stair climbing, lunging, Knee Society Scores, and Oxford Survey Scores were collected at each interval. Patients showed significant improvement in step length, gait speed, symmetry of weight distribution, symmetry of lunging, and speed of stair climbing. Changes in function with long-term follow-up can be precisely measured, making this technology promising for clinical or research applications. PMID:25260032

  2. The results of 479 thumb carpometacarpal joint replacements reported in the Norwegian Arthroplasty Register.

    PubMed

    Krukhaug, Y; Lie, S A; Havelin, L I; Furnes, O; Hove, L M; Hallan, G

    2014-10-01

    In this study we report the results of thumb carpometacarpal (CMC) joint replacements in the Norwegian population over a 17-year period. In total, 479 primary replacements performed from 1994 to 2011 were identified in the Norwegian Arthroplasty Register. Implant survival and risk of revision were analyzed using Cox regression analyses. Four different implant designs were compared and time trends were analyzed. The overall 5 and 10 year survivals were 91% and 90%, respectively. The newer metal total arthroplasties did not outperform the older silicone and mono-block implants. At 5 years, the implant survival ranged from 90% to 94% for the different implant brands. Gender, age, and diagnosis did not influence the risk of revision. The incidence of thumb CMC joint replacement did not change during the study period. Despite relatively satisfactory implant survivorship in our register study, current evidence does not support widespread implementation of thumb CMC replacements. PMID:24784114

  3. Effect of Polyethylene Crosslinking and Bearing Design on Wear of Unicompartmental Arthroplasty.

    PubMed

    Netter, Jonathan; Hermida, Juan C; D'Alessio, Jerry; Kester, Mark; D'Lima, Darryl D

    2015-08-01

    Wear and polyethylene damage continue to be important factors affecting outcomes of unicompartmental knee arthroplasty. We compared two design rationales for unicompartmental arthroplasty: fully congruent mobile bearings; or moderately conforming fixed bearings using experimental and computational wear simulation. Experimental wear rates were 3.89 (±0.12) mg/million cycles for the highly crosslinked Triathlon PKR fixed bearing compared to 18.35 (±0.19) mg/million cycles for the low crosslinked Oxford mobile bearing. Finite element analysis was used to calculate the effect of crosslinking and backside wear. Increase in polyethylene crosslinking reduced wear by 68% while backside wear comprised 46% of the total wear in the mobile bearing. Increasing conformity may not be the sole predictor of wear performance and highly crosslinked fixed-bearing polyethylene insert can also provide high wear performance. PMID:25865811

  4. A New Case of Fracture of a Modular Femoral Neck Device After a Total Hip Arthroplasty

    PubMed Central

    Trieb, Klemens; Stadler, Nicola

    2015-01-01

    This report addresses a new case of a modular femoral neck fracture after total hip arthroplasty. A now seventy-three-year- old overweight female underwent total hip replacement of the right hip because of osteoarthritis in the year 2002. Then, years later, the head and the polyethylene were changed due to wear. In October 2014, the patient was transferred from the trauma department of her hometown to our department after she had slipped and fallen directly on her right hip. The x-rays done at the trauma department have shown no periprosthetic fracture but a fracture of the modular neck. Therefore, the patient was transferred to our department in order to undergo a revision arthroplasty with change of the stem and head after splitting the femur. PMID:26157528

  5. Aseptic hip pneumarthrosis following modular total hip arthroplasty: a potential mimic of hip infection.

    PubMed

    Morag, Yoav; Yablon, Corrie M; Weber, Alexander E; Brandon, Catherine; Blaha, David J

    2015-04-01

    Pneumarthrosis following total hip arthroplasty accompanied by acute hip symptoms is a potentially ominous finding suggesting infection with gas-forming bacteria, a medical emergency. We describe a case of a 61-year-old male presenting to the Emergency Department 43 months following a titanium/titanium (Ti/Ti) modular neck-stem total hip arthroplasty (MTHA) (Wright Medical Systems, Arlington, Tennessee) with acute presentation of hip symptoms and joint gas on radiographs proven to be aseptic hip pneumarthrosis. We review the imaging features of aseptic hip pneumarthrosis following MTHA which have not been elaborated on previously and suggest a less aggressive workup in select cases. We believe emergency radiologists should be aware of this unusual complication as it may mimic a septic hip which may entail an unnecessarily aggressive workup. PMID:25491939

  6. Deep venous thrombosis was not detected after total knee arthroplasty in Japanese patients with haemophilia.

    PubMed

    Takedani, H; Ohnuma, K; Hirose, J

    2015-09-01

    Combined thrombo-prophylaxis with mechanical and pharmacological methods is recommended in patients undergoing total knee or hip arthroplasty. As patients with 'untreated inherited bleeding disorders such as haemophilia' are at risk of bleeding, no prophylaxis has been prescribed for these patients. However, a retrospective study reported subclinical deep venous thrombosis (DVT) in 10% of patients with haemophilia undergoing major orthopaedic surgery. In this study, we aimed to evaluate the risk of DVT after total knee arthroplasty (TKA). We examined 38 TKA in 33 Japanese patients with haemophilia using ultrasonography. We did not detect DVT. The risk of DVT in patients with haemophilia after TKA may be lower than that in the general population. However, as patients with haemophilia progress in age, venous thromboembolism should be considered as a potential problem. PMID:25708424

  7. Do Regional Analgesia and Peripheral Blocks Still Have a Place in Joint Arthroplasty?

    PubMed

    Cushner, Fred D

    2015-10-01

    The efficacy of regional anesthesia and peripheral nerve blocks in the management of postoperative pain has resulted in widespread use of this approach in hip and knee arthroplasty. With extensive clinical use, however, the limitations of this approach have become apparent. These limitations include delays for the surgeon, inefficient use of the operating room, muscular weakness, and associated delays in physical therapy. Periarticular injection of anesthetic and analgesic medications appears to offer comparable benefits to nerve blocks in joint arthroplasty without these limitations. The long-acting anesthetic bupivacaine liposome injectable suspension (EXPAREL®, Pacira Pharmaceuticals, Inc), in particular, has been shown to be highly effective in managing postoperative pain and reducing opioid consumption. Consequently, a growing body of data and extensive clinical experience now support replacing nerve blocks with periarticular injections. PMID:26447432

  8. Histopathological Evaluation of the Anterior Cruciate Ligament in Patients Undergoing Primary Total Knee Arthroplasty.

    PubMed

    Mont, Michael A; Elmallah, Randa K; Cherian, Jeffrey J; Banerjee, Samik; Kapadia, Bhaveen H

    2016-01-01

    This study assessed gross and histopathological ACL changes in arthritic knees (n=174) undergoing total knee arthroplasty. Histopathological changes were assessed and graded as absent (0), mild (1), moderate (2), or marked (3). These were correlated to demographic and clinical factors, and radiographic evaluations. The ACL was intact in 43, frayed in 85, torn in 15, and absent in 31 knees. Eighty-five percent had histological changes. Overall, there were significant associations between greater age and BMI, and histological changes. Grade IV knees had significantly greater calcium pyrophosphate deposits, microcyst formation, and number of pathologic changes. These correlations may aid decision-making when determining suitability for unicompartmental or bicruciate-retaining arthroplasties, though further studies should correlate these histological findings to mechanical and functional knee status. PMID:26239235

  9. Accuracy and efficacy of osteotomy in total knee arthroplasty with patient-specific navigational template

    PubMed Central

    Gan, Yudong; Ding, Jing; Xu, Yongqing; Hou, Chunlin

    2015-01-01

    This study develops and validates a novel patient-specific navigational template for total knee arthroplasty (TKA). A total of 70 patients who underwent TKA were randomized and divided into conventional method group and navigational template group. In the navigational template group, the patient-specific navigational templates were designed and used intraoperatively to assist 35 patients with knee arthroplasty. Information on operation time and blood loss was recorded. After surgery, the positions of the prosthesis were evaluated using CT scan and X-rays. Analysis showed significant differences in errors between the two techniques. In addition, mean operation time and mean blood loss were statistically and significantly lower in the navigational template group than in the conventional group. Overall, the navigational template method showed a high degree of accuracy and efficacy. PMID:26550129

  10. The Classic: Modular Total Knee-Replacement Arthroplasty. A Review of Eighty-nine Patients

    PubMed Central

    2008-01-01

    Fifty-eight osteoarthritic and thirty-one rheumatoid patients underwent modular total knee-replacement arthroplasty. The major indication for the operation was relief of pain. Contraindications to this resurfacing arthroplasty included varus-valgus instability of over 20 degrees, combined varus-valgus instability with flexion contracture of over 40 degrees, marked recurvatum, and predominant patellofemoral symptoms. In 59 per cent of the osteoarthritic and 58 per cent of the rheumatoid patients, complete relief of pain was evident when they were evaluated twenty-four months after surgery, while another 35 per cent of each group had only mild pain related to inclement weather. Their ability to walk long distances without support or limp was increased. Range of motion and ability to climb stairs were not significantly improved. PMID:18795387

  11. Geographic variations in hospital charges and Medicare payments for major joint arthroplasty.

    PubMed

    Thakore, Rachel V; Greenberg, Sarah E; Bulka, Catherine M; Ehrenfeld, Jesse M; Obremskey, William T; Sethi, Manish K

    2015-05-01

    National data on hospital-level charges and Medicare payments have shown that joint arthroplasty is the most common surgical procedure among the elderly. Yet, no study has investigated micro and macro level geographic variations in hospital charges and payment. We used the Medicare Provider Charge Data to investigate Medicare payments and charges for 2750 hospitals accounting for 427,207 patients who underwent major joint arthroplasty and 932 hospitals for 18,714 patients who had a complication/comorbidity. We found a significant difference in hospital charges and payments based on geographic region (P<0.001). We concluded that hospital charges demonstrate a high variability even when using areas to control for differences in hospital wages and high variation in reimbursements in some areas remains unexplained by Medicare's current method of calculating reimbursement. PMID:25556041

  12. Undecidability of the spectral gap.

    PubMed

    Cubitt, Toby S; Perez-Garcia, David; Wolf, Michael M

    2015-12-10

    The spectral gap--the energy difference between the ground state and first excited state of a system--is central to quantum many-body physics. Many challenging open problems, such as the Haldane conjecture, the question of the existence of gapped topological spin liquid phases, and the Yang-Mills gap conjecture, concern spectral gaps. These and other problems are particular cases of the general spectral gap problem: given the Hamiltonian of a quantum many-body system, is it gapped or gapless? Here we prove that this is an undecidable problem. Specifically, we construct families of quantum spin systems on a two-dimensional lattice with translationally invariant, nearest-neighbour interactions, for which the spectral gap problem is undecidable. This result extends to undecidability of other low-energy properties, such as the existence of algebraically decaying ground-state correlations. The proof combines Hamiltonian complexity techniques with aperiodic tilings, to construct a Hamiltonian whose ground state encodes the evolution of a quantum phase-estimation algorithm followed by a universal Turing machine. The spectral gap depends on the outcome of the corresponding 'halting problem'. Our result implies that there exists no algorithm to determine whether an arbitrary model is gapped or gapless, and that there exist models for which the presence or absence of a spectral gap is independent of the axioms of mathematics. PMID:26659181

  13. Surface Replacement Arthroplasty of the Humeral Head in Young, Active Patients

    PubMed Central

    Iagulli, Nicholas D.; Field, Larry D.; Hobgood, E. Rhett; Hurt, James A.; Charles, Ryan; O’Brien, Michael J.; Savoie, Felix H.

    2014-01-01

    Background: The treatment of glenohumeral arthritis in young, active patients remains controversial. Standard total shoulder arthroplasty in this patient group has not obtained the same satisfaction rate as in older patients. One surgical option that has emerged is humeral resurfacing. Hypothesis: Humeral head surface replacement arthroplasty (SRA) would provide satisfactory clinical outcomes in active patients, allowing them to maintain their normal lifestyle without activity restrictions. Study Design: Case series; Level of evidence, 4. Methods: From 2004 to 2007, all consecutive surface replacement arthroplasties of the humerus performed at the authors’ institution were identified and retrospectively reviewed, and 118 patients who underwent SRA during this time were identified. This study included patients younger than 60 years who wished to maintain an active lifestyle; 52 of the 118 patients met the inclusion criteria. University of California at Los Angeles (UCLA) shoulder scores and subjective shoulder value (SSV) scores were used to measure clinical outcomes at an average follow-up of 6 years (range, 4-8 years). Of the 52 patients meeting the inclusion criteria, 48 were contacted and examined for the study, with 4 patients lost to follow-up. Results: The mean postoperative UCLA score was 28.03, with 1 patient requiring revision because of pain and glenoid wear. The mean SSV was 92% (range, 0%-100%), with 3 patients restricting their activity because of the shoulder. Forty-seven of the 48 contacted patients stated that, given the option, they would have the same surgery again. One patient required revision surgery because of pain. Conclusion: Surface replacement arthroplasty provided reasonable results in patients younger than 60 years with high activity demands with a low rate of revision at midterm follow-up. PMID:26535268

  14. The effects of knee arthroplasty on walking speed: A meta-analysis

    PubMed Central

    2012-01-01

    Background Patients with knee osteoarthritis patients have problems with walking, and tend to walk slower. An important aim of knee arthroplasty is functional recovery, which should include a post-operative increase in walking speed. Still, there are several problems with measuring walking speed in groups of knee osteoarthritis patients. Nevertheless, test-retest reliability of walking speed measurements is high, and when the same investigators monitor the same subjects, it should be possible to assess the walking speed effects of knee arthroplasty. The present study reports a meta-analysis of these effects. Methods A total of 16 independent pre-post arthroplasty comparisons of walking speed were identified through MEDLINE, Web of Science, and PEDro, in 12 papers, involving 419 patients. Results For 0.5–5 months post-operatively, heterogeneity was too large to obtain a valid estimate of the overall effect-size. For 6–12 and 13–60 months post-operatively, heterogeneity was absent, low, or moderate (depending on estimated pre-post correlations). During these periods, subjects walked on average 0.8 standard-deviations faster than pre-operatively, which is a large effect. Meta-regression analysis revealed significant effects of time and time squared, suggesting initial improvement followed by decline. Conclusion This meta-analysis revealed a large effect of arthroplasty on walking speed 6–60 months post-operatively. For the first 0.5–5 months, heterogeneity of effect-sizes precluded a valid estimate of short-term effects. Hence, patients may expect a considerable improvement of their walking speed, which, however, may take several months to occur. Meta-regression analysis suggested a small decline from 13 months post-operatively onwards. PMID:22559793

  15. Prospective relation between catastrophizing and residual pain following knee arthroplasty: Two-year follow-up

    PubMed Central

    Forsythe, Michael E; Dunbar, Michael J; Hennigar, Allan W; Sullivan, Michael JL; Gross, Michael

    2008-01-01

    BACKGROUND: Pain is the primary indication for both primary and revision total knee arthroplasty (TKA); however, most arthroplasty outcome measures do not take pain into account. OBJECTIVE: To document the prospective pain experience following TKA, with subjective pain-specific questionnaires to determine if comorbidities, preoperative pain or preoperative pain catastrophizing scores are predictive of long-term pain outcomes. METHODS: Fifty-five patients with a primary diagnosis of osteoarthritis of the knee, who were scheduled to undergo TKA, were asked to fill out the McGill Pain Questionnaire (MPQ) and the Pain Catastrophizing Scale (PCS) preoperatively and at three, 12 and 24 months follow-up. Comorbidities were extracted from the Queen Elizabeth II Health Sciences Centre health information system. RESULTS: The overall response rate (return of completed questionnaires) was 84%. There was a significant decrease in the MPQ scores (P<0.05) postoperatively. PCS scores did not change over time. Receiver operating characteristic curves revealed the number of comorbidities per patient predicted the presence of pain postoperatively, as documented by the numerical rating subscale of the MPQ at 24 months (P<0.05). Receiver operating characteristic curves for pre-operative PCS and rumination subscale scores predicted the presence of pain, as measured by the Pain Rating Index subscale of the MPQ at 24 months (P<0.05). Preoperative PCS scores and comorbidities were significantly higher in the persistent pain group (P<0.05). CONCLUSIONS: The number of comorbidities predicted the presence of pain at 24 months follow-up and, for the first time, preoperative PCS scores were shown to predict chronic postoperative pain. This may enable the identification of knee arthroplasty patients at risk for persistent postoperative pain, thus allowing for efficient administration of preoperative interventions to improve arthroplasty outcomes. PMID:18719716

  16. Long-term outcome of low contact stress total knee arthroplasty with different mobile bearing designs

    PubMed Central

    SOLARINO, GIUSEPPE; SPINARELLI, ANTONIO; CARROZZO, MASSIMILIANO; PIAZZOLLA, ANDREA; VICENTI, GIOVANNI; MORETTI, BIAGIO

    2014-01-01

    Purpose to evaluate the differences in clinical outcome and survivorship of three different mobile bearings for total knee arthroplasty. Methods a retrospective study was conducted in 60 patients (53 females, 7 males, mean age: 68 years and 5 months) each submitted to total knee replacement using one of the three different mobile bearings of the LCS system (Depuy Johnson & Johnson, Warsaw, IN). The diagnosis was knee osteoarthritis in 57 cases and rheumatoid arthritis in three cases. Three different groups of 20 cases each were identified: total knee arthroplasties with mobile menisci (group 1); total knee arthroplasties with the rotating platform (group 2); and total knee arthroplasties with the anteroposterior glide platform (group 3). As regards the component fixation, 33 implants were cementless, three were cemented, and in 24 only the tibial component was cemented. The patella was not replaced. Results although the duration of follow-up differed between the three groups, the clinical and radiological results at final follow-up showed no revision of femoral and/or tibial components for mechanical or septic reasons, and no signs of impending failure. One meniscal bearing, showing polyethylene wear after 17 years, was successfully replaced. Conclusions the present retrospective study confirmed the long-term effectiveness of knee implants with mobile bearings, in which the congruity of the surfaces makes it possible to overcome the problem of high contact stresses that may result in polyethylene wear and osteolysis; at the same time, these implants eliminate constraint forces thereby reducing the risk of mechanical loosening. Level of evidence Level III, retrospective comparative study. PMID:25606553

  17. The GAP-TPC

    E-print Network

    Rossi, B; Boiano, A; Catalanotti, S; Cocco, A G; Covone, G; Di Meo, P; Longo, G; Vanzanella, A; Walker, S; Wang, H; Wang, Y; Fiorillo, G

    2016-01-01

    Several experiments have been conducted worldwide, with the goal of observing low-energy nuclear recoils induced by WIMPs scattering off target nuclei in ultra-sensitive, low-background detectors. In the last few decades noble liquid detectors designed to search for dark matter in the form of WIMPs have been extremely successful in improving their sensitivities and setting the best limits. One of the crucial problems to be faced for the development of large size (multi ton-scale) liquid argon experiments is the lack of reliable and low background cryogenic PMTs: their intrinsic radioactivity, cost, and borderline performance at 87 K rule them out as a possible candidate for photosensors. We propose a brand new concept of liquid argon-based detector for direct dark matter search: the Geiger-mode Avalanche Photodiode Time Projection Chamber (GAP-TPC) optimized in terms of residual radioactivity of the photosensors, energy and spatial resolution, light and charge collection efficiency

  18. Enhancing Postoperative Rehabilitation Following Knee Arthroplasty Using a New Cryotherapy Product: A Prospective Study.

    PubMed

    Mumith, Aadil; Pavlou, Paul; Barrett, Matthew; Thurston, Benjamin; Garrett, Simon

    2015-12-01

    To compare a novel cooling product, Physicool (P, Physicool Ltd, London, England, UK) with a well-established cryotherapy system, Cryocuff (C, Aircast, DJO Global, Vista, California, USA) using pain scores, range of movement (ROM), and cost as outcome measures in the early phase following total knee arthroplasty. We prospectively studied 90 consecutive patients undergoing unilateral total knee arthroplasty by a single surgeon. Following exclusions, 40 patients were recruited to each group. Visual analogue scale (VAS) for pain and ROM before and after application of cooling device was recorded at 24 and 48 hours after surgery. The cost of treatment per patient was also calculated. The VAS were significantly reduced in P on day 1 postsurgery (p = 0.013) and day 2 (p = 0.001) compared to C. A significant increase in ROM was recorded in P at 24 hours (p = 0.004) and at 48 hours (p = 0.009) postsurgery compared to C. The cost benefit of using P over C was approximately £25 per patient. The Physicool system is a safe and effective cooling method for improving pain and ROM in the early postoperative phase following total knee arthroplasty. Furthermore, it offers substantial cost savings. PMID:26623168

  19. The five-year radiological results of the uncemented Oxford medial compartment knee arthroplasty.

    PubMed

    Hooper, N; Snell, D; Hooper, G; Maxwell, R; Frampton, C

    2015-10-01

    This study reports on the first 150 consecutive Oxford cementless unicompartmental knee arthroplasties (UKA) performed in an independent centre (126 patients). All eligible patients had functional scores (Oxford knee score and high activity arthroplasty score) recorded pre-operatively and at two- and five-years of follow-up. Fluoroscopically aligned radiographs were taken at five years and analysed for any evidence of radiolucent lines (RLLs), subsidence or loosening. The mean age of the cohort was 63.6 years (39 to 86) with 81 (53.1%) males. Excellent functional scores were maintained at five years and there were no progressive RLLs demonstrated on radiographs. Two patients underwent revision to a total knee arthroplasty giving a revision rate of 0.23/100 (95% confidence interval 0.03 to 0.84) component years with overall component survivorship of 98.7% at five years. There were a further four patients who underwent further surgery on the same knee, two underwent bearing exchanges for dislocation and two underwent lateral UKAs for disease progression. This was a marked improvement from other UKAs reported in New Zealand Joint Registry data and supports the designing centre's early results. PMID:26430010

  20. Unexplained Perioperative Vertebrobasilar Stroke in a Patient Undergoing Anterior Cervical Decompression and Disc Arthroplasty

    PubMed Central

    Jensen, Cyrus Dokhanian; Jeavons, Richard Paul; Reddy, Guru Raj; Freisem, Tai

    2015-01-01

    Background Vertebrobasilar stroke associated with the anterior approach to the cervical spine is rare and has not been reported in cervical disc arthroplasty surgery. We report the case of a 60-year-old patient who underwent cervical disc arthroplasty at C4-5, C5-6 and C6-7. Postoperatively, due to symptoms and signs of a cerebellar stroke, magnetic resonance imaging of the brain was obtained confirming this diagnosis. Despite thorough investigation no specific identifiable cause for the stroke has been identified. We hypothesis an unrecognised period of intraoperative hypotension may have caused a temporary reduction in vertebrobasilar blood flow. Methods A retrospective review of the patient's case notes and a focused review of literature has been performed. Results Now two years postoperatively the patient has regained full power but has residual problems with balance. She has neuralgic pain down the right side of her body which following investigation is believed to result from the stroke. Conclusions / Level of Evidence Surgeons should be aware vertebrobasilar stroke is a possible rare perioperative complication associated with anterior cervical decompression and disc arthroplasty. Level V. PMID:25713773

  1. Fungal Periprosthetic Joint Infection in Total Knee Arthroplasty: A Systematic Review

    PubMed Central

    Jakobs, Oliver; Schoof, Benjamin; Klatte, Till Orla; Schmidl, Stefan; Fensky, Florian; Guenther, Daniel; Frommelt, Lars; Gehrke, Thorsten; Gebauer, Matthias

    2015-01-01

    Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed. PMID:25874061

  2. Differences in metal ion release following cobalt-chromium and oxidized zirconium total knee arthroplasty.

    PubMed

    Garrett, Simon; Jacobs, Neal; Yates, Piers; Smith, Anne; Wood, David

    2010-08-01

    Ions are released from all metals after implantation in the body through processes of corrosive and mechanical wear. The aim of this study was to investigate whether serum metal ion levels are raised in patients following total knee arthroplasty. Serum levels of chromium, cobalt, aluminium, molybdenum and zirconium were measured in two groups of patients at a minimum of 3 years after knee arthroplasty. Twenty three patients had a cobalt-chromium femoral component and 14 patients had an oxidized zirconium femoral component, acting as a control group as this femoral component is free from cobalt and chromium. All patients had the same titanium tibial base plates, and no patellae were resurfaced. Despite the lack of cobalt and chromium in the prostheses used in the control group, no statistically significant differences in serum cobalt and chromium ion levels were found between the groups. On the basis of these results there does not appear to be any significant rise in serum metal ion levels following total knee arthroplasty several years after implantation. PMID:20973359

  3. Serum metal ion concentrations in paediatric patients following total knee arthroplasty using megaprostheses.

    PubMed

    Friesenbichler, Jörg; Sadoghi, Patrick; Maurer-Ertl, Werner; Szkandera, Joanna; Glehr, Mathias; Ogris, Kathrin; Wolf, Matthias; Weger, Christian; Leithner, Andreas

    2014-01-01

    The purpose of this study was to determine the concentrations of cobalt, chromium, and molybdenum in the serum of paediatric tumour patients after fixed hinge total knee arthroplasty. Further, these metal ion levels were compared with serum metal ion levels of patients with other orthopaedic devices such as hip and knee prostheses with metal-on-metal or metal-on-polyethylene articulation to find differences between anatomical locations, abrasion characteristics, and bearing surfaces. After an average follow-up of 108 months (range: 67 to 163) of 11 paediatric patients with fixed hinge total knee arthroplasty, the mean concentrations for Co and Cr were significantly increased while Mo was within the limits compared to the upper values from the reference laboratory. Furthermore, these serum concentrations were significantly higher compared to patients with a standard rotating hinge device (P = 0.002 and P < 0.001) and preoperative controls (P < 0.001). On the other hand, the serum levels of patients following MoM THA or rotating hinge arthroplasty using megaprostheses were higher. Therefore, periodic long-term follow-ups are recommended due to the rising concerns about systemic metal ion exposure in the literature. Upon the occurrence of adverse reactions to metal debris the revision of the fixed hinge implant should be considered. PMID:25276819

  4. Total hip arthroplasty for surgical management of advanced tuberculous hip arthritis: Case report

    PubMed Central

    Tan, Shi Ming; Chin, Pak Lin

    2015-01-01

    Tuberculosis (TB) arthritis of the hip is a debilitating disease that often results in severe cartilage destruction and degeneration of the hip. In advanced cases, arthrodesis of the hip confers benefits to the young, high-demand and active patient. However, many of these patients go on to develop degenerative arthritis of the spine, ipsilateral knee and contralateral hip, necessitating the need for a conversion to total hip arthroplasty. Conversion of a previously fused hip to a total hip arthroplasty presents as a surgical challenge due to altered anatomy, muscle atrophy, previous surgery and implants, neighbouring joint arthritis and limb length discrepancy. We report a case of advanced TB arthritis of the hip joint in a middle-aged Singaporean Chinese gentleman with a significant past medical history of miliary tuberculosis and previous hip arthrodesis. Considerations in pre-operative planning, surgical approaches and potential pitfalls are discussed and the operative technique utilized and post-operative rehabilitative regime of this patient is described. This case highlights the necessity of pre-operative planning and the operative technique used in the conversion of a previous hip arthrodesis to a total hip arthroplasty in a case of TB hip arthritis. PMID:25793173

  5. Serum Metal Ion Concentrations in Paediatric Patients following Total Knee Arthroplasty Using Megaprostheses

    PubMed Central

    Friesenbichler, Jörg; Sadoghi, Patrick; Maurer-Ertl, Werner; Szkandera, Joanna; Glehr, Mathias; Ogris, Kathrin; Wolf, Matthias; Weger, Christian; Leithner, Andreas

    2014-01-01

    The purpose of this study was to determine the concentrations of cobalt, chromium, and molybdenum in the serum of paediatric tumour patients after fixed hinge total knee arthroplasty. Further, these metal ion levels were compared with serum metal ion levels of patients with other orthopaedic devices such as hip and knee prostheses with metal-on-metal or metal-on-polyethylene articulation to find differences between anatomical locations, abrasion characteristics, and bearing surfaces. After an average follow-up of 108 months (range: 67 to 163) of 11 paediatric patients with fixed hinge total knee arthroplasty, the mean concentrations for Co and Cr were significantly increased while Mo was within the limits compared to the upper values from the reference laboratory. Furthermore, these serum concentrations were significantly higher compared to patients with a standard rotating hinge device (P = 0.002 and P < 0.001) and preoperative controls (P < 0.001). On the other hand, the serum levels of patients following MoM THA or rotating hinge arthroplasty using megaprostheses were higher. Therefore, periodic long-term follow-ups are recommended due to the rising concerns about systemic metal ion exposure in the literature. Upon the occurrence of adverse reactions to metal debris the revision of the fixed hinge implant should be considered. PMID:25276819

  6. Autologous Blood Transfusion after Local Infiltration Analgesia with Ropivacaine in Total Knee and Hip Arthroplasty

    PubMed Central

    Breindahl, Torben; Simonsen, Ole; Hindersson, Peter; Brødsgaard Dencker, Bjarne; Brouw Jørgensen, Mogens; Rasmussen, Sten

    2012-01-01

    Aims. To study the safety of autotransfusion following local infiltration analgesia (LIA) with ropivacaine. Background. Knowledge of blood concentrations of ropivacaine after LIA and autotransfusion is crucial. However, very limited data are available for toxicological risk assessment. Methods. Autotransfusion was studied in patients after total knee arthroplasty (TKA: n = 25) and total hip arthroplasty (THA: n = 27) with LIA using 200?mg ropivacaine, supplemented with two postoperative bolus injections (150?mg ropivacaine). Drainage blood was reinfused within 6?h postoperatively. Results. Reinfusion caused a significant increase in the serum concentration of total ropivacaine for TKA from 0.54 ± 0.17 (mean ± SD) to 0.79 ± 0.20??g/mL (P < 0.001) and a nonsignificant increase for THA from 0.62 ± 0.17 to 0.63 ± 0.18??g/mL. The maximum free (unbound) concentration after reinfusion was 0.038??g/mL. Peak total and free venous ropivacaine concentrations after 8?h and 16?h postoperative bolus injections were 2.6??g/mL and 0.11??g/mL, respectively. All concentrations observed were below the threshold for toxicity and no side effects were observed. Conclusion. Autotransfusion of patients undergoing knee or hip arthroplasty after local infiltration analgesia with 200?mg ropivacaine can be performed safely, even supplemented with 8?h and 16?h postoperative bolus injections. PMID:22919377

  7. Clinical outcomes associated with the initial use of the Canine Unicompartmental Elbow (CUE) Arthroplasty System(®).

    PubMed

    Cook, James L; Schulz, Kurt S; Karnes, G Josh; Franklin, Samuel P; Canapp, Sherman O; Lotsikas, Peter J; Fitzpatrick, Noel; Wheeler, Jason L; Stiffler, Kevin S; Gillick, Mitchell; Cross, Alan R; Walls, Charles M; Albrecht, Mark R; Williams, Ned; Crouch, David T; Lewis, Daniel D; Pozzi, Antonio; Ridge, Patrick

    2015-09-01

    We evaluated mid- to long-term outcomes with respect to function and complications in dogs undergoing canine unicompartmental elbow (CUE) arthroplasty for treatment of medial compartment disease of the elbow. This prospective multicenter case series is the first group of clinical cases to receive CUE arthroplasty. Cases (each elbow that underwent CUE performed by a participating surgeon) were enrolled into an electronic database and prospectively followed to determine and record all associated complications, as well as functional outcomes. There were 103 cases from 18 surgeons. Final follow-up time ranged from 6 to 47 mo with a mean and median of 10 mo. Canine unicompartmental elbow was associated with 1 catastrophic (1%), 11 major (10.7%), and 28 minor (27.2%) complications. Outcomes following CUE were reported as full function in 49 cases (47.6%), acceptable function in 45 cases (43.7%), and unacceptable function in 9 cases (8.7%). We conclude that CUE arthroplasty is an appropriate consideration for treatment of medial compartment disease of the elbow in dogs. PMID:26345493

  8. Intra-articular infusion: a direct approach to treatment of infected total knee arthroplasty.

    PubMed

    Whiteside, L A; Roy, M E; Nayfeh, T A

    2016-01-01

    Bactericidal levels of antibiotics are difficult to achieve in infected total joint arthroplasty when intravenous antibiotics or antibiotic-loaded cement spacers are used, but intra-articular (IA) delivery of antibiotics has been effective in several studies. This paper describes a protocol for IA delivery of antibiotics in infected knee arthroplasty, and summarises the results of a pharmacokinetic study and two clinical follow-up studies of especially difficult groups: methicillin-resistant Staphylococcus aureus and failed two-stage revision. In the pharmacokinetic study, the mean synovial vancomycin peak level was 9242 (3956 to 32 150; sd 7608 ?g/mL) among the 11 patients studied. Serum trough level ranged from 4.2 to 25.2 ?g/mL (mean, 12.3 ?g/mL; average of 9.6% of the joint trough value), which exceeded minimal inhibitory concentration. The success rate exceeded 95% in the two clinical groups. IA delivery of antibiotics is shown to be safe and effective, and is now the first option for treatment of infected total joint arthroplasty in our institution. Cite this article: Bone Joint J 2016;98-B(1 Suppl A):31-6. PMID:26733638

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

    PubMed

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

    2015-11-01

    [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

  10. Metal-on-Metal Total Hip Arthroplasty: Patient Evaluation and Treatment.

    PubMed

    Bolognesi, Michael P; Ledford, Cameron K

    2015-12-01

    Metal-on-metal (MoM) hip articulations were thought to represent a biologic and biomechanically favorable alternative to conventional metal-on-polyethylene total hip arthroplasty implants. However, concerns emerged when registry data reported significantly higher failure rates associated with MoM implants compared with other contemporary hip implants. These high implant failure rates have been attributed to the release of metal particles into the periprosthetic space, creating macroscopic necrosis; corrosive osteolysis; large, sterile hip effusions; and periprosthetic solid and cystic masses (ie, pseudotumors)-a spectrum of findings termed adverse reaction to metal debris. A thorough clinical history and physical examination, along with laboratory data and imaging surveillance of these patients, is critical for appropriate diagnosis and treatment. The decision to perform revision hip arthroplasty of a metal-on-metal implant is multifactorial and should be based on documented, objective clinical indications. A systematic and objective approach to this evaluation and treatment is essential to optimize the care of patients who undergo total hip arthroplasty with MoM implants. PMID:26493972

  11. 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

  12. Anterior knee pain after a total knee arthroplasty: What can cause this pain?

    PubMed Central

    Breugem, Stéfanus Jacob Martinus; Haverkamp, Daniël

    2014-01-01

    Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis, and yet approximately 5%-10% of patients experience residual pain, especially in the anterior part of the knee. Many theories have been proposed to explain the etiology of this anterior knee pain (AKP) but, despite improvements having been made, AKP remains a problem. AKP can be described as retropatellar or peripatellar pain, which limits patients in their everyday lives. Patients suffering from AKP experience difficulty in standing up from a chair, walking up and down stairs and riding a bicycle. The question asked was: “How can a ‘perfectly’ placed total knee arthroplasty (TKA) still be painful: what can cause this pain?”. To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain. Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA. This article is a review of what pain is, how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty. PMID:25035818

  13. PEEK (Polyether-ether-ketone) Based Cervical Total Disc Arthroplasty: Contact Stress and Lubrication Analysis.

    PubMed

    Xin, H; Shepherd, Det; Dearn, Kd

    2012-01-01

    This paper presents a theoretical analysis of the maximum contact stress and the lubrication regimes for PEEK (Polyether-ether-ketone) based self-mating cervical total disc arthroplasty. The NuNec(®) cervical disc arthroplasty system was chosen as the study object, which was then analytically modelled as a ball on socket joint. A non-adhesion Hertzian contact model and elastohydrodynamic lubrication theory were used to predict the maximum contact stress and the minimum film thickness, respectively. The peak contact stress and the minimum film thickness between the bearing surfaces were then determined, as the radial clearance or lubricant was varied. The obtained results show that under 150 N loading, the peak contact stress was in the range 5.9 - 32.1 MPa, well below the yield and fatigue strength of PEEK; the calculated minimum film thickness ranged from 0 to 0.042 µm and the corresponding lambda ratio range was from 0 to 0.052. This indicates that the PEEK based cervical disc arthroplasty will operate under a boundary lubrication regime, within the natural angular velocity range of the cervical spine. PMID:22670159

  14. Two-Stage Revision Arthroplasty for Periprosthetic Hip Infection: Mean Follow-Up of Ten Years

    PubMed Central

    Hu, Chi-Chien; Chen, Chun-Chieh; Chang, Yu-Han; Hsieh, Pang-Hsin

    2015-01-01

    Background. Two-stage revision hip arthroplasty is the gold standard for treatment of patients with chronic periprosthetic joint infection (PJI), but few studies have reported outcomes beyond short-term follow-up. Methods. A total of 155 patients who underwent two-stage revision arthroplasty for chronic PJI in 157 hips were retrospectively enrolled in this study between January 2001 and December 2010. The mean patient age was 57.5 years, the mean prosthetic age was 3.6 years, and the interim interval was 17.8 weeks. These patients were followed up for an average of 9.7 years. Results. At the latest follow-up, 91.7% of the patients were free of infection. The mean Harris hip score improved significantly from 28.3 points before operation to 85.7 points at the latest follow-up. Radiographically, there was aseptic loosening of the stem or acetabular components in 4 patients. In the multivariate survival analysis using a Cox regression model, repeated debridement before final reconstruction, an inadequate interim period, bacteriuria or pyuria, and cirrhosis were found to be the independent risk factors for treatment failure. Conclusion. Our data show that two-stage revision hip arthroplasty provides reliable eradication of infection and durable reconstruction of the joint in patients with PJI caused by a variety of pathogens. PMID:26064901

  15. 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

  16. Gap and stripline combined monitor

    DOEpatents

    Yin, Y.

    1986-08-19

    A combined gap and stripline monitor device for measuring the intensity and position of a charged particle beam bunch in a beam pipe of a synchrotron radiation facility is disclosed. The monitor has first and second beam pipe portions with an axial gap therebetween. An outer pipe cooperates with the first beam pipe portion to form a gap enclosure, while inner strips cooperate with the first beam pipe portion to form a stripline monitor, with the stripline length being the same as the gap enclosure length. 4 figs.

  17. Gap and stripline combined monitor

    DOEpatents

    Yin, Y.

    1984-02-16

    A combined gap and stripline monitor device for measuring the intensity and position of a charged particle beam bunch in a beam pipe of a synchrotron radiation facility. The monitor has first and second beam pipe portions with an axial gap therebetween. An outer pipe cooperates with the first beam pipe portion to form a gap enclosure, while inner strips cooperate with the first beam pipe portion to form a stripline monitor, with the stripline length being the same as the gap enclosure length.

  18. Gap and stripline combined monitor

    DOEpatents

    Yin, Yan (Palo Alto, CA)

    1986-01-01

    A combined gap and stripline monitor device (10) for measuring the intensity and position of a charged particle beam bunch in a beam pipe of a synchotron radiation facility. The monitor has first and second beam pipe portions (11a, 11b) with an axial gap (12) therebetween. An outer pipe (14) cooperates with the first beam pipe portion (11a) to form a gap enclosure, while inner strips (23a-d) cooperate with the first beam pipe portion (11a) to form a stripline monitor, with the stripline length being the same as the gap enclosure length.

  19. Domain walls in gapped graphene

    E-print Network

    G. W. Semenoff; V. Semenoff; Fei Zhou

    2008-05-31

    The electronic properties of a particular class of domain walls in gapped graphene are investigated. We show that they can support mid-gap states which are localized in the vicinity of the domain wall and propagate along its length. With a finite density of domain walls, these states can alter the electronic properties of gapped graphene significantly. If the mid-gap band is partially filled,the domain wall can behave like a one-dimensional metal embedded in a semi-conductor, and could potentially be used as a single-channel quantum wire.

  20. Use of antibiotic-loaded cement in total knee arthroplasty

    PubMed Central

    Hinarejos, Pedro; Guirro, Pau; Puig-Verdie, Lluis; Torres-Claramunt, Raul; Leal-Blanquet, Joan; Sanchez-Soler, Juan; Monllau, Joan Carles

    2015-01-01

    Bone cement has the capacity to release antibiotic molecules if any antibiotic is included in it, and these elution properties are improved as cement porosity is increased. In vitro studies have shown high local antibiotic concentration for many hours or few days after its use. Antibiotic loaded bone cement (ALBC) is helpful when treating an infection in total knee arthroplasty (TKA) revision surgery. The purpose of this paper was to review the evidence for the routine use of ALBC in TKA in the literature, its pros and cons. Many authors have recommended the use of ALBC also in primary TKA for infection prophylaxis, but the evidence based on data from National Registries, randomized clinical trials and meta-analysis suggest a protective effect of ALBC against infection when used in hips, but not (or only mild) in knees. A possible explanation to this finding is that the duration and quantity of locally elevated antibiotic levels after surgery are smaller in TKA, due to the smaller amount of cement used for fixation in TKA-only a layer in the bone surface. There are some concerns about the routine use of ALBC in primary TKA as prophylaxis against infection: Firstly, there is a risk of hypersensivity or toxicity even when the chance is highly improbable. Secondly, there is a reduction in the mechanical properties of the cement, but this can be probably neglected if the antibiotic is used in low doses, not more than 1 g per 40 g cement package. Another significant concern is the increased economic cost, which could be overlooked if there were enough savings in treating fewer prosthetic infections. Finally, there is also a risk of selection of antibiotic-resistant strains of bacteria and this could be the main concern. If used, the choice of the antibiotic mixed in ALBC should consider microbiological aspects (broad antimicrobial spectrum and low rate of resistant bacteria), physical and chemical aspects (thermal stability, high water solubility), pharmacological characteristics (low risk to allergic reactions or toxicity) and economic aspects (not too expensive). The most commonly used antibiotics in ALBC are gentamicin, tobramycin and vancomycin. In conclusion, there is a paucity of randomized clinical trials in the use of ALBC in primary TKAs and the actual evidence of the effect of ALBC in reducing the risk of infection is insufficient. This, in addition to concerns about patient safety, risks of increase in the antibiotic resistance of microorganisms and the increase in costs in the procedure, lead us to recommend a cautious use of ALBC, perhaps only in high-risk patients (immunocompromised, morbidly obese, diabetic and patients with previous history of fracture or infection around the knee) unless the benefits of ALBC use were fully proven. Meanwhile, the rigorous use of peri-operative prophylactic systemic antibiotics and adoption of efficient antiseptic procedures and improved surgical techniques must be considered the gold standard in infection prevention in TKA surgery. PMID:26716084

  1. Dennis S. Bernstein "Mind the gap. Mind the gap.''

    E-print Network

    Bernstein, Dennis S.

    on the m j o r challenges facing thc control community. Among thc challenges identified was the need introspecliiin by thc research community. The significance of the gap Lor systems and control research is ii-term solutions. Next, I'll discuss some factors that have contributed to thc gap's existence (queslioo 4). Thcn I

  2. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients

    PubMed Central

    Kettunen, Jukka; Miettinen, Hannu; Kröger, Heikki

    2009-01-01

    When unicompartmental knee arthroplasty (UKA) failure occurs, a revision procedure to total knee arthroplasty (TKA) is often necessary. We compared the long-term results of this procedure to primary TKA and evaluated whether they are clinically comparable. Twenty-one patients underwent UKA conversion to TKA between 1991 and 2000. The results of these patients were compared to the group of 28 primary TKA patients with the same age, sex and operation time point. The long-term outcomes were evaluated using clinical and radiological analysis. The mean follow-up period of the patients was 10.5 years. The UKA revision patients were more dissatisfied, as measured by the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scale (0–100 mm) compared to the primary TKA patients (pain 18.1/7.8; p?=?0.014; stiffness 25.7/14.4, p?=?0.024; physical function 19.0/14.8, p?=?0.62). Two patients were revised twice in the UKA revision group. There was one revision in the primary TKA group (p?=?0.39). Improvement in range of motion (ROM) was better in the TKA patients compared to the UKA revision patients (8.2°/–2.6°, p?=?0.0001). We suggest that UKA conversion to TKA is associated with poorer clinical outcome as compared to primary TKA. PMID:19471929

  3. Energy gaps in ?-graphdiyne nanoribbons

    SciTech Connect

    Niu, X. N.; Yang, D. Z.; Si, M. S. Xue, D. S.

    2014-04-14

    ?-graphdiyne is a novel predicted Dirac cone material, which is similar to graphene. But the absence of a band gap significantly limits its practical applications. In order to extend this limitation, an opening of energy gap is needed. To this end, we resort to the nanoribbon structure of ?-graphdiyne. This is a conventional proposal to open up the energy gaps in nanomaterials. The results show that both the armchair and the zigzag ?-graphdiyne nanoribbons do generate energy gaps, which are width-dependent. In addition, the underlying mechanism of this opening is explored. The former is ascribed to the combination of quantum confinement and edges' effect, while the latter arises from the edge magnetic ordering. These novel nanoribbons with opening energy gaps would be potentially used in electronic devices.

  4. GAP Analysis Bulletin Number 15

    USGS Publications Warehouse

    Maxwell, Jill, (Edited By); Gergely, Kevin; Aycrigg, Jocelyn; Canonico, Gabrielle; Davidson, Anne; Coffey, Nicole

    2008-01-01

    The Mission of the Gap Analysis Program (GAP) is to promote conservation by providing broad geographic information on biological diversity to resource managers, planners, and policy makers who can use the information to make informed decisions. As part of the National Biological Information Infrastructure (NBII) ?a collaborative program to provide increased access to data and information on the nation?s biological resources--GAP data and analytical tools have been used in hundreds of applications: from basic research to comprehensive state wildlife plans; from educational projects in schools to ecoregional assessments of biodiversity. The challenge: keeping common species common means protecting them BEFORE they become threatened. To do this on a state or regional basis requires key information such as land cover descriptions, predicted distribution maps for native animals, and an assessment of the level of protection currently given to those plants and animals. GAP works cooperatively with Federal, state, and local natural resource professionals and academics to provide this kind of information. GAP activities focus on the creation of state and regional databases and maps that depict patterns of land management, land cover, and biodiversity. These data can be used to identify ?gaps? in conservation--instances where an animal or plant community is not adequately represented on the existing network of conservation lands. GAP is administered through the U.S. Geological Survey. Through building partnerships among disparate groups, GAP hopes to foster the kind of collaboration that is needed to address conservation issues on a broad scale. For more information, contact: John Mosesso National GAP Director 703-648-4079 Kevin Gergely National GAP Operations Manager 208-885-3565

  5. Reverse Shoulder Arthroplasty in the United States: A Comparison of National Volume, Patient Demographics, Complications, and Surgical Indications

    PubMed Central

    Westermann, Robert W.; Pugely, Andrew J.; Martin, Christopher T.; Gao, Yubo; Wolf, Brian R.; Hettrich, Carolyn M.

    2015-01-01

    Background Shoulder arthroplasty is increasing in the United States. Reverse shoulder arthroplasty (RSA) has emerged as an alternative treatment for end-stage glenohumeral pathology. Until recently, administrative coding practices have not differentiated RSA from traditional total shoulder arthroplasty (TSA), and thus national procedural volume has been unknown. The purpose of this study was to define the utilization, patient characteristics, indications and complications for RSA, and contrast these to TSA and hemiarthroplasty (HA). Methods The 2011 Nationwide Inpatient Sample (HCUP-NIS) dataset was queried using ICD-9-CM codes to identify patients undergoing RSA, TSA, or HA. We used weighted estimates of national procedure volume, per-capita utilization, patient comorbidities, and inpatient complications denned by the Agency for Healthcare Research and Quality (AHRQ) and identified them using standard methods described by Elixhauser. ANOVA statistical analysis was used and significance was denned as p value <0.05. Results In 2011, 66,485 patients underwent shoulder arthroplasty; there were 21,692 cases of RSA, 29,359 of TSA, and 15,434 of HA. Utilization of RSA and TSA increased between 2002-2011, and decreased for HA. RSA patients were older (72.7 years vs 67.4 TSA vs 66.8 HA) and more commonly female. Comorbidity burden was highest in patients undergoing HA. Inpatient complications were highest after RSA (p < 0.001). When compared to TSA, RSA was more commonly used in the setting of rotator cuff disease, and posttraumatic sequelae (p<0.001). Conclusions Our findings represent the first national estimates of RSA within the United Sates. RSA is a significant contributor to increasing shoulder arthroplasty utilization nationally representing one-third of arthroplasty cases. Conditions traditionally managed with HA in older populations appear to now be more commonly managed with RSA. RSA is performed on older patients with expanded indications. PMID:26361437

  6. Mind the Gap

    NASA Astrophysics Data System (ADS)

    2008-09-01

    Astronomers have been able to study planet-forming discs around young Sun-like stars in unsurpassed detail, clearly revealing the motion and distribution of the gas in the inner parts of the disc. This result, which possibly implies the presence of giant planets, was made possible by the combination of a very clever method enabled by ESO's Very Large Telescope. Uncovering the disc ESO PR Photo 27a/08 Planet-forming Disc Planets could be home to other forms of life, so the study of exoplanets ranks very high in contemporary astronomy. More than 300 planets are already known to orbit stars other than the Sun, and these new worlds show an amazing diversity in their characteristics. But astronomers don't just look at systems where planets have already formed - they can also get great insights by studying the discs around young stars where planets may currently be forming. "This is like going 4.6 billion years back in time to watch how the planets of our own Solar System formed," says Klaus Pontoppidan from Caltech, who led the research. Pontoppidan and colleagues have analysed three young analogues of our Sun that are each surrounded by a disc of gas and dust from which planets could form. These three discs are just a few million years old and were known to have gaps or holes in them, indicating regions where the dust has been cleared and the possible presence of young planets. The new results not only confirm that gas is present in the gaps in the dust, but also enable astronomers to measure how the gas is distributed in the disc and how the disc is oriented. In regions where the dust appears to have been cleared out, molecular gas is still highly abundant. This can either mean that the dust has clumped together to form planetary embryos, or that a planet has already formed and is in the process of clearing the gas in the disc. For one of the stars, SR 21, a likely explanation is the presence of a massive giant planet orbiting at less than 3.5 times the distance between the Earth and the Sun, while for the second star, HD 135344B, a possible planet could be orbiting at 10 to 20 times the Earth-Sun distance. The observations of the third star, TW Hydrae, may also require the presence of one or two planets. "Our observations with the CRIRES instrument on ESO's Very Large Telescope clearly reveal that the discs around these three young, Sun-like stars are all very different and will most likely result in very different planetary systems," concludes Pontoppidan. "Nature certainly does not like to repeat herself" [1]. "These kinds of observations complement the future work of the ALMA observatory, which will be imaging these discs in great detail and on a larger scale," adds Ewine van Dishoeck, from Leiden Observatory, who works with Pontoppidan. To study the gaps in dust discs that are the size of the Solar System around stars that are located up to 400 light-years away is a daunting challenge that requires a clever solution and the best possible instruments [2]. "Traditional imaging cannot hope to see details on the scale of planetary distances for objects located so far away," explains van Dishoeck. "Interferometry can do better but won't allow us to follow the motion of the gas." Astronomers used a technique known as 'spectro-astrometric imaging' to give them a window into the inner regions of the discs where Earth-like planets may be forming. They were able not only to measure distances as small as one-tenth the Earth-Sun distance, but to measure the velocity of the gas at the same time [3]. "The particular configuration of the instrument and the use of adaptive optics allows astronomers to carry out observations with this technique in a very user-friendly way: as a consequence, spectro-astrometric imaging with CRIRES can now be routinely performed," says team member Alain Smette, from ESO [4].

  7. "Gap" or "Gaps": Challenging the Singular Definition of the Achievement Gap

    ERIC Educational Resources Information Center

    Carpenter, Dick M., II; Ramirez, Al; Severn, Laura

    2006-01-01

    For decades, researchers examined the "achievement gap" between minority and nonminority students. This singular definition of "achievement gap" ignores important within-group differences. This article uses National Education Longitudinal Study (NELS:88) data to examine within-group differences and compares those across Latino, African American,…

  8. Ion Engine Grid Gap Measurements

    NASA Technical Reports Server (NTRS)

    Soulas, Gerge C.; Frandina, Michael M.

    2004-01-01

    A simple technique for measuring the grid gap of an ion engine s ion optics during startup and steady-state operation was demonstrated with beam extraction. The grid gap at the center of the ion optics assembly was measured with a long distance microscope that was focused onto an alumina pin that protruded through the center accelerator grid aperture and was mechanically attached to the screen grid. This measurement technique was successfully applied to a 30 cm titanium ion optics assembly mounted onto an NSTAR engineering model ion engine. The grid gap and each grid s movement during startup from room temperature to both full and low power were measured. The grid gaps with and without beam extraction were found to be significantly different. The grid gaps at the ion optics center were both significantly smaller than the cold grid gap and different at the two power levels examined. To avoid issues associated with a small grid gap during thruster startup with titanium ion optics, a simple method was to operate the thruster initially without beam extraction to heat the ion optics. Another possible method is to apply high voltage to the grids prior to igniting the discharge because power deposition to the grids from the plasma is lower with beam extraction than without. Further testing would be required to confirm this approach.

  9. Pneumatic gap sensor and method

    DOEpatents

    Bagdal, Karl T. (Middletown, OH); King, Edward L. (Trenton, OH); Follstaedt, Donald W. (Middletown, OH)

    1992-01-01

    An apparatus and method for monitoring and maintaining a predetermined width in the gap between a casting nozzle and a casting wheel, wherein the gap is monitored by means of at least one pneumatic gap sensor. The pneumatic gap sensor is mounted on the casting nozzle in proximity to the casting surface and is connected by means of a tube to a regulator and a transducer. The regulator provides a flow of gas through a restictor to the pneumatic gap sensor, and the transducer translates the changes in the gas pressure caused by the proximity of the casting wheel to the pneumatic gap sensor outlet into a signal intelligible to a control device. The relative positions of the casting nozzle and casting wheel can thereby be selectively adjusted to continually maintain a predetermined distance between their adjacent surfaces. The apparatus and method enables accurate monitoring of the actual casting gap in a simple and reliable manner resistant to the extreme temperatures and otherwise hostile casting environment.

  10. Pneumatic gap sensor and method

    DOEpatents

    Bagdal, K.T.; King, E.L.; Follstaedt, D.W.

    1992-03-03

    An apparatus and method for monitoring and maintaining a predetermined width in the gap between a casting nozzle and a casting wheel, wherein the gap is monitored by means of at least one pneumatic gap sensor. The pneumatic gap sensor is mounted on the casting nozzle in proximity to the casting surface and is connected by means of a tube to a regulator and a transducer. The regulator provides a flow of gas through a restictor to the pneumatic gap sensor, and the transducer translates the changes in the gas pressure caused by the proximity of the casting wheel to the pneumatic gap sensor outlet into a signal intelligible to a control device. The relative positions of the casting nozzle and casting wheel can thereby be selectively adjusted to continually maintain a predetermined distance between their adjacent surfaces. The apparatus and method enables accurate monitoring of the actual casting gap in a simple and reliable manner resistant to the extreme temperatures and otherwise hostile casting environment. 6 figs.

  11. Inferior glenosphere placement reduces scapular notching in reverse total shoulder arthroplasty.

    PubMed

    Li, Xinning; Dines, Joshua S; Warren, Russell F; Craig, Edward V; Dines, David M

    2015-02-01

    Scapular notching is a common complication after reverse shoulder arthroplasty and has been associated with poor clinical outcomes. Factors associated with notching include neck shaft angle and glenosphere position. The goal of this study was to evaluate the incidence of notching with an eccentric glenosphere that allows for inferior offset as well as its effect on clinical outcome. The charts of 82 patients who underwent reverse shoulder arthroplasty with this eccentric glenosphere were retrospectively reviewed. Scapular notching was assessed with standard anteroposterior radiographs of the glenohumeral joint according to the Nerot-Sirveaux classification system. Two experienced observers evaluated all radiographs. The presence of radiolucent lines was also evaluated. Both range of motion (ROM) and Constant-Murley scores were obtained. Average age was 74 years (range, 61-91 years), and follow-up was 26.3 months (range, 19-39 months). According to the Nerot-Sirveaux classification, 73 (89%) had no notching, 5 (6%) had grade I notching, 2 (2.5%) had grade II notching, and 2 (2.5%) had grade III notching. The overall presence of notching was 11% and correlated to the amount of inferior offset. No radiolucent lines were seen around the prosthesis. Both ROM and Constant-Murley scores (from 31.3 to 74.2) improved significantly in all patients from preoperative evaluation to final follow-up (P<.05). No significant differences in ROM and functional outcome were seen between the groups with and without notching. The inferior offset glenosphere created with this glenosphere base plate design reduced the incidence of scapular notching in reverse shoulder arthroplasty. This was particularly true when the glenosphere was maximally offset inferiorly. In the short term, notching does not affect ROM or functional outcome. PMID:25665124

  12. An assessment of histopathological criteria for infection in joint arthroplasty in rheumatoid synovium.

    PubMed

    Kataoka, M; Torisu, T; Tsumura, H; Yoshida, S; Takashita, M

    2002-05-01

    Intraoperative frozen section is reported to be a reliable means of identifying occult infection for preoperative evaluation of arthroplasty. The aim of this study was to determine whether the reported histopathological criteria--the existence of more than 10 polymorphonuclear cells (PMN) per high-power field--is valuable for determination of infection during the arthroplasty of patients with rheumatoid arthritis (RA). The permanent histological sections of RA synovium were analysed to study the degree of infiltration of PMNs. Furthermore, in order to examine the penetrative distribution of PMNs within the synovial tissues, immunohistochemical staining of PMNs was performed. In addition, the clinical history, from the postoperative period to the present, was investigated in 46 patients (60 joints). The presence of early- and/or late-stage postoperative infection, the development of postoperative fever, the progression of erythrocyte sedimentation rate (ESR) (more than 30 mm per hour) and the changes in CRP (more than 10 mg per litre) were further examined and compared with the histopathological tissue analyses and findings. The results demonstrated the presence of more than five PMNs per high-power field, excluding surface fibrin and inflammatory exudate in at least five separate microscopic fields in 10 joints (16.7%) of nine patients, out of 60 joints of 46 patients, in which no postoperative infection was evident. As to the magnitude of penetrative distribution of PMNs in 10 joints, there was a trend of deepening infiltration among the patients with intensive PMN infiltration. In addition, no development of postoperative fever, CRP or continuous indications of high ESR values were evident in this group. As the existence of more than 10 PMN per high-power field was not absolutely indicative of occult infection, investigation of frozen section during arthroplasty should be carefully managed. PMID:12086168

  13. Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty

    PubMed Central

    OUYANG, ZHENGXIAO; ZHAI, ZANJING; QIN, AN; LI, HAOWEI; LIU, XUQIANG; QU, XINHUA; DAI, KERONG

    2015-01-01

    The diagnosis of prosthetic joint infection (PJI) following total joint arthroplasty is difficult for clinicians to make decisions due to the similar symptoms presented by aseptic loosening and infection. Gram staining (GS) is a widely used test but its value remains controversial due to conflicting results in the diagnosis of PJI. The aim of the present study was therefore to evaluate the value of GS in the diagnosis of PJI. Searches using MEDLINE, EMBASE and OVID databases were conducted for data published between January 1990 and December 2013. Meta-analysis was used to pool the sensitivity, specificity, diagnostic odd ratios (DORs), area under the receiver-operating characteristic curve (AUC), positive-likelihood ratios (PLRs), negative-likelihood ratios (NLRs) and post-test probability. The heterogeneity and publication bias were assessed, and subgroup and meta-regression analyses were conducted. A total of 18 studies, including a total of 4,647 patients, were selected for analysis. The pooled sensitivity and specificity values for the diagnosis of PJI were 0.19 and 1.00, respectively. The AUC, PLR and NLR were 0.89, 41.6 and 0.82, respectively. Subgroup analyses indicated that the sensitivity/specificity for total hip arthroplasty was 0.14/0.99, whereas that for total knee arthroplasty was 0.14/1.00. Synovial fluid best reflected accurate GS-based diagnoses, with the highest DOR of 242, whereas tissue had the highest AUC of 0.96 (95% CI, 0.94–0.97). GS had a poor clinically acceptable diagnostic value for detecting PJI. These data do not support the routine use of GS, without additional proof of infection, for diagnosing PJI; instead, GS could be used as an adjuvant tool to support the results of other investigations. PMID:26136905

  14. How to Treat the Complex Unstable Intertrochanteric Fractures in Elderly Patients? DHS or Arthroplasty

    PubMed Central

    Hassankhani, Ebrahim Ghayem; Omidi-Kashani, Farzad; Hajitaghi, Hossein; Hassankhani, Golnaz Ghayem

    2014-01-01

    Background: Due to difficulty in obtaining anatomical reduction, management of the unstable intertrochanteric fractures in elderly osteoporotic patients is challenging. The purpose of this study is to compare the results of hip arthroplasty (total, hemi, or bipolar) with DHS in the elderly patients with unstable intertrochanteric fractures. Methods: We prospectively studied and followed-up 80 old patients with complex unstable intertrochanteric fracture from January 2007 to December 2010. Depending on the time of the patients' admission, we alternatively treated them by DHS and arthroplasty, and placed them in Groups A and B, respectively. We followed them up radiologically and also clinically by Harris Hip Score for more than 24 months. Statistical analysis was performed using SPSS version 11.5 for Windows. Results: The mean length of follow-up and age were 34.3±4.1 months (ranged; 24-59) and the 75.2±5.2 years (ranged; 58-96), respectively. Comparing Group A with B, demographic data, mean blood loss, duration of operation, time to walking and duration of hospital stay had no significant difference but overall device related complications were significantly higher in Group A. Functional scores were also higher in Group B, but this difference was not significant statistically. In both groups, the patients with Type A3 compared with Type A2, had more duration of surgery and blood loss. Conclusions: Arthroplasty is an alternative treatment in elderly patients with unstable intertrochanteric fractures and can provide good and satisfactory clinical outcomes associated with low complication and mortality rates. PMID:25386578

  15. 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

  16. Rotator cuff arthropathy: what functional results can be expected from reverse arthroplasty??

    PubMed Central

    Fávaro, Rodrigo Caldonazzo; Abdulahad, Michel; Filho, Salim Mussi; Valério, Rafael; Superti, Mauro José

    2015-01-01

    Objective To evaluate the functional results from reverse arthroplasty and its complications and relationships with types of injury. Methods Twenty-seven shoulders (26 women and one man) were treated. The patients were assessed using the UCLA functional scale. The implant used was the Delta Xtend Depuy® model. The injuries were classified using the Seebauer method for the degree of arthroplasty and the Nerot method for notching. Result The mean age was 77.4 years (range: 67–89) and the follow-up was 25.8 months (range: 6–51). The preoperative UCLA score was 10.1 (range: 6–15) and the postoperative UCLA score was 29.8 (range: 22–35), which was a statistically significant improvement (p < 0.001). According to the Seebauer classification, five patients were 1B, 19 were 2A and three were 2B. Fifteen cases presented complications (55.5%) and notching was the commonest of these, occurring in 14 patients (nine with grade 1 and five with grade 2), but this did not cause instability in any of them. Only one patient (3.7%) had a major complication, consisting of dislocation in the immediate postoperative period. Two patients (7.4%) said that they would undergo the procedure again. One patient (3.7%) underwent a revision procedure. Conclusion Reverse arthroplasty was shown to be an excellent option for treating patients with rotator cuff arthropathy, with a low rate of major complications. Notching was a frequent complication, but in the majority of the cases, it did not present clinical repercussions. PMID:26535197

  17. Adverse events in total knee arthroplasty: Results of a physician independent survey in 260 patients

    PubMed Central

    2010-01-01

    Purpose Identification of all common and potentially avoidable adverse events is crucial to further improve the quality of medical care. The intention of the current study was to evaluate a standardized physician independent survey format on adverse events in total knee arthroplasty. The protocol for reporting adverse drug events following the International Conference of Harmonisation of technical requirements for registration of pharmaceuticals for human use (ICH) was adopted for adverse events occurring during surgical interventions. Material and methods Data of a prospective sequential cohort trial introducing a clinical pathway for total knee arthroplasty was analysed. Reporting of adverse events was done by a physician independent study nurse using the modified ICH-Good Clinical Practice (GCP) format (Structure and Content of Clinical study reports - E3) in 260 patients. The adverse events were graded to their severity and their potential relation to surgical treatment. Results A total of 55 patients (21%) suffered from an adverse event and 16 (6%) from a serious adverse event. In 38 patients' one adverse event occurred, 12 patients showed 2 adverse events and 5 patients suffered from a combination of an adverse and a serious adverse event. A serious adverse event alone occurred in 11 patients. The incidence of adverse events (Fisher p = 0.448) and serious adverse (p = 0.126) events showed no significant difference between the two cohorts. The most common adverse events were deep vein thrombosis (8% and 5%) followed by wound healing problems (1% and 0%) and haematoma (1% and 3%). A wide range of non surgical adverse events were recorded with low incidence levels. Conclusion The use of the modified ICH-GCP format supports standardization of adverse event reporting. Routine assessment of adverse events by a study nurse revealed higher incidence rates of adverse events in total knee arthroplasty. We recommend the implementation of trained paramedical staff for the documentation of adverse events in routine clinical care. PMID:20699004

  18. A new classification system for the adult dysplastic hip requiring total hip arthroplasty: a reliability study.

    PubMed

    Gaston, Mark S; Gaston, Paul; Donaldson, Peter; Howie, Colin R

    2009-01-01

    Current classification systems used for developmental dysplasia of the hip (DDH) in adult patients about to undergo total hip arthroplasty use a combined assessment of the acetabulum and femur which ignores femoral geometry and problems related to reconstruction of leg length. Currently accepted systems are those of Crowe and Hartofilakidis; it is our opinion that they do not predict surgical difficulties encountered at total hip arthroplasty. We describe a new classification system for adult DDH that divides the acetabulum and femur into separate components. The acetabular classification comprises: AI: Dysplastic acetabulum; AII: The acetabulum associated with a low femoral dislocation; AIII: The post-surgical acetabulum, with (AIIIa) or without retained metalwork (AIIIb). The femoral classification consists of: FI: Dysplastic femur but contained within true or low acetabulum; FII: The high femur; FIII: Post-surgical femur, again with or without metalwork (FIIIa and FIIIb). 50 pre-operative radiographs of hips with DDH about to undergo total hip replacement were assessed by orthopaedic consultants, registrars and medical students. They were classified using the new system, Crowe and Hartofilakidis systems. Interobserver and intraobserever reliability was assessed using Fleiss' kappa coefficient with combined (acetabulum and femur) kappa scores for the new system of 0.69 for interobserver and 0.67 for intraobserver reliability. This equated to 'substantial agreement' according to Landis and Koch and the new system showed at least comparable levels of reliability to the Hartofilakidis and Crowe systems. We have demonstrated reproducibility of our new classification system for DDH in the adult population and believe it could provide useful information when planning arthroplasty and be used to predict technical difficulties and outcome. PMID:19462364

  19. Effect of femoral head size on risk of revision for dislocation after total hip arthroplasty

    PubMed Central

    Kostensalo, Inari; Junnila, Mika; Virolainen, Petri; Remes, Ville; Matilainen, Markus; Vahlberg, Tero; Pulkkinen, Pekka; Eskelinen, Antti; Mäkelä, Keijo T

    2013-01-01

    Background and purpose Previous population-based registry studies have shown that larger femoral head size is associated with reduced risk of revision for dislocation. However, the previous data have not included large numbers of hip resurfacing arthroplasties or large metal-on-metal (> 36-mm) femoral head arthroplasties. We evaluated the association between femoral component head size and the risk of revision for dislocation after THA by using Finnish Arthroplasty Register data. Patients and methods 42,379 patients who were operated during 1996–2010 fulfilled our criteria. 18 different cup/stem combinations were included. The head-size groups studied (numbers of cases) were 28 mm (23,800), 32 mm (4,815), 36 mm (3,320), and > 36 mm (10,444). Other risk factors studied were sex, age group (18–49 years, 50–59 years, 60–69 years, 70–79 years, and > 80 years), and time period of operation (1996–2000, 2001–2005, 2006–2010). Results The adjusted risk ratio in the Cox model for a revision operation due to dislocation was 0.40 (95% CI: 0.26–0.62) for 32-mm head size, 0.41 (0.24–0.70) for 36-mm head size, and 0.09 (0.05–0.17) for > 36-mm head size compared to implants with a head size of 28 mm. Interpretation Larger femoral heads clearly reduce the risk of dislocation. The difference in using heads of > 36 mm as opposed to 28-mm heads for the overall revision rate at 10 years follow-up is about 2%. Thus, although attractive from a mechanical point of view, based on recent less favorable clinical outcome data on these large heads, consisting mainly of metal-on-metal prostheses, one should be cautious using these implants. PMID:23799348

  20. Cost of Radiotherapy Versus NSAID Administration for Prevention of Heterotopic Ossification After Total Hip Arthroplasty

    SciTech Connect

    Strauss, Jonathan B. Chen, Sea S.; Shah, Anand P.; Coon, Alan B.; Dickler, Adam

    2008-08-01

    Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered.

  1. Silicon nanowire band gap modification.

    PubMed

    Nolan, Michael; O'Callaghan, Sean; Fagas, Giorgos; Greer, James C; Frauenheim, Thomas

    2007-01-01

    Band gap modification for small-diameter (approximately 1 nm) silicon nanowires resulting from the use of different species for surface termination is investigated by density functional theory calculations. Because of quantum confinement, small-diameter wires exhibit a direct band gap that increases as the wire diameter narrows, irrespective of surface termination. This effect has been observed in previous experimental and theoretical studies for hydrogenated wires. For a fixed cross-section, the functional group used to saturate the silicon surface significantly modifies the band gap, resulting in relative energy shifts of up to an electronvolt. The band gap shifts are traced to details of the hybridization between the silicon valence band and the frontier orbitals of the terminating group, which is in competition with quantum confinement. PMID:17212436

  2. Soft tissue balance in total knee arthroplasty with a force sensor.

    PubMed

    Camarata, David A

    2014-04-01

    This article presents a concise description and literature review of the eLibra Dynamic Ligament Balancing Device in total knee arthroplasty. This device is a force sensor that allows surgeons to balance the medial and lateral collateral ligaments during total knee replacement. This instrument provides precise, quantitative, digital information in newtons during surgery that allows surgeons to accurately externally rotate the femoral component in order to balance the forces across the medial and lateral compartments. The device is highly accurate and simple to use. It relies on objective dynamic data to balance the knee rather than static landmarks or subjective tensiometers. PMID:24684911

  3. Intraoperative platelet-rich plasma does not improve outcomes of total knee arthroplasty.

    PubMed

    Morishita, Masayuki; Ishida, Kazunari; Matsumoto, Tomoyuki; Kuroda, Ryosuke; Kurosaka, Masahiro; Tsumura, Nobuhiro

    2014-12-01

    This randomized controlled study was conducted to assess the effects of platelet-rich plasma (PRP) on outcomes of total knee arthroplasty (TKA). Forty patients who underwent unilateral TKA were evaluated prospectively; 20 received intraoperative PRP and 20 served as control subjects. The results showed no significant differences in reduction of bleeding, range of motion, swelling around the knee joint, muscle power recovery, pain, Knee Society Scores, and Knee Injury and Osteoarthritis Outcome Score between the 2 groups. Additionally, no distinct clinical characteristics were found in patients who received intraoperative PRP. Therefore, we conclude that intraoperative PRP does not improve outcomes of TKA. PMID:24851794

  4. Complications of femoral nerve blockade in total knee arthroplasty and strategies to reduce patient risk.

    PubMed

    Lareau, Justin M; Robbins, Claire E; Talmo, Carl T; Mehio, Abdel K; Puri, Lalit; Bono, James V

    2012-04-01

    Femoral nerve catheters are widely used for analgesia in total knee arthroplasty. Although evidence suggests that catheters improve pain control and may facilitate short-term rehabilitation, few reports exist regarding their complications. This case series explores the experience of femoral nerve catheter use at high-volume orthopedic specialty hospitals. Serious complications including compartment syndrome, periprosthetic fracture, and vascular injury are reported. The authors support femoral nerve catheter use with appropriate precautions taken to reduce risk of patient falls, vascular injury, and wrong-site surgery. PMID:21908171

  5. Risk Factors for Developing Staphylococcus aureus Nasal Colonization in Spine and Arthroplasty Surgery.

    PubMed

    Campbell, Kirk A; Cunningham, Colleen; Hasan, Saqib; Hutzler, Lorraine; Bosco Iii, Joseph A

    2015-12-01

    Staphylococcus aureus nasal colonization is a risk factor for surgical site infection. We conducted a retrospective case-control study of 1,708 consecutively enrolled patients to identify criteria that places orthopaedic surgery patients undergoing spine and total joint arthroplasty surgery at risk for nasal colonization by MRSA and MSSA. Multivariate analysis showed obesity and asthma as significant risk fac - tors for MRSA colonization. The identification of these two risk factors for MRSA colonization may help decolonization programs target patients with these factors for treatment prior to surgery, which could potentially lead to reductions in the rates of surgical site infections. PMID:26630471

  6. Total hip arthroplasty in avascular necrosis of the femoral head in a patient with transplanted heart.

    PubMed

    Samardži?, Ivan; Samardži?, Jure; Mili?i?, Davor; Kolundži?, Robert

    2012-02-01

    With the improvement of transplantation techniques and immunosupresive treatment of transplanted patients, the number of heart transplantations increases worldwide including Croatia. The survival of such patients is significantly increased. Therefore, the prevalence of known complications is high, one of which is avascular necrosis of the femoral head. This paper presents a case of the first patient in Croatia who underwent bilateral hip arthroplasty due to bilateral avascular necrosis of the femoral head as a side effect of corticosteroid therapy after heart transplantation. PMID:22634933

  7. Experimental and analytical validation of a modular acetabular prosthesis in total hip arthroplasty

    PubMed Central

    Romero, Francisco; Amirouche, Farid; Aram, Luke; Gonzalez, Mark H

    2007-01-01

    A finite element model has been developed to predict in vivo micro motion between a modular acetabular cup and liner after cement less total hip arthroplasty. The purpose of this study is to experimentally validate the model. Six LVDT sensors were used to monitor the micromotion of the liner when subjected to loading conditions ranging from 250 N to 5000 N. Deformations at points of interest for both the experiment and FEM were compared. Results of the FEM with different coefficient of friction between the liner and the cup were investigated to correlate with the experimental results. PMID:17506882

  8. The Utility of Increased Constraint in Primary Total Knee Arthroplasty for Obese Patients.

    PubMed

    Tripathi, Mohan S; Heinle, Colin C; Manaqibwala, Moiz I; Tria, Alfred J

    2016-01-01

    Total knee arthroplasty (TKA) for obese patient entails more preoperative comorbidities and complications, and shorter longevity. This article is a retrospective review comparing longevity of the constrained implant with a standard prosthesis. Patient-specific data, Knee Society Scores, complications, and revisions were recorded and compared. No statistical differences were found. The constrained condylar knee for obese patients improves the intramedullary alignment of the prosthesis and supports the surrounding soft tissues. The clinical results are similar to a standard implant in the nonobese with similar longevity at midterm follow-up. PMID:26614920

  9. Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty.

    PubMed

    Frølich, Christina; Hansen, Torben Bæk

    2015-01-01

    Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal. PMID:26020592

  10. Effects of music-based therapy on distress following knee arthroplasty.

    PubMed

    Giaquinto, S; Cacciato, A; Minasi, S; Sostero, E; Amanda, S

    Anxiety and depression are frequent after total knee arthroplasty (TKA). Musical intervention can benefit many, including severe patients (agitated older people with dementia and terminal-ill patients) and surgical cases. This pilot study was aimed at verifying whether music therapy is beneficial after TKA. Reducing anxiety and depression is has a positive effect for the wellbeing of patients and is likely to have positive effects on outcome. In their pilot study, the authors found that a positive and specific effect of singing on depression was seen and that music therapy may be recommended after TKA instead of a pharmacological intervention. PMID:16835556

  11. Does Malrotation of the Tibial and Femoral Components Compromise Function in Kinematically Aligned Total Knee Arthroplasty?

    PubMed

    Nedopil, Alexander J; Howell, Stephen M; Hull, Maury L

    2016-01-01

    Internal and external malrotation of the femoral and tibial components is associated with poor function after total knee arthroplasty (TKA). We determined the degree of malrotation for both components in kinematically aligned TKA and whether this malrotation compromised function. Seventy-one patients (mean age 68 years) were followed after TKA. Malrotation was measured. Simple regression determined the association between malrotation and function. Even though the range of malrotation of the tibial component can be greater than that of the femoral component, the malrotation of the femoral and tibial components bounded by the ranges reported in this study is compatible with a well-functioning TKA. PMID:26614919

  12. Bilateral Total Hip Arthroplasty in a Rare Case of Multicentric Reticulohistiocytosis

    PubMed Central

    Sen, Ramesh Kumar; Das, Ashim; Sharma, Aman

    2015-01-01

    Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, which commonly manifests as muco-cutaneous papulonodules and inflammatory erosive polyarthropathy. In this research, we report the clinical manifestations and management of a rare case of MRH with destructive arthropathy of bilateral hip joints and arthritis mutilans presenting with characteristic deformities. Disabling hip arthropathy that occurs secondary to MRH can be successfully managed with bilateral total hip arthroplasty (THA). Osteopenia and acetabular bone defects must be anticipated during THA. This case is reported due to its rare occurrence and because little literature has been published regarding THA in such patients. PMID:26640636

  13. Atraumatic bilateral scapular spine fracture several months after bilateral reverse total shoulder arthroplasty.

    PubMed

    Nicolay, Simon; De Beuckeleer, Luc; Stoffelen, Daniël; Vanhoenacker, Filip; Pouillon, Marc

    2014-05-01

    We report an 89-year-old woman with bilateral atraumatic scapular spine fracture several months after bilateral reverse total shoulder arthroplasty (RTSA). Recently, RTSA has gained popularity in the surgical treatment of complex shoulder disorders such as cuff tear arthropathy. However, scapular fractures may occur several months after surgery as a late complication of this procedure. In this case report we focus on a relatively uncommon subtype, the scapular spine fracture. Although well-known in the orthopedic literature, radiologists are less familiar with this complication. To the best of our knowledge, bilateral scapular fractures have not yet been reported. PMID:24276680

  14. Prophylaxis with Teicoplanin and Cefuroxime Reduces the Rate of Prosthetic Joint Infection after Primary Arthroplasty

    PubMed Central

    Tornero, Eduard; García-Ramiro, Sebastian; Martínez-Pastor, Juan C.; Bori, Guillem; Bosch, Jordi; Morata, Laura; Sala, Marta; Basora, Misericordia; Mensa, Josep

    2014-01-01

    The aim of this study was to compare the prosthetic joint infection (PJI) rate after total joint arthroplasty in two consecutive periods of treatment with different antibiotic prophylaxes: cefuroxime versus cefuroxime plus teicoplanin. We retrospectively reviewed 1,896 patients who underwent total hip arthroplasty or total knee arthroplasty between March 2010 and February 2013. From March 2010 to August 2011, patients received 1.5 g of cefuroxime during induction of anesthesia and another 1.5 g 2 h later (the C group). From September 2011, 800 mg of teicoplanin was added to cefuroxime (the CT group). Throughout the period studied, there were no variations in pre- or postoperative protocols. Univariate and multivariate analyses were performed to evaluate independent predictors of PJI. There were 995 (55.7%) patients in the C group and 791 (44.3%) in the CT group. Patients in the CT group had a significantly lower PJI rate than patients in the C group (1.26% versus 3.51%, P = 0.002). There were no infections due to Staphylococcus aureus in the CT group (0% versus 1.6% in the C group, P < 0.001). A stepwise forward Cox regression model identified male sex (hazard ratio [HR], 3.85; 95% confidence interval [CI], 2.09 to 7.18), a body mass index of ?35 kg/m2 (HR, 2.93; 95% CI, 1.37 to 6.27), the presence of lung disease (HR, 2.46; 95% CI, 1.17 to 5.15), and red blood cell transfusion (HR, 3.70; 95% CI, 1.89 to 7.23) to be independent variables associated with a higher risk of PJI. The addition of teicoplanin was associated with a lower risk of infection (HR, 0.35; 95% CI, 0.17 to 0.74). In conclusion, the addition of teicoplanin to cefuroxime during primary arthroplasty was associated with a significant reduction in the global PJI rate due to a reduction of infections caused by Gram-positive bacteria. PMID:25403662

  15. Sex differences in the morphological failure patterns following hip resurfacing arthroplasty

    PubMed Central

    2011-01-01

    Background Metal-on-metal hybrid hip resurfacing arthroplasty (with a cementless acetabular component and a cemented femoral component) is offered as an alternative to traditional total hip arthroplasty for the young and active adult with advanced osteoarthritis. Although it has been suggested that women are less appropriate candidates for metal-on-metal arthroplasty, the mechanisms of prosthesis failure has not been fully explained. While specific failure patterns, particularly osteonecrosis and delayed type hypersensitivity reactions have been suggested to be specifically linked to the sex of the patient, we wished to examine the potential influence of sex, clinical diagnosis, age of the patient and the size of the femoral component on morphological failure patterns in a large cohort of retrieved specimens following aseptic failure of hip resurfacing arthroplasty. Methods Femoral remnants retrieved from 173 hips with known patient's sex were morphologically analyzed for the cause of failure. The results were compared with the control group of the remaining 31 failures from patients of unknown sex. The odds ratios (OR) and 95% confidence intervals (CI) of the following morphologically defined variables were calculated using logistic regression analysis: periprosthetic fractures (n = 133), osteonecrosis (n = 151), the presence of excessive intraosseous lymphocyte infiltration (n = 11), and interface hyperosteoidosis (n = 30). Logistic regression analysis was performed both unadjusted and after adjustment for sex, age, the size of the femoral component, and preoperative clinical diagnosis. Results Femoral remnants from female patients had a smaller OR for fracture (adjusted OR: 0.29, 95% CI 0.11, 0.80, P for difference = 0.02) and for the presence of osteonecrosis (adjusted OR: 0.16, 95% CI 0.04, 0.63, P for difference = 0.01). However, women had a higher OR for both the presence of excessive intraosseous lymphocyte infiltration (adjusted OR: 10.22, 95% CI 0.79, 132.57, P for difference = 0.08) and interface hyperosteoidosis (adjusted OR: 4.19, 95% CI 1.14, 15.38, P for difference = 0.03). Conclusions Within the limitations of this study, we demonstrated substantial sex differences in distinct failure patterns of metal-on-metal hip resurfacing. Recognition of pathogenically distinct failure modes will enable further stratification of risk factors for certain failure mechanisms and thus affect future therapeutic options for selected patient groups. PMID:21992554

  16. Streptococcus Dysgalactiae Subspecies Dysgalactiae Infection after Total Knee Arthroplasty: A Case Report

    PubMed Central

    Park, Man Jun; Jung, Chul-Young; Ko, Young-Chul; Kim, Young-June; Kim, Chang-kyu; Kang, Eun-Jin

    2012-01-01

    Streptococcus dysgalactiae subspecies dysgalactiae (SDSD), Lancefield group C streptococcus, is an animal pathogen which often causes pyogenic infection in domestic animals. Human infection by SDSD has been reported as a cellulitis on the upper arm, but a prosthetic joint infection caused by SDSD after total knee arthroplasty (TKA) has not yet been reported in the literature demonstrating that its clinical manifestation and management have not been well established. In this case report, we aimed to present a case of SDSD prosthetic joint infection after TKA, which was successfully treated by two-stage re-implantation with an application of antibiotic-impregnated cement spacer. PMID:22708114

  17. Bilateral Total Hip Arthroplasty in a Rare Case of Multicentric Reticulohistiocytosis.

    PubMed

    Saibaba, Balaji; Sen, Ramesh Kumar; Das, Ashim; Sharma, Aman

    2015-12-01

    Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, which commonly manifests as muco-cutaneous papulonodules and inflammatory erosive polyarthropathy. In this research, we report the clinical manifestations and management of a rare case of MRH with destructive arthropathy of bilateral hip joints and arthritis mutilans presenting with characteristic deformities. Disabling hip arthropathy that occurs secondary to MRH can be successfully managed with bilateral total hip arthroplasty (THA). Osteopenia and acetabular bone defects must be anticipated during THA. This case is reported due to its rare occurrence and because little literature has been published regarding THA in such patients. PMID:26640636

  18. Tuning fork microgyrometers: Narrow gap vs. wide gap design

    NASA Astrophysics Data System (ADS)

    Soria, L.; Pierro, E.; Carbone, G.; Contursi, T.

    2009-04-01

    We analyse the performances of two different configurations of a tuning fork microgyrometer, the so called 'wide gap' design and 'narrow gap' design. In the former case the air gap between the vibrating forks and the walls of the surrounding frame is so large that the air flow around each fork is not influenced by the presence of the frame itself. This geometrical configuration results in a very low air damping, and, hence, allows the instrument to operate at atmospheric pressure. In the case of 'narrow gap' design the distance between the forks and the frame walls is instead very small. As a consequence, the instrument needs to operate under very low pressure conditions, since, at higher pressures, the presence of a thin layer of air would increase the air damping to very large values, and would not allow the correct operation of the instrument. Although the requirement of low pressure conditions represents a drawback of the narrow gap solution, we show that this instrument configuration, when compared to the wide gap design, allows to achieve a significantly smaller dynamic error and a significantly wider range of linearity. Indeed the thickness of the air gap represents an additional parameter that can be adjusted by the designer to optimise the performances of the instrument. An accurate analytical model of the sensor is presented in the paper, which constitutes a helpful designing tool for this kind of device. In particular we focus the attention on the two tines of the drive mode, which are indeed the structural components that more than others influence the instrument performances. We show that the optimal design of these fundamental elements can be obtained by neglecting the interaction with the remaining part of the sensor structure, and show how to design the instrument to minimise the amplitude error. The influence of air damping, structural damping and geometry on the system response in terms of bandwidth and dynamic error is also investigated.

  19. An Examination of the Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties

    ERIC Educational Resources Information Center

    Montez-Ray, Natasha Dawn

    2011-01-01

    As patients prepare for total-knee arthroplasty surgery, they have numerous expectations related to their long-term recovery and function. This research discerned whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective…

  20. Reverse Total Shoulder Replacement with Minimal ACJ Excision Arthroplasty for Management of Massive ACJ Cyst - A Case Report

    PubMed Central

    Shaarani, Shahril R; Mullett, Hannan

    2014-01-01

    Massive acromioclavicular joint (ACJ) cysts are an extremely rare cause of shoulder impairment and with limited consensus in its management. We present the first published case report of a patient with a massive ACJ cyst treated with a reverse total shoulder replacement with minimal ACJ excision arthroplasty. PMID:25279019

  1. Ankle arthroplasty in a patient with bleeding diathesis and the mid-term clinical outcome of the case

    PubMed Central

    Yilmaz, Bar??; Kömür, Baran; Özdemir, Güzelali; Heybeli, Nurettin

    2015-01-01

    Purpose The purpose of this report was to present the case of a patient with bleeding diathesis on whom we performed ankle arthroplasty for the first time. Materials and methods A 29-year old male patient with bleeding diathesis, who had been treated and followed up over a long period, underwent ankle arthroplasty because of osteoarthritis of the ankle. The patient was prepared for surgery by the haematology department in accordance with the guidelines for surgical preparation, diagnosis and management of haemophilia. After ankle arthroplasty was performed, the preoperative and two-year postoperative clinical outcomes were evaluated using a subjective foot score and Maryland foot score. Results Preoperative factor VIII levels were raised to the target level of haemostasis prior to the surgical procedure. The factor VIII levels were maintained within the normal range up to postoperative day 14. The subjective foot score of the patient was 40 preoperatively and 85 postoperatively, whereas their Maryland foot scores were 33 preoperatively and 90 postoperatively. Both scoring systems indicate an excellent clinical outcome. Conclusion As observed, the early and mid-term functional outcomes are promising for patients with bleeding diathesis who undergo ankle arthroplasty.

  2. Luxation traumatique négligée de la hanche traitée par arthroplastie totale de la hanche: à propos de 2 cas

    PubMed Central

    Soufiane, Bensaad; Naserddine, Hammou; Atif, Mechchat; Abdelhamim, El Ibrahimi; Mohemmed, Shimi; Abdelmjide, Elmrini

    2015-01-01

    Les luxations négligées de la hanche sont des lésions exceptionnelles. Elle concerne généralement des traumatismes graves, où les lésions ostéo-articulaires ne sont pas minutieusement recherchées, ou relayer au second plan. L’évolution inéluctable se fait vers la nécrose de la tête fémorale et la coxarthrose. L'arthroplastie permet de raccourcir cette évolution et de réinsérer rapidement ces patients. PMID:26175804

  3. NHS Scotland reduces the postcode lottery for hip arthroplasty: an ecological study of the impact of waiting time initiatives

    PubMed Central

    Kirkwood, Graham; Howie, Colin; Wild, Sarah

    2014-01-01

    Objectives Following the election of the Labour government in 1997, policies were developed in England to reduce waiting times for NHS treatment with commitments to reduce health inequalities. Similar policies were adopted in Scotland but with less emphasis on the use of the private sector to deliver NHS treatments than in England. This study uses routinely collected NHS Scotland data to analyse geographical and socioeconomic inequalities in elective hip arthroplasty treatment before and after the introduction of the waiting time initiatives in Scotland in 2003. Design Ecological study design. Setting Scotland. Participants NHS-funded patients receiving elective hip arthroplasty delivered by the NHS and private hospitals between 1 April 1998 and 31 March 2008. Main outcome measures Directly standardised treatment rates and incidence rate ratios calculated using Poisson regression. Results There was a 42% increase in NHS-funded hip arthroplasties carried out in Scotland from 4095 in 2002–2003 (1 April 2002–31 March 2003) to 5829 in 2007–2008. There is evidence of a statistically significant reduction in geographical inequality (likelihood ratio test p?arthroplasties undertaken privately rose from 1.1% in 2002–2003 to 2.9% in 2007–2008, whereas the NHS Golden Jubilee National Hospital increased its share from 3.3% to 10.6% over the same period. Conclusions The reduction in geographical inequality, or ‘postcode lottery’, in hip arthroplasty treatment in Scotland may be due to increased NHS capacity, in particular the development of the NHS Golden Jubilee National Hospital in Clydebank, Greater Glasgow as a dedicated centre to reduce surgery waiting times. PMID:24566936

  4. Field induced gap infrared detector

    NASA Technical Reports Server (NTRS)

    Elliott, C. Thomas (inventor)

    1990-01-01

    A tunable infrared detector which employs a vanishing band gap semimetal material provided with an induced band gap by a magnetic field to allow intrinsic semiconductor type infrared detection capabilities is disclosed. The semimetal material may thus operate as a semiconductor type detector with a wavelength sensitivity corresponding to the induced band gap in a preferred embodiment of a diode structure. Preferred semimetal materials include Hg(1-x)Cd(x)Te, x is less than 0.15, HgCdSe, BiSb, alpha-Sn, HgMgTe, HgMnTe, HgZnTe, HgMnSe, HgMgSe, and HgZnSe. The magnetic field induces a band gap in the semimetal material proportional to the strength of the magnetic field allowing tunable detection cutoff wavelengths. For an applied magnetic field from 5 to 10 tesla, the wavelength detection cutoff will be in the range of 20 to 50 micrometers for Hg(1-x)Cd(x)Te alloys with x about 0.15. A similar approach may also be employed to generate infrared energy in a desired band gap and then operating the structure in a light emitting diode or semiconductor laser type of configuration.

  5. Explaining the Gender Wealth Gap

    PubMed Central

    Ruel, Erin; Hauser, Robert M.

    2013-01-01

    To assess and explain the United States’ gender wealth gap, we use the Wisconsin Longitudinal Study to examine wealth accumulated by a single cohort over 50 years by gender, by marital status, and limited to the respondents who are their family’s best financial reporters. We find large gender wealth gaps between currently married men and women, and never-married men and women. The never-married accumulate less wealth than the currently married, and there is a marital disruption cost to wealth accumulation. The status-attainment model shows the most power in explaining gender wealth gaps between these groups explaining about one-third to one-half of the gap, followed by the human-capital explanation. In other words, a lifetime of lower earnings for women translates into greatly reduced wealth accumulation. A gender wealth gap remains between married men and women after controlling for the full model that we speculate may be related to gender differences in investment strategies and selection effects. PMID:23264038

  6. Evaluation of intraoperative radioscopy on the coronal alignment of the tibial component in primary knee arthroplasty?

    PubMed Central

    Cobra, Hugo; Hadid, Marcio Bruno; Jácome, Daniel Torres; de Sousa, Eduardo Branco; de Paula Mozella, Alan; e Albuquerque, Rodrigo Pires

    2015-01-01

    Objectives The present study had the objective of evaluating the effect of the use of intraoperative radioscopy in cases of primary knee arthroplasty, on the final alignment of the tibial component. Methods Patients who underwent total knee arthroplasty (TKA) between April 13, 2013, and April 20, 2013, were included in the study. These patients were evaluated retrospectively and two groups were identified: one in which intraoperative radioscopy was used to assess the positioning of the tibial component during the surgery and the other in which this resource was not used. Results The mean angle of alignment of the tibial component in relation to the tibial diaphysis was greater in the group without use of intraoperative radioscopy (90.82) than in the group with radioscopy (90.63), which was a statistically significant result (p < 0.05). Conclusion Use of intraoperative radioscopy during TKA produced a better mean angle of alignment between the tibial component and the tibial diaphysis, in comparison with nonuse. PMID:26535200

  7. Local and systemic toxicity of nanoscale debris particles in total hip arthroplasty.

    PubMed

    Polyzois, Ioannis; Nikolopoulos, Dimitrios; Michos, Ioannis; Patsouris, Efstratios; Theocharis, Stamatios

    2012-04-01

    Over the past 30?years joint replacement prostheses have been developed and refined to enhance durability and reproducibility. Total hip joint arthroplasty is being performed in an increasing number of younger patients; therefore orthopaedic surgeons seek implants with a longer life span. With regards to the progress of mechanical behaviour of the biomaterials used in an arthroplasty, little is known about the long-term biological effects of wear debris. Owing to the composition of the prostheses currently in use, systemic exposure to chromium (Cr), cobalt (Co), nickel (Ni) and aluminium (Al) alloys occurs as a result of the formation of metal wear nano-particles that are released both from metal-on-metal and polyethylene-on-metal bearings, resulting in a postoperative increase in metal ion levels at different organ sites. These particles circulate both locally and systemically, penetrate cell plasma membranes, bind to cellular proteins and enzymes and modulate cytokine expression. Their physiologic effects are poorly understood and their potential toxicity, hypersensitivity and carcinogenicity remain a cause for concern. In this article we will address the issue of whether these nanoscale degradation products are associated with adverse, clinically significant local or systemic toxicologic sequelae. PMID:22328167

  8. Contemporary Ceramic Total Hip Arthroplasty in Patients with Cerebral Palsy: Does It Work?

    PubMed Central

    Yoon, Byung-Ho; Ha, Yong-Chan; Koo, Kyung-Hoi

    2015-01-01

    Background Adult patients with cerebral palsy (CP), who have advanced degenerative arthritis of the hip, have been treated with resection arthroplasty and arthrodesis. Although total hip arthroplasty (THA) has also been used as one of the alternative options, there are few studies on contemporary bearings used in THA. Therefore, we evaluated the results of the contemporary ceramic-on-ceramic THA in adult patients with CP. Methods From January 2005 to December 2007, five adult CP patients (5 hips) underwent THA using contemporary ceramic-on-ceramic bearings. All patients were able to stand or ambulate with intermittent use of assistive devices at home. We retrospectively reviewed the series to determine the results of THA in terms of pain relief, improved function, and durability of prosthesis. Results There were 3 men and 2 women with a mean age of 35.9 years. All patients had pain relief without decline in mobility postoperatively. One hip was dislocated, which was treated successfully with closed reduction and an abduction brace for 2 months. There was no ceramic fracture, loosening, or osteolysis during the mean follow-up of 6.8 years (range, 5.8 to 8.3 years). Conclusions Cementless THA using contemporary ceramic-on-ceramic bearings is a useful option for the treatment of advanced degenerative arthritis of the hip in ambulatory adults with CP. PMID:25729517

  9. 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

  10. Bibliometric Analysis of Orthopedic Literature on Total Knee Arthroplasty in Asian Countries: A 10-year Analysis

    PubMed Central

    Eom, Sang Hwa; Bamne, Ankur B.; Chowdhry, Madhav; Chae, Ihn Seok

    2015-01-01

    Purpose We aimed to determine the quantity and quality of research output of selected Asian countries in the field of total knee arthroplasty (TKA) in the last 10 years. Materials and Methods Top 15 Asian countries were selected according to their gross domestic product. The Science Citation Index Expanded database was used to search for the literature published between 2004 and 2013 using "Total Knee Arthroplasty". The numbers of articles, journals and citations and the contribution of each country were analyzed. The articles were classified according to the type of study and the relative proportion of each type was analyzed. Results Asian surgeons have increasingly contributed to orthopedic literature on TKA for the past 10 years, but the dominant contribution came from only a few countries. The total number of articles published by Asian countries increased by 261%, with Japan producing most of the studies and China showing the maximum growth rate. The majority of studies were published in low impact factor journals. Korea published the highest proportion of articles in high impact factor journals. Clinical papers were most frequent. Conclusions Our identification of research productivity pertaining to TKA among Asian countries gives a unique insight into the level of academic research in the field of TKA in these countries. There is a need to improve the quality of research to enhance the publishing power in high impact journals as well as the need for more basic research and epidemiological studies considering the unique differences among Asian patients undergoing TKA. PMID:26389067

  11. Role of diabetes type in perioperative outcomes after hip and knee arthroplasty in the United States.

    PubMed

    Viens, Nicholas A; Hug, Kevin T; Marchant, Milford H; Cook, Chad; Vail, Thomas Parker; Bolognesi, Michael P

    2012-01-01

    The objective of this study was to determine whether the type of diabetes mellitus (DM) affected the incidence of immediate perioperative complications following joint replacement. From 1988 to 2003, the Nationwide Inpatient Sample recognized 65,769 patients with DM who underwent total hip and knee arthroplasty in the United States. Bivariate and multivariate analyses compared patients with type 1 (n = 8728) and type 2 (n = 57,041) DM regarding common perioperative complications, mortality, and hospital course alterations. Type 1 DM patients had increased length of stays and inflation-adjusted costs after surgery (p < .001). Type 1 patients also had significant increases in the incidence of myocardial infarction, pneumonia, urinary tract infection, postoperative hemorrhage, wound infection, and death (p < .02). Perhaps because of the differences in the duration of disease and their underlying pathologies, patients with type 1 diabetes carry more significant overall perioperative risks and require more health care resources compared with patients with type 2 diabetes following hip and knee arthroplasty. PMID:23327852

  12. The John Charnley Award. Natural history of thromboembolic disease after total hip arthroplasty.

    PubMed

    Pellegrini, V D; Clement, D; Lush-Ehmann, C; Keller, G S; Evarts, C M

    1996-12-01

    In 1079 consecutive patients undergoing total hip arthroplasty between 1984 and 1992, complications of thromboembolic disease and related anticoagulation were reviewed for 6 months after hospital discharge, including cost data. Of 347 patients having venograms, 78 (22.5%) had positive results and 269 (77.5%) had negative results for deep venous thrombosis. In patients with negative venograms, 3 (1.1%) were readmitted with 2 symptomatic deep venous thromboses and nonfatal pulmonary embolism. There were no readmissions among the 55 patients who had venographically evident deep venous thrombosis diagnosed and treated with outpatient warfarin. Overall, 3 of 324 (0.9%) patients with true positive or negative venograms were readmitted for complications of thromboembolic disease. In contrast, 12 of 732 (1.6%) patients not receiving contrast venography were readmitted, including 9 (1.2%) deep venous thromboses and 3 (0.4%) nonfatal pulmonary embolisms. Four of 23 patients (17.4%) with untreated calf deep venous thrombosis suffered 2 nonfatal pulmonary embolisms resulting in readmission and 2 fatal pulmonary embolisms outside the hospital. Untreated calf deep venous thrombosis after total hip arthroplasty represents a significant threat of extension to more proximal veins and distant embolization. Routine thromboembolic disease prophylaxis combined with screening contrast venography and selective therapeutic anticoagulation is effective in preventing late thromboembolic disease complications and, compared with a strategy of extended prophylaxis for all, is cost effective management by reducing exposure of the elderly population to outpatient anticoagulant therapy. PMID:8981880

  13. Effects of Prosthesis Stem Tapers on Stress Distribution of Cemented Hip Arthroplasty

    NASA Astrophysics Data System (ADS)

    Abdullah, Abdul Halim; Nor, Mohd Asri Mohd; Saman, Alias Mohd; Tamin, Mohd Nasir; Kadir, Mohammed Rafiq Abdul

    2010-10-01

    Aseptic loosening effects are critical issues in encouraging long term stability of cemented hip arthroplasty. Stress shielding is believed to be an important factor that contributes to the aseptic loosening problems. The numerous changes in the prosthesis stem design are intended to minimize the stress shielding and aseptic loosening problems and to improve the long term performance of the implants. In this study, the stress distribution in cemented hip arthroplasty is established using finite element method. The taper of the prosthesis is designed to be 3° at anterior/posterior, 3° at medial/lateral and 10° from wide lateral to narrow medial. Major muscle loads and contact forces are simulated for walking (toe-off phase) and stair climbing load cases. Effects of prosthesis stem tapers on the resulting stress distribution are investigated. Results show that compressive stress dominates in the medial plane while tensile stress in the lateral plane of the femur. The corresponding stress levels of intact femur for walking and stair-climbing load cases are 22 and 29 MPa, respectively. The magnitude of Tresca stress for the THA femur in stair-climbing load case remains higher in the region of 85 MPa while the walking load case induces around 40 MPa. The stress range in the straight and single taper stem prosthesis is lower than 260 MPa, while localized Tresca stress is in the order of the yield strength of Ti-6Al-4V alloy for double and triple taper stem design.

  14. Revision arthroplasty for periprosthetic femoral fracture using an uncemented modular tapered conical stem.

    PubMed

    da Assunção, R E; Pollard, T C B; Hrycaiczuk, A; Curry, J; Glyn-Jones, S; Taylor, A

    2015-08-01

    Periprosthetic femoral fracture (PFF) is a potentially devastating complication after total hip arthroplasty, with historically high rates of complication and failure because of the technical challenges of surgery, as well as the prevalence of advanced age and comorbidity in the patients at risk. This study describes the short-term outcome after revision arthroplasty using a modular, titanium, tapered, conical stem for PFF in a series of 38 fractures in 37 patients. The mean age of the cohort was 77 years (47 to 96). A total of 27 patients had an American Society of Anesthesiologists grade of at least 3. At a mean follow-up of 35 months (4 to 66) the mean Oxford Hip Score (OHS) was 35 (15 to 48) and comorbidity was significantly associated with a poorer OHS. All fractures united and no stem needed to be revised. Three hips in three patients required further surgery for infection, recurrent PFF and recurrent dislocation and three other patients required closed manipulation for a single dislocation. One stem subsided more than 5 mm but then stabilised and required no further intervention. In this series, a modular, tapered, conical stem provided a versatile reconstruction solution with a low rate of complications. PMID:26224817

  15. Unicompartmental knee arthroplasty: is the glass half full or half empty?

    PubMed

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

    2015-10-01

    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

  16. Lifestyle and health-related quality of life in Asian patients with total hip arthroplasties.

    PubMed

    Fujita, Kimie; Xia, Zhenlan; Liu, Xueqin; Mawatari, Masaaki; Makimoto, Kiyoko

    2014-09-01

    Total hip arthroplasty reduces pain and restores physical function in patients with hip joint problems. This study examined lifestyle and health-related quality of life before and after total hip arthroplasty in Japanese and Chinese patients. Two hospitals in China recruited 120 patients and 120 Japanese patients matched by age and operative status were drawn from a prospective cohort database. Oxford Hip Score, EuroQol, and characteristics of Asian lifestyle and attitudes toward the operation were assessed. There were no differences between patients from the two countries in quality-of-life-scale scores: postoperative patients had significantly better quality-of-life scores than preoperative patients in both countries. In China, patients who reported that living at home was inconvenient had significantly worse Oxford Hip Scores than those who did not. Mean scores for anxiety items concerning possible dislocation and durability of the implant were significantly higher in Japanese than in Chinese subjects. Our findings suggest that providing information about housing conditions and lifestyles would result in improved quality of life and reduced anxiety in patients with implanted joints. PMID:24845456

  17. Efficacy of Periarticular Injection With a Long-Acting Local Analgesic in Joint Arthroplasty.

    PubMed

    Barrington, John W

    2015-10-01

    Attention to patient satisfaction is critical in today's health care environment-satisfaction surveys inform the development of hospital performance standards and can influence an institution's rankings and reimbursement. The effectiveness of postoperative pain management can affect clinical outcomes and also influence the patient's perception of the overall surgical experience. Ample clinical- trial data now exist that demonstrate the benefits of periarticular injections as part of a multimodal regimen in patients undergoing joint arthroplasty. One option that surgeons now use widely is bupivacaine liposome injectable suspension (EXPAREL®, Pacira Pharmaceuticals, Inc), a long-acting local analgesic that the orthopedic surgeon can administer intraoperatively. The US Food and Drug Administration has approved liposomal bupivacaine for injection into the surgical site to produce postsurgical analgesia. The safety and efficacy of liposomal bupivacaine has been demonstrated in clinical studies in multiple types of surgical procedure, including double-blind, randomized, controlled clinical trials that involved over 1300 patients. In a case-control study comparing clinical and economic parameters before and after the introduction of liposomal bupivacaine as a component of the multimodal perioperative pain regimen for total joint arthroplasty, liposomal bupivacaine provided improved overall pain scores, an increase in patients reporting a pain score of 0, increased patient satisfaction, decreased length of stay, and a decrease in overall costs. PMID:26447426

  18. Sports activity after reverse total shoulder arthroplasty with minimum 2-year follow-up.

    PubMed

    Fink Barnes, Leslie A; Grantham, W Jeffrey; Meadows, Molly C; Bigliani, Louis U; Levine, William N; Ahmad, Christopher S

    2015-02-01

    There is limited information on activity levels of patients with reverse total shoulder arthroplasty (RTSA). We conducted a study of the types of sporting activities in which 78 patients with RTSA could participate. Mean follow-up was 4.8 years. Mean (SD) age at surgery was 75.3 (7.5) years. Seventy-five percent of the patients were women. Sixty-one percent underwent surgery for cuff tear arthropathy, 31% for revision of previous arthroplasty or internal fixation, 7% for complex fractures, and 1% for tumor. Mean (SD) postoperative ASES (American Shoulder and Elbow Surgeons) Standardized Shoulder Assessment Form score was 77.5 (23.4). After surgery, mean active forward elevation was 140°, mean external rotation was 48°, and mean internal rotation was to S1. Four patients played golf; none were able to play tennis. Eighteen patients (23.1%) engaged in 24 high-intensity activities, such as hunting, golf, and skiing; 48.7% engaged in moderate-intensity activities, such as swimming, bowling, and raking leaves; and 28.2% engaged only in low-intensity activities. Regarding reasons for their limited activity, 59% of the patients cited medical problems, 19.2% cited shoulder limitations, 2.5% cited fear of injury, and 19.2% reported not being limited. RTSA results in good pain relief and motion, with a variety of postoperative overhead activities enjoyed by some patients who are not limited by comorbidities. PMID:25658074

  19. Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty

    PubMed Central

    Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W Angus

    2015-01-01

    To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score. PMID:25793164

  20. Intrathecal ketorolac does not improve acute or chronic pain after hip arthroplasty: a randomized controlled trial

    PubMed Central

    Wang, Lu; Bauer, Maria; Curry, Regina; Larsson, Anders; Sessler, Daniel I.; Eisenach, James C.

    2014-01-01

    Hypersensitivity to mechanical stimuli following surgery has been reported in patients who subsequently develop chronic pain after surgery. In animals, peripheral injury increases prostaglandin production in the spinal cord, and spinal cyclooxygenase inhibitors reduce hypersensitivity after injury. We therefore tested the hypothesis that spinal ketorolac reduces hypersensitivity and acute and chronic pain after hip arthroplasty (www.clinicaltrials.gov NCT 00621530). Sixty-two patients having total hip arthroplasty with spinal anesthesia were randomized to receive 13.5 mg hyperbaric bupivacaine with spinal saline or 13.5 mg hyperbaric bupivacaine with 2 mg preservative-free ketorolac. The primary outcome was area of hypersensitivity surrounding the wound 48 hr after surgery, but this only occurred in 4 patients, precluding assessment of this outcome. The groups did not differ in acute pain, acute opioid use, or pain incidence or severity 2 and 6 months after surgery. There were no serious adverse events. Our results suggest that a single spinal dose of ketorolac does not substantially reduce acute surgical pain, and is thus unlikely to reduce the risk of persistent incisional pain. PMID:24535482

  1. Management of the chronic irreducible patellar dislocation in total knee arthroplasty.

    PubMed

    Bullek, D D; Scuderi, G R; Insall, J N

    1996-04-01

    Neglected dislocation of the patella with gonarthrosis, genu valgum, flexion, and external rotation deformity is rarely encountered. Experience with five total knee arthroplasties in three patients with chronic patellar dislocation and gonarthrosis is reported. All knees had a modified proximal patellar realignment and arthroplasty with a constrained prosthesis. Preoperative Hospital for Special Surgery knee scores averaged 55. Average follow-up period was 40 months. At latest follow-up examination, the average Hospital for Special Surgery knee score was 83, the Knee Society knee score was 95, and the functional score averaged 50. There was one complication: a full-thickness lateral skin necrosis requiring flap coverage. The patellar score was zero in all knees. Four knees had mild quadriceps weakness. Three knees rated as excellent and two as good on both The Hospital for Special Surgery and Knee Society rating systems. Radiographic analysis revealed no radiolucent lines or osteolysis. The patellas were centralized in the trochlear groove in all patients. Patellar height averaged 14 mm (range, 12-17 mm). In conclusion, satisfactory results were obtained by restoring axial alignment with a constrained implant and realigning the patella with an extensive proximal realignment. PMID:8713916

  2. Effects of Prosthesis Stem Tapers on Stress Distribution of Cemented Hip Arthroplasty

    SciTech Connect

    Abdullah, Abdul Halim; Nor, Mohd Asri Mohd; Saman, Alias Mohd; Tamin, Mohd Nasir; Kadir, Mohammed Rafiq Abdul

    2010-10-15

    Aseptic loosening effects are critical issues in encouraging long term stability of cemented hip arthroplasty. Stress shielding is believed to be an important factor that contributes to the aseptic loosening problems. The numerous changes in the prosthesis stem design are intended to minimize the stress shielding and aseptic loosening problems and to improve the long term performance of the implants. In this study, the stress distribution in cemented hip arthroplasty is established using finite element method. The taper of the prosthesis is designed to be 3 deg. at anterior/posterior, 3 deg. at medial/lateral and 10 deg. from wide lateral to narrow medial. Major muscle loads and contact forces are simulated for walking (toe-off phase) and stair climbing load cases. Effects of prosthesis stem tapers on the resulting stress distribution are investigated. Results show that compressive stress dominates in the medial plane while tensile stress in the lateral plane of the femur. The corresponding stress levels of intact femur for walking and stair-climbing load cases are 22 and 29 MPa, respectively. The magnitude of Tresca stress for the THA femur in stair-climbing load case remains higher in the region of 85 MPa while the walking load case induces around 40 MPa. The stress range in the straight and single taper stem prosthesis is lower than 260 MPa, while localized Tresca stress is in the order of the yield strength of Ti-6Al-4V alloy for double and triple taper stem design.

  3. Results of a multimodal analgesic trial involving patients with total hip or total knee arthroplasty.

    PubMed

    Skinner, Harry B; Shintani, Ellen Y

    2004-02-01

    The mainstays for pain relief after total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been the opioids, but these medications, though excellent analgesics, have problems limiting their effectiveness. Alternative analgesics have been considered too mild for the pain caused by THA and TKA. These medications have been used in combination, but only in pairs and not in a "stacked modality." Here we report a trial of around-the-clock acetaminophen, rofecoxib, tramadol, and dexamethasone combined with bupivicaine pain pumps and on-demand opioid use (patient-controlled analgesia with morphine). Patients (48 with THA, 54 with TKA) were divided into pain protocol (PP) groups and conventional pain-therapy groups. Important variables were recorded from a chart review. In the PP groups, reductions in opioid use, length of hospital stay (TKA, P=.012), and time on patient-controlled analgesia were significant, as were improvements in pain scores for TKA. In addition, there was a trend in improved pain scores for the PP group with THA. Minor adverse events were similar for the groups, but major medical complications were fewer in the PP group. Preemptive analgesia with multiple non-narcotic medications used in a stacked modality can significantly reduce postoperative pain. PMID:15005598

  4. Virtual gap dielectric wall accelerator

    DOEpatents

    Caporaso, George James; Chen, Yu-Jiuan; Nelson, Scott; Sullivan, Jim; Hawkins, Steven A

    2013-11-05

    A virtual, moving accelerating gap is formed along an insulating tube in a dielectric wall accelerator (DWA) by locally controlling the conductivity of the tube. Localized voltage concentration is thus achieved by sequential activation of a variable resistive tube or stalk down the axis of an inductive voltage adder, producing a "virtual" traveling wave along the tube. The tube conductivity can be controlled at a desired location, which can be moved at a desired rate, by light illumination, or by photoconductive switches, or by other means. As a result, an impressed voltage along the tube appears predominantly over a local region, the virtual gap. By making the length of the tube large in comparison to the virtual gap length, the effective gain of the accelerator can be made very large.

  5. ABORT GAP CLEANING IN RHIC.

    SciTech Connect

    DREES,A.; AHRENS,L.; III FLILLER,R.; GASSNER,D.; MCINTYRE,G.T.; MICHNOFF,R.; TRBOJEVIC,D.

    2002-06-03

    During the RHIC Au-run in 2001 the 200 MHz storage cavity system was used for the first time. The rebucketing procedure caused significant beam debunching in addition to amplifying debunching due to other mechanisms. At the end of a four hour store, debunched beam could account for approximately 30%-40% of the total beam intensity. Some of it will be in the abort gap. In order to minimize the risk of magnet quenching due to uncontrolled beam losses at the time of a beam dump, a combination of a fast transverse kicker and copper collimators were used to clean the abort gap. This report gives an overview of the gap cleaning procedure and the achieved performance.

  6. Folk Belief Theory, the Rigor Gap, and the Achievement Gap

    ERIC Educational Resources Information Center

    Torff, Bruce

    2014-01-01

    Folk belief theory is suggested as a primary cause for the persistence of the achievement gap. In this research-supported theory, culturally specified folk beliefs about learning and teaching prompt educators to direct more rigorous curriculum to high-advantage students but not to low-advantage students, resulting in impoverished pedagogy in…

  7. GAP JUNCTION FUNCTION AND CANCER

    EPA Science Inventory

    Gap Junctions (GJs) provide cell-to-cell communication (GJIC) of essential metabolites and ions. Js allow tissues to average responses, clear waste products, and minimize the effects of xenobiotics by dilution and allowing steady-state catabolism. any chemicals can adversely affe...

  8. Closing the Teacher Quality Gap

    ERIC Educational Resources Information Center

    Haycock, Kati; Crawford, Candace

    2008-01-01

    Schools and districts rarely have a fair distribution of teacher talent. Poor children and black children are less likely to be taught by the strongest teachers and more likely to be taught by the weakest. Several districts have implemented programs to reduce the teacher quality gap. Hamilton County, Tennessee, launched an initiative that included…

  9. The Widening Income Achievement Gap

    ERIC Educational Resources Information Center

    Reardon, Sean F.

    2013-01-01

    Has the academic achievement gap between high-income and low-income students changed over the last few decades? If so, why? And what can schools do about it? Researcher Sean F. Reardon conducted a comprehensive analysis of research to answer these questions and came up with some striking findings. In this article, he shows that income-related…

  10. Bridging the Multimedia Generation Gap.

    ERIC Educational Resources Information Center

    Hurn, Janet; Thibeault, Nancy

    This paper outlines efforts at Miami University (Middletown, Ohio) to bridge the "generation gap" between students who are comfortable using computer technologies and the faculty and staff who are reluctant to use them. Two Instructional Technology Fairs were held on campus (in Springs 1995 and 1996) to show faculty, staff, students, and community…

  11. Large gap magnetic suspension system

    NASA Technical Reports Server (NTRS)

    Abdelsalam, Moustafa K.; Eyssa, Y. M.

    1991-01-01

    The design of a large gap magnetic suspension system is discussed. Some of the topics covered include: the system configuration, permanent magnet material, levitation magnet system, superconducting magnets, resistive magnets, superconducting levitation coils, resistive levitation coils, levitation magnet system, and the nitrogen cooled magnet system.

  12. Multiple input electrode gap controller

    DOEpatents

    Hysinger, C.L.; Beaman, J.J.; Melgaard, D.K.; Williamson, R.L.

    1999-07-27

    A method and apparatus for controlling vacuum arc remelting (VAR) furnaces by estimation of electrode gap based on a plurality of secondary estimates derived from furnace outputs. The estimation is preferably performed by Kalman filter. Adaptive gain techniques may be employed, as well as detection of process anomalies such as glows. 17 figs.

  13. Multiple input electrode gap controller

    DOEpatents

    Hysinger, Christopher L. (Austin, TX); Beaman, Joseph J. (Austin, TX); Melgaard, David K. (Albuquerque, NE); Williamson, Rodney L. (Albuquerque, NE)

    1999-01-01

    A method and apparatus for controlling vacuum arc remelting (VAR) furnaces by estimation of electrode gap based on a plurality of secondary estimates derived from furnace outputs. The estimation is preferably performed by Kalman filter. Adaptive gain techniques may be employed, as well as detection of process anomalies such as glows.

  14. Gap Test Calibrations and Their Scaling

    NASA Astrophysics Data System (ADS)

    Sandusky, Harold

    2011-06-01

    Common tests for measuring the threshold for shock initiation are the NOL large scale gap test (LSGT) with a 50.8-mm diameter donor/gap and the expanded large scale gap test (ELSGT) with a 95.3-mm diameter donor/gap. Despite the same specifications for the explosive donor and polymethyl methacrylate (PMMA) gap in both tests, calibration of shock pressure in the gap versus distance from the donor scales by a factor of 1.75, not the 1.875 difference in their sizes. Recently reported model calculations suggest that the scaling discrepancy results from the viscoelastic properties of PMMA in combination with different methods for obtaining shock pressure. This is supported by the consistent scaling of these donors when calibrated in water-filled aquariums. Calibrations with water gaps will be provided and compared with PMMA gaps. Scaling for other donor systems will also be provided. Shock initiation data with water gaps will be reviewed.

  15. Gaps"

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2013

    2013-01-01

    This study investigated the effect of daily quizzes on the performance of college students. Students in an introductory psychology course used their own wireless-enabled devices to take short Internet-based quizzes at the beginning of every class. The quiz items were drawn approximately equally from material covered in the readings and the…

  16. Center of Mass Compensation during Gait in Hip Arthroplasty Patients: Comparison between Large Diameter Head Total Hip Arthroplasty and Hip Resurfacing

    PubMed Central

    Bouffard, Vicky; Nantel, Julie; Therrien, Marc; Vendittoli, Pascal-André; Lavigne, Martin; Prince, François

    2011-01-01

    Objective. To compare center of mass (COM) compensation in the frontal and sagittal plane during gait in patients with large diameter head total hip arthroplasty (LDH-THA) and hip resurfacing (HR). Design. Observational study. Setting. Outpatient biomechanical laboratory. Participants. Two groups of 12 patients with LDH-THA and HR recruited from a larger randomized study and 11 healthy controls. Interventions. Not applicable. Main Outcome Measures. To compare the distance between the hip prosthetic joint center (HPJC) and the COM. The ratio (RHPJC-COM) and the variability (CVHPJC-COM) were compared between groups. Hip flexor, abductor, and adductor muscle strength was also correlated between groups while radiographic measurements were correlated with the outcome measures. Results. In the frontal plane, HR shows less variability than healthy controls at push-off and toe-off and RHPJC-COM is correlated with the muscle strength ratios (FRABD) at heel contact, maximal weight acceptance, and mid stance. In the sagittal plane, LDH-THA has a higher RHPJC-COM than healthy controls at push-off, and CVHPJC-COM is significantly correlated with FRFLEX. Conclusions. One year after surgery, both groups of patients, LDH-THA and HR, demonstrate minor compensations at some specific instant of the gait cycle, in both frontal and sagittal planes. However, their locomotion pattern is similar to the healthy controls. PMID:22110976

  17. Comparison of Patient-Reported Outcome from Neck-Preserving, Short-Stem Arthroplasty and Resurfacing Arthroplasty in Younger Osteoarthritis Patients

    PubMed Central

    Dettmer, Marius; Pourmoghaddam, Amir; Kreuzer, Stefan W.

    2015-01-01

    Hip resurfacing has been considered a good treatment option for younger, active osteoarthritis patients. However, there are several identified issues concerning risk for neck fractures and issues related to current metal-on-metal implant designs. Neck-preserving short-stem implants have been discussed as a potential alternative, but it is yet unclear which method is better suited for younger adults. We compared hip disability and osteoarthritis outcome scores (HOOS) from a young group of patients (n = 52, age 48.9 ± 6.1 years) who had received hip resurfacing (HR) with a cohort of patients (n = 73, age 48.2 ± 6.6 years) who had received neck-preserving, short-stem implant total hip arthroplasty (THA). Additionally, durations for both types of surgery were compared. HOOS improved significantly preoperatively to last followup (>1 year) in both groups (p < 0.0001, ?2 = 0.69); there were no group effects or interactions. Surgery duration was significantly longer for resurfacing (104.4?min ± 17.8) than MiniHip surgery (62.5?min ± 14.8), U = 85.0, p < 0.0001, ?2 = 0.56. The neck-preserving short-stem approach may be preferable to resurfacing due to the less challenging surgery, similar outcome, and controversy regarding resurfacing implant designs. PMID:26101669

  18. The Effect of Distal Femoral Resection on Fixed Flexion Deformity in Total Knee Arthroplasty.

    PubMed

    Liu, David W; Reidy, James F; Beller, Elaine M

    2016-01-01

    This study aims to quantify the relationship between distal femoral bone resection and correction of fixed flexion in total knee arthroplasty (TKA). Two previous studies have reported conflicting results. Spacers attached to the trial femoral component simulated additional distal femoral resection and the degree of knee flexion was recorded using computer navigation. The 2-mm augment produced an average of 3.37° of flexion deformity, 4-mm augment 6.68°, and 6-mm augment 11.38°. The amount of pre-resection flexion contracture significantly impacted on the effect of each augment. From our results, an additional 3.55 mm of distal femoral bone resection is required to correct 10° fixed flexion and produced less correction of flexion deformity as traditionally believed in TKA. PMID:26321077

  19. Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty: a meta-analysis.

    PubMed

    Bercik, Michael J; Joshi, Ashish; Parvizi, Javad

    2013-03-01

    The objective of this meta-analysis was to compare outcomes of posterior cruciate-retaining and posterior stabilized prostheses. A computerized literature search was conducted to identify randomized controlled trials comparing the clinical outcomes of cruciate-retaining and posterior-stabilized designs. The table of contents of four major Orthopaedic journals and the references section of two arthroplasty text books were reviewed to identify other relevant studies. Ultimately, 1114 patients (1265 knees) were compared. Statistical analysis revealed a significant difference in flexion and range of motion in favor of posterior-stabilized knees, but no difference in complication rates. The clinical importance of this remains unknown. The decision to use one design versus the other should rest with the surgeon's preference and comfort with a particular design. PMID:23433255

  20. A Dual Biomechanical Failure: Exeter Stem and Pubic Rami Insufficiency Fracture, following Hybrid Total Hip Arthroplasty

    PubMed Central

    Samra, Inderpaul; Paliobeis, Christos

    2015-01-01

    Introduction. Incidence of Exeter stem fracture is extremely uncommon. Pubic rami insufficiency fractures following arthroplasty are also rare. To our knowledge no cases of spontaneous stem failure with previous insufficiency fractures have yet been reported. Case Presentation. This report describes a case of spontaneous fracture through a cemented Exeter stem in a 66-year-old patient who had previously undergone a hybrid total hip replacement and was found to have bifocal pubic rami insufficiency fractures. The patient presented 18-year postprimary surgery with spontaneous fracture of the middle third of the cemented femoral stem and adjacent proximal femur. Conclusion. This report demonstrates a unique case of Exeter stem fracture with previous pelvic insufficiency fractures. The case adds to the rare occurrences of Exeter stem failure in the literature and highlights the risk of potential insufficiency fractures in patients undergoing total hip replacement. PMID:26236519

  1. Quantification of soft tissue balance in total knee arthroplasty using finite element analysis.

    PubMed

    Oh, Kwang-Jun; Park, Won Man; Kim, Kyungsoo; Kim, Yoon Hyuk

    2014-01-01

    Unbalanced contact force on the tibial component has been considered a factor leading to loosening of the implant and increased wear of the bearing surface in total knee arthroplasty. Because it has been reported that good alignment cannot guarantee successful clinical outcomes, the soft tissue balance should be checked together with the alignment. Finite element models of patients' lower extremities were developed to analyse the medial and lateral contact force distribution on the tibial insert. The distributions for four out of five patients were not balanced equally, even though the alignment angles were within a clinically acceptable range. Moreover, the distribution was improved by changing soft tissue release and ligament tightening for the specific case. Integration of the biomechanical modelling, image matching and finite element analysis techniques with the patient-specific properties and various dynamic loading would suggest a clinically relevant pre-operative planning for soft tissue balancing. PMID:23477480

  2. [Anesthesia for total hip arthroplasty in a patient with C1 inhibitor deficiency].

    PubMed

    Oyaizu, Tomoko; Kikuchi, Aya; Minoshima, Rie; Nagata, Hiromasa; Sakurai, Hironori; Suzuki, Takeshi; Katori, Nobuyuki; Morisaki, Hiroshi

    2014-07-01

    C1 inhibitor (INH) deficiency is characterized by the presence of angioedema of the extremities, face, airway and the gastrointestinal tract. Airway obstruction is the most common cause of mortality. A 78-year-old woman presented with repeated episodes of angioedema. These episodes were triggered by general anesthesia, dental extraction, venipuncture, vaccination and loxoprofen. The familiy history of similar symptoms was negative. C1 inhibitor concentrate was administered perioperatively for prophylaxis of attacks. Operation was performed under neurolept anesthesia and combined spinal-epidural anesthesia in order to avoid airway manipulation. Postoperative pain was controlled by patient-controlled epidural anesthesia to prevent attacks triggered by pain. The patient had angioedema on both lower extremities perioperatively but did not develop further attacks. Anesthesia was safely performed in a patient with C1 inhibitor deficiency scheduled for total hip arthroplasty. PMID:25098147

  3. Are Revisions of Unicompartmental Knee Arthroplasties More Like a Primary or Revision TKA?

    PubMed

    Lunebourg, Alexandre; Parratte, Sébastien; Ollivier, Matthieu; Abdel, Matthew P; Argenson, Jean-Noël A

    2015-11-01

    If revision is required, most unicompartmental arhroplasties (UKAs) are converted to total knee arthroplasties (TKAs) and conflicting results regarding surgical complexity and outcome have been reported in publications. 48 UKAs converted to a TKA between 1998 and 2009 were matched based on age, gender, and body mass index, pre-operative Knee Society Score, length of follow-up, and date of the index surgery to 48 primary TKAs and 48 revision TKAs. Surgical characteristics, clinical outcomes, and complications were compared at a mean follow-up of 7±4years. Even if a revision of UKA is technically less demanding than a revision TKA, functional scores, quality of life, complications and survival rate after revision UKA are more comparable to a revision than primary TKA. PMID:26100472

  4. Changes in erythrocyte sedimentation rate and C-reactive protein after total hip arthroplasty.

    PubMed

    Aalto, K; Osterman, K; Peltola, H; Räsänen, J

    1984-04-01

    Uncomplicated total hip arthroplasty (THA) was performed in 40 osteoarthritic patients, and changes in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were registered. The follow-up period was one year. Preoperative ESR appeared to be slightly elevated, and CRP levels were normal, with no exceptions. A postoperative maximum ESR of 64 mm/hour was reached six days after surgery. A slow decrease followed, but ESR remained slightly elevated one year later. The changes in CRP were more rapid; a maximum of 134 mg/l was registered on the second day after surgery, and the values were consistently normalized three weeks after surgery. Thus, uneventful recovery after THA seems to be indicated by a normalizing CRP, regardless of ESR values. PMID:6705332

  5. Investigation of inflammatory and hemostatic parameters in female patients undergoing total knee arthroplasty surgery.

    PubMed

    Alturfan, A Ata; Eralp, Levent; Emekli, Nesrin

    2008-12-01

    Tendency to hypercoagulation is a common phenomenon in primary osteoarthritis patients (POA) undergoing total knee arthroplasty (TKA) surgery, but the clinical implications of this condition are not clear. Therefore we aimed to evaluate the inflammatory and coagulation parameters in the patient group and find a possible explanation for the tendency to hypercoagulation occurring in plasma and synovia of inflamed joints. Of the evaluated factors involved in inflammation and coagulation, galectin-3, C reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, FVIIa:C, FXII:C, and platelet count increased, whereas tissue factor (TF) activity in synovia, PT, APTT and FVII:C in plasma and synovia were decreased. In conclusion, activation of inflammation and tendency to hypercoagulation is observed in preoperative plasma and synovia of patients undergoing TKA surgery. PMID:19009338

  6. Serum Metal Ion Levels Following Total Hip Arthroplasty With Modular Dual Mobility Components.

    PubMed

    Matsen Ko, Laura J; Pollag, Kimberley E; Yoo, Joanne Y; Sharkey, Peter F

    2016-01-01

    Dual mobility acetabular components can reduce the incidence of total hip arthroplasty (THA) instability. Modular dual mobility (MDM) components facilitate acetabular component implantation. However, corrosion can occur at modular junctions. Serum cobalt and chromium levels and Oxford scores were obtained at minimum two year follow-up for 100 consecutive patients who had THA with MDM components. Average Oxford score was 43 (range 13-48). Average serum cobalt and chromium values were 0.7 mcg/L (range, 0.0 to 7.0) and 0.6 mcg/L (range, 0.1 to 2.7), respectively. MARS MRI was performed for four patients with pain and elevated serum cobalt levels. Two of these studies were consistent with adverse local tissue reaction. We recommend use of MDM implants in only patients at high risk for dislocation following THA. PMID:26318084

  7. Primary total hip arthroplasty with a spongy metal surface acetabular component for hip dysplasia.

    PubMed

    Takigami, Iori; Ito, Yoshiki; Matsumoto, Kazu; Ogawa, Hiroyasu; Terabayashi, Nobuo; Shimizu, Katsuji

    2013-01-01

    We evaluated the clinical and radiographic results of primary total hip arthroplasty for 81 dysplastic hips (71 patients) using cementless Spongiosa Metal II cups (ESKA Implants, Lübeck, Germany). The mean follow-up period was 6.4 years (minimum 5 years), and the preoperative mean Japanese Orthopaedic Association hip score had improved from 45.2 to 87.4 points at the latest follow-up. The radiographic outcome was no aseptic loosening in all 81 hips. The hip center was located significantly more superior than in the contralateral normal hip in 45 patients, but the difference was less than 10 mm; however, there was no significant difference in the lateral position of the hip center. The use of a Spongiosa Metal II cup for dysplastic hips provided satisfactory 5- to 10-year clinical and radiographic results. PMID:22682038

  8. First case report of vanadium metallosis after ceramic-on-ceramic total hip arthroplasty.

    PubMed

    Pesce, V; Maccagnano, G; Vicenti, G; Notarnicola, A; Lovreglio, P; Soleo, L; Pantalone, A; Salini, V; Moretti, B

    2013-01-01

    The development of metallosis as a complication following rupture of a hip replacement is known to occur as a result of contact with metal components of the prosthesis (1).In such cases, high cobalt (Co), chromium (Cr) and molybdenum (Mo) levels in the blood have been reported by several Authors (2).Recently, it has been stressed that the clinical investigation should focus on general reactions to high circulating metal levels, such as toxicity for the central nervous system (CNS) and the immune system (3).Despite the increasing interest of literature in ceramic-on-ceramic hip arthroplasty (4),little is known about these complications, and in particular of metallosis. To our knowledge this is the first description of a condition of extensive metallosis and radiographic signs presenting as a result of wear of a ceramic-on-ceramic prosthesis. PMID:24382188

  9. WOMAC, EQ-5D and Knee Society Score Thresholds for Treatment Success After Total Knee Arthroplasty.

    PubMed

    Giesinger, Johannes M; Hamilton, David F; Jost, Bernhard; Behrend, Henrik; Giesinger, Karlmeinrad

    2015-12-01

    Our study aimed at developing clinical thresholds (cut-off scores) for the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, EQ-5D and Knee Society Score for discriminating between patients with and without treatment success following total knee arthroplasty (TKA). We performed a retrospective analysis of 1055 patients 2months after TKA and 765 patients 1year after TKA. We considered treatment successful if the patient reported high levels of satisfaction and pain relief, functional increase, and a willingness to undergo the same procedure again. Based on this criterion we identified cut-off scores that will facilitate interpretation of the WOMAC, the EQ-5D and the KSS in TKA patients. PMID:26160647

  10. Perioperative Complications in Patients with Inflammatory Arthropathy Undergoing Total Knee Arthroplasty.

    PubMed

    Schnaser, Erik A; Browne, James A; Padgett, Douglas E; Figgie, Mark P; D'Apuzzo, Michele R

    2015-09-01

    Little data exists comparing acute post-operative outcomes in patients with different types of inflammatory arthritis (IA) after undergoing a total knee arthroplasty (TKA). Our objectives were to compare perioperative complications and determine the most common complications between the different IA subtypes compared with patients with osteoarthritis undergoing primary TKA. We found significant differences when comparing complications within the different subtypes of IA. RA patients, despite having a greater number of comorbidities had a reduced rate of medical complications postoperatively compared to the OA cohort. All of the inflammatory subtypes had a higher rate of orthopedic complications postoperatively compared to the OA group except for patients with AS. However, ankylosing spondylitis had the highest mortality rate as well as medical complication rate among the subtypes. PMID:26111792

  11. IN VIVO OXIDATION CONTRIBUTES TO DELAMINATION BUT NOT PITTING IN POLYETHYLENE COMPONENTS FOR TOTAL KNEE ARTHROPLASTY

    PubMed Central

    Medel, Francisco J.; Kurtz, Steven M.; Sharkey, Peter; Parvizi, Javad; Klein, Gregg; Hartzband, Mark; Kraay, Matthew; Rimnac, Clare M.

    2010-01-01

    The aim of this study was to better understand how in vivo oxidation contributes to fatigue damage in total knee arthroplasty (TKA). 119 tibial inserts were consecutively collected after revision surgery. Of the 119 polyethylene retrievals, 29 were gamma sterilized in air (historical), while the remaining 90 were gamma sterilized in nitrogen (conventional). Surface damage assessment and characterization of oxidation were performed on all the retrievals. Delamination was significantly more prevalent and extensive in the longer-term, highly oxidized, historical tibial inserts. Pitting damage, in contrast, appeared to be equally prevalent between both retrieval groups, and was not correlated with in vivo oxidation. Our findings support our hypothesis that in vivo oxidation is a contributing factor to delamination, but not pitting, in TKA. Despite the lower oxidation displayed by conventional retrievals, this study provides strong evidence that delamination secondary to in vivo oxidation may occur during the second decade of implantation. PMID:20875942

  12. The long-term benefit of computer-assisted surgical navigation in unicompartmental knee arthroplasty

    PubMed Central

    2010-01-01

    We reviewed the outcomes of 30 consecutive primary unicompartmental knee arthroplasties (UKA) performed by a single surgeon for medial compartmental osteoarthritis. Fifteen Allegretto knees were implanted without computer navigation and 15 EIUS knees were implanted with navigation. We compared the survivorship, radiological and clinical outcomes of the two groups at an average of 8.9 years and 6.9 years respectively. The patients were assessed clinically using the Oxford Knee Score (OKS) and radiologically using long-leg weightbearing films and non-weightbearing computed tomography alignment measurements. The overall survivorship was 86.7% at 9 years. A higher proportion of navigated knees were well aligned with a more reproducible position and malaligned knees tended to have a less favourable OKS. However, we found no statistically significant difference in survivorship, clinical outcome and radiological alignment between the two groups. PMID:21194426

  13. The Use of Structural Allograft in Primary and Revision Knee Arthroplasty with Bone Loss

    PubMed Central

    Kuchinad, Raul A.; Garbedian, Shawn; Rogers, Benedict A.; Backstein, David; Safir, Oleg; Gross, Allan E.

    2011-01-01

    Bone loss around the knee in the setting of total knee arthroplasty remains a difficult and challenging problem for orthopaedic surgeons. There are a number of options for dealing with smaller and contained bone loss; however, massive segmental bone loss has fewer options. Small, contained defects can be treated with cement, morselized autograft/allograft or metal augments. Segmental bone loss cannot be dealt with through simple addition of cement, morselized autograft/allograft, or metal augments. For younger or higher demand patients, the use of allograft is a good option as it provides a durable construct with high rates of union while restoring bone stock for future revisions. Older patients, or those who are low demand, may be better candidates for a tumour prosthesis, which provides immediate ability to weight bear and mobilize. PMID:21991418

  14. Can cementing technique reduce the cost of a primary total knee arthroplasty?

    PubMed

    Maheshwari, Aditya V; Argawal, Mayank; Naziri, Qais; Pivec, Robert; Mont, Michael A; Rasquinha, Vijay J

    2015-06-01

    Studies on cost containment of total knee arthroplasty (TKA) have generated substantial interest over the past decade. Although multiple studies have evaluated the various intraoperative methods to control cost, no prior study has evaluated the economic impact and the clinical outcome based on amount of bone cement needed for a primary TKA. At a minimum of 3 years follow-up, we observed no difference in implant survivorship or Knee Society scores, but did observe substantial cost savings when one versus two packets of bone cement were used in combination with a hand mixing technique. By eliminating several extra cement mixing products, we achieved an approximately $1,000 cost saving per case with no difference in clinical outcomes at midterm follow-up. PMID:24752922

  15. Modern abbreviated computer navigation of the femur reduces blood loss in total knee arthroplasty.

    PubMed

    Licini, David J; Meneghini, R Michael

    2015-10-01

    Computer assisted surgery (CAS) optimizes component position in total knee arthroplasty (TKA), yet effects specifically on blood loss are less known. This study purpose was to determine whether a modern abbreviated CAS protocol would reduce blood loss in TKA compared to conventional instrumentation. One hundred consecutive TKAs were retrospectively reviewed comparing abbreviated CAS versus conventional IM instrumentation. Blood loss was determined using drain output, change in hemoglobin, and calculated blood loss. The CAS group demonstrated less hourly drain output (P=0.02), hemoglobin change (P=0.001), and estimated blood loss (P=0.001) versus conventional instrumentation. With proven advantages of accurate component placement and improved functional outcome after TKA, CAS provides additional value by reducing blood loss in TKA. PMID:25971778

  16. Total Hip Arthroplasty after Treatment of an Atypical Subtrochanteric Femoral Fracture in a Patient with Pycnodysostosis

    PubMed Central

    Yuasa, Takahito; Maeda, Koichi; Kaneko, Kazuo; Yoshikata, Kazunori

    2015-01-01

    The authors describe the case of a 51-year-old woman with an osteonecrosis of her right femoral head after treatment of an atypical subtrochanteric fracture caused by pycnodysostosis. She had this fracture after a low-trauma fall. She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis. The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients. We report a rare case of total hip arthroplasty (THA) in a patient with pycnodysostosis who developed an osteonecrosis of the femoral head after treatment of an atypical subtrochanteric femoral fracture. We performed cementless THA in combination with a plate and cables. Cementless THA is a potential intervention in a patient with pycnodysostosis; although the bone quality may have been sclerotic, healing is not a problem in this condition. PMID:26448892

  17. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes

    PubMed Central

    Petis, Stephen; Howard, James L.; Lanting, Brent L.; Vasarhelyi, Edward M.

    2015-01-01

    Total hip arthroplasty (THA) has revolutionized the treatment of hip arthritis. A number of surgical approaches to the hip joint exist, each with unique advantages and disadvantages. The most commonly used approaches include the direct anterior, direct lateral and posterior approaches. A number of technical intricacies allow safe and efficient femoral and acetabular reconstruction when using each approach. Hip dislocation, abductor insufficiency, fracture and nerve injury are complications of THA, although their relative risk varies by approach. Numerous clinical trials have sought to elicit differences in patient-reported outcomes, complication rates and return to function among the surgical approaches. This review outlines some of the technical pearls of performing a THA through either a direct anterior, direct lateral or posterior approach. A literature review outlines the impact of surgical approach on clinical outcomes and clinically relevant complication rates. PMID:25799249

  18. Patient Factors and Cost Associated with 90-Day Readmission Following Total Hip Arthroplasty.

    PubMed

    Plate, Johannes F; Brown, Matthew L; Wohler, Andrew D; Seyler, Thorsten M; Lang, Jason E

    2016-01-01

    This study sought to identify specific costs for 90-day readmissions following total hip arthroplasty in a bundled payment system. Hospital billing records revealed 139 readmissions (8.93%) in 1781 patients. Mean costs for surgical readmissions were greater (P=0.002) compared with medical reasons, but similar for Medicare/Medicaid and private payers (P=0.975). Costs for imaging, laboratory workup, medication and transfusions, and hospital cost correlated with increasing SOI (P<0.05). Patients transferred from outside hospitals or rehabilitation had higher hospital (P=0.006) and operating room costs (P=0.001) compared to patients admitted from ED or clinic. Hospitals that care for complex patients with Medicare/Medicaid may experience increased costs for unplanned 90-day readmissions highlighting considerations for payer mix. PMID:26278485

  19. 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 2weeks. 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

  20. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment.

    PubMed

    Sculco, P K; Abdel, M P; Hanssen, A D; Lewallen, D G

    2016-01-01

    The treatment of bone loss in revision total knee arthroplasty has evolved over the past decade. While the management of small to moderate sized defects has demonstrated good results with a variety of traditional techniques (cement and screws, small metal augments, impaction bone grafting or modular stems), the treatment of severe defects continues to be problematic. The use of a structural allograft has declined in recent years due to an increased failure rate with long-term follow-up and with the introduction of highly porous metal augments that emphasise biological metaphyseal fixation. Recently published mid-term results on the use of tantalum cones in patients with severe bone loss has reaffirmed the success of this treatment strategy. Cite this article: Bone Joint J 2016;98-B(1 Suppl A):120-4. PMID:26733657

  1. Is Single-Radius Design Better for Quadriceps Recovery in Total Knee Arthroplasty?

    PubMed Central

    Kim, Duk-Hyun; Kim, Dong-Kyoon; Lee, Sang-Hak; Bae, Dae-Kyung

    2015-01-01

    Purpose Although single-radius (SR) designs have a theoretical advantage in quadriceps recovery following total knee arthroplasty (TKA), there has been a paucity of objective evaluation studies. Materials and Methods One hundred and twenty minimally invasive TKAs were prospectively randomized by a single surgeon into 2 groups: SR design TKA group and multi-radius design TKA group. Quadriceps force and power were assessed using a dynamometer, and clinical data were investigated preoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. Results There were no differences between two groups in quadriceps recovery and clinical results throughout the follow-up period. Furthermore, the proportion of patients whose postoperative quadriceps force and power reached preoperative level was similar in both groups. Conclusions Femoral component design itself would not significantly influence quadriceps recovery after TKA. PMID:26676282

  2. Reduced Blood Loss and Transfusion Rates: Additional Benefits of Local Infiltration Anaesthesia in Knee Arthroplasty Patients.

    PubMed

    Bhutta, Mohammed A; Ajwani, Sanil H; Shepard, Gordon J; Ryan, William G

    2015-11-01

    We hypothesised that local infiltration of anaesthesia (LIA) containing adrenaline may reduce peri-operative blood loss and transfusion requirements in primary total knee arthroplasty patients (TKA) when compared to simple patient control analgesia (PCA). In this retrospective cohort study there were 22 TKAs in the PCA group and 27 TKAs in the LIA group. There were no drains used or significant differences in demographics between groups. There was a statistically significant difference in blood loss (P = 0.003), between the LIA group (M = 942 ml, CI 829-1055), and the PCA group (M = 1314 ml, CI 1099-1527). Patients receiving PCA were 4.3 times more likely to require blood transfusion. Using the LIA technique reduces blood loss and risk of blood transfusion. PMID:26115980

  3. Which is more invasive—mini versus standard incisions in total hip arthroplasty?

    PubMed Central

    Kiyama, T.; Naito, M.; Shiramizu, K.; Huang, G.

    2009-01-01

    In this study, interleukin-6 (IL-6), C-reactive protein (CRP), and haemoglobin levels were evaluated to compare the degree of surgical invasion between mini and standard incisions in total hip arthroplasty (THA). Sixty-two patients admitted for primary cementless THA were enrolled in this randomised study. The patients were allocated to have surgery through either a mini incision of <10 cm or a standard incision of 15 cm. In each group, inflammatory responses were evaluated by IL-6, CRP, and haemoglobin levels before operation and one day after operation. Significant differences were not found in IL-6, CRP, and haemoglobin levels between both groups. At six months after surgery, there were no significant differences in postoperative Harris hip scores or radiographic evaluations between both groups. In conclusion, a 5.0 cm difference in the skin incision to the hip joint seemed to have no influence on the degree of surgical invasion during THA. PMID:19148642

  4. Long-Term Survivorship and Clinical Outcomes Following Total Knee Arthroplasty.

    PubMed

    Jauregui, Julio J; Cherian, Jeffrey J; Pierce, Todd P; Beaver, Walter B; Issa, Kimona; Mont, Michael A

    2015-12-01

    Total knee arthroplasty (TKA) is one of the most successful commonly performed orthopedic procedures; as such, the purpose was to assess the long-term outcomes and survivorship of primary TKAs with a dual-radius prosthesis. We evaluated 125-patients (145-knees), with a mean age of 63years (37-90years) for a mean 11-year follow-up (10-13years). Outcomes were assessed with KSS, UCLA, SF-36, satisfaction scores, and aseptic survivorship analysis. At 10-year follow-up, the UCLA (6-points), KSS objective (84-points) and functional (73-points), SF-36 physical (41-points) and mental (51-points), and patient satisfaction (14-points) scores were reported to be good to excellent. The 10-year Kaplan-Meier survivorship rate was 99%; one TKA demonstrated radiographic loosening. At a minimum 10-year follow-up, this device demonstrated satisfactory outcomes and outstanding aseptic-survivorship rates. PMID:26100473

  5. Patient Selection in Short Stay Total Hip Arthroplasty for Medicare Patients.

    PubMed

    Lovald, Scott T; Ong, Kevin L; Lau, Edmund C; Joshi, Girish P; Kurtz, Steven M; Malkani, Arthur L

    2015-12-01

    There is a trend towards shortening inpatient hospital stays following total hip arthroplasty (THA) in an effort to reduce healthcare costs and potentially decrease complications. The purpose of this study was to identify patients who are at risk for readmission, complications, and mortality after short stay THA. The Medicare sample (1997-2011) was used to identify THA patients with 1-2-day (Group A, n=2949) or 3-day (Group B, n=8707) stays. Complication risks were similar between groups, though there was a reduced risk for hospitalization for Group A (adjusted hazard ratio=0.90, P=0.029). These findings suggest that age and comorbidities, particularly diabetes and cardiovascular conditions, have the greatest effect on readmission and event risk after short stay THA. PMID:26115979

  6. Design parameters dependences on contact stress distribution in gait and jogging phases after total hip arthroplasty.

    PubMed

    Rixrath, E; Wendling-Mansuy, S; Flecher, X; Chabrand, P; Argenson, J N

    2008-01-01

    We have developed a mathematical model to calculate the contact stress distribution in total hip arthroplasty (THA) prosthesis between the articulating surfaces. The model uses the clearance between bearing surfaces as well as the inclination and thickness of the Ultra High Molecular Weight Poly-Ethylene (UHMWPE) cup to achieve this. We have used this mathematical model to contrast the maximal force during normal gait and during jogging. This is based on the assumption that the contact stress is proportional to the radial deformation of the cup. The results show that the magnitude of the maximal contact stress remains constant for inclination values in the range of [0-35 degrees ] and increase significantly with the cup clearance and liner thickness for inclination values in the range of [35-65 degrees ]. A major use for this model would be the calculation of spatial contact stress distribution during normal gait or jogging for different couples of bearing surfaces. PMID:18234204

  7. Cement augmentation of the acetabulum for revision total hip arthroplasty for infection.

    PubMed

    Rogers, Benedict A; Kuchinad, R; Garbedian, S; Backstein, D; Gross, A E; Safir, O A

    2015-02-01

    Antibiotic-loaded cement spacers in first-stage revision hip arthroplasty for infection are associated with a high dislocation and fracture rate. This technical note describes a novel surgical technique, utilizing screws and cement, improving acetabular coverage and reducing the risk of mechanical failure. Fifteen infected hip prostheses underwent removal, cement acetabular augmentation and insertion of a femoral cement spacer. Eleven hips had successful infection eradication and subsequently underwent a second stage revision procedure a mean duration of 15 weeks (9-48) after the first stage. No dislocations or fractures of the cement spacers were observed. This technique affords the potential to reduce the duration of time cement spacers remaining in situ, provides enhanced mechanical stability and improved antibiotic elution through cement-on-cement articulation. PMID:25532622

  8. Patient dissatisfaction after total knee arthroplasty for hemophilic arthropathy and osteoarthritis (non-hemophilia patients).

    PubMed

    Rodriguez-Merchan, E Carlos

    2016-01-01

    In advanced painful hemophilic arthropathy of the knee (APHAK) and advanced painful osteoarthritis of the knee (APOAK) the last resort is total knee arthroplasty (TKA). However, some patients with APOAK are not satisfied despite a good clinical result. A review the literature on APHAK and APOAK was performed to know their rates of dissatisfaction and their main causes. In APOAK the rate of dissatisfaction ranges between 3 and 28.3%. Causes of dissatisfaction in APOAK are high preoperative body mass index, lack of fulfillment of patient expectations, a low 1-year WOMAC, preoperative pain at rest, a postoperative complication requiring hospital readmission, and a poor preoperative psychological state. Very limited information exists on APAHAK in the literature, but it also shows an increase in patient satisfaction after TKA. However, the results do not reach the same level as in patients with APOAK, due to residual symptoms and impairment of other joints. PMID:26561009

  9. Modular cementless cup for total hip arthroplasty: results at 4-year follow-up.

    PubMed

    Bistolfi, Alessandro; Massazza, Giuseppe; Rosso, Federica; Ventura, Stefano; Lagalla, Francesco; Crova, Maurizio

    2012-08-01

    The aim is to perform the assessment of a modular cementless acetabular cup with a tapered internal design for all bearing couplings. In 190 unselected consecutive patients, 207 total hip arthroplasties were implanted. The implants were clinically and radiographically evaluated. Follow-up was 49.7 ± 8.1 months. The average Harris hip score improved from 55.5 ± 5.7 to 94.7 ± 3.4 (P < 0.05). All cups were well-positioned and stable. The Kaplan-Maier cumulative survivorship was 98.5 ± 0.8%. No significant differences have been noted in dividing patients according to the different liner materials (P < 0.005). The study, whose rationale is the novelty of this kind of implant, suggests the efficacy of the Delta-PF acetabular cup. PMID:22223107

  10. The use of spacers (static and mobile) in infection knee arthroplasty.

    PubMed

    Mazzucchelli, Luca; Rosso, Federica; Marmotti, Antongiulio; Bonasia, Davide Edoardo; Bruzzone, Matteo; Rossi, Roberto

    2015-12-01

    Revision total knee arthroplasty (TKA) is the treatment of choice in patients with periprosthetic joint infection. It may be performed in either a single stage or two stages. In the latter option, between stages, an antibiotic-loaded spacer may be used to maintain a certain amount of joint stability and mobility after the infected implant is removed, adding an intra-articular concentration of antibiotics. There are two types of antibiotic-loaded cement spacers: static and dynamic. Static spacers basically create a temporary arthrodesis with antibiotic-loaded cement and usually are handmade within the surgical field. Dynamic spacers can be created intraoperatively by using different tools or may be prepackaged by the manufacturer; they allow range of motion between stages. In this article, the authors review the indications, surgical techniques, and results for static and dynamic spacers in two-stage revision TKA. PMID:26395472

  11. Bundled Payments for Elective Primary Total Knee Arthroplasty: An Analysis of Medicare Administrative Data.

    PubMed

    Cram, Peter; Lu, Xin; Li, Yue

    2015-03-01

    Bundled payments have been proposed as a mechanism for restraining health care spending for total knee arthroplasty (TKA), but empirical data are limited. We used Medicare data to examine variation in payments for TKA during a window extending 30 days before to 90 days after TKA for 167 186 patients who underwent elective primary TKA in 2009. Mean Medicare payment was US$23 656. We found that 2.5% of patients incurred payments of >US$50 000 (0.2% >US$100 000). Payments were lower for men and for non-Hispanic whites but higher for patients with greater comorbidity. Episode-of-care payment for primary TKA varies substantially depending upon patient demographics and comorbidity. To the extent that similar patients tend to be clustered within hospitals, bundled payments could inadvertently cause financial harm to certain health systems while rewarding others. PMID:26246946

  12. The influence of preoperative deformity on valgus correction angle: an analysis of 503 total knee arthroplasties.

    PubMed

    Mullaji, Arun B; Shetty, Gautam M; Kanna, Raj; Vadapalli, Ramesh Chandra

    2013-01-01

    We prospectively studied variations in valgus correction angle (VCA) and the influence of preoperative limb deformity on VCA in 503 consecutive total knee arthroplasties done in 393 patients. The percentage of limbs that had VCA values less than 5° was 10.9%, and that with VCA values greater than 7° was 44.9%. The percentage of limbs with VCA greater than 7° was significantly more in varus knees, and that with VCA less than 5° was significantly more in valgus knees; preoperative deformity showed a significant correlation with VCA. Choosing a fixed-routine VCA of 5° to 7° may cause an unacceptable planning error that may be minimized by individualizing VCA or using computer navigation. PMID:22677145

  13. Tibia valga morphology in osteoarthritic knees: importance of preoperative full limb radiographs in total knee arthroplasty.

    PubMed

    Alghamdi, Ahmed; Rahmé, Michel; Lavigne, Martin; Massé, Vincent; Vendittoli, Pascal-André

    2014-08-01

    Osteoarthritis of the knee is associated with deformities of the lower limb. Tibia valga is a contributing factor to lower limb alignment in valgus knees. We evaluated 97 valgus knees and 100 varus knees. Long-leg films were taken in weight bearing with both knees in full extension. For valgus knees, 52 knees (53%) had a tibia valga deformity. Average tibia valgus deformation was 5.0°. For varus knees, there was only 1 case of tibia valga (1%), with a deformation of 2.5°. The aim of this study was to assess the prevalence of primary tibia valga in valgus and varus knees and understand how it affects our approach to total knee arthroplasty (TKA). We recommend having full-leg length films when planning for TKA in valgus knees. PMID:24726171

  14. Radiographic Evaluations of Revision Total Knee Arthroplasty: A Plea for Uniform Assessments.

    PubMed

    Elmallah, Randa K; Scuderi, Giles R; Jauregui, Julio J; Meneghini, R Michael; Dennis, Doug A; Backstein, David B; Bourne, Robert B; Mont, Michael A

    2015-11-01

    Thorough radiographic evaluation is necessary for perioperative assessments in revision total knee arthroplasty. There has been a large degree of variability in reporting these findings within the peer-reviewed literature. Our purpose was to evaluate studies that radiographically assessed alignment in the coronal and sagittal plane, patella alignment and thickness, presence and characterization of implant interface, and radiolucency. Secondly, we reviewed studies using a standardized reporting system to evaluate radiographic findings (the Knee Society Roentgenographic Evaluation and Scoring System) and the number of times it was referenced. Only 62% of studies evaluated all radiographic parameters, 57% to 91% assessed each metric, and 55% used standardized reporting systems. This emphasizes the need for a uniform evaluation method to ensure consistent radiographic assessment and optimal standard of care. PMID:26364904

  15. Delayed sciatic nerve palsy following resurfacing hip arthroplasty caused by metal debris

    PubMed Central

    Kayani, Babar; Rahman, Jeeshan; Hanna, Sammy A; Cannon, Stephen R; Aston, William J; Miles, Jonathan

    2012-01-01

    The rapid rise in the incidence of failed metal-on-metal hip articulations in recent years has led to many patients requiring complex revision surgery. These failed metal prostheses may produce local metallic debris, which promotes both local and systemic adverse effects. We report an unusual case of failed metal-on-metal resurfacing hip arthroplasty presenting with ipsilateral buttock pain and foot drop 6?months after surgery. After thorough investigations, the metal-on-metal bearing was revised to a metal-on-polyethylene total hip replacement. This resulted in marked improvement in the systemic symptoms, inflammatory marke and metal ion levels postoperatively. However, neither clinical nor neurophysiological sciatic nerve recovery followed. The patient eventually required tendon transfer surgery for her persistent foot drop. PMID:23152177

  16. Intra-Articular Giant Heterotopic Ossification following Total Knee Arthroplasty for Charcot Arthropathy

    PubMed Central

    Tsuge, Shintaro; Aoki, Yasuchika; Sonobe, Masato; Shibata, Yoshifumi; Sasaki, Yu; Nakagawa, Koichi

    2013-01-01

    Although the Charcot arthropathy may be associated with serious complications, total knee arthroplasty (TKA) is the preferred choice of treatment by patients. This case report presents an 80-year-old man with intra-articular giant heterotopic ossification following loosening of femoral and tibial implants and femoral condylar fracture. He had undergone TKA because of Charcot neuropathy seven years ago and had been doing well since. Immediately after a left knee sprain, he became unable to walk. Because he had developed a skin ulcer on his left calf where methicillin-resistant Staphylococcus aureus was detected, we postponed revision surgery until the ulcer was completely healed. While waiting, intra-articular bony fragments grew larger and formed giant heterotopic ossified masses. Eventually, the patient underwent revision surgery, and two major ossified masses were carefully and successfully extirpated. It should be noted that intra-articular heterotopic giant ossification is a significant complication after TKA for neuropathic arthropathy. PMID:24151574

  17. The Choice Between Total Hip Arthroplasty and Arthrodesis in Adolescent Patients: A Survey of Orthopedic Surgeons.

    PubMed

    Kelman, Mark G; Studdert, David M; Callaghan, John J; Farid, Monica S; Titan, Ashley L; Dietz, Frederick R

    2016-01-01

    For adolescent patients with end-stage hip disease, the choice between total hip arthroplasty (THA) and arthrodesis is complex; the clinical evidence is not definitive, and there are difficult trade-offs between clear short-term benefits from THA and uncertain long-term risks. We surveyed nearly 700 members of the Pediatric Orthopedic Society of North America and the American Association of Hip and Knee Surgeons. Respondents chose between a recommendation of THA or arthrodesis in four clinical vignettes. A clear majority of surgeons recommended THA in two of the vignettes, however opinion was somewhat divided in one vignette (overweight adolescent) and deeply divided in another (adolescent destined for manual labor job). Across all vignettes, recommendations varied systematically according to surgeons' age and their attitudes regarding tradeoffs between life stages. PMID:26298281

  18. Preoperative anemia increases postoperative complications and mortality following total joint arthroplasty.

    PubMed

    Viola, Jessica; Gomez, Miguel M; Restrepo, Camilo; Maltenfort, Mitchell G; Parvizi, Javad

    2015-05-01

    Single-institution, large case-controlled study examines the association between preoperative anemia and adverse outcomes following total joint arthroplasty (TJA). We collected data from our institutional database of patients who underwent primary and aseptic revision TJA. Only 2576 patients had anemia preoperatively, and 10,987 patients had hemoglobin within the normal range. Multivariate analysis was used to determine the effect of preoperative anemia on the incidence of medical complications, infection, LOS and mortality. Anemic patients had a higher rate of complications (odds ratio 2.11), namely cardiovascular 26.5% versus 11.8%, and genitourinary 3.9% versus 0.9%. Our study confirms that patients with preoperative anemia are likely to exhibit a higher incidence of postoperative complications following TJA. Preoperative optimization may be needed in an effort to reduce these complications. PMID:25669131

  19. Tourniquet Release Prior to Dressing Application Reduces Blistering Following Total Knee Arthroplasty.

    PubMed

    Heller, Snir; Chen, Antonia; Restrepo, Camilo; Albert, Emily; Hozack, William J

    2015-07-01

    Skin blisters occur in up to 20% of patients after total knee arthroplasty (TKA). Tourniquet release results in a limb volume increase of 10%. We hypothesized that releasing tourniquet before application of circumferential dressing will decrease blister formation. A prospective study was conducted on 135 consecutive primary TKAs. The tourniquet was released immediately after wound closure to allow for re-perfusion and then a dressing was applied. These patients were compared to a historical cohort of 200 primary TKAs, where the tourniquet was released after application of dressing. There was a significant difference in the incidence of blisters between the two groups [Late 7.5% (15/200) vs early release 2.2% (3/135) P=0.028]. Releasing the tourniquet prior to dressing application has reduced the incidence of blistering following TKA. PMID:25770863

  20. Gap junctions as electrical synapses.

    PubMed

    Bennett, M V

    1997-06-01

    Gap junctions are the morphological substrate of one class of electrical synapse. The history of the debate on electrical vs. chemical transmission is instructive. One lesson is that Occam's razor sometimes cuts too deep; the nervous system does its operations in a number of different ways and a unitarian approach can lead one astray. Electrical synapses can do many things that chemical synapses can do, and do them just as slowly. More intriguing are the modulatory actions that chemical synapses can have on electrical synapses. Voltage dependence provides an important window on structure function relations of the connexins, even where the dependence may have no physiological role. The new molecular approaches will greatly advance our knowledge of where gap junctions occur and permit experimental manipulation with high specificity. PMID:9278865

  1. Hard-gapped Holographic Superconductors

    E-print Network

    Pallab Basu; Jianyang He; Anindya Mukherjee; Hsien-Hang Shieh

    2009-12-05

    In this work we discuss the zero temperature limit of a "p-wave" holographic superconductor. The bulk description consists of a non-Abelian SU(2) gauge fields minimally coupled to gravity. We numerically construct the zero temperature solution which is the gravity dual of the superconducting ground state of the "p-wave" holographic superconductors. The solution is a smooth soliton with zero horizon size and shows an emergent conformal symmetry in the IR. We found the expected superconducting behavior. Using the near horizon analysis we show that the system has a "hard gap" for the relevant gauge field fluctuations. At zero temperature the real part of the conductivity is zero for an excitation frequency less than the gap frequency. This is in contrast with what has been observed in similar scalar- gravity-gauge systems (holographic superconductors). We also discuss the low but finite temperature behavior of our solution.

  2. Electronic gap sensor and method

    DOEpatents

    Williams, R.S.; King, E.L.; Campbell, S.L.

    1991-08-06

    Disclosed are an apparatus and method for regulating the gap between a casting nozzle and a casting wheel in which the gap between the casting nozzle and the casting wheel is monitored by means of at least one sensing element protruding from the face of the casting nozzle. The sensing element is preferably connected to a voltage source and the casting wheel grounded. When the sensing element contacts the casting wheel, an electric circuit is completed. The completion of the circuit can be registered by an indicator, and the presence or absence of a completed circuit indicates the relative position of the casting nozzle to the casting wheel. The relative positions of the casting nozzle and casting wheel can thereby be selectively adjusted to continually maintain a predetermined distance between their adjacent surfaces. 5 figures.

  3. Bipolar hip arthroplasty for avascular necrosis of femoral head in young adults

    PubMed Central

    Dudani, Baldev; Shyam, Ashok K; Arora, Pankush; Veigus, Arjun

    2015-01-01

    Background: Bipolar hip arthroplasty (BHA) is one of the options for treatment of avascular necrosis (AVN) of the femoral head. Acetabular erosion and groin pain are the most allowing for gross motion between the common complications. We propose that these complications are secondary to improper acetabular preparation allowing for motion between the BHA head and the acetabulum. Materials and Methods: The current study retrospectively evaluated patients’records from case files and also called them for clinical and radiological followup. 96 hips with AVN of the femoral head treated with BHA were included in the study. All patients were males with a mean age of 42 years (range 30-59 years). In all cases, the acetabulum was gently reamed till it became uniformly concentric to achieve tight fitting trial cup. Clinical followup using Harris hip score (HHS) and radiological study for cup migration were done at followup. Results: The mean followup was 7.52 years (range 4-16 years). The HHS significantly improved from a preoperative value of 39.3 (range, 54-30) to a postoperative value of 89.12 (range 74-96). According to HHS grades, the final outcome was excellent in 52 hips, good in 28 and fair in 16 hips. Hip and groin pain was reported in four hips (5%), but did not limit activity. Subsidence (less than 5 mm) of the femoral component was seen in 8 cases. Subgroup analysis showed patients with Ficat Stage 3 having better range of motion, but similar HHS as compared to Ficat Stage 4 patients. Conclusion: Bipolar hip arthroplasty (BHA) using tight fitting cup and acetabular reaming in AVN hip has a low incidence of groin pain, acetabular erosion and revision in midterm followup. Good outcome and mid term survival can be achieved irrespective of the Ficat Stage. PMID:26015634

  4. Cementless Hip Arthroplasty in Southern Iran, Midterm Outcome and Comparison of Two Designs

    PubMed Central

    Shahcheraghi, Gholam Hossein; Hashemi, Seyed Ali

    2015-01-01

    Background: Cementless hip prosthesis was designed to provide biologic fixation, without the use of cement. The second generation components have shown more reliable bone ingrowths and survival rates. We are reporting a midterm result of two designs of cementless prosthesis in a unique culture with different social habits and expectations. Methods: 52 primary cementless total hip arthroplasty in 42 patients with the mean age of 48.8 years were retrospectively studied. Two groups of prosthesis had been implanted: Harris-Galante II (HGII) in 15 and Versys-Trilogy (V-T) in 37 hips, both from Zimmer company. The patients were assessed clinically, radiographically and with Harris hip score, SF36, WOMAC, and MACTAR questionnaires, with 65 months (26-136) mean follow-up. Results: All the V-T prostheses had survived well. Eight of HG II were revised by the last follow-up in 19-102 months. All had undergone acetabular revision and 2 combined with femoral revision. Broken tines of HGII cups were seen in 4 radiographs. The 65 months overall survival was 96.2% for femoral and 84.6% for acetabular components. 90% had good or excellent Harris hip scores. The functional scores were poorer in the HG II group. Pain relief and improved walking were the two main patients’ expectations fulfilled in 97.6% and 92.8%, respectively. Conclusions: The outcome of cementless total hip arthroplasty (THA) is satisfactory and comparable with the literature based on the results of function and survival of this small comparative group. The use of HGII acetabular component should be abandoned. PMID:26379348

  5. Catastrophic failure of a low profile metal-backed glenoid component after total shoulder arthroplasty

    PubMed Central

    Vuillermin, Carley B.; Trump, Mark E.; Barwood, Shane A.; Hoy, Gregory A.

    2015-01-01

    Context: The longevity of the glenoid component in total shoulder arthroplasty (TSA) continues to be problematic. All polyethylene glenoid components have been most widely used, but loosening rates with time and the need for revision has resulted in high-profile metal-backed components with the potential for a more stable prosthesis bone interface and liner exchange. High revision rates in the high profile metal backed designs led us to evaluate a low profile metal backed component. Aims: To examine the rate and mode of failure of a TSA in a single surgeon consecutive series that has been identified by the Australian National Joint Replacement Registry to have a higher than anticipated rate of revision. Materials and Methods: This is a single surgeon retrospective consecutive series of 51 arthroplasties undertaken in 50 patients (18 males and 32 females) with an average age of 70.4 ears (range 51-90) and mean follow-up of 5.5 years (range 3.7-8.1). Results: We observed a very high (29%) rate of revision of the metal-backed glenoid components in this series. The primary mode of failure was glenoid baseplate nonintegration which with a well-fixed central cage screw led to bone resorption and implant breakage or disassembly. Conclusion: Analysis of the mode of failure of implants identified by robust registries is essential for the development of new prostheses and the pursuit of prosthesis longevity. This low profile metal backed prosthesis has been withdrawn, but without a published mechanism of failure. We feel that any prosthesis withdrawal should be accompanied by appropriate published mechanisms to prevent future component design errors based on similar design problems. PMID:26622128

  6. Comparison of self-reported and measured range of motion in total knee arthroplasty patients

    PubMed Central

    Unver, Bayram; Karatosun, Vasfi

    2015-01-01

    Total knee arthroplasty (TKA) is an established method used in the treatment of end-stage knee osteoarthritis. Range of motion (ROM) and relief from pain show success of TKA. One of the most important aims of this treatment is to achieve an adequate ROM. Numerous outcome instruments and patient-reported questionnaires are in use to evaluate of TKA patients. For this purpose, disease-specific questionnaires and self-reported ROM and function evaluation tools are also being developed. The most important criteria in musculoskeletal care is assessing the joint mobility of the patient’s. Joint mobility can be measured with visual estimates, universal goniometer, X-ray radiography, digital gravity goniometers and applications found in smart phones. Apart from the reliability and validity of the method, obtaining the same results from different examiners is very important. The clinical follow-up of patients is an important part of postoperative care after TKA. The follow-up interval and duration remain dependent on the physician’s anticipation of the clinical progress of the individual patient. Long-term surveillance of joint arthroplasty is necessary, but it has also become increasingly burdensome as greater numbers of TKAs are performed, and in younger populations. Patient self-reported questionnaires and self-goniometric measurement are used by many investigators to decrease this burden on the surgeon or staff, and in combination with telemedicine radiographs might be a reasonable option to routine clinic visits. They could reasonably be expected to lower the burden on both the patient and the clinician without eliminating contact and thus sacrificing quality of care. At the same time, it would reduce the financial burden too. Self-reported measured ROM can use in the routine follow-ups to reduce surgeons, physiotherapist and other staff. PMID:26417576

  7. The Analysis of Risk Factors in No Thumb Test in Total Knee Arthroplasty

    PubMed Central

    Kim, Jee Hyoung; Ko, Dong Oh; Yoo, Chang Wook; Chun, Tae Hwan; Lee, Jung Soo

    2011-01-01

    Background We would like to analyze the risk factors of no thumb test among knee alignment tests during total knee arthroplasty surgery. Methods The 156 cases of total knee arthroplasty by an operator from October 2009 to April 2010 were analyzed according to preoperative indicators including body weight, height, degree of varus deformity, and patella subluxation and surgical indicators such as pre-osteotomy patella thickness, degree of patella degeneration, no thumb test which was evaluated after medial prepatella incision and before bone resection (1st test), no thumb test which was evaluated with corrective valgus stress (2nd test, J test), and the kind of prosthesis. We comparatively analyzed indicators affecting no thumb test (3rd test). Results There was no relation between age, sex, and body weight and no thumb test (3rd test). Patellar sulcus angle (p = 0.795), patellar congruence angle (p = 0.276) and preoperative mechanical axis showed no relationship. The 1st no thumb test (p = 0.007) and 2nd test (p = 0.002) showed significant relation with the 3rd no thumb test. Among surgical indicators, pre-osteotomy patella thickness (p = 0.275) and degeneration of patella (p = 0.320) were not relevant but post-osteotomy patellar thickness (p = 0.002) was relevant to no thumb test (3rd test). According to prosthesis, there was no significance with Nexgen (p = 0.575). However, there was significant correlation between Scorpio (p = 0.011), Vanguard (p = 0.049) and no thumb test (3rd test). Especially, Scorpio had a tendency to dislocate the patella, but Vanguard to stabilize the patella. Conclusions No thumb test (3rd test) is correlated positively with 1st test, 2nd test, and post-osteotomy patella thickness. Therefore, the more patella osteotomy and the prosthesis with high affinity to patellofemoral alignment would be required for correct patella alignment. PMID:22162789

  8. Comparison of self-reported and measured range of motion in total knee arthroplasty patients.

    PubMed

    Unver, Bayram; Nalbant, Abdurrahman; Karatosun, Vasfi

    2015-08-01

    Total knee arthroplasty (TKA) is an established method used in the treatment of end-stage knee osteoarthritis. Range of motion (ROM) and relief from pain show success of TKA. One of the most important aims of this treatment is to achieve an adequate ROM. Numerous outcome instruments and patient-reported questionnaires are in use to evaluate of TKA patients. For this purpose, disease-specific questionnaires and self-reported ROM and function evaluation tools are also being developed. The most important criteria in musculoskeletal care is assessing the joint mobility of the patient's. Joint mobility can be measured with visual estimates, universal goniometer, X-ray radiography, digital gravity goniometers and applications found in smart phones. Apart from the reliability and validity of the method, obtaining the same results from different examiners is very important. The clinical follow-up of patients is an important part of postoperative care after TKA. The follow-up interval and duration remain dependent on the physician's anticipation of the clinical progress of the individual patient. Long-term surveillance of joint arthroplasty is necessary, but it has also become increasingly burdensome as greater numbers of TKAs are performed, and in younger populations. Patient self-reported questionnaires and self-goniometric measurement are used by many investigators to decrease this burden on the surgeon or staff, and in combination with telemedicine radiographs might be a reasonable option to routine clinic visits. They could reasonably be expected to lower the burden on both the patient and the clinician without eliminating contact and thus sacrificing quality of care. At the same time, it would reduce the financial burden too. Self-reported measured ROM can use in the routine follow-ups to reduce surgeons, physiotherapist and other staff. PMID:26417576

  9. 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

  10. Radiologic Outcomes According to Varus Deformity in Minimally Invasive Surgery Total Knee Arthroplasty

    PubMed Central

    Yoo, Ju-Hyung; Han, Chang-Dong; Oh, Hyun-Cheol; Park, Jun-Young; Choi, Seung-Jin

    2016-01-01

    Purpose To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity. Materials and Methods The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5° varus (Group 1, 351 cases), 5° to less than 10° varus (Group 2, 189 cases), 10° to less than 15° varus (Group 3, 59 cases), and 15° varus or more (Group 4, 28 cases). Results On average, the alignment of the tibial implant was 0.2±1.4°, 0.1±1.3°, 0.1±1.6°, and 0.3±1.7° varus, and the tibiofemoral alignment was 5.2±1.9°, 4.7±1.9°, 4.9±1.9°, and 5.1±2.0° valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0±3° varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p<0.0001). There was no difference in terms of tibiofemoral alignment, with 83.9%, 82.9%, 85.4%, and 86.7% of each group, respectively, showing 6±3° valgus angulation (p>0.05). Conclusion Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity. PMID:26632405

  11. Continuous intra-articular infusion of bupivacaine for postoperative pain following total knee arthroplasty.

    PubMed

    Nechleba, Jeffrey; Rogers, Vincent; Cortina, Gary; Cooney, Timothy

    2005-07-01

    This study assessed the efficacy of local, continuous infusion of bupivacaine for pain control following total knee arthroplasty. Eleven men and 19 women with an average age of 65 years (range: 43-83 years) randomly received either 0.25% bupivacaine or normal saline by local infusion pump. Standard wound drainage also was implemented. Pain was assessed with a visual analog scale along with patient-controlled analgesia demand, narcotic delivery, and nonsteroidal anti-inflammatory administration. Drug lost to drainage also was assessed. Mean preoperative visual analog scores were similar between the saline and bupivacaine groups (6.5 +/- 1.4 and 6.1 +/- 2.0, respectively; P = .535). By the end of the second postoperative day, scores decreased to 3.4 +/- 3.2 for the saline group and 2.5 +/- 1.6 for the bupivacaine group. Although postoperative reductions were statistically significant (P = .007), the main treatment effect was not (P = .404). Mean narcotic demand and usage were 87 +/- 114.1 requests with usage of 11.8 +/- 12.3 mg for the saline group and 96 +/- 104.8 requests with usage of 7.5 +/- 3.8 mg for the bupivacaine group (P = .505). Cumulative ketorolac administration was 47 +/- 52.2 mg for the saline group and 83.6 +/- 64.9 mg for the bupivacaine group (P=.100). Hydrocodone-acetaminophen usage also was similar between the saline and bupivacaine groups (88 +/- 43.9 mg and 64.6 +/- 35 mg, respectively) (P = .112). Drug lost to drainage was estimated to be 27%. These findings suggest continuous local analgesic infusion after total knee arthroplasty does not offer significant improvements in either pain relief or medication use. Drug loss from drainage may exceed 25% and may compromise analgesic effectiveness. PMID:16152868

  12. Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty

    PubMed Central

    2012-01-01

    Background Dislocation remains a difficult problem in total hip arthroplasty. Large-diameter femoral heads may lower the incidence of dislocation by enhancing the jump distance and decreasing impingement, but their performance against small-diameter heads has not been assessed. This study compared the mid-term radiographic and functional outcomes of two matched cohorts of patients undergoing total hip arthroplasty who had a high pre-operative risk for dislocation and who received either small-diameter (26- or 28-millimeters) or large-diameter (?36-millimeters) femoral heads. Methods All patients who received large-diameter heads (?36-millimeter) between 2002 and 2005, and who had pre-operative risk factors for dislocation, were identified in the institution’s joint registry. Forty-one patients (52 hips) who received large-diameter heads were identified, and these patients were matched to 48 patients (52 hips) in the registry who received small-diameter femoral heads. Results At mean final follow-up of 62 months (range, 49 to 101 months), both groups achieved excellent functional outcomes as measured by Harris Hip scores, with slightly better final scores in the large-diameter group (90 vs. 83 points). No patient showed any radiographic signs of loosening. No patient dislocated in the large-diameter femoral head group; the smaller-diameter group had a greater rate of dislocation (3.8%, 2 out of 52). Conclusions Large-diameter femoral head articulations may reduce dislocation rates in patients who have a high pre-operative risk for dislocation while providing the same functional improvements and safety as small-diameter bearings. PMID:23039109

  13. Revision of metal-on-metal hip arthroplasty in a tertiary center

    PubMed Central

    2013-01-01

    Background and purpose Operative findings during revision of metal-on-metal hip arthroplasty (MOMHA) vary widely and can involve massive soft tissue and bone disruption. As a result, planning of theater time and resources is difficult, surgery is challenging, and outcomes are often poor. We describe our experience with revision of MOMHA and provide recommendations for management. Patients and methods We present the findings and outcomes of 39 consecutive MOMHAs (in 35 patients) revised in a tertiary unit (median follow-up time 30 (12–54) months). The patients underwent a preoperative work-up including CT, metal artifact reduction sequence (MARS) MRI, and blood metal ion levels. Results We determined 5 categories of failure. 8 of 39 hips had conventional failure mechanisms including infection and impingement. Of the other 31 hips, 14 showed synovitis without significant disruption of soft tissue; 6 had a cystic pseudotumor with significant soft tissue disruption; 7 had significant osteolysis; and 4 had a solid pseudotumor. Each category of failure had specific surgical hazards that could be addressed preoperatively. There were 2 reoperations and 1 patient (2 hips) died of an unrelated cause. Median Oxford hip score (OHS) was 37 (9–48); median change (?OHS) was 17 (–10 to 41) points. ?OHS was similar in all groups—except those patients with solid pseudotumors and those revised to metal-on-metal bearings, who fared worse. Interpretation Planning in revision MOMHA is aided by knowledge of the different categories of failure to enable choice of appropriate personnel, theater time, and equipment. With this knowledge, satisfactory outcomes can be achieved in revision of metal-on-metal hip arthroplasty. PMID:23621810

  14. Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty.

    PubMed

    Postacchini, Roberto; Paoloni, Marco; Carbone, Stefano; Fini, Massimo; Santilli, Valter; Postacchini, Franco; Mangone, Massimiliano

    2015-09-18

    Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation. PMID:26194874

  15. A novel technique for identification of fractured ceramic acetabular liner in total hip arthroplasty: a case report.

    PubMed

    Shafafy, Roozbeh; Foote, Julian; Hargrove, Richard

    2015-10-13

    In total hip arthroplasty ceramic bearings are liable to fracture. We present the case of an 82-year-old male with groin pain and an audible squeak 6 months post ceramic on ceramic hip arthroplasty. Initial plain radiography and examination under anaesthetic (EUA) were normal. Fluoroscopy with normal image exposure was also unremarkable. Over penetration of the image intensifier film demonstrated a fracture of the ceramic acetabular liner. The patient subsequently underwent a revision of both acetabular and femoral bearing surfaces.Displaced ceramic liner fractures are easy to identify with plain radiographs. We recommend the use of over penetration using image intensification as a technique to help identify subtle ceramic liner fractures. To our knowledge this has not been previously reported in the literature. PMID:25907387

  16. Prevalence and Perioperative Outcomes of Off-Label Total Hip and Knee Arthroplasty in the United States, 2000-2010.

    PubMed

    Malcolm, Tennison; Szubski, Caleb R; Schiltz, Nicholas K; Klika, Alison K; Koroukian, Siran M; Barsoum, Wael K

    2015-11-01

    "Off-label use" refers to medical device utilization for purposes or subpopulations other than those approved by the United States Food and Drug Administration. The primary goal of this study was to determine the current epidemiology of off-label total hip and knee arthroplasties (THA and TKA, respectively) in the United States and to project further off-label use through 2040. Over the past decade, the prevalence of off-label THA and TKA was 30.4% and 37.0%, respectively, growing ~70% from 2000 to 2010. By 2040, the majority of THAs (86.1%) and TKAs (91.5%) could be off-label. The high prevalence of off-label arthroplasty and the dramatically shifting patient profile illustrated by these results highlight the need for continued medical device surveillance among on- and off label patients. PMID:26059502

  17. Do 'Surgical Helmet Systems' or 'Body Exhaust Suits' Affect Contamination and Deep Infection Rates in Arthroplasty? A Systematic Review.

    PubMed

    Young, Simon W; Zhu, Mark; Shirley, Otis C; Wu, Qing; Spangehl, Mark J

    2016-01-01

    This systematic review examined whether negative-pressure Charnley-type body exhaust suits (BES) or modern positive-pressure surgical helmet systems (SHS) reduce deep infection rates and/or contamination in arthroplasty. For deep infection, four studies (3990 patients) gave adjusted relative risk for deep infection of 0.11 (P = 0.09) against SHS. Five of 7 (71%) studies found less air contamination and 2 of 4 studies (50%) less wound contamination with BES. One of 4 (25%) found less air contamination with SHS and 0 of 1 (0%) less wound contamination. In contrast to BES, modern SHS designs were not shown to reduce contamination or deep infection during arthroplasty. PMID:26321627

  18. Bearing Change to Metal-On-Polyethylene for Ceramic Bearing Fracture in Total Hip Arthroplasty; Does It Work?

    PubMed

    Lee, Soong Joon; Kwak, Hong Suk; Yoo, Jeong Joon; Kim, Hee Joong

    2016-01-01

    We evaluated the short-term to midterm results of reoperation with bearing change to metal-on-polyethylene (MoP) after ceramic bearing fracture in ceramic-on-ceramic total hip arthroplasty. Nine third-generation ceramic bearing fractures (6 heads and 3 liners) were treated with bearing change to MoP. Mean age at reoperation was 52.7 years. Mean follow-up was 4.3 years. During follow-up, 2 of 3 liner-fractured hips and 1 of 6 head-fractured hips showed radiologic signs of metallosis and elevated serum chromium levels. Re-reoperation with bearing rechange to a ceramic head was performed for the hips with metallosis. One liner-fractured hip had periprosthetic joint infection. Dislocation occurred in 3 hips. From our experience, bearing change to MoP is not a recommended treatment option for ceramic bearing fracture in total hip arthroplasty. PMID:26404851

  19. Early follow-up after primary total knee and total hip arthroplasty with rapid recovery?: Focus groups.

    PubMed

    van Egmond, J C; Verburg, H; Vehmeijer, S B W; Mathijssen, N M C

    2015-09-01

    Rapid recovery protocols reduce the length of hospital stay after Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). However, little is known about the early postoperative phase. The purpose of this study was to examine which problems patients encountered during the first six weeks after primary TKA or THA surgery with rapid recovery. We invited twenty patients for a focus group meeting which discussed various subjects regarding the first six weeks after hospital discharge. The focus group meetings were analysed qualitatively. Patients were mostly satisfied by the short length of hospital stay. Patients who lived alone needs more care and would like to stay longer in the hospital. After THA surgery all patients complained of inability to sleep. More patients experienced pain after TKA surgery compared to THA surgery. All patients had various experiences regarding physical therapy therefore an evidence based rehabilitation protocol might be needed. PMID:26435240

  20. Techniques for periarticular infiltration with liposomal bupivacaine for the management of pain after hip and knee arthroplasty: a consensus recommendation.

    PubMed

    Joshi, Girish P; Cushner, Fred D; Barrington, John W; Lombardi, Adolph V; Long, William J; Springer, Bryan D; Stulberg, Bernard N

    2015-01-01

    Periarticular infiltration analgesia when used as a component of multimodal analgesia regimen has been shown to provide excellent pain relief after major joint replacement surgery. Recently, a liposomal formulation of bupivacaine (Exparel) has been approved for administration into the surgical site to produce postsurgical analgesia. It is a sustained release preparation of bupivacaine that has been shown to provide pain relief for up to 72 hours with a single local administration. Because the success of infiltration technique depends on systematic, extensive, meticulous tissue injection before surgical wound closure, a group convened to address the best practice for periarticular injection techniques for hip and knee replacement surgery. This article provides recommendations for optimal solution for injection (i.e., drug combinations or ``cocktail'' and total volume) as well as detailed description (including illustrations) of the infiltration technique for primary, revision, and unicompartmental knee arthroplasty and primary and revision hip arthroplasty using various surgical approaches. PMID:25830260

  1. Preoperative Staphylococcus aureus Screening/Decolonization Protocol Before Total Joint Arthroplasty-Results of a Small Prospective Randomized Trial.

    PubMed

    Sousa, Ricardo J G; Barreira, Pedro M B; Leite, Pedro T S; Santos, Ana Claudia M; Ramos, Maria Helena S S; Oliveira, António F

    2016-01-01

    To study the prevalence of Staphylococcus aureus carriage and the impact of preoperatively treating carriers in prosthetic joint infection (PJI), a prospective randomized trial was organized. From January 2010 to December 2012, 1028 of 1305 total joint arthroplasties performed were screened, and selected carriers underwent preoperative decolonization. We observed a 22.2% (228/1028) S aureus colonization rate and only 0.8% methicillin-resistant S aureus. Prosthetic joint infection rate was higher, albeit not significantly, in S aureus carriers than among noncarriers-3.9% (9/228) vs 2.0% (16/800). Treated and untreated carriers showed no significant differences-3.4% (3/89) vs 4.3% (6/139). Most of the 14 S aureus PJI occurred in noncarriers suggesting a lack of causal relation between nasal and PJI S aureus. No clear benefit in screening/decolonizing carriers before total joint arthroplasty could be demonstrated. PMID:26362785

  2. Low Rates of Heterotopic Ossification After Resurfacing Hip Arthroplasty With Use of Prophylactic Radiotherapy in Select Patients

    PubMed Central

    Kruser, Tim J.; Kozak, Kevin R.; Cannon, Donald M.; Platta, Christopher S.; Heiner, John P.; Illgen, Richard L.

    2012-01-01

    Recent reports have noted higher rates of heterotopic ossification (HO) with surface replacement arthroplasty (SRA) than with traditional total hip arthroplasty in the absence of postoperative HO prophylaxis. This study reports rates and grades of HO in 44 SRA patients with at least 1 year of follow-up. Heterotopic ossification prophylaxis was used in 32 (73%) of 44 cases. Heterotopic ossification prophylaxis consisted of radiotherapy (22/32), nonsteroidal anti-inflammatory drugs (8/32), or both (2/32). One case of clinically significant HO was documented in the no-prophylaxis group. This strategy of selective HO prophylaxis in patients felt by orthopedic surgeons to be at high risk of HO resulted in low rates of clinically relevant HO after SRA (1/44, 2.3%). Further study is needed to establish optimal selection criteria for HO prophylaxis after SRA. PMID:22245125

  3. Gapped sampled spectrum Doppler estimation.

    PubMed

    Liu, Paul; Liu, Dong

    2013-07-01

    Duplex and triplex transmit patterns that involve gaps in the spectrum Doppler samples allow pulse repetition frequency increases and/or frame rate increases that cannot be flexibly achieved by conventional uniformly sampled transmit schemes. We make two claims in this paper. First, previously reported nonparametric gapped sampled spectrum estimators are technically feasible for handling the duplex and triplex transmit patterns found in common medical ultrasound applications. Second, such estimators that coherently average within an axial/temporal 2-D window have superior SNR compared with their incoherent counterparts. Moreover, this fact extends to previously reported fully sampled incoherent estimators, which can be improved by using their coherent version. We verify the methods by steady-state flow phantom experiments and in vivo examples of the left clavicular artery and the ascending aorta. For the flow phantom experiments, we use the three quantitative metrics of SNR, root mean square error, and zero frequency peak full-width at half-maximum to evaluate robustness and resolution. Results indicate that through proper parameters, periodically gapped estimators can produce results similar to their fully sampled counterparts. Fourier synthesis of the spectral estimates produces the fully sampled time-domain audio signal, and we give stereo audio examples for the clavicular artery. PMID:25004500

  4. Improved gapped alignment in BLAST.

    PubMed

    Cameron, Michael; Williams, Hugh E; Cannane, Adam

    2004-01-01

    Homology search is a key tool for understanding the role, structure, and biochemical function of genomic sequences. The most popular technique for rapid homology search is BLAST, which has been in widespread use within universities, research centers, and commercial enterprises since the early 1990s. In this paper, we propose a new step in the BLAST algorithm to reduce the computational cost of searching with negligible effect on accuracy. This new step-semigapped alignment-compromises between the efficiency of ungapped alignment and the accuracy of gapped alignment, allowing BLAST to accurately filter sequences with lower computational cost. In addition, we propose a heuristic-restricted insertion alignment-that avoids unlikely evolutionary paths with the aim of reducing gapped alignment cost with negligible effect on accuracy. Together, after including an optimization of the local alignment recursion, our two techniques more than double the speed of the gapped alignment stages in BLAST. We conclude that our techniques are an important improvement to the BLAST algorithm. Source code for the alignment algorithms is available for download at http://www.bsg.rmit.edu.au/iga/. PMID:17048387

  5. A Historical and Economic Perspective on Sir John Charnley, Chas F. Thackray Limited, and the Early Arthroplasty Industry

    PubMed Central

    Gomez, Pablo F; Morcuende, Jose A

    2005-01-01

    In the 1960s, Sir John Charnley pioneered modern total hip arthroplasty (THA) and spent the next two decades refining all aspects of the procedure, working with the commercial firm of Chas F. Thackray Limited, now a subsidiary of DePuy Orthopaedics, a Johnson and Johnson Company. We review here that relationship, in light of the complex relationships today that exist among industry, researchers, surgeons, and the public. PMID:16089068

  6. Topological Valley Currents in Gapped Dirac Materials

    E-print Network

    Lensky, Yuri D.

    Gapped 2D Dirac materials, in which inversion symmetry is broken by a gap-opening perturbation, feature a unique valley transport regime. Topological valley currents in such materials are dominated by bulk currents produced ...

  7. A Reluctance Actuator Gap Disturbance Testbed

    E-print Network

    Meléndez H., Roberto J

    2014-01-01

    We have designed and built a Reluctance Actuator Gap Disturbance Testbed. The testbed emulates the short stroke and long stroke interaction of modern lithography stages. The testbed can be used to impart gap disturbance ...

  8. 30 CFR 57.6603 - Air gap.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Explosives Extraneous Electricity-Surface and Underground § 57.6603 Air gap. At least a 15-foot air gap shall be provided between the...

  9. 30 CFR 56.6603 - Air gap.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Explosives Extraneous Electricity § 56.6603 Air gap. At least a 15-foot air gap shall be provided between the blasting circuit and the electric...

  10. 30 CFR 57.6603 - Air gap.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Explosives Extraneous Electricity-Surface and Underground § 57.6603 Air gap. At least a 15-foot air gap shall be provided between the...

  11. 30 CFR 57.6603 - Air gap.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Explosives Extraneous Electricity-Surface and Underground § 57.6603 Air gap. At least a 15-foot air gap shall be provided between the...

  12. 30 CFR 57.6603 - Air gap.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Explosives Extraneous Electricity-Surface and Underground § 57.6603 Air gap. At least a 15-foot air gap shall be provided between the...

  13. 30 CFR 56.6603 - Air gap.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Explosives Extraneous Electricity § 56.6603 Air gap. At least a 15-foot air gap shall be provided between the blasting circuit and the electric...

  14. 30 CFR 56.6603 - Air gap.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Explosives Extraneous Electricity § 56.6603 Air gap. At least a 15-foot air gap shall be provided between the blasting circuit and the electric...

  15. Closing the Prescription Drug Coverage Gap

    MedlinePLUS

    ... does the coverage gap discount work for brand-name drugs? Companies that make brand-name prescription drugs ... the coverage gap, will all Medicare-covered brand-name prescription drugs be discounted? If a drug company ...

  16. Coating with a Modular Bone Morphogenetic Peptide Promotes Healing of a Bone-Implant Gap in an Ovine Model

    PubMed Central

    Lu, Yan; Lee, Jae Sung; Nemke, Brett; Graf, Ben K.; Royalty, Kevin; Illgen, Richard; Vanderby, Ray; Markel, Mark D.; Murphy, William L.

    2012-01-01

    Despite the potential for growth factor delivery strategies to promote orthopedic implant healing, there is a need for growth factor delivery methods that are controllable and amenable to clinical translation. We have developed a modular bone growth factor, herein termed “modular bone morphogenetic peptide (mBMP)”, which was designed to efficiently bind to the surface of orthopedic implants and also stimulate new bone formation. The purpose of this study was to coat a hydroxyapatite-titanium implant with mBMP and evaluate bone healing across a bone-implant gap in the sheep femoral condyle. The mBMP molecules efficiently bound to a hydroxyapatite-titanium implant and 64% of the initially bound mBMP molecules were released in a sustained manner over 28 days. The results demonstrated that the mBMP-coated implant group had significantly more mineralized bone filling in the implant-bone gap than the control group in C-arm computed tomography (DynaCT) scanning (25% more), histological (35% more) and microradiographic images (50% more). Push-out stiffness of the mBMP group was nearly 40% greater than that of control group whereas peak force did not show a significant difference. The results of this study demonstrated that mBMP coated on a hydroxyapatite-titanium implant stimulates new bone formation and may be useful to improve implant fixation in total joint arthroplasty applications. PMID:23185610

  17. Clinical evaluation of a mobile sensor-based gait analysis method for outcome measurement after knee arthroplasty.

    PubMed

    Calliess, Tilman; Bocklage, Raphael; Karkosch, Roman; Marschollek, Michael; Windhagen, Henning; Schulze, Mareike

    2014-01-01

    Clinical scores and motion-capturing gait analysis are today's gold standard for outcome measurement after knee arthroplasty, although they are criticized for bias and their ability to reflect patients' actual quality of life has been questioned. In this context, mobile gait analysis systems have been introduced to overcome some of these limitations. This study used a previously developed mobile gait analysis system comprising three inertial sensor units to evaluate daily activities and sports. The sensors were taped to the lumbosacral junction and the thigh and shank of the affected limb. The annotated raw data was evaluated using our validated proprietary software. Six patients undergoing knee arthroplasty were examined the day before and 12 months after surgery. All patients reported a satisfactory outcome, although four patients still had limitations in their desired activities. In this context, feasible running speed demonstrated a good correlation with reported impairments in sports-related activities. Notably, knee flexion angle while descending stairs and the ability to stop abruptly when running exhibited good correlation with the clinical stability and proprioception of the knee. Moreover, fatigue effects were displayed in some patients. The introduced system appears to be suitable for outcome measurement after knee arthroplasty and has the potential to overcome some of the limitations of stationary gait labs while gathering additional meaningful parameters regarding the force limits of the knee. PMID:25171119

  18. Clinical Evaluation of a Mobile Sensor-Based Gait Analysis Method for Outcome Measurement after Knee Arthroplasty

    PubMed Central

    Calliess, Tilman; Bocklage, Raphael; Karkosch, Roman; Marschollek, Michael; Windhagen, Henning; Schulze, Mareike

    2014-01-01

    Clinical scores and motion-capturing gait analysis are today's gold standard for outcome measurement after knee arthroplasty, although they are criticized for bias and their ability to reflect patients' actual quality of life has been questioned. In this context, mobile gait analysis systems have been introduced to overcome some of these limitations. This study used a previously developed mobile gait analysis system comprising three inertial sensor units to evaluate daily activities and sports. The sensors were taped to the lumbosacral junction and the thigh and shank of the affected limb. The annotated raw data was evaluated using our validated proprietary software. Six patients undergoing knee arthroplasty were examined the day before and 12 months after surgery. All patients reported a satisfactory outcome, although four patients still had limitations in their desired activities. In this context, feasible running speed demonstrated a good correlation with reported impairments in sports-related activities. Notably, knee flexion angle while descending stairs and the ability to stop abruptly when running exhibited good correlation with the clinical stability and proprioception of the knee. Moreover, fatigue effects were displayed in some patients. The introduced system appears to be suitable for outcome measurement after knee arthroplasty and has the potential to overcome some of the limitations of stationary gait labs while gathering additional meaningful parameters regarding the force limits of the knee. PMID:25171119

  19. Technical considerations and functional results in primary uncemented hip arthroplasty using short femoral stems through mini-invasive techniques

    PubMed Central

    Moga, M; Pogarasteanu, ME

    2014-01-01

    Abstract Primary hip arthroplasty is a surgical procedure through which the coxofemoral joint is replaced with a prosthetic implant. Arthroplasties can be total or partial, cemented or uncemented. These procedures are generally indicated as a form of treatment for arthritic pain or in the case of severe trauma, such as femoral neck fractures. The most commonly used approaches are: Smith Peterson, Watson Jones, Hardinge, Moore Southern and Ludloff. Recently, mini-invasive approaches have started being used, while correlated with short femoral stems. Short metaphyseal femoral stems have been introduced as an alternative to conventional stems, having a series of advantages: preservation of bone stock (high cervical osteotomies), preservation of the anatomical anteversion of the femural neck, decrease in cortical stress forces, decrease in the remaining thigh pain, a longer life of the prosthesis, with the possibility of revision to a conventional prosthesis, and the possibility to be used in correlation with mini-invasive procedures. Short femoral stems implanted through a mini-invasive approach allow the conservation of the femoral bone stock, permitting an ulterior re-intervention, in the context of an ageing population, with a globally rising long-term survival rate. Moreover, the superiority of the total hip arthroplasty with a short femoral stem was discussed through mini-invasive approaches, in the day-to-day realities of our Clinic. PMID:25408765

  20. The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty

    PubMed Central

    Hernandez, Arnaldo José; de Almeida, Adriano Marques; Fávaro, Edmar; Sguizzato, Guilherme Turola

    2012-01-01

    OBJECTIVE: To evaluate the association between tourniquet and total operative time during total knee arthroplasty and the occurrence of deep vein thrombosis. METHODS: Seventy-eight consecutive patients from our institution underwent cemented total knee arthroplasty for degenerative knee disorders. The pneumatic tourniquet time and total operative time were recorded in minutes. Four categories were established for total tourniquet time: <60, 61 to 90, 91 to 120, and >120 minutes. Three categories were defined for operative time: <120, 121 to 150, and >150 minutes. Between 7 and 12 days after surgery, the patients underwent ascending venography to evaluate the presence of distal or proximal deep vein thrombosis. We evaluated the association between the tourniquet time and total operative time and the occurrence of deep vein thrombosis after total knee arthroplasty. RESULTS: In total, 33 cases (42.3%) were positive for deep vein thrombosis; 13 (16.7%) cases involved the proximal type. We found no statistically significant difference in tourniquet time or operative time between patients with or without deep vein thrombosis. We did observe a higher frequency of proximal deep vein thrombosis in patients who underwent surgery lasting longer than 120 minutes. The mean total operative time was also higher in patients with proximal deep vein thrombosis. The tourniquet time did not significantly differ in these patients. CONCLUSION: We concluded that surgery lasting longer than 120 minutes increases the risk of proximal deep vein thrombosis. PMID:23018303