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1

Continuous ropivacaine infusion vs transdermal fentanyl for providing postoperative analgesia following temporomandibular joint interpositional gap arthroplasty  

PubMed Central

Aim The purpose of this study was to evaluate the postoperative pain control and mouth opening in patients undergoing temporomandibular joint interpositional gap arthroplasty by either placing an epidural catheter in the incision wound and infusing ropivacaine 0.25% or by using a transdermal fentanyl patch. Materials and Methods: The study was prospective, randomized and double blind. Eighty patients belonging to American Society of Anesthesiologists grade I and II, 18–32 years of age, scheduled for temporomandibular joint interpositional gap arthroplasty were randomized into 2 groups; ropivacaine group (G rop): to receive 0.25% ropivacaine infusion and transdermal fentanyl group (G tf): to receive transdermal fentanyl patch. For postoperative pain (Visual Analog Score [VAS]) and analgesic requirements were assessed 2, 4 and 8 h after surgery and each morning, until and 4 days after surgery. Results: Time to first analgesic requirement was found to be significantly (P < 0.0001) higher in G rop (49 ± 6.7) as compared with G tf (32 ± 9.1) VAS were also significantly lower in G rop throughout the postoperative period. Postoperatively, mouth opening was better in G rop as compared with G tf, which was statistically significant. Conclusion: It was concluded that by placing an epidural catheter at the incision wound and continuously infusing with ropivacaine 0.25% effectively controls the postoperative pain in patients undergoing temporomandibular joint interpositional gap arthroplasty and provides better postoperative mouth opening. PMID:22442580

Dhasmana, Satish; Singh, Vibha; Pal, U.S.

2010-01-01

2

Temporomandibular joint interpositional gap arthroplasty under intravenous (I.V) conscious sedation.  

PubMed

Ankylosis may be defined as the fusion of joint surfaces. Temporomandibular joint (TMJ) ankylosis is a condition that may cause chewing, digestion, speech, esthetic and psychological disorders. It is a devastating disorder resulting in inability to open the mouth. As a result of this, General anaesthesia, is very difficult to administer because laryngeal inlet is not directly visualized. Even the blind nasal intubation is difficult because of small mandible and tongue fall following relaxation. There are various techniques to overcome these challenges. At times these techniques fail and tracheostomy has to be done. All the risks associated with difficult intubation, and general anaesthesia can be avoided if the surgery is done under conscious sedation. Conscious sedation, a simple but safe and effective method of anaesthesia is described here, which allows successful temporomandibular joint interpositional gap arthroplasty. PMID:23139547

Dhasmana, Satish; Singh, Vibha; Mohammad, Shadab; Pal, U S

2009-12-01

3

Thumb carpometacarpal arthroplasty with ligament reconstruction and interposition costochondral arthroplasty.  

PubMed

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

Trumble, Thomas; Rafijah, Gregory; Heaton, Dennis

2013-08-01

4

Ceramic interpositional arthroplasty for fourth and fifth tarsometatarsal joint arthritis.  

PubMed

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

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

2012-01-01

5

Resection Interposition Arthroplasty for Failed Distal Ulna Resections  

PubMed Central

The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate. PMID:24436784

Papatheodorou, Loukia K.; Rubright, James H.; Kokkalis, Zinon T.; Sotereanos, Dean G.

2013-01-01

6

The Modified Oblique Keller Capsular Interpositional Arthroplasty for Hallux Rigidus  

PubMed Central

Background: Hallux rigidus is a common problem characterized by localized osteoarthritis and limited range of motion of the hallux. First metatarsophalangeal joint arthrodesis has been the accepted procedure for the treatment of late-stage disease. Despite the success of arthrodesis, some patients object to the notion of eliminating motion at the metatarsophalangeal joint. For this reason, motion-sparing procedures such as the modified oblique Keller capsular interpositional arthroplasty have been developed. Methods: We compared a cohort of ten patients (ten toes) who had undergone the modified Keller arthroplasty with a group of twelve patients (twelve toes) who had undergone a first metatarsophalangeal joint arthrodesis at an average of sixty-three and sixty-eight months, respectively. Clinical outcomes were evaluated, and range of motion, great toe dynamometer strength, plantar pressures, and radiographs were assessed. Results: Clinical outcome differences existed between the groups, with the American Orthopaedic Foot and Ankle Society score being significantly higher for the arthroplasty group than for the arthrodesis group. The arthroplasty group had a mean of 54° of passive and 30° of active range of motion of the first metatarsophalangeal joint. The plantar pressure data revealed significantly higher pressures in the arthrodesis group under the great toe but not under the second metatarsal head. Conclusions: The modified oblique Keller capsular interpositional arthroplasty appears to be a motion-sparing procedure with clinical outcomes equivalent to those of arthrodesis, and it is associated with a more normal pattern of plantar pressures during walking. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. PMID:20720136

Mackey, R. Brian; Thomson, A. Brian; Kwon, Ohyun; Mueller, Michael J.; Johnson, Jeffrey E.

2010-01-01

7

Resection arthroplasty with and without capsular interposition for treatment of severe hallux rigidus  

PubMed Central

Resection arthroplasty—known as the Keller procedure—is used for the treatment of severe hallux rigidus. As a modification of this procedure, resection arthroplasty is combined with cheilectomy and interposition of the dorsal capsule and extensor hallucis brevis tendon, which are then sutured to the flexor hallucis brevis tendon on the plantar side of the joint (capsular interposition arthroplasty). In this study the clinical and radiological outcome of 22 feet treated by interposition arthroplasty were investigated and compared with those of 30 feet on which the Keller procedure was performed. The mean follow-up period was 15 months. No statistically significant difference was found between either group concerning patient satisfaction, clinical outcome and increase in range of motion of the first metatarsophalangeal joint. At follow-up, patients who had undergone interposition arthroplasty did not show statistically significantly better American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores than those of the Keller procedure group. A high rate of osteonecrosis of the first metatarsal head was found in both groups. These radiological findings did not correlate with the clinical outcome at follow-up. In conclusion, no significant benefit in clinical or radiological outcome was found for capsular interposition arthroplasty compared with the Keller procedure. PMID:17929015

Meizer, Roland; Kramer, Rudolf; Aigner, Nicolas; Landsiedl, Franz; Steinboeck, Gunther

2007-01-01

8

The Artelon CMC spacer compared with tendon interposition arthroplasty  

PubMed Central

Background and purpose The Artelon CMC spacer is designed for surgical treatment of osteoarthritis (OA) in the carpometacarpal joint of the thumb (CMC-I). Good results using this degradable device were previously presented in a pilot study. We now present results from a larger randomized, controlled, multicenter study. Patients and methods 109 patients (94 females) with a mean age of 60 (42–83) years, suffering from painful CMC OA, were included in the study at 7 centers in Sweden. The patients were randomized to Artelon CMC spacer (test, n = 72) or tendon arthroplasty (control, n = 37) at a ratio of 2:1. Perceived pain was recorded on a visual analog scale (VAS) before treatment and after 3, 6, and 12 months, when measuring maximal tripod pinch strength (primary outcome measure). In addition, range of motion, radiographic findings, and functional testing were recorded pre- and postoperatively. Results Swelling and pain were more common in the test group and 6 implants were removed because of such symptoms. 5 of these patients did not receive antibiotics preoperatively according to the study protocol. In a per-protocol analysis, i.e. patients without signs of concomitant OA in the scaphoid-trapezium-trapezoid (STT) joint and those in the test group who received antibiotics, the mean difference in tripod pinch strength increase, adjusted for baseline, was 1.4 kg in favor of the test group (not statistically significant). Statistically significant pain relief was achieved in both groups, with perceived pain gradually decreasing during the follow-up period. In the intention-to-treat analysis but not in the per-protocol analysis, significantly better pain relief (VAS) was obtained in the control group. Patient-perceived disability evaluated by the DASH questionnaire improved in both groups. Interpretation The Artelon CMC spacer did not show superior results compared to tendon interposition arthroplasty. Proper use of preoperative antibiotics and a thorough patient selection appear to be important for the results. PMID:20180717

Wiig, Monica; Alnehill, Håkan; Berggren, Magnus; Björnum, Sten; Geijer, Mats; Kopylov, Philippe; Sollerman, Christer

2010-01-01

9

Interpositional arthroplasty of the calcaneocuboid joint using a regenerative tissue matrix to treat recurrent nonunion.  

PubMed

Nonunion after foot arthrodesis is a difficult clinical problem to solve. This article presents a case of a patient who underwent 3 unsuccessful attempts at calcaneocuboid joint arthrodesis. This problem was salvaged with interpositional arthroplasty of the joint with successful clinical outcome. A 49-year-old woman with longstanding rheumatoid arthritis underwent triple hindfoot arthrodesis. Although the talonavicular joint and the talocalcaneal joints achieved successful arthrodesis, the calcaneocuboid joint did not unite. Revision arthrodesis of the joint, as well as another attempt at percutaneous grafting had failed. Infection was ruled out by biopsy. In each instance, her postoperative course was complicated by difficulty complying with nonweight bearing restrictions, changes in her rheumatoid arthritis medications, and medical comorbidities. Considering all of her medical and rehabilitation issues, she underwent interpositional arthroplasty using a regenerative tissue matrix, rather than a fourth attempt at arthrodesis. Allograft dermal matrix was used as interpositional material at the calcaneocuboid joint. One year postoperatively, the patient reports only mild discomfort in the hindfoot, which does not interfere with her activities of daily living. In the difficult setting of multiple failed attempts at arthrodesis, interpositional arthroplasty can be considered in a nonweight-bearing joint such as the calcaneocuboid joint. Interpositional arthroplasty represents a technique capable of providing pain relief in clinical situations in which osseous union cannot be achieved. PMID:19301788

Kim, David H; Berkowitz, Mark; Pino, Edward; Bruck, Edward

2009-02-01

10

Outcome following autogenous soft tissue interpositional arthroplasty for end-stage hallux rigidus: a systematic review.  

PubMed

Autogenous soft tissue interpositional arthroplasty has been proposed as an alternative to arthrodesis and other forms of arthroplasty for treatment of end-stage hallux rigidus because of the perceived safety and efficacy. The author undertook a systematic review of electronic databases and other relevant sources to identify material relating to the outcomes following autogenous soft tissue interpositional arthroplasty for end-stage hallux rigidus. Information from peer-reviewed journals, as well as from non-peer-reviewed publications, abstracts and posters, textbooks, and unpublished works, were also considered. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they involved consecutively enrolled patients undergoing isolated autogenous soft tissue interpositional arthroplasty for the treatment of end-stage hallux rigidus, evaluated patients at mean follow-up of 12-months' duration or longer, included pre- and postoperative range of motion of the first metatarsal-phalangeal joint, determined pre- and postoperative outcomes using a scoring system, and documented any complications. Two studies involving a total of 28 autogenous soft tissue interpositional arthroplasties for end-stage hallux rigidus were identified that met the inclusion criteria. There were 12 men (52%) and 11 women (48%) with a mean age of 58.2 years followed for a mean of 21.6 months. Both studies used the AOFAS First Metatarsal-Phalangeal-Hallux Scoring System, which had a mean of 26.0 preoperatively rising to 89.4 postoperatively. First metatarsal-phalangeal joint dorsiflexion had a mean of 16.7 degrees preoperatively rising to 51.1 degrees postoperatively. Complications occurred in 4 (14.3%) feet and no feet required surgical revision. The results of this systematic review demonstrate improvement in patient outcomes and first metatarsal-phalangeal joint dorsiflexion, as well as few complications following autogenous soft tissue interpositional arthroplasty for end-stage hallux rigidus. However, there is still a need for methodologically sound prospective cohort studies that compare autogenous soft tissue interpositional arthroplasty with other forms of arthroplasty and arthrodesis for end-stage hallux rigidus. PMID:20350819

Roukis, Thomas S

2010-01-01

11

Silastic arthroplasty of the first metatarsophalangeal joint as salvage for failed revisional fusion with interpositional structural bone graft.  

PubMed

Silastic arthroplasty of the first metatarsophalangeal joint should be considered a viable salvage procedure either for cases of previously failed fusion with interpositional tricortical bone grafting, or for cases of painful previous Kellers, as it can restore length back to the toe, power, stability of gait and therefore reduce pain. PMID:23632182

Kumar, Vishwajeet; Clough, Tim

2013-01-01

12

Interposition arthroplasty in post-traumatic temporomandibular joint ankylosis: A retrospective study.  

PubMed

Temporomandibular joint ankylosis which is most frequently caused by trauma, presents with restriction in mouth opening in early stages and if children are the victim and not treated early, it presents with growth retardation of the involved mandibular side. Various methods are available for surgical correction. We have reviewed our experience with the efficacy of different interpositional materials in post-traumatic cases in our set up with special reference to temporal fascia over last three years. Twenty seven patients with history of trauma, mostly fall from height, have been studied. They were evaluated clinically and by computed tomography (CT) scan, orthopantogram and x- ray lateral oblique view. The most common age group was 10-15 years with mean 12.5 years and male to female ratio 1:2. Preoperative mouth opening (inter incisor distance) was 1-2 mm in 17 cases and 2-4 mm in 10 cases. We have used temporalis fascia in nine, costochondral graft in seven, silastic sheets in five and T-plates in six cases. Post-operatively, adequate mouth opening of 30-50 mm was observed in six months follow-up and more than 50 mm at one year follow up in 21 cases out of which nine cases have interpositional material as temporalis fascia alone. The postoperative period was uneventful in all cases and none required re-operation for recurrences. We conclude that interpositional arthroplasty, especially with pedicled temporal fascia, is the best method to prevent recurrences and establish good mouth opening and full range of jaw movements. PMID:20368853

Tripathy, Satyaswarup; Yaseen, Mohd; Singh, Nitya N; Bariar, L M

2009-07-01

13

Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal joint osteoarthritis: results after minimum 2 years of follow-up.  

PubMed

A prospective study was undertaken to assess the outcomes of a series of patients treated using pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis. We analysed the results of this procedure in 27 trapeziometacarpal joints of 25 patients. The mean follow-up interval was 34 months (range 26-52). The study showed that pyrocarbon interpositional arthroplasty provided excellent pain relief and high patient satisfaction. Overall function, according to disabilities of the arm, shoulder and hand (DASH) score, improved from 48 points preoperatively to 14 points at the last follow-up assessment. Key pinch strength recorded in the operated hands was comparable with the results obtained in the contralateral hand and in healthy individuals from the same population. No further operations were performed in the study group. Partial trapeziectomy with pyrocarbon arthroplasty may prove to be a successful option for the treatment of trapeziometacarpal joint osteoarthritis. Further long-term comparative studies are warranted. PMID:24509425

Mariconda, M; Russo, S; Smeraglia, F; Busco, G

2014-02-01

14

Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty.  

PubMed

Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence. PMID:24163567

Bhatnagar, Ankur; Verma, Vinay Kumar; Purohit, Vishal

2013-01-01

15

Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty  

PubMed Central

Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence. PMID:24163567

Bhatnagar, Ankur; Verma, Vinay Kumar; Purohit, Vishal

2013-01-01

16

Autogenous capsular interpositional arthroplasty surgery for painful hallux rigidus: assessing changes in range of motion and postoperative foot health.  

PubMed

The autogenous capsular interpositional arthroplasty procedure can be a motion-sparing alternative to arthrodesis for the treatment of recalcitrant hallux rigidus deformity. Previous studies have reported positive results; however, many had small samples or lacked comparable preoperative measures. The present study used a prospective cohort study to assess the benefit of this technique for increasing range of motion, and comparative data to assess the reduction of pain and improvements in perceived foot health status for a consecutively drawn sample of patients. Thirty-four patients (44 feet) reviewed using a long-arm goniometer at a mean of 3.75 years after surgery experienced a significant increase in dorsiflexion (preoperative mean 11.09° ± 10.13°; postoperative mean 26.64° ± 10.07°; p < .001); plantar flexion remained unchanged. Additionally, 15 of 17 patients for whom the hallux abductus angle was initially greater than the normal range was within the normal range postoperatively. The postoperative patient perceptions of foot pain were significantly better than those from a comparable sample of patients presenting for a surgical opinion (t[69] = 6.80), just as were the perceptions of foot function, foot health, and footwear comfort (p < .001 for all). The postoperative perceptions of foot pain were comparable with the postoperative results from a range of previously published studies. These results have shown, with improvements in range of motion and reduction in pain, that autogenous capsular interpositional arthroplasty is a useful, motion-sparing technique in the treatment of painful hallux rigidus and should be considered for classification as a clinical practice guideline. PMID:25441283

Clews, Clayton N L; Kingsford, Andrew C; Samaras, Dean J

2015-01-01

17

Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?-a prospective clinical study of 15 cases.  

PubMed

The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5-8mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0-2mm in 8 cases and 2-9mm in 9. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence. PMID:23219020

Babu, Lokesh; Jain, Manoj Kumar; Ramesh, C; Vinayaka, N

2013-09-01

18

Long-term follow-up of trapeziectomy with abductor pollicis longus tendon interposition arthroplasty for osteoarthritis of the thumb carpometacarpal joint  

PubMed Central

Purpose To evaluate the long-term clinical and radiographic outcomes of trapeziectomy with abductor pollicis longus tendon interposition arthroplasty for moderate to severe osteoarthritis of the thumb carpometacarpal joint (Eaton stages III-IV). Methods We evaluated 13 patients (15 thumbs) who underwent trapeziectomy and abductor pollicis longus tendon interposition arthroplasty for end-stage osteoarthritis of the thumb carpometacarpal joint, at an average follow-up of 15 years. Subjective clinical outcomes evaluated included visual analogue scale scores and disability of arm shoulder and hand score questionnaires. Objective clinical evaluation included lateral pinch and grip tests, and a range of active and passive thumb movements. All patients underwent a radiological assessment by two independent senior radiologists. Wherever possible, results obtained from the operated thumbs were compared to the non-operated side. Results At a mean of 15 years post operation (range 15–17 years), there was no statistical difference between the operated and non-operated hands with regards to grip and pinch strength. In all cases CMC and MCPJ range of motion in the operative hand was either equal to or greater than non-operative counterparts. Mean visual analogue scale score was 2.13 and mean DASH score was 16.85. Mean carpal height was 0.52 and mean trapezial space ratio was 0.163. There were no early or late complications recorded and no revision surgery was required. Conclusion It is the opinion of these authors that abductor pollicis longus tendon interposition arthroplasty is able to provide high-quality long-term results for patients who suffer from moderate to severe osteoarthritis of the thumb carpometacarpal joint. Level of evidence Therapeutic Level IV. PMID:24403751

Avisar, Erez; Elvey, Michael; Wasrbrout, Ziv; Aghasi, Maurice

2013-01-01

19

Lateral thigh fascia lata as interpositional graft for temporomandibular joint ankylosis.  

PubMed

Successful management of temporomandibular joint (TMJ) ankylosis depends on adequate gap arthroplasty and interpositional graft; the objective is to produce a functioning pseudoarthrosis that prevents reankylosis and provides adequate mobility. Several interpositional grafts have been used for the treatment of temporomandibular joint ankylosis such as indigenous pterygomasseteric sling, temporalis muscle/fascia, auricular cartilage, fat and dermis-fat. Lateral thigh fascia lata (LTFL) graft is commonly used in neurosurgical practice and in other surgical specialities. We present a case of lateral thigh fascia lata used as interpositional graft for the treatment of a unilateral fibrous temporomandibular joint ankylosis. PMID:23997493

Alemán, Ramón Manuel; Martínez, María Guadalupe

2012-09-01

20

The use of Swanson silastic interposition arthroplasty in revision thumb-base surgery for failed trapeziectomy; a case series of 10 patients.  

PubMed

Patients who report ongoing adverse symptoms following trapeziectomy may require revision surgery. We present a series of 10 patients who underwent revision surgery using a Silastic interpositional finger joint arthroplasty. Mean age was 60 (range 48-70) years, with a mean interval between primary and revision surgery of 34 (range 12-84) months. Review was performed at an average of 53 (range 21-136) months. Nine of the 10 patients reported improvement in pain, and all patients reported improvement in pinch grip, activities of daily living, and satisfaction at having undergone revision surgery. There were no complications. We found good medium-term results and high satisfaction rates. We advocate this technique as an effective treatment option in these difficult cases, provided other treatable causes of poor outcome are excluded. PMID:22618556

Umarji, S I M; Arnander, M W T; Evans, D M

2012-09-01

21

[Anconeus arthroplasty: a salvage procedure in recurrent heterotopic ossification].  

PubMed

Anconeus interpositional arthroplasty has been used in the treatment of radiocapitellar and radioulnar joint problems occurring after trauma. We performed anconeus interposition arthroplasty in a 31-year-old male patient who developed heterotopic ossification (HTO) in the elbow following surgical treatment of an isolated radial neck fracture. Treatment with implant removal and excision of the radial head resulted in recurrent HTO and a stiff elbow. The patient underwent excision of the heterotrophic new bone and mobilization of the proximal radius. The anconeus muscle was mobilized and interposed between the proximal radius and ulna. Sixteen months after the operation, forearm rotation, elbow flexion and extension increased by 80 degrees , 45 degrees , and 60 degrees , respectively. Control X-rays showed maintenance of the radiohumeral gap without any signs of HTO. PMID:19293618

Seyahi, Aksel; Atalar, Ata Can; Demirhan, Mehmet

2009-01-01

22

Versatility of full thickness skin-subcutaneous fat grafts as interpositional material in the management of temporomandibular joint ankylosis.  

PubMed

The authors present a review of seven patients (eight joints) with temporomandibular ankylosis treated between 2007 and 2008. The aim of this retrospective study was to present the experience of using full thickness skin-subcutaneous fat grafts, harvested from the patient's abdomen as interpositional material after gap arthroplasty. All patients presented with osseous ankylosis and were graded according to Topazian's classification. Postoperative follow up ranged from 12 to 24 months. Maximal inter-incisal opening (MIO) on presentation ranged from 0 to 8mm, which stabilized to 27-44mm at follow up. There was no evidence of re-ankylosis. This study found merit in the use of autogenous full thickness skin-subcutaneous fat graft as an interpositional material for up to 2 years following ankylosis release. PMID:20952163

Thangavelu, A; Santhosh Kumar, K; Vaidhyanathan, A; Balaji, M; Narendar, R

2011-01-01

23

Failure of interpositional membrane to prevent recurrent arthrofibrosis.  

PubMed

Silicone has been used in numerous health care roles, from catheters to finger joint arthroplasties, with proven success. Its use as an interpositional membrane for the prevention of adhesions has been attempted in various anatomic sites with unpredictable results. We present a case report of a patient with recurrent arthrofibrosis requiring multiple operative procedures including manipulations under anesthesia, arthroscopies, and unicompartmental and eventual total knee replacement. After developing stiffness after total knee arthroplasty, the patient received placement of a silicone interpositional membrane with the goal of minimizing scar formation. Arthrofibrosis recurred, and only eventual removal of the membrane and correction of the underlying overstuffed patellofemoral compartment has allowed for maintained functional improvement in motion after 3 years. PMID:21329259

Meehan, John P; Abbi, Gaurav

2010-09-01

24

Hallux rigidus. Excisional arthroplasty.  

PubMed

The authors feel that capsular interposition arthroplasty can give predictable pain relief in carefully selected individuals with severe (grade III) hallux rigidus. Attention to the relative lengths of the first and second metatarsals, minimal shortening of the proximal phalanx, and use of the dorsal capsule and EHB tendon as an interposition all contribute to good to excellent objective and subjective results. Approximately 30% of patients undergoing this procedure experience some degree of transfer metatarsalgia postoperatively and probably require orthoses for sports. The authors feel that this operation presents a reasonable alternative to many patients who are candidates for an arthrodesis of the first MTP joint for advanced degenerative disease. PMID:11232402

Hamilton, W G; Hubbard, C E

2000-09-01

25

Development of a Pneumatic Tensioning Device for Gap Measurement during Total Knee Arthroplasty  

PubMed Central

Background Despite the importance of soft tissue balancing during total knee arthroplasty (TKA), all estimating techniques are dependent on a surgeon's manual distraction force or subjective feeling based on experience. We developed a new device for dynamic gap balancing, which can offer constant load to the gap between the femur and tibia, using pneumatic pressure during range of motion. Methods To determine the amount of distraction force for the new device, 3 experienced surgeons' manual distraction force was measured using a conventional spreader. A new device called the consistent load pneumatic tensor was developed on the basis of the biomechanical tests. Reliability testing for the new device was performed using 5 cadaveric knees by the same surgeons. Intraclass correlation coefficients (ICCs) were calculated. Results The distraction force applied to the new pneumatic tensioning device was determined to be 150 N. The interobserver reliability was very good for the newly tested spreader device with ICCs between 0.828 and 0.881. Conclusions The new pneumatic tensioning device can enable us to properly evaluate the soft tissue balance throughout the range of motion during TKA with acceptable reproducibility. PMID:22949949

Kwak, Dai-Soon; Kong, Chae-Gwan; Han, Seung-Ho; Kim, Dong-Hyun

2012-01-01

26

ORTHOSPHERE(®) interpostitional arthroplasty used in great toe interphalangeal joint arthritis-a case report.  

PubMed

We report the first case in which an ORTHOSPHERE(®) spherical ceramic interposition arthroplasty has been used successfully in a patient with complex great toe pathology. The ORTHOSPHERE(®) (Wright Medical Technology, Arlington, TN) is a spherical ceramic interpositional arthroplasty designed for use in CMC joint arthritis. It has also been documented for use in basal fourth and fifth metatarsal arthritis [Shawen SB, Anderson RB, Cohen BE, Hammit MD. Spherical ceramic interpositional arthroplasty for basal fourth and fifth metatarsal arthritis. Foot Ankle Int 2007;28(8):896-901]. PMID:21047610

Obolensky, Lucy; Hawken, Richard; Davis, James

2010-12-01

27

Flexion-extension gap in cruciate-retaining versus posterior-stabilized total knee arthroplasty: a cadaveric study.  

PubMed

We re-examined experimental model results using half-body specimens with intact extensor mechanisms and navigation to evaluate cruciate-retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA) component gaps through an entire range of motion. Six sequential testing regimens were conducted with the knee intact, with a CR TKA in place, and with a PS TKA in place, with and without 22 N traction in place at each stage. Each of 10 knees was taken through six full ranges of motion from 0° to 120° at every stage using a navigated knee system to record component gapping. No significant difference was found between loaded and unloaded component gaps, and no significant differences were found in component gapping between CR and PS TKAs throughout a full range of motion. Flexion-extension gap measurements were significantly different from previously published data (at 90° flexion). No difference was found in kinematics when comparing CR and PS TKA component designs. Our results suggest that intact extensor mechanisms may be required to perform proper kinematic studies of TKA. Our findings provide evidence that the extensor mechanism may play a major role in the flexion-extension gaps in cadaveric knees. PMID:24474152

Matthews, Joshua; Chong, Alexander; McQueen, David; O'Guinn, Justin; Wooley, Paul

2014-05-01

28

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

Code of Federal Regulations, 2011 CFR

...2011-04-01 false Interarticular disc prosthesis (interpositional implant). 872... § 872.3970 Interarticular disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis (interpositional implant) is...

2011-04-01

29

Intraoral approach for arthroplasty for correction of TMJ ankylosis.  

PubMed

This study evaluates the authors' technique using the intraoral approach for the management of temporomandibular joint (TMJ) ankylosis. The technique was used on 16 TMJs in 14 patients with a mean age of 28.5 years; their average postoperative mouth-opening was 33.7 mm. All the patients had Sawhney's type IV TMJ ankylosis except a child with type I. One patient had recurrent ankylosis and was managed using the same intraoral approach again. Average follow-up was 56 months. The protocol consists of interpositional arthroplasty via an intraoral approach and aggressive mouth-opening exercises. An intraoral incision is made over the buccal shelf and the soft tissue of the mandibular ramus reflected. Osteotomy is carried out at the coronoid process and adequate osteotomy is accomplished at the level of the condylar neck. Adequate gap osteotomy at the ankylosed condyle is performed and followed by placement of the interpositional material, such as rib cartilage, masseter, buccal fat pad and costochondral graft. The wound is then closed meticulously. The advantages of this intraoral approach are excellent cosmetic appearance with no facial scar, lower risk of injury to the facial nerve or auriculotemporal nerve and no salivary fistula formation. PMID:19733034

Ko, E C; Chen, M Y; Hsu, M; Huang, E; Lai, S

2009-12-01

30

Flexion Gap Measured in 45 Degrees and 90 Degrees of Hip Flexion Positions during Total Knee Arthroplasty: Measurement by Navigation System  

PubMed Central

Purpose To evaluate the influence of thigh weight in different hip flexion positions on the knee flexion gap in total knee arthroplasty (TKA). Materials and Methods We evaluated 20 patients (25 knees) with osteoarthritis of the knee that underwent TKA using a navigation system from May 2010 to April 2011. After posterior cruciate ligament sacrificing, complete soft tissue balancing, and fixation of all components with cement, the flexion gaps were measured with the patello-femoral joint reduced. Medial and lateral flexion gaps were measured separately in both the 90°-90° and 45°-90° flexion positions of the hip-knee joints. Results The medial and lateral flexion gaps in the 45°-90° flexion position of the hip-knee joints were 13.02±2.17 mm and 13.12±2.21 mm, respectively. The medial and lateral flexion gaps in the 90°-90° flexion position were 12.92±2.03 mm and 13.08±2.29 mm, respectively. The flexion gaps showed no significant (p>0.05) differences between the two different hip flexion positions. Conclusions Flexion gaps in TKA were not influenced by hip flexion positions (45° or 90° of flexion). Therefore, soft tissue balancing and polyethylene thickness should not be affected by hip flexion positions during TKA. PMID:24944972

Lee, Jin Kyu; Chung, Kyu-Sung; Kim, Bo-Hyun

2014-01-01

31

Regenerative tissue matrix as an interpositional spacer following excision of a cuboid-navicular tarsal coalition: a case study.  

PubMed

This article describes the use of an acellular human dermal regenerative tissue matrix as an interpositional spacer to maintain the distance between the cuboid and navicular, and to prevent recurrence, following surgical excision of a cuboid-navicular tarsal coalition in an adult female. The use of this acellular matrix as an interpositional spacer has previously been documented for use in association with arthroplasty for the treatment of hallux rigidus. After more than 3 years of follow-up, the patient was progressing well and there was no evidence of recurrent coalition or consolidation of the resection site. To the best of our knowledge, this is the first report of the use of this material for the treatment of tarsal coalition, published in the peer-reviewed literature. PMID:21354012

Hounshell, Charles R

2011-01-01

32

Long-term results of tendon shortening trapeziometacarpal arthroplasty.  

PubMed

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

Budoff, Jeffrey E; Gordon, Leonard

2002-12-01

33

Anteriorly pedicled wide temporalis muscle flap with the minimum zygomatic osteotomy technique for post-discectomy temporomandibular joint arthroplasty.  

PubMed

An anteriorly pedicled temporalis muscle flap has been shown to be a suitable interpositional material for the treatment of ankylosis and post-discectomy arthroplasty. The passage of the wide flap beneath the zygomatic arch into the joint space can be difficult owing to its bulk, causing excessive trauma to the vascularized pedicle. We describe the use of minimum zygomatic osteotomy without fixation for the passage of an anteriorly pedicled wide temporalis muscle flap for post-discectomy arthroplasty. PMID:25059518

Saigusa, Makoto; McNaught, Michael J

2014-10-01

34

[Salvage procedures of the elbow. Alternatives to elbow arthroplasty].  

PubMed

Destructive changes of the elbow joint represent a challenge for both patient and surgeon. Resection arthroplasty is associated with postoperative instability and loss of power and is a rarely performed procedure. Interpositional arthroplasty remains a useful option for healthy active patients with severe post-traumatic elbow arthrosis and is one of the oldest methods used to reconstruct the elbow. The principle of interpositional arthroplasty is based on a sparing resection of the destroyed joint surface and on creating a congruent elbow joint with human tissue. Nowadays, autogenous dermis, fascia lata or Achilles allograft are used. A preoperatively stable elbow is required to prevent instability following interpositional arthroplasty. The use of total elbow arthroplasty is limited due to the contraindications and in such cases the only remaining options are salvage procedures of the elbow. In general, arthrodesis should be performed in patients with painful osteoarthritis of the elbow with high demands on the upper extremities. Historically, tuberculosis was the most common indication for elbow arthrodesis and various methods of elbow arthrodesis have been described. However, most attention has been given to the position in which the elbow joint should be fixed and should be decided depending on the individual characteristics of the patient. Sufficient bone stock is crucial for a successful elbow arthrodesis and in cases with massive bone loss reconstruction of the elbow using an allograft can be performed to restore bone quality. However, the high complication rate of this procedure limits the scope of its use. Nevertheless, allograft procedures can restore pain-free joint function for several years. PMID:21113701

Kälicke, T; Weber, O; Backhaus, M; Muhr, G; Citak, M

2010-12-01

35

Ankle arthrodiastasis and interpositional ankle exostectomy.  

PubMed

Arthrosis of the ankle joint, typically posttraumatic in nature, can affect younger and older populations alike. A multitude of procedures exist for treatment, such as arthrodesis, total joint replacement, arthrodiastasis, and articular repair. Current literature has demonstrated success in articular surface repair and arthrodiastasis as separate procedures. This article reviews the technique of ankle arthrodiastasis and interpositional ankle exostectomy, consisting of background, mechanism of action, indications, patient selection criteria, complications, and advantages in the current literature. PMID:23044059

Sagray, Bryan A; Levitt, Bradley A; Zgonis, Thomas

2012-10-01

36

Antesternal colonic interposition for corrosive esophageal stricture.  

PubMed

Restoration of swallowing in a patient with dysphagia due to nondilatable corrosive stricture of esophagus remains a surgical challenge. Organs available for replacement are stomach, jejunum, or colon. Jejunum is useful to replace a small segment, whereas stomach and colon are required for a long-segment replacement. In cases where the stomach is also injured, colon remains the only option. The route of colonic interposition has also been a subject of debate over the years. Antesternal, retrosternal, or esophageal bed passage are the routes described. In the present series, the data of antesternal colonic interposition (ACI) performed for nondilatable benign esophageal strictures in 32 patients (1988-2011) have been retrospectively analyzed. The results indicate that ACI for corrosive strictures is a quick and simple procedure. Thoracotomy is avoided and anastomosis is easily performed in the neck, and mortality rate due to anastomotic failure or graft failure is diminished. This retrospective analysis discusses the ease, effectiveness, quality of life, morbidity, and mortality of ACI and compares the pros and cons of ACI with other procedures described in the literature. PMID:24799785

Gvalani, Anil Kumar; Deolekar, Samir; Gandhi, Jignesh; Dalvi, Abhay

2014-02-01

37

Distraction Arthroplasty  

MedlinePLUS

... who has ankle arthritis. W hat is the goal of distraction arthroplasty? The major goal of this treatment is healing of damaged tissue ... AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images ...

38

Hallux rigidus: what lies beyond fusion, resectional arthroplasty, and implants.  

PubMed

Hallux rigidus (HR) is the limitation of motion at the first metatarsophalangeal (MTP) joint, most commonly secondary to degenerative arthritis. Surgical options for treating HR include 2 general categories: joint salvage and joint destruction. A hybrid of techniques from the 2 categories has emerged: cartilage resurfacing, interpositional arthroplasty, and arthrodiastasis. These procedures address the pathologic condition of the first MTP joint more directly than joint salvage and avoid many of the negative complications, consequences, and connotations of joint destruction procedures. Alternative surgical options for the treatment of recalcitrant pain associated with HR are evolving and are discussed in this review. PMID:21669345

Galli, Melissa M; Hyer, Christopher F

2011-04-01

39

Radiology of colonic interposition and its associated complications  

Microsoft Academic Search

A retrospective review of the medical records, pathology reports, and radiographic studies of 81 patients who had undergone colonic interposition was undertaken, with special attention to postoperative complications. Both early (within 30 days postoperatively, 81 patients) and late (later than 30 days postoperatively, 57 patients) complications were reviewed. Early findings included anastomotic narrowing (18 patients), anastomotic leak (13), aspiration (11),

Lee R. Christensen; Jonathan Shapir

1986-01-01

40

Revision of a failed Swanson arthroplasty to a total wrist replacement restores wrist function and movements.  

PubMed

This study reports a case of revision of a failed Swanson silastic interpositional wrist replacement to a Universal 2 (KMI Medical Inc., San Diego, CA, Jan 2009) total wrist arthroplasty, in a 68-year-old woman with rheumatoid arthritis and pyrophosphate arthropathy. At the 2-year follow-up, the patient was pain-free and was able to perform all activities of daily living, documented by subjective assessment and objective scores. The disabilities of the arm, shoulder, and hand (DASH) scores improved from 98.3 preoperatively to 55.1 postoperatively. A failed Swanson silastic interpositional wrist replacement may be successfully revised to an uncemented primary wrist replacement with good functional results at early follow-up. PMID:24025028

Khan, Yasmin; Konan, Sujith; Sorene, Elliot

2014-04-01

41

Early results with a patient specific interpositional knee device.  

PubMed

The iForma ConforMIS Interpositional knee device is a recently developed patient specific implant used for the treatment of mild to moderate uni-compartmental osteoarthritis. The benefits over traditional methods of surgical management are: it is less invasive, can be performed as a day procedure and does not limit future options. Bespoke implants are produced from data extracted from MRIs. Twenty-six patients with the iForma ConforMIS interpositional knee implant from November 2007 were retrospectively reviewed. The average age was 54.7 years, The average pre-operative WOMAC score was 37.8 improving to 67.6 post-operatively. Five patients required revision. No dislocations were reported. Our early experience suggests this device is a viable and safe treatment option. However, patient selection plays an important role in the outcome following surgery and long term results should be awaited. PMID:23019783

Brooks, Francis; Akram, Tahira; Roy, Stuart; Pemberton, David; Chandatreya, Amit

2012-08-01

42

Interposition vein graft for giant coronary aneurysm repair  

NASA Technical Reports Server (NTRS)

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.

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

2000-01-01

43

'BOND': An Interposition Agents Based Fault Injector for Windows NT  

Microsoft Academic Search

The goal of this paper is to present BOND, a Software Fault Injection tool able to simulate abnormal behavior of a computer system running Windows NT 4.0 Operating System. The Fault Injector is based on interposition techniques, which guarantees a low impact on the execution of the target program, and allows the injection of Commercial off-the-Shelf software programs. BOND allows

Andrea Baldini; Alfredo Benso; Silvia Chiusano; Paolo Prinetto

2000-01-01

44

Bipolar hip arthroplasty.  

PubMed

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

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

2011-12-01

45

Ten-Year Experience With Transvaginal Vesicovaginal Fistula Repair Using Tissue Interposition  

Microsoft Academic Search

PurposeThe success rate of vesicovaginal fistula repair is improved by tissue interposition. The Martius flap produces reliable results but it has increased morbidity. A peritoneal flap is easily created with minimal morbidity and it can be used for proximal fistulas. We describe our 10-year experience with tissue interposition for transvaginal repair of vesicovaginal fistulas.

KARYN SCHLUNT EILBER; ELIZABETH KAVALER; LARISSA V. RODRÍGUEZ; NIRIT ROSENBLUM; SHLOMO RAZ

2003-01-01

46

Tourniquetless Total Knee Arthroplasty  

MedlinePLUS Videos and Cool Tools

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

47

Prospective Single-Arm, Multi-Center Trial of a Patient-Specific Interpositional Knee Implant: Early Clinical Results  

PubMed Central

Background: The treatment of unicompartmental arthritis in younger patients is challenging. The aim of this study is to report final safety and efficacy analysis results for the iForma patient–specific interpositional device, which is designed for the treatment of isolated medial or lateral compartment arthritis of the knee. Methods: From June 2005 to June 2008 78 subjects (42 men, 36 women) received an iForma implant. The mean age was 53 years, the mean Body Mass Index 29.0. We surveyed the WOMAC scores, the visual analog pain scale and the Knee Society Scores. Results: The mean follow up was 16.4 months. The mean WOMAC knee scores increased from 48.3 before surgery to 71.3 after 24 months. A reduction in pain was achieved for all five pain measures using a standard visual analog scale (VAS). Knee Society Knee Score improved from 39.2 before to 61.9 24 month after surgery. The Knee Society Function Scores improved form preoperative 64.5 to 82.5 2 years postoperative. The preoperative range of motion could be restored. The overall revision rate was 24%. 15 implants were removed early, 4 knees were revised without implant removal. Conclusion: Within narrow indication of patients with unicompartmental disease, the iForma device can provide improvement in knee function and reduction in pain, however, with a significant higher risk of early revision compared to traditional arthroplasty. Respecting this limitation it may be an alternative option for arthritic patients with unicompartmental disease who have contraindications to High Tibial Osteotomy or are too young for knee replacement; the iForma device further has the distinct advantage of time and cost saving compared to those procedures. PMID:21552462

Koeck, F.X; Luring, C; Goetz, J; Handel, M; Tingart, M; Grifka, J; Beckmann, J

2011-01-01

48

Hip Resurfacing Arthroplasty  

Microsoft Academic Search

In the last 10 years, resurfacing hip arthroplasty has become a popular option again for treating hip disorders in younger, active patients in some parts of the world. We report the Australian experience with this operation based on the Australian National Joint Replacement Registry and the literature available on the Australian experience in Resurfacing.

Martin L. Buergi; William L. Walter

2007-01-01

49

A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition  

PubMed Central

Background Vasectomy techniques have been the subject of relatively few rigorous studies. The objective of this analysis was to compare the effectiveness of two techniques for vas occlusion: intraluminal cautery versus ligation and excision with fascial interposition. More specifically, we aimed to compare early failure rates, sperm concentrations, and time to success between the two techniques. Methods We compared semen analysis data from men following vasectomy using two occlusion techniques. Data on intraluminal cautery came from a prospective observational study conducted at four sites. Data on ligation and excision with fascial interposition came from a multicenter randomized controlled trial that evaluated the efficacy of ligation and excision with versus without fascial interposition. The surgical techniques used in the fascial interposition study were standardized. The surgeons in the cautery study used their customary techniques, which varied among sites in terms of type of cautery, use of fascial interposition, excision of a short segment of the vas, and use of an open-ended technique. Men in both studies had semen analyses two weeks after vasectomy and then approximately every four weeks. The two outcome measures for the analyses presented here are (a) time to success, defined as severe oligozoospermia, or <100,000 sperm/mL in two consecutive semen analyses; and (b) early vasectomy failure, defined as >10 million sperm/mL at week 12 or later. Results Vasectomy with cautery was associated with a significantly more rapid progression to severe oligozoospermia and with significantly fewer early failures (1% versus 5%). Conclusion The use of cautery improves vasectomy outcomes. Limitations of this comparison include (a) the variety of surgical techniques in the cautery study and differences in methods of fascial interposition between the two studies, (b) the uncertain correlation between sperm concentrations after vasectomy and the risk of pregnancy, and (c) the use of historical controls and different study sites. PMID:15509302

Sokal, David; Irsula, Belinda; Chen-Mok, Mario; Labrecque, Michel; Barone, Mark A

2004-01-01

50

Posterior-stabilized versus cruciate-retaining total knee arthroplasty  

Microsoft Academic Search

A prospective, randomized, double-blind trial was carried out to compare cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasties (TKAs). A total of 40 knees were randomized to receive either a NexGen CR (Zimmer, Warsaw, IN) or a Legacy PS (Zimmer, Warsaw, IN) TKA. All knees were implanted with identical surgical technique, making sure to balance precisely the flexion-extension gaps before

Michael Tanzer; Karen Smith; Stephen Burnett

2002-01-01

51

Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial [ISRCTN77781689  

Microsoft Academic Search

BACKGROUND: Randomized controlled trials comparing different vasectomy occlusion techniques are lacking. Thus, this multicenter randomized trial was conducted to compare the probability of the success of ligation and excision vasectomy with, versus without, fascial interposition (i.e. placing a layer of the vas sheath between two cut ends of the vas). METHODS: The trial was conducted between December 1999 and June

David Sokal; Belinda Irsula; Melissa Hays; Mario Chen-Mok; Mark A Barone

2004-01-01

52

A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition  

Microsoft Academic Search

BACKGROUND: Vasectomy techniques have been the subject of relatively few rigorous studies. The objective of this analysis was to compare the effectiveness of two techniques for vas occlusion: intraluminal cautery versus ligation and excision with fascial interposition. More specifically, we aimed to compare early failure rates, sperm concentrations, and time to success between the two techniques. METHODS: We compared semen

David Sokal; Belinda Irsula; Mario Chen-Mok; Michel Labrecque; Mark A Barone

2004-01-01

53

Colon interposition in the treatment of esophageal caustic strictures: 40 years of experience.  

PubMed

The objective of this article was to analyze 40 years of experience of colon interposition in the surgical treatment of caustic esophageal strictures from the standpoints of our long-term personal experience. Colon interposition has proved to be the most suitable type of reconstruction for esophageal corrosive strictures. The choice of colon graft is based on the pattern of blood supply, while the type of anastomosis is determined by the stricture level and the part of colon used for reconstruction. In the period between 1964 and 2004, colon interposition was performed in 336 patients with a corrosively scared esophagus, using the left colon in 76.78% of the patients. In 87.5% a colon interposition was performed, while in the remaining patients an additional esophagectomy with colon interposition had to be done. Hypopharyngeal strictures were present in 24.10% of the patients. Long-term follow-up results were obtained in the period between 1 to up to 30 years. Early postoperative complications occurred in 26.48% of patients, among which anastomosic leakage was the most common. The operative mortality rate was 4.16% and late postoperative complications were present in 13.99% of the patients. A long-term follow up obtained in 84.82% of the patients found excellent functional results in 75.89% of them. We conclude that a colon graft is an excellent esophageal substitute for patients with esophageal corrosive strictures, and when used by experienced surgical teams it provides a low rate of postoperative morbidity and mortality, and long-term good and functional quality of life. PMID:17958730

Knezevi?, J D; Radovanovi?, N S; Simi?, A P; Kotarac, M M; Skrobi?, O M; Konstantinovi?, V D; Pesko, P M

2007-01-01

54

Sports After Hip Resurfacing Arthroplasty  

Microsoft Academic Search

Background: No information is available concerning patients' sports activity after hip resurfacing arthroplasty.Hypothesis: Patients treated by hip resurfacing arthroplasty will be able to achieve a high level of sports activity.Study Design: Case series; Level of evidence, 4.Methods: We surveyed 112 patients by postal questionnaire to determine their sporting activities at a mean of 23.5 (range, 9—40) months after hip resurfacing

Florian-D. Naal; Nicola A. Maffiuletti; Urs Munzinger; Otmar Hersche

2007-01-01

55

A critical review of interpositional grafts following temporomandibular joint discectomy with an overview of the dermis-fat graft.  

PubMed

The aim of this critical review is to determine what constitutes an ideal disc replacement material and whether any of the existing materials reported in the literature satisfy the requirements of an effective disc substitute following temporomandibular joint (TMJ) discectomy. Over the last half century a myriad of interpositional materials have been used in the TMJ but nearly all have been less than successful. The disasters that followed the early use of alloplastic interpositional implants in the 1980s prompted the increased use of autogenous grafts in the 1990s. Whilst studies by the author on the use of dermis-fat grafts have been largely positive, there are still concerns that make the dermis-fat graft a less than ideal interpositional material for use in discectomized joint cavities. In reviewing the literature, it is clear that there is still no ideal interpositional material that satisfies all the criteria for replacement of a missing articular disc following TMJ discectomy. PMID:21195585

Dimitroulis, G

2011-06-01

56

Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial [ISRCTN77781689  

PubMed Central

Background Randomized controlled trials comparing different vasectomy occlusion techniques are lacking. Thus, this multicenter randomized trial was conducted to compare the probability of the success of ligation and excision vasectomy with, versus without, fascial interposition (i.e. placing a layer of the vas sheath between two cut ends of the vas). Methods The trial was conducted between December 1999 and June 2002 with a single planned interim analysis. Men requesting vasectomies at eight outpatient clinics in seven countries in North America, Latin America, and Asia were included in the study. The men were randomized to receive vasectomy with versus without fascial interposition. All surgeons performed the vasectomies using the no-scalpel approach to the vas. Participants had a semen analysis two weeks after vasectomy and then every four weeks up to 34 weeks. The primary outcome measure was time to azoospermia. Additional outcome measures were time to severe oligozoospermia (<100 000 sperm/mL) and vasectomy failure based on semen analyses. Results We halted recruitment after the planned interim analysis, when 841 men had been enrolled. Fascial interposition decreased time to azoospermia (hazard ratio [HR], 1.35; P < 0.0001) and time to severe oligozoospermia (HR, 1.32; P < 0.0001) and reduced failures based on semen analysis by about half, from 12.7% (95% confidence interval [CI], 9.7 to 16.3) to 5.9% (95% CI, 3.8 to 8.6) (P < 0.0001). Older men benefited less from fascial interposition than younger men in terms of the speed of achieving azoospermia. However, the number of vasectomy failures was reduced to a similar degree in all age groups. Slightly more adverse events occurred in the fascial interposition group, but the difference was not significant. These failure rates may appear high to practitioners in countries such as the USA, but they are similar to results from other careful studies of ligation and excision techniques. Conclusion Fascial interposition significantly improves vasectomy success when ligation and excision is the method of vas occlusion. A limitation of this study is that the correlation between postvasectomy sperm concentrations and risk of pregnancy is not well quantified. PMID:15056388

Sokal, David; Irsula, Belinda; Hays, Melissa; Chen-Mok, Mario; Barone, Mark A

2004-01-01

57

Ileal Interposition Improves Glucose Tolerance in Low Dose Streptozotocin-treated Diabetic and Euglycemic Rats  

Microsoft Academic Search

Background  The surgical treatment for obesity promotes massive weight loss and early improvement in co-morbid conditions such as type-2\\u000a diabetes. Because surgically mediated glycemic improvements are immediate, the mechanisms involved appear to be weight loss\\u000a independent. Ileal interposition has been used to gain understanding of the relative role that the lower intestine plays in\\u000a mediating metabolic improvement. Here, we report that

April D. Strader; Trine Ryberg Clausen; Sean Z. Goodin; Donna Wendt

2009-01-01

58

Is Reverse Shoulder Arthroplasty a Reasonable Alternative for Revision Arthroplasty?  

Microsoft Academic Search

Background  Reverse shoulder arthroplasty (RSA) improves function in selected patients with complex shoulder problems. However, we presume\\u000a patient function would vary if performed primarily or for revision and would vary with other patient-specific factors.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We compared (1) the shoulder scores and (2) complications in patients with RSA for revision arthroplasty with patients who\\u000a had RSA as a primary procedure; and (3)

Luke Austin; Benjamin Zmistowski; Edward S. Chang; Gerald R. Williams Jr

59

[Nickel allergy and painful unicondylar knee arthroplasty].  

PubMed

A 56-year-old woman with unicondylar knee arthroplasty (Oxford III, Biomet) complained of persistent, burning pain in her knee. The arthroplasty failure was caused by a nickel allergy. The diagnosis was confirmed by positive patch testing, lymphocyte transformation test and histological analysis of the neosynovia around the implant. The unicondylar knee arthroplasty was explanted and replaced by a titanium-coated knee prosthesis (INNEX CR, Zimmer). PMID:22442001

Dezulovic, M; Baur, U; Stangl, R; Baur, W; Lenz, E

2012-06-01

60

Partial physeal growth arrest: treatment by bridge resection and fat interposition.  

PubMed

Twenty-eight skeletally immature patients underwent 29 primary physeal bridge resections at Children's Hospital and Medical Center in Seattle, Washington. Twenty-two resections were followed for 2 years. There were 11 excellent, five good, two fair, and four poor results. Overall mean growth was 83% with 98% in the excellent group and 96% in the good group. Physeal bridge resection is an effective method of treating partial physeal growth arrest. Results with fat compare favorably with results of other interposition materials without the disadvantages of local reaction and implant removal. PMID:2250063

Williamson, R V; Staheli, L T

1990-01-01

61

Repair of intramural hematoma of the ascending aorta without graft interposition.  

PubMed

A 68-year-old woman was admitted to hospital with a one-hour history of chest pain and syncopal episode. Transesophageal echocardiography showed an intramural aortic hematoma with cardiac tamponade. The patient underwent repair of the ascending aorta without graft interposition (resection and end-to-end anastomosis). The patient had an uneventful postoperative course and the 38-month follow-up was event-free. This case report shows that end-to-end anastomosis in patients with intramural hematoma and absence of intimal tearing, may provide good long-term results. PMID:10532215

Speziale, G; Fattouch, K; Chiavarelli, R; Marino, B

1999-08-01

62

Trapeziectomy and ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist.  

PubMed

Isolated osteoarthritis of the scaphotrapeziotrapezoid joint is rather rare compared with thumb trapeziometacarpal osteoarthritis. The aim of this retrospective study was to evaluate the outcome of 15 consecutive patients treated with trapeziectomy/ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist. After a mean follow-up of 54 months, 14 patients (15 wrists) were available for clinical and radiological examination. The median pain intensity was 0 on a 0-10 visual analogue scale, both at rest and with activity, mean grip strength averaged 24 kg, pinch strength 5 kg. The disabilities of the arm, shoulder and hand (DASH) score was 16, and a modified Mayo Wrist Score 84. Correlation between the degree of scaphotrapezoid osteoarthritis and pain at rest, pain with activity, and DASH score was not significant. The findings from our study suggest that trapeziectomy/ligament reconstruction tendon interposition is an effective procedure for treating isolated scaphotrapeziotrapezoid osteoarthritis, and that additional partial trapezoid excision is not necessary. PMID:24334602

Langenhan, R; Hohendorff, B; Probst, A

2014-10-01

63

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

PubMed Central

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

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

2014-01-01

64

The Swedish Knee Arthroplasty Register  

PubMed Central

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

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

2014-01-01

65

Dislocation after total hip arthroplasty  

Microsoft Academic Search

Hip dislocation has long been one of the major complications after total hip arthroplasty (THA). From 1980 to 1994, we performed\\u000a 2728 THAs (including primary and revision cases). There were 97 hips (3.6%) with the complication of dislocation, 62 of which\\u000a were followed up for at least 2 years (mean 5.3 years; range 2–12 years). Single dislocations occurred in 40%

L.-J. Yuan; C.-H. Shih

1999-01-01

66

Osteopetrosis and total hip arthroplasty  

Microsoft Academic Search

Summary. Two patients with osteopetrosis and osteoarthrosis of the hip underwent “hybrid” total hip replacement. There are technical\\u000a difficulties in seating acetabular and femoral components on hard and brittle osteopetrotic bone with an obliterated marrow\\u000a cavity. Although the surgical procedures are challenging, this form of arthroplasty is recommended for hip osteoarthrosis\\u000a which is associated with osteopetrosis.\\u000a   

T. Matsuno; N. Katayama

1998-01-01

67

Application of Hemi-Hip Joint Arthroplasty  

Microsoft Academic Search

Total hip replacement and hip resurfacing arthroplasty are two popular methods for curing the diseases of hip joints to date. While the technology can be considered to be mature, there are still some problems in practice. So, another method, hemi-hip joint arthroplasty, was introduced in this paper. The structure and materials of the prothesis, its experiments in vitro and the

Lan Chen; Mingzhao Chen; Lantian Chen; Ming Hu; Yiwang Bao

2008-01-01

68

Wagner resurfacing arthroplasty of the canine hip  

Microsoft Academic Search

Twelve surface replacement arthroplasties were performed on the hips of ten mongrel dogs using scaled-down replicas of the Wagner prosthesis. The contralateral hips and two further animals served as nonoperated controls. Animals were killed 5 months postoperatively. Clinical, radiological, histological and fluorochrome-labelling studies were employed to assess the bony and soft tissue reaction to resurfacing arthroplasty. There was no clinical

J. Schatzker; S. B. Goodman; G. Sumner-Smith; V. L. Fornasier; N. Goften; R. S. Bell

1987-01-01

69

Hip Resurfacing Arthroplasty and Perioperative Blood Testing  

PubMed Central

It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate. PMID:25349744

Smith, Ian

2014-01-01

70

Acute limb ischemia following closed reduction of a hip arthroplasty dislocation.  

PubMed

Hip dislocation is a well-described complication of total hip arthroplasty (THA) and dislocation rates are substantially higher following revision hip arthroplasty. Vascular complications following closed reduction of hip dislocations are exceedingly rare, but a high index of suspicion is essential for patients with underlying vascular abnormalities. Popliteal artery aneurysms are the most common peripheral arterial aneurysms with a prevalence of 1% and they should be suspected in patients with prominent popliteal pulses. This article presents a case of an 84-year-old man with a revision total THA who sustained a posterior hip dislocation. The hip was reduced under conscious sedation using the Bigelow technique. The leg was distally neurovascularly intact based on the clinical exam immediately before and after the reduction. Over the next few hours, the foot became progressively ischemic and an urgent computed tomography angiogram revealed bilateral popliteal artery aneurysms with acute thrombosis of the aneurysm on the affected limb. The patient underwent emergent femoral popliteal bypass using a Dacron supported interpositional graft. The majority of the foot was salvaged but the toes eventually became necrotic. Direct compression of the aneurysm during reduction of the hip dislocation in conjunction with transiently decreased blood pressure from conscious sedation likely resulted in a low flow state within the artery leading to thrombosis of the aneurysm. To our knowledge, this is the first reported case of such an event. This case emphasizes the need for a high index of suspicion for vascular injuries following manipulation of limbs with underlying arterial aneurysms. Reduction maneuvers for hip dislocations should be modified to minimize compression of the popliteal fossa in limbs with vascular abnormalities. Serial postreduction neurovascular exams are essential for identification and prompt management of vascular complications. PMID:20954657

Marsh, Jonathan P; Turgeon, Thomas; Guzman, Randolph

2010-10-01

71

Shoulder Arthroplasties have Fewer Complications than Hip or Knee Arthroplasties in US Veterans  

Microsoft Academic Search

Total shoulder arthroplasties (TSA) are being performed more commonly for treatment of arthritis, although fewer than either\\u000a hip (THA) or knee (TKA) arthroplasties. Total shoulder arthroplasty also provides general health improvements that are comparable\\u000a to THA. One study suggests TSAs are associated with lower morbidity and mortality than THAs and TKAs. To confirm and extend\\u000a that study, we therefore examined

Edward V. Fehringer; Ted R. Mikuls; Kaleb D. Michaud; William G. Henderson; James R. O’Dell

2010-01-01

72

Failure of aseptic revision total knee arthroplasties.  

PubMed

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

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

2015-02-01

73

Total joint arthroplasty: tips for improving efficiency.  

PubMed

Total joint arthroplasty is a very successful procedure that alleviates pain in arthritic patients. However, our current healthcare delivery system may not be able to provide the value of arthroplasty to match the demand in our increasing arthritic population. Increasing hospital efficiency and value for patients needing total joint replacement will bring this pain-relieving procedure to more patients with benefits to surgeons and hospitals. This article reviews segments in the knee arthroplasty pathway that will provide efficiency and value when they are optimized. PMID:24911640

Gittins, Mark; Doucette, Diane

2014-03-01

74

Bone grafting in shoulder arthroplasty.  

PubMed

Shoulder arthroplasty is one of the fastest-growing fields in orthopedic surgery. Deficiency of the glenoid or humeral bone stock is a major challenge that can result from degenerative arthritis, component loosening or extraction, fracture, or malignancy. Approximately 15% of primary reconstructions will require bone grafting, and the rate is higher for revisions. The authors present a systematic review of the current literature focused on the indications for and results of bone grafting techniques. This provides the practicing surgeon with a set of strategies to address bone loss in the primary and revision settings, whether using an anatomic or reverse design. PMID:23127445

Riboh, Jonathan C; Garrigues, Grant E

2012-11-01

75

Contoured iliac crest allograft interposition for pericapsular acetabuloplasty in developmental dislocation of the hip: technique and short-term results  

PubMed Central

Background Pericapsular acetabuloplasty procedures have been widely used as an integral component of combined surgery to treat developmental hip dislocation after walking age. The stability of the acetabuloplasty and the maintenance of the acetabular correction will depend on the structural integrity of the iliac crest autograft, which, traditionally, has been inserted as the interposition material. Problems related to the use of an autograft have been encountered by various surgeons—including the authors—namely, graft displacement and resorption, which may necessitate internal fixation or result in revision surgery. To overcome autograft failure, the use of an allograft as the interposition material has been introduced by some surgeons. This study describes the radiologic results of 147 hips treated for developmental hip dislocation by means of a standard protocol of open hip reduction and pericapsular acetabuloplasty with a contoured iliac crest allograft as the interposition material. Methods This retrospective study reviewed the radiographs of 147 hips presenting with late developmental dislocation which were treated by open reduction and a concomitant pericapsular acetabuloplasty using a contoured iliac crest allograft as the interposition material. The minimum follow up period was 2 years. Measurement of the acetabular index (AI) was the main variable. The efficacy of the interposed iliac crest allograft as the main stabiliser of the acetabuloplasty was reflected by the maintenance of the corrected AI during the follow up period. Loss of acetabular correction, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection, hip redislocation and avascular necrosis (AVN) as possible complications were documented. Results The treatment protocol of a combined open reduction of the hip and pericapsular acetabuloplasty, inserting a contoured iliac crest allograft as the interposition material, resulted in concentrically reduced and stable hips in 96.6% of our cases. The redislocation rate was 3.4%. All of the allografts were completely incorporated at 6 months post-surgery with no graft-related infections. In only two hips was the acetabular correction not maintained. None of the osteotomies required internal fixation for stability, even in older children. Conclusion We believe that a contoured iliac crest allograft as the pericapsular acetabuloplasty interposition material renders excellent osteotomy stability that eliminates the need for internal fixation and—in the short-term—maintains the correction of the acetabulum achieved intra-operatively. PMID:21966307

Alhussainan, Thamer S.; Al Zayed, Zayed; Hamdi, Nezar; Bubshait, Dalal

2010-01-01

76

[Total ankle arthroplasty for rheumatoid arthritis].  

PubMed

Modern second generation total ankle arthroplasty is now a serious alternative to ankle fusion in patients with rheumatoid arthritis after careful assessment of the indications. The midterm results with 10-year survival rates between 70% and 90% and the possible revision for implant exchange or arthrodesis are the reasons for the increasing importance of ankle arthroplasty. Patients with rheumatoid arthritis in particular with generally lower physical requirements can expect a pain-free function of the operated ankle for 8-10 years. In comparison to fusion ankle arthroplasty allows a significantly faster remobilization and reserves the correction capabilities of the ankle. Arthrodesis remains a valuable therapeutic alternative for severe bony destruction and instability as well as a possible fallback for failure of arthroplasty. PMID:21691912

Schill, S; Wetzel, R

2011-07-01

77

Glenoid Reconstruction in Revision Shoulder Arthroplasty  

Microsoft Academic Search

Failed shoulder arthroplasty associated with glenoid bony deficiency is a difficult problem. Revision surgery is complex with\\u000a unpredictable outcome. We asked whether revision shoulder arthroplasty with glenoid bone grafting could lead to good outcome.\\u000a We retrospectively reviewed 21 patients who underwent glenoid bone grafting using corticocancellous bone grafting or impaction\\u000a grafting using cancellous bone graft. Three patients underwent revision TSA,

Bassem Elhassan; Mehmet Ozbaydar; Lawrence D. Higgins; Jon J. P. Warner

2008-01-01

78

Registry Outcomes of Unicompartmental Knee Arthroplasty Revisions  

Microsoft Academic Search

Perceptions of the difficulty and outcome of unicompartmental knee arthroplasty revision (rev-UKA) vary. We analyzed differences\\u000a in the complexity, cost, and survival of rev-UKAs compared with revision TKAs (rev-TKA). One hundred eighty knee arthroplasty\\u000a revisions (68 rev-UKAs\\/112 rev-TKAs), defined as a minimum of tibial or femoral component revision, were identified from a\\u000a community joint registry of 7587 knee implants performed

Thomas E. Dudley; Terence J. Gioe; Penny Sinner; Susan Mehle

2008-01-01

79

Leg axis correction with ConforMIS iForma™ (interpositional device) in unicompartmental arthritis of the knee  

Microsoft Academic Search

Degeneration of the meniscus and the articular cartilage in unicompartmental osteoarthritis of the knee results in progressive\\u000a deformity of the leg axis. It is the aim of this study to evaluate if a leg axis correction can be achieved by implanting\\u000a a customised metallic interpositional device for the knee (ConforMIS iForma™). Before and after implanting a ConforMIS iForma™\\u000a knee implant,

Franz Xaver Koeck; Lars Perlick; Christian Luring; Martin Handel; Johannes Beckmann; Oliver Linhardt; Joachim Grifka

2009-01-01

80

Removal and successful re-implantation of a customized interpositional knee device following an early postoperative infection: A case report  

Microsoft Academic Search

We report the first case of early postoperative infection after a medial hemiarthroplasty of the knee with a customized ConforMIS\\u000a iForma™ interpositional device. The infection was treated successfully by revision surgery with implant removal and antibiotic\\u000a therapy. Despite the additional diagnosis of rheumatoid arthritis that did not affect the treated knee, the preservation of\\u000a bony and ligamentous structures enabled a

Franz Xaver Koeck; Bjoern Rath; Hans-Robert Springorum; Markus Tingart; Joachim Grifka; Johannes Beckmann

2010-01-01

81

Proximal femoral arthroplasty in patients undergoing revision hip arthroplasty.  

PubMed

Bone loss represents one of the greatest challenges in revision joint surgery. A retrospective review was conducted of both radiographic and clinical outcomes of eleven patients who underwent revision arthroplasty using a long extensively porous coated cylindrical femoral component. All patients' femurs presented with severe proximal femoral bone loss (Paprosky class IIIB and IV). With a mean follow-up of 8 years (2 to 14) we report no femoral revisions and one acetabular revision to a constrained cup secondary to instability. All patients were clinically and radiographically stable. We did not observe any issue with proximal stress shielding or component loosening. The article reports that in patients with severe proximal femoral bone loss, extensively porous-coated non-modular stems are a viable option offering stable and predictable outcomes. PMID:25134742

March, Gerard M J; Dehghan, Niloofar; Gala, Luca; Spangehl, Mark J; Kim, Paul R

2014-11-01

82

Diagnosis, Causes and Treatments of Instability Following Total Knee Arthroplasty  

PubMed Central

Instability following total knee arthroplasty is one of the major causes of revision surgery. In most cases, it can be prevented by using an appropriate prosthesis and a good surgical technique. Particular attention should be given to confirmation of diagnosis for which thorough history taking, complete physical examination and radiographic evaluation are needed. With regard to treatment, identification of the etiology of instability is crucial for establishing proper treatment plans; instability would persist without correction of the cause of the initial instability. For successful revision surgery, balanced medio-lateral and flexion-extension gaps should be achieved. Constrained or rotating-hinge total knee prosthesis should also be considered as an alternative option for certain subsets of patients with instability. PMID:24944970

Chang, Moon Jong; Lim, Hyungtae; Lee, Na Rae

2014-01-01

83

Imaging of elbow replacement arthroplasty.  

PubMed

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

Roth, Eira; Chew, Felix S

2015-02-01

84

Arterial injury in total knee arthroplasty.  

PubMed

Arterial complications associated with knee arthroplasty are relatively rare, although probably underreported, complications of knee arthroplasty that carry a risk of significant morbidity. Thorough preoperative assessment and close liaison with a vascular surgeon, combined with an appreciation of common anatomical variants or distorted anatomy, may help prevent both thromboembolic and direct injuries from occurring. Clinical features of arterial complications following knee arthroplasty may vary significantly from acute hemorrhage or ischemia in the immediate postoperative period to chronic pain and swelling presenting even months following the procedure. There is potential for diagnostic confusion and delay that may adversely affect outcome. Early diagnosis along with vascular surgical review and intervention is key to successful management. PMID:20580198

Butt, Usman; Samuel, Rohit; Sahu, Ajay; Butt, Imran S; Johnson, David S; Turner, Philip G

2010-12-01

85

A flow visualization model of duodenogastric reflux after esophagectomy with gastric interposition  

PubMed Central

Background Our goal was to verify surgical factors that affect duodenogastric reflux (DGR) after esophagectomy through the use of a flow visualization model that would mimic an intrathoracic gastric tube. Methods Transparent gastric tube models for different routes (retrosternal space [RS] and posterior mediastinum [PM]) were fabricated. Various distal pressures were applied to the experimental model filled with water, and the flow was recorded with a high-speed camera. The volume and maximum height of the refluxate through the pylori of two different sizes (7.5 mm, 15 mm) in two different postures (upright, semi-Fowler) was measured by analyzing the video clips. Results For the large pylorus setting, when the pressures of 20, 30, and 40 mmHg were applied in the upright position, the volumes of the refluxate in the RS/PM tubes were 87.7?±?1.1/96.4?±?1.7 mL, 150.8?±?1.1/158.0?±?3.2 mL, and 156.8?±?3.3/198.0?±?4.7 mL (p?interposition or pyloric drainage procedure, or both, is associated with high reflux of duodenal contents. PMID:24067071

2013-01-01

86

Total Knee Arthroplasty Considerations in Rheumatoid Arthritis  

PubMed Central

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

Danoff, Jonathan R.; Geller, Jeffrey A.

2013-01-01

87

Biomechanics of reverse total shoulder arthroplasty.  

PubMed

Reverse total shoulder arthroplasty is an effective procedure for treatment of glenohumeral joint disease among patients with severe rotator cuff deficiency. Improvements in prosthetic design are the result of an evolved understanding of both shoulder and joint replacement biomechanics. Although modern generations of the reverse shoulder prosthesis vary in specific design details, they continue to adhere to Grammont's core principles demonstrated by his original Delta III prosthesis. This review article discusses the biomechanics of reverse total shoulder arthroplasty with a focus on elements of implant design and surgical technique that may affect stability, postoperative complications, and functional outcomes. PMID:25441574

Berliner, Jonathan L; Regalado-Magdos, Ashton; Ma, C Benjamin; Feeley, Brian T

2015-01-01

88

Unicompartmental knee arthroplasty: a review of literature  

Microsoft Academic Search

Purpose  There has been a resurgence of interest in unicompartmental knee arthroplasty (UKA) for the treatment of medial unicompartmental\\u000a knee osteoarthritis (OA). Improved prosthetic design, minimally invasive surgical techniques, and strict patient selection\\u000a criteria have resulted in improved survivorship and functional outcomes.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A review of orthopedic literature was conducted regarding the advantages of UKA versus total knee arthroplasty (TKA); UKA\\u000a indications;

Bernardino Saccomanni

89

Intraoperative Duplex Ultrasound Criteria for Performing Interposition Bypass in the Treatment of Popliteal Artery Entrapment Syndrome.  

PubMed

We present a case series of 3 surgical procedures (2 patients) in which intraoperative duplex ultrasound (IDUS) was used to determine whether the chronic compression of the popliteal artery caused by popliteal artery entrapment syndrome had injured the artery to such a degree that interposition bypass was required. Patients initially underwent standard clinical evaluation including history and physical examination and noninvasive diagnostic testing including postexercise ankle-brachial indexes and angiography with evocative maneuvers before surgery. IDUS was performed. Doppler was used to calculate peak systolic velocities (PSVs) and velocity ratios (VRs) across areas of suspected injury. B-mode was used to assess arterial wall thickness (AWT) and sclerotic changes. Patients were followed in the postoperative period with surveillance duplex ultrasound (US). Three limbs (2 patients) underwent IDUS evaluation after popliteal decompression. Limb 1 demonstrated an elevated intraoperative PSV of 295 cm/sec with an elevated VR of 2.52 (295/117 cm/sec) and AWT of 1.1 mm. Interposition bypass was performed after popliteal decompression. Postoperative surveillance duplex US revealed a reduction of the PSV to 90 cm/sec. Limb 2 showed a mildly elevated intraoperative PSV of 211.5 cm/sec with a VR of 1.86 (211.5/114 cm/sec) and AWT of 0.8 mm. An interposition bypass was not performed. Limb 3 demonstrated an elevated intraoperative PSV of 300 cm/sec with an elevated VR of 2.51 (300/119.5 cm/sec) and AWT of 1.0. Interposition bypass was performed. Postoperative surveillance duplex US revealed a reduction of the PSV to 115 cm/sec. IDUS was very helpful in the operative management and intraoperative decision making process for popliteal artery entrapment. An elevated PSV of 250-275 cm/sec or greater on IDUS and a VR of 2.0 or greater, in conjunction with B-mode demonstration of arterial wall injury, was useful in identifying severely injured popliteal arterial segments. Additional prospective studies are warranted to further investigate objective criteria that indicate the need for bypass. PMID:25449985

White, Joseph M; Golarz, Scott R; White, Paul W; Craig, Robert M; Whittaker, David R

2015-01-01

90

Knee Lymphocutaneous Fistula Secondary to Knee Arthroplasty  

PubMed Central

Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published. PMID:25580333

Pérez-de la Fuente, T.; Sandoval, E.; Alonso-Burgos, A.; García-Pardo, L.; Cárcamo, C.; Caballero, O.

2014-01-01

91

Modular Uncemented Tricompartmental Total Knee Arthroplasty  

Microsoft Academic Search

Background: The incidence of posttraumatic osteoarthrosis, especially in younger patients, increases. In different studies total knee arthroplasty (TKA) is only indicated in 0–12% of cases of posttraumatic osteoarthrosis, because most authors feel that the indication for TKA in younger patients should be narrowly restricted. The most common indications for TKA include primary idiopathic osteoarthrosis and rheumatoid arthritis predominantly in patients

Gunther O. Hofmann; Oliver Wolf; Thomas Mückley

2005-01-01

92

Complex primary total hip arthroplasty.  

PubMed

Although total hip arthroplasty is now a classic procedure that is well controlled by orthopedic surgeons, some cases remain complex. Difficulties may be due to co-morbidities: obesity, skin problems, muscular problems, a history of neurological disease or associated morphological bone deformities. Obese patients must be informed of their specific risks and a surgical approach must be used that obtains maximum exposure. Healing of incisions is not a particular problem, but adhesions must be assessed. Neurological diseases may require tenotomy and the use of implants that limit instability. Specific techniques or implants are necessary to respect hip biomechanics (offset, neck-shaft angle) in case of a large lever arm or coxa vara. In case of arthrodesis, before THA can be performed, the risk of infection must be specifically evaluated if the etiology is infection, and the strength of the gluteal muscles must be determined. Congenital hip dysplasia presents three problems: the position and coverage of the cup, placement of a specific or custom made femoral stem, with an osteotomy if necessary, and finally lowering the femoral head into the cup by freeing the soft tissues or a shortening osteotomy. Acetabular dysplasia should not be underestimated in the presence of significant bone defect (BD), and reconstruction with a bone graft can be proposed. Sequelae from acetabular fractures presents a problem of associated BD. Internal fixation hardware is rarely an obstacle but the surgical approach should take this into account. Treatment of acetabular protrusio should restore a normal center of rotation, and prevent recurrent progressive protrusion. The use of bone grafts and reinforcement rings are indispensible. Femoral deformities may be congenital or secondary to trauma or osteotomy. They must be evaluated to restore hip biomechanics that are as close to normal as possible. Fixation of implants should restore anteversion, length and the lever arm. Most problems that can make THA a difficult procedure may be anticipated with proper understanding of the case and thorough preoperative planning. PMID:23375960

Boisgard, S; Descamps, S; Bouillet, B

2013-02-01

93

Quality of outcome data in knee arthroplasty.  

PubMed

Background and purpose - Recent reports on developer bias in unicondylar knee arthroplasty led to concerns about quality of publications regarding knee implants. We therefore compared revision rates of registry and non-registry studies from the beginning of knee arthroplasty up to the present. We assessed the time interval between market introduction of an implant and emergence of reliable data in non-registry studies. Material and methods - We systematically reviewed registry studies (n = 6) and non-registry studies (n = 241) on knee arthroplasty published in indexed, peer-reviewed international scientific journals. The main outcome measure was revision rate per 100 observed component years. Results and interpretation - For 82% of the 34 knee implants assessed, revision data from non-registry studies are either absent or poor. 91% of all studies were published in the second and third decade after market introduction. Only 5% of all studies and 1% of all revisions were published in the first decade. The first publications on revision rates of total knee arthroplasty (TKA) started 6 years after market introduction, and reliable data were found from year 12 onward in non-registry studies. However, in unicondylar knee arthroplasty (UKA) the first publications on revision rates could be found first 13 years after market introduction. Revision rates of TKA from non-registry studies were reliable after year 12 following market introduction. UKA revision rates remained below the threshold of registry indices, and failed to demonstrate adjustment towards registries. Thus, the superiority of registry data over non-registry data regarding outcome measurement was validated. PMID:25191934

Pabinger, Christof; Lumenta, David Benjamin; Cupak, Daniel; Berghold, Andrea; Boehler, Nikolaus; Labek, Gerold

2015-02-01

94

Defining the Relationship between Obesity and Total Joint Arthroplasty  

Microsoft Academic Search

Objective: The purpose of this study was to examine the relationship between obesity and patient-administered outcome measures after total joint arthroplasty.Research Methods and Procedures: A voluntary questionnaire-based registry contained 592 primary total hip arthroplasty patients and 1011 primary total knee arthroplasty patients with preoperative and 1-year data. Using logistic regression, the relationships between body mass index and the several outcome

Beverly Stickles; Leslie Phillips; William Timothy Brox; Brett Owens; William L. Lanzer

2001-01-01

95

Total hip arthroplasties: What are the reasons for revision?  

Microsoft Academic Search

Primary total hip arthroplasties have reported success rates of greater than 95% in many series with a longer than 10-year\\u000a follow-up. Revision total hip arthroplasty due to such factors as increased high-activity levels, younger patients undergoing\\u000a the procedure and increasing life expectancy has become more prevalent. An understanding of the mechanisms and timing of total\\u000a hip arthroplasty failure can direct

Slif D. Ulrich; Thorsten M. Seyler; Derek Bennett; Ronald E. Delanois; Khaled J. Saleh; Issada Thongtrangan; Michael Kuskowski; Edward Y. Cheng; Peter F. Sharkey; Javad Parvizi; James B. Stiehl; Michael A. Mont

2008-01-01

96

Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty  

PubMed Central

An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty. PMID:24944978

Shin, Young-Soo; Hwang, Yeok-Gu; Savale, Abhijit Prakash

2014-01-01

97

Internal Fixation Compared with Arthroplasty for Displaced Fractures of the Femoral Neck  

Microsoft Academic Search

Background: The optimal choice for the stabilization of displaced femoral neck fractures remains controversial, with al- ternatives including arthroplasty and internal fixation. Our objective was to determine the effect of arthroplasty (hemiar- throplasty, bipolar arthroplasty, and total hip arthroplasty), compared with that of internal fixation, on rates of mortality, revision, pain, function, operating time, and wound infection in patients with

MOHIT BHANDARI; P. J. DEVEREAUX; MARC F. S WIONTKOWSKI; PAUL TORNETTA III; WILLIAM OBREMSKEY; KENNETH J. KOVAL; SEAN NORK; SHEILA SPRAGUE; EMIL H. SCHEMITSCH; GORDON H. GUYATT

98

The Nordic Arthroplasty Register Association  

PubMed Central

Background and purpose The possibility of comparing results and of pooling the data has been limited for the Nordic arthroplasty registries, because of different registration systems and questionnaires. We have established a common Nordic database, in order to compare demographics and the results of total hip replacement surgery between countries. In addition, we plan to study results in patient groups in which the numbers are too small to be studied in the individual countries. Material and methods Primary total hip replacements (THRs) from 1995–2006 were selected for the study. Denmark, Sweden, and Norway contributed data. A common code set was made and Cox multiple regression, with adjustment for age, sex, and diagnosis was used to calculate prosthesis survival with any revision as endpoint. Results 280,201 operations were included (69,242 from Denmark, 140,821 from Sweden, and 70,138 from Norway). Females accounted for 60% of the patients in Denmark and Sweden, and 70% in Norway. Childhood disease was the cause of 3.1%, 1.8%, and 8.7% of the operations in Denmark, Sweden, and Norway, respectively. Resurfacing of hips accounted for 0.5% or less in all countries. The posterior approach was used in 91% of cases in Denmark, 60% in Sweden, and 24% in Norway. Cemented THRs were used in 46% of patients in Denmark, in 89% of patients in Sweden, and in 79% of patients in Norway. Of the 280,201 primary THRs, 9,596 (3.4%) had been revised. 10-year survival was 92% (95% CI: 91.6–92.4) in Denmark, 94% (95% CI: 93.6–94.1) in Sweden, and 93% (95% CI: 92.3–93.0) in Norway. In Denmark, 34% of the revisions were due to dislocation, as compared to 23% in Sweden and Norway. Replacement of only cup or liner constituted 44% of the revisions in Denmark, 29% in Sweden, and 33% in Norway. Interpretation This unique common Nordic collaboration has shown differences between the countries concerning demographics, prosthesis fixation, and survival. The large number of patients in this database significantly widens our horizons for future research. PMID:19513887

Fenstad, Anne M; Salomonsson, Roger; Mehnert, Frank; Furnes, Ove; Overgaard, Søren; Pedersen, Alma B; Herberts, Peter; Kärrholm, Johan; Garellick, Göran

2009-01-01

99

Early death following primary total hip arthroplasty.  

PubMed

This study aims to describe the timing, cause of death, and excess surgical mortality associated with primary total hip arthroplasty when compared to a population awaiting primary total hip arthroplasty. Mortality rates were calculated at cutoffs of 30 and 90 days post-operation or following the addition to the waiting list. Cause of death was recorded from the death certificate. An excess surgical mortality of 0.256% at 30 days (P = 0.002) and 0.025% at 90 days post-operation (P = 0.892), unaffected by age or gender, was seen with myocardial infarction and pneumonia the cause of death in the majority of cases. By using a more appropriate control population, an excess surgical mortality at 30 days post-operation is demonstrated; the effect diminishes at 90 days post-operation. PMID:24650899

Jones, Mark D; Parry, Michael C; Whitehouse, Michael R; Blom, Ashley W

2014-08-01

100

Postoperative Vision Loss after Reverse Shoulder Arthroplasty  

PubMed Central

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

Scadden, John

2014-01-01

101

Wagner resurfacing arthroplasty of the canine hip.  

PubMed

Twelve surface replacement arthroplasties were performed on the hips of ten mongrel dogs using scaled-down replicas of the Wagner prosthesis. The contralateral hips and two further animals served as nonoperated controls. Animals were killed 5 months postoperatively. Clinical, radiological, histological and fluorochrome-labelling studies were employed to assess the bony and soft tissue reaction to resurfacing arthroplasty. There was no clinical or radiographic evidence of prosthetic loosening. Histological examination disclosed a thick foreign body and chronic inflammatory membrane containing acrylic cement and polyethylene wear particles at the bone-cement interface of both components. Generally, the bone marrow and trabecula were viable. There was evidence of increased bony remodelling and new bone formation in the subchondral area. The similarity between the above findings and those of aseptic component loosening in man suggests a mechanism whereby wear debris initiate a biological foreign body reaction culminating in component loosening. PMID:3551879

Schatzker, J; Goodman, S B; Sumner-Smith, G; Fornasier, V L; Goften, N; Bell, R S

1987-01-01

102

Gap Junctions  

PubMed Central

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

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

2013-01-01

103

Dilemmas in Uncemented Total Hip Arthroplasty  

Microsoft Academic Search

In this thesis, different aspects that are related to the survivorship and clinical outcome in uncemented total hip arthroplasty are analysed. In Chapter 2, the survival rate, Harris Hip score and radiographic features of a proximally hydroxyapatite coated titanium alloy femoral stem (Bi-Metric, Biomet) was evaluated. In conclusion, at an average follow-up of 8 years, this proximally HA-coated femoral component

J. H. M. Goosen

2009-01-01

104

Metal on metal hip resurfacing arthroplasty  

Microsoft Academic Search

This paper explores the cost utility of metalon-metal hip resurfacing arthroplasty (MOM) as an alternative intervention to\\u000a total hip replacement or ‘watchful waiting’ for patients with advanced hip disease. Early implant failure among younger and\\u000a more active elderly patients can mean that the use of total hip replacement (THR) is delayed, with patients managed through\\u000a ‘watchful waiting’, a combination of

L. McKenzie; L. Vale; S. Stearns; K. McCormack

2003-01-01

105

Why Revision Total Hip Arthroplasty Fails  

Microsoft Academic Search

Current outcomes data on revision total hip arthroplasty focuses on specific implants and techniques rather than more general\\u000a outcomes. We therefore examined a large consecutive series of failed THAs undergoing revision to determine if survivorship\\u000a and modes of failure differ in comparison to the current data. We retrospectively reviewed the medical records of 1100 revision\\u000a THAs. The minimum followup was

Bryan D. Springer; Thomas K. Fehring; William L. Griffin; Susan M. Odum; John L. Masonis

2009-01-01

106

Lateral unicompartmental knee arthroplasty: a review  

Microsoft Academic Search

Lateral unicondylar knee arthroplasty (UKA) has been utilized as a treatment for isolated lateral tibiofemoral osteoarthritis\\u000a (OA) since the first description of UKA in the 1970s. To date, there remains some controversy on UKA procedures. As indications\\u000a for lateral UKA are usually rare, surgeon experience seems to be the key factor for a successful intervention. Better understanding\\u000a of biomechanics of

Thomas J. HeyseCarsten; Carsten O. Tibesku

2010-01-01

107

The Swedish Knee Arthroplasty Register: a review.  

PubMed

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

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

2014-07-01

108

Gender and Arthroplasty Type Affect Prevalence of Moderate-Severe Pain Post Total Hip Arthroplasty  

Microsoft Academic Search

Objective: To investigate the impact of gender, age and arthroplasty type (primary vs. revision) on prevalence of moderate-severe\\u000a hip pain.\\u000a \\u000a Methods: Using an Institutional Total Joint Registry, we identified a cohort of patients who underwent primary of revision\\u000a THA from 1996–2004 and responded to the follow-up questionnaires. We compared the prevalence of moderate or severe hip pain\\u000a based on arthroplasty

J. A. Singh; S. E. Gabriel; D. Lewallen

109

Sensitivity to implant materials in patients with total knee arthroplasties  

Microsoft Academic Search

Materials used for total knee arthroplasty (TKA), may elicit an immune response whose role in the outcome of the arthroplasty is still unclear. The aim of this study was to evaluate the frequency of sensitization in patients who had undergone TKA, and the clinical impact of this event on the outcome of the implant. Ninety-four subjects were recruited, including 20

Donatella Granchi; Elisabetta Cenni; Domenico Tigani; Giovanni Trisolino; Nicola Baldini; Armando Giunti

2008-01-01

110

Resurfacing knee arthroplasty in patients with allergic sensitivity to metals  

Microsoft Academic Search

Background. The problem of metal sensitivity (Ni, Cr, and Co) in arthroplasty is still unsolved. To prevent the risk of allergy in cases with proved metal allergy in an epicutaneous test, a Natural Knee total knee arthroplasty, made totally from titanium (Ti-6Al-4V) and polyethylene, can be implanted. The results of this device have to be compared to the results of

C. Pellengahr; W. Mayer; M. Maier; P. E. Müller; C. Schulz; H. R. Dürr; H. Trouillier; M. Steinborn; V. Jansson; H. J. Refior

2003-01-01

111

The radiographic appearances of allografts in total hip arthroplasty revisions  

Microsoft Academic Search

The aim of this study was to describe the radiographic appearances of femoral allografts in 29 total hip arthroplasty (THA) revision procedures among 21 patients. Each patient had evidence of severe bone loss in the proximal femur related to previous hip arthroplasty. Proximal femoral allografts and cortical strut allografts were used to supplement and reinforce the native femur. The radiographic

M. A. R. O'Reilly; S. V. Kattapuram; H. P. Chandler

1997-01-01

112

Total shoulder arthroplasty in patients with Parkinson's disease  

Microsoft Academic Search

Treatment of orthopaedic problems in patients with Parkinson's disease can be problematic and include failure of fixation or prosthetic dislocation. A study was undertaken to assess the outcome of total shoulder arthroplasty in this patient group. Fifteen patients with Parkinson's disease underwent 16 unconstrained shoulder arthroplasties. Thirteen of the patients had mild to moderate Parkinson's disease according to the Hoehn

Laurie D Koch; Robert H Cofield; J. Eric Ahlskog

1997-01-01

113

Total hip arthroplasty revision in elderly patients.  

PubMed

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

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

2013-10-01

114

Periprosthetic fractures around total knee arthroplasty  

PubMed Central

INTRODUCTION The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function. METHODS A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were ‘periprosthetic fracture(s)’, ‘femur’, ‘tibia’, ‘patella(r)’, ‘complication(s)’, ‘failure(s)’, ‘risk(s)’, ‘prevalence’, ‘incidence’, ‘epidemiology’ and ‘classification(s)’. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified. RESULTS Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement. CONCLUSIONS Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon. PMID:22943223

Sarmah, SS; Patel, S; Reading, G; El-Husseiny, M; Douglas, S; Haddad, FS

2012-01-01

115

Intestinal adaptation after ileal interposition surgery increases bile acid recycling and protects against obesity-related comorbidities.  

PubMed

Surgical interposition of distal ileum into the proximal jejunum is a bariatric procedure that improves the metabolic syndrome. Changes in intestinal and hepatic physiology after ileal interposition (transposition) surgery (IIS) are not well understood. Our aim was to elucidate the adaptation of the interposed ileum, which we hypothesized, would lead to early bile acid reabsorption in the interposed ileum, thus short circuiting enterohepatic bile acid recycling to more proximal bowel segments. Rats with diet-induced obesity were randomized to IIS, with 10 cm of ileum repositioned distal to the duodenum, or sham surgery. A subgroup of sham rats was pair-fed to IIS rats. Physiological parameters were measured until 6 wk postsurgery. IIS rats ate less and lost more weight for the first 2 wk postsurgery. At study completion, body weights were not different, but IIS rats had reversed components of the metabolic syndrome. The interposed ileal segment adapted to a more jejunum-like villi length, mucosal surface area, and GATA4/ILBP mRNA. The interposed segment retained capacity for bile acid reabsorption and anorectic hormone secretion with the presence of ASBT and glucagon-like-peptide-1-positive cells in the villi. IIS rats had reduced primary bile acid levels in the proximal intestinal tract and higher primary bile acid levels in the serum, suggesting an early and efficient reabsorption of primary bile acids. IIS rats also had increased taurine and glycine-conjugated serum bile acids and reduced fecal bile acid loss. There was decreased hepatic Cyp27A1 mRNA with no changes in hepatic FXR, SHP, or NTCP expression. IIS protects against the metabolic syndrome through short-circuiting enterohepatic bile acid recycling. There is early reabsorption of primary bile acids despite selective "jejunization" of the interposed ileal segment. Changes in serum bile acids or bile acid enterohepatic recycling may mediate the metabolic benefits seen after bariatric surgery. PMID:20595624

Kohli, Rohit; Kirby, Michelle; Setchell, Kenneth D R; Jha, Pinky; Klustaitis, Kori; Woollett, Laura A; Pfluger, Paul T; Balistreri, William F; Tso, Patrick; Jandacek, Ronald J; Woods, Stephen C; Heubi, James E; Tschoep, Matthias H; D'Alessio, David A; Shroyer, Noah F; Seeley, Randy J

2010-09-01

116

Unusual cases of pigmented villonodular synovitis after arthroplasty.  

PubMed

Pigmented Villonodular Synovitis (PVNS) is a relatively rare, benign proliferation lesion of the synovium of large joints. The etiology is varied and unclear. We had report a 79-year-old woman had PVNS after 14 years right hip arthroplasty with metal prosthesis. Here we report another 4 patients had PVNS after arthroplasty. The second one had PVNS in the 2(th) year after hip arthroplasty with bone cement prosthesis. The specimen was brown and like usual PVNS in tissue. The third case had PVNS in the 8(th) after arthroplasty with human bone prosthesis because of the recurrence of PVNS. The proliferated synovium became black from brown. There was brown and many groups black pigment in the tissue. The fourth one had PVNS in the 4(th) year after knee arthroplasty with polyethylene prosthesis. The specimen was yellow. There was no pigment in the tissue but multinucleated giant cells with unstained foreign body. The fifth patient had PVNS in the 10(th) month after the left hip arthroplasty with metal prosthesis. The macroscopy was yellow. There were hemosiderin particles in the tissue but black metal particles. This indicates that arthroplasty with prosthesis could cause some new disease or PVNS had new etiology with different pathological show. PMID:24955198

Ma, Xiao-Mei; Xia, Chun-Yan; Fu, Pei-Liang; Liu, Hui-Min; Yu, Hong-Yu; He, Jin

2014-01-01

117

Measured flexion following total knee arthroplasty.  

PubMed

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

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

2012-10-01

118

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

PubMed Central

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

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

2015-01-01

119

Dual mobility in total hip arthroplasty.  

PubMed

Dual-mobility articulations have shown promising results. Postoperative instability remains the most common reason for revision of a total hip arthroplasty (THA). Dual-mobility cups have been shown to decrease the rate of dislocation in primary THA and have been used to treat and prevent instability in revision THA. Greater range of motion and a greater head-to-neck ratio and a greater jump distance are achieved, resulting in a lower risk of instability. Concerns with dual-mobility cups include wear and intraprosthetic dislocation. Specific design modifications have aimed to improve cup fixation and decrease polyethylene wear and the risks of intraprosthetic dislocation. PMID:24267202

Plummer, Darren R; Haughom, Bryan D; Della Valle, Craig J

2014-01-01

120

Revision of the Sheehan total knee arthroplasty.  

PubMed

The use of the Sheehan knee prosthesis extended from 1971 to 2002. It incorporated a semi-constrained hinge with intra-medullary stems cemented into the femur and tibia. While some authors have reported excellent short-term results, others have reported revision rates of up to 31% at 5--10 years. The aim of this study was to review the senior author's experience in revising these arthroplasties. We review 54 Sheehan total knee replacements and discuss the difficulties encountered during first and subsequent revisions and the often-complex reconstruction techniques used to overcome these. PMID:15965689

Hurson, C; Boran, S; Synnott, K; Powell, O; Quinlan, W

2005-08-01

121

Total knee arthroplasty in patients with a previous patellectomy.  

PubMed

Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients. PMID:24151951

Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

2013-01-01

122

Knee joint stiffness and function following total knee arthroplasty   

E-print Network

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 ...

Lane, Judith

2010-01-01

123

Dual mobility cups in total hip arthroplasty.  

PubMed

Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France. Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity. In this article, we review the use of dual mobility cup in total hip arthroplasty in terms of its history, biomechanics, outcomes and complications based on more than 20 years of medical literature. PMID:25035820

De Martino, Ivan; Triantafyllopoulos, Georgios Konstantinos; Sculco, Peter Keyes; Sculco, Thomas Peter

2014-07-18

124

Complications of Medial Unicompartmental Knee Arthroplasty  

PubMed Central

Background We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA). Methods This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed. Results Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed. Conclusions The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required. PMID:25436058

Ji, Jong Hun; Park, Sang Eun; Song, In Soo; Kang, Hanvit; Ha, Ji Yoon

2014-01-01

125

Evaluating comorbidities in total hip and knee arthroplasty: available instruments  

Microsoft Academic Search

Each year millions of patients are treated for joint pain with total joint arthroplasty, and the numbers are expected to rise.\\u000a Comorbid disease is known to influence the outcome of total joint arthroplasty, and its documentation is therefore of utmost\\u000a importance in clinical evaluation of the individual patient as well as in research. In this paper, we examine the various

Kristian BjorgulWendy; Wendy M. Novicoff; Khaled J. Saleh

2010-01-01

126

Comprehensive gait analysis in posterior-stabilized knee arthroplasty  

Microsoft Academic Search

Sixteen patients implanted with a posterior-stabilized prosthesis (Insall-Burstein PS II, Zimmer, Warsaw, IN) and 32 age-matched control subjects were evaluated by isokinetic muscle testing and comprehensive gait analysis at a mean 46 months following the index arthroplasty. The contralateral knee was normal in 13 patients and an asymptomatic total knee arthroplasty in 3 patients. No significant differences (P > .05)

Stephen A. Wilson; Peter D. McCann; Robert S. Gotlin; H. K. Ramakrishnan; Mary E. Wootten; John N. Insall

1996-01-01

127

Achieving Deep Flexion After Primary Total Knee Arthroplasty  

Microsoft Academic Search

Total knee arthroplasty patients often have difficulty performing activities involving flexion beyond 130°. The NexGen LPS Flex (Zimmer Inc, Warsaw, Ind) mobile bearing implant accommodates up to 155° of flexion. Two hundred eighteen total knee arthroplasties were performed using this implant on 125 patients over a 2-year period with a minimum of 5 years follow-up. All data were collected prospectively.

Samih Tarabichi; Yasir Tarabichi; Marwan Hawari

2010-01-01

128

RETRACTED ARTICLE: Unicompartmental knee arthroplasty: a review of literature  

Microsoft Academic Search

There has been a resurgence of interest in unicompartmental knee arthroplasty (UKA) for treatment of medial unicompartmental\\u000a knee osteoarthritis (OA). Improved prosthetic design, minimally invasive surgical techniques, and strict patient selection\\u000a criteria have resulted in improved survivorship and functional outcomes. A review of orthopedic literature was conducted regarding\\u000a the advantages of UKA versus total knee arthroplasty (TKA), UKA indications, survivorship,

Bernardino Saccomanni

2010-01-01

129

Reversed shoulder arthroplasty in cuff tear arthritis, fracture sequelae, and revision arthroplasty  

PubMed Central

Background and purpose Reversed shoulder arthroplasty may be used for severe arthropathy where conventional prostheses cannot restore the function sufficiently. We analyzed the medium–term results and potential complications of the reversed prostheses, and also the influence of etiology on the result. Methods 52 women and 7 men, average age 70 (60–82) years, were followed for mean 4 (2–7) years. The indications were cuff tear arthropathy (CTA) (23), fracture sequelae (20), and revision of a failed conventional arthroplasty (16). Results The average Constant score improved from 18 (2–55) points to 59 (17–96) points. It rose from 26 to 74 points in patients with CTA, from 12 to 48 in those with fracture sequelae, and from 10 to 54 points in revision arthroplasty. We also found an overall improvement in active forward flexion from 47° to 105°, and in active abduction from 46° to 93°. Scapular notching was seen in 51 shoulders. Radiolucent lines below the base–plate were present in 2 cases. There were no instances of loosening. Revisions were necessary in 15 patients: 5 with infections (all had had prior surgery), 5 with hematoma, 3 with dislocations, and 2 with disconnections of the shaft components. Interpretation Reversed prosthetic replacement is a suitable method for restoring function and attaining pain relief in severe arthropathies. The results in revision arthroplasty are less predictable, with complications and revision rates higher than those in CTA patients. The reversed prosthesis should therefore only be used when conventional methods have failed. PMID:20450427

Stechel, Annika; Fuhrmann, Uwe; Rott, Olaf; Irlenbusch, Ulrich

2010-01-01

130

Dissociation of intestinal and hepatic activities of FXR and LXR? supports metabolic effects of terminal ileum interposition in rodents.  

PubMed

The farnesoid X receptor (FXR) and the liver x receptors (LXRs) are bile acid-activated receptors that are highly expressed in the enterohepatic tissues. The mechanisms that support the beneficial effects of bariatric surgery are only partially defined. We have investigated the effects of ileal interposition (IT), a surgical relocation of the distal ileum into the proximal jejunum, on FXR and LXRs in rats. Seven months after surgery, blood concentrations of total bile acids, taurocholic acid, an FXR ligand, and taurohyocholic acid, an LXR? ligand, were significantly increased by IT (P < 0.05). In contrast, liver and intestinal concentrations of conjugated and nonconjugated bile acids were decreased (P < 0.05). These changes were associated with a robust induction of FXR and FXR-regulated genes in the intestine, including Fgf15, a negative regulator of bile acid synthesis. IT repressed the liver expression of glucose-6-phosphatase (G6PC) and phosphoenolpyruvate carboxykinase (Pepck), two gluconeogenetic genes, along with the expression of LXR? and its target genes sterol regulatory element-binding protein (Srebp) 1c and fatty acid synthase (Fas) in the liver. Treating IT rats with chenodeoxycholic acid ameliorated insulin signaling in the liver. Whether confirmed in human settings, these results support the association of pharmacological therapies with bariatric surgeries to exploit the selective activation of intestinal nuclear receptors. PMID:23835330

Mencarelli, Andrea; Renga, Barbara; D'Amore, Claudio; Santorelli, Chiara; Graziosi, Luigina; Bruno, Angela; Monti, Maria Chiara; Distrutti, Eleonora; Cipriani, Sabrina; Donini, Annibale; Fiorucci, Stefano

2013-10-01

131

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

PubMed Central

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

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

2014-01-01

132

Dissociation of Intestinal and Hepatic Activities of FXR and LXR? Supports Metabolic Effects of Terminal Ileum Interposition in Rodents  

PubMed Central

The farnesoid X receptor (FXR) and the liver x receptors (LXRs) are bile acid–activated receptors that are highly expressed in the enterohepatic tissues. The mechanisms that support the beneficial effects of bariatric surgery are only partially defined. We have investigated the effects of ileal interposition (IT), a surgical relocation of the distal ileum into the proximal jejunum, on FXR and LXRs in rats. Seven months after surgery, blood concentrations of total bile acids, taurocholic acid, an FXR ligand, and taurohyocholic acid, an LXR? ligand, were significantly increased by IT (P < 0.05). In contrast, liver and intestinal concentrations of conjugated and nonconjugated bile acids were decreased (P < 0.05). These changes were associated with a robust induction of FXR and FXR-regulated genes in the intestine, including Fgf15, a negative regulator of bile acid synthesis. IT repressed the liver expression of glucose-6-phosphatase (G6PC) and phosphoenolpyruvate carboxykinase (Pepck), two gluconeogenetic genes, along with the expression of LXR? and its target genes sterol regulatory element-binding protein (Srebp) 1c and fatty acid synthase (Fas) in the liver. Treating IT rats with chenodeoxycholic acid ameliorated insulin signaling in the liver. Whether confirmed in human settings, these results support the association of pharmacological therapies with bariatric surgeries to exploit the selective activation of intestinal nuclear receptors. PMID:23835330

Mencarelli, Andrea; Renga, Barbara; D’Amore, Claudio; Santorelli, Chiara; Graziosi, Luigina; Bruno, Angela; Monti, Maria Chiara; Distrutti, Eleonora; Cipriani, Sabrina; Donini, Annibale; Fiorucci, Stefano

2013-01-01

133

Revision total hip arthroplasty due to pain from hypersensitivity to cobalt-chromium in total hip arthroplasty.  

PubMed

We report a case with hypersensitivity to CoCr in total hip arthroplasty coupled with conventional polyethylene and CoCr femoral head. The patient complained of left hip pain and systemic fever, and computed tomography imaging revealed a periprosthetic cystic lesion, so we performed revision total hip arthroplasty using a titanium stem and ceramic head and highly crosslinked polyethylene. Hip pain and cystic lesion disappeared 3 years after revision surgery. PMID:21130600

Kosukegawa, Ima; Nagoya, Satoshi; Kaya, Mitsunori; Sasaki, Koichi; Sasaki, Mikito; Yamashita, Toshihiko

2011-09-01

134

Health-related quality of life in veterans with prevalent total knee arthroplasty and total hip arthroplasty  

Microsoft Academic Search

Objective. To study the HRQOL in veterans with prevalent total knee arthroplasty (TKA) or total hip arthroplasty (THA) and compare them with age- and gender-matched US population and control veteran population without these procedures. Methods. A cohort study and cross-sectional survey on veterans obtained demographics and HRQOL with Short-Form 36 for veterans (SF- 36V). Veterans were categorized into: primary TKA;

J. A. Singh; J. A. Sloan

2008-01-01

135

In vivo patellar kinematics during total knee arthroplasty.  

PubMed

Patellar maltracking after total knee arthroplasty often results in complications, including anterior knee pain, instability and impingement, and is therefore better resolved intraoperatively. Many factors can affect patellar kinematics during knee replacement, including component position, implant design, joint alignment, and soft tissue tensions. However, to our knowledge, the impact of arthroplasty on patellar kinematics has not been previously reported in vivo. A computer-assisted surgery (CAS) system was developed to measure the pre-arthroplasty patellar kinematics, display the distance between this path and the surface of the planned femoral component, and compare the post-arthroplasty path to the pre-arthroplasty path. Three surgeons from three centers used this CAS system to measure the in vivo pre- and post-arthroplasty kinematics of 18 patients. There was a small, but consistent, proximal shift in the tibial joint lines (mean: 4.2 mm), resulting in pseudo patella-baja, i.e., relatively more distal contact of the patella on the femoral component. This led to significant changes in proximodistal and anteroposterior patellar positioning as well as patellar flexion following arthroplasty (p < 0.008). Mediolateral shift, tilt and internal/external spin had the greatest magnitudes of change (mean: 4.1 mm, 4.6 degrees and 4.6 degrees, respectively) relative to their mean pre-arthroplasty ranges (averaging 2.1 mm, 5.8 degrees and 5.8 degrees, respectively); however, these changes were distributed almost equally medially and laterally, indicating no surgical bias in any one direction. Female patients had more lateral tilt on average than male patients throughout flexion (p < 0.004 post-arthroplasty, p < 0.03 pre-arthroplasty, in later flexion), as well as other kinematic differences; there may therefore be potential for improving overall kinematic results by focusing on gender differences during research, design and surgery. This study demonstrated the feasibility of using a CAS system to measure patellofemoral kinematics. Intraoperative awareness of patellar tracking, including knowledge of the tibiofemoral joint line, could have an impact on the surgical plan and thereby improve the postoperative outcome. PMID:19085237

Anglin, Carolyn; Ho, Karen C T; Briard, Jean-Louis; de Lambilly, Charles; Plaskos, Christopher; Nodwell, Eric; Stindel, Eric

2008-11-01

136

[CT and MRI of hip arthroplasty].  

PubMed

Metal-induced artifacts impair image quality of computed tomography (CT) and magnetic resonance imaging (MRI) in patients with hip prostheses. Due to new developments in metal artifact reduction both methods can now be used for evaluation of a painful hip prosthesis. Iterative reconstruction algorithms and dual-energy scans are among the newer CT techniques for artifact reduction, while slice-encoding for metal artifact correction (SEMAC) and multi-acquisition variable-resonance image combination (MAVRIC) have introduced substantial improvements for MRI. Loosening of the hip prosthesis, osteolysis from small wear particles and pseudotumors in metal-on-metal prostheses are specific pathologies in patients with total hip arthroplasty. Other causes of painful hip prostheses are infections, fractures, tendinopathies, tendon ruptures, muscle and nerve alterations and heterotopic ossifications. PMID:24973123

Agten, C A; Sutter, R; Pfirrmann, C W A

2014-07-01

137

Robotic-assisted unicompartmental knee arthroplasty.  

PubMed

In recent years, development of computer graphics and haptic feedback technology enabled the use of virtual reality. Virtual reality provides the opportunity to combine 3D visual imagery with interactivity, visual, and tactile realism. Robotic-assisted orthopedic surgery is defined as the use of computers and robotic technology to assist the orthopedist in providing musculoskeletal care, in which machine has the capability of precision and accuracy. Robotic-assisted orthopedic surgery is used in simulating diagnosis, preoperative and intraoperative planning, and actual surgery. One of the main areas for computer-assisted surgical applications is unicompartmental or bicompartmental knee arthroplasty, in which the clinical efficacy is improved by providing enhanced component positioning with dynamic ligament balancing. PMID:25370877

Tamam, Cuneyt; Poehling, Gary G

2014-12-01

138

Revision of total hip arthroplasty in octogenarians.  

PubMed

Twenty-seven revision total hip arthroplasties were performed in patients who were at least eighty years old. The average duration of follow-up was five years. There were no perioperative deaths, and only 11 per cent (three) of the patients had a major complication; all of the complications resolved. The only re-revision was the placement of an extended lip-liner for the treatment of recurrent dislocation. Of the twenty-five patients who were alive at the time of the most recent follow-up or who had been survived by a family member who could be interviewed, twenty-one (84 per cent) said that the operation had improved function, twenty-three (92 per cent) had less pain, and twenty-two (88 per cent) were satisfied with the result. PMID:7713976

Ballard, W T; Callaghan, J J; Johnston, R C

1995-04-01

139

[Sir John Charnley and total hip arthroplasty].  

PubMed

Sir John Charnley (1911-1982), pioneer of the total hip prosthesis, saved countless elderly people from immobility. During the Second World War he assisted Dudley Buxton, orthopaedic surgeon to the British armed forces in the Middle East, in developing new instruments and splints. After the war he first studied healing of bone fractures and the role of compression, and then completely dedicated himself to arthroplasty of the hip. Through countless experiments he found the optimal diameter for the head of the stainless steel prosthesis as well as the optimal polymer for the socket; he also advocated tight cementing of the shaft into the femur. Sir John Charnley received the Lasker Award in 1974 and was knighted in 1977. PMID:21939571

Burgers, Paul T P W; van Gijn, Jan

2011-01-01

140

Outcomes of primary total joint arthroplasty after lung transplantation.  

PubMed

Lung transplantation is increasingly common with improving survival rates. Post-transplant patients can be expected to seek total hip (THA) and knee arthroplasty (TKA) to improve their quality of life. Outcomes of 20 primary total joint arthroplasties (15 THA, 5 TKA) in 14 patients with lung transplantation were reviewed. Clinical follow-up time averaged 27.5 and 42.8 months for THA and TKA respectively. Arthroplasty indications included osteonecrosis, osteoarthritis, and fracture. All patients subjectively reported good or excellent outcomes with a final average Harris Hip Score of 88.7, Knee Society objective and functional score of 92.0. There were 4 minor and 1 major acute perioperative complications. 1 late TKA infection was successfully treated with two-stage revision. The mortality rate was 28.5% (4/14 patients) at an average 20.6 months following but unrelated to arthroplasty. Overall, total joint arthroplasty can be safely performed and provide good functional outcomes in lung transplant recipients. PMID:23642450

Ledford, Cameron K; Watters, Tyler Steven; Wellman, Samuel S; Attarian, David E; Bolognesi, Michael P

2014-01-01

141

Hip arthroplasty for failed treatment of proximal femoral fractures.  

PubMed

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

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

2010-10-01

142

Cervical arthroplasty: the beginning, the middle, the end?  

PubMed

Cervical arthroplasty has developed as an alternative to spinal fusion for the treatment of cervical radiculopathy and myelopathy. The popularity of artificial discs has grown as the evidence of complications following arthrodesis has increased, making the theoretical advantages (motion preservation, altering the natural history of disease, prevention of adjacent segment disease) of disc replacement more attractive. However, as more discs are implanted and the length of follow-up increases, reported complications such as heterotopic ossification, device migration and spontaneous fusion of arthroplasty devices are growing. As a result, surgeons and patients face a challenge when deciding between motion-preserving or fusion surgery. Currently, there is inadequate evidence to promote extensive use of artificial discs for cervical spondylosis, despite promising short-term and intermediate clinical outcomes. However, there is also insufficient evidence to cease using them completely. The use of arthroplasty over fusion in the long term can only be justified if the incidence of adjacent segment disease decreases as a result. Despite the level of investment and research into arthroplasty outcomes, long-term follow-up has yet to be completed and has not convincingly demonstrated the effect of artificial discs on adjacent segment disease. Further long-term randomised trials are necessary to determine whether cervical arthroplasty is able to reduce the incidence of adjacent segment disease and, in doing so, replace arthrodesis as the gold standard treatment for cervical spondylosis. PMID:21815734

Richards, O; Choi, D; Timothy, J

2012-02-01

143

computational group theory with GAP 1 GAP in Sage  

E-print Network

computational group theory with GAP 1 GAP in Sage the GAP system combinatorics and list 2013 1 / 44 #12;computational group theory with GAP 1 GAP in Sage the GAP system combinatorics and list explicitly in Sage via 1 the class Gap, do help(gap); or 2 opening a Terminal Session with GAP, type gap

Verschelde, Jan

144

[Early clinical and radiological results following cervical disc arthroplasty].  

PubMed

The aim of this study was to assess early results of anterior cervical decompression and arthroplasty for cervical disc disease. The results of operations of 32 patients (43 instrumented levels) were examined to assess clinical outcome, the restoration of disc height, postoperative lordosis, mobility of instrumented segment and complication rate. Clinical outcome evaluated with VAS score improved from 7.5 preoperatively to 2.7 post operation. There was improvement in disc height measured by Tureyen method of 48%, 5 degree restoration of lordosis per segment and average 5 degree mobility of operated segment. In two cases spontaneous fusion occurred. There were no loosening of prosthesis observed. Overall the study shows that early results of arthroplasty are clinically efficient and safe as fusion. Assessment of biomechanical advantages of arthroplasty demands further observation to compare if long-term results are superior to fusion. PMID:18092697

Pa?ciak, Marek; Wadek, Tomasz; Widuchowski, Jerzy; Grzywocz, Jerzy; Werner, Krystian; Swiderski, Micha?

2007-01-01

145

Early Postoperative Mortality Following Joint Arthroplasty: A Systematic Review  

PubMed Central

Objective To perform a systematic review of 30- and 90-day mortality rates in patients undergoing hip or knee arthroplasties. Methods Five databases were searched for English-language studies of mortality in hip or knee arthroplasties and the following data were extracted: patient characteristics (age, gender, ethnicity), arthroplasty characteristics (unilateral vs bilateral, hip vs knee), system factors (hospital volume and surgeon volume), year of study, etc… Mortality rates were compared across variable categories; proportions were compared using relative risk ratios and 95% confidence intervals. Results Out of 650 titles and abstracts, 80 studies qualified for data inclusion. 35%, 34% and 31% studies provided 30-, 90- and >90-day mortality rates. Overall 30-day mortality rates published across all types of arthroplasties were 0.3%, 90-day: 0.7%. For those reports with specific rates, 30-day mortality was significantly higher in men than women (1.8% vs 0.4%; relative risk (RR): 3.93, 95% confidence interval (CI), 3.30–4.68) and bilateral vs unilateral procedures (0.5% vs 0.3%; RR, 1.6, 95% CI:1.49–1.72), but no differences were noted by the underlying diagnosis of osteoarthritis vs rheumatoid arthritis (0.4% vs 0.3%; RR 0.77, 95% CI:0.48–1.24). 90-day mortality showed non-significant trends favoring women, osteoarthritis as the underlying diagnosis, and unilateral procedures. Conclusions Several demographic and surgical factors were associated with higher 30-day mortality rates following knee and hip arthroplasties. More studies are needed to examine the effect of body mass index, comorbidities, and other modifiable factors, in order to identify interventions designed to lower mortality rates following arthroplasty procedures. PMID:21724724

Singh, Jasvinder A; Kundukulam, Joseph; Riddle, Daniel L.; Strand, Vibeke; Tugwell, Peter

2014-01-01

146

Measuring Tools for Functional Outcomes in Total Knee Arthroplasty  

Microsoft Academic Search

Total knee arthroplasty has come under increasing scrutiny attributable to the fact that it is a high-volume, high-cost medical\\u000a intervention in an era of increasingly scarce medical resources. Health-related quality-of-life outcomes have been developed\\u000a such that healthcare providers might determine how good an intervention is and whether it is cost-effective. Total knee arthroplasty\\u000a has been subjected to disease-specific, patient-specific, global

Robert B. Bourne

2008-01-01

147

Arthroscopic lysis of adhesions for the stiff total knee arthroplasty.  

PubMed

The management of the stiff knee after total knee arthroplasty is controversial. Manipulation under anesthesia and open lysis of adhesions are techniques that can theoretically address the fibrous scar tissue, but their efficacy has been shown to be variable. We describe the technique of arthroscopic lysis of adhesions for the stiff knee after total knee arthroplasty. The advantages of this technique include minimally invasive debridement of scar tissue within defined compartments of the knee and evaluation for the presence and treatment of focal lesions (e.g., loose bodies or impinging synovial or soft tissue). The total arc of motion can be improved with a systematic arthroscopic approach. PMID:25473616

Enad, Jerome G

2014-10-01

148

Nucleus disc arthroplasty with the NUBAC™ device: 2-year clinical experience.  

PubMed

Low back pain (LBP) due to degenerative disc disease (DDD) is a common condition that can be treated along a continuum of care: from conservative therapies to several surgical choices. Nucleus arthroplasty is an emerging technology that could potentially fill part of the gap in the spine continuum of care. The introduction of recent technologies that allow the replacement of the degenerated disc nucleus using prosthetic devices may be considered an additional therapeutic tool that can be used by the surgeon in selected cases of LBP due to DDD. Nucleus arthroplasties are designed to treat early stages of DDD, which are one of the most common spinal disorders in the population under 65 years of age. NUBAC™ is the first articulating nucleus disc prosthesis, designed to optimally respect the lumbar anatomy, kinematics, and biomechanics, constructed in unique two-piece manufactured from polyetheretherketone (PEEK) with an inner ball/socket articulation. The optimal indications for NUBAC™ implantation are: disc height >5 mm, degenerative disc changes at an early stage (Pfirmann 2, 3), single level affection, integrity of posterior facet joints, lack of local anatomical contraindication, failure of conservative treatment for at least 6 months. From December 2006 to January 2009, a total of 39 patients underwent nucleus disc arthroplasty with NUBAC™ device. 22 cases have 2-year follow up. There have been no major intra-operative or post-operative vascular or neurological complications in this series. The data showed that there were significant decreases in both Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) after the procedure, with a meaningful improvement of symptoms in all patients. Although preliminary, the initial results are encouraging. The absence of any major intra-operative and post-operative complications supports the design rationale of the NUBAC™, being less invasive comparing to total disc replacement (TDA) and with a low rate of surgical risk. The effectiveness of data as seen in 2-year follow-up on both VAS and ODI have also suggested that the NUBAC™ could be considered a viable treatment option for patients with LBP caused by DDD. PMID:21416380

Balsano, M; Zachos, A; Ruggiu, A; Barca, F; Tranquilli-Leali, P; Doria, C

2011-05-01

149

Patellar malalignment treatment in total knee arthroplasty  

PubMed Central

Summary The patella, with or without resurfacing, plays a fundamental role in the success of a total knee arthroplasty (TKA). Patellofemoral joint complications are due to problems related to the patient, to the surgical technique, or to the design of the components. Patellar tracking is influenced by several factors: a severe preoperative valgus, the presence of pre-existing patellofemoral dysplasia, the design of the femoral component, the surgical approach, the Q angle, the mechanical alignment of the limb, the tightness of the lateral retinaculum, the positioning of the patellar component in the proximal-distal and medial-lateral directions, the patella height, the patella (native or resurfaced) thickness, the size of the femoral and the tibial components, and the alignment and rotation of the components. Several factors are crucial to prevent patellar maltracking in TKA: the use of an anatomical femoral component, a meticulous surgical technique, careful dynamic intraoperative assessment of patellar tracking, and, if necessary, the achievement of an adequate lateral release.

Gasparini, Giorgio; Familiari, Filippo; Ranuccio, Francesco

2013-01-01

150

Emerging technologies in arthroplasty: additive manufacturing.  

PubMed

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

Banerjee, Samik; Kulesha, Gene; Kester, Mark; Mont, Michael A

2014-06-01

151

Biomechanics of the Birmingham hip resurfacing arthroplasty.  

PubMed

The effects of the method of fixation and interface conditions on the biomechanics of the femoral component of the Birmingham hip resurfacing arthroplasty were examined using a highly detailed three-dimensional computer model of the hip. Stresses and strains in the proximal femur were compared for the natural femur and for the femur resurfaced with the Birmingham hip resurfacing. A comparison of cemented versus uncemented fixation showed no advantage of either with regard to bone loading. When the Birmingham hip resurfacing femoral component was fixed to bone, proximal femoral stresses and strains were non-physiological. Bone resorption was predicted in the inferomedial and superolateral bone within the Birmingham hip resurfacing shell. Resorption was limited to the superolateral region when the stem was not fixed. The increased bone strain observed adjacent to the distal stem should stimulate an increase in bone density at that location. The remodelling of bone seen during revision of failed Birmingham hip resurfacing implants appears to be consistent with the predictions of our finite element analysis. PMID:16877617

Ong, K L; Kurtz, S M; Manley, M T; Rushton, N; Mohammed, N A; Field, R E

2006-08-01

152

Metal-on-Metal Total Hip Resurfacing Arthroplasty  

PubMed Central

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

2006-01-01

153

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

Microsoft Academic Search

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

Juul Achten; Nick R Parsons; Richard P Edlin; Damian R Griffin; Matthew L Costa

2010-01-01

154

Exeter total hip arthroplasty with matte or polished stems  

Microsoft Academic Search

Summary. Objective. To compare implant survival rates after total hip arthroplasty with Exeter matte or polished stems and to determine the relationship of synovitis\\/joint effusion to signs of implant loosening and stem type. Material and methods. The first part of the study included retrospective revision rate analysis of 118 primary hip replacements performed during 1991-1995. Two different designs of Exeter

Alfredas Smailys; Uldis Kesteris; Romas Jonas Kalesinskas; Hans Wingstrand

155

A Cost-effectiveness Analysis of Total Hip Arthroplasty  

E-print Network

-adjusted life expectancy (QALE) associated with total hip arthroplasty (THA) for persons with functionally outcomes and costs of THA and nonoperative managements. Main Outcome Measures.\\p=m-\\Amodified four. These functional classes were assigned utility values to allow the relative effectiveness of THA to be expressed

Hazen, Gordon

156

Rapid recovery after Oxford unicompartmental arthroplasty through a short incision  

Microsoft Academic Search

Forty Oxford medial unicompartmental arthroplasties (UCAs) were performed through a short incision medial to the patellar tendon, without dislocation of the patella, using updated instruments (Oxford Knee Phase III, Biomet Ltd., Bridgend, UK). The rate of recovery of these knees (measured by the time taken to achieve straight-leg raising, 70° of flexion, and independent stair climbing) was compared with that

A. J. Price; J. Webb; H. Topf; C. A. F. Dodd; J. W. Goodfellow; D. W. Murray

2001-01-01

157

CLINICAL RESEARCH Does A Kinematically Aligned Total Knee Arthroplasty Restore  

E-print Network

CLINICAL RESEARCH Does A Kinematically Aligned Total Knee Arthroplasty Restore Function Without or prearthritic joint lines of the knee. However, aligning the components to the joint lines of the normal knee and the incidence of catastrophic failure were different when the tibial component, knee, and limb alignment were

Hull, Maury

158

Total knee arthroplasty implanted with and without kinematic navigation  

Microsoft Academic Search

Between September 2000 and February 2002 we inserted 120 total knee arthroplasties. In 60 patients we used the standard technique, and in 60 patients we used the OrthoPilot navigation system. Postoperatively all patients had standing long radiographs of the lower extremity from the hip joint to the ankle. We considered the ideal value of the anatomic lateral tibiofemoral angle (LTFA)

R. Hart; M. Janecek; A. Chaker; P. Bucek

2003-01-01

159

Early and Late Manipulation Improve Flexion After Total Knee Arthroplasty  

Microsoft Academic Search

Manipulations have been considered effective only in the early postoperative period. From a total joint registry containing 9640 primary total knee arthroplasties (TKAs), 195 patients who underwent manipulation under anesthesia (MUA) were identified. A total of 102 had MUA within 90 days (early), and 93 more than 90 days (late) after TKA. Average pain (10-point scale), satisfaction (10-point scale), flexion

Robert S. Namba; Maria Inacio

2007-01-01

160

Total knee arthroplasty after ipsilateral peripheral arterial bypass graft  

Microsoft Academic Search

A retrospective review was done of the total joint registry at the Mayo Clinic, Rochester, Minnesota, which contains the computerized records of 19,808 consecutive total knee arthroplasties (TKAs) including primary and revision that were performed from 1970 to 1997. From that database, 9 patients were found to have had a TKA after an ipsilateral peripheral arterial reconstruction. One patient had

Norman S. Turner; Mark W. Pagnano; Franklin H. Sim

2001-01-01

161

Short-Term Coagulation Complications Following Total Knee Arthroplasty  

Microsoft Academic Search

Data from 3278 patients from a prospective patient-centered total joint registry was used to investigate the rates of complications in the first 6 months following primary total knee arthroplasty. All patients reporting deep venous thrombosis (DVT), pulmonary embolism (PE), or major bleeding were identified through patient self-reporting. Complications were verified by a review of imaging records and direct communication with

Craig H. Dushey; Lindsey J. Bornstein; Michael M. Alexiades; Geoffrey H. Westrich

2011-01-01

162

Importance of Attenuating Quadriceps Activation Deficits after Total Knee Arthroplasty  

PubMed Central

Total knee arthroplasty (TKA) is associated with persistent quadriceps dysfunction. Since quadriceps dysfunction impairs functional performance, minimizing quadriceps dysfunction by attenuating central activation deficits early after surgery may improve function later in life. Rehabilitation strategies incorporating neuromuscular electrical stimulation and early, aggressive quadriceps strengthening may prove beneficial. Further, surgical approaches such as minimally invasive TKA may minimize post-operative quadriceps dysfunction. PMID:22249398

Thomas, Abbey C.; Stevens-Lapsley, Jennifer E.

2012-01-01

163

Mycobacterium bovis infection of total hip arthroplasty after intravesicular bacille Calmette-Guérin therapy.  

PubMed

Bacille Calmette-Guérin (BCG) is a live, attenuated strain of Mycobacterium bovis. Intravesicular BCG therapy is the most effective treatment for superficial bladder cancer. The most common complication of this treatment is cystitis; there is a wide range of other complications. The English-language literature includes reports of 3 total hip arthroplasty infections and 1 total knee arthroplasty infection with M bovis after BCG therapy. These secondary infections may present either acutely during the therapy, months, or even years later. In this article, we report the case of a patient who presented with a painful right hip 6 years after successful total hip arthroplasty and 3 years after treatment for bladder cancer. Left total hip arthroplasty was performed 2 years after right hip arthroplasty. Surgeons examining a painful joint arthroplasty should be particularly suspicious of infection if the patient has a history of BCG therapy. PMID:22263218

Srivastava, Ajay; Ostrander, James; Martin, Sidney; Walter, Norman

2011-11-01

164

Periprosthetic Bone Remodelling in Total Knee Arthroplasty  

PubMed Central

ABSTRACT 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

GEORGEANU, Vlad; ATASIEI, Tudor; GRUIONU, Lucian

2014-01-01

165

Total knee arthroplasty in elderly osteoporotic patients.  

PubMed

Often in daily practice the choice of a prosthesis does not rise out of considerations about literature evidences, but it seems to be related to the personal experience and "surgical philosophy" of surgeon. The choice of prosthesis in total joint replacement is usually justified by biological and mechanical parameters that the surgeon considers before surgery. Osteoporosis is a disease characterized by a reduced bone mass and a degeneration of the bone tissue; it leads to bone fragility, so to a higher risk of fractures. Bone resistance, as all the changes in the microarchitecture of the bone tissue, is linked to bone density. Because of the bone density variation and/or the changes in the bone micro-architecture, as the bone strength decreases, the risk of fractures increases. It is important to understand all the factors taking part in both normal and abnormal bone remodelling. Osteoporosis does not imply a concrete bone loss, but a change of the bone micro-architecture itself. In these cases the choice of the patient and implant design are very important. In the period between March 1997-July 2002, we implanted 100 consecutive TKA (total knee arthroplasty) Genesis II in 97 subjects (79 female); mean age was 77.1 years old. All TKA were performed because of primary osteoarthritis of the knee. All patients had complete pain relief and excellent knee score. The surgical and medical complications were in accordance with the published literature. We must consider all existing medical conditions, the state of the knee and local needs of the elderly patient. Thus, within these limits, the total knee can improve the ability of patients to manage the activities of daily living and improve their quality of life. PMID:21970933

Spinarelli, Antonio; Petrera, Massimo; Vicenti, Giovanni; Pesce, Vito; Patella, Vittorio

2011-04-01

166

Future Bearing Surfaces in Total Hip Arthroplasty  

PubMed Central

One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom implant longevity is paramount. Even though various new bearing surfaces have been investigated, research is still ongoing, and only short-term results have been reported from clinical trials. Future bearing surfaces can be developed in the following ways: (1) change in design, (2) further improvement of polyethylene, (3) surface modification of the metal, (4) improvement in the ceramic, and (5) use of alternative, new materials. One way to reduce wear and impingement in THA is to make changes in its design by using a large femoral head, a monobloc metal shell with preassembled ceramic liner, dual mobility cups, a combination of different bearing surfaces, etc. Polyethylene has improved over time with the development of highly crosslinked polyethylene. Further improvements can be made by reinforcing it with vitamin E or multiwalled carbon nanotubes and by performing a surface modification with a biomembrane. Surface modifications with titanium nitride or titanium niobium nitride are implemented to try to improve the metal bearings. The advance to the fourth generation ceramics has shown relatively promising results, even in young patients. Nevertheless, further improvement is required to reduce fragility and squeaking. Alternative materials like diamond coatings on surfaces, carbon based composite materials, oxidized zirconium, silicon nitride, and sapphire are being sought. However, long-term studies are necessary to confirm the efficacy of these surfaces after enhancements have been made with regard to fixation technique and implant quality. PMID:24605198

2014-01-01

167

Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from The Swedish Knee Arthroplasty Registry.  

PubMed

The Swedish Knee Arthroplasty Registry (SKAR) has recorded knee arthroplasties prospectively in Sweden since 1975. The only outcome measure available to date has been revision status. While questionnaires on health outcome may function as more comprehensive endpoints, it is unclear which are the most appropriate. We tested various outcome questionnaires in order to determine which is the best for patients who have had knee arthroplasty as applied in a cross-sectional, discriminative, postal survey. Four general health questionnaires (NHP, SF-12, SF-36 and SIP) and three disease/site-specific questionnaires (Lequesne, Oxford-12, and WOMAC) were tested on 3600 patients randomly selected from the SKAR. Differences were found between questionnaires in response rate, time required for completion, the need for assistance, the efficiency of completion, the validity of the content and the reliability. The mean overall ranks for each questionnaire were generated. The SF-12 ranked the best for the general health, and the Oxford-12 for the disease/site-specific questionnaires. These two questionnaires could therefore be recommended as the most appropriate for use with a large knee arthroplasty database in a cross-sectional population. PMID:11341416

Dunbar, M J; Robertsson, O; Ryd, L; Lidgren, L

2001-04-01

168

Impact of Cost Reduction Programs on Short-Term Patient Outcome and Hospital Cost of Total Knee Arthroplasty  

Microsoft Academic Search

Background: During the 1990s, cost reduction programs were developed to decrease the hospital cost of total knee arthroplasty. The purpose of this study was to evaluate the impact of hospital cost reduction programs for total knee arthroplasty on patient outcome at our hospital. Methods: We evaluated 159 patients who had undergone unilateral primary total knee arthroplasty for the treatment of

WILLIAM L. HEALY; RICHARD IORIO; JOHN KO; DAVID APPLEBY; DAVID W. L EMOS

169

POMEN UVEDBE REGISTRA TOTALNE ENDOPROTETIKE V SLOVENIJI (RETEPS) IMPORTANCE OF FOUNDATION OF THE NATIONAL TOTAL JOINT ARTHROPLASTY REGISTRY  

Microsoft Academic Search

Background. Total arthroplasty is one of the most interesting and fast developing fields in orthopaedic surgery. Practicaly every joint in the human body is involved with total hip arthroplasties being the most frequent and with the longest history. The major complication of total arthroplasty is aseptic loosening of one or both prosthetic components. Revision procedures are very difficult due to

Ingrid Milošev

170

Metal-on-Metal Hip Resurfacing Arthroplasty  

PubMed Central

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

Sehatzadeh, S; Kaulback, K; Levin, L

2012-01-01

171

Total patellar skin loss from cryotherapy after total knee arthroplasty.  

PubMed

The use of cryotherapy after total knee arthroplasty is a very common therapeutic adjunct accepted as routine postoperative care. We present 2 cases of total patellar skin loss due to cryotherapy after total knee arthroplasty. Substantial soft tissue defects were created after the initial debridement of the necrotic tissue. Both patients were evaluated for frostbite, and the wounds were sharply debrided. Application of an advanced wound management technique involves the use of a collagen-glycosaminoglycan biodegradable bilayer matrix, silver impregnated antimicrobial dressing, and low-pressure vacuum device, followed by delayed split thickness skin grafting and low-pressure vacuum device. We find that this technique provided durable soft tissue coverage for necrotic wounds of the knee that do not involve the joint capsule. PMID:22749659

Dundon, John M; Rymer, Michael C; Johnson, Ron M

2013-02-01

172

Dual-mobility acetabular components in total hip arthroplasty.  

PubMed

With dislocation being one of the most serious complications of total hip arthroplasty, prevention of recurrent instability has been the driving force behind several implant designs, including large-diameter heads, metal-on-metal bearing surfaces, and constrained acetabular components. Dual-articulation acetabular component design was similarly conceived in an effort to reduce postoperative dislocation risk. This design, developed in France in 1975 and popularized in Europe, was recently approved in the United States and represents a new surgical option for United States orthopedic surgeons performing total hip arthroplasty. In this article, we review the dual-articulation design in terms of its history, biomechanical concepts, published indications, contraindications, outcomes, and complications based on more than 20 years of largely French clinical experience. PMID:24278908

McArthur, Benjamin A; Nam, Denis; Cross, Michael B; Westrich, Geoffrey H; Sculco, Thomas P

2013-10-01

173

Hemi-hamate arthroplasty for pilon fractures of finger  

PubMed Central

Background: Injury following proximal interphalangeal joint fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered. The degree of stability is directly determined by the amount of middle phalangeal palmar lip involvement. Materials and Methods: Hemihamate arthroplasty procedure was used in the reconstruction in five cases with comminuted, impacted fractures of the proximal end of middle phalanx of the finger. Three patients were presented within 2 weeks; one patient came by one month and the other by three months following the injury. All patients presented with posterior subluxation of PIP joint. Results: Functional outcome following this procedure in both acute and chronic cases resulted in adequate restoration of joint stability and function. Conclusions: Hemihamate arthroplasty is an adjuvant in the treatment of unstable intra-articular pilon fracture involving PIP joint. PMID:22279280

Korambayil, Pradeoth M.; Francis, Anto

2011-01-01

174

Early failures in total hip arthroplasty -- a changing paradigm.  

PubMed

Between 2001 and 2011, 1168 revision hip arthroplasties were reviewed for "early" failures within 5 years of the primary total hip arthroplasty (THA). 24.1% underwent revision within 5 years of index THA. Aseptic loosening, infection, instability, metallosis, and fracture were common modes of failure. In our previous report from 1986 to 2000, 33% were "early" revisions, with instability and aseptic loosening accounting for over 70% of these early failures. While the proportion of "early" revisions decreased 9% from our previous report, this rate remains alarming. The emergence of metallosis and aseptic loosening of monoblock metal on metal shells as leading causes of early failures is concerning. This report suggests caution in the early adoption of new innovations before evidence based medicine is available to justify the risk of their use. PMID:24444568

Melvin, J Stuart; Karthikeyan, Tharun; Cope, Robert; Fehring, Thomas K

2014-06-01

175

Non-oncologic total femoral arthroplasty: retrospective review.  

PubMed

Total femoral arthroplasty (TFA) is an option to amputation in the setting of excessive bones loss during revision total hip and knee arthroplasty. Twenty non-oncologic TFAs with a minimum of 2years follow-up were retrospectively reviewed. The average clinical follow-up was 73±49months. The incidence of new infection was 25% (5/20), while the overall infection rate was 35% (7/20). The incidence of primary hip instability was 10% (2/20), while the overall instability rate was 25% (5/20). Six patients (30%) required revision. The average pre-operative HHS was 30.2±13.1. The average post-operative HHS was 65.3±16.9. TFA is a viable alternative to amputation in non-oncologic patients with massive femoral bone deficiency. However, TFA performed poorly in the setting of infection and instability. PMID:25041874

Amanatullah, Derek F; Trousdale, Robert T; Hanssen, Arlen D; Lewallen, David G; Taunton, Michael J

2014-10-01

176

Topical versus intravenous tranexamic acid in total knee arthroplasty.  

PubMed

The objective of this study is to compare the effectiveness of intravenous versus topical application of tranexamic acid in patients undergoing knee arthroplasty. All patients who underwent primary knee arthroplasty at our total joint center over a 12-month period were included in the study. One surgeon utilized 1g of IV TXA at time of incision in all patients (n=373) except those with a documented history of venous thromboembolism (VTE). Two surgeons utilized a topical application of TXA for all patients without exception (n=198) in which the joint was injected after capsular closure with 3g TXA/100mL saline. The transfusion rate was 0% in the topical group vs. 2.4% in the IV group and this was statistically significant (P<0.05). PMID:25458092

Hamlin, Brian R; DiGioia, Anthony M; Plakseychuk, Anton Y; Levison, Tim J

2014-10-12

177

Osteoarthritis of the costovertebral joints: the results of resection arthroplasty.  

PubMed

Thoracic back pain caused by osteoarthritis of a single costovertebral joint is a poorly recognised condition. We report a series of five patients who were successfully treated by resection arthroplasty of this joint. Each had received a preliminary image-guided injection of local anaesthetic and steroid into the joint to confirm it as the source of pain. The surgical technique is described. There were no complications. The pain improved from a mean of 7.0 (6 to 8) on a visual analogue scale to 2.0 (0 to 4) post-operatively. The final post-operative Oswestry disability index was a mean of 19.4 (9 to 38). Isolated osteoarthritis of a costovertebral joint is a rare but treatable cause of thoracic back pain. It is possible to obtain excellent short- and intermediate-term relief from pain with resection arthroplasty in appropriately selected patients. PMID:17957073

Sales, J R; Beals, R K; Hart, R A

2007-10-01

178

Peroneal nerve dysfunction after total knee arthroplasty: characterization and treatment.  

PubMed

The purpose of this study was to report on the presentation, evaluation, treatment, and outcome of patients who had a peroneal nerve dysfunction after total knee arthroplasty. Six patients were unable to achieve adequate range of motion after physical therapy, and the remaining 5 patients had sensory symptoms that interfered with daily activities despite adequate range of motion. All 11 patients had abnormal electrodiagnostic testing but had intact motor strength and were treated with surgical decompression of the nerve. The patients with motion problems had a mean increase in range of motion of 40 ° (range, 20 °-70 °) at final follow-up. All patients with dominant sensory symptoms had a resolution of leg and foot pain after treatment. Orthopedic surgeons should be aware of peroneal nerve dysfunction as a possible cause of unsatisfactory rehabilitation and/or persistent atypical lateral leg pain after total knee arthroplasty. PMID:20570090

Zywiel, Michael G; Mont, Michael A; McGrath, Mike S; Ulrich, Slif D; Bonutti, Peter M; Bhave, Anil

2011-04-01

179

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 (...

180

Femoral fracture during non-cemented total hip arthroplasty  

Microsoft Academic Search

A study of the data on 1 ,318 consecutive non-cemented total hip-replacement arthroplasties re- vealed thirty-nine intraoperative fractures of the femur (3 per cent), only half of which were diagnosed intra- operatively. The fractures occurred in the proximal re- gion of the femur or at the tip of the stem of the prosthesis. Most were incomplete and minimally dis- placed,

JT Schwartz; JG Mayer; CA Engh

1989-01-01

181

A calibrated patient positioning device for total hip arthroplasty  

Microsoft Academic Search

Component malpositioning in total hip arthroplasty (THA) may lead to dislocation of the prosthesis. Improper positioning of\\u000a the patient on the table has been noted as one of the reasons for component malpositioning. Lateral position is routinely\\u000a used for posterior approach to the hip and is also commonly employed for the lateral approach to the hip. We describe the\\u000a use

Palaniappan Lakshmanan; Shahbhaz Mohammad Yasir Ahmed; David J. Woodnutt

2008-01-01

182

Femoral Revision Hip Arthroplasty: A Comparison of Two Stem Designs  

Microsoft Academic Search

\\u000a Abstract  For various reasons the tapered, fluted, modular titanium (TFMT) stem has become our component of choice over cylindrical,\\u000a nonmodular cobalt chrome (CNCC) components for THA revision. We therefore asked whether the TFMT femoral components better\\u000a achieved three important goals of revision arthroplasty than CNCC stems: (1) improving quality of life; (2) avoiding complications;\\u000a and (3) preserving or restoring femoral bone

Corey J. Richards; Clive P. Duncan; Bassam A. Masri; Donald S. Garbuz

2010-01-01

183

Revision Total Hip Arthroplasty for Ceramic Head Fracture  

Microsoft Academic Search

The results of revision total hip arthroplasty (THA) for ceramic head fracture have generally been disappointing, largely due to third body wear after incomplete synovectomy. We have followed 8 patients who sustained ceramic head fractures and were subsequently revised to a metal-on-polyethylene articulation. There were no revisions for osteolysis or aseptic loosening at a mean follow-up of 10.5 years. The

Vineet Sharma; Amar S. Ranawat; Vijay J. Rasquinha; JoAnne Weiskopf; Holly Howard; Chitranjan S. Ranawat

2010-01-01

184

Metal-cancellous Lübeck total hip arthroplasty in hemodialysis patients  

Microsoft Academic Search

We report the results of total hip arthroplasty (THA) in patients on hemodialysis (HD). The metal-cancellous cementless Lübeck\\u000a (MCCL) prosthesis was used in a series of consecutive 17 patients between April 1996 and March 2000. The patients were evaluated\\u000a clinically and radiographically, and data were recorded during prospective follow-up. We reviewed the 17 patients after follow-up\\u000a for more than two

T. Nakai; K. Masuhara; S. Yamasaki; T. Fuji; N. Kanbara

2003-01-01

185

Dislocation and Infection After Revision Total Hip Arthroplasty  

Microsoft Academic Search

Dislocation and infection are common complications of total hip arthroplasty (THA). This study evaluated the correlation between the number of revision THAs and the incidence of these complications. Data were obtained from 749 revision THAs. Average follow-up was 13.2 ± 5.9 years. Patients were grouped as first, second, third, and fourth or greater revision THA. Dislocation rates (5.68%, 7.69%, 8.33%,

Yona Kosashvili; David Backstein; Oleg Safir; Dror Lakstein; Allan E. Gross

2011-01-01

186

Revision total hip arthroplasty: the femoral side using cemented implants  

Microsoft Academic Search

Advances in surgical technique and implant technology have improved the ten-year survival after primary total hip arthroplasty\\u000a (THA). Despite this, the number of revision procedures has been increasing in recent years, a trend which is predicted to\\u000a continue into the future. Revision THA is a technically demanding procedure often complicated by a loss of host bone stock\\u000a which may be

Graeme Holt; Samantha Hook; Matthew Hubble

2011-01-01

187

Revision hip arthroplasty prosthesis: a study implant stability  

Microsoft Academic Search

Revision total hip replacement has high rates of failure, which appear to be due in part to deficient bone stock that does\\u000a not provide an adequate environment for implant fixation. We reviewed the clinical outcomes and implant stability following\\u000a total hip revisions using the S-ROM implant. Between 1996 to 2001, we performed 62 cementless revision hip arthroplasties\\u000a using the S-ROM

M. El-Deen; S. Zahid; D. T. Miller; A. Nargol; R. Logishetty

2006-01-01

188

Parsonage-Turner syndrome after total-hip arthroplasty  

Microsoft Academic Search

A 68-year-old patient developed Parsonage-Turner syndrome after total hip arthroplasty. There was an acute onset of intense pain in the shoulder 48 hours after surgery followed by complete paralysis of the shoulder and almost complete loss of strength in the arm. Recovery was slow, and mild weakness persisted 7 years after the operation. Parsonage-Turner syndrome has been associated with various

Jean-Pierre A Simon; Guy Fabry

2001-01-01

189

Management of the Deficient Patella in Revision Total Knee Arthroplasty  

Microsoft Academic Search

There are a number of options available to manage the patella when revising a failed total knee arthroplasty. If the previous\\u000a patellar component is well-fixed, undamaged, not worn, and compatible with the femoral revision component, then it can be\\u000a retained. When a patellar component necessitates revision and is removed with adequate remaining patellar bone stock, an onlay-type\\u000a all-polyethylene cemented implant

Ryan M. Garcia; Matthew J. Kraay; Patricia A. Conroy-Smith; Victor M. Goldberg

2008-01-01

190

Bone Grafting Severe Glenoid Defects in Revision Shoulder Arthroplasty  

Microsoft Academic Search

During revision total shoulder arthroplasty, bone grafting severe glenoid defects without concomitant reinsertion of a glenoid\\u000a prosthesis may be the only viable reconstructive option. However, the fate of these grafts is unknown. We questioned the durability\\u000a and subsidence of the graft and the associated clinical outcomes in patients who have this procedure. We retrospectively reviewed\\u000a 11 patients with severe glenoid

Jason J. Scalise; Joseph P. Iannotti

2008-01-01

191

Predicting the longer term outcomes of total knee arthroplasty  

Microsoft Academic Search

We asked the question of what are the patient level predictors (age, gender, body mass index, education, ethnicity, mental health, and comorbidity) for a sustained functional benefit at a minimum of 1 year follow-up after total knee arthroplasty(TKA). Five hundred fifty-one consecutive patients were reviewed from our joint registry between the years of 1998 and 2005. Baseline demographic data and the

Rajiv Gandhi; Herman Dhotar; Fahad Razak; Peggy Tso; J. Roderick Davey; Nizar N. Mahomed

2010-01-01

192

A Navigation System for Computer Assisted Unicompartmental Arthroplasty  

Microsoft Academic Search

http:\\/\\/www.ior.it\\/biomec\\/ Abstract. This work presents an overview of a prototype navigation system for computer assisted unicompartmental arthroplasty. The navigation system allows the surgeon to use a minimally invasive surgical technique, solving the problems due to a restricted knee exposure with an augmented reality environment. The key feature of the system is an interactive graphical interface in which a 3D model

Maurilio Marcacci; Oliver Tonet; Giuseppe Megali; Paolo Dario; Maria Chiara Carrozza; Laura Nofrini; Pier Francesco La Palombara

2000-01-01

193

Biotribology of Alternativ Bearing Materials for Knee Arthroplasty  

Microsoft Academic Search

\\u000a The objective of our study was to combine knee wear simulation, a method for sterile generation of wear particles and an in\\u000a vivo model (murine knee joint) for the characterisation of alternativ bearing materials for knee arthroplasty. A fixed bearing\\u000a unicompartmental knee design was used to investigate the wear properties of carbon fiber reinforced polyetheretherketone (CFR-PEEK)\\u000a in comparison to the

T. M. Grupp; S. Utzschneider; J. Schwiesau; B. Fritz; C. Schröder; W. Blömer; V. Jansson

194

A multimodality regimen for deep venous thrombosis prophylaxis in total knee arthroplasty  

Microsoft Academic Search

Data indicate that deep venous thrombosis (DVT) occurs at the time of knee arthroplasty. Nevertheless, literature concerning DVT prophylaxis has only recently addressed this contention. This prospective study evaluated the efficacy of a perioperative prophylactic regimen. Between January 1996 and June 2001, 1,308 knees (964 surgeries) underwent total knee arthroplasty. Patients were treated routinely with intraoperative heparin (1000 units intravenous

Richard D. Reitman; Roger H. Emerson; Linda L. Higgins; Tiffera R. Tarbox

2003-01-01

195

Primary and Revision Arthroplasty Surgery Caseloads in the United States from 1990 to 2004  

Microsoft Academic Search

We analyzed the temporal changes in the caseload of primary and revision hip and knee arthroplasty surgeons in the United States between 1990 and 2004. The Nationwide Inpatient Sample was used to identify arthroplasty procedures and the surgeons who performed them. Annual caseloads were analyzed for each procedure; 47% ± 2% and 39% ± 2% of hip and knee surgeons

Steven M. Kurtz; Kevin L. Ong; Jordana Schmier; Ke Zhao; Fionna Mowat; Edmund Lau

2009-01-01

196

Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows  

PubMed Central

Background Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results. Materials Our case series includes 9 patients (seven males and two females) with the mean age of 34 years (13-56 years). Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation. Results The average duration of follow up is 65 months (45 months-80 months). The mean Mayo's elbow performance score (MEPS) preoperatively was 48 (35-70). The MEPS at final follow up was 80 (60-95). With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°). The mean post operative range of motion at final follow up was 27°of extension (20-500), 116°of flexion (1100-1300), and the arc of motion was 88°(800-1000). One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities. Conclusion We conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients. PMID:22142391

2011-01-01

197

Revision total hip arthroplasty using the Zweymuller femoral stem  

PubMed Central

Background A variety of femoral stem designs have been reported to be successful in revision total hip arthroplasty without consensus as to optimal design. We evaluated the clinical and radiographic outcomes in a consecutive series of femoral revisions using a wedge-shape, tapered-stem design at medium and long-term follow-up. Materials and methods We performed a retrospective review of clinical and radiographic outcomes of twenty-eight consecutive femoral revisions arthroplasties, which were done using the Zweymuller femoral stem. Results The mean follow-up was 7.4 years (range 2–15 years). No stem re-revision was necessary. All stems were judged to be stable by radiographic criteria at the most recent follow-up. The final mean Harris hip score was 90. There was no difference in Harris hip scores, implant stability, or radiological appearance (distal cortical hypertrophy or proximal stress shielding) of the implants between medium-term (mean 5.7 years) and long-term (mean 12.4 years) follow-up. Conclusions We found the Zweymuller femoral stem design to be durable for revision hip arthroplasty when there is an intact metaphyseal-diaphyseal junction for adequate press-fit stability at surgery. PMID:19384617

Huo, Michael H.; Keggi, Kristaps J.

2008-01-01

198

An objective examination for painful hip after total hip arthroplasty.  

PubMed

An objective method for evaluating the cause of pain in hip arthroplasty was investigated in patients with a radiolucent zone of less than 2 mm at the cement-bone interface or the cement-stem or socket interface. Eight patients with a McKee-Farrar total hip prosthesis followed up for an average of 102 months and 20 patients with a Charnley total hip prosthesis observed for an average of 43 months were studied. Different components of the implant materials, such as cement monomer, BaSO4, ceramic, acrylic cement, stainless steel and high-density polyethylene, (HDP) were exposed to normal plasma. Contact activation of plasma was found to occur for all materials, except for HDP, yielding plasma kallikrein. The induced prekallikrein activation was markedly reduced in vitro by Trasylol. There was a significant increase in plasma kallikrein activity in the patients with discomfort and/or pain without gross loosening compared with the patients with pain-free hip arthroplasties. Furthermore, statistically significant enhancement of the kallikrein activity was observed in plasma from the femoral vein at the site of operation compared with that from the cubital vein of the same subject. The enhanced plasma kallikrein activity in the patients gradually decreased, as did the clinical symptoms, when Trasylol was administered. It is concluded that measurement of plasma kallikrein activity may produce useful information about the process of total hip arthroplasty and provide an objective evaluation of pain. PMID:6179385

Nakahara, M

1982-08-01

199

Applications of porous tantalum in total hip arthroplasty.  

PubMed

Porous tantalum is an alternative metal for total joint arthroplasty components that offers several unique properties. Its high volumetric porosity (70% to 80%), low modulus of elasticity (3 MPa), and high frictional characteristics make it conducive to biologic fixation. Tantalum has excellent biocompatibility and is safe to use in vivo. The low modulus of elasticity allows for more physiologic load transfer and relative preservation of bone stock. Because of its bioactive nature and ingrowth properties, tantalum is used in primary as well as revision total hip arthroplasty components, with good to excellent early clinical results. In revision arthroplasty, standard and custom augments may serve as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fibrous ingrowth properties and allows for substantial soft-tissue attachment, indicating potential for use in cases requiring reattachment of muscles and tendons to a prosthesis. Development of modular components and femoral stems also is being evaluated. The initial clinical data and basic science studies support further investigation of porous tantalum as an alternative to traditional implant materials. PMID:17077337

Levine, Brett; Della Valle, Craig J; Jacobs, Joshua J

2006-11-01

200

Safe surgical technique: iliac osteotomy via the anterior approach for revision hip arthroplasty  

PubMed Central

Robert Judet first performed hip arthroplasty via the anterior approach (AA) in 1947 on an orthopaedic table. Our center has a near 20-year experience on more than 3500 patients operated by AA hip arthroplasty. While primary AA total hip arthroplasty techniques have been discussed in the literature, revision AA total hip arthroplasty techniques are relatively new. The current article in the Journal’s “Safe Surgical Technique” series describes the successful application of an adjunctive iliac osteotomy to improve femoral exposure in two selected patients undergoing AA revision hip arthroplasty. The potential risk/complications of an iliac osteotomy include iatrogenic fracture, malunion/nonunion, infection, and pain. These potential risks should be weighed against the potential benefits of improved surgical exposure and/or risks of other revision techniques. Future prospective longitudinal studies will be helpful to determine efficacy and risk profile compared to other revision techniques. PMID:25473418

2014-01-01

201

Autosomal Dominant Type I Osteopetrosis Is Related with Iatrogenic Fractures in Arthroplasty  

PubMed Central

Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO. PMID:25436076

van Hove, Ruud P.; de Jong, Tjitte

2014-01-01

202

obesity on the risk for total hip or knee arthroplasty. Clin Orthop  

E-print Network

To the Editor: We read with great interest the article ‘‘Role of Obesity on the Risk for Total Hip or Knee Arthroplasty’ ’ by Bourne et al. [1] in the December 2007 issue of CORR. The authors state increasing obesity was associated with increased relative risk for hip or knee arthroplasty. They found almost 75 % of total hip arthroplasty recipients and 88 % of total knee arthroplasty recipients were overweight or obese whereas the percentage of overweight or obese people for the Canadian population is 51.4%. These percentages could reflect a relationship between obesity and the risk of hip and knee arthroplasties, but there are no data regarding the etiologic factors leading to obesity in these patients. Arthrosis of the hip or the knee causes pain in the affected joint and typically results in a

Clin Orthop Relat Res; Sarper Gursu Md; Kerem Aydin Md; S. Gursu; K. Aydin

2008-01-01

203

Autosomal dominant type I osteopetrosis is related with iatrogenic fractures in arthroplasty.  

PubMed

Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO. PMID:25436076

van Hove, Ruud P; de Jong, Tjitte; Nolte, Peter A

2014-12-01

204

Raman gap solitons  

PubMed

We show that an intense pump pulse, detuned far from the Bragg resonance of a nonlinear periodic structure, can excite a gap soliton at a wavelength within the band gap that corresponds to the Raman shift of the medium. This Raman gap soliton is a stable, long-lived, quasistationary excitation that exists within the grating even after the pump pulse has passed. We find both stationary solitons as well as slow Raman gap solitons with velocities as low as 1% of the speed of light. The predicted phenomena should be observable in fiber Bragg gratings and other nonlinear photonic band gap structures. PMID:11019152

Winful; Perlin

2000-04-17

205

The gap gene network  

PubMed Central

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

2010-01-01

206

GapZappers  

NSDL National Science Digital Library

In this online Flash activity students use their knowledge of addition of fractions and equivalent forms to navigate 15 levels of play. Each level progresses in difficulty and includes gaps measured in meters that students must fill in using fractional pieces to enable the lizard to move on in the field of play. Once the gap is filled, check the gap and the lizard will move on showing the fractional equation that solved the problem.

King, Colleen

2013-01-01

207

Pain after hip arthroplasty managed by Brennan Healing Science.  

PubMed

A case is presented illustrating the potential effect of Brennan Healing Science on pain following hip arthroplasty for avascular necrosis. A 54-year-old woman experienced anterior groin pain, numbness at the bottom of her foot, and occasional grinding at her hip 22 years after right total hip arthroplasty secondary to avascular necrosis. X-ray films showed signs of osteolysis behind the acetabular cup and asymmetric decreased polyethylene thickness of the acetabular prosthetic. Her orthopedic surgeon advised the patient to follow up every 6-9 months to avoid catastrophic failure of the implant, with plans for surgical revision to be scheduled at the next appointment. The patient sought alternative treatment to avoid an invasive procedure. On presentation, the patient had difficulty walking up the stairs into the treatment room due to pain which she rated a 9/10. She found it painful to rotate, flex, extend her hip, or to sit. Hands-on healing techniques based on the Brennan Healing Science method were initiated, starting at the feet, balancing the energy, and working the way up the joints. Once the work at the hip was completed, the hands-on techniques continued up the centerline of the body and the healing was brought to a close. On completion of a 60-minute healing, the patient was able to stand freely and rated her pain as a 4/10. Flexion, extension, and rotation at the hip were no longer distressing. She was able to walk up and down stairs without distress and denied instability, bursitis, or trochanteric or iliopsoas pain or swelling. Repeat X-rays showed decrease in bone spurs and no hardware problem, and her orthopedic surgeon recommended follow-up after 2 years. It is suggested that Brennan Healing Science techniques could play an effective and cost-efficient role in the treatment of pain following hip arthroplasty. PMID:24439097

Namavar, Roxanna

2014-01-01

208

Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty  

PubMed Central

Background: Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to administer the disabilities of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median follow-up time of 60 months (range: 2 to 102 months). Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation. PMID:25386579

Kachooei, Amir Reza; Chase, Samantha M; Jupiter, Jesse B

2014-01-01

209

Catastrophic failure of ceramic-on-ceramic total hip arthroplasty presenting as squeaking hip  

PubMed Central

A 68-year-old woman with osteoarthritis had a ceramic-on-ceramic left total hip arthroplasty, including ceramic femoral head and acetabular liner. At 5?years after surgery, the patient developed onset of a very loud squeaking noise, which could be heard 25?m from her, associated with limited hip movement. Findings at revision surgery included a broken ceramic femoral head component, complete wear of the ceramic acetabular component, and black wear debris. Squeaking hip after ceramic-on-ceramic total hip arthroplasty may be associated with catastrophic failure of the arthroplasty components. PMID:23429031

Malem, David; Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik

2013-01-01

210

Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis  

Microsoft Academic Search

Purpose  Whether to resurface the patella during a primary total knee arthroplasty remains a controversial issue. The aim of this study\\u000a was to determine the advantages and disadvantages of patellar resurfacing during total knee arthroplasty for osteoarthritis\\u000a through an evaluation of the current literature.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A meta-analysis of randomized controlled trials comparing patellar resurfacing with nonresurfacing during total knee arthroplasties\\u000a was performed.

Yonghui FuGuangbin; Guangbin Wang; Qin Fu

211

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

PubMed

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

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

2014-06-01

212

Direct anterior approach for revision total hip arthroplasty  

PubMed Central

Revision total hip arthroplasty (THA) can be successfully performed through the direct anterior (DA) approach. Patient positioning, the surgical approach and specific instruments are important for obtaining adequate exposure. Acetabular exposure can be facilitated by capsular release and correct placement of retractors. Distal and proximal extension of the incision, as well as a femoral extended trochanteric osteotomy (ETO) can be performed to increase femoral exposure. The purposes of this article are to describe the DA approach, provide surgical techniques for revision THA through this approach, and describe the indications, contraindications and complications of this approach. PMID:25405154

Manrique, Jorge; Heller, Snir; Hozack, William J.

2014-01-01

213

Revision Total Knee Arthroplasty Infection: Incidence and Predictors  

Microsoft Academic Search

Background  Deep infection remains one of the most devastating and costly complications after total knee arthroplasty (TKA). The risk\\u000a of deep infection after revision TKA is reportedly greater than that for primary TKA; however, we do not know the exact incidence\\u000a of infection after revision TKA.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We determined the incidence of infection after revision, the type of microorganisms involved and TKA,

S. M. Javad Mortazavi; Justin Schwartzenberger; Matthew S. Austin; James J. Purtill; Javad Parvizi

2010-01-01

214

Cemented Total Hip Arthroplasty With Subtrochanteric Osteotomy in Dysplastic Hips  

Microsoft Academic Search

Background  Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) can be technically challenging. Restoring\\u000a the anatomic center of hip rotation may require femoral osteotomy. Techniques using cementless components are widely reported\\u000a but less is known about using cemented components that may be more appropriate with osteopenic bone.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We therefore determined the rate of union, complications,

Colin R. Howie; Nicholas E. Ohly; Ben Miller

2010-01-01

215

Robotic-assisted unicompartmental knee arthroplasty: the MAKO experience.  

PubMed

Since its introduction, unicompartmental knee arthroplasty has been controversial because of poor early clinical outcomes due to implant design, bony fixation, surgical instrumentation, and technique. Improvements in surgical technique and implant design have resulted in improved results and greater survivorship. The ability to obtain accurate implant placement includes avoiding surgeon decisions leading to potential errors. These errors include alignment in the sagittal, coronal, and axial planes on each prepared condyle as well as the preservation of the joint line and the resulting overall limb alignment as something critical to obtaining a successful outcome. PMID:25435041

Roche, Martin

2015-01-01

216

Development of a surgical robot for cementless total hip arthroplasty.  

PubMed

The long-term success of cementless total hip arthroplasty (THA) may depend on bone ingrowth into the porous-fixation surfaces of the implant. The ingrowth process is facilitated when the surgeon achieves a satisfactory fit for the prosthesis. Clinically or roentgenographically visible failure and persistent thigh pain after cementless THA remain significant problems, both of which may be alleviated by more precise preparation of the femoral canal and selection of an appropriately sized prosthesis. The objective of this study was to obtain an exact fit for the prosthesis through the use of an image-directed surgical robot for femoral canal preparation. PMID:1446455

Paul, H A; Bargar, W L; Mittlestadt, B; Musits, B; Taylor, R H; Kazanzides, P; Zuhars, J; Williamson, B; Hanson, W

1992-12-01

217

Gap year volunteer tourism  

Microsoft Academic Search

The valorisation of cross-cultural understanding and promotion of an ethic of global citizenship are at the forefront of the recent development and proliferation of international ‘gap year’ travel programs and policies. Governments and industry alike promote gap year travel uncritically as a guaranteed pathway to the development of inclusive ideologies associated with global citizenship. In this paper we examine how

Stephen Wearing; John Neil

218

Bridging a Cultural Gap  

ERIC Educational Resources Information Center

There has been a broad wave of change in tertiary calculus courses in the past decade. However, the much-needed change in tertiary pre-calculus programmes--aimed at bridging the gap between high-school mathematics and tertiary mathematics--is happening at a far slower pace. Following a discussion on the nature of the gap and the objectives of a…

Leviatan, Talma

2008-01-01

219

Revision total joint arthroplasty: the epidemiology of 63,140 cases in New York State.  

PubMed

Recent evidence suggests a substantial rise in the number of revision total joint arthroplasty (TJA) procedures performed. The New York State SPARCS inpatient database was utilized to identify revision total shoulder, knee, and hip arthroplasty procedures between 1993 and 2010. Yearly incidence and related epidemiology were analyzed. A total of 1,806 revision TSA, 26,080 revision TKA, and 35,254 revision THA cases were identified. The population-based incidence of these procedures increased 288%, 246%, and 44% respectively (P<0.001). Revision burden for hip arthroplasty decreased from 16.1% in 2001 to 11.5% in 2010 (P<0.001). The rates of revision TSAs and TKAs increased at a substantially faster rate than that of revision THAs. Revision burden for hip arthroplasty steadily has decreased since 2001. PMID:23680502

Bansal, Ankit; Khatib, Omar N; Zuckerman, Joseph D

2014-01-01

220

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

PubMed Central

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

Sakellariou, Vasileios I; Babis, George C

2014-01-01

221

Posterior cruciate ligament-retaining and posterior-stabilized total knee arthroplasty: differences in surgical technique  

PubMed Central

Summary The debate over the relative merits of substituting or retaining the posterior cruciate ligament in total knee arthroplasty is still ongoing. This article discusses the differences between the two procedures, considering the biomechanics and the surgical techniques involved.

D’Anchise, Roberto; Andreata, Mauro; Balbino, Cristiana; Manta, Nicola

2013-01-01

222

Physiological and mechanical influences on muscle function following total knee arthroplasty   

E-print Network

End-stage osteoarthritis is characterised by pain and reduced physical function, for which total knee arthroplasty (TKA) is recognised to be a highly effective procedure. Post-operative outcome and resultant function however ...

Hamilton, David Finlay

2011-11-25

223

Numerical modelling of the pelvis and acetabular construct following hip arthroplasty   

E-print Network

The study presents finite element models of the acetabular construct and the pelvis. Particular attention is given to investigating the behaviour of the acetabular construct following revision hip arthroplasty, carried out ...

Phillips, Andrew T M

224

Intraoperative CT navigation for glenoid component fixation in reverse shoulder arthroplasty  

PubMed Central

CT navigation has been shown to improve component positioning in total shoulder arthroplasty. The technique can be useful in achieving strong initial fixation of the metal backed glenoid in reverse shoulder arthroplasty. We report a 61 years male patient who underwent reverse shoulder arthroplasty for rotator cuff arthropathy. CT navigation was used intraoperatively to identify best possible glenoid bone and to maximize the depth of the fixation screws that anchor the metaglene portion of the metal backed glenoid component. Satisfactory positioning of screws and component was achieved without any perforation or iatrogenic fracture in the scapula. CT navigation can help in maximizing the purchase of the fixation screws that dictate the initial stability of the glenoid component in reverse shoulder arthroplasty. The technique can be extended to improve glenoid component position [version and tilt] with the availability of appropriate software. PMID:23531710

Gavaskar, Ashok S; Vijayraj, K; Subramanian, SD Muthukumar

2013-01-01

225

Intraoperative CT navigation for glenoid component fixation in reverse shoulder arthroplasty.  

PubMed

CT navigation has been shown to improve component positioning in total shoulder arthroplasty. The technique can be useful in achieving strong initial fixation of the metal backed glenoid in reverse shoulder arthroplasty. We report a 61 years male patient who underwent reverse shoulder arthroplasty for rotator cuff arthropathy. CT navigation was used intraoperatively to identify best possible glenoid bone and to maximize the depth of the fixation screws that anchor the metaglene portion of the metal backed glenoid component. Satisfactory positioning of screws and component was achieved without any perforation or iatrogenic fracture in the scapula. CT navigation can help in maximizing the purchase of the fixation screws that dictate the initial stability of the glenoid component in reverse shoulder arthroplasty. The technique can be extended to improve glenoid component position [version and tilt] with the availability of appropriate software. PMID:23531710

Gavaskar, Ashok S; Vijayraj, K; Subramanian, Sd Muthukumar

2013-01-01

226

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

E-print Network

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 ...

Mangudi Varadarajan, Kartik, 1981-

2010-01-01

227

A simple technique for harvesting autogenous morcellized bone-graft during primary hip arthroplasty  

Microsoft Academic Search

A technique for producing morcellized bone-graft from the femoral head for reconstituting the acetabulum in primary hip arthroplasty is described. The method is simple to perform, requires no additional equipment, and is effective.

S. Rashad; R. G. Middleton; M. Hamlett; P. Chapman-Sheath; J. Hollingdale

1997-01-01

228

Metal Allergy Screening Prior to Joint Arthroplasty and Its Influence on Implant Choice: A Delphi Consensus Study Amongst Orthopaedic Arthroplasty Surgeons  

PubMed Central

Purpose This study was undertaken to obtain a consensus amongst joint arthroplasty experts with regards to metal allergy screening prior to joint arthroplasty and the choice of implant in patients with potential metal allergy. Materials and Methods A web based Delphi consensus study was used including orthopaedic surgeons that had previously published on the topic of knee, hip or shoulder arthroplasty. Two rounds of questionnaires were sent via electronic mail. Consensus was considered reached if agreement was 60% or higher. Results Eighteen surgeons responded to the first and 17 to the second round of questionnaires. There was consensus that patients having metal arthroplasty surgery should not be routinely questioned about metal allergy prior to surgery. There was consensus that patch testing is not necessary even if metal allergy is suspected. Most respondents agreed in proceeding with cobalt chromium or stainless steel implant in patients suspected of metal allergy regardless of the results of cutaneous patch testing. Conclusions This consensus study suggests that routine metal allergy screening prior to joint arthroplasty is not essential. The use of traditional cobalt chromium/stainless steel implants is recommended regardless of the patient's metal allergy status based on expert opinion through this study. PMID:24368996

Razak, Arif; Ebinesan, Ananthan Dave

2013-01-01

229

Polyethylene damage and knee kinematics after total knee arthroplasty.  

PubMed

This study characterizes the relationship between in vivo knee kinematics and polyethylene damage by combining fluoroscopic analysis of tibiofemoral contact during dynamic activities and implant retrieval analysis in the same patients. Six patients (eight knees) underwent posterior cruciate ligament-retaining total knee arthroplasty. All patients participated in fluoroscopic analysis during a stair-rise and descent activity and treadmill gait an average of 18 months after arthroplasty, and articular contact was measured. Subsequently, all polyethylene tibial inserts were retrieved after an average of 26 months in vivo function: three at autopsy and five at revision. There was a statistically significant correlation between the damage location on the retrieved inserts and the articular contact location measured fluoroscopically during the activities. The femoral contact and polyethylene damage occurred predominantly on the posterior half of the tibial articular surface, and the damage pattern was largest in the compartment with the greatest range of in vivo femoral contact for each patient. This study showed that in vivo fluoroscopic analysis can predict the damage location on the polyethylene articular surface. PMID:11716412

Harman, M K; Banks, S A; Hodge, W A

2001-11-01

230

Patellofemoral Crepitus after Total Knee Arthroplasty: Etiology and Preventive Measures  

PubMed Central

Patellofemoral crepitus and clunk syndrome are infrequent, yet troublesome complications of total knee arthroplasty with a reported incidence of 0%-18%. They are primarily associated with implantation of posterior cruciate substituting designs. These entities are the result of peripatellar fibrosynovial hyperplasia at the junction of the superior pole of the patella and the distal quadriceps tendon which becomes entrapped within the superior aspect of the intercondylar box of the femoral component during knee flexion. When the knee extends, a crepitant sensation occurs as the fibrosynovial tissue exits the intercondylar box. Numerous etiologies have been proposed such as femoral component designs with a high intercondylar box ratio, previous knee surgery, reduced patellar tendon length, thinner patellar components, reduced patella-patellar component composite thickness, and smaller femoral components. Preventative measures include choice of femoral components with a reduced intercondylar box ratio, use of thicker patellar components, avoidance of over-resection of the patella, and debridement of the fibrosynovial tissue at the time of knee arthroplasty. Most patients with crepitus are unaware of the problem or have minimal symptoms so that no treatment is required. If significant disability is incurred, symptoms can be eliminated in a high percentage of patients with arthroscopic debridement of the fibrosynovial hyperplasia. PMID:24605184

Conrad, David N.

2014-01-01

231

Cervical arthroplasty complicated by delayed spontaneous fusion. Case report.  

PubMed

The authors describe the case of a 55-year-old woman who presented with a left C-6 radiculopathy and neck pain and in whom there was evidence of disc/osteophyte compression of the left C-6 nerve root. The patient underwent a C5-6 anterior cervical decompression and placement of a Bryan disc prosthesis. More than 7000 cervical discs have been inserted worldwide. Postoperatively, dynamic imaging demonstrated loss of motion at the instrumented level. The patient suffered persistent neck and arm pain that was slow to resolve. Seventeen months after the initial surgery osseous fusion was observed across the interspace and posterior surface of the prosthesis. This is the first documented case of fusion occurring at the level at which cervical arthroplasty had been performed. The precise reason for this phenomenon is unclear, but potential contributing factors include patient-related issues, poor motion due to neck pain, or possibly implant-related issues. To date, this is an exceedingly rare complication and warrants careful and prolonged follow up of all arthroplasty-treated cases. PMID:15796366

Parkinson, Jonathon F; Sekhon, Lali H S

2005-03-01

232

Hospital volume affects outcome after total knee arthroplasty.  

PubMed

Background and purpose - The influence of hospital volume on the outcome of total knee joint replacement surgery is controversial. We evaluated nationwide data on the effect of hospital volume on length of stay, re-admission, revision, manipulation under anesthesia (MUA), and discharge disposition for total knee replacement (TKR) in Finland. Patients and methods - 59,696 TKRs for primary osteoarthritis performed between 1998 and 2010 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified into 4 groups according to the number of primary and revision knee arthroplasties performed on an annual basis throughout the study period: 1-99 (group 1), 100-249 (group 2), 250-449 (group 3), and ? 450 (group 4). The association between hospital procedure volume and length of stay (LOS), length of uninterrupted institutional care (LUIC), re-admissions, revisions, MUA, and discharge disposition were analyzed. Results - The greater the volume of the hospital, the shorter was the average LOS and LUIC. Smaller hospital volume was not unambiguously associated with increased revision, re-admission, or MUA rates. The smaller the annual hospital volume, the more often patients were discharged home. Interpretation - LOS and LUIC ought to be shortened in lower-volume hospitals. There is potential for a reduction in length of stay in extended institutional care facilities. PMID:25323798

Pamilo, Konsta J; Peltola, Mikko; Paloneva, Juha; Mäkelä, Keijo; Häkkinen, Unto; Remes, Ville

2015-02-01

233

Postoperative blood loss prevention in total knee arthroplasty.  

PubMed

Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed. PMID:24122437

Banerjee, Samik; Kapadia, Bhaveen H; Issa, Kimona; McElroy, Mark J; Khanuja, Harpal S; Harwin, Steven F; Mont, Michael A

2013-12-01

234

Can pelvic tilting be ignored in total hip arthroplasty?  

PubMed Central

INTRODUCTION The orientation of acetabular component is influenced by pelvic tilt, body position and individual variation in pelvic parameters. Most post-operative adverse events may be attributed to malposition of the component in the functional position. There is evidence that orientation of the pelvis changes from the supine to standing position. Authors report a case of recurrent dislocation after total hip arthroplasty due to excessive pelvic tilting. PRESENTATION OF CASE A 69-year old female with coxarthrosis had undergone total hip replacement with recurrent dislocation of the hip on bearing weight in spite of using constrained acetabular component. DISCUSSION Our case report substantiates the influence of pelvic tilt, incurred by a sagittal deformity of spine, on dynamic orientation of the acetabular cup which was positioned in accordance with the anatomic landmarks alone. If the reference is only bony architecture and dynamic positions of the pelvis are not taken into account, improper functional orientation of the acetabular cup can result in sitting and standing positions. These can induce instability even in anatomically appropriately oriented acetabular component. CONCLUSION The sagittal position of pelvis is a key factor in impingement and dislocation after total hip arthroplasty. Pelvic tilting affects the position of acetabular component in the sagittal plane of the body as compared with its anatomic position in the pelvis. We suggest a preoperative lateral view of spine-pelvis, in upright and supine position for evaluation of a corrective adaptation of the acetabular cup accordingly with pelvic balance. PMID:25128730

Shon, Won Yong; Sharma, Vivek; keon, Oh jong; Moon, Jun Gyu; Suh, Dong Hun

2014-01-01

235

Bone Cement Solidifiliation Influence the Limb Alignment and Gap Balance during TKA  

PubMed Central

Introduction. Mechanical alignment deviation after total knee arthroplasty is a major reason for early loosening of the prosthesis. Achieving optimum cement penetration during fixation of the femoral and tibial component is an essential step in performing a successful total knee arthroplasty. Bone cement is used to solidify the bone and prosthesis. Thickness imbalance of bone cement leads to the deviation of mechanical alignment. To estimate the influence of bone cement, a retrospective study was conducted. Materials and Methods. A total of 36 subjects were studied. All the TKA were performed following the standard surgical protocol for navigated surgery by medial approach with general anaesthesia. Prostheses were fixed by bone cement. Results. We compared the mechanical axis, flexion/extension, and gap balance before and after cementation. All the factors were different compared with those before and after cementation. Internal rotation was reached with statistical significance (P = 0.03). Conclusion. Bone cement can influence the mechanical axis, flexion/extension, and gap balance. It also can prompt us to make a change when poor knee kinematics were detected before cementation.

Shi, Dongquan; Xu, Xingquan; Guo, Anyun; Dai, Jin; Xu, Zhihong; Chen, Dongyang; Jiang, Qing

2015-01-01

236

The effect of obesity on the outcome of hip and knee arthroplasty  

Microsoft Academic Search

The aim of this study was to evaluate the outcome of joint arthroplasty in obese and non-obese patients. We reviewed 2,026\\u000a consecutive primary total hip and 535 primary total knee arthroplasties performed for osteoarthritis. Patients were separated\\u000a into two groups according to their body mass index (BMI): non-obese (BMI?

Eric Yeung; Mark Jackson; Shaun Sexton; William Walter; Bernard Zicat

2011-01-01

237

Total hip arthroplasty after avascular necrosis of the femoral head: does etiology affect the results?  

Microsoft Academic Search

Introduction The aim of the study was to evaluate the results of total hip arthroplasty (THA) due to avascular necrosis (AVN) of the femoral head and to establish whether the cause of AVN affects the results. Material and methods A group of 68 patients, 17–82 years of age (mean: 49.9 years) underwent 84 total hip arthroplasties due to AVN. The patients were

Israel Dudkiewicz; Alon Covo; Moshe Salai; Amnon Israeli; Yehuda Amit; Aharon Chechik

2004-01-01

238

Design of novel drill guide device for cement removal in revision hip arthroplasty  

Microsoft Academic Search

Total hip arthroplasty (THA) is one of the most commonly performed surgical procedures. The requirement for revision hip arthroplasty (RHA) is increasing due to the increased use of THA in the elderly population and in younger patients with high physical demands. The revision rate for THA is approximately 10% at ten years.\\u000aRemoval of the distal cement plug in revision

Ian Robertson

2010-01-01

239

A Randomized Trial of Hydroxyapatite-Coated Femoral Stems in Total Hip Arthroplasty  

Microsoft Academic Search

A prospective randomized trial comparing hydroxyapatite (HA)-coated and non–HA-coated femoral total hip arthroplasty components was conducted. Sixty-one consecutive patients undergoing primary hip arthroplasty were randomized to receive an identical femoral component with or without HA. Forty-eight hips were available for review at an average of 13 years and 5 months after surgery. The only femoral stem revised was secondary to

Dan Camazzola; Terry Hammond; Rajiv Gandhi; J. Roderick Davey

2009-01-01

240

Issues relating to long-term follow-up in hip arthroplasty surgery  

Microsoft Academic Search

We reviewed 598 cemented Charnley and Hi-nek total hip arthroplasties at 7 years. Data were obtained from general practitioners, hospital medical notes, microfilm, and patient questionnaires. Outcome measures were revision rates, survival analysis, 12-item Oxford Hip Score, and satisfaction ratings. There were 471 Charnley (79%) and 127 Hi-nek (21%) total hip arthroplasties; 139 deaths (23%) occurred, and 5 (<1%) were

Jill Dawson; Evelyn Jameson-Shortall; Mark Emerton; Julian Flynn; Peter Smith; Roger Gundle; David Murray

2000-01-01

241

The Biomet Bi-Metric Total Hip Arthroplasty and Universal Acetabular Cup  

Microsoft Academic Search

We report on the medium-term results of the Bi-Metric (Biomet UK Ltd, Bridgend, UK) uncemented total hip arthroplasty system used with the Universal acetabular cup and polyethylene liner secured with the Ringloc (Biomet UK Ltd) mechanism. Fifty-eight total hip arthroplasties in 49 patients (mean age at implantation, 57.1 years) were identified, with 45 hips followed up at a mean of

David Llewellyn Isaac; Justin Forder; Andrew D. Skyrme; Stephen E. James

2007-01-01

242

Is Recovery Faster for Mobile-bearing Unicompartmental than Total Knee Arthroplasty?  

Microsoft Academic Search

How does unicompartmental compare with total knee arthroplasty in durability, incidence of complications and manipulations,\\u000a recovery, postoperative function, and return to sport and work? We matched 103 patients (115 knees) treated with a mobile-bearing\\u000a unicompartmental device through July 2005 to a selected group of 103 patients (115 knees) treated with cruciate retaining\\u000a total knee arthroplasty for bilaterality, age, gender and

Adolph V. Lombardi Jr; Keith R. Berend; Christopher A. Walter; Jorge Aziz-Jacobo; Nicholas A. Cheney

2009-01-01

243

The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population  

Microsoft Academic Search

With the increasing life expectancy, a greater number of elderly patients are being referred to an orthopaedic department\\u000a to have elective total knee arthroplasty (TKA). Total knee arthroplasty should be considered in the very elderly only after\\u000a carefully balancing the benefits of surgery against the risks of surgery. The aim of this study was to analyse the mortality,\\u000a morbidity and

S. V. Karuppiah; P. A. Banaszkiewicz; W. M. Ledingham

2008-01-01

244

Comparison of Robotic-Assisted and Conventional Manual Implantation of a Primary Total Knee Arthroplasty  

Microsoft Academic Search

This study was aimed to compare robotic-assisted implantation of a total knee arthroplasty with conventional manual implantation. We controlled, randomized, and reviewed 72 patients for total knee arthroplasty assigned to undergo either conventional manual implantation (excluding navigation-assisted implantation cases) of a Zimmer LPS prosthesis (Zimmer, Warsaw, Ind) (30 patients: group 1) or robotic-assisted implantation of such a prosthesis (32 patients:

Sang Eun Park; Chun Taek Lee

2007-01-01

245

CASE REPORT Temporomandibular Joint Arthroplasty With Human Amniotic Membrane: A Case Report  

PubMed Central

This case reports the usage of human amniotic membrane combined with a costochondral graft as an interpositional material in temporomandibular joint reconstruction for the first time in humans. Because of the favorable outcome 20 months postoperatively, it has to be considered as an approach bringing to light the antiadhesive potential of amniotic membrane. This case report must be regarded as initial spadework and should motivate other institutions to intensify their clinical research in this field. Because of the fact that currently used interpositional materials do not prevent the recurrence of temporomandibular joint ankylosis sufficiently, it is of great interest to establish a proper therapeutic intervention fulfilling these demands. Furthermore, the demonstrated antiadhesive properties of amniotic membrane highlight its multifaceted field of application. Nevertheless, further studies have to prove the findings reported in our case. PMID:23573337

Bauer, Florian; Hingsammer, Lukas M.; Wolff, Klaus-Dietrich; Kesting, Marco R.

2013-01-01

246

CASE REPORT Temporomandibular Joint Arthroplasty With Human Amniotic Membrane: A Case Report.  

PubMed

This case reports the usage of human amniotic membrane combined with a costochondral graft as an interpositional material in temporomandibular joint reconstruction for the first time in humans. Because of the favorable outcome 20 months postoperatively, it has to be considered as an approach bringing to light the antiadhesive potential of amniotic membrane. This case report must be regarded as initial spadework and should motivate other institutions to intensify their clinical research in this field. Because of the fact that currently used interpositional materials do not prevent the recurrence of temporomandibular joint ankylosis sufficiently, it is of great interest to establish a proper therapeutic intervention fulfilling these demands. Furthermore, the demonstrated antiadhesive properties of amniotic membrane highlight its multifaceted field of application. Nevertheless, further studies have to prove the findings reported in our case. PMID:23573337

Bauer, Florian; Hingsammer, Lukas M; Wolff, Klaus-Dietrich; Kesting, Marco R

2013-01-01

247

Can gap junctions deliver?  

PubMed

In vivo delivery of small interfering RNAs (siRNAs) to target cells via the extracellular space has been hampered by dilution effects and immune responses. Gap junction-mediated transfer between cells avoids the extracellular space and its associated limitations. Because of these advantages cell based delivery via gap junctions has emerged as a viable alternative for siRNA or miRNA delivery. Here we discuss the advantages and disadvantages of extracellular delivery and cell to cell delivery via gap junction channels composed of connexins. This article is part of a Special Issue entitled: The Communicating junctions, composition, structure and characteristics. PMID:21986484

Brink, Peter R; Valiunas, Virginijus; Gordon, Chris; Rosen, Michael R; Cohen, Ira S

2012-08-01

248

A Phase 2b Study of DU-176b, Prevention of Venous Thromboembolism in Patients After Total Hip Arthroplasty  

ClinicalTrials.gov

Anticoagulants; Venous Thromboembolism; Thromboembolism; Thrombosis; Enoxaparin Sodium; Embolism and Thrombosis; Deep Vein Thrombosis; DU-176b; Edoxaban; Factor Xa; Oral; Arthroplasty, Replacement, Hip

2010-09-14

249

Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty.  

PubMed

The efficaciousness of topical tranexamic acid use at the end of knee arthroplasty surgery to reduce blood loss and transfusion requirements has previously been shown. The aim of this study was to retrospectively assess the effectiveness of topical tranexamic acid use, comparing 155 patients undergoing hip and knee arthroplasty surgery in which tranexamic acid was routinely used, to a group of 149 patients from a similar time frame prior to the introduction of tranexamic acid use. The transfusion rate fell from 19.3% to 2.3% for hip arthroplasty patients and from 13.1% to 0% for knee arthroplasty patients; these differences were significant. We also found significant reductions in haemoglobin loss, blood loss and length of stay of 8 g/L, 244 mL and 1.0 days respectively for hip arthroplasties and 15 g/L, 527 mL and 1.2 days respectively for knee arthroplasties following the introduction of tranexamic acid. PMID:24095586

Gilbody, Julian; Dhotar, Herman S; Perruccio, Anthony V; Davey, J Roderick

2014-04-01

250

Bile-acid-mediated decrease in endoplasmic reticulum stress: a potential contributor to the metabolic benefits of ileal interposition surgery in UCD-T2DM rats  

PubMed Central

SUMMARY Post-operative increases in circulating bile acids have been suggested to contribute to the metabolic benefits of bariatric surgery; however, their mechanistic contributions remain undefined. We have previously reported that ileal interposition (IT) surgery delays the onset of type 2 diabetes in UCD-T2DM rats and increases circulating bile acids, independently of effects on energy intake or body weight. Therefore, we investigated potential mechanisms by which post-operative increases in circulating bile acids improve glucose homeostasis after IT surgery. IT, sham or no surgery was performed on 2-month-old weight-matched male UCD-T2DM rats. Animals underwent an oral fat tolerance test (OFTT) and serial oral glucose tolerance tests (OGTT). Tissues were collected at 1.5 and 4.5 months after surgery. Cell culture models were used to investigate interactions between bile acids and ER stress. IT-operated animals exhibited marked improvements in glucose and lipid metabolism, with concurrent increases in postprandial glucagon-like peptide-1 (GLP-1) secretion during the OFTT and OGTTs, independently of food intake and body weight. Measurement of circulating bile acid profiles revealed increases in circulating total bile acids in IT-operated animals, with a preferential increase in circulating cholic acid concentrations. Gut microbial populations were assessed as potential contributors to the increases in circulating bile acid concentrations, which revealed proportional increases in Gammaproteobacteria in IT-operated animals. Furthermore, IT surgery decreased all three sub-arms of ER stress signaling in liver, adipose and pancreas tissues. Amelioration of ER stress coincided with improved insulin signaling and preservation of ?-cell mass in IT-operated animals. Incubation of hepatocyte, adipocyte and ?-cell lines with cholic acid decreased ER stress. These results suggest that postoperative increases in circulating cholic acid concentration contribute to improvements in glucose homeostasis after IT surgery by ameliorating ER stress. PMID:23264565

Cummings, Bethany P.; Bettaieb, Ahmed; Graham, James L.; Kim, Jaehyoung; Ma, Fangrui; Shibata, Noreene; Stanhope, Kimber L.; Giulivi, Cecilia; Hansen, Frederik; Jelsing, Jacob; Vrang, Niels; Kowala, Mark; Chouinard, Michael L.; Haj, Fawaz G.; Havel, Peter J.

2013-01-01

251

Risk Factors for Periprosthetic Joint Infection after Total Hip Arthroplasty and Total Knee Arthroplasty in Chinese Patients  

PubMed Central

Purpose The purpose of this hospital-based case–control study was to evaluate the risk factors for periprosthetic joint infection (PJI) of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Chinese patients. Method From January 2000 to December 2012, 45 patients undergoing THA and TKA who developed PJI were recruited for case subjects; controls were 252 without PJI, matched by year of index for surgery and type of surgery. Conditional logistic regressions were run to compute odds ratios (ORs) and 95% confidence intervals (CIs). Results Demographic factors and comorbid conditions associated with an increased adjusted risk of PJI (in decreasing order of significance) were diabetes (OR?=?5.47, 95% CI: 1.77–16.97; p?=?0.003), age (65–75 vs. 45–65 years) (OR?=?3.36, 95% CI: 1.30–8.69; p?=?0.013), BMI (?28 vs. 18.5–28 kg/m2) (OR?=?2.77, 95% CI: 1.20–6.40; p?=?0.017), place of residence (rural) (OR?=?2.63, 95% CI: 1.13–6.10; p?=?0.025) and alcohol abuse (OR?=?2.95, 95% CI: 1.06–8.23; p?=?0.039). Conclusion Patients with diabetes, older age, BMI of ?28 kg/m2 and alcohol abuse or living in rural areas, had increased PJI risk. Additional systematic large-scale studies are needed to verify these results. PMID:24748009

Liu, Fengxiang; Li, Huiwu; Mao, Yuanqing; Zhu, Zhenan

2014-01-01

252

Assessment of quadriceps muscle weakness in patients after total knee arthroplasty and total hip arthroplasty: methodological issues.  

PubMed

The aim of this exploratory study was to verify whether the evaluation of quadriceps muscle weakness is influenced by the testing modality (isometric vs. isokinetic vs. isoinertial) and by the calculation method (within-subject vs. between-subject comparisons) in patients 4-8months after total knee arthroplasty (TKA, n=29) and total hip arthroplasty (THA, n=30), and in healthy controls (n=19). Maximal quadriceps strength was evaluated as (1) the maximal voluntary contraction (MVC) torque during an isometric contraction, (2) the peak torque during an isokinetic contraction, and (3) the one repetition maximum (1-RM) load during an isoinertial contraction. Muscle weakness was calculated as the difference between the involved and the uninvolved side (within-subject comparison) and as the difference between the involved side of patients and controls (between-subject comparison). Muscle weakness estimates were not significantly affected by the calculation method (within-subject vs. between-subject; P>0.05), whereas a significant main effect of testing modality (P<0.05) was observed. Isometric MVC torque provided smaller weakness estimates than isokinetic peak torque (P=0.06) and isoinertial 1-RM load (P=0.008), and the clinical occurrence of weakness (proportion of patients with large strength deficits) was also lower for MVC torque. These results have important implications for the evaluation of quadriceps muscle weakness in TKA and THA patients 4-8months after surgery. PMID:24290027

Lauermann, S P; Lienhard, K; Item-Glatthorn, J F; Casartelli, N C; Maffiuletti, N A

2014-04-01

253

Generation gaps in engineering?  

E-print Network

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. ...

Kim, David J. (David Jinwoo)

2008-01-01

254

California: Emigrant Gap  

Atmospheric Science Data Center

article title:  Emigrant Gap Fire, California     View Larger Image ... smoke plumes from wildfires burning throughout Northern California on August 13, 2001. The overview image represents an area of 336 ...

2014-05-15

255

Fiber optic gap gauge  

DOEpatents

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.

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

2006-11-14

256

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...

257

There Are GAPS and There Are GAPS  

NSDL National Science Digital Library

Access to the article is free, however registration and sign-in are required. Guanine nucleotide-binding proteins (G proteins) transduce a very large number of cellular regulatory signals. Several recent papers have shown that the larger heterotrimeric G proteins are regulated by a class of molecules known as the RGS proteins (regulators of G protein-signaling family) that are analogous to the GAPs (GTPase activating proteins), which regulate small monomeric G proteins. Iyengar summarizes this evidence and discusses the mechanism of action of the RGS proteins.

Ravi Iyengar (Mount Sinai School of Medicine; Department of Pharmacology)

1997-01-03

258

Sexual activity after total hip arthroplasty: a motion capture study.  

PubMed

Relative risk of impingement and joint instability during sexual activities after total hip arthroplasty (THA) has never been objectively investigated. Hip range of motion necessary to perform sexual positions is unknown. A motion capture study with two volunteers was performed. 12 common sexual positions were captured and relevant hip joint kinematics calculated. The recorded data were applied to prosthetic hip 3D models to evaluate impingement and joint instability during motion. To explore the effect of acetabular component positioning, nine acetabular cup positions were tested. Four sexual positions for women requiring intensive flexion (> 95°) caused prosthetic impingements (associated with posterior instability) at 6 cup positions. Bony impingements (associated with anterior instability) occurred during one sexual position for men requiring high degree of external rotation (> 40°) combined with extension and adduction at all cup positions. This study hence indicates that some sexual positions could be potentially at risk after THA, particularly for women. PMID:24018159

Charbonnier, Caecilia; Chagué, Sylvain; Ponzoni, Matteo; Bernardoni, Massimiliano; Hoffmeyer, Pierre; Christofilopoulos, Panayiotis

2014-03-01

259

Tibiofemoral kinematic analysis of kneeling after total knee arthroplasty.  

PubMed

Some surgeons warn against kneeling after total knee arthroplasty (TKA), because limited clinical data exist. We describe the tibiofemoral contact position of TKA components during kneeling in vivo. Ten posterior-substituting (PS) and 10 cruciate-retaining (CR) designs were examined using a radiographic image-matching technique. Movement from standing to kneeling at 90 degrees produced different responses. CR knees translated anteriorly (medial, 4 +/- 4 mm; lateral, 2 +/- 6 mm). PS knees underwent little posterior translation (medial, 0.2 +/- 3 mm; lateral, 1 +/- 4 mm). Movement from 90 degrees to maximum flexion produced femoral posterior translation (CR medial, 5 +/- 4 mm; CR lateral, 5 +/- 4 mm; PS medial, 6 +/- 4 mm; PS lateral, 6 +/- 3 mm). The relationship between tibiofemoral contact position and flexion angle was more variable for CR (r2=.38) than for PS (r2=.64). Knee kinematics was similar to other deep-flexion weight-bearing activities. PMID:15483808

Incavo, Stephen J; Mullins, Eric R; Coughlin, Kathryn M; Banks, Scott; Banks, Anne; Beynnon, Bruce D

2004-10-01

260

Surgical management of recurrent dislocation after total hip arthroplasty.  

PubMed

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

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

2014-02-01

261

Outcome of total knee arthroplasty in hemophilic arthropathy.  

PubMed

The clinical histories of 45 consecutively performed TKAs in 32 patients with hereditary bleeding disorders were reviewed retrospectively. The mean follow up was 88.7 (range, 24-232) months. The cumulative probability of infection free-survival was 87.8% after 180 months. When removal of component was defined as endpoint, the survival probability was 86.4% after 180 months. In regression analysis no significant independent risk factors for infection or aseptic loosening were identified. The HSS score improved significantly from 45 to 85 points. Hemophilic patients can be considered to be at high risk for prosthetic failure, our study has demonstrated favorable functional results of total knee arthroplasty in hemophilic patients. PMID:23958233

Panotopoulos, Joannis; Ay, Cihan; Trieb, Klemens; Schuh, Reinhard; Windhager, Reinhard; Wanivenhaus, Hugo A

2014-04-01

262

Arthroplasty - current strategies for the management of knee osteoarthritis.  

PubMed

Osteoarthritis of the knee is a major clinical burden. Recent decades have witnessed an improved understanding of knee physiology and kinematics, which has led to the introduction of a wide range of enhanced prosthetic implant designs for a variety of indications. However, the increase in the number of procedures performed annually has led to complications being encountered at higher rates than ever before, requiring the development of optimised therapeutic strategies. The future holds several promising options, primarily in the treatment of early osteoarthritis, biological therapy, surgical navigation and patient-specific implants. This review provides an insight into the current options of knee arthroplasty, with emphasis on available designs, and examines the complications that may be encountered. PMID:25664971

Ahmad, Sufian S; Gantenbein, Benjamin; Evangelopoulos, Dimitrios S; Schär, Michael O; Schwienbacher, Stefan; Kohlhof, Hendrick; Kohl, Sandro

2015-01-01

263

[Short-stemmed endoprostheses in total hip arthroplasty].  

PubMed

Short-stemmed endoprostheses in total hip arthroplasty are anchored exclusively in the metaphysis and the proximal part of the diaphysis. Therefore, they are much shorter than the classic standard stems. These implants are specially favourable in terms of eventual revision surgery, and also due to the fact that with close diaphyseal bone marrow spaces a sufficient proximal size dimensioning is possible. In this study, the best known short-stemmed systems in clinical use are introduced. Positive long-term results are so far available only with the Pipino and Mayo stems, short and partially medium-term experience with the remaining short stems (C.F.P.(R), Metha, PROXIMA, ESKA) are--with the available learning curve--encouraging. Despite the call for sufficient experience and scientific evaluation, short-stemmed endoprostheses already represent a valuable alternative in endoprosthetics for younger patients. PMID:17377765

Gulow, J; Scholz, R; Freiherr von Salis-Soglio, G

2007-04-01

264

Study on implant stability in cementless total knee arthroplasty  

PubMed Central

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

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

2012-01-01

265

Short bone-conserving stems in cementless hip arthroplasty.  

PubMed

? Short bone-conserving femoral stems in total hip arthroplasty were designed to preserve proximal bone stock.? Given the distinct fixation principles and location of loading among these bone-conserving stems, a classification system is essential to compare clinical outcomes.? Due to the low quality of currently available evidence, only a weak recommendation can be provided for clinical usage of certain stem designs, while some other designs cannot be recommended at this time.? A high prevalence of stem malalignment, incorrect sizing, subsidence, and intraoperative fractures has been reported in a subset of these short stem designs.? Stronger evidence, including prospective multicenter randomized trials comparing standard stems with these newer designs, is necessary before widespread use can be recommended. PMID:25320202

Khanuja, Harpal S; Banerjee, Samik; Jain, Deepak; Pivec, Robert; Mont, Michael A

2014-10-15

266

Total Hip Arthroplasty - over 100 years of operative history  

PubMed Central

Total hip arthroplasty (THA) has completely revolutionized the nature in which the arthritic hip is treated, and is considered to be one of the most successful orthopaedic interventions of its generation. With over 100 years of operative history, this review examines the progression of the operation from its origins, together with highlighting the materials and techniques that have contributed to its development. Knowledge of its history contributes to a greater understanding of THA, such as the reasons behind selection of prosthetic materials in certain patient groups, while demonstrating the importance of critically analyzing research to continually determine best operative practice. Finally, we describe current areas of research being undertaken to further advance techniques and improve outcomes. PMID:22355482

Knight, Stephen Richard; Aujla, Randeep; Biswas, Satya Prasad

2011-01-01

267

Pain after total hip arthroplasty: a psychiatric point of view  

PubMed Central

After total hip arthroplasty (THA), many studies report that a small percentage of patients mention painful symptoms, whose origin remains more or less obscure. We investigated 1,000 patients who had undergone a THA at least one year before their inclusion in the survey protocol. Among these 1,000 patients, 64 were complaining of pain in the region of the operated hip. These were later examined and investigated, both clinically (physical and psychiatric examination) and paraclinically (radiography, biology). Those requiring it received adequate treatment and the others were only regularly followed up. We identified the cause of all but one patient’s pain. In all cases except one, the symptoms of pain without physical cause had a psychiatric origin. The results of our study show that, if the clinical picture is not perfectly clear, a psychiatric screening before surgery could contribute to decreasing the incidence of pain syndrome after THA. PMID:17968546

Anract, P.; Mathieu, M.; Courpied, J. P.

2007-01-01

268

Cemented versus cementless fixation in total knee arthroplasty  

PubMed Central

The question of whether to use cemented or cement-less fixation for a total knee arthroplasty (TKA) is still debated. Discouraging preliminary results of cement-less TKAs have determined the worldwide use of cemented implants. However, with the development of biotechnologies and new biomaterials with high osteoconductive properties, biological fixation is now becoming an attractive option for improving the longevity of TKAs, especially in young patients. There is no evidence in the current literature to support the use of one method of fixation. The extensive clinical experience with cemented implants gathered over the years justifies their widespread use. New randomized clinical trials are necessary to compare cementless fixation based on the new ingrowth surfaces with standard cemented implants.

MATASSI, FABRIZIO; CARULLI, CHRISTIAN; CIVININI, ROBERTO; INNOCENTI, MASSIMO

2013-01-01

269

Recurrent total knee arthroplasty dislocation after dorsal meningioma diagnosed.  

PubMed

We report on a 68-year-old woman with gonarthrosis who underwent total knee arthroplasty. Having initially achieved a satisfactory result, she developed at 5 months postoperation an irreducible flexion contracture necessitating revision surgery; but no pathological findings were discovered. In the immediate postoperative period, the patient developed a severe spasm of the hamstring muscles and a paralysis of the external popliteal sciatic nerve with a posterior dislocation of the knee. After reduction, an electromyography study showed an alteration in medullary sensitive conduction; and the magnetic resonance image showed a lesion compatible with meningioma. This complication has not been previously described as a consequence of spinal tumor. Technical considerations are described for this rare complication, which remains a serious challenge for the orthopedic surgeon. PMID:21474273

Lopiz, Yaiza; García-Fernández, Carlos; Marco, Fernando; López-Durán, Luis

2011-12-01

270

Traditions and myths in hip and knee arthroplasty  

PubMed Central

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

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

2014-01-01

271

Spontaneous modular femoral head dissociation complicating total hip arthroplasty.  

PubMed

Modular femoral heads have been used successfully for many years in total hip arthroplasty. Few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. Although there has always been some concern over the potential for fretting, corrosion, and generation of particulate debris at the modular junction, this was not considered a significant clinical problem. More recently, concern has increased because fretting and corrosive debris have resulted in rare cases of pain, adverse local tissue reaction, pseudotumor, and osteolysis. Larger femoral heads, which have gained popularity in total hip arthroplasty, are suspected to increase the potential for local and systemic complications of fretting, corrosion, and generation of metal ions because of greater torque at the modular junction. A less common complication is dissociation of the modular femoral heads. Morse taper dissociation has been reported in the literature, mainly in association with a traumatic event, such as closed reduction of a dislocation or fatigue fracture of the femoral neck of a prosthesis. This report describes 3 cases of spontaneous dissociation of the modular prosthetic femoral head from the trunnion of the same tapered titanium stem because of fretting and wear of the Morse taper in a metal-on-polyethylene bearing. Continued clinical and scientific research on Morse taper junctions is warranted to identify and prioritize implant and surgical factors that lead to this and other types of trunnion failure to minimize complications associated with Morse taper junctions as hip implants and surgical techniques continue to evolve. PMID:24972443

Talmo, Carl T; Sharp, Kinzie G; Malinowska, Magdalena; Bono, James V; Ward, Daniel M; LaReau, Justin

2014-06-01

272

The Use of Preoperative Epoetin-? in Revision Hip Arthroplasty  

PubMed Central

Purpose: To evaluate the efficacy of preoperative epoetin-? on the revision hip arthroplasty patient. We hypothesized that epoetin-? will reduce blood transfusion. A pertinent review of the literature is provided. Methods: Forty-six patients were retrospectively reviewed. Sixteen patients received epoetin-?. Patients were case matched by age, preoperative hemoglobin, surgery, gender, and BMI. 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 decreased in the epoetin-? group. Hemoglobin in the intervention group increased from 12.0 to 14.5, preoperatively. Patients who received epoetin-? were 0.78 (RR=0.225) times as likely to receive a transfusion. Number Needed to Treat (NNT) to avoid one allogeneic transfusion was 1.84. Age, Gender, BMI, ASA, total and hidden blood loss, preoperative Iron supplements, preop Hct, preop PLT, PT, PTT, and INR were similar. One (6.0%) patient developed an uncomplicated deep venous thrombosis in the intervention group. Conclusions: The mildly anemic revision hip arthroplasty patient is at increased risk for transfusion. Epoetin-? increased preoperative hemoglobin counts and reduced transfusions in this study; it also decreased patient length of hospital stay likely allowing for an 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:22629289

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

2012-01-01

273

Primary total knee arthroplasty in severe valgus knee  

PubMed Central

Abstract Aim: Outcome of primary total arthroplasty for osteoarthritis of the knee with valgus deformity. Materials and methods: Between 2005 and 2007, 28 primary total knee replacements were performed for osteoarthritis of the knee with valgus deformity. 21 cases were women and 7 men with a mean age of 66.6 years (extremes 54-81). The clinical and radiological evaluations were done considering the knee range of motion, Knee Society Score (KSS) and femorotibial angle measured on the frontal standing long leg X-rays. Preoperatively, the knee valgus deformity angle was 6 to 15 degrees in 14 cases, 15 to 25 degrees in 10 cases and over 25 degrees in 4 cases. Results: After a mean follow-up time of 14 months (extremes 7-29), the knee range of motion improved from a mean of 71 degrees (extremes 52-87) preoperatively to a mean of 95 degrees (extremes 78-110) postoperatively. The KSS value improved from 21.3 points (extremes 1-33) preoperatively to 80.7 points (extremes 70-92) postoperatively and the frontal femorotibial angle from a mean value of 21 degrees (extremes 11-39) of valgus before surgery, to a mean of 9 degrees (extremes 0-12) of valgus after surgery. Conclusions: Long leg AP view X-ray examination in standing position is mandatory. The standard medial parapatellar approach is appropriate in this type of arthroplasty even if significant knee valgus deviations are present because it avoids the lateral approach complications. Postoperatively, one can get an aligned and stable knee if a judicious and progressive periarticular soft tissues balancing is achieved, in both flexion and extension position. PMID:24868248

Radulescu, R; Badila, A; Japie, I; Ciobanu, T; Manolescu, R

2013-01-01

274

Uncertainties in Gapped Graphene  

E-print Network

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.

Eylee Jung; Kwang S. Kim; DaeKil Park

2011-07-27

275

Comparison of Cruciate Retaining and PCL Sacrificing TKA with Respect to Medial and Lateral Gap Differences in Varus Knees After Medial Release.  

PubMed

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

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

2015-01-01

276

Charnley low-friction arthroplasty of the hip. Five to 25 years survivorship in a general hospital  

Microsoft Academic Search

BACKGROUND: Some studies have raised the question about whether the good results obtained with the Charnley prosthesis could be replicated at general hospitals when it comes to the frequency of early complications and failure rates, both of which would be higher than those published by centres devoted to hip arthroplasties. METHODS: We reviewed the results of 404 Low Friction Arthroplasties

Daniel Hernández-Vaquero; Abelardo Suárez-Vazquez; Jesus Fernandez-Lombardia

2008-01-01

277

Closing the Health Gap  

NSDL National Science Digital Library

The US Department of Health and Human Services (HHS) and ABC Radio Networks are working together to help African-Americans gain access to the best possible information regarding health issues. HHS reports that life expectancies for African-Americans lag five years behind expectancies for White Americans. The new Website Closing the Health Gap has links to information on health conditions such as diabetes and cancer as well as consumer health resources that relate to African-Americans' particular needs. Each page offers links, publications, and any news related to the subject, all in an effort to close "the health gap."

2001-01-01

278

An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation.  

PubMed

Congestion in the anterior section in a right liver (RL) without a middle hepatic vein (MHV) may lead to graft dysfunction. To solve this problem, an RL draining MHV branches with autologous or cryopreserved vessels can be introduced. However, these vessels are often unavailable, and their preparation is time-consuming. An expanded polytetrafluoroethylene (ePTFE) graft may be used for anterior section drainage. Between February and November 2005, 26 recipients underwent RL liver transplantation draining MHV branches with an ePTFE graft (group P). Twenty-six ePTFE grafts (6 or 7 mm in internal diameter) drained 35 MHV branches on the back table to the graft right hepatic vein or to the recipient's inferior vena cava. The patency of the ePTFE graft was checked with computed tomography scans of the liver. The outcome of group P was compared with those of an RL group with MHV (group M, n=17) and an RL group without reconstruction of MHV or its tributaries (group R, n=85). The 1-month and 4-month patency rates (PRs) of the ePTFE grafts were 80.8% (21/26) and 38.5% (10/26). All showing early obstruction of the ePTFE graft had congestion in the anterior section, but all showing late obstruction were asymptomatic. The 1-month PRs of group P were comparable to, but the 4-month PRs were lower than, those of group M (both 94.1%; P<0.05). However, 1-year patient and graft survival rates of group P (both 100%) were comparable to those of group M (94.1% and 100%) and better than those of group R (83.5% and 88.2%; P<0.05). In conclusion, the early PR of group P was good, and late obstruction of the ePTFE graft had no impact on congestion in the anterior section or patient survival. Therefore, an ePTFE graft may be a useful interposition material for anterior section drainage in RL transplantation without serious complications. PMID:17663413

Yi, Nam-Joon; Suh, Kyung-Suk; Lee, Hae Won; Cho, Eung-Ho; Shin, Woo Young; Cho, Jai Young; Lee, Kuhn Uk

2007-08-01

279

Surgeon variability in total knee arthroplasty component alignment: a Monte Carlo analysis.  

PubMed

Component mal-alignment in total knee arthroplasty has been associated with increased revision rates and poor clinical outcomes. A significant source of variability in traditional, jig-based total knee arthroplasty is the performance of the surgeon. The purpose of this study was to determine the most sensitive steps in the femoral and tibia arthroplasty procedures. A computational model of the total knee arthroplasty procedure was created, and Monte Carlo simulations were performed that included surgeon variability in each step of the procedure. The proportion of well-aligned components from the model agrees with clinical literature in most planes. When components must be aligned within ±3° in all planes, component alignment was most sensitive to the accuracy of identifying the lateral epicondyle for the femoral component, and to the precision of the transverse plane alignment of the extramedullary guide for the tibial component. This model can be used as a tool for evaluating different procedural approaches or sources of variability to improve the quality of the total knee arthroplasty procedure. PMID:23590719

Gatti, Christopher J; Hallstrom, Brian R; Hughes, Richard E

2014-11-01

280

Bilateral custom-fit total knee arthroplasty in a patient with poliomyelitis.  

PubMed

In limbs affected by poliomyelitis, total knee arthroplasty results in satisfactory pain relief. However, the risk of failure is high, especially if the preoperative quadriceps power is low. Therefore, treating osteoarthritis in the current patient represented a challenging procedure. A 66-year-old man presented with tricompartmental osteoarthritis of both knees, with valgus deformity of 14° on the left knee and 11° on the right knee. He walked with a bilateral knee recurvatum of 30° and a grade 1 quadriceps power. The authors treated both knees with cemented custom-fit hinged total knee arthroplasty with 30° of recurvatum in the tibial keel. Clinical scores showed good results 1 year postoperatively, especially on the subjective data of quality of life and function. At follow-up, radiographs showed good total knee arthroplasty positioning on the right side and a small mechanical loosening at the end of the tibial keel on the left side. Only 5 studies (Patterson and Insall; Moran; Giori and Lewallen; Jordan et al; and Tigani et al) have reported total knee arthroplasty results in patients with poliomyelitis. This study reports an original case of bilateral custom-fit hinged total knee arthroplasty in a patient with poliomyelitis. To the authors' knowledge, this is the first report of this type of procedure in the literature. The key point is the degree of recurvatum that is needed to allow walking, avoiding excessive constraints on the implants that can lead to early mechanical failure. PMID:25350629

Tardy, Nicolas; Chambat, Pierre; Murphy, Colin G; Fayard, Jean-Marie

2014-09-01

281

Crossing the Gap  

ERIC Educational Resources Information Center

In a nation where education is funded largely by local property taxes, schools in wealthy communities have plenty of funds to spend on programs that get their kids ready for college. Schools in poor communities scrimp and save to get the job done--or hope that funding from the state will help fill in the gap. This article describes how students…

Lockette, Tim

2009-01-01

282

Bridging the Gender Gap  

E-print Network

Bridging the Gender Gap: Growing the Next Generation of Women in Computing A sobering fact: the U need to ensure our research and development teams are diverse enough to anticipate, respond, and serve Develop: This radically new software development environment lets you write code for your phone on your

Chaudhuri, Surajit

283

Closing the Performance Gap.  

ERIC Educational Resources Information Center

Describes how the principal of a K-2, 400-student suburban elementary school near Flint, Michigan, worked with her staff and superintendent to develop and implement a strategic plan to close the student achievement gap. Reports significant improvement in reading and math scores after 1 year. (PKP)

Riggins, Cheryl G.

2002-01-01

284

Temperature Dependent Hybridization Gaps  

NASA Astrophysics Data System (ADS)

A number of heavy-fermion/mixed-valent materials show hybridization gaps either at the Fermi-energy or close to the Fermi-energy. In the former case, a heavy-fermion semiconducting state ensues and in the later case, the system remains metallic at low temperatures. In either case, the electronic structure is extremely temperature-dependent. It has been observed that the gap closes and the heavy quasiparticle bands disappear at high temperatures. The magnitude of the gaps scale with effective quasiparticle masses. A phenomenological model is presented that exhibits a temperature-dependence which is consistent with the above behavior. The model is based on a periodic array of Anderson impurities in which the electron correlations are represented by the coupling to bosons with an Einstein spectra. The model can be solved via systematic approximation. The solution describes the temperature- dependence of coherent and incoherent structures in the electronic excitation spectra. The predicted hybridization gaps for the metallic case are compared with data from photoemission experiments on UPd2Al3.

Riseborough, Peter

2011-03-01

285

Bridging the Gap.  

ERIC Educational Resources Information Center

Presents a critique of existing methodology used in curriculum updates in academic institutions, suggesting that an integrated approach is more realistic and meaningful to study and to bridging the gap between academic curriculum and industry's needs. Specifically recommends that curriculum-related and job-related data be analyzed simultaneously.…

Mansour, Ali H.; And Others

1986-01-01

286

Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty  

PubMed Central

Purpose Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease. Materials and Methods Sixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery. Results VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded. Conclusion Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up. PMID:24954339

Oh, Chang Hyun; Kim, Do Yeon; Ji, Gyu Yeul; Kim, Yeo Ju; Hyun, Dongkeun; Kim, Eun Young; Park, Hyeonseon; Park, Hyeong-Chun

2014-01-01

287

Comparison of Floseal(r) and electrocautery in hemostasis after total knee arthroplasty  

PubMed Central

Objective To evaluate whether hemostasis with eletrocauterization in comparison with Floseal(r) leads to different bleeding rates during total knee arthroplasty. Methods A comparative study was performed between two groups: group with ten consecutive total knee arthroplasties with Floseal(r) used as hemostatic method and control group with ten consecutive total knee arthroplasties with eletrocauterization as hemostatic method. Bleeding parameters such as debit of the drain, liquid infusion and blood transfusion rate were recorded. Results Floseal(r) group received less blood transfusion, less liquid infusion and lower drainage in absolute numbers compared to the control group. However, no parameter was statistically significant. Conclusion Hemostasis with Floseal(r) is as effective as hemostasis with eletrocauterization, what makes it a viable alternative to patients with contraindication to electric scalpel use. Level of Evidence II, Prospective Comparative Study. PMID:24453689

Helito, Camilo Partezani; Gobbi, Riccardo Gomes; Castrillon, Lucas Machado; Hinkel, Betina Bremer; Pécora, José Ricardo; Camanho, Gilberto Luis

2013-01-01

288

Outcomes of post-operative periprosthetic femur fracture around total hip arthroplasty: a review.  

PubMed

As the number of primary total hip arthroplasties increase over the next several decades so will the incidence of periprosthetic fractures around the femoral stem. Treatment can reliably be predicted using the Vancouver classification with internal fixation being indicated in fractures involving a stable implant and revision arthroplasty indicated in those with unstable prostheses. Non-displaced fractures involving the greater and lesser trochanter can generally be treated non-operatively. Extensively porous-coated stems and the use of modular uncemented revision stems to treat Vancouver B fractures have shown encouraging results. The treatment of Vancouver C periprosthetic fractures continues to follow basic AO fixation principles with an emphasis on eliminating stress risers with adequate implant overlap and length. This review will focus on the risk factors and classification of these fractures, as well as highlight the treatment options for post-operative periprosthetic femoral fractures around a total hip arthroplasty. PMID:25209073

Wu, Eddie S; Cherian, Jeffrey J; Kapadia, Bhaveen H; Banerjee, Samik; Jauregui, Julio J; Mont, Michael A

2015-01-01

289

Hypersensitivity to benzoyl peroxide in a cemented total knee arthroplasty: cement allergy.  

PubMed

A small but significant proportion of cemented total knee arthroplasties develop aseptic loosening. Polyethylene debris is unlikely to be the cause in the small subgroup that experiences early loosening. Allergy to polymethylmethacrylate bone cement or its constituents has been reported in several different industries and in dentistry, dermatology, and joint arthroplasty. Although allergy to polymethylmethacrylate bone cement or its constituents is unusual, the possibility of a systemic inflammatory response and consequent pain and loosening must be considered. We report a case history of a patient who developed a systemic reaction and intractable pain after a total knee arthroplasty who was subsequently shown to be hypersensitive to the benzoyl peroxide component of bone cement. PMID:18078897

Edwards, Stuart Andrew; Gardiner, Jonathan

2007-12-01

290

Assessment of asymmetric leg loading before and after total hip arthroplasty using instrumented shoes  

PubMed Central

Background Total hip arthroplasty is a successful surgical treatment in patients with osteoarthritis of the hip. Different questionnaires are used by the clinicians to assess functional capacity and the patient's pain, despite these questionnaires are known to be subjective. Furthermore, many studies agree that kinematic and kinetic parameters are crucial to evaluate and to provide useful information about the patient’s evolution for clinicians and rehabilitation specialists. However, these quantities can currently only be obtained in a fully equipped gait laboratory. Instrumented shoes can quantify gait velocity, kinetic, kinematic and symmetry parameters. The aim of this study was to investigate whether the instrumented shoes is a sufficiently sensitive instrument to show differences in mobility performance before and after total hip arthroplasty. Methods In this study, patients undergoing total hip arthroplasty were measured before and 6–8?months after total hip arthroplasty. Both measurement sessions include 2 functional mobility tasks while the subject was wearing instrumented shoes. Before each measurement the Harris Hip Score and the Traditional Western Ontario and McMaster Universities osteoarthritis index were administered as well. Results The stance time and the average vertical ground reaction force measured with the instrumented shoes during walking, and their symmetry index, showed significant differences before and after total hip arthroplasty. However, the data obtained with the sit to stand test did not reveal this improvement after surgery. Conclusions Our results show that inter-limb asymmetry during a walking activity can be evaluated with the instrumented shoes before and after total hip arthroplasty in an outpatient clinical setting. PMID:24581227

2014-01-01

291

Effect of anterior translation of the talus on outcomes of three-component total ankle arthroplasty  

PubMed Central

Background Ankle osteoarthritis commonly involves sagittal malalignment with anterior translation of the talus relative to the tibia. Total ankle arthroplasty has become an increasingly popular treatment for patients with symptomatic ankle osteoarthritis. However, no comprehensive study has been conducted on the outcomes of total ankle arthroplasty for osteoarthritis with preoperative sagittal malalignment. The purpose of this study was to evaluate the effect of anterior translation of the talus on outcomes of three-component total ankle arthroplasty. Methods One hundred and four osteoarthritic ankles in 104 patients who underwent three-component total ankle arthroplasty were included in this study. The 104 ankles were divided into 2 groups: ankles with anteriorly translated talus (50 ankles), and ankles with non-translated talus (54 ankles). Clinical and radiographic outcomes were assessed in both groups. The mean follow-up duration was 42.8?±?17.9 months (range, 24 to 95 months). Results Forty-six (92%) of 50 ankles with anterior translation of the talus showed relocation of the talus within the mortise at 6 months, and 48 (96%) ankles were relocated at 12 months after total ankle arthroplasty. But, 2 (4%) ankles were not relocated until the final follow-up. The AOFAS scores, ankle range of motion, and radiographic outcomes showed no significant difference between the two groups at the final follow-up (p?>?0.05 for each). Conclusions In majority of cases, the anteriorly translated talus in osteoarthritic ankles was restored to an anatomical position within 6 months after successful three-component total ankle arthroplasty. The clinical and radiographic outcomes in the osteoarthritic ankles with anteriorly translated talus group were comparable with those in non-translated talus group. PMID:24007555

2013-01-01

292

GAP-REACH  

PubMed Central

Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-itemGAP-REACH© checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (? = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article. PMID:24080673

Lewis-Fernández, Roberto; Raggio, Greer A.; Gorritz, Magdaliz; Duan, Naihua; Marcus, Sue; Cabassa, Leopoldo J.; Humensky, Jennifer; Becker, Anne E.; Alarcón, Renato D.; Oquendo, María A.; Hansen, Helena; Like, Robert C.; Weiss, Mitchell; Desai, Prakash N.; Jacobsen, Frederick M.; Foulks, Edward F.; Primm, Annelle; Lu, Francis; Kopelowicz, Alex; Hinton, Ladson; Hinton, Devon E.

2015-01-01

293

Photonic Band Gap  

NSDL National Science Digital Library

Created by Boyang Liu and Professor Seng-Tiong Ho at Northwestern University, and presented by the NanoEd Resource Portal, this site covers the concept of the photonic band gap. Here, visitors will find a basic description of the concept, ideas of how to incorporate it into classroom activities, and a user's manual to walk students step-by-step through the concept. There is also a link to an interactive simulation (the link is labeled Open Visualization), which allows students to adjust the wavelength and color of the light source, particle size, and incident angle to view changes to the photonic band gap. This is a thorough and useful resource for any nanotechnology classroom.

Ho, Seng-Tiong

294

Retrospective Analysis of Infection Rate After Early Reoperation in Total Hip Arthroplasty  

Microsoft Academic Search

Background  Infection is a devastating complication of total hip arthroplasty (THA). Unavoidable reoperation during the acute recovery\\u000a phase of hip arthroplasty has the potential for an increased infection rate but the risk is not well established nor is the\\u000a fate of these infected hips.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We therefore report the infection rate for patients undergoing THA who returned to the operating room within

Hussein Darwiche; Wael K. Barsoum; Alison Klika; Viktor E. Krebs; Robert Molloy

2010-01-01

295

Inflammatory Pseudotumor Complicated by Recurrent Dislocations after Revision Total Hip Arthroplasty  

PubMed Central

A 71-year-old female with a history of right total hip arthroplasty presented with an enlarging pseudotumor. Pseudotumor is a known complication following metal-on-metal and metal-on-conventional polyethylene and metal-on-highly cross-linked polyethylene implants. Revision total hip arthroplasty following resection of pseudotumor has resulted in an increase in incidence of postoperative complications. Despite stable implants, these complications arise from the amount of soft tissue damage combined with the loss of tissue support around the resected hip. Our case is a clear example of a major complication, recurrent dislocation, following resection and revision surgery. PMID:25161791

Lee, Jason; Schwarzkopf, Ran

2014-01-01

296

Flexor Carpi Ulnaris Muscle Flap for Soft Tissue Reconstruction after Total Elbow Arthroplasty  

PubMed Central

The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty. PMID:25400974

Okamoto, Syunro; Ai, Hachinota; Tsuchiya, Hiroyuki

2014-01-01

297

Successful LCL reconstruction and PCL repair for LCL tear and PCL avulsion following total knee arthroplasty.  

PubMed

Total knee arthroplasty represents a well-established and successful procedure; however, ligament incompetence is known to negatively affect surgical outcomes. Here we present an unusual case of early total knee arthroplasty failure secondary to femoral posterior cruciate ligament (PCL) avulsion and associated lateral collateral ligament (LCL) tear, treated successfully with primary PCL repair and LCL reconstruction. For LCL reconstruction, a peroneus longus allograft was passed through an anterior to posterior bony tunnel in the fibular head and docked into a horizontal femoral tunnel. Level of evidence Case report, Level IV. PMID:23756851

Flierl, Michael A; Bravman, Jonathan T; Eckhoff, Donald G

2014-11-01

298

Patellofemoral crepitation and clunk complicating posterior-stabilized total knee arthroplasty.  

PubMed

Patellofemoral crepitation and clunk (PCC) is an important potential complication of total knee arthroplasty. Numerous factors, including implant design, range of motion, and certain radiographic parameters, may contribute to the development of PCC. Although the diagnosis is primarily clinical, imaging modalities may be helpful in cases of diagnostic uncertainty. Arthroscopic débridement is the preferred method of treating PCC in patients whose symptoms require intervention. A full understanding of the diagnosis, management, and prevention of PCC is essential for orthopedic surgeons who perform total knee arthroplasties. PMID:25303444

Gladnick, Brian P; Gonzalez Della Valle, Alejandro

2014-10-01

299

Kinematic analysis of mobile-bearing total knee arthroplasty using a 6DOF knee simulator  

Microsoft Academic Search

Background  The purpose of this study was to investigate the kinematics of the polyethylene insert in two designs of mobilebearing total\\u000a knee arthroplasty, using a six-degrees-of-freedom knee simulator. It was consequently not clear whether the motion of the\\u000a polyethylene bearing in mobile-bearing total knee arthroplasty could be demonstrated during the gait cycle or more rapid movement.\\u000a \\u000a \\u000a \\u000a Methods  A mobile-bearing knee (Zimmer) and

Satoshi Hamai; Hiromasa Miura; Hidehiko Higaki; Takeshi Shimoto; Yoshitaka Nakanishi; Yukihide Iwamoto

2008-01-01

300

Total ankle arthroplasty and tibialis posterior tendon transfer for ankle osteoarthritis and drop foot deformity.  

PubMed

Total ankle arthroplasty is an alternative to arthrodesis in selected patients with end-stage arthritis of the ankle. We report on the clinical features, radiographic findings, management and results in a 58-year-old man with associated ankle osteoarthritis and drop foot deformity. The patient was managed with a total ankle arthroplasty and tibialis posterior tendon transfer. Three years after the procedure, the patient was able to walk, had no pain, and had a stable joint with 5° dorsiflexion and 20° plantar flexion. PMID:21783086

Thermann, Hajo; Gavriilidis, Iosif; Longo, Umile Giuseppe; Maffulli, Nicola

2011-09-01

301

Evaluation of the learning curve associated with uncemented primary porous-coated anatomic total hip arthroplasty.  

PubMed

The results of the first and second groups of 50 consecutive primary, uncemented porous-coated anatomic arthroplasties were analyzed to evaluate the learning curve associated with the procedure. Femoral fit, acetabular cup angle, femoral fracture rate, minimum two-year clinical hip ratings, and clinical symptoms were compared between the two groups. Significant improvement in achieving better femoral canal filling with the prosthesis and lower acetabular cup angle placements was documented in the second 50 cases. Although a definite learning curve in mastering the technique of uncemented total hip arthroplasty was observed, thigh pain rate and clinical ratings were not improved after two years. PMID:1516304

Callaghan, J J; Heekin, R D; Savory, C G; Dysart, S H; Hopkinson, W J

1992-09-01

302

Scorpio single radius total knee arthroplasty. A minimal five-year follow-up multicentric study  

Microsoft Academic Search

Purpose  Our goal was to evaluate the five-year follow-up results of the Scorpio single radius total knee arthroplasty.\\u000a \\u000a \\u000a \\u000a Method  We performed a retrospective study based upon a multicentre database to evaluate the minimum five-year follow-up clinical\\u000a and radiological results of 747 patients (831 knees) who underwent primary Scorpio single radius total knee arthroplasty.\\u000a \\u000a \\u000a \\u000a \\u000a Results  The mean age of the patients was 71.9 years. At

Frédéric Borrione; Paul Bonnevialle; Christian Mabit; Olivier Guingand; Denis Bertin; François Bonnomet; Christophe Denis; Gilles Gagna

303

Hallux rigidus: surgical treatment with the crescentic oblique basilar resection arthroplasty (COBRA).  

PubMed

The treatment of advanced hallux rigidus in an older, more sedentary population with poor bone stock or comorbidities that may make corrective osteotomy, fusion, and implant fixation more problematic has frequently been an issue for orthopedic surgeons. The traditional Keller resection arthroplasty has not fared well because of various problems. Crescentic oblique basilar resection arthroplasty is a viable surgical treatment alternative for older, more sedentary patients who have advanced hallux rigidus with or without hallux valgus. This may also be a good alternative procedure in a more active patient who wishes to avoid fusion of the joint while maintaining some first MTP motion. PMID:19232989

Marks, Richard M

2009-03-01

304

Clinical Outcomes Assessment of Three Similar Hip Arthroplasty Bearing Surfaces  

PubMed Central

This report examines the clinical performance of three very similar total hip arthroplasty designs with distinctly different bearing surfaces used over the course 10-17 years. Clinical outcomes assessments for each group are compared in the context of varying implant related costs related to the latest technology at the time of surgery. Eighty-one surgeries were studied and differ by bearing surface. In this study, 36 hips are ceramic on polyethylene, 27 are metal on polyethylene and 18 are metal on metal. All polyethylene components are nonhighly cross-linked. The ceramic on polyethylene group has younger patients, on average, and higher percentage of patients with significant polyethylene wear. These groups have an average follow-up time of 8.6 years when assessing functional hip scores, thigh pain, groin pain, revision surgeries and radiographic osteolysis. The implant purchasing cost at the time of surgery was assessed to determine if a correlation exists between outcomes and the more technologically advanced implants use at the time of surgery. Based on midterm clinical outcome assessment, no correlation between initial hospital cost and clinical outcomes of one bearing surface over another can be found. PMID:25002938

Parsons, Christopher; Batson, Ryan; Reighard, Shane; Tanner, Stephanie; Snider, Becky; Pace, Thomas B.

2014-01-01

305

Review of 10-year results of PCA hip arthroplasty  

PubMed Central

Objective To assess the long-term results of the PCA uncemented total hip replacement. Design A prospective nonrandomized clinical trial. Follow-up ranged from 8 to 11 years (mean 10.3 years). Setting A university hospital. Patients One hundred consecutive PCA arthroplasties were performed on 89 patients. All operations were supervised by a single surgeon. The patients’ status was reviewed between September and November 1996 by an independent observer. Seventy-three total hip replacements were available for review. Intervention PCA uncemented acetabular and femoral replacement through a lateral surgical approach. Main outcome measures The need for revision, which was classified as failure, and definite 3-zone acetabular radiolucency, which was considered radiologic evidence of loosening. Results The time to failure of the acetabulum averaged 8 years. Femoral failure occurred in 3 patients an average of 4 years postoperatively. The overall failure rate for the acetabulum was 13% and for the femur 7%. Conclusions The acetabular failure rate is unacceptably high. Patients who have had hip replacement with the PCA prosthesis should be followed over the long term. PMID:9492747

Hastings, David E.; Tobin, Helen; Sellenkowitsch, Marilyn

1998-01-01

306

Effect of a pathological scapular tilt after total shoulder arthroplasty.  

PubMed

Total shoulder arthroplasty (TSA) is an accepted and most successfully used treatment for different shoulder pathologies. Different risk factors for the failure of the prosthesis are known. A pathological scapular orientation, observed in elderly people or in patients suffering from neuromuscular diseases, could be a cause of failure, which has not been investigated yet. To test this hypothesis, a numerical musculoskeletal model of the glenohumeral joint was used to compare two TSA cases: a reference normal case and a case with a pathological anterior tilt of the scapula. An active abduction of 150° was simulated. Joint force, contact pattern, polyethylene and cement stress were evaluated for both cases. The pathological tilt slightly increased the joint force and the contact pressure, but also shifted the contact pattern. This eccentric contact increased the stress level within the polyethylene of the glenoid component and within the surrounding cement layer. This adverse effect occurred mainly during the first 60° of abduction. Therefore, a pathological orientation of the scapula may increase the risk of a failure of the cement layer around the glenoid component. These preliminary numerical results should be confirmed by a clinical study. PMID:22375919

Röthlisberger, Marion; Pioletti, Dominique P; Farron, Alain; Terrier, Alexandre

2013-01-01

307

No clinical benefit of gender-specific total knee arthroplasty  

PubMed Central

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

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

2014-01-01

308

Kinematics of medial unicondylar knee arthroplasty: an in vivo investigation.  

PubMed

This study investigated the weight-bearing flexion of 7 knees with previous medial unicondylar knee arthroplasty (UKA), using a dual fluoroscopic imaging system. The data indicated that the patients had consistent posterior translation of the medial femoral condyle and consistent internal rotation of the tibia with flexion. The articular contact location remained just anterior and medial to the center of the polyethylene insert throughout the range of motion. Femoral condylar lift-off was found in 2 patients at a maximum flexion angle of 130.7 +/- 10.2 degrees. The other 5 patients had a maximum flexion angle of 113.9 +/- 7.2 degrees. The small range of tibiofemoral contact excursion in both anteroposterior and mediolateral directions indicated a medial pivot contact pattern during flexion, corresponding to the observed internal tibial rotation. This may help reduce tibial loosening, thus increasing implant longevity. The observed coincidence between condylar lift-off and higher flexion angles may reveal the causative factors that enhance knee flexion after UKA. PMID:19634728

Hanson, George R; Moynihan, Angela L; Suggs, Jeremy F; Kwon, Young-Min; Johnson, Todd; Li, Guoan

2009-07-01

309

Intraoperative assessment of tibiofemoral contact stresses in total knee arthroplasty.  

PubMed

The production of polyethylene wear debris in total knee arthroplasty (TKA) is due to multiple factors. In particular, inadequate implant alignment and high bearing surface contact stresses are associated with polyethylene failure. Optimal implant placement and soft tissue balancing may contribute to reducing wear and the production of polyethylene particles. We present a case in which a quantitative technique was used to measure tibiofemoral contact stresses during implantation of a total knee prosthesis in vivo. In a knee with preoperative varus and fixed flexion deformity, medial compartment contact stresses after initial resection were reduced from 14.3 MPa to 11.3 MPa in neutral alignment by additional bone resection. Posterior cruciate release was required to reduce contact stresses further and to provide satisfactory balance between medial and lateral compartments, as determined by the operating surgeon, and was confirmed by the measurement system (3.8 MPa medially; 3.0 MPa laterally). This technique has potential to fine-tune implant positioning and ligament balancing during TKA. PMID:9880186

Wallace, A L; Harris, M L; Walsh, W R; Bruce, W J

1998-12-01

310

[Gait analysis after minimally invasive total hip arthroplasty].  

PubMed

Upon implantation of a hip prosthesis by total hip arthroplasty (THA), clinical criteria are not always sufficient for an objective assessment of the functional outcome. Thus, functional improvement of gait behavior was comparatively validated by instrumented 3D gait analysis for a current, minimally invasive surgical approach (MIS; anterolateral approach) and a conventional, transgluteal approach (KONV). In selected cases, disturbed motion sequences were registered by measuring the muscle activity via high-resolution, monopolar surface electromyography (S-EMG) above the operation area. Despite continuous and significant improvement of practically all analyzed kinematic and kinetic gait parameters for both surgical approaches already after 5 weeks but in particular after 6 and 12 months, no significant differences were detected between the 2 procedures for any parameter or time point. The S-EMG demonstrated non-physiological muscle activation on the operated, but also on the non-operated side, even at 6 months after surgery. Advantages of the MIS approach thus seem primarily restricted to early, post-operative results, such as more rapid pain reduction and rehabilitation. PMID:22552542

Sander, K; Layher, F; Anders, C; Roth, A; Babisch, J; Scholle, H-C; Kinne, R W

2012-05-01

311

Revision in cemented and cementless infected hip arthroplasty.  

PubMed

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

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

2013-01-01

312

Predicting poor physical performance after total knee arthroplasty.  

PubMed

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

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

2012-11-01

313

Rotation flaps for coverage after total knee arthroplasty  

PubMed Central

OBJECTIVE: To evaluate the results obtained using local myocutaneous rotation flaps in cases of wound dehiscence after total knee arthroplasty. METHODS: Patients undergoing these surgical procedures were selected in the 2000-2012 period. The nine selected cases during this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius, and in one case we used advancing skin. RESULTS: Eighty nine percent of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation due to failure on treatment of infections, and one case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. CONCLUSION: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage it caused. Level of Evidence IV, Case Series. PMID:24453672

Pozzobon, Leonardo Rafael; Helito, Camilo Partezani; Guimarães, Tales Mollica; Gobbi, Riccardo Gomes; Pécora, José Ricardo; Camanho, Gilberto Luis

2013-01-01

314

Low manipulation prevalence following fast-track total knee arthroplasty.  

PubMed

Background and purpose - Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may have influenced the prevalence of joint stiffness and subsequent manipulation. We investigated the prevalence of manipulation following fast-track TKA and identified patients at risk of needing manipulation. Patients and methods - 3,145 consecutive unselected elective primary unilateral TKA patients operated in 6 departments with well-defined fast-track settings were included in the study. Demographic data, prevalence, type and timing of manipulation, and preoperative and postoperative ROM were recorded prospectively, ensuring complete 1-year follow-up. Results - 70 manipulations were performed within 1 year (2.2%) at a mean of 4 months after index surgery. Younger age and not using walking aids preoperatively were associated with a higher risk of manipulation. LOS ? 4 days (as opposed to a longer LOS) was not associated with an increased risk of manipulation. Interpretation - The prevalence of manipulation was lower or comparable to that in most published studies following more conventional pathways. Inherent patient demographics were identified as risk factors for manipulation whereas LOS ? 4 days was not. Thus, fast-track TKA does not result in increased risk of manipulation-despite a shorter LOS. Optimized pain treatment and early mobilization may contribute to these favorable results that support the use of fast-track. PMID:25267501

Husted, Henrik; Jørgensen, Christoffer C; Gromov, Kirill; Troelsen, Anders

2014-09-30

315

Total knee arthroplasty in osteogenesis imperfecta: case report.  

PubMed

Osteogenesis imperfecta (OI) is a rare congenital disorder of type capital I, Ukrainian collagen production that results in brittle bones and affects body systems containing collagen. The increasing life span of patients with OI has recently revealed a high incidence of osteoarthritis of the knee. A 53 year-old man with OI presented with bilateral knee pain. He had severe deformities of the proximal part of the femur with subsegment post-traumatic osteoarthritis of both sides of the knees. However, the frequency of fracture gradually decreased and he had not experienced a fracture for 17 years. His bone mineral density was extremely low for his age. He underwent cemented total knee arthroplasty (TKA) on the left knee. One year later, the patient had relief of pain and he could walk without assistance. To our knowledge, only three knee replacements in two patients with OI have been reported, so this case is extremely rare. Although whether a patient with OI is a suitable candidate for knee replacement, it was a useful treatment for osteoarthritis in this case. PMID:18757201

Nishimura, Akinobu; Hasegawa, Masahiro; Kato, Ko; Fukuda, Aki; Sudo, Akihiro; Uchida, Atsumasa

2008-12-01

316

Indoor and Outdoor Mobility following Total Knee Arthroplasty  

PubMed Central

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

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

2013-01-01

317

Osteolysis around an uncemented cobalt chrome total hip arthroplasty.  

PubMed

One hundred consecutive uncemented Porous Coated Anatomic total hip arthroplasties performed in 91 patients who obtained prospective serial clinical and radiographic evaluation during a minimum 7-year followup period were studied for the occurrence, extent, and progression of localized periprosthetic bone loss (osteolysis). Periprosthetic bone loss occurred around the femoral component in 11 hips, the acetabular component in 2 hips, and both components in 2 hips during the followup interval. The bone loss was progressive in 6 hips (2 of 11 femoral cases, 2 of 2 acetabular cases, and 2 of 2 both component cases). It frequently occurred around components that showed no evidence of acetabular migration or femoral subsidence (11 of 15 cases). The average age at surgery of patients in the bone loss group was 10 years younger than the nonbone loss group (in the 100 hip cohort). Clinically, most patients with bone loss were asymptomatic, with the average Harris hip rating of 92.4 points (range, 85-99 points). With this particular device at this interval of followup (7 years), the acetabular and the proximal femoral osteolytic lesions are of greatest concern. Wear of the acetabular component was greater for cases with osteolysis than for those without osteolysis, but the difference was not significant. PMID:7671492

Xenos, J S; Hopkinson, W J; Callaghan, J J; Heekin, R D; Savory, C G

1995-08-01

318

Outcome of Salvage Lumbar Fusion after Lumbar Arthroplasty  

PubMed Central

Study Design Retrospective review. Purpose This study aims to define the role of lumbar fusion for persistent back pains after the lumbar disc replacement. Overview of Literature Little is written about lumbar fusion after optimally placed lumbar arthroplasty in patients with persistent lower back pains. Methods Retrospective review of cases of lumbar artificial disc requiring subsequent fusion because of persistent back pains despite optimally placed artificial discs. Outcomes were evaluated using Oswestry Disability Index (ODI) and visual analogue scale (VAS). Clinical improvements indicated 25% improvement in ODI and VAS values. Results Five patients met the study criteria. The mean baseline ODI for the five patients was 52. The mean baseline VAS scores for back and leg pains were 76 and 26, respectively. All the five patients had optimally placed prosthesis. The indication for surgery was the constant low back pains found in all the patients. Revision surgery involved disc explantation and fusion in two of the patients and posterolateral fusion without removing the prosthesis in three. None of the patients achieved adequate pain control after the revision surgery despite the solid bony fusion documented by postoperative computed tomography. The mean ODI value after the fusion was 55. The mean values for back and leg pains VAS were 72 and 30, respectively. Conclusions Lack of good pain relief after successful lumbar artifical disc replacements may indicate different etiology for the back pains. The spine-treating surgeons should have a high threshold level to perform salvage fusion at that level. PMID:24596600

Deutsch, Harel

2014-01-01

319

Revision in Cemented and Cementless Infected Hip Arthroplasty  

PubMed Central

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

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

2013-01-01

320

Total hip arthroplasty with acetabular fixation: an unexpected complication.  

PubMed

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

Khoriati, Al-Achraf

2014-04-01

321

A Perspective on Robotic Assistance for Knee Arthroplasty  

PubMed Central

Knee arthroplasty is used to treat patients with degenerative joint disease of the knee to reduce pain and restore the function of the joint. Although patient outcomes are generally quite good, there are still a number of patients that are dissatisfied with their procedures. Aside from implant design which has largely become standard, surgical technique is one of the main factors that determine clinical results. Therefore, a lot of effort has gone into improving surgical technique including the use of computer-aided surgery. The latest generation of orthopedic surgical tools involves the use of robotics to enhance the surgeons' abilities to install implants more precisely and consistently. This review presents an evolution of robot-assisted surgical systems for knee replacement with an emphasis on the clinical results available in the literature. Ever since various robotic-assistance systems were developed and used clinically worldwide, studies have demonstrated that these systems are as safe as and more accurate than conventional methods of manual implantation. Robotic surgical assistance will likely result in improved surgical technique and improved clinical results. PMID:23738083

Netravali, Nathan A.; Shen, Feimo; Park, Youngbae; Bargar, William L.

2013-01-01

322

The Use of Epoetin-? in Revision Knee Arthroplasty  

PubMed Central

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

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

2012-01-01

323

Osseointegration of Fitmore stem in total hip arthroplasty.  

PubMed

Currently, an increasing number of younger patients undergo total hip arthroplasty surgery. This has led to a minimal invasive approach and the use of short, bone preserving, femoral stems. In this study, we sought to evaluate osseointegration of the Fitmore stem (Zimmer, Inc; Warsaw, IN) during the first 12 mo after surgery, which reflects the biological phenomenon of osseointegration with radiographic evaluation and bone densitometry (dual-energy X-ray absorptiometry). We evaluated 33 patients (mean age 62.3) using dual-energy X-ray absorptiometry scan around the stem and X-ray. Moreover, we studied functional recovery using the Harris Hip Score, timed up and go test, and a quality of life form (SF-36), during the follow-up period. At 12 mo, we observed an increased periprosthetic bone mineral density in region of interest 1 (1.7%) and region of interest 7 (8.3%), where there is usually a greater amount of bone resorption. Also Harris Hip Score, timed up and go test, and SF-36 showed an improvement of clinical conditions of all patients. We also used a control group with a standard stem implanted. Because this is the first study correlating osseointegration and clinical outcome of the Fitmore stem, further clinical studies will be necessary to confirm good/positive results and a long stable fixation. PMID:24613452

Gasbarra, Elena; Celi, Monica; Perrone, Fabio L; Iundusi, Riccardo; Di Primio, Luigia; Guglielmi, Giuseppe; Tarantino, Umberto

2014-01-01

324

Extracorporeally irradiated autograft-prosthetic composite arthroplasty with vascular reconstruction for primary bone tumor of the proximal tibia.  

PubMed

The proximal tibia is a common site for primary bone tumors. Proximal tibial tumors may invade the adjacent soft-tissue by destroying the cortex and may further invade neurovascular bundles. We treated a patient with primary bone tumor of the proximal tibia with neurovascular invasion by extracorporeally irradiated autograft-prosthetic composite arthroplasty with vascular reconstruction. In cases of concomitant allograft arthroplasty and vascular reconstruction, we recommend that vascular reconstruction be performed before arthroplasty to minimize ischemia time. Good oncological and functional outcomes were achieved 75 months after surgery. Therefore, this reconstruction technique can be considered as a good treatment option. PMID:20926245

Emori, Makoto; Hashimoto, Nobuyuki; Hamada, Ken-Ichiro; Naka, Norifumi; Takami, Hiroshi; Araki, Nobuhito

2011-02-01

325

Changes in the functional flexion axis of the knee before and after total knee arthroplasty using a navigation system.  

PubMed

Long term satisfaction of patients with total knee arthroplasty (TKA) has lagged behind that of total hip arthroplasty. One possible reason is the failure of the artificial joint to recreate natural kinematics of the knee. This study evaluated the pre and post implant functional flexion axis in the knees of 285 total knee arthroplasty patients using a surgical navigation system. Results showed that post-implant there was less femoral rollback early in flexion on the lateral side of the joint than pre-implant. Designing future generations of knee implants to allow for this motion may give patients a more 'natural' feeling knee and may benefit outcomes. PMID:24836651

Wilson, David A J; Astephen Wilson, Janie L; Richardson, Glen; Dunbar, Michael J

2014-07-01

326

Recurrent stenosis of common carotid-intracranial internal carotid interposition saphenous vein bypass graft caused by intimal hyperplasia and treated with endovascular stent placement. Case report and review of the literature.  

PubMed

Intimal hyperplasia is a well-known cause of delayed stenosis in vein bypass grafts in all types of vascular surgery. Options for treatment of stenosis in peripheral and coronary artery bypass grafts include revision surgery and the application of endovascular techniques such as balloon angioplasty and stent placement. The authors present a case of stenosis caused by intimal hyperplasia in a high-flow common carotid artery-intracranial internal carotid artery (IICA) saphenous vein interposition bypass graft that had been constructed to treat a traumatic pseudoaneurysm of the intracavernous ICA. The stenosis recurred after revision surgery and was successfully treated by endovascular stent placement in the vein graft. The literature on stent placement for vein graft stenoses is reviewed, and the authors add a report of its application to external carotid-internal carotid bypass grafts. Further study is required to define the role of endovascular techniques in the management of stenotic cerebrovascular disease. PMID:10067933

Brennan, J W; Morgan, M K; Sorby, W; Grinnell, V

1999-03-01

327

Simultaneous and multisite measure of micromotion, subsidence and gap to evaluate femoral stem stability.  

PubMed

The initial stability of cementless femoral components is crucial for the long-term success of total hip arthroplasty. This has been reported in animal and clinical studies. Until now, the stability was evaluated by the measurement of relative micromotion on a few simultaneous locations around the stem in cadaveric experiments. This paper presents an extended experimental setup to measure simultaneously local micromotion, subsidence and gap on hundreds of points at the bone-stem interface. This technique we applied to anatomical and straight stems in three pairs of cadaveric femurs. Measurements were in agreement with typically reported values. Conversely to other methods, which measure micromotion between implant and bone anchoring points of the measuring device, our method provides local micromotion between stem surface and adjacent bone surface. The observed variation of micromotion at the peri-implant surface confirms the importance of this simultaneous measure on a lot of points around the implant. PMID:22356845

Gortchacow, Michael; Wettstein, Michael; Pioletti, Dominique P; Müller-Gerbl, Magdalena; Terrier, Alexandre

2012-04-30

328

Mind the gap  

E-print Network

In this summary of the application of Dyson-Schwinger equations to the theory and phenomenology of hadrons, some deductions following from a nonperturbative, symmetry-preserving truncation are highlighted, notable amongst which are results for pseudoscalar mesons. We also describe inferences from the gap equation relating to the radius of convergence of a chiral expansion, applications to heavy-light and heavy-heavy mesons, and quantitative estimates of the contribution of quark orbital angular momentum in pseudoscalar mesons; and recapitulate upon studies of nucleon electromagnetic form factors.

M. S. Bhagwat; A. Krassnigg; P. Maris; C. D. Roberts

2006-12-06

329

Miscibility Gap Systems  

NASA Technical Reports Server (NTRS)

Immiscible droplets embedded in a host fluid in which a temperature gradient exists migrate toward the hot end of the host fluid because of the temperature dependence of the interfacial energy of the droplet. This thermocapillary migration effect was exploited in the design of a controllable heat valve which is the thermal analog of the electronic vacuum triode. Studies have also been made of test cells that could use thermocapillary migration to facilitate the study of condensation and dissolution kinetics in miscibility-gap solutions.

Schmid, L. A.

1985-01-01

330

Closing the stop gap  

E-print Network

Light stops are a hallmark of the most natural realizations of weak-scale supersymmetry. While stops have been extensively searched for, there remain open gaps around and below the top mass, due to similarities of stop and top signals with current statistics. We propose a new fast-track avenue to improve light stop searches for R-parity conserving supersymmetry, by comparing top cross section measurements to the theoretical prediction. Stop masses below ~ 180 GeV can now be ruled out for a light neutralino. The possibility of a stop signal contaminating the top mass measurement is also briefly addressed.

Michal Czakon; Alexander Mitov; Michele Papucci; Joshua T. Ruderman; Andreas Weiler

2014-07-03

331

Fixation of the NexGen HA-TCP-coated cementless, screwless total knee arthroplasty: comparison with conventional cementless total knee arthroplasty of the same type.  

PubMed

We performed a 12-month prospective study on 59 patients (92 knees) who underwent NexGen (Zimmer Inc, Warsaw, IN) cruciate-retaining total knee arthroplasty. In the control group, uncoated components were fixed using screws, whereas the hydroxyapatite-tricalcium phosphate (HA-TCP) group underwent screwless fixation of coated components. At 12 months postoperatively, there was a radiographic clear zone around the femoral and tibial components of 56.5% and 32.6% of the knees in the control group. The HA-TCP group showed a clear zone at the medial aspect of the tibial component in only 1 knee. These results suggested that HA-TCP-coated articular components show good initial fixation without using screws. The NexGen coated knee arthroplasty may be useful for solving the problems of cementless fixation. PMID:12066275

Gejo, Ryuichi; Akizuki, Shaw; Takizawa, Tsutomu

2002-06-01

332

Update on cervical disc arthroplasty: where are we and where are we going?  

Microsoft Academic Search

Despite the very good results of anterior cervical discectomy and fusion, there are concerns of adjacent level degeneration.\\u000a For this reason, interest has grown in the potential for motion sparing alternatives. Cervical disc arthroplasty is thus evolving\\u000a as a potential alternative to fusion. Specific design characteristic and implants will be reviewed and outcomes summarized.

Jorge J. Jaramillo-de la Torre; Jonathan N. Grauer; James J. Yue

2008-01-01

333

Pain Management and Accelerated Rehabilitation for Total Hip and Total Knee Arthroplasty  

Microsoft Academic Search

Improved pain management techniques and accelerated rehabilitation programs are revolutionizing our patients' postoperative experience after total hip and knee arthroplasty. The process involves regional anesthesia with multimodal pain control using local periarticular injections in combination with enhanced patient education and accelerated rehabilitation provided by a dedicated team of surgeons, physicians, anesthesiologists, physician assistants, physical therapists, and social workers. With this

Amar S. Ranawat; Chitranjan S. Ranawat

2007-01-01

334

Interdisciplinary team approach in the rehabilitation of hip and knee arthroplasties.  

PubMed

Use of an interdisciplinary case management team approach in the treatment of patients with hip or knee arthroplasty has resulted in a decrease in length of stay and achievement of functional outcomes at the authors' center. Case management was used to standardize patient care and to measure each patient's progress toward independence against established criteria of treatment outcomes. Outcomes established for physical therapy were ambulation distance, performance of a home exercise program, stair climbing, amount of active knee flexion (for knee arthroplasties), and incorporation of hip precautions. Outcomes for occupational therapy were bed mobility, chair transfers, toilet transfers, and activities of daily living with emphasis on lower extremity dressing. The case management team consists of an occupational therapist, an occupational therapy assistant, a physical therapist, and two nurses. The specific role of the occupational therapy personnel in this team approach is to maximize, by discharge, a patient's functional level of independence in activities of daily living. Data from a 6-month period indicated that occupational therapy goals were achieved for 79% of the 33 knee arthroplasty patients and 73% of the 37 hip arthroplasty patients. PMID:8042687

Erickson, B; Perkins, M

1994-05-01

335

Posterior distal cement extrusion during primary total hip arthroplasty: A cause for concern?  

Microsoft Academic Search

Manually operated injection systems are routinely used to deliver polymethyl methacrylate during cemented femoral component primary total hip arthroplasty (THA). The goal of cement delivery is to achieve sufficient intrusion of cement into the trabecular bone of the prepared femur so that the femoral component is securely bonded to the femur. We have observed posterior distal cement extrusion (PDCE), which

Jonathan L. Knight; Timothy Coglon; Chad Hagen; John Clark

1999-01-01

336

Decreased posterior tibial slope increases strain in the posterior cruciate ligament following total knee arthroplasty  

Microsoft Academic Search

The purpose of this study was to measure the strain in the posterior cruciate ligament as a function of knee flexion angle and posterior tibial slope following total knee arthroplasty with a posterior cruciate ligament-retaining design. Posterior cruciate ligament strain was measured in seven fresh-frozen cadavers for posterior tibial slopes of 10°, 8°, and 5°. For all three levels of

Robert Singerman; John C. Dean; Hector D. Pagan; Victor M. Goldberg

1996-01-01

337

Hip Resurfacing Arthroplasty in Treatment of Avascular Necrosis of the Femoral Head  

PubMed Central

Background Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. Material/Methods Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul’s method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. Results The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score – UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. Conclusions Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients. PMID:25618763

Pyda, Micha?; Koczy, Bogdan; Widuchowski, Wojciech; Widuchowska, Ma?gorzata; Sto?tny, Tomasz; Mielnik, Micha?; Hermanson, Jacek

2015-01-01

338

Revision to reverse shoulder arthroplasty with retention of the humeral component  

PubMed Central

Background Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. Newer modular systems allow conversion from anatomic to reverse shoulder arthroplasty with retention of a well-fixed humeral stem. We report on a prospectively evaluated series of conversions from hemiarthroplasty to reverse shoulder arthroplasty. Methods In 14 cases of failed hemiarthroplasty due to rotator cuff deficiency and painful pseudoparalysis (in 13 women), revision to reverse shoulder arthroplasty was performed between October 2006 and 2010, with retention of the humeral component using modular systems. Mean age at the time of operation was 70 (56–80) years. Pre- and postoperative evaluation followed a standardized protocol including Constant score, range of motion, and radiographic analysis. Mean follow-up time was 2.5 (2–5.5) years. Results Mean Constant score improved from 9 (2–16) to 41 (17–74) points. Mean lengthening of the arm was 2.6 (0.9–4.7) cm without any neurological complications. One patient required revision due to infection. Interpretation Modular systems allow retainment of a well-fixed humeral stem with good outcome. There is a risk of excessive humeral lengthening. PMID:24032523

2013-01-01

339

Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty  

ERIC Educational Resources Information Center

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…

Tali, Maie; Maaroos, Jaak

2010-01-01

340

Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty.  

PubMed

The possibility of infection should be considered in every revision shoulder arthroplasty even in the absence of clinical symptoms and signs of infection because indolent infection is prevalent. Detection of infection in apparently aseptic failed arthroplasties poses a diagnostic challenge as the conventional principles and criteria used for hip and knee arthroplasty are not generally applicable. Propionibacterium acnes and Staphylococcus epidermidis are among the infectious organisms most commonly identified in such situations. Serum inflammatory markers are essential but are often unreliable as they have poor sensitivity in the shoulder. Preoperative shoulder joint aspiration culture is an important step but is subject to high false-negative rates. Lower cutoff values of synovial fluid analysis are used for detection of periprosthetic infection than for native joint infection as demonstrated in the knee literature. Intraoperatively, frozen section should be considered when a diagnosis of infection has not been established even in the presence of clinical suspicion. Gram stain is currently not recommended because of its low sensitivity and negative predictive value. Intraoperative culture is critical and should be performed whenever there is clinical suspicion of infection. Unexpected positive intraoperative cultures are not uncommon, and 6% to 25% of them appear to represent true infection as demonstrated with positive follow-up cultures or subsequent development of infection. In revision shoulder arthroplasty, determining the presence of infection can be difficult. A standardized approach is needed to determine the best course of treatment in this particular clinical setting. PMID:25487903

Updegrove, Gary F; Armstrong, April D; Kim, H Mike

2014-12-01

341

Computer-Assisted Ankle Joint Arthroplasty Using Bio-engineered Autografts  

E-print Network

Computer-Assisted Ankle Joint Arthroplasty Using Bio-engineered Autografts R. Sidler1 , W. K study was conducted for the ankle joint, compris- ing a simplified rotational symmetric bone surface bioengineered autografts. The ankle joint was chosen as a first target J. Duncan and G. Gerig (Eds.): MICCAI

342

Replacement arthroplasty in the weight-bearing shoulder of paraplegic patients.  

PubMed

We review the early results of shoulder arthroplasty in the weight-bearing shoulder of long-term paraplegic patients. We have been unable to find previously published results of this subgroup of shoulder arthroplasty patients in the literature. Five paraplegic, female patients who had undergone shoulder arthroplasty were analyzed. All patients had been prospectively assessed with the American Shoulder and Elbow Surgeons (ASES) function score and the Constant score. The mean age at the time of surgery was 70 years. Three shoulders had full-thickness rotator cuff tears, and two were repaired at the time of shoulder arthroplasty. The mean preoperative Constant score was 30 out of 100, improving to 52 out of 100 at a mean follow-up of 30 months (range, 24-36 months). The mean preoperative ASES function score was 28 out of 55, improving to 37 out of 55. One patient was pain-free after surgery, and the mean postoperative pain score was 10 out of 15. There were no features of progressive radiolucency around the glenoid or the humeral components at last review apart from one case in which glenoid implant migration occurred. In view of the satisfactory improvement in terms of pain, mobility, and independence, we believe that it is reasonable to continue to offer this procedure to this subgroup of patients. We will, however, remain vigilant with regard to any further complications arising in these prostheses in the medium to long term as a result of increased loading. PMID:15220875

Garreau De Loubresse, C; Norton, M R; Piriou, P; Walch, G

2004-01-01

343

High Failure Rate of a Constrained Acetabular Liner in Revision Total Hip Arthroplasty  

Microsoft Academic Search

Fifty-five consecutive revision total hip arthroplasties (THAs) in 51 patients in which a constrained acetabular liner was used (Duraloc Constrained Liner, DePuy, Warsaw, Ind) were reviewed. In these revisions, 41 constrained liners were placed for recurrent instability and 14 for inadequate stability at the time of revision THA. The mean age of the cohort was 62 years, and 38 of

Craig J. Della Valle; Dennis Chang; Scott Sporer; Richard A. Berger; Aaron G. Rosenberg; Wayne G. Paprosky

2005-01-01

344

Clinical Outcome of Salmon Calcitonin Nasal Spray Treatment in Postmenopausal Women after Total Hip Arthroplasty  

Microsoft Academic Search

Objective: The increasing rate of hip fractures is giving rise to a number of socio-economic problems for the aging community. In addition to being unable to resume their previous living habits, many patients fail to achieve full functional recovery after the fractures. Total hip arthroplasty (THA) is a successful operation for the majority of patients with all forms of hip

P. Peichl; A. Griesmacher; W. Kumpan; R. Schedl; E. Prosquil; H. Bröll

2005-01-01

345

A modified direct lateral approach for primary and revision total hip arthroplasty  

Microsoft Academic Search

A prospective analysis of 453 consecutive primary and revision total hip arthroplasties (THAs) were reviewed. The modified direct lateral approach was used in 306 of 319 (96%) primary THAs and 115 of 134 (86%) revision cases for a total of 421 of 453 (93%) procedures. There were three dislocations in the revision group of patients. All three patients had at

Joseph T. Moskal; John W. Mann

1996-01-01

346

Risk Factors for Revision for Early Dislocation in Total Hip Arthroplasty  

Microsoft Academic Search

Risk factors were investigated for revision for dislocation in primary total hip arthroplasties (THAs) between September 1, 1999, and December 31, 2004, as reported by the Australian Orthopaedic Association National Joint Replacement Registry. For 65992 primary THAs, the only initial diagnoses with significantly increased relative risk (RR) of revision for dislocation compared to osteoarthritis were fractured neck of femur (RR,

Jonathan L. Conroy; Sarah L. Whitehouse; Stephen E. Graves; Nicole L. Pratt; Philip Ryan; Ross W. Crawford

2008-01-01

347

Hip arthroplasty after failed free vascularized fibular grafting for osteonecrosis in young patients  

Microsoft Academic Search

This study reports the results of total hip arthroplasty (THA) for osteonecrosis after failed free vascularized fibular grafting (FVFG) at a 5-year minimum follow-up. In this study, 73 patients (89 THA) were treated for failed FVFG, and survival of THA was discussed. Clinical outcome was measured using a pain and function survey (possible 91 points) in 84 hips and Harris

Keith R Berend; Eunice Gunneson; James R Urbaniak; Thomas P Vail

2003-01-01

348

Hospital Volume and Inpatient Mortality Outcomes of Total Hip Arthroplasty in the United States  

Microsoft Academic Search

The purpose of this study was to examine the effect of hospital volume on outcomes for primary and revision total hip arthroplasty (THA). The Nationwide Inpatient Sample database was used to identify our patient set. These data include a sample of non-Medicare and Medicare patients who are unique to this study, increasing external validity compared with other studies. Outcome variables

Christopher Doro; Justin Dimick; Reid Wainess; Gilbert Upchurch; Andrew Urquhart

2006-01-01

349

Cementless total hip arthroplasty using porous-coated Biomet acetabular cups (Hexloc and Ringloc types)  

Microsoft Academic Search

This study examined the mid-term (more than 5 years) results of cementless total hip arthroplasty (THA) using Biomet acetabular cups (locking mechanism: Hexloc type or Ringloc type). A series of 58 patients (70 hips) who had undergone cementless THA at our department were available for inclusion in this study. The average age at surgery was 55.2 years, and the average

Kengo Yamamoto; Atsuhiro Imakiire; Takaaki Shishido; Toshinori Masaoka; Ryuji Koizumi; Koji Ito; Keiji Sano

2003-01-01

350

Periarticular Regional Analgesia in Total Knee Arthroplasty: A Review of the Neuroanatomy and Injection Technique.  

PubMed

Perioperative pain control after total knee arthroplasty may be insufficient, resulting in insomnia, antalgic ambulation, and difficulty with rehabilitation. Current strategies, including the use of femoral nerve catheters, may control pain but have been associated with falls, motor blockade, and quadriceps inhibition. Periarticular infiltration using the appropriate technique and knowledge of intraarticular knee anatomy may increase pain control and maximize rehabilitation. PMID:25435030

Guild, George N; Galindo, Rubin P; Marino, Joseph; Cushner, Fred D; Scuderi, Giles R

2015-01-01

351

Evaluation of Hallux Interphalangeal Joint Arthroplasty Compared With Nonoperative Treatment of Recalcitrant Hallux Ulceration.  

PubMed

Patients with chronic diabetes can develop plantar hallux ulcerations secondary to neuropathy, increased pressure, and deformity. The present retrospective study evaluated the efficacy of hallux interphalangeal joint (HIPJ) arthroplasty to address recalcitrant ulceration. Two groups of patients with diabetes were compared: a surgical group of 13 patients and a nonsurgical standard therapy group of 13 patients. The patients in the surgical group underwent HIPJ arthroplasty. All the patients in the standard therapy group received local wound care and offloading. The mean duration of follow-up was 19.5 (range 1.2 to 47.9) months, and the mean age was 55 ± 13.0 years. Statistical significance was found in the surgical group for faster time to healing (3.5 weeks [2.5, 4.25] vs 9 weeks [2, 17.29], p = .033) and lower incidence of ulcer recurrence (8% ± 7.69 vs 54% ± 53.85, p = .031). There were also fewer amputations in the surgical group (0% ± 0 vs 38% ± 38.6, p = .063). To our knowledge, only 1 other published study has evaluated HIPJ arthroplasty as a treatment of recalcitrant hallux ulceration. The present study adds comparison data from a nonoperative standard therapy group and found that HIPJ arthroplasty is an effective curative treatment option to address chronic plantar hallux ulcerations in diabetic patients with neuropathy. PMID:25441849

Lew, Eric; Nicolosi, Nicole; McKee, Patrick

2014-11-13

352

Health care subsidy and outcomes of total knee arthroplasty in Asians.  

PubMed

Singapore has a nonmodified universal health care system in which the government ensures affordable health care in the public health system, largely through a system of compulsory savings, subsidies, and price controls. Patients seeking treatment via the public health system may also choose for nonsubsidized options, with the benefits of being able to choose a surgeon, better privacy, and shorter time to surgery. To the authors' knowledge, few studies have reported the effect of health care subsidies on total knee arthroplasty outcomes. The purpose of this study was to assess whether patients receiving a health care subsidy had good outcomes or fared worse than their paying counterparts after undergoing conventional total knee arthroplasty. The authors retrospectively reviewed 369 patients who underwent total knee arthroplasty between 2006 and 2010. Patients were stratified into 2 groups: nonsubsidized (n=95) and subsidized patients (n=274). Outcome measures, such as range of motion, function score, knee score, Oxford Knee Questionnaire, and the Short Form 36 questionnaire, were compared between the groups at 6-month and 2-year follow-up. Subsidized patients had good postoperative outcomes, and no significance differences existed in outcome scores and range of motion between the 2 groups at 6-month and 2-year follow-up except in the mean function score, where patients in the nonsubsidized group did better (P=.019). Subsidized patients had good outcomes and did not fare worse than nonsubsidized patients after conventional total knee arthroplasty, except for their knee function score. PMID:23746034

Bin Abd Razak, Hamid Rahmatullah; Xiang, Toh Rui; Chi, Chong Hwei; Andrew, Tan Hwee Chye

2013-06-01

353

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

PubMed Central

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

2011-01-01

354

Gait assessment in unicompartmental knee arthroplasty patients: Principal component modelling of gait waveforms and clinical status  

Microsoft Academic Search

The reduction and analysis of gait waveform data is a significant barrier to the clinical application of gait analysis. Principal component modelling of gait waveform data reduced the waveform data to measures of distance from normal and these distance measures were shown to be sensitive to changes in gait pattern associated with knee osteoarthritis and its treatment by unicompartmental arthroplasty.

Kevin J. Deluzio; Urs P. Wyss; Patrick A. Costigan; Charles Sorbie; Benny Zee

1999-01-01

355

Total knee arthroplasty in a pseudoachondroplastic dwarfism patient with bilateral patellar dislocation.  

PubMed

Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of a 59-year-old man with underlying pseudoachondroplastic dwarfism. Advanced osteoarthritis due to bilateral neglected congenital patellar dislocation was treated with total knee arthroplasty without patella relocation surgery. Two years later, the patient had an improvement in Knee Society scores, painless function, and stability. PMID:23177661

Oh, Kwang-Jun; Yoon, Jung-Ro; Yang, Jae-Hyuk

2013-01-01

356

Dissociation of the Femoral Head and Trunion After Constrained Conversion Total Hip Arthroplasty for Poliomyelitis  

Microsoft Academic Search

A conversion total hip arthroplasty using a 58-mm cementless shell and screws and constrained acetabular liner was performed in a 71-year-old patient with a nonunion of an intertrochanteric fracture and poliomyelitis with flail extremities. Preoperatively, the fractured lower extremity was painful and normally used by the patient for pivot transfers from his wheelchair. Five months postoperatively, the patient sustained complete

Anthony Spinnickie; Stuart B. Goodman

2007-01-01

357

Three-Dimensional Kinematic Analysis and Modeling of Knee Implants after Total Knee Arthroplasty Operation  

Microsoft Academic Search

Recently, the Total Knee Arthroplasty (TKA) operations were become a routine procedure. The precise measurement of TKA kinematics was required. Normally, the measurement was done by matching the monocular fluoroscopic image with 3D CAD model of the knee implant. But, the monocular vision has much reduced accuracy for determining translation perpendicular to the image plane. This article presents a technique

Congwei WANG; Naoko HIROSE; Hiroshi ARISAWA; Toshiharu SHIRAI; Tomoyuki SAITO

2007-01-01

358

Randomized Control Trial Comparing Radiographic Total Knee Arthroplasty Implant Placement Using Computer Navigation Versus Conventional Technique  

Microsoft Academic Search

The aim of this study is to assess the radiological outcome of conventional techniques versus computer-navigated surgery for total knee arthroplasty. Ninety patients with knee arthritis were prospectively randomized into 3 groups: conventional technique: extramedullary (EM) and intramedullary (IM) tibia guide versus computer navigation surgery (CAS). Two surgeons performed all procedures. Standardized long leg coronal and sagittal x-rays were evaluated

Pak Lin Chin; Kuang Ying Yang; Seng Jin Yeo; Ngai Nung Lo

2005-01-01

359

2003 Hap Paul Award paper of the International Society for Technology in Arthroplasty  

Microsoft Academic Search

Knee arthroplasty implants are designed with features that provide varying articular constraint over the range of flexion such that the pattern of knee motion may also vary. Because the motions of total knee implants have a direct influence on patient function and device longevity, it is important to understand how knee implants based on a variety of design philosophies perform

Scott A. Banks; W. Andrew Hodge

2004-01-01

360

INTRODUCTION Total knee arthroplasty (TKA) is considered the treatment of choice  

E-print Network

INTRODUCTION Total knee arthroplasty (TKA) is considered the treatment of choice for candidates with severe deterioration of the knee due to osteoarthritis. However after 10 years the failure rate is between 7 %[1] and 10%[2] and a with new, larger components must be implanted. This procedure is called

Schmidt, Jill E.

361

Histologic retrieval analysis of a porous tantalum metal implant in an infected primary total knee arthroplasty  

Microsoft Academic Search

Porous tantalum (Zimmer, Inc, Warsaw, IN) has the theoretical advantage of improved biologic fixation due to its high porosity, interconnected pore space and modulus of elasticity. We present a case report documenting the retrieval and bone ingrowth analysis of a porous tantalum tibial component in an infected total knee arthroplasty (TKA). Results demonstrated a significantly larger amount of bone ingrowth

Chris Sambaziotis; Andrew Lovy; Karyn E. Koller; Roy D. Bloebaum; David M. Hirsh; Sun Jin Kim

362

Surgical exposure for reverse total shoulder arthroplasty: differences in approaches and outcomes.  

PubMed

Reverse shoulder arthroplasty can relieve pain and restore function in properly selected patients. The procedure is commonly performed through one of 2 surgical approaches: deltopectoral or anterosuperior. This article describes the surgical approaches, discusses advantages and disadvantages of each approach, reviews the current literature, and presents data from our clinical experience. PMID:25435034

Gillespie, Robert J; Garrigues, Grant E; Chang, Edward S; Namdari, Surena; Williams, Gerald R

2015-01-01

363

Relationship between Improvements in Physical Measures and Patient Satisfaction in Rehabilitation after Total Knee Arthroplasty  

ERIC Educational Resources Information Center

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…

Nazzal, Mahmoud I.; Bashaireh, Khaldoon H.; Alomari, Mahmoud A.; Nazzal, Mohammad S.; Maayah, Mikhled F.; Mesmar, Mohammad

2012-01-01

364

Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head.  

PubMed

Background Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. Material and Methods Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul's method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. Results The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score - UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. Conclusions Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients. PMID:25618763

Pyda, Micha?; Koczy, Bogdan; Widuchowski, Wojciech; Widuchowska, Ma?gorzata; Sto?tny, Tomasz; Mielnik, Micha?; Hermanson, Jacek

2015-01-01

365

Duplex Ultrasonography for the Detection of Deep Vein Thrombi After Total Hip or Knee Arthroplasty  

Microsoft Academic Search

The usefulness of real-time duplex ultrasonography (DU) as a screening test for deep vein thrombosis (DVT) in high-risk patients remains uncertain. To determine the sensitivity and specificity of DU for the detection of DVT, the authors prospectively studied 178 consecutive patients after total hip (n=113) or total knee (n = 66) arthroplasty. The deep veins from the inguinal ligament to

C. Gregory Elliott; Mary Suchyta; Steven C. Rose; Steve Talbot; Clynn Ford; Gary Raskob; Russell Hull; Bruce Davidson

1993-01-01

366

Sonographically guided injection of anesthetic for iliopsoas tendinopathy after total hip arthroplasty.  

PubMed

We report 2 patients who developed pain in the region of the iliopsoas tendon after undergoing total hip arthroplasty. The pain was temporarily relieved by sonographically guided injection of steroid and anesthetic and was subsequently treated by surgical release of the tendon. PMID:15293303

Wank, Ross; Miller, Theodore T; Shapiro, Jeffrey F

2004-09-01

367

Lunar phase does not influence perioperative complications in total hip arthroplasty  

PubMed Central

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

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

2012-01-01

368

The effect of pulsed irrigation on the incidence of heterotopic ossification after total hip arthroplasty  

Microsoft Academic Search

Abstract: Heterotopic ossification (HO) is a common complication of total hip arthroplasty (THA). Pulsed lavage is being used with increasing frequency for THA. A prospective randomized, double-blind trial was initiated to determine if pulsed lavage affected the incidence of HO. A total of 94 THAs in 91 patients were analyzed. No significant difference in the incidence of HO was found

R. J. S Sneath; F. D Bindi; J Davies; E. J Parnell

2001-01-01

369

LD hip arthroplasty. Design concepts and first clinical trials of a new modular system.  

PubMed

The new LD modular hip arthroplasty is made of Ti6A14V. The acetabular component has a hemispheric expansive metallic ring and a polyethylene nucleus in the shape of a cone segment. Since June 1988, when the clinical trials began, 352 arthroplasties have been performed with 112 total hip arthroplasties among them. Only 60 noncemented total hip arthroplasties, with the longest follow-up evaluation reaching 24 months, were analyzed. Patients with revision operations were excluded. The results have been evaluated using the Merle D'Aubigne scoring scale. Good results were found in 86% of cases. Pain improved markedly at three months in the postoperative period. At six months, the Trendelenburg sign was negative in 76% and positive in 12%. The Duchenne sign was positive in 11%. Major complications included three dislocations, two acetabular component revisions caused by initial malposition, one external popliteal nerve palsy, one deep infection, and two periprosthetic fractures. No acetabular migrations have been found. There are six femoral sinkings of less than 1 cm. Heterotopic ossifications Grade II-III appear in 24% of cases. The results to date are evaluated clinically and radiologically. The acetabular design has proved efficient, and the femoral components show a low incidence of stress shielding. PMID:1395268

Lopez-Duran Stern, L; Cabadas, M I; Fernández-Fernández-Arroyo, J M; Zarzoso, R; Sanchez-Barbero, J C; Granado, J

1992-10-01

370

Intraoperative Passive Kinematics of Osteoarthritic Knees before and after Total Knee Arthroplasty  

E-print Network

and postoperatively using gait analysis,9 fluoroscopy10­15 and dynamic radioster- eometry.16­19 The tibiofemoralIntraoperative Passive Kinematics of Osteoarthritic Knees before and after Total Knee Arthroplasty of Mechanical Engineering, Stanford University, Stanford, California 4 Palo Alto Veterans Affairs Heath Care

Delp, Scott

371

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

E-print Network

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 ...

Massimini, Daniel Frank

2009-01-01

372

The Danish Shoulder Arthroplasty Registry: clinical outcome and short-term survival of 2,137 primary shoulder replacements  

PubMed Central

The Danish Shoulder Arthroplasty Registry (DSR) was established in 2004. Data are reported electronically by the surgeons. Patient-reported outcome is collected 10–14 months postoperatively using the Western Ontario osteoarthritis of the shoulder index (WOOS). 2,137 primary shoulder arthroplasties (70% women) were reported to the registry between January 2006 and December 2008. Mean age at surgery was 69 years (SD 12). The most common indications were a displaced proximal humeral fracture (54%) or osteoarthritis (30%). 61% were stemmed hemiarthroplasties, 28% resurfacing hemiarthroplasties, 8% reverse shoulder arthroplasties, and 3% total arthroplasties. Median WOOS was 59% (IQR: 37–82). 5% had been revised by the end of June 2010. The most frequent indications for revision were dislocation or glenoid attrition. PMID:22329671

2012-01-01

373

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

ClinicalTrials.gov

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

2015-01-06

374

Early complications of anterior supine intermuscular total hip arthroplasty.  

PubMed

Anterior supine intermuscular total hip arthroplasty (THA) performed on a fracture table has been increasingly used for primary THA. Accurate cup placement, low incidence of dislocation, shorter hospital stay, and faster return of function are potential benefits of the technique. However, a high complication rate, particularly during a surgeon's learning curve, has been reported. A retrospective analysis of 61 consecutive anterior supine intermuscular primary THAs with at least 6-month follow-up was performed. All procedures were performed using the anterior supine intermuscular approach with cementless implants under fluoroscopic guidance on a fracture table. Prospectively collected data were retrospectively reviewed to evaluate the early complication rate and radiographic accuracy of implant placement. Five (8.2%) intraoperative complications were observed: including 3 trochanteric fractures and 2 calcar fractures, 4 of which required cable fixation during the index procedure. One nondisplaced trochanteric fracture was treated conservatively. One patient sustained an injury of the lateral femoral cutaneous nerve. Postoperative complications included 1 anterior dislocation, 1 infected superficial hematoma, 1 stem subsidence, and 1 loose stem, with the latter 2 presenting as increasing thigh pain postoperatively and requiring stem revision. The overall complication rate was 16.4% (10/61). Overall, 3 patients (4 hips; 6.5%) required reoperation. No femoral or sciatic nerve injuries occurred, and no patient was diagnosed with venous thromboembolism. All intraoperative fractures occurred during the first 32 cases, and none during the last 29 cases. A potentially high incidence of complications with the anterior supine intermuscular THA exists during a surgeon's learning curve in an academic setting. PMID:23464946

Yi, Chengla; Agudelo, Juan F; Dayton, Michael R; Morgan, Steven J

2013-03-01

375

Postoperative pain treatment after total hip arthroplasty: a systematic review.  

PubMed

Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The aim of this systematic review was to document the procedure-specific evidence for analgesic interventions after total hip arthroplasty (THA). This PRISMA-compliant and PROSPERO-registered review includes randomized placebo-controlled trials (RCTs) of medication-based analgesic interventions after THA. Endpoints were postoperative opioid consumption, pain scores (rest and during mobilization), adverse events, and length of hospital stay. Fifty-eight trials with 19 different interventions were retrieved. High risk of bias, substantial differences in assessment-tools and criteria for pain, irregular reporting of adverse events, considerable differences in supplemental analgesic consumption, and basic analgesic regimens generally characterized trials. Meta-analyses of non-steroidal anti-inflammatory drugs, local infiltration analgesia, intrathecal opioids, and lumbar plexus block provided a 24-hour intravenous morphine-sparing effect of 14.1 (95 % confidence interval: 8.0-20.2) mg, 7.5 (3.7-11.3) mg, 19.8 (14.9-24.7) mg, and 11.9 (6.4-17.3) mg, respectively. Non-steroidal anti-inflammatory drugs and lumbar plexus block were demonstrated to provide reductions in postoperative pain scores. Intrathecal opioids increased pruritus, and lumbar plexus block reduced nausea and pruritus. The GRADE-rated quality of evidence ranged from low to very low throughout the analyses. This review demonstrated, that some analgesic interventions may have the capacity to reduce mean opioid requirements and/or mean pain intensity compared with controls, but the available randomized placebo-controlled trials does not allow a designation of a "best proven intervention" for THA. PMID:25599296

Højer Karlsen, Anders Peder; Geisler, Anja; Petersen, Pernille Lykke; Mathiesen, Ole; Dahl, Jørgen B

2015-01-01

376

Endocannabinoids and acute pain after total knee arthroplasty.  

PubMed

Osteoarthritis (OA) of the knee is a progressive disease that is associated with inflammation of the joints and lower extremity pain. Total knee arthroplasty (TKA) is a surgical procedure that aims to reduce pain and restore motor function in patients suffering from OA. The immediate postoperative period can be intensely painful leading to extended recovery times including persistent pain. The endocannabinoid system regulates nociception, and the activation of cannabinoid receptors produces antinociceptive effects in preclinical models of OA. To date, the influence of the endocannabinoid tone on pain and disability in OA patients and on acute postoperative pain in humans has not been explored. In this study, we provide the first comprehensive profile of endocannabinoids in serum, cerebrospinal fluid, and synovial fluid of patients with painful end-stage OA undergoing TKA and examine correlations between endocannabinoid levels, interleukin 6, functional disability, acute postoperative pain, and postoperative opioid use. Our results reveal that central (cerebrospinal fluid) and peripheral (synovial fluid) levels of the endocannabinoid 2-arachidonoyl glycerol were significantly elevated in patients who developed higher postoperative pain after TKA. In addition, synovial fluid 2-arachidonoyl glycerol levels were positively correlated with postoperative opioid use. Similarly, synovial fluid levels of the anti-inflammatory lipid palmitoylethanolamide correlated with functional disability in OA. Taken together, our results are the first to reveal associations between central and peripheral endocannabinoid levels and postoperative pain. This suggests that endocannabinoid metabolism may serve as a target for the development of novel analgesics both for systemic or local delivery into the joint. PMID:25599456

Azim, Syed; Nicholson, James; Rebecchi, Mario J; Galbavy, William; Feng, Tian; Reinsel, Ruth; Volkow, Nora D; Benveniste, Helene; Kaczocha, Martin

2015-02-01

377

Risk Factors for Early Revision after Total Hip Arthroplasty  

PubMed Central

Objective Revision total hip arthroplasty (THA) is associated with increased cost, morbidity, and technical challenge compared to primary THA. A better understanding of the risk factors for early revision is needed to inform strategies to optimize patient outcomes. Methods 207,256 patients who underwent primary THA between 1997–2005 in California and New York were identified from statewide databases. Unique patient identifiers were used to identify early revision THA (<10 years from index procedure). Patient characteristics (demographics, comorbidities, insurance type, preoperative diagnosis), community characteristics (education level, poverty, population density), and hospital characteristics (annual THA volume, bed size, teaching status) were evaluated using multivariable regression to determine risk factors for early revision. Results The probabilities of undergoing early aseptic revision and early septic revision were 4% and less than 1% at 5 years, respectively. Women were 29% less likely than men to undergo early septic revision (p<0.001). Patients with Medicaid and Medicare were 91% and 24%, respectively, more likely to undergo early septic revision than privately-insured patients (p=0.01; p<0.001). Hospitals performing <200 THA annually had a 34% increased risk of early aseptic revision compared to hospitals performing >400 THA annually (p<0.001). Conclusion A number of identifiable factors, including younger age, Medicaid, and low hospital volume increase the risk of undergoing early revision THA. Patient-level characteristics distinctly affect the risk of revision within 10 years, particularly if due to infection. Our findings reinforce the need for continued investigation of the predictors of early failure following THA. PMID:24285406

Dy, Christopher J.; Bozic, Kevin J.; Pan, Ting Jung; Wright, Timothy M.; Padgett, Douglas E.; Lyman, Stephen

2014-01-01

378

Calcium phosphate cement composites in revision hip arthroplasty.  

PubMed

Loosening of the femoral component in a total hip arthroplasty with concomitant bone loss can pose a problem for revision surgery due to inadequate structure in the remaining femur. While impaction allografting has shown promise, it has also shown serious complications, especially with moderate to severe bone loss. It may be possible to stabilize the graft layer with a bioresorbable cement to improve clinical results. This study examines the mechanical properties of a potential morsellized bone-bioresorbable composite. Morsellized bone was mixed with a commercially available bioresorbable cement (alpha-BSM, Etex Corp.) in compositions of 0%, 25%, 50% and 75% bone. Unconfined compression and diametral tensile and confined compression tests were performed to determine the composite mechanical properties. The composition containing 50% bone tended to exhibit the highest uniaxial strengths, as well as the highest confined compression modulus. The uniaxial compressive strength and stiffness of this composition was in the range of cancellous bone. Uniaxial compressive modulus decreased with increasing bone fraction whereas elongation exhibited the opposite trend. Bone fraction had a significant effect on compressive strength (p < 0.0001), compressive modulus (p < 0.0001), elongation (p < 0.01), tensile strength (p < 0.0001) and confined compressive modulus (p = 0.04). The addition of a bioresorbable cement to the allograft layer may improve the properties of the layer, preventing early subsidence seen in some clinical studies of impaction allografting, and therefore improving the clinical results. Further testing is required to evaluate the in vitro mechanical performance, as well as in vivo remodelling characteristics. PMID:16023190

Speirs, Andrew D; Oxland, Thomas R; Masri, Bassam A; Poursartip, Anoush; Duncan, Clive P

2005-12-01

379

Patient satisfaction with mobile compression devices following total hip arthroplasty.  

PubMed

The goal of this study was to evaluate patient satisfaction with the use of a mobile compression device after anterior total hip arthroplasty. Two hundred forty-seven patients used the mobile compression device for 10 days after surgery with recommended adjunctive 325 mg aspirin therapy. The device has a rechargeable battery pack that weighs 1.65 lb and is attached to compression sleeves worn over the calves of both lower extremities. It delivers sequential compression to the sleeves at a pressure of 50 mm Hg for about 10 seconds at a cycle of 1/min and is synchronized to the patient's venous blood flow pulses. A questionnaire was administered to all patients at 1-month follow-up to gauge patient perception of the device. There were 14 questions about comfort, noise, cost, pain, skin breakdown, rash, and falls related to the device. Overall, 234 of 247 (94.7%) patients stated that they would use the device again. The most common complaint from patients was that the mobile compression device was cumbersome (63.6%). Twenty-five patients (10.1%) reported having a fall while using the device, although no fall-related injuries were documented. Therefore, the authors recommend counseling patients about fall risk and reminding them to use caution while moving about with the device. Despite the limitations described in this study, the data confirmed that patients who used the device had an overall positive response to the system and would choose to use the device again rather than using chemical agents for deep venous thrombosis prophylaxis. PMID:25102501

McAsey, Craig J; Gargiulo, Jeanine M; Parks, Nancy L; Hamilton, William G

2014-08-01

380

Predictive value of robotic-assisted total hip arthroplasty.  

PubMed

Acetabular cup positioning, leg-length discrepancy, and global offset are important parameters associated with outcomes following total hip arthroplasty (THA). Deviation from an accepted range of values can lead to significant complications, including dislocation, leg-length discrepancy, impingement, accelerated bearing surface wear, and revisions. The purpose of this study was to assess whether robotic-assisted THA was reliable in predicting radiographic measurements of cup inclination and anteversion, leg-length change, and global offset change. All 61 robotic-assisted THAs that met the inclusion and exclusion criteria were performed by a single surgeon through a mini-posterior approach. Data provided by the robot were collected prospectively, and radiographic data were collected retrospectively by 2 blinded independent reviewers. The cohort in this study consisted of 27 male and 34 female patients, with an average age of 60.5 years. A strong inter- and intraobserver correlation was found for the radiographic measurements of cup inclination, cup anteversion, leg-length discrepancy, and global offset (r>0.8 with P<.001 for all). Ninety-six point seven percent of robotic-measured inclination angles and 98.4% of robotic-measured anteversion angles were within 10° of radiographic measurements. One hundred percent of robotic-measured leg-length change and 91.8% of robotic-measured global offset change were within 10 mm of radiographic measurements. Robotic-assisted THA showed good predictive value for cup inclination and anteversion angles and measurements of leg-length change and global offset change done postoperatively on plain radiographs. Further refinement of the robotic system would make it more accurate in predicting the postoperative parameters mentioned. [Orthopedics. 2015; 38(1):e31-e37.]. PMID:25611417

El Bitar, Youssef F; Jackson, Timothy J; Lindner, Dror; Botser, Itamar B; Stake, Christine E; Domb, Benjamin G

2015-01-01

381

Is tantalum protective against infection in revision total hip arthroplasty?  

PubMed

We hypothesised that the use of tantalum (Ta) acetabular components in revision total hip arthroplasty (THA) was protective against subsequent failure due to infection. We identified 966 patients (421 men, 545 women and 990 hips) who had undergone revision THA between 2000 and 2013. The mean follow up was 40.2 months (3 months to 13.1 years). The mean age of the men and women was 62.3 years (31 to 90) and 65.1 years (25 to 92), respectively. Titanium (Ti) acetabular components were used in 536 hips while Ta components were used in 454 hips. In total, 73 (7.3%) hips experienced subsequent acetabular failure. The incidence of failure was lower in the Ta group at 4.4% (20/454) compared with 9.9% (53/536) in the Ti group (p < 0.001, odds ratio 2.38; 95% CI 1.37 to 4.27). Among the 144 hips (64 Ta, 80 Ti) for which revision had been performed because of infection, failure due to a subsequent infection was lower in the Ta group at 3.1% (2/64) compared with 17.5% (14/80) for the Ti group (p = 0.006). Thus, the use of Ta acetabular components during revision THA was associated with a lower incidence of failure from all causes and Ta components were associated with a lower incidence of subsequent infection when used in patients with periprosthetic joint infection. Cite this article: Bone Joint J 2015;97-B:45-9. PMID:25568412

Tokarski, A T; Novack, T A; Parvizi, J

2015-01-01

382

Ulnar head implant arthroplasty: an intermediate term review of 1 surgeon's experience.  

PubMed

Ulnar head arthroplasty has been an emerging alternative for salvage of resection arthroplasty at the distal radioulnar joint (DRUJ) since the early 1990s. Recently, it has been offered for initially treating painful arthrosis or instability of the DRUJ. This follow-up study reports a surgeon's experience treating DRUJ disorders with ulnar head arthroplasty. Twenty-two wrists in 20 patients (11 females, 9 males), 6 with no prior wrist procedures were treated between 1995 and 2006 for painful DRUJ disorders with either Herbert-Martin (Martin Medizin-Technik, Tuttingen, Germany) or Avanta (Small Bone Innovations, New York, NY) head prosthesis. Follow-up averaged 54.3 months. A standardized telephone survey determined preoperative /postoperative verbal analog pain scores and a modified Mayo Wrist Score (delineating poor, fair, good, or excellent outcomes). Data suggest that ulnar head implant arthroplasty is a reasonable treatment option for DRUJ-related pain, loss of function, or salvage of failed distal ulna resection procedures. The analog pain score statistically significant decreased by 1.68 points when comparing preoperative to postoperative scores. Average Modified Mayo Wrist Scores were good, independent of whether the procedure was primary or salvaged. No significant difference was seen between the primary or salvage group modified Mayo Wrist Scores. Whereas averaged modified Mayo scores for both the primary and salvage groups were in the good category, prostheses used as primary procedures may be associated with fewer poor or fair outcomes. Two good and 1 excellent outcome of 3 wrists requiring revision procedures suggest that even with revision of the implant arthroplasty, satisfactory results may be expected. PMID:19730047

Yen Shipley, Nancy; Dion, Greg R; Bowers, William H

2009-09-01

383

Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty  

PubMed Central

Summary Background Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from “painful prosthesis”, which currently represents a clinical problem. Methods A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. Results Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ?3) persisting for at least 4 months after surgery, or new onset of pain (VAS ?3) after the first 4 months, lasting ?2 months. Acute pain reported as VAS score ?7 in patients who underwent TJA should be always immediately investigated. Conclusions The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention. PMID:24133526

Piscitelli, Prisco; Iolascon, Giovanni; Innocenti, Massimo; Civinini, Roberto; Rubinacci, Alessandro; Muratore, Maurizio; D’Arienzo, Michele; Leali, Paolo Tranquilli; Carossino, Anna Maria; Brandi, Maria Luisa

2013-01-01

384

The Prevalence of Radiographic Criteria of Femoral Acetabular Impingement in Patients Undergoing Hip Arthroplasty Surgery  

PubMed Central

Background: Pistol grip deformity of the proximal femur has been reported as a potential cause of hip pain and early-onset arthritis. The exact incidence of patients with osteoarthritis resulting from femoral acetabular impingement (FAI) is unknown. The purpose of this study was to explore the relationship between radiographic markers of FAI in patients undergoing hip arthroplasty. Methods: We retrospectively reviewed the radiographs of patients undergoing hip arthroplasty by a single surgeon over a 2-year period. The patients were divided by age, those younger than 65 years and (group A) and those 65 years and older (group B). The radiographs were evaluated for morphology consistent with FAI including an ? angle >55°, crossover sign, coxa profunda, acetabular protrusio, and ischial spine sign. Three independent reviewers evaluated all the radiographs. The incidence of CAM, Pincer, and mixed deformities were compared between the 2 groups. Results: A total of 255 patients with 258 hip arthroplasties were included in this analysis. Group A was found to have a greater number of patients with CAM morphology. Linear regression analysis revealed that the ? angle was greater in younger patients. Conclusion: Patients undergoing hip arthroplasty exhibit a high incidence of radiographic abnormalities consistent with FAI. The CAM-type morphology occurs more frequently in younger patients with advanced arthritis requiring hip arthroplasty. This morphology is thought to cause a delaminating injury to the cartilage of the acetabulum. This study supports the notion that CAM-type morphology is a risk factor for early development of degenerative arthritis of the hip. PMID:24660096

LaFrance, Russell; Williams, Richard; Madsen, Wes; Maloney, Michael; Drinkwater, Christopher; Giordano, Brian

2014-01-01

385

Uncemented total hip arthroplasty in patients less than twenty-years.  

PubMed

A variety of conditions may lead to arthritis of the hip during adolescence. Although uncommon, total hip arthroplasty may occasionally be necessary for treatment of end-stage disabling arthritis of the hip in the young. There is paucity of information documenting the outcome of uncemented total hip arthroplasty in adolescents. We report our experience with total hip arthroplasty in patients under the age of twenty years. The results of 35 consecutive total hip arthroplasties performed at our institution in 25 patients between 1993 and 2003 were reviewed. There were 17 females and 8 males with a mean age of 17.6 years (range: 13.5 to 20). All patients received a Hydroxyapatite (HA) plasma sprayed Titanium acetabular component and a tapered femoral stem proximally coated with HA. Follow-up averaged 6.6 years (range: 4.2 to 10). The underlying diagnosis was avascular necrosis (16 hips), juvenile rheumatoid arthritis (9 hips), sequelae of DDH (2 hips), spondyloepiphyseal dysplasia (2 hips), sequelae of Perthes (2 hips), osteoarthritis (2 hips), post-traumatic arthritis (1 hip), and pseudo rheumatoid chondrodysplasia (1 hip). There was a significant improvement in function and relief of pain as measured by the Harris Hip score and SF-36. All uncemented components were found to be stable and osseo-integrated at the latest followup. There were no complications, or reoperations. There was one revision secondary to severe polyethylene wear. This patient was revised 10 years after the index surgery. Uncemented total hip arthroplasty was found to confer a significant improvement in function and to have an acceptable short-term outcome in very young patients with end-stage arthritis of the hip. Longer-term follow-up is needed to assess the durability of this procedure in adolescents. PMID:19058694

Restrepo, Camilo; Lettich, Thomas; Roberts, Nathan; Parvizi, Javad; Hozack, William J

2008-10-01

386

Filling the launch gap  

NASA Astrophysics Data System (ADS)

Vehicles proposed to fill the gap in the U.S. space program's space transport needs for the next decade resulting from the January Challenger disaster, are discussed. Prior to the accident, the Air Force planned to purchase a Complementary Expendable Launch Vehicle system consisting of 10 single-use Titan-34D7 rockets. Another heavy lift booster now considered is the Phoenix H. Commercial launch vehicle systems projected to be available in the necessary time frame include the 215,000-pound thrust 4000-pound LEO payload capacity NASA Delta, the 11,300-pound LEO payload capacity Atlas Centaur the first ICBM, and the all-solid propellant expendable 2000-pound LEO payload Conestoga rocket. Also considered is the man-rated fully reusable Phoenix vertical take-off and vertical-landing launch vehicle.

Hoeser, S.

1986-05-01

387

Gap and stripline combined monitor  

DOEpatents

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.

Yin, Y.

1986-08-19

388

Observation of polychromatic gap solitons  

E-print Network

theoretically and observe experimentally poly- chromatic gap solitons generated by supercontinuum light-induced broadening and color separation to the simultaneous spatio-spectral localization of supercontinuum light

389

Novel Gapped Quantum Wire  

NASA Astrophysics Data System (ADS)

High quality state of the art quantum wires (QWRs) can be fabricated by the novel cleaved edge overgrowth technique, proposed by (Pfeiffer et al., 1990). Transverse quantization in these QWRs leads to a succession of nested energy bands. With the lowest two successive energy levels occupied, gapped phases are possible including, e.g, an intersubband charge density wave (ICDW) and a Cooper phase with strong superconducting fluctuations (Starykh et al., 2000). Due to the possibility of density reorganization, in which it becomes favorable for the two lowest subbands to match their densities, the ICDW is usually the most likely state. Recently, by exploiting the valley degeneracy in AlAs, a single QWR has been fabricated with two degenerate nonoverlapping bands separated in k space by half an Umklapp vector (Moser et al. 2004). For low densities this structure is able to access a multiple subband regime that is not subject to the density reorganizing ICDW, leaving the Cooper phase to flourish. Using Abelian bosonization, we explore the relevant interaction terms for this system, including Umklapp assisted Cooper scattering, and discuss the phase diagram.

Datta, Trinanjan

2005-03-01

390

Novel Gapped Quantum Wire  

NASA Astrophysics Data System (ADS)

High quality state of the art quantum wires (QWRs) can be fabricated by the novel Cleaved Edge Overgrowth (CEO) technique, proposed by (Pfeiffer et al, 1990). Transverse quantization in these QWRs leads to a succession of nested energy bands. With the lowest two successive energy levels occupied, gapped phases are possible including, e.g., an intersubband charge density wave (ICDW) and a Cooper phase with strong superconducting fluctuations (Starykh et al, 2000). Due to the possibility of density reorganization, in which it becomes favorable for the two lowest subbands to match their densities, the ICDW is usually the most likely state. Recently, by exploiting the valley degeneracy in AlAs, a single QWR has been fabricated with two degenerate nonoverlapping bands separated in k space by half an Umklapp vector (Moser et al 2004). For low densities the structure is able to access a multiple subband regime that is not subject to the density reorganizing ICDW, leaving a Cooper phase to flourish. Using Abelian bosonization, we explore the relevant interaction terms for this system, including Umklapp assisted Cooper scattering and discuss the phase diagram.

Datta, Trinanjan

2005-04-01

391

Research and Applications: Gap Analysis  

NSDL National Science Digital Library

The US Geological Survey's Gap Analysis Program (GAP) is a cooperative project that attempts to map land cover and vertebrate species distribution in order to enhance conservation land management activities. Visitors can view data about protected areas and species as well as read USGS publications on this program.

392

Essential amino acid supplementation in patients following total knee arthroplasty  

PubMed Central

Background. By the year 2030, 3.48 million older U.S. adults are projected to undergo total knee arthroplasty (TKA). Following this surgery, considerable muscle atrophy occurs, resulting in decreased strength and impaired functional mobility. Essential amino acids (EAAs) have been shown to attenuate muscle loss during periods of reduced activity and may be beneficial for TKA patients. Methods. We used a double-blind, placebo-controlled, randomized clinical trial with 28 older adults undergoing TKA. Patients were randomized to ingest either 20 g of EAAs (n = 16) or placebo (n = 12) twice daily between meals for 1 week before and 2 weeks after TKA. At baseline, 2 weeks, and 6 weeks after TKA, an MRI was performed to determine mid-thigh muscle and adipose tissue volume. Muscle strength and functional mobility were also measured at these times. Results. TKA patients receiving placebo exhibited greater quadriceps muscle atrophy, with a –14.3 ± 3.6% change from baseline to 2 weeks after surgery compared with –3.4 ± 3.1% for the EAA group (F = 5.16, P = 0.036) and a –18.4 ± 2.3% change from baseline to 6 weeks after surgery for placebo versus –6.2 ± 2.2% for the EAA group (F = 14.14, P = 0.001). EAAs also attenuated atrophy in the nonoperated quadriceps and in the hamstring and adductor muscles of both extremities. The EAA group performed better at 2 and 6 weeks after surgery on functional mobility tests (all P < 0.05). Change in quadriceps muscle atrophy was significantly associated with change in functional mobility (F = 5.78, P = 0.021). Conclusion. EAA treatment attenuated muscle atrophy and accelerated the return of functional mobility in older adults following TKA. Trial registration. Clinicaltrials.gov NCT00760383. Funding. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Office of the Director (OD), and the National Institutes of Health Office of Dietary Supplements (ODS), NIH grant K01HD057332, and the Medical Research Foundation, Oregon Health and Science University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the funders. PMID:24135139

Dreyer, Hans C.; Strycker, Lisa A.; Senesac, Hilary A.; Hocker, Austin D.; Smolkowski, Keith; Shah, Steven N.; Jewett, Brian A.

2013-01-01

393

Choice of anaesthetic regimen influences haemodynamic response to cemented arthroplasty.  

PubMed

Haemodynamic changes during bilateral cemented arthroplasty (BCA) were compared in dogs anaesthetized with isoflurane/N2O (ISOF) or diazepam/fentanyl (100 microg x kg(-1))N2O(FENT). Eight animals were anaesthetized with each regimen. After establishing monitoring and recording baseline values, BCA was performed. Haemodynamic measurements included aortic blood pressure (ABP), pulmonary artery pressure (PAP), right and left atrial pressures, and cardiac output. These were recorded at 30, 60, 180 and 300 sec after BCA. Lungs were removed and examined postmortem using quantitative morphometry. Groups demonstrated similar increases in PAP (ISOF 15 +/- 2 to 32 +/- 7, FENT 19 +/- 4 to 38 +/- 13; P> 0.05 between groups, P< 0.05 vs baseline). The proportion of lung vasculature occluded by fat was not different between groups (ISOF 9.63 +/- 3.38%, FENT 8.85 +/- 2.20%). Stroke volume decreased similarly in both groups (P> 0,05 between groups, P< 0.05 vs baseline). However, ABP decreased within one minute of BCA in ISOF (111 +/- 17 to 55 +/- mmHg, P< 0.05 and two of eight dogs died. All FENT dogs survived and hypotension (118 +/- 20 to 102 +/- 24 mmHg) was transient and less severe (P< 0.05 vs ISOF). Increased heart rate (HR) was noted in FENT following BCA (73 +/- 8 to 108 +/- 25 beats x min(-1); P< 0.05). Baseline HR was higher in ISOF (P< 0.05) and no increase in HR was noted. Systemic vascular resistance decreased in ISOF (P< 0.05), but not FENT (P> 0.05 vs baseline, P< 0.05 vs ISOF). To assess the role of slower baseline HR in FENT (73 +/-8) versus ISOF (131 +/- 5), six FENT dogs were paced (130 beats x min(-1)) with epicardial leads and an AV sequential pulse generator to simulate the ISOF group's baseline HR. Haemodynamic stability was maintained in this group in spite of a more rapid baseline HR. The choice of anaesthetic regimen strongly influenced acute haemodynamic changes in response to BCA. PMID:8706204

Guest, C B; Byrick, R J; Mazer, C D; Wigglesworth, D F; Mullen, J B; Tong, J H

1995-10-01

394

Gap ecology in Florida scrub: Species occurrence, diversity and gap properties  

Microsoft Academic Search

Questions: Studies of gap effects have been conducted mainly in forests. We studied gap ecology in a pyrogenic Ceratiola ericoides (Florida rosemary) dominated shrubland and asked: How do gap size and the frequency of large gaps change across the fire chronosequence? Do larger gaps differ from smaller gaps in vegetation structure or species diversity? Are effects of gaps independent of,

Eric S. Menges; Alaä Craddock; Jessica Salo; Robin Zinthefer; Carl W. Weekley

2008-01-01

395

Energy gaps in ?-graphdiyne nanoribbons  

SciTech Connect

?-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.

Niu, X. N.; Yang, D. Z.; Si, M. S., E-mail: sims@lzu.edu.cn; Xue, D. S., E-mail: xueds@lzu.edu.cn [Key Laboratory for Magnetism and Magnetic Materials of the Ministry of Education, Lanzhou University, Lanzhou 730000 (China)

2014-04-14

396

GAP Analysis Bulletin Number 15  

USGS Publications Warehouse

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

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

2008-01-01

397

Mind the Gap  

NASA Astrophysics Data System (ADS)

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].

2008-09-01

398

Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty  

PubMed Central

Alumina-on-alumina bearings in total hip arthroplasty have been developed in an attempt to minimise debris and the occurrence of osteolytic lesions. The outstanding tribological properties of this bearing system are explained by low surface roughness, high hardness for major scratch resistance, and high wettability. Since the 1970s, technological improvements in the manufacturing process of alumina components together with a better understanding of Morse taper technology have provided a surgical grade material with high density, high purity and small grains. Published studies on the outcome of total hip arthroplasty performed with this new generation of implants showed high survivorship especially in young and active patients, with survival rates free of revision of 90.8% to 97.4% at ten years. However, concern remains over ceramic liner fracture and squeaking, which has been noted recently with increasing prevalence. This review will discuss the current knowledge on the use of alumina-on-alumina bearings. PMID:21191579

Zaoui, Amine; Zadegan, Frédéric; Sedel, Laurent; Nizard, Rémy

2010-01-01

399

Accuracy of knee range of motion assessment after total knee arthroplasty.  

PubMed

Measurement of knee joint range of motion (ROM) is important to assess after total knee arthroplasty. Our objective was to determine level of agreement and accuracy between observers with different knowledge on total ROM after total knee arthroplasty. Forty-one patients underwent x-ray of active and passive knee ROM (gold standard). Five different raters evaluated observed and measured ROM: orthopedic surgeon, clinical fellow, physician assistant, research fellow, and a physical therapist. A 1-way analysis of variance was used to determine differences in ROM between raters over both conditions. Limit of agreement for each rater for both active and passive total ROM under both conditions was calculated. Analysis of variance indicated a difference between raters for all conditions (range, P = .004 to P < or =.0001). The trend for all raters was to overestimate ROM at higher ranges. Assessment of ROM through direct observation without a goniometer provides inaccurate findings. PMID:18722308

Lavernia, Carlos; D'Apuzzo, Michele; Rossi, Mark D; Lee, David

2008-09-01

400

Kneeling is safe for patients implanted with medial-pivot total knee arthroplasty designs.  

PubMed

Nine ADVANCE (Wright Medical Technology, Arlington, TN)) Medial-Pivot (MP) and 9 ADVANCE Double-High total knee arthroplasties were analyzed under radiographic surveillance at standing, mid kneeling, and full kneeling. In vivo tibiofemoral contact positions were obtained using the 3- to 2-dimensional image registration technique. The contact in Double-High knee was always more posterior than that in the MP knee presumably because of the presence of the posterior cruciate ligament. The contact positions in both the designs moved anterior from standing to mid kneeling, moved posterior from mid kneeling to full kneeling, and remained within the intended articulation range of the implants. This study indicates that kneeling is safe in MP total knee arthroplasty even in the absence of a cam-post or posterior cruciate ligament. PMID:20541359

Barnes, C Lowry; Sharma, Adrija; Blaha, J David; Nambu, Satya N; Carroll, Michael E

2011-06-01

401

A nomogram to predict major complications after hip and knee arthroplasty.  

PubMed

We aimed to develop a nomogram for risk stratification of major postoperative complications in hip and knee arthroplasty based on preoperative and intraoperative variables, and assessed whether this tool would have better predictive performance compared to the Surgical Apgar Score (SAS). Logistic regression analysis was performed to develop a nomogram. Discrimination and calibration were assessed. Net reclassification improvement (NRI) was used to compare to the SAS. All variables were found to be statistically significant predictors of post-operative complications except race and lowest heart rate. The concordance index was 0.76 with good calibration. Compared to the SAS, the NRI was 71.5% overall. We developed a clinical prediction tool, the Morbidity and Mortality Acute Predictor for arthroplasty (arthro-MAP) that might be useful for postoperative risk stratification. PMID:24793891

Wuerz, Thomas H; Kent, David M; Malchau, Henrik; Rubash, Harry E

2014-07-01

402

Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty.  

PubMed

The objective of this study was to determine if tranexamic acid (TXA) applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). Two hundred and ninety consecutive patients from a single surgeon were enrolled. In TKA, TXA solution was injected into the knee after closure of the arthrotomy. In THA, the joint was bathed in TXA solution at three points during the procedure. In both THA and TKA the TXA solution was at a concentration of 3 g TXA per 100 mL saline. The mean blood loss was significantly higher in the non-TXA patients in both TKA and THA groups. Postoperative transfusions decreased dramatically with TXA, dropping from 10% to 0%, and from 15% to 1%, in the TKA and THA groups, respectively. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA. PMID:23886406

Konig, Gerhardt; Hamlin, Brian R; Waters, Jonathan H

2013-10-01

403

Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty  

PubMed Central

The objective of this study was to determine if tranexamic acid (TXA) applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). Two hundred and ninety consecutive patients from a single surgeon were enrolled. In TKA, TXA solution was injected into the knee after closure of the arthrotomy. In THA, the joint was bathed in TXA solution at three points during the procedure. In both THA and TKA the TXA solution was at a concentration of 3gm TXA per 100mL saline. The mean blood loss was significantly higher in the non-TXA patients in both TKA and THA groups. Postoperative transfusions decreased dramatically with TXA, dropping from 10% to 0%, and from 15% to 1%, in the TKA and THA groups, respectively. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA. PMID:23886406

Konig, Gerhardt; Hamlin, Brian R.; Waters, Jonathan H.

2013-01-01

404

Cost benefit analysis of topical tranexamic acid in primary total hip and knee arthroplasty.  

PubMed

The purpose of this study was to provide a cost-benefit analysis of topical tranexamic acid (TXA) in primary total hip and knee arthroplasty patients. A retrospective cohort of 591 consecutive patients, 311 experimental and 280 control, revealed a transfusion rate reduction from 17.5% to 5.5%, increased postoperative hemoglobin, and decreased delta hemoglobin without an increase in adverse events (all P < 0.001). This led to saving $83.73 per patient based on transfusion costs alone after accounting for the cost of TXA. Hospital disposition to home compared to subacute nursing facility was also significantly increased by 9.3% (P < 0.02). We conclude that topical TXA reduces transfusion rate, increases home disposition, and reduces cost in primary hip and knee arthroplasty. PMID:24630599

Tuttle, John R; Ritterman, Scott A; Cassidy, Dale B; Anazonwu, Walter A; Froehlich, John A; Rubin, Lee E

2014-08-01

405

Mid-term outcomes in HIV-positive patients after primary total hip or knee arthroplasty.  

PubMed

We hypothesized that infection rates following total joint arthroplasty (TJA) in those with the human immunodeficiency virus (HIV) without hemophilia or drug use would be similar to rates in HIV-negative patients. Records at an urban HIV referral hospital were searched for patients who underwent primary total hip and knee arthroplasty from 2003 to 2010. The primary outcome was revision for infection. 372 HIV-negative and 22 HIV-positive TJA patients met inclusion criteria. The HIV-positive group had more deep infections than the HIV-negative group (9.1% v 2.2%, P=0.102). There were no infections in those with AIDS-defining CD4 counts. Those with HIV may have a higher risk of developing a deep infection. A low CD4 count is not an absolute contraindication to TJA in HIV positive patients. PMID:23867663

Lin, Carol A; Takemoto, Steven; Kandemir, Utku; Kuo, Alfred C

2014-02-01

406

Total knee arthroplasty in patients with ipsilateral fused hip: a technical note.  

PubMed

We report the surgical technique used to perform posterior-stabilized total knee arthroplasty (TKA) in two patients with a well positioned and functional hip arthrodesis. Intraoperatively, the operating table was placed in an increased Trendelenburg position. Episodically, we flexed the foot of the table by 90° to allow maximal knee flexion to facilitate exposure and bone cuts. We opted to resect the patella and tibia first to enable exposure, given the stiffness of the arthritic knee. One patient's medical condition prohibited complex conversion total hip arthroplasty (THA) prior to the TKA. The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky. The final outcome provided satisfactory results at a minimum of 2 years postoperatively. TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion. PMID:25436074

Goodman, Stuart B; Huddleston, James I; Hur, Dong; Song, Sang Jun

2014-12-01

407

Twenty-year survival analysis in total knee arthroplasty by a single surgeon.  

PubMed

Between January 1988 and December 2006, a total of 3014 primary total knee arthroplasties (TKAs) in 2042 patients were performed, and survivorship analysis was performed. Survivorship analysis showed a 10-year survival of 93.8% and a 20-year survival of 70.9%. There was no significant difference in the survival rate according to sex and diagnosis (P = .142 and .443, respectively). The survival rate was higher in the patients older than 60 years (P < .001). The survival rate of Total Condylar IV (TC-IV) was higher than that of Ortholoc (Dow Corning Wright Medical, Arlington, Tenn) (P < .001). Total knee arthroplasty results in satisfactory long-term survival rates. However, the survival rate decreases over time. The risk of requiring revision TKA was related to age and type of implants. Careful consideration is necessary to decide the time for TKA and select type of implants. PMID:22177792

Bae, Dae Kyung; Song, Sang Jun; Park, Man Jun; Eoh, Jae Hyung; Song, Jong Hoon; Park, Cheol Hee

2012-08-01

408

Histologic retrieval analysis of a porous tantalum metal implant in an infected primary total knee arthroplasty.  

PubMed

Porous tantalum (Zimmer, Inc, Warsaw, Ind) has the theoretical advantage of improved biologic fixation because of its high porosity, interconnected pore space, and modulus of elasticity. We present a case report documenting the retrieval and bone ingrowth analysis of a porous tantalum tibial component in an infected total knee arthroplasty. Results demonstrated a significantly larger amount of bone ingrowth present in the tibial posts (36.7%) when compared with the bone ingrowth into the tibial baseplate (4.9%) (P < .001). The data suggest that bone ingrowth seen in the plugs as well as baseplate was suggestive of viable bone tissue with healthy bone marrow, osteocytes, and lamella, resulting in a well-fixed tibial implant even at revision surgery for an infected total knee arthroplasty. PMID:22178612

Sambaziotis, Chris; Lovy, Andrew J; Koller, Karyn E; Bloebaum, Roy D; Hirsh, David M; Kim, Sun Jin

2012-08-01

409

Reliability of preoperative measurement with standardized templating in Total Knee Arthroplasty  

PubMed Central

AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly, the reliability and correspondence between the size of said measurement and the actual implant utilized was determined. Secondly, the existing correlation between the intra- and interobserver determinations with the intraclass correlation coefficient was analyzed. RESULTS: An overall correspondence of 54%, improving up to 92% when the measured size admitted a difference of one size, was found. Good intra- and interobserver reliability with an intraclass correlation coefficient greater than 0.90 (P < 0.001) was also discovered. CONCLUSION: Agreement between the preoperative measurement with standardized acetate templates and the prosthetic size implanted can be considered satisfactory. We thus conclude it is a reproducible technique. PMID:24147264

Hernandez-Vaquero, Daniel; Abat, Ferran; Sarasquete, Juan; Monllau, Juan Carlos

2013-01-01

410

Total Knee Arthroplasty in Patients with Ipsilateral Fused Hip: A Technical Note  

PubMed Central

We report the surgical technique used to perform posterior-stabilized total knee arthroplasty (TKA) in two patients with a well positioned and functional hip arthrodesis. Intraoperatively, the operating table was placed in an increased Trendelenburg position. Episodically, we flexed the foot of the table by 90° to allow maximal knee flexion to facilitate exposure and bone cuts. We opted to resect the patella and tibia first to enable exposure, given the stiffness of the arthritic knee. One patient's medical condition prohibited complex conversion total hip arthroplasty (THA) prior to the TKA. The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky. The final outcome provided satisfactory results at a minimum of 2 years postoperatively. TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion. PMID:25436074

Goodman, Stuart B.; Huddleston, James I.; Hur, Dong

2014-01-01

411

Total knee arthroplasty in a spinal cord-injured patient: a case report.  

PubMed

Patients with spinal cord injuries are prone to knee hydrarthrosis (also known as "water on the knee"), which can cause pain, functional impairment and the restriction of social activities. Total knee arthroplasty is a potentially appropriate treatment. Here, we report on a patient presenting partial T12 AIS grade C paraplegia who was able to walk with two forearm crutches, an ankle-foot orthosis on the right leg and a knee-ankle-foot orthosis on the left leg. Thirteen years after the spinal cord injury, the patient presented with septic arthritis of the right knee, complicated by recurrent hydrarthrosis during standing and walking. Arthroscopy revealed advanced osteoarthritis. Total knee arthroplasty was performed, with very good functional and social outcomes two and half years after surgery. PMID:19720574

Koubaa, S; Ksibi, I; Lebib, S; Tlili, L; Ben Salah, F Z; Dziri, C; Zehi, K; Zouari, M

2009-01-01

412

Surface replacement arthroplasty of the proximal interphalangeal and metacarpophalangeal joints: The current state  

PubMed Central

Surface replacement arthroplasty for proximal interphalangeal joint and metacarpophalangeal joints are becoming popular. Low profile, anatomically designed implants limit the amount of bone removed but need preservation of the collateral ligaments. Pyrocarbon and cobalt-chrome stemmed unconstrained implants on ultra-high molecular weight polyethylene are the two commonly available bearing surfaces. The indications for small joint arthroplasty are degenerative, post-traumatic or rheumatoid arthritis. Early results are encouraging, primarily in patient satisfaction and pain relief, but are based on low numbers. The main concerns are progressive loss of range due to implant settling, dislocation, squeaking and poor osteo-integration with the appearance of a radiolucent line at the bone–implant interface. Our experience suggests that metacarpophalangeal joint replacements consistently give good results. PMID:22022042

Singh, Harvinder; Dias, Joseph J.

2011-01-01

413

Management of bone loss in revision total hip arthroplasty using custom cementless femoral components.  

PubMed

Forty-seven consecutive revision total hip arthroplasties were performed using porous ingrowth custom-made prostheses designed from plain radiographs and computed tomography scans. At an average follow-up period of 30 months (range, 2-4 years), one revision has been required for loosening. The average Harris pain score was 39 and the average total score was 84 at the last follow-up evaluation. Complications included nine cases (19%) with intraoperatively detected fractures of the proximal femur treated with cerclage wires and seven cases (15%) with subsidence greater than 3 mm. There were no postoperative infections and only two dislocations. At the time of surgery local particulate bone graft was used in all cases. Thirty-four percent required structural graft to restore bone stock; no case required grafting for prosthesis stability. Management of bone loss in total hip arthroplasty using a custom cementless prosthesis appears to provide an attractive alternative to massive bone grafting. PMID:8326304

Bargar, W L; Murzic, W J; Taylor, J K; Newman, M A; Paul, H A

1993-06-01

414

Nontraumatic fracture of the femoral condylar prosthesis in a total knee arthroplasty leading to mechanical failure.  

PubMed

This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before. PMID:24587928

Swamy, Girish N; Quah, Conal; Bagouri, Elmunzar; Badhe, Nitin P

2014-01-01

415

Nontraumatic Fracture of the Femoral Condylar Prosthesis in a Total Knee Arthroplasty Leading to Mechanical Failure  

PubMed Central

This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before. PMID:24587928

Swamy, Girish N.; Quah, Conal; Bagouri, Elmunzar; Badhe, Nitin P.

2014-01-01

416

Large versus small femoral heads in metal-on-metal total hip arthroplasty  

Microsoft Academic Search

The recent resurgence of metal-on-metal total hip arthroplasty has afforded the surgeon new options in femoral head diameters that were not previously available. Reduction in the risk for dislocation and potential improvements in articular wear are the obvious advantages of large-diameter femoral heads. Total hips with larger-diameter femoral heads are more resistant to dislocation. The clinical experience with 616 38

John M. Cuckler; K. David Moore; Adolph V. Lombardi; Edward McPherson; Roger Emerson

2004-01-01

417

Bioball universal modular neck adapter as a salvage for failed revision total hip arthroplasty.  

PubMed

Management of recurrent dislocation of total hip arthroplasty is often a challenging and daunting task. Re-revision of such a total hip prosthesis may not be easy as the removal of a well-fixed, fully coated stem is extremely difficult. We managed to salvage instability in three revision hip cases in which the fully coated stem had subsided by using a bioball universal neck adapter without changing the femoral stem or acetabular cup. PMID:24133315

Vaishya, Raju; Sharma, Mrinal; Chaudhary, Rajeev Raj

2013-09-01

418

Do Tantalum and Titanium Cups Show Similar Results in Revision Hip Arthroplasty?  

Microsoft Academic Search

Porous surfaces are intended to enhance osteointegration of cementless implants. Tantalum has been introduced in an effort\\u000a to enhance osseointegration potential of uncemented components. We therefore compared the clinical outcome of acetabular components\\u000a with two different porous surfaces. We retrospectively reviewed 283 patients (295 hips) who underwent cementless revision\\u000a hip arthroplasty with either an HA-coated titanium cup (207 patients, 214

S. Mehdi Jafari; Benjamin Bender; Catelyn Coyle; Javad Parvizi; Peter F. Sharkey; William J. Hozack

2010-01-01

419

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

PubMed Central

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

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

2014-01-01

420

Importance of neurological evaluation before reverse shoulder arthroplasty in patients with previous poliomyelitis.  

PubMed

We present a case report of a patient, affected by post-polio syndrome and cuff tear arthropathy of his right shoulder, who underwent reverse shoulder arthroplasty. A previous radial deficiency was unmasked in the post-operative follow-up, with passive elbow bending when the forearm was put in an antigravitational position. A precise preoperative neurological evaluation is mandatory in shoulder replacement in order to estimate the functional outcome after surgery. PMID:19367520

Castoldi, Filippo; Lollino, Nicola; Caranzano, Francesco; Assom, Marco

2009-06-01

421

Cement-in-cement revision hip arthroplasty: an analysis of clinical and biomechanical literature  

Microsoft Academic Search

Introduction  The number of revision hip arthroplasties is increasing but several aspects of this procedure could be improved. One method\\u000a of reducing intra-operative complications is the cement-in-cement technique. This procedure entails cementing a smaller femoral\\u000a prosthesis into the existing stable cement mantle. The aim of this systematic review is to provide a concise overview of the\\u000a existing historical, operative, biomechanical and

P. Keeling; P. J. Prendergast; A. B. Lennon; P. J. Kenny

2008-01-01

422

Investigation of Inflammatory and Hemostatic Parameters in Female Patients Undergoing Total Knee Arthroplasty Surgery  

Microsoft Academic Search

Tendency to hypercoagulation is a common phenomenon in primary osteoarthritis patients (POA) undergoing total knee arthroplasty\\u000a (TKA) surgery, but the clinical implications of this condition are not clear. Therefore we aimed to evaluate the inflammatory\\u000a and coagulation parameters in the patient group and find a possible explanation for the tendency to hypercoagulation occurring\\u000a in plasma and synovia of inflamed joints.

A. Ata Alturfan; Levent Eralp; Nesrin Emekli

2008-01-01

423

One stage revision arthroplasty of the hip for deep gram negative infection  

Microsoft Academic Search

Summary.   \\u000a We describe the use of one stage revision arthroplasty of the hip for deep gram negative infections. We have followed up\\u000a 15 patients for an average of 8 years following operation. Two procedures failed, one at two years due to aseptic loosening\\u000a and another because of persistent infection. We attribute the low reinfection rate (1\\/15) to meticulous surgical

V. V. Raut; M. S. Orth; M. C. Orth; P. D. Siney; B. M. Wroblewski

1996-01-01

424

Conversion of Hip Arthrodesis to Total Hip Arthroplasty: Survivorship and Clinical Outcome  

Microsoft Academic Search

This study evaluated survivorship and clinical outcomes of patients undergoing conversion of a hip arthrodesis to a total hip arthroplasty (THA) and compared them to 2 patient cohorts: primary THA and first-time revision THA. Patients completed 5 standardized outcome questionnaires. The study cohort was compared to matched groups of primary THA and first-time revision THA patients. Twenty-six patients were identified,

Corey J. Richards; Clive P. Duncan

2011-01-01

425

Le frottement métal-métal en arthroplastie de hanche : aspect de matériovigilance  

Microsoft Academic Search

This study is dedicated to the problems met with metal-metal bearing prostheses. We have analysed the results of the reports sent to the AFSSAPS relating incidents described with this interface.Only 11 incidents were reported during the last 4 years by surgeons from different centers in France. At a mean follow-up of 7 years, we collected 2614 total hip arthroplasties with

N. Passuti; S. Terver

2007-01-01

426

Primary ileus after total hip arthroplasty: rare complication or sentinel event?  

Microsoft Academic Search

The incidence of hip dislocation after primary total hip arthroplasty (THA) has been reported to range from 1 to 25% in THA\\u000a revision. Here, we explore the hypothesis that there is a correlation between postoperative ileus (POI) and THA dislocation,\\u000a with POI after THA possibly representing a sentinel event. We retrospectively identified a cohort of 529 consecutive patients\\u000a who underwent

Alberto Vannelli; Domenico LaVeneziana; Mario Rampa; Luigi Battaglia; Ermanno Leo

427

THE DIAGNOSTIC VALUE OF C-REACTIVE PROTEIN IN INFECTED TOTAL HIP ARTHROPLASTIES  

Microsoft Academic Search

In 50 patients with non-infected total hip arthroplasties (THA), 233 C-reactive protein (CRP) values were obtained over a three-year period. Six of these 50 patients occasionally had CRP values of over 20 mg\\/I. The erythrocyte sedimentation rate (ESR) and CRP concentration were measured in 23 patients with deep infections of THA before revision. In 1 1 patients the infections were

L. SANZEN; A. S. CARLSSON

428

Long-term results of the threaded Weill cup in primary total hip arthroplasty  

Microsoft Academic Search

Uncemented, threaded acetabular components with smooth surface treatment were widely used in continental Europe in the 1970s\\u000a and 1980s for primary total hip arthroplasty (THA). Previously published studies showed high failure rates in the mid-term.\\u000a In a consecutive series of 116 patients, 127 threaded cups with smooth surface treatment (Weill cup; Zimmer, Winterthur, Switzerland)\\u000a were implanted in combination with one

Michael Clarius; Alexander W. Jung; Patric Raiss; Marcus R. Streit; Christian Merle; Peter R. Aldinger

2010-01-01

429

Population-Based Rates of Revision of Primary Total Hip Arthroplasty: A Systematic Review  

Microsoft Academic Search

BackgroundMost research on failure leading to revision total hip arthroplasty (THA) is reported from single centers. We searched PubMed between January 2000 and August 2010 to identify population- or community-based studies evaluating ten-year revision risks. We report ten-year revision risk using the Kaplan-Meier method, stratifying by age and fixation technique.ResultsThirteen papers met the inclusion criteria. Cemented prostheses had Kaplan-Meier estimates

Kelly L. Corbett; Elena Losina; Akosua A. Nti; Julian J. Z. Prokopetz; Jeffrey N. Katz; Francois Patrick Rannou

2010-01-01

430

Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Followup  

Microsoft Academic Search

Metal-on-metal total hip resurfacing arthroplasty has had excellent reported results at early to midterm followup, and some\\u000a studies suggest that outcomes are comparable to conventional THA. We compared the clinical and radiographic outcomes of two\\u000a closely matched groups of 54 patients who underwent resurfacing and conventional THA, respectively. Each group consisted of\\u000a 36 men and 18 women who had a

Michael A. Mont; David R. Marker; Jonathan M. Smith; Slif D. Ulrich; Mike S. McGrath

2009-01-01

431

Total hip arthroplasty in patients with deficient bone stock and small femoral canals  

Microsoft Academic Search

Total hip arthroplasty in patients requiring very small femoral stems is a challenge because frequently deformity and inadequate bone stock, especially of the acetabulum, are also present. An analysis of 34 consecutive cases managed with a 9-mm distal diameter noncemented stem was performed. The mean patient age was 42.6 years and mean follow-up time was 7.8 years. Two patients were

H. U. Cameron; O. B. Lee; H. Chou

2003-01-01

432

Uncemented press-fit total hip arthroplasty using the identifit custom-molding technique  

Microsoft Academic Search

Fifty-three primary uncemented custom-molded Identifit (Depuy, Warsaw, IN) hip arthroplasties were evaluated prospectively at a mean follow-up period of 30 months. The custom technique provided the capability to reproduce the unique femoral offset, version, and height in each hip and to achieve high percentages of femoral canal fill. Surgical time for unilateral cases was a mean 153 minutes. Clinical results,

Raymond P. Robinson; James E. Clark

1996-01-01

433

Bone—graft augmentation for acetabular deficiencies in total hip arthroplasty  

Microsoft Academic Search

The results of 102 consecutive primary and revision total hip arthroplasties performed with bone-grafting for acetabular bone deficiencies were reviewed at an average of 10.2 years (range, 4–18.6) after surgery. Ninety-one percent had structural bone defects and 57% had underlying developmental dysplasia of the hip. Overall acetabular revision rates for aseptic loosening were 8% at 5 years and 26% at

Brian P. Lee; Miguel E. Cabanela; Steven L. Wallrichs; Duane M. Ilstrup

1997-01-01

434

Are abductor muscle quality and previous revision surgery predictors of constrained liner failure in hip arthroplasty?  

Microsoft Academic Search

Dislocation is one of the most common complications of total hip arthroplasty. The use of constrained liners is an option\\u000a for the management of chronic hip instability, typically used after other methods have failed. The purposes of this study\\u000a were to evaluate the overall clinical outcomes and failure rates of a tripolar constrained liner design, to assess the radiographic\\u000a outcomes

Michael G. Zywiel; Loi’y H. Mustafa; Peter M. Bonutti; Michael A. Mont

2011-01-01

435

Effect of proximal femoral osteoporosis on cementless hip arthroplasty: A short-term clinical analysis*  

PubMed Central

Objective: The aim of this retrospective investigation was to explore the influence of femoral osteoporosis on short-term curative effects of cementless hip arthroplasty and to evaluate the femoral metaphyseal bone mineral density (BMD) for femoral osteoporosis in order to guide prosthesis choice and rehabilitation. Methods: We performed 127 total arthroplasty operations between June 1999 to February 2003 and investigated 49 cementless hip replacements with the Metalcancellous cementless Lubeck II system being used in all hips. There were twenty men and twenty-nine women whose mean age at the time of the operation was 60 years (range, 52~81 years). The patients were divided into osteoporosis or normal groups according to the femoral metaphyseal BMD measured preoperatively. The average duration of follow-up was 30 months (range, 8~52 months). We evaluated all of the patients from a clinical standpoint with use of a standard-terminology questionnaire with respect to the short-term curative effects and patients’ satisfaction. Hip pain status and functional ability were important indicators of treatment efficacy. Results: Harris hip score and patients’ satisfaction in femoral osteoporosis patients who underwent noncemented hip arthroplasty were lower (P=0.004, P=0.03) while the incidence of thigh pain was higher (P=0.03) than the patients with non-osteoporosis. Conclusion: The higher incidence of pain, as well as the decrease in function experienced by the patients in osteoporosis group, supports the case that cementless arthroplasty is not a better choice for those patients and that we had better select prosthesis based on the femoral metaphyseal BMD. PMID:17173366

Lou, Xian-feng; Li, Yu-hong; Lin, Xiang-jin

2007-01-01

436

Relationship between functional results and coxofemoral kinematic in gait analysis after total hip arthroplasty  

Microsoft Academic Search

. This study aimed at finding a relationship between functional results obtained after a total hip arthroplasty and gait analysis. One hundred primary Charnley prosthesis (66 patients) were reviewed, with a mean follow-up of 4.5 (1-22) years with good or very good functional results according to the MDA scale. Hip kinematic parameters were studied with the VICON system, and results

G. Polle; X. Roussignol; A. C. Tobenas; N. Biga; F. H. Dujardin

2002-01-01

437

Utilization of Critical Care Services among Patients Undergoing Total Hip and Knee Arthroplasty  

PubMed Central

Background A paucity of data exist on the use of critical care services (CCS) among hip and knee arthroplasty patients. The authors sought to identify the incidence and risk factors for the use of CCS among these patients and compare the characteristics and outcomes of patients who require CCS to those who do not. Methods The authors analyzed hospital discharge data of patients who underwent primary hip or knee arthroplasty in approximately 400 United States hospitals between 2006 and 2010. Patient and healthcare system-related demographics for admitted patients requiring CCS were compared with those who did not. Differences in outcomes, including mortality, complications, disposition status, and hospital charges, were analyzed. Regression analysis was performed to identify risk factors for requiring CCS. Results A total of 528,495 patients underwent primary total hip (n = 172,467, 33%) and knee arthroplasty (n = 356,028, 67%). Of these, 3% required CCS. On average, CCS patients were older and had a higher comorbidity burden than did patients not requiring CCS. CCS patients experienced more complications, had longer hospital stays and higher costs, and were less likely to be discharged home than were non-CCS patients. Risk factors with increased odds for requiring CCS included advanced age, use of general versus neuraxial anesthesia, and the presence of postoperative cardiopulmonary complications. Conclusions Approximately 1 of 30 patients undergoing total joint arthroplasty requires CCS. Given the large number of these procedures performed annually, anesthesiologists, orthopedic surgeons, critical care physicians, and administrators should be aware of the attendant risks this population represents and allocate resources accordingly. PMID:22634871

Memtsoudis, Stavros G.; Sun, Xuming; Chiu, Ya-Lin; Nurok, Michael; Stundner, Ottokar; Pastores, Stephen M.; Mazumdar, Madhu

2013-01-01

438

Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty  

Microsoft Academic Search

SummaryBackground In-vitro studies indicate that platelet function and the coagulation cascade are impaired by hypothermia. However, the extent to which perioperative hypothermia influences bleeding during surgery remains unknown. Accordingly, we tested the hypothesis that mild hypothermia increases blood loss and allogeneic transfusion requirements during hip arthroplasty.Methods Blood loss and transfusion requirements were evaluated in 60 patients undergoing primary, unilateral total

H Schmied; A Reiter; A Kurz; D. I Sessler; S Kozek

1996-01-01

439

The use of a modular rotating hinge component in salvage revision total knee arthroplasty  

Microsoft Academic Search

Revision total knee arthroplasty (TKA) using a second-generation modular rotating hinge design was performed on 16 knees in 15 patients over a 5-year period. Follow-up of 2 to 6 years (mean, 51 months) was obtained in 14 knees in 13 patients. Indications for revision were aseptic loosening of a hinged prosthesis (8 knees), loosening and bone loss associated with chronic

Robert L. Barrack; Thomas R. Lyons; Robert Q. Ingraham; Jeremy C. Johnson

2000-01-01

440

Self-reported neurological clinical manifestations of metal toxicity in metal-on-metal hip arthroplasty.  

PubMed

Adverse reactions to metal particle debris have been increasingly reported as a complication following large head metal-on-metal (MoM) hip arthroplasty. Elevated metal ion levels are a cause for concern. The aim of this study is to evaluate whether exposure to cobalt is associated with patient characteristics and symptoms of neuropathy, representing nervous system dysfunction. A cross-sectional study was conducted comparing patients with a MoM total hip arthroplasty and patients with a conventional hip arthroplasty. They received three questionnaires, one to assess neurotoxic complaints and two standardised self-administered questionnaires to identify symptoms that are suggestive of peripheral neuropathy. Current and historical data were available for whole blood cobalt levels in all patients. We analysed potential predictive factors for cobalt based on five different cut-off levels (0-2, 2-4, 4-10, 10-20, >20 µg/L). We performed 723 MoM total hip arthroplasties in 643 patients in our clinic. The response rate was 89%. Male-female ratio was 236/280, median age 63.6 years (30-72) with a mean follow-up of 50.6 months (20-86). We also sent the questionnaires to 98 patients in the control group. An increase in the incidence of reported symptoms was not consistent with higher serum cobalt levels. Female gender was the only consistent predictive factor for serum cobalt at different cobalt cut-off levels in the multivariate analysis. The study population did not show an increase in reported symptoms with elevated cobalt levels. Neurotoxic symptoms and whole blood cobalt levels did not show a consistent relationship with different dichotomised levels of cobalt exposure. PMID:25096449

van Lingen, Christiaan P; Ettema, Harmen B; Van Der Straeten, Catherine; Kollen, Bouwdewijn J; Verheyen, Cees C P M

2014-12-01

441

Outcomes following large joint arthroplasty: does socio-economic status matter?  

PubMed Central

Background We sought to determine whether socio-economic status (SES) is an independent predictor of outcome following total knee (TKR) and hip (THR) replacement in Australians. Methods In this prospective cohort study, we included patients undergoing TKR and THR in a public hospital in whom baseline and 12-month follow-up data were available. SES was determined using the Australian Bureau of Statistics ‘Index of Relative Advantage and Disadvantage’. Other independent variables included patients’ demographics, comorbidities and procedure-related variables. Outcome measures were the International Knee Society Score and Harris Hip Score pain and function subscales, and the Short Form Health Survey (SF-12) physical and mental component scores. Results Among 1,016 patients undergoing TKR and 835 patients undergoing THR, in multiple regression analysis, SES score was not independently associated with pain and functional outcomes. Female sex, older age, being a non-English speaker, higher body mass index and presence of comorbidities were associated with greater post-operative pain and poorer functional outcomes following arthroplasty. Better baseline function, physical and mental health, and lower baseline level of pain were associated with better outcomes at 12 months. In univariate analysis, for TKR, the improvement in SF-12 mental health score post arthroplasty was greater in patients of lower SES (3.8?±?12.9 versus 1.5?±?12.2, p?=?0.008), with a statistically significant inverse association between SES score and post-operative SF-12 mental health score in linear regression analysis (coefficient?0.28, 95% CI: ?0.52 to ?0.04, p?=?0.02). Conclusions When adjustments are made for other covariates, SES is not an independent predictor of pain and functional outcome following large joint arthroplasty in Australian patients. However, relative to baseline, patients in lower socioeconomic groups are likely to have greater mental health benefits with TKR than more privileged patients. Large joint arthroplasty should be made accessible to patients of all SES. PMID:24885773

2014-01-01

442

Silent soft tissue pathology is common with a modern metal-on-metal hip arthroplasty  

PubMed Central

Background and purpose Adverse reactions to metal debris have been reported to be a cause of pain in metal-on-metal hip arthroplasty. We assessed the incidence of both symptomatic and asymptomatic adverse reactions in a consecutive series of patients with a modern large-head metal-on-metal hip arthroplasty. Methods We studied the early clinical results and results of routine metal artifact-reduction MRI screening in a series of 79 large-head metal-on-metal hip arthroplasties (ASR; DePuy, Leeds, UK) in 68 patients. 75 hips were MRI scanned at mean 31 (12–52) months after surgery. Results 27 of 75 hips had MRI-detected metal debris-related abnormalities, of which 5 were mild, 18 moderate, and 4 severe. 8 of these hips have been revised, 6 of which were revised for an adverse reaction to metal debris, diagnosed preoperatively with MRI and confirmed histologically. The mean Oxford hip score (OHS) for the whole cohort was 21. It was mean 23 for patients with no MRI-based evidence of adverse reactions and 19 for those with adverse reactions detected by MRI. 6 of 12 patients with a best possible OHS of 12 had MRI-based evidence of an adverse reaction. Interpretation We have found a high early revision rate with a modern, large-head metal-on-metal hip arthroplasty. MRI-detected adverse rections to metal debris was common and often clinically “silent”. We recommend that patients with this implant should be closely followed up and undergo routine metal artifact-reduction MRI screening. PMID:21504335

2011-01-01

443

Constrained components for the unstable hip following total hip arthroplasty: a literature review  

Microsoft Academic Search

Patients with chronic instability or late dislocation following total hip arthroplasty often require operative management.\\u000a Unfortunately, there is an increased risk of recurrent dislocation following revision in these patients. Over the past decade\\u000a the use of constrained devices for patients with chronic instability has gained increased interest; however, there is a paucity\\u000a of studies available in the literature regarding the

J. T. Williams Jr; P. S. Ragland; S. Clarke

2007-01-01

444

Effect of Total Knee Arthroplasty Implant Position on Flexion Angle Before Implant-Bone Impingement  

Microsoft Academic Search

We generated patient-specific computer models of total knee arthroplasty from 10 patients to compute maximum flexion angle before implant-bone impingement. Motion was simulated for 5 different femoral implant positions and 11 different tibial insert positions at 4 different tibial posterior slopes. In the neutral position, the mean maximum flexion angle was 136.3°. The range because of anatomical variation among patients

Hideki Mizu-uchi; Clifford W. Colwell; Shuichi Matsuda; Cesar Flores-Hernandez; Yukihide Iwamoto; Darryl D. D'Lima

2011-01-01

445

The Mark Coventry Award: In Vivo Knee Forces During Recreation and Exercise After Knee Arthroplasty  

Microsoft Academic Search

Knee forces directly affect arthroplasty component survivorship, wear of articular bearing surfaces, and integrity of the\\u000a bone-implant interface. It is not known which activities generate forces within a range that is physiologically desirable\\u000a but not high enough to jeopardize the survivorship of the prosthetic components. We implanted three patients with an instrumented\\u000a tibial prosthesis and measured knee forces and moments

Darryl D. D’Lima; Nikolai Steklov; Shantanu Patil; Clifford W. Colwell Jr

2008-01-01

446

Five-year results of the Innex total knee arthroplasty system  

Microsoft Academic Search

The clinical and radiographic results of 174 female and 86 male Innex (Zimmer, Warsaw, Indiana) mobile bearing total knee\\u000a arthroplasty systems (245 patients) were evaluated, with particular emphasis on gender-related differences at five-year follow-up.\\u000a Pre-operative Knee Society (KS) function and total scores were lower in women than in men. All KS scores showed a significant\\u000a improvement at follow-up, but women

Urs K. Munzinger; Nicola A. Maffiuletti; Thomas Guggi; Mario Bizzini; Stefan Preiss; Tomas Drobny

2010-01-01

447

Lateral unicompartimental knee arthroplasty: indications, technique and short-medium term results  

Microsoft Academic Search

Lateral unicompartmental knee arthroplasty (UKA) is a valid alternative treatment in the event of arthritis confined to the\\u000a lateral compartment. This paper examines its indications, technique and short to medium-term results. A total of 159 Miller–Galante\\u000a cemented UKA prostheses (Zimmer, Warsaw, Indiana) were implanted consecutively (131 medial and 28 lateral) by the same surgeon.\\u000a This study investigates 28 lateral UKAs

Piero Volpi; Luca Marinoni; Corrado Bait; Marco Galli; Matteo Denti

2007-01-01

448

The Coverage Characteristic of Tibial Component for Unicompartmental Knee Arthroplasty in Chinese Patients – a Morphological Analysis  

Microsoft Academic Search

\\u000a The treatment of unicompartmental knee arthritis with unicompartmental knee arthroplasty (UKA) has renewed popularity in recent\\u000a years. Good coverage of tibial component and proximal resected tibial surface can be expected to improve the strength of component\\u000a fixation and thus avoid component subsidence, especially for the situation that body weight mainly transfers through the cortex\\u000a of the medial tibial plateau. Most

T. W. Chang; H. W. Wei; W. C. Chen; K. J. Lin; C. K. Cheng

449

Development of a Regional Model of Care for Ambulatory Total Shoulder Arthroplasty  

Microsoft Academic Search

Total shoulder arthroplasty (TSA) has traditionally been performed as inpatient surgery to provide adequate postoperative\\u000a analgesia via intermittent opioid administration. We developed a regional model for ambulatory TSA using continuous brachial\\u000a plexus nerve block (CBPNB). We asked whether this regional model would allow us to select patients to undergo outpatient TSA\\u000a using CBPNB while providing similar outcomes to those patients

S. H. Gallay; J. J. A. Lobo; J. Baker; K. Smith; K. Patel

2008-01-01

450

Outcomes of Routine Use of Antibiotic-Loaded Cement in Primary Total Knee Arthroplasty  

Microsoft Academic Search

The routine use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA) is controversial. Outcomes were recorded in patients who underwent primary TKA from May 2003 to March 2007 using a community-based total joint registry. Infection rates were compared in patients undergoing TKA with ALBC and regular cement. A total of 22?889 primary TKA were performed, with 2030

Robert S. Namba; Yuexin Chen; Elizabeth W. Paxton; Tamara Slipchenko; Donald C. Fithian

2009-01-01

451

Long-term survival of the T-28 versus the TR28 cemented total hip arthroplasties  

Microsoft Academic Search

Between 1974 and 1980, 550 total hip arthroplasties (THAs) (479 patients) were performed using T-28 and TR-28 cemented prostheses (TR-28 is shot-blast chrome and T-28 is polished stainless steel). There were 379 cemented THAs in 321 patients in the T-28 group and 171 cemented THAs in 158 patients in the TR-28 group. Average follow-up of the patients still alive at

John B. Meding; Jeffrey M. Nassif; Merrill A. Ritter

2000-01-01

452

Computer-assisted cup positioning in total hip arthroplasty: usefulness, limits and future  

Microsoft Academic Search

The basic hypothesis for computer-assisted placement of the cup in total hip arthroplasty (THA) is that navigation will improve\\u000a cup positioning around the targeted values previously defined in the literature as the gold standard for cup placement and\\u000a reduce the number of outliers. Reducing the outliers will theoretically reduce the number of dislocation, improve range of\\u000a motion and reduce wear.

S. Parratte; J.-M. Aubaniac; J.-N. Argenson

2008-01-01

453

A novel computer-assisted surgical technique for revision total knee arthroplasty  

Microsoft Academic Search

Revision total knee arthroplasty (RTKA) is a skill-demanding intervention presenting several technical challenges to the surgeon due to bone deficiencies and lack of anatomical references. Computer-assisted navigation systems can potentially solve these problems. An innovative computer-assisted surgical technique for RTKA is presented. The system is image free. Based on anatomical landmarks acquired on the patient, the system automatically plans the

Maurilio Marcacci; Laura Nofrini; Francesco Iacono; Alessandro Di Martino; Simone Bignozzi; Mirco Lo Presti

2007-01-01

454

Computer-assisted surgery can reduce blood loss after total knee arthroplasty  

Microsoft Academic Search

The aim of this study was to compare blood loss and transfusion requirements in patients undergoing computer-assisted total\\u000a knee arthroplasty (TKA) and patients operated with conventional instrumentation with intra-medullar guides. A prospective\\u000a randomized study of 87 patients undergoing a TKA assigned to conventional technique (n = 44) or computer-assisted surgery (n = 43) was conducted. All patients were operated by the same surgeon and

Pedro Hinarejos; Mónica Corrales; Antonia Matamalas; Elvira Bisbe; Enric Cáceres

2009-01-01

455

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

PubMed Central

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

2012-01-01

456

One-stage Hip Arthroplasty and Bone Grafting for Bilateral Femoral Head Osteonecrosis  

Microsoft Academic Search

One-stage hip arthroplasty and contralateral core decompression with bone grafting were performed for 30 patients with bilateral\\u000a femoral head osteonecrosis between April 2002 and June 2005. The treatment course, clinical and radiographic outcomes, and\\u000a medical costs were compared with another 30 age-, gender-, etiology-, and disease extent-matched patients undergoing two-stage\\u000a treatment during the same period. The two groups had similar

Lih-Yuann Shih; Yon-Cheong Wong; Hsin-Nung Shih

2009-01-01

457

Autologous bone grafting without screw fixation for tibial defects in total knee arthroplasty  

Microsoft Academic Search

.   We evaluated 30 knees with autologous bone grafts, performed without screw fixation, for tibial defects in total knee arthroplasty\\u000a (TKA). The tibial defects were classified into three types: contained, flat peripheral, and slant peripheral. The resected\\u000a femoral condyle was fixed with a combination of bone cement and the tibial component, without using screws. The patients were\\u000a followed for an

Wataru Watanabe; Kozo Sato; Eiji Itoi

2001-01-01

458

Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cement in patients with type C bone  

Microsoft Academic Search

Although cementless arthroplasty with a tapered titanium femoral component has proven reliable in young patients with excellent bone quality, studies involving patients with poor bone quality are lacking. The present study evaluates the results of total hip arthroplasty (THA) using such a femoral component in patients with Type C femoral bone. Ninety-two THAs were performed in 81 patients aged 65

Richard D Reitman; Roger Emerson; Linda Higgins; William Head

2003-01-01

459

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

Microsoft Academic Search

BACKGROUND: There is worldwide variation in rehabilitation practices after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and no agreement on which interventions will lead to optimal short and long term patient outcomes. As a first step in the development of clinical practice guidelines for post-acute rehabilitation after THA and TKA, we explored experiences and attitudes about rehabilitation practices

Marie D. Westby; Catherine L. Backman

2010-01-01

460

Metal hypersensitivity in total knee arthroplasty: revision surgery using a ceramic femoral component - a case report.  

PubMed

We present a case involving the revision of a total knee arthroplasty with a metal femoral component using a ceramic implant due to metal hypersensitivity. A 58-year-old female patient underwent total knee arthroplasty (TKA) with a standard metal bicondylar knee system. She suffered from persistent pain and strong limitations in her range of motion (ROM) associated with flexion during the early postoperative period. Arthroscopic arthrolysis of the knee joint and intensive active and passive physical treatment, in combination with a cortisone regime, temporarily increased the ROM and reduced pain. No signs of low grade infection or other causes of implant failure were evident. Histology of synovial tissue revealed lymphoplasmacellular fibrinous tissue, consistent with a type IV allergic reaction. Allergometry (skin reaction) revealed type IV hypersensitivity against nickel-II-sulfate and palladium chloride. Revision surgery of the metal components was performed with a cemented ceramic femoral component (same bicondylar design) and a cemented titanium alloy tibial component. Postoperative evaluations were performed 10days, and 3 and 12months after the revision surgery. There was an increased ROM in flexion to 90° at the 12month follow-up. No swelling or effusion was observed at all clinical examinations after the revision surgery. No pain at rest and moderate walking pain were evident. The presented case demonstrates that ceramic implants are a promising solution for patients suffering from hypersensitivity to metal ions in total knee arthroplasty. PMID:21292491

Bergschmidt, Philipp; Bader, Rainer; Mittelmeier, Wolfram

2012-03-01