Sample records for interpositional gap arthroplasty

  1. The Modified Oblique Keller Capsular Interpositional Arthroplasty for Hallux Rigidus

    PubMed Central

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

    2010-01-01

    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

  2. Proximal row carpectomy with allograft scaffold interposition arthroplasty.

    PubMed

    Carneiro, Ronaldo dos Santos; Dias, Carlos Eduardo Baião Nogueira Maia; Baptista, Carolina Moutinho Peneda Morais

    2011-12-01

    The authors present a solution for motion preservation in severe wrist arthritis with intercarpal involvement. Acellular dermal allograft is used as an interposition arthroplasty in these situations, rather than local tissue flaps such as previously described. Proximal row carpectomy has been shown to be one of the most successful procedures to correct chronic destructive arthritis in the wrist, keeping useful motion. Traditionally, a contraindication for proximal row carpectomy includes an arthritis that invades the lunate-capitate joint. The authors describe a technique to extend the traditional indications by covering the eroded articular surfaces with dermal allograft scaffold. PMID:22105639

  3. X-ray changes after expanded polytetrafluoroethylene (Gore-Tex) interpositional arthroplasty.

    PubMed

    Greenberg, J A; Mosher, J F; Fatti, J F

    1997-07-01

    Thirty-one patients with degenerative osteoarthritis at the trapeziometacarpal joint underwent 34 expanded polytetrafluoroethylene interpositional arthroplasties. The average follow-up period for the group of patients was 41 months (range, 15-82 months). Subjective results and objective measurements for the patients at the time of review were favorable. X-ray analysis, however, revealed a high incidence of osteolytic lesions associated with microparticulate degeneration consistent with reactive particulate synovitis. Owing to the unacceptably high rate of secondary osteolysis, the authors recommend that use of this material for trapeziometacarpal or pantrapezial arthroplasty be abandoned. PMID:9260623

  4. Interpositional arthroplasty with palmaris longus tendon graft for osteonecrosis of the second metatarsal head: a case report.

    PubMed

    Liao, Chi-Yang; Lin, Aaron Chih-Chang; Lin, Chih-Ying; Chao, Tai-Kuang; Lu, Tzu-Chuan; Lee, Hung-Maan

    2015-01-01

    Osteonecrosis of the second metatarsal head is often attributed to Freiberg's disease. We describe the case of a 27-year-old Taiwanese male soldier with persistent painful disability of the right forefoot of 9 months' duration, but no history of trauma. A series of radiographs suggested the diagnosis of late-stage Freiberg's disease. The lesion was treated with interpositional arthroplasty using a palmaris longus tendon graft, in a modification of the traditional interpositional arthroplastic technique for treating Freiberg's disease. After 2 years of follow-up examinations, the patient was satisfied with the clinical outcome, despite having a limited range of motion of the right second metatarsophalangeal joint relative to the adjacent toes. The patient returned to his army group with functional activity that was better than he had experienced before surgery. We believe this modified interpositional arthroplastic treatment strategy will provide more symptom relief and satisfactory functionality for the treatment of late-stage Freiberg's disease. PMID:25631196

  5. Elbow interposition arthroplasty in children and adolescents: long-term follow-up

    PubMed Central

    Rodriguez, Janeth; Oliver, Guillermo

    2007-01-01

    A long-term follow-up was made of 12 elbows operated upon between 1971 and 1986, with more than 20 years’ follow-up, in nine males and three females, age at the time of surgery between 10 and 19 years . Eight right and four left elbows were involved, and there were three aetiological causes. Seven cases were sequelae of elbow fractures, of which five were supracondylar and two were of the olecranon. There were four cases of juvenile rheumatoid arthritis and one was post-osteomyelitis. The surgical technique involved a modification made by Vainio of MacAusland’s technique (wider resection of the osseous ends and total covering of the bloody surfaces) [5, 9]. After extirpating the tissue blocking the joint, we proceeded to remodel the distal humerus in a wide V shape, the proximal end of the ulnar and, if necessary, the radial head. The proximal end of the ulna was sectioned transversely. All surgery was carried out sub-periosteally. Then, an interposition material was placed in one piece and sutured over the distal humerus and cut ends of the ulna and radius. The articular ends were brought together, and the capsule was closed using equidistant stitching, as is the skin. A small compression bandage was applied, and the arm was immobilised with a collar and cuff sling, with the forearm flexed to slightly less than a right angle. In ten cases, the interposition material was fascia lata grafts; in one case, skin graft and in one case, Gelfoam graft. Early rehabilitation began when post-operative pain allowed. Follow-up ranged from 25 to 32 years. Pre-surgical movement ranged between 90° and 120° of flexion and 30° and 90° of extension. Post-operative range varied between 90° and 150° of flexion. The five cases of full pre-operative ankylosis achieved between 90° and 150° of flexion and between 0° and 70° of extension. The total range of motion at the latest follow-up varied from 35° to 150°. Patients who were able to perform flexion of 120° or more were considered to be excellent, those between 90° and 119° were graded good, from 60° to 89° fair and those 59° or less poor. The ability to attain a hand to mouth position requires a mobility of 120°. We obtained excellent results in two patients, good results in three, fair results in four and poor results in three. The fascia lata was used in 83% of cases, obtaining excellent to good results in five patients (41%). Elbow interposition arthroplasty has its indications in children and adolescents where arthrodesis or total joint replacement cannot be performed. PMID:17308908

  6. Arthroscopic evaluation and treatment by tendon interpositional arthroplasty of first carpometacarpal joint arthritis.

    PubMed

    Pegoli, L; Parolo, C; Ogawa, T; Toh, S; Pajardi, G

    2007-01-01

    Basal joint arthritis of the thumb is usually seen in females beginning from the fourth and fifth decades. In the last two decades, arthroscopic techniques have brought new chances of diagnosis and treatment for this condition. In this paper, the authors describe the indications and their experience concerning arthroscopic hemitrapezectomy and tendon interposition using the palmaris longus tendon. A series of 16 patients with a maximum follow-up of 12 months is analysed. All of the 16 patients were followed and assessed with grasp strength, pinch strength, DASH and MAYO evaluation score both pre- and post-operatively at 12 months follow-up. According to the MAYO score, there were six excellent results, six good, three fair and one poor. No complications occurred. According to our preliminary results, this procedure with the proper indications gives a valid option for the treatment of thumb carpometacarpal joint arthritis in stages I and II according to Eaton's classification. PMID:17613182

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

    PubMed Central

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

    2013-01-01

    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

  8. [Interposition arthroplasties in the area of the proximal carpal row (lunate and scaphoid replacement/partial replacement].

    PubMed

    Strässle, H; Nigst, H; Buck-Gramcko, D; Wilhelm, A

    1983-09-01

    Prostheses are recommended for replacement of the scaphoid. Results of tendon interposition after resection of small proximal fragments are unpredictable. Therefore alternative procedures like liquid silicone casts or replacement by a lunate prosthesis (or part of the prosthesis of the scaphoid) have to be evaluated. If after removal of the lunate a prosthesis does not fit into the cavity we recommend filling this cavity with liquid silicone. PMID:6629153

  9. First Metatarsophalangeal Joint Interpositional Arthroplasty Using a Meniscus Allograft for the Treatment of Advanced Hallux RigidusSurgical Technique and Short-term Results

    Microsoft Academic Search

    Eugene L. DelaCruz; Adam R. Johnson; Benjamin L. Clair

    2011-01-01

    Hallux rigidus is a progressive disorder of the first metatarsophalangeal (MTP) joint. The disorder is characterized by a loss of range of motion, degenerative changes, and pain within the joint. In later stages of the disease, the surgical procedure of choice is arthrodesis of the joint. Recently, salvage procedures of the first MTP joint using soft tissue interposition has gained

  10. Comparison between two computer-assisted total knee arthroplasty: gap-balancing versus measured resection technique

    Microsoft Academic Search

    Domenico Tigani; G. Sabbioni; R. Ben Ayad; M. Filanti; N. Rani; N. Del Piccolo

    2010-01-01

    Two surgical strategies are possible in total knee arthroplasty (TKA): a measured resection technique, in which bone landmarks\\u000a are used to guide resections equal to the distal and posterior thickness of the femoral component, or a gap-balancing approach,\\u000a in which equal collateral ligament tension in flexion and extension is sought before and as a guide to final bone cuts. In

  11. Trapeziometacarpal osteoarthritis: pyrocarbon interposition implants

    PubMed Central

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

    2014-01-01

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

  12. Simple resection arthroplasty for treatment of 4th and 5th tarsometatarsal joint problems. A technical tip and a small case series.

    PubMed

    Koenis, M J J; Louwerens, J W K

    2015-03-01

    Osteoarthritis, primary or secondary, of the fourth and/or fifth tarsometatarsal (TMT) joint is a rare condition. When conservative treatment fails or prooves to be unacceptable for the patient, operative treatment is an option. In this article the technique of resection arthroplasty is described and a retrospective case series of 6 patients is presented. Three patients underwent tendon interposition arthroplasty after resection of the two joints and in the last three cases no interposition at all was performed. Results suggest that resection arthroplasty without interposition may be as effective as other operative treatment options for patients with fourth and fifth TMT pathology. PMID:25682411

  13. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  14. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  15. Intestinal interposition for benign esophageal disease

    Microsoft Academic Search

    Racquel Smith Bueno; Carlos Galvani; Santiago Horgan

    2008-01-01

    Opinion statement  Various options exist for intestinal interposition for benign, but debilitating, end-stage esophageal disorders. Principally,\\u000a the stomach, colon, or jejunum is used for esophageal replacement. Much debate exists regarding the ideal esophageal replacement\\u000a option. The conduit choice must be tailored to the individual patient. Unlike malignant processes, the conduit choice for\\u000a benign disorders must be sufficiently durable and functional. Colonic

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

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3970 Interarticular disc prosthesis (interpositional implant). (a) Identification. An...

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3970 Interarticular disc prosthesis (interpositional implant). (a) Identification. An...

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3970 Interarticular disc prosthesis (interpositional implant). (a) Identification. An...

  19. Soft-tissue arthroplasty for hallux rigidus.

    PubMed

    Coughlin, Michael J; Shurnas, Paul J

    2003-09-01

    Seven patients (seven feet) were evaluated at an average follow-up of 42 months following soft-tissue interposition arthroplasty of the hallux metatarsophalangeal (MTP) joint for severe hallux rigidus. The technique involved reaming of the base of the proximal phalanx and metatarsal head to decompress the first MTP joint and placement of a soft-tissue tendon bundle as a biologic spacer. Six of seven patients had bilateral disease, and a positive family history of hallux rigidus. At final follow-up, all seven patients rated their result as good or excellent, the level of pain was substantially reduced, and the mean AOFAS score substantially improved from 46 to 86 points. Mild metatarsalgia was noted by four patients and characterized by mild plantar callosities in these cases. The mean MTP dorsiflexion improved from 9 degrees to 34 degrees and patients demonstrated good to excellent plantarflexion strength on manual muscle testing and with toe rise. Physical examination of the involved feet demonstrated no evidence of pes planus, metatarsus primus elevatus, Achilles tendon contracture, or metatarsocuneiform joint hypermobility in any of the seven. The technique of soft-tissue interposition arthroplasty as described gave excellent pain relief and reliable function of the hallux, and is an alternative treatment to MTP arthrodesis in select cases of severe hallux rigidus. PMID:14524514

  20. Distraction Arthroplasty

    MedlinePLUS

    Injections and other Procedures Treatments of the Ankle Treatments of the Big Toe Treatments of the Heel Treatments of the Midfoot Treatments of the Smaller Toes AOFAS / FootCareMD / Treatments Distraction Arthroplasty ...

  1. Pyrocarbon Interposition after Capitate Head Resection

    PubMed Central

    Ferrand, Mathieu; Bellemere, Philippe

    2013-01-01

    Background?Isolated lunocapitate disease is a rare situation. It includes both capitolunate arthritis and osteonecrosis of the capitate head. The management of this pathology is not defined yet. Case Description?We treated three patients by resection of the capitate head and interposition of a so-called capitolunate Pi2 implant (Tornier, BioProfile, Grenoble, France). We reported encouraging results at average follow-up of 4.8 years. Literature Review?Several procedures have been reported in this indication. All suffer from lack of follow-up. Four-corner fusion seems to be the most reliable solution at the expense of wrist stiffness. Clinical Relevance?case series PMID:24436841

  2. Trapezium prosthetic arthroplasty (silicone, Artelon, metal, and pyrocarbon).

    PubMed

    Vitale, Mark A; Taylor, Fraser; Ross, Mark; Moran, Steven L

    2013-02-01

    Trapezium prosthetic arthroplasty has been utilized to treat basal joint arthritis for nearly five decades in an attempt to mitigate some of the potential disadvantages of trapeziectomy while preserving range of motion. Implant arthroplasty seeks to preserve joint biomechanics, avoids metacarpal subsidence, and should provide immediate stability. These benefits may lead to improvements in strength, durability, and a decrease in metacarpophalangeal joint hyperextension which can occur subsequent to metacarpal shortening. First generation implants were primarily silicone trapezial spacers. While the use of these implants has been curtailed by their association with silicone synovitis, they still remain an option for low demand, rheumatoid patients. More recently developed synthetic spacers such as Artelon interposition arthroplasties have had results inferior to more established procedures including trapeziectomy. A variety of metal total joint prostheses have been developed and some of the more recent designs have shown good short-term outcomes. There are a number of different pyrocarbon implants that have become more recently available which range from trapezial substitution to non-anatomic hemiarthroplasty. Pyrocarbon arthroplasty offers a number theoretical advantages however early results have been mixed and further long term data is required. PMID:23168027

  3. Vaginal vault prolapse following cystectomy: transvaginal reconstruction by mesh interposition.

    PubMed

    Graefe, Flora; Beilecke, Kathrin; Tunn, Ralf

    2013-08-01

    The present study aims to introduce a transvaginal interposition of polypropylene mesh as a reproducible procedure for women with vaginal vault prolapse following cystectomy due to bladder carcinoma. No recurrent prolapse occurred in two cases 16 and 4 months after the operation. With apical fixation of the mesh, vaginal length can be maintained. No perioperative complications appeared. Performing the technique in a reproducible way seems feasible irrespective of differing anatomical conditions. PMID:22955251

  4. Interposition vein graft for giant coronary aneurysm repair

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

  5. Bioreconstructive Poly-L\\/D-Lactide Implant Compared With Swanson Prosthesis in Metacarpophalangeal Joint Arthroplasty in Rheumatoid Patients: a Randomized Clinical Trial

    Microsoft Academic Search

    P. B. Honkanen; R. Tiihonen; E. T. Skyttä; M. Ikävalko; M. U. K. Lehto; Y. T. Konttinen

    2010-01-01

    It was hypothesized that the bioresorbable interposition implant might offer a viable alternative to conventional silicone implant arthroplasty in rheumatoid metacarpophalangeal joint destruction. A randomized clinical study was performed to compare a stemless poly-L\\/D-lactide copolymer 96: 4 (PLDLA) implant with the Swanson silicone implant. Results in 52 patients (53 hands and 175 joints) at a mean follow-up of 2 years

  6. Vesicocutaneous fistula treatment by using omental flap interposition

    PubMed Central

    Basatac, Cem; Cicek, Mehmet Cagatay

    2015-01-01

    A fistula is defined as an abnormal association of two or more epithelial lining. Therefore, vesicocutaneous fistula (VCF) represents an extra anatomic communication between the bladder wall and the external surface of the skin. The most common cause is iatrogenic; however, numerous factors may play a role in the formation of VCFs. When a VCF is identified, it should be treated properly due to its bothersome complaints and social effects. Nonetheless, no certain consensus has been achieved, yet. In this case, we report the feasibility and efficacy of omental flap interposition during VCF repair. PMID:25687443

  7. Glanuloplasty by ventral skin interposition in hypospadias repair: preliminary report

    Microsoft Academic Search

    Hassan Shaker; Mahmoud Ezzat

    2009-01-01

    Purpose  It was our aim in this study to develop a technique that is rather simple, overcomes the problems of Devine and Horton glanuloplasty\\u000a in patients with small glans, and is flexible to be tailored to any hypospadias surgery.\\u000a \\u000a \\u000a \\u000a Methods  A total of 11 patients were included in this preliminary report. A triangular skin flap was interpositioned between the developed\\u000a glanular wings

  8. The effect of continuous jejunal interposition on gastrointestinal hormones after distal gastrectomy

    PubMed Central

    Lv, Zhen-Ye; Ye, Zai-Yuan; Shao, Qin-Shu; Zhang, Wei; Zhang, Qin; Sun, Yuan-Shui; Li, Shu-Guang; Wang, Yuan-Yu; Xu, Ji

    2012-01-01

    The objective of our study was to determine the effect of continuous jejunal interposition on gastrointestinal hormones after distal gastrectomy, and lay a foundation for surgical management. Distal subtotal gastrectomy experimental model were established on 24 adult Beagle dogs. Digestive tract reconstruction of the dogs was randomly divided into continuous jejunal interposition group, Billroth II anastomosis group and isolated jejunum interposition group. The content of serum gastrin, plasma motilin and cholecystokinin after different digestive tract reconstructions was detected and compared by enzyme-linked immunosorbent assay In the dogs which received continuous jejunal interposition, postoperative serum gastrin level was significantly lower than before surgery either in fasting or postprandial state (all p<0.05). The serum gastrin level of continuous jejunal interposition group was significantly higher than the other groups in postprandial state (all p<0.05), and was significantly higher than Billroth II -type anastomosis group in fasting state (p<0.05). Furthermore, the postoperative plasma motilin and cholecystokinin levels were significantly higher than before surgery either in fasting or postprandial in dogs received continuous jejunal interposition (all p<0.05). The postoperative plasma motilin level of continuous jejunal interposition group was significantly higher than the other groups in postprandial state (all p<0.05), and was significantly higher than Billroth II -type anastomosis group in fasting state (p<0.05). However, the postoperative cholecystokinin level of continuous jejunal interposition group was significantly lower than the other groups (allp p<0.05). Continuous jejunal interposition after distal gastrectomy could maintain the postoperative plasma motilin and serum gastrin in a relatively high level, while cholecystokinin in a low level. PMID:22364297

  9. Stiffness after total knee arthroplasty.

    PubMed

    Manrique, Jorge; Gomez, Miguel M; Parvizi, Javad

    2015-04-01

    Stiffness after total knee arthroplasty (TKA) adversely affects outcome and impacts patient function. Various risk factors for stiffness after TKA have been identified, including reduced preoperative knee range of motion, history of prior knee surgery, etiology of arthritis, incorrect positioning or oversizing of components, and incorrect gap balancing. Mechanical and associated causes, such as infection, arthrofibrosis, complex regional pain syndrome, and heterotopic ossification, secondary gain issues have also been identified. Management of stiffness following TKA can be challenging. The condition needs to be assessed and treated in a staged manner. A nonsurgical approach is the first step. Manipulation under anesthesia may be considered within the first 3 months after the index TKA, if physical therapy fails to improve the range of motion. Beyond this point, consideration should be given to surgical intervention such as lysis of adhesions, either arthroscopically or by open arthrotomy. If the cause of stiffness is deemed to be surgical error, such as component malpositioning, revision arthroplasty is indicated. The purpose of this article is to evaluate the various aspects of management of stiffness after TKA. PMID:25513992

  10. Tourniquetless Total Knee Arthroplasty

    MedlinePLUS Videos and Cool Tools

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

  11. Cervical total disc arthroplasty.

    PubMed

    Basho, Rahul; Hood, Kenneth A

    2012-06-01

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

  12. Mortality after shoulder arthroplasty.

    PubMed

    Inacio, Maria C S; Dillon, Mark T; Miric, Alexander; Anthony, Faith; Navarro, Ronald A; Paxton, Elizabeth W

    2014-09-01

    One year post-operative mortality among patients with primary elective total shoulder arthroplasty (ETSA) and traumatic shoulder arthroplasty (TSA) were compared to the general population of a large healthcare system. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated. 614 ETSA patients, 1.0% one year mortality, and 168 TSA patients, 5.4% mortality rate, were evaluated. Patients with ETSA (SMR = 0.4, 95% CI 0.1-0.7) had lower odds of mortality than expected, while patients with TSA (SMR = 1.8, 95% CI 0.6-3.0) did not have higher than expected odds of mortality compared to the reference population. Understanding excess mortality following shoulder arthroplasty surgery allows providers to evaluate current practices and identify ways to optimize patients prior to surgery. PMID:24836652

  13. Dislocation after total knee arthroplasty.

    PubMed

    Wazir, N N; Shan, Y; Mukundala, V V; Gunalan, R

    2007-05-01

    Two cases of dislocation of total knee arthroplasty presented to us within the same week. The first patient is a 71-year-old woman who underwent bilateral primary total knee arthroplasty. The left knee dislocated three weeks after the surgery. Due to failure of conservative measures, she underwent revision total knee arthroplasty. The other patient is a 72-year-old woman presenting ten years after primary total knee arthroplasty, with a traumatic dislocation of the knee joint. She was treated as an outpatient with closed manipulative reduction. PMID:17453086

  14. Functional Outcome Following Colon Interposition in Total Pharyngoesophagectomy with or without Laryngectomy

    Microsoft Academic Search

    Mieke Moerman; Hossein Fahimi; Wim Ceelen; Piet Pattyn; Hubert Vermeersch

    2003-01-01

    Our study compares deglutition between a group who had undergone total esophagopharyngolaryngectomy and a group who had esophagectomy and partial pharyngectomy with preserved larynx, after reconstruction of the upper digestive tract with pedicled colon interposition. In four patients the laryngeal structures could be preserved (three caustic burns and one proximal esophageal tumor). Six patients underwent a total laryngopharyngectomy for large

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

    Microsoft Academic Search

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

    2004-01-01

    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

  16. Acute type A aortic dissection surgery impeded by substernal colon interposition.

    PubMed

    Vondran, Maximilian; Bakhtiary, Farhad; Borger, Michael Andrew; Mohr, Friedrich Wilhelm

    2015-01-01

    A 54-year old female patient presented with acute aortic dissection, Stanford type A, and a past history of oesophageal resection with substernal colon interposition. Preoperative computer tomography confirmed the aortic dissection and revealed a colonic graft that was adherent to the sternum. We report the first successful surgical treatment of aortic dissection in this challenging patient. PMID:25312995

  17. Results of modified lapidus arthrodesis procedure using medial eminence as an interpositional autograft.

    PubMed

    Fleming, Lee; Savage, Thomas J; Paden, Matthew H; Stone, Paul A

    2011-01-01

    The Lapidus procedure has received wide acceptance as a valuable operation for correcting moderate to severe hallux valgus, especially in the presence of hypermobility. However, shortening of the first ray inherently occurs as the first metatarsocuneiform joint cartilage and subchondral bone are resected in preparation for arthrodesis. The purpose of this study was to radiographically compare the degree of shortening of the first ray with and without the use of the first metatarsal medial eminence as an interpositional autograft at the site of metatarsocuneiform fusion. Preoperative and postoperative radiographs were measured in 35 consecutive patients who underwent 37 modified Lapidus procedures for hallux valgus repair. In group A, 20 surgeries were performed without use of the interpositional autograft, and served as the control. In group B, 14 surgeries were performed using the medial eminence as an interpositional autograft. The mean amount of first ray shortening was 5.3 ± 1.66 mm in group A and 2.69 ± 1.56 mm in group B, and this difference was statistically significant (P < .001). All patients progressed to complete union, and the median follow-up was 6 months (range, 4-60). Based on these results, the use of the medial eminence as an interpositional autograft in conjunction with Lapidus arthrodesis resulted in a 49.2% reduction in the amount of shortening of the first ray and proved to be a useful source of readily available bone graft. PMID:21513868

  18. Free tendon interposition grafting for the repair of ruptured extensor tendons in the rheumatoid hand

    Microsoft Academic Search

    J. Mountney; C. M. Blundell; P. McArthur

    1998-01-01

    Sixteen ruptured extensor tendons were repaired in seven rheumatoid hands using autogenous palmaris longus tendon as a free interposition graft. The patients were reviewed at an average of 17 months (range, 5–45) after repair. Subjectively all patients were satisfied with the clinical results, and achieved a return to their level of ability before tendon rupture. A biomechanical model suggests that

  19. Interposition saphenous vein bypass graft between the common and intracranial internal carotid arteries

    Microsoft Academic Search

    Michael K Morgan; Jeffrey Brennan; M. Jerome Day

    1996-01-01

    22 common carotid to intracranial internal carotid artery bypass grafts with interposition saphenous vein were performed in 20 patients over a four year period. The distal anastomosis was end-to-end on the internal carotid artery at a site between the ophthalmic and posterior communicating arteries. Early occlusion (rendered patent with Urokinase) occurred in one graft resulting in fatal infarction. Flow included

  20. Outcomes for jejunal interposition reconstruction compared with Roux-en-Y anastomosis: A meta-analysis

    PubMed Central

    Fan, Kai-Xi; Xu, Zhong-Fa; Wang, Mei-Rong; Li, Dao-Tang; Yang, Xiang-Shan; Guo, Jing

    2015-01-01

    AIM: To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer. METHODS: A systematic literature search was conducted by two independent researchers on PubMed, EMBASE, the Cochrane Library, Google Scholar, and other English literature databases, as well as the Chinese Academic Journal, Chinese Biomedical Literature Database, and other Chinese literature databases using “Gastrostomy”, “Roux-en-Y”, and “Interposition” as keywords. Data extraction and verification were performed on the literature included in this study. RevMan 5.2 software was used for data processing. A fixed-effects model was applied in the absence of heterogeneity between studies. A random effects model was applied in the presence of heterogeneity between studies. RESULTS: Ten studies with a total of 762 gastric cancer patients who underwent total gastrostomy were included in this study. Among them, 357 received jejunal interposition reconstruction after total gastrostomy, and 405 received Roux-en-Y anastomosis. Compared with Roux-en-Y anastomosis, jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome (OR = 0.18, 95%CI: 0.10-0.31; P < 0.001), increased the prognostic nutritional index [weighted mean difference (WMD) = 6.02, 95%CI: 1.82-10.22; P < 0.001], and improved the degree of postoperative weight loss [WMD = 2.47, 95%CI: -3.19-(-1.75); P < 0.001]. However, there is no statistically significant difference in operative time, hospital stay, or incidence of reflux esophagitis. CONCLUSION: Compared with Roux-en-Y anastomosis, patients who underwent jejunal interposition reconstruction after total gastrostomy had a lower risk of postoperative long-term complications and improved life quality. PMID:25780310

  1. Direct aortic interposition of anomalous left anterior descending coronary artery without cardiopulmonary bypass.

    PubMed

    Cebi, Niyazi; Frömke, Johannes; Walterbusch, Gerd

    2004-12-01

    An anomalous origin of the left anterior descending (LAD) coronary artery arising from the pulmonary artery is a congenital malformation rarely described in adults. We describe the case of a 42-year-old man with this malformation who underwent an interposition of the LAD coronary artery to the ascending aorta with an off-pump technique. The clinical presentation, angiographic findings, and surgical treatment are discussed. PMID:15561071

  2. Augmented repairs and use of interposition grafts in pelvic reconstructive surgery: Part I

    Microsoft Academic Search

    Jonathan S. Starkman; Joanna Togami; J. Christian Winters; Roger R. Dmochowski

    2007-01-01

    Because the prevalence of pelvic organ prolapse increases with age and the number of women aged 65 years and older is expected\\u000a to double in the next 25 years, demand is increasing for subspecialty services related to pelvic floor disorders. Synthetic\\u000a and biologic interposition grafts have been proposed as a way of augmenting weakened host tissues during pelvic reconstructive\\u000a surgical

  3. Total wrist arthroplasty.

    PubMed

    McBeath, Rowena; Osterman, A Lee

    2012-11-01

    This article reviews the history of total wrist arthroplasty as a treatment option for painful, nonfunctional wrists in disease states. Technologic advances in materials, wear properties, and manufacturing now account for increased implant longevity. They may also improve total wrist replacement design, survival, and hence patient function. Also, alternative surgical treatments such as distal radius hemiarthroplasty may serve as a treatment option for patients with higher activity levels and diffuse arthritis. With careful patient selection, soft tissue considerations, and novel implant designs, TWA may become a viable treatment staple for patients with functional wrist disability. PMID:23101610

  4. Functional outcome following colon interposition in total pharyngoesophagectomy with or without laryngectomy.

    PubMed

    Moerman, Mieke; Fahimi, Hossein; Ceelen, Wim; Pattyn, Piet; Vermeersch, Hubert

    2003-01-01

    Our study compares deglutition between a group who had undergone total esophagopharyngolaryngectomy and a group who had esophagectomy and partial pharyngectomy with preserved larynx, after reconstruction of the upper digestive tract with pedicled colon interposition. In four patients the laryngeal structures could be preserved (three caustic burns and one proximal esophageal tumor). Six patients underwent a total laryngopharyngectomy for large pharyngeal tumors. Swallowing was assessed by a questionnaire, clinical examination, and videofluoroscopy. All patients had normal intake of semisolid foods and fluids. All patients but three experienced some feeling of "narrowing" of the tract: four at the level of the hypopharynx, two at the oropharyngeal level, one at the oral level. In the laryngectomy group, solid food caused some degree of delayed swallowing in three patients. Dumping occurred in one case out of the nonlaryngectomy group. On clinical examination a tense motility in all laryngectomy patients appeared, food remnants in five and repeated swallowing movements in four. The videofluoroscopy confirmed repeated swallowing movements and presence of residual food in the oral cavity. Temporal stagnation occurred at the anastomosis site in all patients and in two patients at a place of colon redundancy. Colon interposition is a reliable reconstruction and gives the possibility of a good functional outcome. Although preservation of the larynx facilitates swallowing even in this reconstructive procedure, it may be better to perform a total laryngopharyngectomy and colon interposition in oncological cases where the pharyngeal remnant is borderline for primary closure. PMID:12825900

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

    PubMed Central

    2014-01-01

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

  6. Knee Arthroplasty: Disabilities in Comparison to the General Population and to Hip Arthroplasty Using a

    E-print Network

    Paris-Sud XI, Université de

    Knee Arthroplasty: Disabilities in Comparison to the General Population and to Hip Arthroplasty Handicap, Paris, France Abstract Background: Knee arthroplasty is increasing exponentially due to the aging over two years in people with knee arthroplasty to that in the general population. A secondary

  7. Instability after total knee arthroplasty.

    PubMed

    Parratte, Sebastien; Pagnano, Mark W

    2008-01-01

    Instability after total knee arthroplasty is reported to result in implant failure, and substantial instability often requires revision surgery. Successful outcomes can be achieved after revision total knee arthroplasty, particularly if the etiology of the instability is identified before the revision procedure. After careful clinical and radiologic analysis, instability can be classified as extension instability, flexion instability, or genu recurvatum. It is important to understand the causes and recommended treatments of each type of instability. PMID:18399593

  8. Benign esophageal stricture after thermal injury treated with esophagectomy and ileocolon interposition

    PubMed Central

    Kitajima, Toshihiro; Momose, Kota; Lee, Seigi; Haruta, Shusuke; Shinohara, Hisashi; Ueno, Masaki; Fujii, Takeshi; Udagawa, Harushi

    2014-01-01

    Thermal injuries of the esophagus are rare causes of benign esophageal stricture, and all published cases were successfully treated with conservative management. A 28-year-old Japanese man with a thermal esophageal injury caused by drinking a cup of hot coffee six months earlier was referred to our hospital. The hot coffee was consumed in a single gulp at a party. Although the patient had been treated conservatively at another hospital, his symptoms of dysphagia gradually worsened after discharge. An upper gastrointestinal endoscopy and computed tomography revealed a pin-hole like area of stricture located 19 cm distally from the incisors to the esophagogastric junction, as well as circumferential stenosis with notable wall thickness at the same site. The patient underwent a thoracoscopic esophageal resection with reconstruction using ileocolon interposition. The pathological findings revealed wall thickening along the entire length of the esophagus, with massive fibrosis extending to the muscularis propria and adventitia at almost all levels. Treatment with balloon dilation for long areas of stricture is generally difficult, and stent placement in patients with benign esophageal stricture, particularly young patients, is not yet widely accepted due to the incidence of late adverse events. Considering the curability and quality-of-life associated with a long expected prognosis, we determined that surgery was the best treatment option for this young patient. In this case, we decided to perform an esophagectomy and reconstruction with ileocolon interposition in order to preserve the reservoir function of the stomach and to avoid any problems related to the reflux of gastric contents. In conclusion, resection of the esophagus is a treatment option in patients with benign esophageal injury, especially in cases involving young patients with refractory esophageal stricture. In addition, ileocolon interposition may help to improve the quality-of-life of patients. PMID:25083096

  9. Immediate Laparoscopic Nontransvesical Repair without Omental Interposition for Vesicovaginal Fistula Developing after Total Abdominal Hysterectomy

    PubMed Central

    Lee, Jung Hun; Lee, Kyo Won; Han, Jong Sul; Choi, Pil Cho; Hoh, Jeong-Kyu

    2010-01-01

    Background and Objective: We conducted this study to evaluate the feasibility and efficacy of immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula (VVF) developing after total abdominal hysterectomy (TAH), which causes not only social and economic misery for the patient but also considerable stress to the physicians who perform the surgery. Methods: We performed a retrospective review of 5 women who underwent immediate laparoscopic nontransvesical repair without omental interposition for VVFs, developing after TAH from October 2007 to March 2009. In terms of laparoscopic procedure, cystoscopy was performed to confirm the location of fistula and ureteral openings, initially. Without opening the bladder, the fistula tract was identified, and the bladder was dissected from the vagina. The bladder defect was closed by using intracorporeal, continuous, and double-layer suturing, laparoscopically. The vaginal defect was closed using interrupted and single-layer suturing, vaginally. A Foley catheter was inserted for 2 weeks and removed after bladder integrity was confirmed with a retrograde cystogram. Results: The median age and body mass index of the patients were 47 years and 22.3 kg/m2, respectively. Operating time, hemoglobin change, and hospital stay were 95 minutes, 1.1 g/dL, and 5 days, respectively. There were no complications or laparoconversions. During follow-up (median 56.1 weeks; range 26.6 to 74.0), there was no evidence of recurrence. Conclusions: Immediate laparoscopic nontransvesical repair without omental interposition might be an effective, feasible alternative to the traditional methods in select patients with small sized (<1 cm) VVF developing after TAH. PMID:20932366

  10. History of cervical disc arthroplasty.

    PubMed

    Baaj, Ali A; Uribe, Juan S; Vale, Fernando L; Preul, Mark C; Crawford, Neil R

    2009-09-01

    Enthusiasm for cervical disc arthroplasty is based on the premise that motion-preserving devices attenuate the progression of adjacent-segment disease (ASD) in the cervical spine. Arthrodesis, on the other hand, results in abnormal load transfer on adjacent segments, leading to the acceleration of ASD. It has taken several decades of pioneering work to produce clinically relevant devices that mimic the kinematics of the intervertebral disc. The goal of this work is to trace the origins of cervical arthroplasty technology and highlight the attributes of devices currently available in the market. PMID:19722812

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

    PubMed Central

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

    2014-01-01

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

  12. Unlinked total elbow arthroplasty.

    PubMed

    Marsh, Jonathan P; King, Graham J W

    2015-01-01

    For more than 60 years, total elbow arthroplasty (TEA) has been successfully used to treat a variety of elbow conditions. Although first designed to treat older patients with rheumatoid arthritis, the indications have expanded to include younger, higher-demand patients with a broad range of elbow pathology. Two groups of TEA currently exist. The first group includes linked or semiconstrained elbows with a mechanical connection between the humeral and ulnar components that prevents disassociation. These implants do not rely on muscular or ligamentous tissues for stability. The second group includes unlinked implants that have no physical connection between the humeral and ulnar components. They rely on bearing surface architecture as well as soft-tissue integrity for elbow stability. Critical to the success of unlinked implants is a thorough preoperative evaluation of elbow stability, including bone stock, collateral ligament integrity, and periarticular muscle function. Unlinked implants should apply less strain to the bone-cement-implant interfaces, which may theoretically decrease rates of bearing wear and aseptic loosening. For this reason, some surgeons prefer unlinked implants for younger, higher-demand patients. To date, unlinked implants have not been clinically shown to improve survivorship compared with linked devices. No prospective randomized trials comparing linked and unlinked TEAs are currently available. Historically, unlinked implants have had higher revision rates, mostly caused by instability and early design flaws. More recent series have shown no significant differences in outcomes compared with linked devices. Unlinked TEA provides reliable pain relief and improved range of motion for patients with a variety of elbow disorders. Diligent patient selection and careful surgical technique are of utmost importance when considering an unlinked TEA as a treatment option. The recent development of convertible implants now allows surgeons to make intraoperative decisions regarding elbow stability and convert to a linked implant without revising the stems. PMID:25745909

  13. Revision Arthroplasty in the Haemophiliac Patient

    PubMed Central

    Molloy, A. P.; O'Neill, B. J.; Molloy, L.; White, B.; Smyth, H.; Carthy, T. Mc.

    2013-01-01

    Arthroplasty in the haemophiliac patient is associated with higher rates of infection and is traditionally performed in a younger age group. Despite this there is little evidence in the literature regarding revision arthroplasty in this cohort of patients. We describe the case of a periprosthetic fracture in a haemophiliac patient requiring revision arthroplasty, who did not consent to receiving blood products due to religious beliefs, with a successful outcome. PMID:23738171

  14. MR imaging of hip arthroplasty implants.

    PubMed

    Fritz, Jan; Lurie, Brett; Miller, Theodore T; Potter, Hollis G

    2014-01-01

    Hip arthroplasty has become the standard treatment for end-stage hip disease, allowing pain relief and restoration of mobility in large numbers of patients; however, pain after hip arthroplasty occurs in as many as 40% of cases, and despite improved longevity, all implants eventually fail with time. Owing to the increasing numbers of hip arthroplasty procedures performed, the demographic factors, and the metal-on-metal arthroplasty systems with their associated risk for the development of adverse local tissue reactions to metal products, there is a growing demand for an accurate diagnosis of symptoms related to hip arthroplasty implants and for a way to monitor patients at risk. Magnetic resonance (MR) imaging has evolved into a powerful diagnostic tool for the evaluation of hip arthroplasty implants. Optimized conventional pulse sequences and metal artifact reduction techniques afford improved depiction of bone, implant-tissue interfaces, and periprosthetic soft tissue for the diagnosis of arthroplasty-related complications. Strategies for MR imaging of hip arthroplasty implants are presented, as well as the imaging appearances of common causes of painful and dysfunctional hip arthroplasty systems, including stress reactions and fractures; bone resorption and aseptic loosening; polyethylene wear-induced synovitis and osteolysis; adverse local tissue reactions to metal products; infection; heterotopic ossification; tendinopathy; neuropathy; and periprosthetic neoplasms. A checklist is provided for systematic evaluation of MR images of hip arthroplasty implants. MR imaging with optimized conventional pulse sequences and metal artifact reduction techniques is a comprehensive imaging modality for the evaluation of the hip after arthroplasty, contributing important information for diagnosis, prognosis, risk stratification, and surgical planning. PMID:25019450

  15. [Case report--total hip arthroplasty after femoral osteotomy].

    PubMed

    Hirose, Kazuyoshi; Takagi, Hideki; Iwata, Hisashi

    2004-07-01

    Osteoarthritis that is the most common cartilage disease is difficult to treat conservatively. Usually it is treated by operative therapy. Osteotomy and arthroplasty are the popular operation. Osteotomy has a problem of unstable results. Some patients need arthroplasty after osteotomy, cause of getting worse of pain. It is difficult to operate arthroplasty for deformity of proximal femor after osteotomy. We report arthroplasty using ROBODOC is easy to operate cementless hip arthroplasty after osteotomy. PMID:15577087

  16. Outcome after total hip arthroplasty

    Microsoft Academic Search

    Jay R. Lieberman; Frederick Dorey; Paul Shekelle; Lana Schumacher; Douglas J. Kilgus; Bert J. Thomas; Gerald A. Finerman

    1997-01-01

    The purpose of this study was to examine the relationship between the Harris Hip Score (HHS), a traditional method of patient assessment of a total hip arthroplasty (THA), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a commonly used health-related quality-of-life survey. One hundred forty patients returning for routine clinical follow-up evaluation of a primary THA were asked

  17. Is Duplex Venous Surveillance Worthwhile after Arthroplasty?

    Microsoft Academic Search

    Thomas E. Brothers; Charles E. Frank; Beth Frank; Jacob G. Robison; Bruce M. Elliott; H. Del Schutte; Keith D. Merrill; Richard J. Friedman

    1997-01-01

    Deep venous thrombosis (DVT) complicates 60% of knee and 80% of hip arthroplasties performed without prophylactic therapy. Routine postoperative duplex ultrasound surveillance has been proposed for the detection of venous thrombosis following arthroplasty. In order to determine whether surveillance represents an effective strategy to detect postoperative DVT when prophylaxis is used, surveillance duplex exams obtained after primary or revision hip

  18. [A case of vesicovaginal fistula repair with rectus abdominus myofascial interposition flap after radical hysterectomy and radiation therapy].

    PubMed

    Endo, Yuki; Iigaya, Shigeki; Nishimura, Taiji; Ishii, Naohiro; Kitaoka, Yoshihisa; Kawashima, Toshifumi; Ohara, Chiharu; Hamasaki, Tsutomu; Kondo, Yukihiro

    2014-10-01

    Vesicovaginal fistulas (VVFs) caused after radiation are difficult to repair and require interposition of non-irradiated, well-vascularized tissue between urinary bladder and vagina. A 48-year-old female suffered cervical cancer and underwent radical hysterectomy followed by radiation therapy which caused VVF. The initial surgical repair performed 3 months after development of VVF, was unsuccessful because of the absence of peritoneum or omentum to interpose between urinary bladder and vagina probably due to history of cesarean section and radical hysterectomy. The second surgical repair was performed 15 months after the first surgery utilizing a rectus abdominus myofascial (RAM) interposition flap. Fifteen months after the second operation, she remains free from incontinence. This case suggests that RAM is useful even for postradiation VVF. PMID:25391781

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

    Microsoft Academic Search

    William J. WadeThamer; Thamer S. Alhussainan; Zayed Al Zayed; Nezar Hamdi; Dalal Bubshait

    2010-01-01

    Background  Pericapsular acetabuloplasty procedures have been widely used as an integral component of combined surgery to treat developmental\\u000a hip dislocation after walking age. The stability of the acetabuloplasty and the maintenance of the acetabular correction will\\u000a depend on the structural integrity of the iliac crest autograft, which, traditionally, has been inserted as the interposition\\u000a material. Problems related to the use of

  20. Surgical Treatment of Morbid Obesity: Midterm Outcomes of the Laparoscopic Ileal Interposition Associated to a Sleeve Gastrectomy in 120 Patients

    Microsoft Academic Search

    Aureo L. DePaula; Alessandro R. Stival; Alfredo Halpern; Sergio Vencio

    2011-01-01

    The aim of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition associated to a sleeve\\u000a gastrectomy (LII-SG) for the treatment of morbid obesity. The procedure was performed in 120 patients: 71 women and 49 men\\u000a with mean age of 41.4 years. Mean body mass index (BMI) was 43.4?±?4.2 kg\\/m2. Patients had to meet requirements of the 1991

  1. Use of an electronic system for soft tissue balancing in primary total knee arthroplasty.

    PubMed

    D'Angelo, Fabio; Binda, Tommaso; Cherubino, Paolo

    2013-11-01

    Accurate soft tissue balancing during total knee arthroplasty has a direct effect on patellofemoral tracking and knee range of motion. Numerous instruments and methods are available to balance knee prostheses. The eLIBRA Dynamic Knee Balancing System (Synvasive Technology, Inc, Reno, Nevada) is an electronic device that establishes femoral component rotation using ligamentous tone. The eLIBRA is an articulating spacer that emulates implant trials before anteroposterior femoral cuts are made to obtain a dynamic gap symmetry. PMID:24200429

  2. Failure of aseptic revision total knee arthroplasties

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  4. Proximal gastrectomy with jejunal interposition and TGRY anastomosis for proximal gastric cancer

    PubMed Central

    Zhao, Ping; Xiao, Shuo-Meng; Tang, Ling-Chao; Ding, Zhi; Zhou, Xiang; Chen, Xiao-Dong

    2014-01-01

    AIM: To compare the short-term outcomes of patients who underwent proximal gastrectomy with jejunal interposition (PGJI) with those undergoing total gastrectomy with Roux-en-Y anastomosis (TGRY). METHODS: From January 2009 to January 2011, thirty-five patients underwent PGJI, and forty-one patients underwent TGRY. The surgical efficacy and short-term follow-up outcomes were compared between the two groups. RESULTS: There were no differences in the demographic and clinicopathological characteristics. The mean operation duration and postoperative hospital stay in the PGJI group were statistically longer than those in the TGRY group (P = 0.00). No anastomosis leakage was observed in two groups. No statistically significant difference was found in endoscopic findings, Visick grade or serum albumin level. The single-meal food intake in the PGJI group was more than that in the TGRY group (P = 0.00). The PG group showed significantly better hemoglobin levels in the second year (P = 0.02). The two-year survival rate was not significantly different (PGJI vs TGRY, 93.55% vs 92.5%, P = 1.0). CONCLUSION: PGJI is a safe, radical surgical method for proximal gastric cancer and leads to better outcomes in terms of the single-meal food intake and hemoglobin level, compared with TGRY in the short term. PMID:25009402

  5. Extracranial-Intracranial Bypass Surgery Using a Radial Artery Interposition Graft for Cerebrovascular Diseases

    PubMed Central

    Roh, Sung Woo; Sung, Han Yoo; Jung, Young Jin; Kwun, Byung Duk; Kim, Chang Jin

    2011-01-01

    Objective To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases. Methods The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically. Results Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators. Conclusion EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery. PMID:22102946

  6. Comparative outcomes of total joint arthroplasty

    Microsoft Academic Search

    Merrill A. Ritter; Marjorie J. Albohm; E. Michael Keating; Philip M. Faris; John B. Meding

    1995-01-01

    A prospective pre- and postoperative general health\\/quality-of-life factor comparison, using the Rand SF-36 Health Status Questionnaire (TyPE Specification, Quality Quest [Health Outcomes Institute, Minneapolis, MN]), was carried out on a consecutive series of patients with diagnosed osteoarthritis undergoing total hip and knee arthroplasty between March 1991 and March 1994. Study groups consisted of 85 total hip arthroplasty patients, 93 total

  7. Venous thromboembolic disease management patterns in total hip arthroplasty and total knee arthroplasty patients

    Microsoft Academic Search

    J. Wesley Mesko; Richard A Brand; Richard Iorio; Ivan Gradisar; Richard Heekin; Ross Leighton; Robert Thornberry

    2001-01-01

    The American Association of Hip and Knee Surgeons (AAHKS) distributed a survey to its members exploring practice patterns implemented to prevent venous thromboembolic disease (VTED) in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Of 720 (33%) members, 236 responded. Prophylaxis was prescribed for 100% of patients during the course of hospitalization for THA and TKA. Warfarin

  8. Gap balancing sacrifices joint-line maintenance to improve gap symmetry: a randomized controlled trial comparing gap balancing and measured resection.

    PubMed

    Babazadeh, Sina; Dowsey, Michelle M; Stoney, James D; Choong, Peter F M

    2014-05-01

    A total knee arthroplasty can be completed using two techniques; measured resection or gap balancing. A prospective blinded randomized controlled trial was completed with 103 patients randomized to measured resection (n = 52) or gap balancing (n = 51). Primary outcome measure was femoral component rotation. Secondary outcome measures were joint-line change, gap symmetry and function and quality-of-life outcomes. Gap balancing resulted in a significantly raised joint-line compared to measured resection. Gap symmetry was significantly better using gap balancing. Functional outcomes and quality-of-life were not significantly different at 24 months. Using computer navigation, gap balancing significantly raises the joint-line in order to improve gap symmetry. This does not result in a clinical difference in function or quality of life at 24 months. PMID:24183325

  9. Coronal Plane Stability Before and After Total Knee Arthroplasty

    E-print Network

    Delp, Scott

    Coronal Plane Stability Before and After Total Knee Arthroplasty Robert A. Siston, PhD*,, ; Stuart of total knee arthroplasty depends in part on proper soft tissue management to achieve a stable joint. It is unknown to what degree total knee arthroplasty changes joint stability. We used a surgical navigation

  10. Diagnosis, Causes and Treatments of Instability Following Total Knee Arthroplasty

    PubMed Central

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

    2014-01-01

    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

  11. Repair of unilateral absence of right pulmonary artery with contralateral pulmonary artery autograft interposition in an infant.

    PubMed

    Bilal, Mehmet Salih; Yildirim, Ozgur; Avsar, Mustafa; Ozyuksel, Arda

    2015-04-01

    Unilateral absence of the pulmonary artery (PA) is a rare congenital abnormality. Although a traditional 2-stage approach with a preceding systemic-to-PA shunt followed by a definitive repair is mandatory in patients with absent extrapericardial pulmonary arteries, more creative solutions are necessary when 1-stage repair is concerned. We present a novel technique for repairing the absent intrapericardial right pulmonary artery (RPA) with a contralateral PA autograft segment interposition. We believe that this technique using solely autologous tissue is effective in patients in whom the intrapericardial segment of the PAs is absent. PMID:25841844

  12. Instability after total knee arthroplasty.

    PubMed

    McNabb, David Clinton; Kim, Raymond H; Springer, Bryan D

    2015-04-01

    Total knee arthroplasty (TKA) has shown to portend good long-term survivorship and excellent patient satisfaction. There are various etiologies of failure of a TKA. Instability is a major cause of the need for revision. Often, increased constraint is needed to supplement or perform the function of incompetent ligament and soft tissue structures. Posterior cruciate retaining (PCR) TKA has the least constraint. Posterior cruciate substituting (PS) TKA increases sagittal constraint. Varus-valgus constraint (VVC) adds a marked increase in coronal stability. The ultimate in constraint in TKA is a linked hinged implant. In revision TKA, it is the surgeon's responsibility to implant the prosthesis with the necessary constraint to impart adequate stability. PMID:25518877

  13. Imaging of elbow replacement arthroplasty.

    PubMed

    Roth, Eira; Chew, Felix S

    2015-02-01

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

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

    PubMed

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

    2013-11-01

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

  15. Uncommon Indications for Reverse Total Shoulder Arthroplasty

    PubMed Central

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

    2013-01-01

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

  16. Periprosthetic fractures after total knee arthroplasty.

    PubMed

    Tharani, Ravi; Nakasone, Cass; Vince, Kelly G

    2005-06-01

    Fractures around total knee arthroplasties are challenging clinical problems and include the following: stress fractures of the pelvis and femoral neck, supracondylar femur fractures, fractures of the proximal tibial metaphysis and diaphysis, and patellar fractures. Treatment focuses on restoration of the patient's prefracture functional status. The etiology of supracondylar femur fractures is multifactorial and treatment includes immobilization, retrograde intramedullary nailing, open reduction and internal fixation, and revision arthroplasty. The "Less Invasive Stabilization System" plate has recently been added to the list of viable fixation options. Tibial metaphyseal and diaphyseal fractures are less common and usually treated with revision arthroplasty. In the absence of maltracking or component loosening, vertical patellar fractures often respond to immobilization. Disruption of the extensor mechanism may require cerclage wiring or even extensor mechanism allografting if chronic. Conventional tension band wiring usually fails. Patellar fractures are controversial and problematic. PMID:15991125

  17. Total Knee Arthroplasty in Rheumatoid Arthritis

    PubMed Central

    Lee, Jin Kyu

    2012-01-01

    The course of rheumatoid arthritis varies from mild disease to severe joint destructive variant that progresses rapidly, eventually leading to unremitting pain and joint deformity. In advanced disease, total knee arthroplasty has proven to be the most successful intervention that reduces knee pain and improves physical function in rheumatoid arthritis patients. However, as rheumatoid arthritis patients carry additional potential for late complications, many important considerations regarding preoperative evaluation and surgical technique must be taken into account in order to improve the results of total knee arthroplasty in this subgroup of patients. PMID:22570845

  18. Gemella haemolysans Infection in Total Hip Arthroplasty

    PubMed Central

    Rose, Barry; Jeer, Parminder J. S.; Spriggins, Anthony J.

    2012-01-01

    Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up. PMID:23227390

  19. Total knee arthroplasty considerations in rheumatoid arthritis.

    PubMed

    Danoff, Jonathan R; Moss, Garrett; Liabaud, Barthelemy; Geller, Jeffrey A

    2013-01-01

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

  20. Biomechanics of reverse total shoulder arthroplasty.

    PubMed

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

    2015-01-01

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

  1. Fat embolism syndrome and elective knee arthroplasty

    Microsoft Academic Search

    Kathryn Jenkins; Frances Chung; Richard Wennberg; Edward E. Etchells; Rod Davey

    2002-01-01

    Purpose  To report a case of fat embolism syndrome (FES) following elective left knee arthroplasty and review the diagnosis, investigation,\\u000a prevention and perioperative management of this condition.\\u000a \\u000a \\u000a \\u000a Clinical features  A 76-yr-old lady presented for left total knee arthroplasty under general anesthesia. After an uneventful anesthetic and initial\\u000a recovery, she developed respiratory and neurological complications six hours postoperatively necessitating supportive care\\u000a in the

  2. Unicompartmental knee arthroplasty: a review of literature

    Microsoft Academic Search

    Bernardino Saccomanni

    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;

  3. Total Knee Arthroplasty Considerations in Rheumatoid Arthritis

    PubMed Central

    Danoff, Jonathan R.; Geller, Jeffrey A.

    2013-01-01

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

  4. Metacarpophalangeal joint arthroplasty in rheumatoid arthritis: results of Swanson implants and digital joint operative arthroplasty

    Microsoft Academic Search

    M. Rittmeister; M. Porsch; M. Starker; F. Kerschbaumer

    1999-01-01

    We discuss 69 metacarpophalangeal (MP) implant arthroplasties performed in 30 patients with rheumatoid arthritis. The follow-up\\u000a averaged 5 years. We studied 19 finger joint prostheses by Condamine, digital joint operative arthroplasty (stabilized version;\\u000a DJOA) and 50 flexible silicone Swanson implants. We used a new comprehensive scoring system to evaluate the MP alloarthroplasties.\\u000a Such a scoring system incorporates clinical and radiological

  5. Preoperative Evaluations in Revision Total Knee Arthroplasty

    Microsoft Academic Search

    Steven J. MacDonald; Robert B. Bourne

    2006-01-01

    There are many causes of total knee arthroplasty failure, and an accurate preoperative diagnosis is essential to optimize the results of revision surgery. We discuss our standard pre- operative evaluation routine and we retrospectively reviewed the last 295 patients who underwent revision total knee ar- throplasty to establish the clinical value of the most com- monly performed investigations used to

  6. [Difficult cases of total knee arthroplasty].

    PubMed

    Takagi, Hideki; Hirose, Kazuyoshi; Iwata, Hisashi

    2004-07-01

    We report two difficult cases in total knee arthroplasty (TKA). One is an arthritis mutilans knee with large tibial bone deficiency that required TKA using tibial metal wedge augmentation. Another is a post-traumatic OA knee with varus deformity and rotational malalignment that had TKA by the ROBODOC system. PMID:15577088

  7. Knee Lymphocutaneous Fistula Secondary to Knee Arthroplasty

    PubMed Central

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

    2014-01-01

    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

  8. Quality of outcome data in knee arthroplasty

    PubMed Central

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

    2015-01-01

    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

  9. Mobile-bearing unicondylar knee arthroplasty: the Oxford experience.

    PubMed

    Hurst, Jason M; Berend, Keith R

    2015-01-01

    With the recent increase in medial unicompartmental arthroplasty, this article reviews the design history, indications, results, and modern technique for the implantation of the Oxford mobile-bearing unicompartmental arthroplasty. The article also discusses how the indications for the Oxford differ from the historical indications for medial unicompartmental arthroplasty and supports this paradigm shift with review of the recent data. A detailed series of surgical pearls is also presented to help surgeons with the surgical nuances of the Oxford partial knee. PMID:25435040

  10. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    PubMed Central

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

    2014-01-01

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

  11. The Release of Gentamicin from Acrylic Bone Cements in a Simulated Prosthesis-Related Interfacial Gap

    Microsoft Academic Search

    Johannes G. e. Hendriks; Danie Lle Neut; Jim R. Van Horn; Henny C. Van Der Mei; Henk J. Busscher

    Abstract: Gentamicin is added to polymethylmethacrylate bone cements in orthopedics as a measure against infection in total joint arthroplasties. Numerous studies have been published on gentamicin release from bone cements, but none have been able to estimate the local concentrations in the prosthesis-related interfacial gap, present after implantation. The aim of this study was to develop a method allowing determination

  12. Cementless two-stage exchange arthroplasty for infection after total hip arthroplasty.

    PubMed

    Masri, Bassam A; Panagiotopoulos, Kostas P; Greidanus, Nelson V; Garbuz, Donald S; Duncan, Clive P

    2007-01-01

    We retrospectively reviewed all patients at one center with an infected total hip arthroplasty treated with 2-stage revision using cementless components for the second stage and the PROSTALAC articulated spacer at the first stage. Twenty-nine patients were reviewed and followed for at least 2 years postoperatively. An isolated Staphylococcus species was cultured in 76% (22/29) of patients. Three (10.3%) of 29 patients had recurrent infection at the site of the prosthesis. One of the 3 patients ultimately underwent a Girdlestone arthroplasty. Another patient was managed with irrigation and debridement, whereas the final patient was treated with intravenous antibiotics alone. Treatment of infection at the site of a hip arthroplasty with 2-stage revision using cementless components and an articulated spacer yields recurrence rates similar to revisions where at least one of the components at the second stage is fixed with antibiotic-loaded cement. PMID:17197311

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

    PubMed Central

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

    2015-01-01

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

  14. Total knee arthroplasty in patients with poliomyelitis.

    PubMed

    Jordan, Louis; Kligman, Mordechai; Sculco, Thomas P

    2007-06-01

    Between 1991 and 2001, 17 primary total knee arthroplasties were performed in 15 patients with limbs affected by poliomyelitis. Eight patients had a constrained condylar knee design, 8 a posterior stabilized design, and 1 a hinged design. Mean follow-up was 41.5 months. The mean Knee Society knee score improved from 45 preoperatively to 87 postoperative. Knee stability was obtained in all patients, including 4 patients with less than antigravity quadriceps strength. Radiologic evaluation showed satisfactory alignment with no signs of loosening. Complications included 1 case of deep venous thrombosis and 2 knees that required a manipulation for stiffness. Pain relief, functional improvement, and knee stability can be achieved after constrained total knee arthroplasty in patients with poliomyelitis despite impaired quadriceps strength, and osseous and soft tissue abnormalities. PMID:17562411

  15. Biomarkers in Arthroplasty: A Systematic Review

    PubMed Central

    Mertens, Marty T; Singh, Jasvinder A

    2011-01-01

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

  16. Postoperative Vision Loss after Reverse Shoulder Arthroplasty

    PubMed Central

    Scadden, John

    2014-01-01

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

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

    Microsoft Academic Search

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

    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

  18. Footprint mismatch in lumbar total disc arthroplasty

    Microsoft Academic Search

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

    2008-01-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the\\u000a implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The\\u000a fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening\\u000a and biomechanical failure

  19. Sciatic neuropathy secondary to total hip arthroplasty wear debris

    Microsoft Academic Search

    Steven R. Fischer; David J. Christ; Bernard A. Roehr

    1999-01-01

    Sciatic neuropathy after total hip arthroplasty can result from several causes. We present a case in which a large cystic mass developed around a failed total hip arthroplasty. The lesion extended through the greater sciatic notch and into the pelvis producing sciatic nerve compression. The diagnosis was delayed, and the patient underwent a laminectomy without relief of symptoms before an

  20. Total hip arthroplasties: What are the reasons for revision?

    PubMed Central

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

    2007-01-01

    Primary total hip arthroplasties have reported success rates of greater than 95% in many series with a longer than 10-year follow-up. Revision total hip arthroplasty due to such factors as increased high-activity levels, younger patients undergoing the procedure and increasing life expectancy has become more prevalent. An understanding of the mechanisms and timing of total hip arthroplasty failure can direct efforts aimed at reducing revision rates. This study was conducted to evaluate the indications for revision hip arthroplasty and relate these to the time after the index primary hip arthroplasty. A review of all revision hip arthroplasties at two centres over a 6-year time period identified 225 patients who underwent 237 revisions. The overall mean time to revision was 83 months (range: 0–360 months). The cause of failure was aseptic loosening in 123 hips (51.9%), instability in 40 hips (16.9%) and infection in 37 hips (5.5%). When stratified into two groups (less than 5 years, more than 5 years after the index primary hip arthroplasty), 118 of 237 (50%) revisions occurred in less than 5 years, with 33% due to instability and 24% resulting from infection. The majority of the causes of failure within 5 years in these early revisions were instability and deep infection. The success of hip arthroplasty is likely to be compromized if technical aspects of the surgery for appropriate component positioning and critical protocols to minimise complications such as infection are not given the proper attention. PMID:17443324

  1. Optimized Registration for Computer Assisted Total Knee Arthroplasty

    E-print Network

    Omiecinski, Curtis

    260 Optimized Registration for Computer Assisted Total Knee Arthroplasty Jon-Michael Tucker, Mc Pennsylvania State University Introduction: Total knee arthroplasty, (TKA), also known as total knee, a cement epoxy is then used to firmly secure the mechanical components that will operate as "new knees

  2. Total shoulder arthroplasty in patients with Parkinson's disease

    Microsoft Academic Search

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

    1997-01-01

    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

  3. Physical Activity After Total Joint Arthroplasty

    PubMed Central

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

    2011-01-01

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

  4. Periprosthetic Fractures Following Total Knee Arthroplasty

    PubMed Central

    Kim, Nam Ki

    2015-01-01

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

  5. GUEPAR knee arthroplasty results and late complications.

    PubMed

    Jones, E C; Insall, J N; Inglis, A E; Ranawat, C S

    1979-05-01

    One hundred eight GUEPAR knee arthroplasties have been studied with a follow-up of one year on 41; 2 years on 22 and 3 years on 45 knees. Overall results were 17% excellent, 44% good, 10% fair and 29% poor. Excellent results were comparatively fewer in rheumatoid arthritis. There was a deterioration in the quality of results of arthroplasty with longer follow-up. The incidence of deep infection was 11%. There was a significant correlation between early wound drainage and deep infection. More than half of the infected knees have not required intervenition as yet. One knee was revised and 3 had attempted arthrodesis with one successful fusion. Two patients died with septicemia. Axle migration occurred in 8 knees and femoral stem breakage in 2 knees. Loosening was found in 27% of the knees with progressive reduction in quality of the arthroplasty. Incomplete cementing predisposed to loosening. Patellar symptoms were present in 28% of the knees. Patellar subluxation and dislocation occurred in 49% of the knees. More than half of these were symptomatic. With normal patellofemoral alignment, pain was more common in the osteoarthritic knee. Use of a patellar implant with GUEPAR knee prostesis should be restricted to severely disabled patients with major fixed deformities. Mechanical failure can be minimized by proper positioning of the implant, correct alignment of the extensor mechanism and adequate cement around the entire stem. PMID:477066

  6. Periprosthetic fractures following total knee arthroplasty.

    PubMed

    Yoo, Jae Doo; Kim, Nam Ki

    2015-03-01

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

  7. Radiological assessment of irreducible posterolateral knee subluxation after dislocation due to interposition of the vastus medialis: a case report.

    PubMed

    Paulin, Emilie; Boudabbous, Sana; Nicodème, Jean-Damien; Arditi, Daniel; Becker, Christoph

    2015-06-01

    Knee dislocation is a serious and relatively uncommon traumatism that every emergency room is supposed to diagnose and treat rapidly. Most of the time these dislocations reduce spontaneously or with closed reduction. If a subluxation persists, an incarceration of soft tissue in the joint must be suspected. Irreducible knee subluxations after dislocation are rare entities better described in the orthopaedic than in the radiological literature. However, the initial radiological assessment is an important tool to obtain the correct diagnosis, to detect neurovascular complications, and to plan the most suitable treatment. In cases of delayed diagnosis, the functional prognosis of the joint and even the limb may be seriously compromised primarily because of vascular lesions. Thereby, vascular imaging is essential in cases of dislocation of the knee, and we will discuss the role of angiography and the more recent use of computed tomography angiography or magnetic resonance angiography. Our patient presented with an irreducible knee subluxation due to interposition of the vastus medialis, and we will review the classical clinical presentation and 'do not miss' imaging findings on conventional radiography, computed tomography angiography, and magnetic resonance imaging. Finally, we will also report the classical imaging pathway indicated in knee dislocation, with a special emphasis on the irreducible form. PMID:25560996

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

    PubMed Central

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

    2014-01-01

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

  9. Gap Winds

    NSDL National Science Digital Library

    2014-09-14

    This module provides a basic understanding of why gap winds occur, their typical structures, and how gap wind strength and extent are controlled by larger-scale, or synoptic, conditions. You will learn about a number of important gap flows in coastal regions around the world, with special attention given to comprehensively documented gap wind cases in the Strait of Juan de Fuca and the Columbia River Gorge. Basic techniques for evaluating and predicting gap flows are presented. The module reviews the capabilities and limitations of the current generation of mesoscale models in producing realistic gap winds. By the end of this module, you should have sufficient background to diagnose and forecast gap flows around the world, and to use this knowledge to understand their implications for operational decisions. Other features in this module include a concise summary for quick reference and a final exam to test your knowledge. Like other modules in the Mesoscale Meteorology Primer, this module comes with audio narration, rich graphics, and a companion print version.

  10. Gap Junctions

    PubMed Central

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

    2013-01-01

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

  11. Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty

    Microsoft Academic Search

    Matthew R. Bong; Kenneth A. Egol; Kenneth J. Koval; Frederick J. Kummer; Edward T. Su; Kazuho Iesaka; Jordi Bayer; Paul E. Di Cesare

    2002-01-01

    Simulated supracondylar fractures were created proximal to posterior cruciate ligament–retaining total knee arthroplasty components in paired human cadaver femora and stabilized with either a retrograde-inserted locked supracondylar nail or the Less Invasive Stabilization System (LISS; Synthes USA, Paoli, PA). Loads were applied to create bending and torsional moments on the simulated fracture stabilized with either no gap or a 10-mm

  12. Unusual cases of pigmented villonodular synovitis after arthroplasty

    PubMed Central

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

    2014-01-01

    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 2th 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 8th 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 4th 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 10th 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

  13. Perioperative complications of total ankle arthroplasty.

    PubMed

    Myerson, Mark S; Mroczek, Kenneth

    2003-01-01

    A retrospective radiographic and chart review was performed for the initial 50 patients who underwent Agility (DePuy, Warsaw IN) total ankle arthroplasty by the senior author (M.S.M.). The review focused on the perioperative complications of nerve or tendon lacerations, intraoperative fractures, acute deep infections, wound complications and component positioning. Major wound complications were defined as those requiring a soft-tissue coverage procedure. Minor wound complications did not require soft tissue coverage and included wound breakdowns, wound edge necrosis, and superficial infections. The immediate mortise and lateral postoperative radiographs were reviewed to measure component positioning. The patients were divided into two groups to compare the initial 25 patients (Group A) with the subsequent 25 patients (Group B). There were no major wound complications in either group. Minor wound complications decreased from six in Group A to two in Group B. There were four lacerations (flexor hallucis longus, posterior tibial tendon, deep peroneal nerve, and superficial peroneal nerve), all occurring in Group A. Five patients sustained intraoperative fractures in Group A, as compared with two fractures in Group B. The number of components varying greater than 4 degrees from neutral as measured by the lateral talar, lateral tibial and mortise tibial component angles decreased by 9% from Group A to Group B. The only tibial component to be placed in more than 4 degrees of valgus occurred in Group A. It seems that a notable learning curve exists in the performance of total ankle arthroplasty as demonstrated by a comparison of the initial 25 patients with the subsequent 25 patients performed by one orthopaedic surgeon. This improvement most likely resulted from the use of enhanced techniques and further training with the prosthesis. This information can be used as a teaching tool to decrease the incidence of complications for surgeons performing their initial arthroplasties with this potentially technically demanding procedure. PMID:12540076

  14. Measured flexion following total knee arthroplasty.

    PubMed

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

    2012-10-01

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

  15. Bicompartmental knee arthroplasty: the clinical outcomes.

    PubMed

    Tria, Alfred J

    2013-07-01

    Replacement of the patellofemoral and medial tibiofemoral joints has been performed since the 1980s. Bicompartmental replacement was modified. Two different designs were developed: one custom implant and one with multiple predetermined sizes. The surgical technique and instruments are unique and training is helpful. There are no clinical reports for the custom design as of yet. The standard implant has several reports in the literature with only fair to good results and has subsequently been withdrawn from the market. Bicompartmental arthroplasty remains a questionable area of knee surgery. At present, the two separate implant technique is the best choice. PMID:23827832

  16. Vaginal mass following uncemented total hip arthroplasty

    PubMed Central

    Shin, Young-Soo; Jung, Tae-Wan; Han, Seung-Beom

    2014-01-01

    A 53-year-old woman developed a vaginal mass following an uncemented total hip arthroplasty. The mass was in direct communication with the hip through an acetabular medial wall defect after loosening of the acetabular component. The mass formation was caused simultaneously by changes secondary to polyethylene wear, a tiny delamination of the porous titanium mesh coating and a broken antirotational tab on the acetabular cup, all of which may have served as sources of metal particles. A careful evaluation of the patient's history, symptoms, X-ray findings and computed tomography scans should always be performed to ensure accurate diagnosis. PMID:25404779

  17. Modes of failure of total knee arthroplasty: registries and realities.

    PubMed

    Siqueira, Marcelo B P; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K

    2015-04-01

    Revision knee arthroplasty places a major strain on the health care system and is associated with high rates of complications, readmissions, and reoperations. Determining the modes of failure of total knee arthroplasty (TKA) preoperatively is essential for a successful revision procedure. Nationwide arthroplasty registries have served as reliable quality control instruments and as data sources of clinical studies that can potentially help guide the investigation of a failed TKA. Modes of failure vary according to the setting of the procedure (primary vs revision arthroplasty) and the prosthesis level of constraint. This article reviews the most prevalent modes of failure of primary and revision TKA, and further quantifies rates and specific modes of failure of bicruciate retaining, posterior cruciate retaining, posterior stabilizing, varus-valgus constrained, and hinged implants. PMID:25419836

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

    PubMed Central

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

    2012-01-01

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

  19. Blood management in total joint arthroplasty.

    PubMed

    Sculco, Thomas P; Baldini, Andrea; Keating, E Michael

    2005-01-01

    One of the primary goals in the perioperative care of orthopaedic patients undergoing surgery is the avoidance of allogeneic transfusion. There are a number of ways to lessen blood loss during surgical intervention including regional hypotensive anesthesia, careful and atraumatic surgical technique, and coagulation of bleeding surfaces. Achieving coagulation is difficult in spinal and arthroplasty procedures because of the large cancellous surfaces that are vascular and are not amenable to ligature or thermal coagulation. All measures of autologous blood salvage should be used including preoperative deposit of autologous blood, hemodilution techniques, intraoperative salvage (when appropriate), and postoperative retrieval and reinfusion. The use of perioperative recombinant erythropoietin is also a useful adjunct to promote stimulation of the bone marrow and increased red cell production. Although many infectious diseases that are transmitted through allogeneic blood transfusions have been lessened by better screening techniques, there is still potential life threatening reactions and viral transmissions that may be avoided by comprehensive blood management in joint arthroplasty. PMID:15948435

  20. Dual mobility cups in total hip arthroplasty

    PubMed Central

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

    2014-01-01

    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

  1. Extensor mechanism allograft in total knee arthroplasty

    PubMed Central

    Helito, Camilo Partezani; Gobbi, Riccardo Gomes; Tozi, Mateus Ramos; Félix, Alessandro Monterroso; Angelini, Fábio Janson; Pécora, José Ricardo

    2013-01-01

    Objective To analyze the experience with allograft transplantation of the extensor mechanism in total knee arthroplasty and compare results with the international experience. Methods We retrospectively evaluated three cases of extensor mechanism allograft after total knee arthroplasty performed in our hospital with the aid of one of the few tissue banks in Brazil and attempt to establish whether our experiences were similar to others reported in the world literature regarding patient indication, techniques, and outcomes. Results Two cases went well with the adopted procedure, and one case showed bad results and progressed to amputation. As shown in the literature, the adequate tension of the graft, appropriate tibial fixation and especially the adequate patient selection are the better predictors of good outcomes. Previous chronic infection can be an unfavorable predictor. Conclusion This surgical procedure has precise indication, albeit uncommon, either because of the rarity of the problem or because of the low availability of allografts, due to the scarcity of tissue banks in Brazil. Level of Evidence IV, Case Series. PMID:24453688

  2. Footprint mismatch in lumbar total disc arthroplasty

    PubMed Central

    Michaela, Gstoettner; Denise, Heider; Liebensteiner, Michael

    2008-01-01

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

  3. Combined total gastrectomy, total esophagectomy, and D2 lymph node dissection with transverse colonic interposition for adenocarcinoma of the gastroesophageal junction.

    PubMed

    Butte, Jean M; Waugh, Enrique; Parada, Hugo; De La Fuente, Hernán

    2011-09-01

    The surgical treatment of adenocarcinoma of the gastroesophageal junction (GEJ) is complex. A large tumor involving a substantial portion of both the esophagus and stomach requires complete resection with negative proximal and distal margins as well as D2 lymph node dissection. Some investigators have found that patients who do not undergo radical resection have a worse prognosis; however, more aggressive surgical treatments are associated with increased morbidity and mortality. We describe our operative technique designed for complete resection of tumors of the GEJ. We used this technique to operate on nine patients, none of whom suffered anastomotic leakage or necrosis of the colonic interposition graft. PMID:21874440

  4. Preoperative lower limb venography in patients undergoing total hip arthroplasty.

    PubMed

    Chumas, P; O'Doherty, D P; Pearse, M; Magnussen, P; Crozier, A; Gregg, P J

    1988-01-01

    Using bilateral ascending venography, the authors examined 93 consecutive patients undergoing total hip arthroplasty for the presence of asymptomatic preoperative leg vein thrombosis. Radiologic abnormalities were seen in only four patients, and this was not statistically significant (P greater than .1). There were no complications from the procedure. It is suggested that routine preoperative screening for deep vein thrombosis prior to hip arthroplasty is unnecessary but may be appropriate in patients at particularly high risk for thromboembolic complications. PMID:3183676

  5. The Feasibility and Perioperative Complications of Outpatient Knee Arthroplasty

    Microsoft Academic Search

    Richard A. Berger; Sharat K. Kusuma; Sheila A. Sanders; Elizabeth S. Thill; Scott M. Sporer

    2009-01-01

    The duration of hospitalization and subsequent length of recovery after elective knee arthroplasty have decreased. We hypothesized\\u000a same-day discharge following either a unicompartmental (UKA) or total knee arthroplasty (TKA) in an unselected group of patients\\u000a would not result in a higher perioperative complication rate than standard-length hospitalization when following a comprehensive\\u000a perioperative clinical pathway, including preoperative teaching, regional anesthesia, preemptive

  6. Evaluating comorbidities in total hip and knee arthroplasty: available instruments

    Microsoft Academic Search

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

    2010-01-01

    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

  7. High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

    Microsoft Academic Search

    Andrew S. Neviaser; Charles Chang; Stephen Lyman; Alejandro Gonzales Della Valle; Steven B. Haas

    2010-01-01

    Pulmonary embolism (PE) complicates 1% to 10% of total joint arthroplasties and generally requires immediate anticoagulation.\\u000a Low-molecular-weight heparins have supplanted unfractionated heparin as the treatment of choice for PE and hold a 1A recommendation\\u000a from the American College of Chest Physicians for this indication. However, the complications of enoxaparin treatment begun\\u000a in close proximity to arthroplasty surgery are not well

  8. RETRACTED ARTICLE: Unicompartmental knee arthroplasty: a review of literature

    Microsoft Academic Search

    Bernardino Saccomanni

    2010-01-01

    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,

  9. Unicondylar knee arthroplasty in a patient with poliomyelitis.

    PubMed

    Middleton, Fiona R; Boardman, David R; Abbassian, Ali; Maurice, Hugh D

    2009-01-01

    Osteoarthritis in patients who have had poliomyelitis creates a significant challenge. The loss, or reduction of power in the quadriceps, combined with recurvatum and often patella baja can cause problems when considering total knee arthroplasty. The authors present the first case report of a unicondylar knee arthroplasty in such a patient. Functional knee scores improved, although some persistent degree of disability remained due to the preexisting poor muscle power. PMID:19327264

  10. Bleeding in Knee Arthroplasty: Age, Drained Volume, and Ischemia Time.

    PubMed

    Ares, Oscar; Seijas, Roberto; Sallent, Andrea; Popescu, Dragos; Lozano, Luis

    2014-08-27

    Drainages in primary knee arthroplasty remain unclear. Our aim is to analyze variables that may affect bleeding in knee arthroplasty (age, drained volume, and ischemia time). We included 188 knee arthroplasties, divided into three groups: conventional approach for total knee arthroplasty (TKA), minimally invasive total knee arthroplasty (MIS), and unicompartmental knee arthroplasty (UNI). Main variables analyzed for the present study were age, drained volume, and ischemia time. Other recorded variables were operated knee, pre- and postoperative hematocrit, diagnosis, comorbidities, and transfusions required. No relationship between age and drained volume was observed. However, patients younger than 70 years presented a major rate of survival curve bleeding. A statistically significant difference was found between drained volume in UNI in contrast to TKA and MIS. There was a significant relationship between time and bleeding at 24 hours postoperative, observing that the greater the bleeding, the longer it would keep bleeding (log-rank, p?

  11. The Influence of the Contralateral Knee Prior to Knee Arthroplasty on Post-Arthroplasty Function: The Multicenter Osteoarthritis Study

    PubMed Central

    Maxwell, Jessica; Niu, Jingbo; Singh, Jasvinder A.; Nevitt, Michael C.; Law, Laura Frey; Felson, David

    2013-01-01

    Background: Some of the poor functional outcomes of knee arthroplasty may be due to pain in the contralateral, unreplaced knee. We investigated the relationship between the preoperative pain status of the contralateral knee and the risk of a poor postoperative functional outcome in patients who underwent knee arthroplasty. Methods: We analyzed data on 271 patients in the Multicenter Osteoarthritis Study who had undergone knee arthroplasty since the time of enrollment. Eighty-six percent of these patients were white, 72% were female, and the mean age was sixty-seven years. The severity of pain in the knee contralateral to the one that was replaced was measured before the knee arthroplasty with use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale, with the scores being grouped into four categories (0, 1 to 4, 5 to 9, and 10 to 20). Poor post-arthroplasty function six months or more after surgery was determined with use of the Patient Acceptable Symptom State (PASS) outcome tool and a clinical performance measure of walking speed. We evaluated the relationship between contralateral pain severity and the functional outcomes with use of Poisson regression. Results: Seventy-two (27%) of 264 patients demonstrated poor post-arthroplasty function by failing to attain the threshold PASS score, and seventy-six (30%) of 250 subjects had a slow walking speed. As the pre-arthroplasty pain in the contralateral knee increased, there was a steady increase in the proportion with poor post-arthroplasty function (p < 0.0001 for PASS and p = 0.04 for slow walking speed). Compared with patients who had no pre-arthroplasty pain in the contralateral knee, those in the highest category of contralateral pain severity had 4.1 times the risk (95% confidence interval, 1.5 to 11.5) of having poor self-reported post-arthroplasty function. Patients in whom both knees had been replaced at the time of outcome collection were less likely to have poor self-reported function than those in whom only one knee had been replaced. Conclusions: Preoperative pain in the contralateral knee is strongly associated with self-reported post-arthroplasty functional outcome and may therefore be a useful indicator of prognosis or a potential target of perioperative intervention. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:23780536

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

    Microsoft Academic Search

    J. A. Singh; J. A. Sloan

    2008-01-01

    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;

  13. Evaluation of the painful total knee arthroplasty.

    PubMed

    Cercek, Robert; Bassett, Richard; Myerthall, Steve

    2015-04-01

    There are a substantial number of patients who continue to complain of pain following total knee arthroplasty (TKA). There are many potential causes of continued pain, and these are broadly categorized into intrinsic and extrinsic sources. When evaluating a patient with a painful TKA, the physician begins with a thorough history and physical examination, along with the appropriate radiographs. Further workup includes laboratory analysis, specifically evaluating the inflammatory markers erythrocyte sedimentation rate and C-reactive protein, along with a synovial fluid aspirate evaluating the white blood cell count with differential and culture. Advanced imaging modalities are sometimes helpful when the diagnosis remains unclear, including stress radiographs, live fluoroscopic imaging, ultrasound, nuclear imaging, and magnetic resonance imaging. Further surgery is not advisable without a clear diagnosis, as this is associated with very poor results. Instead, serial follow-up or a referral to a specialist for a second opinion may be most appropriate. PMID:25419834

  14. Total hip arthroplasty after rotational acetabular osteotomy.

    PubMed

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

    2015-03-01

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

  15. Robotic-assisted unicompartmental knee arthroplasty.

    PubMed

    Tamam, Cuneyt; Poehling, Gary G

    2014-12-01

    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

  16. [Total hip and knee arthroplasty for arthropathy in a hemophiliac].

    PubMed

    Takedani, H; Mikami, S; Abe, Y; Kin, H; Kawasaki, N

    2000-02-01

    We evaluated the medium-term follow-up results, effectiveness, and suitability of arthroplasty for hemophilic arthropathy. We performed 26 total knee and 9 total hip arthroplasty operations on hemophilic patients between 1988 and 1998 under general anesthesia and appropriate hemostatic management. Postoperative treatment for hemophilic arthropathy is the same as that for osteoarthritis and rheumatoid arthritis. After their operations, patients experienced relief from pain and intra-articular bleeding in affected joints but only marginal improvement in the range of motion. In general, total joint arthroplasty is not indicated for young patients. However, arthropathy can have a severe impact on the active life of patients during their youth. For severe hemophilic arthritis, total knee and hip arthroplasty can lead to a pain-free and improved quality of life. We believe total knee and hip arthroplasty is a good solutions for hemophiliac arthropathy before severe deformity occurs. Although treated relatively young hemophilic patients, age was not considered to be a contraindication. PMID:10723237

  17. Algorithm of physical therapy exercises following total hip arthroplasty.

    PubMed

    Stry?a, Wanda; Pogorza?a, Adam M; Rogala, Piotr; Nowakowski, Andrzej

    2013-01-01

    Authors present a set of exercises for patients after total hip replacement (THR) treated due to idiopathic hip joint osteoarthritis. Outcome of surgical treatment depends largely on physical therapy conducted after the procedure. Physical therapy following total hip arthroplasty involves restoration of proper physical function. Exercises increase the strength of hip girdle muscles and stabilize the involved hip joint. Total postoperative rehabilitation improves the gait esthetics. Restoring patient's full independence in everyday and professional life after total hip arthroplasty is the best test for properly conducted rehabilitation. A rehabilitation algorithm following hip arthroplasty was established based on the data acquired from literature and authors' own studies. Methods of rehabilitation following total arthroplasty was unified with regard to the type of endoprosthesis (cemented and non-cemented). Rehabilitation after revision and cancer arthroplasties were not taken into consideration. Exercises were divided into those performed in supine and standing positions as well as resistance training (using an elastic TheraBand® tape). At a later stage of rehabilitation, marching and walking as well as cycloergometer training were included. Patient's position during the day and in the sleep for two months following THR was taken into account, including some types of exercises that are contraindicated and pose a threat of endoprosthesis luxation. PMID:23306317

  18. Use of Oral Mucoperiosteal and Pterygo-Masseteric Muscle Flaps as Interposition Material in Surgery of Temporomandibular Joint Ankylosis: A Comparative Study

    PubMed Central

    Anyanechi, CE; Osunde, OD; Bassey, GO

    2015-01-01

    Background: The most common complication of surgery for the release of temporomandibular joint (TMJ) ankylosis is relapse of the ankylosis. To prevent re-ankylosis, a variety of interpositional materials have been used. Aim: The aim was to compare the surgical outcome of oral mucoperiosteal flap, not hitherto used as interpositional material, with pterygo-masseteric muscles flap after surgical release of TMJ ankylosis. Subjects and Methods: This was a prospective randomized study of all consecutive patients treated for the release of complete TMJ bony ankylosis, from January 2003 to December 2012, at the Oral and Maxillofacial unit of our institution. The patients were randomized into two groups: The pterygo-masseteric group comprises 22 patients while the oral mucoperiosteal group had 23 patients. Information on demographics, clinical characteristics, and postoperative complications over a 5 year follow-up period were obtained, and analyzed using the statistical package for social sciences (Statistical Package for the Social Sciences version 13, Chicago, IL, USA). A P < 0.05 was considered significant. Results: The age of the patients ranged from 15 to 28 mean 20.3 (3.35) years while the duration of ankylosis ranged from 2 to 16 mean 5.1 (3.4) years. The baseline demographic (gender; P = 0.92; side; P = 0.58) and clinical characteristics in terms of etiology (P = 0.60) and age (P = 0.52) were comparable in both treatment groups. All the patients presented with complete bony TMJ ankylosis with a preoperative inter-incisal distance of <0.5 cm. The intraoperative mouth opening achieved ranged from 4 cm to 5 cm, mean 4.6 (0.27) cm and this was not different for either group (P = 0.51). The patients were followed up postoperatively for a period ranging from 3 to 5 years, mean 3.4 (0.62) years. The mouth opening decreased, over the period of postoperative review, from the initial range of 4–5 cm to 2.9–3.6 cm, and this was not different in both groups (P = 0.18). Conclusion: This study suggests that oral mucoperiosteal flap could be an option in the choice of interpositional materials in surgery of TMJ ankylosis.

  19. Cementless revision for infection following total hip arthroplasty.

    PubMed

    Mitchell, Philip A; Masri, Bassam A; Garbuz, Donald S; Greidanus, Nelson V; Duncan, Clive P

    2003-01-01

    Eradication of chronic infection complicating total hip arthroplasty requires removal of all infected, devitalized and foreign tissue, including the arthroplasty components. Reimplantation into a sterile bed is the goal of treatment in most patients and successful reimplantation yields better functional results than excision arthroplasty. Reimplantation may be performed at the same stage as débridement as part of a single-stage procedure, using cemented components with antibiotic-loaded cement. Alternatively, a two-stage procedure may be performed so that the débridement and reimplantation are separated by a period of antibiotic delivery, both locally and systemically. The results of these treatment regimens and the rationale for cementless reconstruction at the second stage of a two-stage treatment protocol are important considerations in the treatment of periprosthetic infection. PMID:12690860

  20. Irreducible Fracture-dislocation of the Ankle Associated with Interposition of the Tibialis Posterior Tendon in the Syndesmosis: A Case Report.

    PubMed

    Lacasse, Jean-Simon; Laflamme, Melissa; Penner, Murray J

    2014-05-17

    Although ankle fracture-dislocations are common orthopedic injuries, it is very uncommon for them to be irreducible, and such cases require special attention. We report the case of a closed fracture-dislocation of the ankle in a 17-year-old male that required 3 surgeries because of persistent anterior subluxation of the talus on the postoperative radiographs. After advanced radiologic investigations, tibialis posterior tendon interposition in the syndesmosis was identified as the cause of the subluxation. This is a very rare event, reported in only 5 patients in published studies. Once the diagnosis was identified by magnetic resonance imaging, the tendon was relocated to its anatomic position, and the tibiofibular and tibiotalar joints were reduced adequately. The patient was then able to regain a satisfactory level of function many months after the initial trauma. PMID:24846161

  1. Can Tantalum Cones Provide Fixation in Complex Revision Knee Arthroplasty?

    Microsoft Academic Search

    Paul F. Lachiewicz; Michael P. Bolognesi; Robert A. Henderson; Elizabeth S. Soileau; Thomas Parker Vail

    Background  The best method for managing large bone defects during revision knee arthroplasty is unknown. Metaphyseal fixation using porous\\u000a tantalum cones has been proposed for severe bone loss. Whether this approach achieves osseointegration with low complication\\u000a rates is unclear.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We therefore asked: (1) What is the risk of infection in revision knee arthroplasty with large bone defects reconstructed\\u000a with porous tantalum

  2. Incidence of dysphagia comparing cervical arthroplasty and ACDF

    PubMed Central

    Segebarth, Brad; Datta, Jason C.; Darden, Bruce; Janssen, Michael E.; Murrey, Daniel B.; Rhyne, Alfred; Beckham, Ruth; Ponce, Caroline

    2010-01-01

    Study design Retrospective cohort from randomized prospective clinical trial. Objective Evaluate incidence of dysphagia between instrumented ACDF and a no-profile cervical disc arthroplasty. Summary of background data Dysphagia is a well-known complication following anterior cervical discectomy and fusion (ACDF) and the etiology is multifactorial. One potential source for postoperative dysphagia involves the anterior profile of the implant used. Hence, a no-profile cervical disc arthroplasty could theoretically have fewer soft tissue adhesions and a lower incidence of dysphagia. The purpose of this study is to compare the incidence of dysphagia at least 1 year postoperatively following ACDF with anterior plating and a no-profile cervical disc arthroplasty. Methods A cohort of 87 patients meeting the inclusion criteria for the prospective, randomized, multicenter IDE trial of ProDisc-C versus ACDF were evaluated for dysphagia. Forty-five patients were randomized to receive cervical arthroplasty and 42 patients were randomized to the ACDF and plate group. The Bazaz-Yoo dysphagia questionnaire was administered in a blinded fashion after completion of at least 12 months follow-up. Results Follow-up averaged 18.2 months and included 76 (87%) of the 87 enrolled, with 38 of the original 45 in the arthroplasty group and 38 of the original 42 in the ACDF group. Six of 38 (15.8%) in the arthroplasty group versus 16 of 38 (42.1%) in the ACDF group reported ongoing dysphagia complaints. This was found to be statistically significant (P = .03). Conclusion This study suggests a significantly lower rate of dysphagia with a no-profile cervical disc arthroplasty compared to instrumented ACDF for single level disc disease between C3-7. Though there are many potential etiologies, we hypothesize this is related to the lack of anterior hardware in the retropharyngeal space. Operative technique, operating time, and significant midline retraction did not seem to result in more dysphagia complaints. Future studies comparing cervical disc arthroplasty and no-profile fusion devices may help delineate the effect that anterior instrumentation profile has on postoperative dysphagia.

  3. Emerging technologies in arthroplasty: additive manufacturing.

    PubMed

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

    2014-06-01

    Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future. PMID:24764230

  4. Patellar malalignment treatment in total knee arthroplasty

    PubMed Central

    Gasparini, Giorgio; Familiari, Filippo; Ranuccio, Francesco

    2013-01-01

    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. PMID:25606506

  5. Navigated versus conventional total knee arthroplasty.

    PubMed

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

    2014-06-01

    Computer-aided navigation in total knee arthroplasty (TKA) promises improved alignment, performance, and survivorship. Previous meta-analyses demonstrated that navigation yields better component alignment; however, they did not discuss other indicators of performance. This meta-analysis compares navigated (NAV) and conventional (CONV) TKAs and includes clinical outcomes and adverse events. Forty-seven studies (22 randomized trials) of varying methodological quality involving 7,151 TKAs created the sample population. Statistical analyses included analysis of variance of weighted means and random effects modeling. As seen in previous meta-analyses, NAV is favored over CONV TKA. Analysis of surgical characteristics found that length of surgery and tourniquet times were lower for CONV, but not significant. Meta-analysis found that tourniquet times favored CONV but not a strong relationship for length of surgery. Analysis of individual adverse events did not reveal any significant differences. However, when examining adverse events in their totality, the NAV experienced significantly fewer complications. TKA performed with imageless navigation improves component alignment, provides for lower blood loss, improves clinical outcomes as measured by Knee Society and WOMAC scores, and has fewer total adverse events. Published data are insufficient to determine any correlations between component alignment and outcomes. PMID:24234551

  6. Instability in primary total knee arthroplasty.

    PubMed

    Del Gaizo, Daniel J; Della Valle, Craig J

    2011-09-01

    Instability is one of the most common causes of failure of total knee arthroplasty (TKA). The presentation can vary from pain to frank dislocation with the etiologies just as varied. Instability after TKA can be classified by where the instability occurs in the knee's arc of motion as well as the chronicity of the problem. Acute instability is related to intraoperative injuries or excessive release of important coronal stabilizers such as the medial collateral ligament in extension or the posterolateral corner in flexion. Chronic instability in extension is often related to varus/valgus malalignment. Chronic instability in flexion can be related to an undersized femoral component, excessive tibial slope, or excessive elevation of the joint line affecting the isometry of the collateral ligaments in midflexion. Recurvatum instability is a rare complication that often coincides with extensor mechanism dysfunction or neuromuscular disorders. When addressing instability after TKA, it is critical to determine the root cause of the problem as well as evaluate for other causes of pain such as infection or aseptic loosening. When revision surgery is warranted, it should follow the basic principles of restoring a neutral mechanical alignment, setting the appropriate component rotation, balancing the flexion and extension spaces, and restoring the height of the native joint line. PMID:21902150

  7. Total knee arthroplasty in patients with poliomyelitis.

    PubMed

    Tigani, D; Fosco, M; Amendola, L; Boriani, L

    2009-12-01

    We performed a retrospective chart and radiograph review of 10 patients with a history of poliomyelitis involving a limb that subsequently underwent primary total knee arthroplasty between 2000 and 2008. One posterior stabilized (PS), two condylar constrained (CCK), and seven rotating hinge (RHK) prostheses belonging to the same system were implanted. Eight patients were followed for a minimum of 2 years (mean 4.3 years, range 2 to 8.5 years); one patient required revision for prosthesis infection. The last patient was followed for just six months reporting excellent pain relief, and without complications. American Knee Society Score (AKSS) improved postoperatively in all eight patients with at least 2 years follow-up. The improvement was more marked for the knee score, which increased from a mean of 37 points preoperatively (range 20 to 51) to 75.7 points postoperatively (range 50 to 92); for the functional score the mean increase was only 15.8 points, from a mean of 38.5 points (range 20 to 70) to 54.3 points (range 20 to 80) after the intervention. One patient had a recurrence of the recurvatum deformity after implanting a CCK prosthesis. We found that a rotating hinge prosthesis that allowed hyperextension was suitable treatment for patients with knee osteoarthritis and polio as this compensated for loss of quadriceps power. PMID:19443223

  8. Cold compressive dressing after total knee arthroplasty.

    PubMed

    Healy, W L; Seidman, J; Pfeifer, B A; Brown, D G

    1994-02-01

    The efficacy of a cold compressive dressing after total knee arthroplasty (TKA) was prospectively studied in 105 knees in 76 patients. All components were cemented. All patients were placed in continuous passive motion machines after operation. A cold compressive Cryocuff dressing was applied to 50 knees after operation. An ACE wrap and ice pack were applied to the knees of 55 control patients after operation. Postoperative range of motion was recorded as maximum active flexion at two to four days (interval one), at seven to 14 days (interval two), and four to six weeks (interval three). Swelling was measured at the same time intervals by circumference at the midpatella and circumference at the distal thigh one inch proximal to the superior pole of the patella. Use of postoperative narcotics was calculated for postoperative days zero to three and for postoperative days four to seven. Wound drainage was recorded for all knees. The use of a cold compressive dressing after TKA was not associated with an increase in range of motion at any point after the operation. The Cryocuff dressing did not appreciably reduce swelling around the knee after TKA. No significant difference was found in the amount of postoperative wound drainage between the two groups of patients. In patients undergoing unilateral TKA, no significant difference existed between the narcotic requirements of control patients and patients wearing the cold compressive dressing. PMID:7907012

  9. The need for surgical revision after isolated valenti arthroplasty for hallux rigidus: a systematic review.

    PubMed

    Roukis, Thomas S

    2010-01-01

    Isolated Valenti arthroplasty has been proposed for treatment of moderate to severe hallux rigidus because of the perceived safety and efficacy. Furthermore, it has been proposed that undergoing isolated Valenti arthroplasty does not prevent the ability to perform revision surgery consisting of Keller resection arthroplasty, prosthetic implant arthroplasty, or arthrodesis. The author undertook a systematic review of electronic databases and other relevant sources to identify material relating to the need for surgical revision after isolated Valenti arthroplasty for hallux rigidus. Information from peer-reviewed journals as well as non-peer-reviewed publications, abstracts, and posters was 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 Valenti arthroplasty, if they evaluated patients in person at mean follow-up > or = 12 months' duration, and if they included details of complications after Valenti arthroplasty requiring surgical intervention. Three studies involving isolated Valenti arthroplasty were identified that met the inclusion criteria. Therefore, a total of 44 isolated Valenti arthroplasties were identified that met the inclusion criteria, with 2 (4.6%) undergoing surgical revision in the form of Keller resection arthroplasty (n = 1) and 1 plantarflexory base osteotomy (n = 1). No studies provided detailed information regarding complications specific to the exact grade of hallux rigidus in patients who underwent isolated Valenti arthroplasty. The results of this systematic review make clear the low incidence of revision surgery required after isolated Valenti arthroplasty for hallux rigidus. However, there is still a need for methodologically sound prospective cohort studies that focus on the use of isolated Valenti arthroplasty for specific grades of hallux rigidus and compare this procedure with other accepted forms of surgical treatment for moderate to severe hallux rigidus. PMID:20350824

  10. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    PubMed Central

    2006-01-01

    Executive Summary Objective The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Clinical Need Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. The Technology Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a conventional THR with a small (28 mm) ball. First, the large femoral head reduces the chance of dislocation, so that rates of dislocation are less than those with conventional THR. Second, the range of motion with hip resurfacing arthroplasty is higher than that achieved with conventional THR. A variety of MOM hip resurfacing implants are used in clinical practice. Six MOM hip resurfacing implants have been issued licences in Canada. Review Strategy A search of electronic bibliographies (OVID Medline, Medline In-Process and Other Non-Indexed Citations, Embase, Cochrane CENTRAL and DSR, INAHTA) was undertaken to identify evidence published from Jan 1, 1997 to October 27, 2005. The search was limited to English-language articles and human studies. The literature search yielded 245 citations. Of these, 11 met inclusion criteria (9 for effectiveness, 2 for safety). The result of the only reported randomized controlled trial on MOM hip resurfacing arthroplasty could not be included in this assessment, because it used a cemented acetabular component, whereas in the new generation of implants, a cementless acetabular component is used. After omitting this publication, only case series remained. Summary of Findings   Health Outcomes The Harris hip score and SF-12 are 2 measures commonly used to report health outcomes in MOM hip resurfacing arthroplasty studies. Other scales used are the Oxford hip score and the University of California Los Angeles hip score. The case series showed that the mean revision rate of MOM hip resurfacing arthroplasty is 1.5% and the incidence of femoral neck fracture is 0.67%. Across all studies, 2 cases of osteonecrosis were reported. Four studies reported improvement in Harris hip scores. However, only 1 study reported a statistically significant improvement. Three studies reported improvement in SF-12 scores, of which 2 reported a significant improvement. One study reported significant improvement in UCLA hip score. Two studies reported postoperative Oxford hip scores, but no preoperative values were reported. None of the reviewed studies r

  11. The Otto Aufranc Award: Demineralized Bone Matrix Around Porous Implants Promotes Rapid Gap Healing and Bone Ingrowth

    Microsoft Academic Search

    Letitia Lim; J. Dennis Bobyn; Kristian M. Bobyn; Louis-Philippe Lefebvre; Michael Tanzer

    Background  Noncemented revision arthroplasty is often complicated by the presence of bone implant gaps that reduce initial stability\\u000a and biologic fixation. Demineralized bone matrix has osteoinductive properties and therefore the potential to enhance gap\\u000a healing and porous implant fixation.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We determined at what times and to what extent demineralized bone matrix promotes gap healing and bone ingrowth around a porous\\u000a implant.

  12. Paraneoplastic Clostridium septicum Infection of a Total Knee Arthroplasty

    Microsoft Academic Search

    Colin D. C. Burnell; Thomas R. Turgeon; David R. Hedden; Eric R. Bohm

    2011-01-01

    We describe a case of a well-functioning total knee arthroplasty acutely infected with Clostridium septicum. This is the first reported infection of a prosthetic joint with this organism. A search for the source of this infection uncovered a colonic malignancy. This organism is highly associated with gastrointestinal malignancy, and appropriate investigation should be carried out when it is discovered. The

  13. Patients' expectations and satisfaction with total hip arthroplasty

    Microsoft Academic Search

    Carol A. Mancuso; Eduardo A. Salvati; Norman A. Johanson; Margaret G. E. Peterson; Mary E. Charlson

    1997-01-01

    Although there have been many studies focusing on the increasingly important assessment of patients' satisfaction, few studies have specifically addressed this issue for total hip arthroplasty (THA). The goals of this study were to measure patients' satisfaction with THA and to evaluate the relationships of expectations and outcome to patients' satisfaction. A total of 180 patients were surveyed 2 to

  14. Prevention of Venous Thromboembolism After Hip or Knee Arthroplasty

    Microsoft Academic Search

    Frederick A. Anderson; Wei Huang; Richard J. Friedman; Louis M. Kwong; Jay R. Lieberman; Vincent D. Pellegrini

    A survey was mailed to a representative sample of US orthopedic surgeons to assess protocols for the prevention of venous thromboembolism after lower extremity total joint arthroplasty. Practices were examined by type of operation, annual surgical volume, and opinions of consensus guidelines issued by the American Academy of Orthopaedic Surgeons and the American College of Chest Physicians. Although there was

  15. Effect of total hip arthroplasty on cardiovascular fitness

    Microsoft Academic Search

    Michael D. Ries; Edward F. Philbin; Gerald D. Groff; Karen A. Sheesley; Jonathan A. Richman; Franklin Lynch

    1997-01-01

    Thirty patients who underwent total hip arthroplasty and 18 patients with medically treated arthritis participated in this study. Both groups of patients underwent a cardiovascular fitness exercise test on entering the study and 6 months, 1 year, and 2 years later. Fitness was assessed by patient performance on a graded maximal exercise test using a bicycle ergometer and metabolic cart.

  16. Severe metallosis after total elbow arthroplasty-a case report.

    PubMed

    Sayed-Noor, Arkan S; Sjödén, Göran O

    2010-03-01

    We present a case of severe metallosis after total elbow arthroplasty in a female patient presenting with manifestations resembling a septic loosening. We discuss the clinical and the operative findings as well as the outcome of this uncommon complication. A review of the literature regarding the pathogenesis, radiographic appearance, and management of metallosis in prosthetic joints is presented. PMID:19444525

  17. Metallosis in revision total elbow arthroplasty. Complications and staging method.

    PubMed

    Degreef, Ilse; Sciot, Raf; De Smet, Luc

    2008-12-01

    Although total elbow arthroplasty is a reliable treatment method for the arthritic joint, revision is necessary if loosening, instability, wear, fracture or infection occurs. We report 12 patients with 19 months (10-29) follow-up after revision arthroplasty for painful loosening in six cases, periprosthetic fracture in three, gross instability in one and skin perforation with possible infection in two. All cases presented with severe metallosis. Fractures were seen in four, triceps insufficiency in three and skin perforation in two. All patients were treated with exchange arthroplasty using the Coonrad-Morrey prosthesis. Three patients had in addition strut-allografting. The two patients with skin perforation and possible infection had a staged procedure. Mayo Elbow Performance Score improved from 24 to 87 with uneventful healing, fracture consolidation and allograft incorporation. At follow-up, triceps insufficiency persisted in all three cases. Transient neuropathy was present in five patients (4 ulnar, 1 radial). Metallosis in total elbow arthroplasty may be associated with severe tissue damage. A staging method is presented. PMID:19205321

  18. Sporting and physical activity following Oxford medial unicompartmental knee arthroplasty

    Microsoft Academic Search

    N. Fisher; M. Agarwal; S. F. Reuben; D. S. Johnson; P. G. Turner

    2006-01-01

    The purpose of this study was to evaluate and assess the sporting and physical activities of patients who had undergone an Oxford medial unicompartmental knee arthroplasty (UKA). Seventy-six patients who underwent a UKA between 2000 and 2003 were reviewed. Demographic data such as age, sex and comorbidities were recorded. University of California Los Angeles (UCLA) activity level ratings and Oxford

  19. Periprosthetic fractures of the femur after total knee arthroplasty

    PubMed Central

    McGraw, Phil

    2010-01-01

    Periprosthetic fracture following total knee arthroplasty is a potentially serious complication. This injury can involve the distal femur, proximal tibia or the patella. This review article analyzes the prevalence, risk factors, classification and treatment options for periprosthetic fractures of the femur. PMID:20661762

  20. Operative stabilization of supracondylar femur fractures above total knee arthroplasty

    Microsoft Academic Search

    Peter L Althausen; Mark A Lee; Christopher G Finkemeier; John P Meehan; Juan J Rodrigo

    2003-01-01

    Periprosthetic fractures of the distal femur above a total knee arthroplasty present a challenging surgical problem for orthopedic surgeons. Numerous operative and nonoperative treatment options exist including casting, Rush rods, supracondylar nails, and plate fixation. Potentially significant complications are associated with all current treatment alternatives. Plate or nail constructs frequently achieve limited distal fixation, leading to loss of fixation and

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

    PubMed

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

    2014-11-01

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

  2. Infection after primary total hip arthroplasty.

    PubMed

    Lindeque, Bennie; Hartman, Zach; Noshchenko, Andriy; Cruse, Margaret

    2014-04-01

    The number of primary total hip arthroplasties (THAs) performed in the United States each year continues to climb, as does the incidence of infectious complications. The changing profile of antibiotic-resistant bacteria has made preventing and treating primary THA infections increasingly complex. The goal of this review was to summarize (1) the published data concerning the risk of surgical site infection (SSI) after primary THA by type of bacteria and (2) the effect of potentially modifying factors. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, Web of Science, and PubMed were searched. Studies dated between 2001 and 2011 examining primary THA in adults were included. Meta-analysis of the collected data was performed. The pooled SSI rate was 2.5% (95% confidence interval [Cl], 1.4%-4.4%; P<.001; n=28,883). The pooled deep prosthetic joint infection (PJI) rate was 0.9% (95% Cl, 0.4%-2.2%; P<.001; n=28,883). The pooled rate of methicillin-resistant Staphylococcus aureus SSI was 0.5% (95% Cl, 0.2%-1.5%; P<.001; n=26,703). This is approximately 20% of all SSI cases. The pooled rate of intraoperative bacterial wound contamination was 16.9% (95% Cl, 6.6%-36.8%; P=.003; n=2180). All these results had significant heterogeneity. The postoperative risk of SSI was significantly associated with intraoperative bacterial surgical wound contamination (pooled rate ratio, 2.5; 95% Cl, 1.4%-4.6%; P=.001; n=19,049). PMID:24762833

  3. Future Bearing Surfaces in Total Hip Arthroplasty

    PubMed Central

    2014-01-01

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

  4. Periprosthetic Bone Remodelling in Total Knee Arthroplasty

    PubMed Central

    GEORGEANU, Vlad; ATASIEI, Tudor; GRUIONU, Lucian

    2014-01-01

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

  5. L5 – S1 Segmental Kinematics After Facet Arthroplasty

    PubMed Central

    Voronov, Leonard I.; Havey, Robert M.; Rosler, David M.; Sjovold, Simon G.; Rogers, Susan L.; Carandang, Gerard; Ochoa, Jorge A.; Yuan, Hansen; Webb, Scott

    2009-01-01

    Background Facet arthroplasty is a motion restoring procedure. It is normally suggested as an alternative to rigid fixation after destabilizing decompression procedures in the posterior lumbar spine. While previous studies have reported successful results in reproducing normal spine kinematics after facet replacement at L4-5 and L3-4, there are no data on the viability of facet replacement at the lumbosacral joint. The anatomy of posterior elements and the resulting kinematics at L5-S1 are distinctly different from those at superior levels, making the task of facet replacement at the lumbosacral level challenging. This study evaluated the kinematics of facet replacement at L5-S1. Methods Six human cadaveric lumbar spines (L1-S1, 46.7 ± 13.0 years) were tested in the following sequence: (1) intact (L1-S1), (2) complete laminectomy and bilateral facetectomy at L5-S1, and (3) implantation of TFAS-LS (Lumbosacral Total Facet Arthroplasty System, Archus Orthopedics, Redmond, Washington) at L5-S1 using pedicle screws. Specimens were tested in flexion (8Nm), extension (6Nm), lateral bending (LB, ± 6Nm), and axial rotation (AR, ± 5Nm). The level of significance was ? = .017 after Bonferroni correction for three comparisons: (1) intact vs. destabilized, (2) destabilized vs. reconstructed, and (3) intact vs. reconstructed. Results Laminectomy-facetectomy at L5-S1 increased the L5-S1 angular range of motion (ROM) in all directions. Flexion-extension (F-E) ROM increased from 15.3 ± 2.9 to 18.7 ± 3.5 degrees (P < .017), LB from 8.2 ± 1.8 to 9.3 ± 1.6 degrees (P < .017), and AR from 3.7 ± 2.0 to 5.9 ± 1.8 degrees (P < .017). The facet arthroplasty system decreased ROM compared to the laminectomy-facetectomy condition in all tested directions (P < .017). The facet arthroplasty system restored the L5-S1 ROM to its intact levels in LB and AR (P > .017). F-E ROM after the facet arthroplasty system implantation was smaller than the intact value (10.1 ± 2.2 vs. 15.3 ± 2.9 degrees, P < .017). The load-displacement curves after the facet arthroplasty system implantation at L5-S1 were sigmoidal, and quality of motion measures were similar to intact, demonstrating graded resistance to angular motion in F-E, LB and AR. Conclusions The facet arthroplasty system was able to restore stability to the lumbosacral segment after complete laminectomy and bilateral facetectomy, while also allowing near-normal kinematics in all planes. While F-E ROM after the facet arthroplasty system implantation was smaller than the intact value, it was within the physiologic norms for L5-S1. These results are consistent with previous studies of facet arthroplasty at L3-L4 and L4-L5 and demonstrate that TFAS technology can be adapted to the lumbosacral joint with functionality comparable to its application in superior lumbar levels.

  6. Inception report and Gap analysis

    E-print Network

    Inception report and Gap analysis Boiler inspection Riga, June 2004 #12;Inception report and gap............................................................................... 4 2.1 INSTITUTIONAL GAPS........................................................................................................................ 4 2.3 TECHNICAL GAP

  7. Gracilis muscle interposition with primary rectal without urethral repair for moderate sized rectourethral fistula caused by brachytherapy for prostate cancer: a case report

    PubMed Central

    2012-01-01

    Introduction There is a 0.16% chance of a rectourethral fistula after prostate brachytherapy monotherapy using Palladium-103 or Iodine-125 implants. We present an unusual case report of a rectourethral fistula following brachyradiotherapy monotherapy for prostate adenocarcinoma. It was also associated with unusual management of the fistula. Case presentation A 58-year-old Caucasian man underwent brachyradiotherapy monotherapy as definitive treatment for verified intracapsular prostate adenocarcinoma receiving 56 Iodine-125 implants using a transrectal ultrasound-guided technique. The patient started to complain of severe perineal pain and mild rectal bleeding 15Â months after brachyradiotherapy. A biopsy of mucosa of his anterior rectal wall was performed. A moderate sized rectourethral fistula was confirmed 23Â months after implantation of Iodine-125 seeds. Laparoscopic sigmoidostomy and suprapubic cystostomy were then performed. Long-term cortisone applications in combination with 30 sessions of hyperbaric oxygen therapy, and antibacterial therapies were initiated due to necrotic infection. A gracilis muscle interposition to create a partition between the patient's rectum and urethra in conjunction with primary rectal repair but without urethral repair were performed 6 months later. The 3cm rectal defect was repaired via a 3cm-long horizontal perineal incision. The 1.5cm urethral defect just below the prostate was not repaired. The patient underwent an optic internal urethrotomy 3Â months later for a 1.5cm-long urethral stricture. Several planned preventive urethral buginages were performed to avoid urethral stricture recurrence. At 12Â months postoperatively, there were no signs of a fistula and cancer recurrence. He now has a normal voiding and anal continence. Conclusion Severe rectal pain, bleeding, and local anterior necrotic proctitis are predictors of a rectourethral fistula. Urinary and fecal diversion is the first-step operation. Gracilis muscle interposition in conjunction with primary rectal repair but without urethral reconstruction is one of the reconstructive surgery options for moderate 2cm to 3cm rectourethral fistulas. Internal urethrotomy is a procedure for postoperative urethral strictures of 1.5cm in length. PMID:23009550

  8. Results of an Initial Experience with Custom-fit Positioning Total Knee Arthroplasty in a Series of 48 Patients

    E-print Network

    Results of an Initial Experience with Custom-fit Positioning Total Knee Arthroplasty in a SeriesD ORTHOPEDICS 2008; 31:857 September 2008 The custom-fit approach to total knee arthroplasty in conjunction outcome. Total knee arthroplasty (TKA) restores a significant degree of function, especially for the low

  9. Navigation-Assisted Total Knee Arthroplasty for Osteoarthritis with Extra-Articular Femoral Deformity and/or Retained Hardware

    PubMed Central

    Egawa, Hiroshi; Goto, Tomohiro; Takasago, Tomoya; Takai, Michihiro; Hirano, Tetsuya; Kawasaki, Yoshiteru; Yasui, Natsuo

    2013-01-01

    Total knee arthroplasty (TKA) for osteoarthritis (OA) patients with extra-articular deformity is still challenging because angular deformity, canal sclerosis, or the retained hardware that precludes the use of the traditional intramedullary guide. In addition, atypical bone cut for intra-articular correction leads to imbalanced soft tissue gap. Furthermore, corrective osteotomy should be considered for severe deformity or para-articular deformity cases. Recently, navigation-assisted TKA has been reported to increase the accuracy of prosthetic positioning and limb alignment. This system can calculate mechanical axis regardless of extra-articular deformity, canal sclerosis, or retained hardware. Accordingly, navigation surgery has been considered to be a powerful option especially in TKAs with extra-articular deformity cases. Here, we report 3 successful navigation-assisted TKAs for osteoarthritis with extra-articular deformities and/or retained hardware. Navigation-assisted TKA is an effective and reliable alternative for patients with extra-articular deformities. PMID:24191210

  10. Metal-on-Metal Hip Resurfacing Arthroplasty

    PubMed Central

    Sehatzadeh, S; Kaulback, K; Levin, L

    2012-01-01

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

  11. Sciatic neuropathy secondary to total hip arthroplasty wear debris.

    PubMed

    Fischer, S R; Christ, D J; Roehr, B A

    1999-09-01

    Sciatic neuropathy after total hip arthroplasty can result from several causes. We present a case in which a large cystic mass developed around a failed total hip arthroplasty. The lesion extended through the greater sciatic notch and into the pelvis producing sciatic nerve compression. The diagnosis was delayed, and the patient underwent a laminectomy without relief of symptoms before an abdominopelvic computed tomography (CT) scan revealed the mass. After revision of the components and excision of the accessible portion of the lesion, the symptoms improved. Resolution of the intrapelvic portion of the mass was demonstrated on follow-up CT scan, suggesting that retroperitoneal resection of this type of lesion may not be required at the time of revision of the components. PMID:10512454

  12. In vivo determination of total knee arthroplasty kinematics

    SciTech Connect

    Komistek, Richard D [ORNL; Mahfouz, Mohamed R [ORNL; Bertin, Kim [Utah Bone & Joint Center, Salt Lake City, Utah (USA); Rosenberg, Aaron [Rush-Presbyterian-St. Luke's Med Center, Chicago IL (USA); Kennedy, William [Kennedy-White Orthopaedic Center, Sarasota, FL (USA)

    2008-01-01

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

  13. Haematogenous infection of a total knee arthroplasty with Klebsiella pneumoniae

    PubMed Central

    Pepke, Wojciech; Lehner, Burkhard; Bekeredjian-Ding, Isabelle; Egermann, Marcus

    2013-01-01

    This case report describes a prosthetic joint infection due to the haematogenous spread of Klebsiella pneumoniae from a genitourinary focus. Prior to the infection, the patient was diagnosed with early stage prostatic carcinoma, which had been successfully treated with surgery. However, in the time period following surgical treatment, the patient suffered recurring urinary tract infections. During the course of these recurring infections, he developed a concurrent bacterial infection of his total knee arthroplasty. Two sequential joint aspirates revealed K pneumoniae to be the cause. Therefore, two-stage revision total knee arthroplasty was performed. This case reiterates the fact that invasive therapeutic procedures can cause bacteraemia resulting in infection of a joint replacement. We would therefore like to emphasise the importance of prophylactic antibiotic treatment prior to invasive therapies, particularly in organs with potentially large counts of bacteria. PMID:23592813

  14. A computerized system for radiographical evaluation in total hip arthroplasty.

    PubMed

    Cianci, R; Baruffaldi, F; Fabbri, F; Affatato, S; Toni, A; Giunti, A

    1995-04-01

    In the field of orthopaedic surgery radiographical image evaluation is frequently used to determine possible pathological processes. For total hip arthroplasty in particular, it is important to evaluate both preoperative femoral morphology and post-operative prosthesis performance in terms of bone adhesion to the implant and, consequently, loosening or stability of prosthesis components. References to a method called Roentgen stereophotogrammetric analysis (RSA) exist in the literature; however, the authors note that this method is expensive and requires the insertion of markers during the operation. Here we present an alternative computerized method for radiographical evaluation which we call radiographical evaluation system in total hip arthroplasty (RESTHA). The accuracy and the repeatability of the method have been evaluated using a medium-sized pelvis-femur system made of composite material. A mean error of +/- 2 mm has been associated to each experimental point. A post-operative inquiry case study is presented to indicate the applicability of the method. PMID:7656557

  15. Biomechanical consequences of patellar component medialization in total knee arthroplasty.

    PubMed

    Anglin, Carolyn; Brimacombe, Jill M; Wilson, David R; Masri, Bassam A; Greidanus, Nelson V; Tonetti, Jérôme; Hodgson, Antony J

    2010-08-01

    The optimal amount of patellar component medialization in knee arthroplasty is unknown. We measured the impact, on patellofemoral kinematics and contact force distribution, of 0.0-, 2.5-, and 5.0-mm patellar component medialization in 7 cadaveric specimens implanted with knee arthroplasty components. The knees were flexed dynamically in a weight-bearing rig. Medialization led to lateral shift of the patellar bone, slight medial shift of the patellar component in the femoral groove, lateral tilt of the patella, reduced patellofemoral contact force in later flexion, and lateral shift of the center of pressure in early flexion. Effects on shift and tilt were proportional to the amount of medialization. As a result of this investigation, we recommend medializing the patellar component slightly-on the order of 2.5 mm. PMID:19643568

  16. Extensively coated cementless femoral components in revision hip arthroplasty.

    PubMed

    Greidanus, N; Antoniou, J; Paprosky, W

    2000-01-01

    A septic loosening and osteolysis can compromise the available host bone in patients requiring revision hip arthroplasty. Secure fixation of revision femoral components may not be possible if reliant only on proximal femoral bone for biologic fixation or cement interdigitation. The challenge for the revision arthroplasty surgeon is to find the best method to secure the implant in a femur with deficient bone proximally that will provide stability for load bearing and motion. In addition to providing stability, the implant must be durable and maintain long-term fixation. With over 16 years of experience with fully porous coated femoral revision implants, we have found that maximizing prosthetic-bone fit in the proximal femoral diaphyseal bone provides reliable long-term fixation in the majority of femoral revision cases. PMID:21136415

  17. Extensively Coated Cementless Femoral Components in Revision Hip Arthroplasty.

    PubMed

    Greidanus, Nelson; Antoniou, John; Paprosky, Wayne

    2000-10-01

    A septic loosening and osteolysis can compromise the available host bone in patients requiring revision hip arthroplasty. Secure fixation of revision femoral components may not be possible if reliant only on proximal femoral bone for biologic fixation or cement interdigitation. The challenge for the revision arthroplasty surgeon is to find the best method to secure the implant in a femur with deficient bone proximally that will provide stability for load bearing and motion. In addition to providing stability, the implant must be durable and maintain long-term fixation. With over 16 years of experience with fully porous coated femoral revision implants, we have found that maximizing prosthetic-bone fit in the proximal femoral diaphyseal bone provides reliable long-term fixation in the majority of femoral revision cases. PMID:12219307

  18. Learning curve for the anterior approach total hip arthroplasty.

    PubMed

    Goytia, Robin N; Jones, Lynne C; Hungerford, Marc W

    2012-01-01

    The anterior approach to total hip arthroplasty has the advantages of using intermuscular and internervous planes, but it is technically demanding. We evaluated the learning curve for this approach with regard to operative parameters and immediate outcomes. From November 2005 through May 2007, 73 patients underwent 81 consecutive primary anterior-approach total hip arthroplasties. We grouped the hips into three consecutive groups of 20 and one of 21, and surgical and fluoroscopy times, estimated blood loss, intraoperative and postoperative complications, patient comorbidities, component position, and leg-length discrepancy were compared (statistical significance, p < 0.05). Comparing Groups 1 and 4, there were only two significant differences: operative time, 124 to 98 minutes, respectively, and estimated blood loss, 596 to 347 mL, respectively. Proficiency improved after Group 2 (40 cases) and was more marked after Group 3 (60 cases), with no major complications. Surgeons considering this approach should expect a substantial learning period. PMID:22995355

  19. Conversion of a Surgical Elbow Arthrodesis to Total Elbow Arthroplasty

    PubMed Central

    Rog, Dominik; Zuckerman, Lee M.; Riedel, Barth

    2015-01-01

    Arthrodesis of the elbow joint addresses pain due to intra-articular pathology, but with significant functional limitations. Loss of motion at the elbow is not completely compensated by the wrist and shoulder joints and elbow fusion is thus purely a salvage procedure. Advances in joint arthroplasty have allowed surgeons to address the functional limitations of arthrodesis, but despite these advances the elbow is still one of the joint replacements with higher complication rate. Conversion of a joint fusion to arthroplasty has been reported for the hip, knee, shoulder, and ankle. The takedown of a surgically fused elbow was reported in German literature in 2013. We present the first such case report in the English literature with a 49-year-old male whose status is elbow fusion performed for trauma 31 years prior.

  20. Conversion of a surgical elbow arthrodesis to total elbow arthroplasty.

    PubMed

    Rog, Dominik; Zuckerman, Lee M; Riedel, Barth

    2015-01-01

    Arthrodesis of the elbow joint addresses pain due to intra-articular pathology, but with significant functional limitations. Loss of motion at the elbow is not completely compensated by the wrist and shoulder joints and elbow fusion is thus purely a salvage procedure. Advances in joint arthroplasty have allowed surgeons to address the functional limitations of arthrodesis, but despite these advances the elbow is still one of the joint replacements with higher complication rate. Conversion of a joint fusion to arthroplasty has been reported for the hip, knee, shoulder, and ankle. The takedown of a surgically fused elbow was reported in German literature in 2013. We present the first such case report in the English literature with a 49-year-old male whose status is elbow fusion performed for trauma 31 years prior. PMID:25815223

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

    PubMed

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

    2014-06-01

    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

  2. Genu recurvatum as a complication after total knee arthroplasty.

    PubMed

    Erceg, Marinko; Raki?, Mladen

    2012-06-01

    A 73-year-old female patient underwent total knee arthroplasty for arthrosis. After surgery, recurvatum instability over 55 degrees occurred. Two years later, primary endoprosthesis was removed and a revision endoprosthesis implanted. However, complete deformity occurred again. Two years later, the thickest revision polyethylene tibial implant was implanted on the same endoprosthesis. In spite of using knee orthosis, recurvatum deformity returned. Seven months later, new revision rotating hinge prosthesis was implanted. This procedure seems to have solved the problem. The knee deformity in this specific case was larger than the deformity in cases reported so far, and it was solved after three surgical procedures. Rotating hinge prosthesis seems to be the method of choice for immediate repair of recurvatum instability after total knee arthroplasty. PMID:23115953

  3. The use of postoperative suction drainage in total knee arthroplasty.

    PubMed

    Reilly, T J; Gradisar, I A; Pakan, W; Reilly, M

    1986-07-01

    A retrospective review of 299 total knee arthroplasties performed between 1973 and 1983 revealed 170 knees in which postoperative suction drainage was used and 129 knees in which drains were not used. Comparison between these two groups revealed no statistically significant difference in wound problems, postoperative temperatures, or resulting range of motion. However, blood transfusions were given more than twice as often to the patients whose knees were drained (39% compared to 16%, p less than .01). The drained group also had a greater decrease in hemoglobin than the nondrained group (3.1 gm compared to 2.6 gm, p less than .01). In a review of these patients, no advantage was found for the use of postoperative suction drainage in the uncomplicated total knee arthroplasty. PMID:3720129

  4. Minimum two-year outcomes of modular bicompartmental knee arthroplasty.

    PubMed

    Kamath, Atul F; Levack, Ashley; John, Thomas; Thomas, Beverly S; Lonner, Jess H

    2014-01-01

    The purpose of this study was to determine the results of modular unlinked bicompartmental knee arthroplasty (BiKA) for medial (or lateral) and patellofemoral arthritis. Twenty-nine modular BiKAs were followed prospectively, for a mean of 31 months (range, 24-46 months). Outcome measures included Knee Society Knee and Function Scores, KOOS, SF-12, and WOMAC, as well as radiographic assessments and implant survivorship. Two tail paired Student's t test was used to determine statistical differences between preoperative and postoperative scores. Mean range of motion (ROM) improved from 122° to 133° (P<0.001). There was a statistically significant improvement across all functional scores. One patient underwent conversion to total knee arthroplasty at 3 years for knee instability. There were no cases of patellar instability, implant loosening or wear, or progressive arthritis. PMID:23731787

  5. Easy Identification of Mechanical Axis during Total Knee Arthroplasty

    PubMed Central

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

    2013-01-01

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

  6. Ileal interposition surgery-induced improvement of hyperglycemia and insulin resistance in Goto-Kakizaki rats by upregulation of TCF7L2 expression.

    PubMed

    Sun, Xu; Song, Maomin; Bai, Rixing; Cheng, Shi; Xing, Ying; Yuan, Huisheng; Wang, Pilin; Zhou, Lisa

    2013-05-01

    The aim of this study was to investigate the effects of ileal interposition (IT) on glucose and insulin resistance (IR) in type 2 diabetic mellitus (T2DM), and the role of T-cell factor 7-like 2 (TCF7L2), formerly known as TCF4, in the downregulation of hyperglycemia following IT. Goto-Kakizaki (GK) rats subjected to IT surgery (GK-IT group), GK rats subjected to sham surgery (GK-Sham group) and Wistar (WS) rats subjected to sham surgery (WS-Sham group) were investigated in this study. Fasting plasma glucose, body weight, food intake per 1 kg body weight, insulin and a homeostasis model assessment of insulin resistance (HOMA-IR) were measured pre- and post-surgery. The rats were euthanized 28 days post-surgery and the pancreas of each rat was dissected. The expression levels of TCF7L2 mRNA and protein were analyzed by quantitative RT-PCR and western blotting, respectively. Our results revealed that IT improved both fasting plasma glucose levels and IR in GK rats by upregulating the expression of the TCF7L2 protein. IT provides a valuable therapeutic option for patients with T2DM. Upregulation of TCF7L2 protein expression may be a possible mechanism underlying the improvement of T2DM following IT. PMID:23737909

  7. Paraneoplastic Clostridium septicum infection of a total knee arthroplasty.

    PubMed

    Burnell, Colin D C; Turgeon, Thomas R; Hedden, David R; Bohm, Eric R

    2011-06-01

    We describe a case of a well-functioning total knee arthroplasty acutely infected with Clostridium septicum. This is the first reported infection of a prosthetic joint with this organism. A search for the source of this infection uncovered a colonic malignancy. This organism is highly associated with gastrointestinal malignancy, and appropriate investigation should be carried out when it is discovered. The importance of full anaerobic bacterial identification by the microbiology laboratory is underscored by this case. PMID:20870378

  8. Revision rate after short-stem total hip arthroplasty

    PubMed Central

    van Oldenrijk, Jakob; Molleman, Jeroen; Klaver, Michel; Poolman, Rudolf W; Haverkamp, Daniel

    2014-01-01

    Background and purpose The aim of short-stem total hip arthroplasty is to preserve proximal bone stock for future revisions, to improve biomechanical reconstruction, and to make minimally invasive approaches easier. It is therefore being increasingly considered to be a sound alternative to conventional total hip arthroplasty, especially for young and active patients. However, it is still unknown whether survival rates of short-stem hips match current standards. We made a systematic summary of reported overall survival after short-stem total hip arthroplasty. Materials and methods We conducted a systematic review of English, French, German, and Dutch literature. 2 assessors independently identified clinical studies on short-stem hip arthroplasty. After recalculating reported revision rates, we determined whether each implant had a projected revision rate of 10% or less at 10 years of follow-up or a revision rate per 100 observed component years of 1 or less. Stems were classified as “collum”, “partial collum”, or “trochanter-sparing”. Results and Interpretation We found 49 studies, or 51 cohorts, involving 19 different stems. There was a large increase in recent publications. The majority of studies included had a follow-up of less than 5 years. We found a large number of observational studies on “partial collum” and “trochanter-sparing” stems, demonstrating adequate survival rates at medium-term follow-up. Clinical evidence from “collum stem” studies was limited to a small number of studies with a medium-term follow-up period. These studies did not show a satisfactory overall survival rate. PMID:24694271

  9. Outcomes of Total Joint Arthroplasty in HIV Patients

    PubMed Central

    Falakassa, Jonathan; Diaz, Alejandro; Schneiderbauer, Michaela

    2014-01-01

    Background Advancement in human immunodeficiency virus (HIV) therapies has increased life expectancy. The need for joint replacement is expected to increase as this population develops degenerative changes from aging and avascular necrosis (AVN). Studies have shown a higher risk of peri-prosthetic joint infections (PJI) in HIV patients. However, these studies include a high percentage of hemophiliacs, which may be a confounding variable. With the advent of highly active anti-retroviral therapy (HAART) and evolving HIV demographics, we hypothesize the rate of PJIs in HIV patients are comparable to the general population. Methods We performed a retrospective cohort study using prospectively collected data from our arthroplasty database. We identified 24 HIV patients that underwent 31 primary hip and one primary knee arthroplasty between July 1, 2000 and September 30, 2012. Mean age was 50 years (range 31-74). Mean follow-up was 14 months (range 1.5-60). Results There were no PJIs in our HIV population. All HIV patients were non-hemophiliacs on HAART. Thirty-one total hip arthroplasties (THA) and one total knee arthroplasty were performed. Twenty-one HIV patients underwent THA for AVN. Eight patients had bilateral AVN. One patient needed revision for aseptic loosening. The mean CD4 count was 647 (194-1193). Mean viral load was undetectable in 19 patients and unavailable in five. Conclusions Our HIV population had a lower rate of PJI compared to infection rates in prior literature. Despite our limited patient population, our data suggests that well controlled HIV patients on HAART therapy with undetectable viral loads and CD4 >200 are at similar risk of PJI as the average population. PMID:25328467

  10. Does Regional Anesthesia Improve Outcome After Total Knee Arthroplasty?

    Microsoft Academic Search

    Alan J. R. Macfarlane; Govindarajulu Arun Prasad; Vincent W. S. Chan; Richard Brull

    2009-01-01

    Total knee arthroplasty (TKA) is amenable to various regional anesthesia techniques that may improve patient outcome. We sought\\u000a to answer whether regional anesthesia decreased mortality, cardiovascular morbidity, deep venous thrombosis and pulmonary\\u000a embolism, blood loss, duration of surgery, pain, opioid-related adverse effects, cognitive defects, and length of stay. We\\u000a also questioned whether regional anesthesia improved rehabilitation. To do so, we

  11. Femoral fracture during non-cemented total hip arthroplasty

    Microsoft Academic Search

    JT Schwartz; JG Mayer; CA Engh

    1989-01-01

    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,

  12. Vibroacoustography for the assessment of total hip arthroplasty

    PubMed Central

    Kamimura, Hermes A. S.; Wang, Liao; Carneiro, Antonio A. O.; Kinnick, Randall R.; An, Kai-Nan; Fatemi, Mostafa

    2013-01-01

    OBJECTIVES: This paper proposes imaging with 3-dimensional vibroacoustography for postoperatively assessing the uncovered cup area after total hip arthroplasty as a quantitative criterion to evaluate implant fixation. METHODS: A phantom with a bone-like structure covered by a tissue-mimicking material was used to simulate a total hip arthroplasty case. Vibroacoustography images of the uncovered cup region were generated using a two-element confocal ultrasound transducer and a hydrophone inside a water tank. Topological correction based on the geometry of the implant was performed to generate a 3-dimensional representation of the vibroacoustography image and to accurately evaluate the surface. The 3-dimensional area obtained by the vibroacoustography approach was compared to the area evaluated by a 3-dimensional motion capture system. RESULTS: The vibroacoustography technique provided high-resolution, high-contrast, and speckle-free images with less sensitivity to the beam incidence. Using a 3-dimensional-topology correction of the image, we accurately estimated the uncovered area of the implant with a relative error of 8.1% in comparison with the motion capture system measurements. CONCLUSION: Measurement of the cup coverage after total hip arthroplasty has not been well established; however, the covered surface area of the acetabular component is one of the most important prognostic factors. The preliminary results of this study show that vibroacoustography is a 3-dimensional approach that can be used to postoperatively evaluate total hip arthroplasty. The favorable results also provide an impetus for exploring vibroacoustography in other bone or implant surface imaging applications. PMID:23778334

  13. Determinants of the subjective functional outcome of total joint arthroplasty

    Microsoft Academic Search

    B. Caracciolo; S. Giaquinto

    2005-01-01

    The aim of the study is three-fold: (i) to analyze association between early subjective functional outcome of total joint arthroplasty (TJA) and patient-related risk factors; (ii) to evaluate the six-month subjective functional outcome of TJA as compared with subjective functional status of non-operated outpatients; (iii) to evaluate TJA self-perceived amelioration rates compared to the status of an age-matched sample from

  14. Weight changes and the risk of knee osteoarthritis requiring arthroplasty

    PubMed Central

    Manninen, P; Riihimaki, H; Heliovaara, M; Suomalainen, O

    2004-01-01

    Objective: To examine the effect of weight changes between 20 and 50 years of age on the risk of severe knee osteoarthritis (OA) requiring arthroplasty. Subjects and methods: Cases were 55–75 year old men and women (n = 220) having had knee arthroplasty for primary osteoarthritis at the Kuopio University Hospital in 1992–93. Controls (n = 415) were randomly selected from the population of Kuopio Province. Weight at the age of 20, 30, 40, and 50 years was collected retrospectively with a postal questionnaire. Results: After adjustment for age, sex, history of physical workload, recreational physical activity, and previous knee injury, weight gain resulting to a shift from normal body mass index (BMI ?25 kg/m2) to overweight (BMI >25 kg/m2) was associated with a higher relative risk of knee OA requiring arthroplasty than persistent overweight from 20–50 years of age, compared with those with normal relative weight during the corresponding age period. The odds ratios (OR) were 3.07 (95% confidence interval 1.87 to 5.05) for those with normal weight at the age of 20 years and overweight at two or three of the ages 30, 40 or 50 years, 3.15 (1.85 to 5.36) for those with overweight from the age of 30 years, and 2.37 (1.21 to 4.62) for those with overweight from the age of 20 years, respectively. Conclusion: In adult life, a shift from normal to overweight may carry a higher risk for knee OA requiring arthroplasty than does constant overweight. PMID:15479892

  15. Multimodal prophylaxis for venous thromboembolic disease after total hip and knee arthroplasty: current perspectives

    Microsoft Academic Search

    Ning LU; Eduardo A. Salvati

    2010-01-01

    Life-threatening in the short term and leading to a high level of morbidity in the long term, venous thromboembolism (VTE) is the most fearful complication following lower limb arthroplasty. With advances in surgical procedure, anesthetic management and postoperative convalescence have altered the risks of venous thromboembolism after total joint arthroplasty in the lower extremity. The pathogenesis of VTE is multifactorial

  16. Hospital Course and Early Clinical Outcomes of Two-incision Total Hip Arthroplasty

    Microsoft Academic Search

    Meng-Ling Lu; Shih-Wei Chou; Wen-E Yang; Vinesh Senan; Pang-Hsing Hsieh; Hsin-Nung Shih; Mel S. Lee

    Background: Minimally invasive total hip arthroplasty has been reported to have a better functional recovery by minimizing soft tissue trauma as compared with the conventional approach. This study analyzed the hospital course and early clinical outcomes of a series of 63 two-incision total hip arthroplasties. Methods: Sixty patients (63 hips) were enrolled between September 2003 and July 2004 and followed

  17. Modeling early recovery of physical function following hip and knee arthroplasty

    Microsoft Academic Search

    Deborah M Kennedy; Paul W Stratford; Steven E Hanna; Jean Wessel; Jeffrey D Gollish

    2006-01-01

    BACKGROUND: Information on early recovery after arthroplasty is needed to help benchmark progress and make appropriate decisions concerning patient rehabilitation needs. The purpose of this study was to model early recovery of physical function in patients undergoing total hip (THA) and knee (TKA) arthroplasty, using physical performance and self-report measures. METHODS: A sample of convenience of 152 subjects completed testing,

  18. The influence of steroid injections on the incidence of infection following total knee arthroplasty

    Microsoft Academic Search

    Geoffrey Horne; Peter Devane; Andrew Davidson; Kathryn Adams; Gordon Purdie

    Aim To investigate whether a relationship exists between preoperative intra-articular steroid injections and postoperative wound healing in total knee arthroplasty (TKA). Similar research studies on total hip arthroplasty (THA) have found higher rates of post surgical problems in hips that have been injected with steroids. Methods Thirty-eight patients with TKA postoperative wound infection, and 352 TKA patients without postoperative wound

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

    E-print Network

    Delp, Scott

    Intraoperative Passive Kinematics of Osteoarthritic Knees before and after Total Knee ArthroplastyScience (www.interscience.wiley.com). DOI 10.1002/jor.20163 ABSTRACT: Total knee arthroplasty is a successful procedure to treat pain and functional disability due to osteoarthritis. However, precisely how a total knee

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

    E-print Network

    Delp, Scott

    Posterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty Melinda J. Cromie,1,2 Robert A. Siston,1,2,3,4 Nicholas J. Giori,2,5 Scott L (20­608) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes

  1. Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows

    PubMed Central

    2011-01-01

    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

  2. Bone Grafting Severe Glenoid Defects in Revision Shoulder Arthroplasty

    PubMed Central

    Iannotti, Joseph P.

    2008-01-01

    During revision total shoulder arthroplasty, bone grafting severe glenoid defects without concomitant reinsertion of a glenoid prosthesis may be the only viable reconstructive option. However, the fate of these grafts is unknown. We questioned the durability and subsidence of the graft and the associated clinical outcomes in patients who have this procedure. We retrospectively reviewed 11 patients with severe glenoid deficiencies from aseptic loosening of a glenoid component who underwent conversion of a total shoulder arthroplasty to a humeral head replacement and glenoid bone grafting. Large cavitary defects were grafted with either allograft cancellous chips or bulk structural allograft, depending on the presence or absence of glenoid vault wall defects, without prosthetic glenoid resurfacing. Clinical outcomes (Penn Shoulder Score, maximum 100 points) improved from 23 to 57 at a minimum 2-year followup (mean, 38 months; range, 24–73 months). However, we observed substantial graft subsidence in all patients, with eight of 11 patients having subsidence greater than 5 mm; the magnitude of graft resorption did not correlate with clinical outcome scores. Greater subsidence was seen with structural than cancellous chip allografts. Bone grafting large glenoid defects during revision shoulder arthroplasty can improve clinical outcome scores, but the substantial resorption of the graft material remains a concern. Level of Evidence: Level III Prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196386

  3. Infection prevention methodologies for lower extremity total joint arthroplasty.

    PubMed

    Kapadia, Bhaveen H; Pivec, Robert; Johnson, Aaron J; Issa, Kimona; Naziri, Qais; Daley, Jacqueline A; Mont, Michael A

    2013-03-01

    Despite advances in our understanding of surgical site infections following total joint arthroplasty, this serious surgical complication continues to represent a substantial economic burden for the patient, the treating institution and the healthcare system. After increasing for the past decade, infection rates have stabilized at 1.6%; however, the total cost is projected to increase with the total number of revision procedures performed. A systematic review of the literature was performed to identify studies that assess the efficacy of pre-, peri- and post-operative infection prevention strategies in the setting of total hip or knee arthroplasty. Preference was given to randomized-controlled trials, data from national registries and meta-analyses within the past 5 years; however, all relevant articles were included in this analysis. The results of the literature search returned 549 articles that addressed infection in total joint arthroplasty, of which 71 specifically addressed infection prevention. Topics that were addressed included the CDC recommendations, skin preparation techniques, hair removal techniques, surgical draping techniques, operative dress, operating room ventilation, operating room traffic and antibiotic utilization. Newer infection prevention techniques, such as preoperative antiseptic scrubbing, are affected and may help reduce the infection rate, while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate. PMID:23480090

  4. Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease

    PubMed Central

    2015-01-01

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

  5. Applications of porous tantalum in total hip arthroplasty.

    PubMed

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

    2006-11-01

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

  6. [Bilateral avascular necrosis after resurfacing hip arthroplasty. A case report].

    PubMed

    Sanz-Ruiz, P; Chana-Rodríguez, F; Villanueva-Martínez, M; Vaquero-Martín, J

    2011-01-01

    Resurfacing hip arthroplasty is an alternative to conventional arthroplasty and it is indicated in young and active patients. Good results and the prevention of complications stem from a meticulous surgical technique and proper patient selection. We present herein the case of a 43 year-old patient who, after undergoing bilateral hip replacement with resurfacing prostheses, sustained a non-simultaneous fracture of both femoral necks due to avascular necrosis. He was treated by placing a metaphyseal anchoring stem. Postoperative X-rays showed proper implant placement without femoral notching, with a discrete 7 degrees valgus alignment of the femoral component. Both passive and active mobility was painful. X-rays showed cervical fracture of the right femur. The femoral head was attached to the implant, with no metallosis nor loosening of the femoral or acetabular components, but the bone had a fragmented and friable appearance that histopathologically was defined as avascular necrosis. Femoral neck fracture is the main complication after resurfacing hip arthroplasty. The effect of other factors like bone necrosis due to cement is unknown. PMID:22512114

  7. Metallosis following knee arthroplasty: a histological and immunohistochemical study.

    PubMed

    Schiavone Panni, A; Vasso, M; Cerciello, S; Maccauro, Giulio

    2011-01-01

    Metallosis represents a rare and severe complication of knee replacement surgery. It is caused by the infiltration and accumulation of metallic debris into the peri-prosthetic structures, deriving from friction between metallic prosthetic components. In knee arthroplasty, this event generally occurs as a result of polyethylene wear of the tibial or metal-back patellar component. The real incidence of metallosis is still unknown, although it seems to be more frequent in hip than in knee arthroplasty. The metallic debris induces a massive release of cytokines from inflammatory cells, making a revision necessary whenever osteolysis and loosening of the prosthesis occur. We report four patients who underwent revision of their knee arthroplasty because of severe metallosis. In one of these patients, polyethylene wear had determined friction between the metal-back patellar component and the anterior portion of the femoral component. In the remaining three cases, metallosis was caused by friction between the femoral and tibial prosthetic metal surfaces, resulting from full-thickness wear of the tibial polyethylene. T lymphocytes were activated by metal particles present in periprosthetic membranes. In all patients, one-stage revision was necessary, with rapid pain disappearance and a complete functional recovery of the knee joint. PMID:21978703

  8. Augmented Glenoid Component for Bone Deficiency in Shoulder Arthroplasty

    PubMed Central

    Rice, Robert S.; Miletti, Joseph; Schleck, Cathy; Cofield, Robert H.

    2008-01-01

    Asymmetric posterior glenoid wear caused by degenerative glenohumeral arthritis can be addressed by several techniques during total shoulder arthroplasty. The purpose of this study was to evaluate the midterm outcome of a posterior augmented glenoid component to determine the clinical and radiographic outcome, including complications and the need for revision surgery. Between 1995 and 1999, 13 patients (14 shoulders) underwent a shoulder arthroplasty with an augmented glenoid component to treat posterior glenoid bone deficiency. All 14 shoulders had advanced osteoarthritis. The minimum followup for these 13 patients was 2 years (mean, 5 years; range, 2–8 years). The mean age of these patients was 66 years at the time of surgery (range, 52–78 years). The mean active elevation was 160° (range, 120°–180°) and external rotation was 56° (range, 30°–90°). According to a modified Neer result rating system, 36% of patients had an excellent result, 50% a satisfactory result, and 14% an unsatisfactory result. Our results suggest patients undergoing total shoulder arthroplasty with an asymmetric glenoid component for osteoarthritis achieve satisfactory mid-term pain relief and improvement in function; however, instability is not always corrected. The advantage of this component seems marginal, and its use has been discontinued. Level of Evidence: Level IV, retrospective review. See Guidelines for Authors for a complete description of levels of evidence. PMID:18196365

  9. Clinical experience with novel oral anticoagulants for thromboprophylaxis after elective hip and knee arthroplasty.

    PubMed

    Messerschmidt, Cory; Friedman, Richard J

    2015-04-01

    Anticoagulant medications help to reduce the risk of thromboembolic events after total hip arthroplasty and total knee arthroplasty. Traditionally, this has been accomplished with medications, such as low-molecular-weight heparin and warfarin. However, these traditional anticoagulants possess a variety of shortcomings that leave much room for improvement. A new class of oral anticoagulants is now available, and present a more convenient option for safe and efficacious thromboprophylaxis in post arthroplasty patients, particularly in the outpatient setting. This review focuses on the direct thrombin inhibitor, dabigatran, and the selective factor Xa inhibitors, rivaroxaban and apixaban, and the clinical data to date about their use in total hip arthroplasty and total knee arthroplasty patients. PMID:25767271

  10. AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty

    PubMed Central

    2011-01-01

    Background In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. Methods A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. Results The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Conclusions Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty. PMID:21781327

  11. The prototype GAPS (pGAPS) experiment

    NASA Astrophysics Data System (ADS)

    Mognet, S. A. I.; Aramaki, T.; Bando, N.; Boggs, S. E.; von Doetinchem, P.; Fuke, H.; Gahbauer, F. H.; Hailey, C. J.; Koglin, J. E.; Madden, N.; Mori, K.; Okazaki, S.; Ong, R. A.; Perez, K. M.; Tajiri, G.; Yoshida, T.; Zweerink, J.

    2014-01-01

    The General Antiparticle Spectrometer (GAPS) experiment is a novel approach for the detection of cosmic ray antiparticles. A prototype GAPS (pGAPS) experiment was successfully flown on a high-altitude balloon in June of 2012. The goals of the pGAPS experiment were: to test the operation of lithium drifted silicon (Si(Li)) detectors at balloon altitudes, to validate the thermal model and cooling concept needed for engineering of a full-size GAPS instrument, and to characterize cosmic ray and X-ray backgrounds. The instrument was launched from the Japan Aerospace Exploration Agency's (JAXA) Taiki Aerospace Research Field in Hokkaido, Japan. The flight lasted a total of 6 h, with over 3 h at float altitude (~33 km). Over one million cosmic ray triggers were recorded and all flight goals were met or exceeded.

  12. Fatigue Failure of the GAP Ring

    Microsoft Academic Search

    Gavan P. Duffy; Mary I. O'Connor; Mark P. Brodersen

    2007-01-01

    This study reports the results and early failures using the Graft Augmentation Prosthesis ring in the reconstruction of acetabular defects encountered during total hip arthroplasty. Seventeen consecutive Graft Augmentation Prosthesis rings were used during 7 complex primary and 10 revision hip arthroplasties. Five patients died during the follow-up period. Of the remaining 12 patients, 7 had been revised at an

  13. USGS Gap Analysis Program

    NSDL National Science Digital Library

    This site provides the latest information on the Gap Analysis Program (GAP). The central goal of the GAP Program is to collect and integrate many levels of biological, physical, and policy information on a large scale, in order to identify gaps in current resource management plans. It is maintained by the USGS Biological Resources Division with the mission of "providing regional assessments of the conservation status of native vertebrate species and natural land cover types and to facilitate the application of this information to land management activities." This site is divided into eight sections: overview, the gap analysis handbook, state project information, gap reports/publications, a bulletin board, aquatic gap, nature mapping (an educational tool), and links to related sites. New press releases and conference poster contents are featured at the top of the site. Users can access state and regional GAP information or use the search engine to find other topics of interest.

  14. 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 (...

  15. Funding Gap Study.

    ERIC Educational Resources Information Center

    Newmyer, Joe; McIntyre, Chuck

    The "funding gap" in public higher education in California represents the difference between state appropriations and the amount needed to fully support each segment's educational mission. This report identifies and defines the funding gap for the California Community Colleges (CCC); measures the consequences of this gap on program quality and…

  16. Triggered vacuum gaps

    Microsoft Academic Search

    J. M. Lafferty

    1966-01-01

    Characteristics of a sealed vacuum gap are described and the difficulties encountered in applying this gap as an overvoltage protection device are discussed. It is shown how these difficulties can be ameliorated by the use of gas-free electrode materials and by triggering the gap when breakdown is required. Several methods of triggering are discussed and some practical triggering devices are

  17. Behind the Pay Gap

    ERIC Educational Resources Information Center

    Dey, Judy Goldberg; Hill, Catherine

    2007-01-01

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

  18. Treatment of patello-femoral arthritis using the Lubinus patello-femoral arthroplasty: a retrospective review.

    PubMed

    Smith, A M; Peckett, W R C; Butler-Manuel, P A; Venu, K M; d'Arcy, J C

    2002-02-01

    There are few published results in the literature on patello-femoral arthroplasty. The aim of this study was to help to define the place of patello-femoral arthroplasty in the treatment of isolated patello-femoral arthritis. All patients who underwent patello-femoral arthroplasty using the Lubinus prosthesis for patello-femoral arthritis between 1992 and 1998 in two neighbouring district general hospitals were studied. There were 34 patients who underwent 45 arthroplasties. The modified Hungerford and Kenna scoring system and the Insall and Crosby scoring system were used to clinically evaluate the patients. Serial radiographs were assessed for patellar malalignment, mechanical failure and progressive arthritic change. Twenty-three knees (64%) had a good or excellent result, six (17%) had an unsatisfactory result and seven (19%) were revised to either a total knee arthroplasty (5 knees) or patellofemoral arthroplasty (2 knees). Although the results do not compare favourably with those of total knee replacement for generalised arthritis of the knee; we believe that with careful patient selection coupled with careful surgical technique, patello-femoral arthroplasty can be successfully used to treat isolated patello-femoral osteoarthritis. PMID:11830378

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

    Microsoft Academic Search

    Yonghui FuGuangbin; Guangbin Wang; Qin Fu

    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.

  20. Ceramic Head Fracture in Ceramic-on-Polyethylene Total Hip Arthroplasty

    PubMed Central

    Nho, Jae-Hwi; Song, Ui-Seoub; Kim, Woo-Jong; Suh, You-Sung

    2013-01-01

    Revision rates of total hip arthroplasty have decreased after introducing total hip arthroplasty (THA) using ceramic component, since ceramic components could reduce components wear and osteolysis. The fracture of a ceramic component is a rare but potentially serious event. Thus, ceramic on polyethylene articulation is gradually spotlighted to reduce ceramic component fracture. There are a few recent reports of ceramic head fracture with polyethylene liner. Herein, we describe a case of a ceramic head component fracture with polyethylene liner. The fractured ceramic head was 28 mm short neck with conventional polyethylene liner. We treated the patient by total revision arthroplasty using 4th generation ceramic on ceramic components. PMID:24142666

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

    PubMed Central

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

    2013-01-01

    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

  2. Pain after hip arthroplasty managed by Brennan Healing Science.

    PubMed

    Namavar, Roxanna

    2014-01-01

    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

  3. Direct Hospital Cost Determinants Following Hip and Knee Arthroplasty.

    PubMed

    Peel, Tn; Cheng, Ac; Liew, D; Buising, Kl; Lisik, J; Carroll, Ka; Choong, Pfm; Dowsey, Mm

    2014-12-01

    Objective Total joint arthroplasty (TJA) places a significant economic burden on healthcare resources. This cohort study examines the costs associated with arthroplasty in 827 patients undergoing hip and knee TJA from January 2011 to June 2012 at a single centre in Melbourne, Australia. Methods Data included total inpatient, outpatient and readmissions costs in the 30 days following TJA. Factors associated with cost were modelled using negative binomial regression and extrapolated to the Australian population. Results The base cost (i.e. the cost in a patient with no modifying factors) over the first 30 days following TJA was Australian (AU) $13060 (Interquartile range AU$12126, 14067). The median length of stay was 4 days (range 2-33) and 35 patients (4%) were readmitted in the first 30 days following index TJA, the majority of whom had a surgical site infection (SSI) (74%). The following factors were independently associated with increased costs: SSI, pre-operative warfarin therapy, American Society of Anesthesiologists (ASA) score of 3 or 4, hip TJA, increasing operation time, increasing post-operative blood transfusion requirements, other nosocomial infections, post-operative venous thromboembolism (VTE), pressure ulcers, post-operative confusion and acute urinary retention. Based on data from the present study, the cost of TJA in Australia is estimated to exceed AU$1 billion per year. Preventable post-operative complications were major cost drivers: SSI and VTE added a further AU$97 million and AU$66 million, respectively, to arthroplasty costs in the first 30 days following surgery. Conclusions This unique study has identified important factors influencing TJA costs and providing guidance for future research and resource allocation. This article is protected by copyright. All rights reserved. PMID:25470687

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

    PubMed Central

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

    2014-01-01

    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

  5. Bilateral total hip arthroplasty in siblings with Stickler Syndrome.

    PubMed

    Banerjee, D; Anderson, J A; Taveras, N A; González Della Valle, A

    2007-01-01

    Stickler Syndrome is an infrequent autosomal dominant connective tissue disorder. The most prevalent mutation affects type II collagen gene and results in abnormalities in cartilage, vitreous and nucleus pulposus. Orthopaedic manifestations include joint hyper- mobility and pain with early development of secondary osteoarthritis. The condition has a predilection for the femoral head and patients usually present in their third to fourth decade with secondary hip arthritis. We report on two siblings with Stickler Syndrome who presented with hip osteoarthritis in their third decade of life and underwent staged bilateral total hip arthroplasties (THA). The patients experienced pain relief and improved quality of life after surgery. PMID:19197843

  6. Midterm results of total knee arthroplasty after high tibial osteotomy

    Microsoft Academic Search

    Konstantinos J. Kazakos; Christos Chatzipapas; Dionysios Verettas; Vasilios Galanis; Konstantinos C. Xarchas; Ioannis Psillakis

    2008-01-01

    Background  The outcome of total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is still controversial. In order to determine\\u000a if osteotomy has any effect on this outcome we performed a medium-term review of a cohort of patients with knee osteoarthritis.\\u000a \\u000a \\u000a \\u000a Materials and methods  Thirty-two patients (38 knees), who were treated with a HTO before the TKA during the last 8 years, were

  7. Reducing surgical site infection in arthroplasty of the lower limb

    PubMed Central

    Johnson, R.; Jameson, S. S.; Sanders, R. D.; Sargant, N. J.; Muller, S. D.; Meek, R. M. D.; Reed, M. R.

    2013-01-01

    Objectives To review the current best surgical practice and detail a multi-disciplinary approach that could further reduce joint replacement infection. Methods Review of relevant literature indexed in PubMed. Results Surgical site infection is a major complication following arthroplasty. Despite its rarity in contemporary orthopaedic practice, it remains difficult to treat and is costly in terms of both patient morbidity and long-term health care resources. Conclusions Emphasis on education of patients and all members of the health-care team and raising awareness in how to participate in preventative efforts is imperative. PMID:23610703

  8. Fracture of the ceramic epiphysis in hip arthroplasty.

    PubMed

    Toni, A; Terzi, S; Sudanese, A; Zappoli, F A; Giunti, A

    1996-01-01

    Between November 1985 and October 1993, a total of 694 ceramic-ceramic hip arthroplasties were implanted; up until 1987 the alumina used in the first 82 cases was Ostalox, produced by IMEC of Caravaggio, characterized by poor control of the size of the crystals; after 1987 Biolox alumina of the Feldmhule company was used in 612 cases. Fracture of the ceramic head occurred in 2 cases; in both patients ceramic was of the Ostalox type, meaning a 2.4% incidence of fracture; up until the present none of the 612 Biolox heads has presented this complication. PMID:8791872

  9. Patient satisfaction after total knee and hip arthroplasty.

    PubMed

    Lau, Rick L; Gandhi, Rajiv; Mahomed, Safiyyah; Mahomed, Nizar

    2012-08-01

    Patient satisfaction is an important outcome measurement in TKA/THA surgery. Patient satisfaction can be evaluated from 2 perspectives, determinants of satisfaction and components of satisfaction.(5) In total joint arthroplasty, improvements in satisfaction can be achieved by examining these perspectives. Patient satisfaction is one of the many PROMs used in orthopedic surgery and is an integral part of the growing sentiment to evaluate surgery from the patient's perspective as well as from the surgeon's. The importance of measuring outcomes from the patient perspective is integral to today's patient-centered models of care. PMID:22840303

  10. Selecting the surgical approach for revision total hip arthroplasty.

    PubMed

    Kerboull, L

    2015-02-01

    Selecting the approach for revision total hip arthroplasty is a crucial step in pre-operative planning. Whether the surgical objectives can be reached via a conventional approach or require a specific approach must be determined. The best approach depends on multiple factors including the reason for revision, patient's characteristics, implants requiring removal, previous approach, soft tissue and bone lesions, and surgeon's level of experience. These factors are discussed herein, as well as the potential and limitations of conventional approaches and the indications for specific approaches. PMID:25553602

  11. Direct anterior approach for revision total hip arthroplasty

    PubMed Central

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

    2014-01-01

    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

  12. Heat shock proteins in total knee arthroplasty. A pilot study

    Microsoft Academic Search

    Francisco Chana; M. Concepcion Guisasola; Manuel J. Villanueva; Julio de las Heras; Jose Antonio Calvo; Javier Vaquero

    2010-01-01

    Introduction  Thanks to the development of defense mechanisms, the human body has been able to adapt to adverse environmental conditions\\u000a causing acute and chronic stress. This adaptive response includes a specific group of proteins called heat shock proteins\\u000a (Hsps).\\u000a \\u000a \\u000a \\u000a \\u000a Objective  The present study examines the biology of Hsps and other acute phase reactants in patients subjected to uncomplicated total\\u000a knee arthroplasty as

  13. Advanced blood management strategies for elective joint arthroplasty.

    PubMed

    Layton, Jodi L; Rubin, Lee E; Sweeney, Joseph D

    2013-03-01

    There is a high prevalence of anemia detected in the preoperative work-up of elective surgical patients preparing for total joint replacement. The impact of anemia in this population has significant implications due to elevations in postoperative morbidity and mortality. By using current clinical guidelines and medical evidence, clinicians can improve outcomes for these patients by employing a three-phase approach, focused on preoperative assessment, intraoperative hemostasis, and postoperative blood product management. Strategies to optimize preoperative hemoglobin levels, reduce intraoperative blood losses, and decrease postoperative transfusion rates can independently and collectively improve overall patient care and surgical outcomes following lower extremity total joint arthroplasty. PMID:23641434

  14. The Canadian Arthroplasty Society's experience with hip resurfacing arthroplasty. An analysis of 2773 hips.

    PubMed

    2013-08-01

    The purpose of this study was twofold: first, to determine whether the five-year results of hip resurfacing arthroplasty (HRA) in Canada justified the continued use of HRA; and second, to identify whether greater refinement of patient selection was warranted. This was a retrospective cohort study that involved a review of 2773 HRAs performed between January 2001 and December 2008 at 11 Canadian centres. Cox's proportional hazards models were used to analyse the predictors of failure of HRA. Kaplan-Meier survival analysis was performed to predict the cumulative survival rate at five years. The factors analysed included age, gender, body mass index, pre-operative hip pathology, surgeon's experience, surgical approach, implant sizes and implant types. The most common modes of failure were also analysed. The 2773 HRAs were undertaken in 2450 patients: 2127 in men and 646 in women. The mean age at operation was 50.5 years (sd 8.72; 18 to 82) and mean follow-up was 3.4 years (sd 2.1; 2.0 to 10.1). At the last follow-up a total of 101 HRAs (3.6%) required revision. Using revision for all causes of failure as the endpoint, Kaplan-Meier survival analysis showed a cumulative survival of 96.4% (95% confidence interval (CI) 96.1 to 96.9) at five years. With regard to gender, the five-year overall survival was 97.4% in men (95% CI 97.1 to 97.7) and 93.6% in women (95% CI 92.6 to 94.6). Female gender, smaller femoral components, specific implant types and a diagnosis of childhood hip problems were associated with higher rates of failure. The most common cause of failure was fracture of the femoral neck, followed by loosening of the femoral component. The failure rates of HRA at five years justify the ongoing use of this technique in men. Female gender is an independent predictor of failure, and a higher failure rate at five years in women leads the authors to recommend this technique only in exceptional circumstances for women. PMID:23908418

  15. Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

    PubMed Central

    Zijlstra, Wierd P; Bos, Nanne; van Raaij, Jos JAM

    2008-01-01

    Background Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation. Methods A randomized controlled trial will be conducted. Patients to be included suffer from non-inflammatory degenerative joint disease of the hip, are aged between 18 and 80 and are admitted for primary cementless unilateral total hip arthroplasty. Patients in the metal-on-metal group will receive a cementless titanium alloy acetabular component with a cobalt-chromium liner and a cobalt-chromium femoral head varying from 38 to 60 mm. Patients in the metal-on-polyethylene group will receive a cementless titanium alloy acetabular component with a polyethylene liner and a 28 mm cobalt-chromium femoral head. We will assess acetabular bone mineral density by dual energy x-ray absorptiometry (DEXA), serum ion concentrations of cobalt, chromium and titanium, self reported functional status (Oxford hip score), physician reported functional status and range of motion (Harris hip score), number of dislocations and prosthetic survival. Measurements will take place preoperatively, perioperatively, and postoperatively (6 weeks, 1 year, 5 years and 10 years). Discussion Superior results of large head metal-on-metal total hip arthroplasty over conventional hip arthroplasty have been put forward by experts, case series and the industry, but to our knowledge there is no randomized controlled evidence. Conclusion This randomized controlled study has been designed to test whether large head metal-on-metal cementless total hip arthroplasty leads to less periprosthetic bone density loss and higher serum metal ion concentrations compared to 28 mm metal-on-polyethylene cementless total hip arthroplasty. Trial registration Netherlands Trial Registry NTR1399 PMID:18842151

  16. GapZappers

    NSDL National Science Digital Library

    Colleen King

    2013-01-01

    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.

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

    E-print Network

    Most, Ephrat, 1970-

    2004-01-01

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

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

    E-print Network

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

    2007-01-01

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

  19. Comparison of total hip arthroplasty in osteoarthritis of mechanical and rheumatologic causes

    PubMed Central

    Ejnisman, Leandro; Leonhardt, Nathalia Zalc; Fernandes, Laura Fillipini Lorimier; Leonhardt, Marcos de Camargo; Vicente, José Ricardo Negreiros; Croci, Alberto Tesconi

    2014-01-01

    Objective: To compare the use of uncemented implants in total hip arthroplasty in patients with rheumathologic diseases and mechanical osteoarthrosis. Methods: We retrospectively evaluated 196 patients who were operated by the Hip and Arthroplasty Surgery Group of the IOT-HCFMUSP between 2005 and 2009. Patients were divided into two groups: mechanical causes (165 patients) and rheumathologic causes (31 patients). Groups were compared between each other in age, gender and follow-up time. Osseointegration rate and percentage of failure in arthroplasty were evaluated. Results: No statistically significant difference was found in osseointegration rates (in both femoral and acetabular components) in both groups. The rates of revision surgery and implant survival also did not show statistically significant differences. Conclusion: The use of uncemented total hip arthroplasty did not show worse results in rheumathologic patients. Level of Evidence III, Retrospective Case Control Study. PMID:24644419

  20. Fracture of the unresurfaced patella after total knee arthroplasty: a report of two cases.

    PubMed

    Seijas, Roberto; Orduna, Juan Manuel; Castro, M C; Granados, Nuria; Baliarda, Jordi; Alcantara, Emili

    2009-08-01

    Patellar fractures are unusual in total knee arthroplasty without patellar resurfacing. We present 2 such cases that occurred within postoperative 2 months and were managed conservatively. Both patients had their knee function preserved. PMID:19721167

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

    E-print Network

    Mangudi Varadarajan, Kartik, 1981-

    2010-01-01

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

  2. Shoulder prosthetic arthroplasty options in 2014: what to do and when to do it.

    PubMed

    Pinkas, Daphne; Wiater, J Michael; Spencer, Edwin E; Edwards, T Bradley; Uribe, John W; Declercq, Geert; Murthi, Anand M; Hertel, Ralph

    2015-01-01

    The number of shoulder arthroplasty procedures performed in the United States is steadily increasing as a result of an expansion in implant options, clinical indications, and surgical experience. Available options include stemmed implants, short-stemmed or stemless prostheses, fracture-specific designs, resurfacing implants, partial surface replacement, metal-backed or polyethylene glenoid components designed for cementation or bone ingrowth, and reverse total shoulder arthroplasty. Efforts to re-create anatomy, improve outcomes, and avoid complications have resulted in many changes in prosthesis design. Despite these changes, failures still occur, and revision surgery is sometimes necessary. A thorough knowledge of current arthroplasty options, indications, and the principles of implantation is necessary to optimize outcomes after shoulder arthroplasty. PMID:25745905

  3. Physiological and mechanical influences on muscle function following total knee arthroplasty 

    E-print Network

    Hamilton, David Finlay

    2011-11-25

    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 is variable. Many...

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

    PubMed Central

    Sakellariou, Vasileios I; Babis, George C

    2014-01-01

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

  5. Shoulder arthroplasty in osteoarthritis: correlation between function and radiographic parameters

    PubMed Central

    Gracitelli, Mauro Emilio Conforto; Duarte, Fernando Aires; Toffoli, Rogerio Padovani; Burnato, João Henrique; Malavolta, Eduardo Angeli; Ferreira, Arnaldo Amado

    2013-01-01

    OBJECTIVES: To evaluate the correlation between radiographic parameters and functional assessments of patients with osteoarthritis of the shoulder who underwent shoulder arthroplasty and to describe the functional outcomes of this procedure in our institution. METHODS: We evaluated 21 patients (22 shoulders) who underwent shoulder arthroplasty between 1998 and 2010 and with a minimum follow-up of 12 months. Clinical evaluation was performed using the Constant-Murley scale, UCLA, EVA and by measuring the active motion. We analysed preoperative (distance between the top of the head and the humerus and the acromion, superior migration, neck angulation, medial "offset", subluxation, glenoid erosion) and postoperative radiographic parameters (rod inclination, migration of components and loosening). RESULTS: Patients showed significant improvement in all parameters: flexion (p = 0.0083), abduction (p = 0.0266), external rotation (p = 0.0062), Constant-Murley (p = 0.0001 ), UCLA (p <0.0001) and VAS (p = 0.0002). The superior migration of the humerus showed a significant correlation with UCLA and Constant-Murley scores (p = 0.0480 and p = 0.0110, respectively). The other radiographic parameters showed no correlation with the clinical outcomes. CONCLUSION: The superior migration of the humerus is related to worse clinical scores. Level of Evidence IV, Case Series. PMID:24453651

  6. The economics of new age arthroplasty: can we afford it?

    PubMed

    Sculco, Thomas P

    2010-09-01

    New technology in joint replacement design and materials adds cost that must be documented by improved outcomes. This is not always the case as the recent metal/metal data has shown. The current economics of arthroplasty have put increasing financial pressure on hospitals and will progress under new health care legislation. New technology must be cost-effective and this will be increasingly difficult in an era of outstanding long-term results with current designs. Cost may necessitate less expensive alternatives, eg, generic implants, in arthroplasty patients. Joint replacement surgery has evolved over the past 4 decades into a highly successful surgical procedure. Earlier designs and materials that demonstrated inferior functional and long-term results have disappeared in a Darwinian fashion. Through this evolutionary process many of the current designs have proven efficacy and durability. Current outcome data indicates that hip and knee designs demonstrate 90% to 95% success rates at 15-year follow-up. Technologic advances are necessary to improve implant design and materials, however, only in an environment of reduced reimbursement to hospitals can the increase cost be justified. PMID:20839675

  7. Early failure of articular surface replacement XL total hip arthroplasty.

    PubMed

    Steele, Garen D; Fehring, Thomas K; Odum, Susan M; Dennos, Anne C; Nadaud, Matthew C

    2011-09-01

    The ASR (articular surface replacement) XL (DePuy, Warsaw, Ind) metal-on-metal hip arthroplasty offers the advantage of stability and increased motion. However, an alarming number of early failures prompted the evaluation of patients treated with this system. A prospective study of patients who underwent arthroplasty with the ASR XL system was performed. Patients with 2-year follow-up or any revision were included. Failure rates, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and radiographs were evaluated. Ninety-five patients (105 hips) were included. There were 16 revisions. Thirteen (12%) were aseptic acetabular failures. Eight were revised for aseptic loosening; 4, for metallosis; 1, for malposition; 2, for infection; and 1, for periprosthetic fracture. Mean time to revision was 1.6 years (0.18-3.4 years). The ASR XL with a revision rate of 12% is the second reported 1 piece metal-on-metal system with a significant failure rate at early follow-up. This particular class of implants has inherent design flaws that lead to early failure. PMID:21550764

  8. Can pelvic tilting be ignored in total hip arthroplasty?

    PubMed Central

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

    2014-01-01

    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

  9. Small Stem Total Hip Arthroplasty in Hypoplasia of the Femur

    PubMed Central

    Haverkamp, Daniel; Van der Vis, Harm M.; Besselaar, Philip P.; Marti, René K.

    2008-01-01

    Total hip arthroplasty in hypoplastic femurs is technically difficult and the incidence of complications and aseptic loosening is relatively high. Cemented, uncemented, off-the-shelf, and custom-made stems all have been advocated in these cases. From 1978 to 1997, we performed 86 total hip arthroplasties in 77 patients with a hypoplastic femur using a cemented, off-the-shelf, small, curved, cobalt-chromium stem. We hypothesized results equaled those of the identical but larger-sized stems in normal-sized femora which were used as comparisons. Clinical and radiographic evaluations were performed. Minimum followup was 4.2 years (mean, 12 years; range, 4.2–20.3 years); mean Harris hip score was 88, and mean hip flexion was 104°. Six stems were revised: four because of aseptic loosening, one after a femoral fracture, and one because of malpositioning. Complications included one perforation and one fracture of the femur, one fracture, one nonunion of the greater trochanter, and one deep infection. Implant survivorship for all hips at 15 years with aseptic revision of the stem as the end point was 90% (confidence interval, 82–99) which equaled results of the larger stems. The small off-the-shelf cemented Weber stem has a high long-term survival and a low complication rate. Survival compares favorably with other small-sized total hip systems. Level of Evidence: Level III, therapeutic study, case-control. PMID:18343979

  10. Hospital volume affects outcome after total knee arthroplasty

    PubMed Central

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

    2015-01-01

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

  11. Rapidity Gaps Between Jets

    E-print Network

    J. M. Butterworth; M. E. Hayes; M. H. Seymour; L. E. Sinclair

    1996-09-02

    An excess of events with a rapidity gap between jets, over what would be expected from non-diffractive processes, has been observed at HERA. A process based on a perturbative QCD calculation of colour singlet exchange has been added to HERWIG. With this addition, HERWIG is able to describe the number of events with a gap between jets over the number without a gap. This gap fraction is predicted to rise at large rapidity intervals between jets which would only be visible if the detector coverage were increased.

  12. Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty

    Microsoft Academic Search

    Michael G. Zywiel; Jacqueline A. Daley; Ronald E. Delanois; Qais Naziri; Aaron J. Johnson; Michael A. Mont

    Surgical site infections following elective knee arthroplasties occur most commonly as a result of colonisation by the patient’s\\u000a native skin flora. The purpose of this study was to evaluate the incidence of deep surgical site infections in knee arthroplasty\\u000a patients who used an advance cutaneous disinfection protocol and who were compared to patients who had peri-operative preparation\\u000a only. All adult

  13. Rivaroxaban for venous thromboembolism prevention after total knee arthroplasty: RECORD3 findings

    Microsoft Academic Search

    Walter Ageno

    2009-01-01

    Patients undergoing major orthopaedic surgery are at considerable risk for venous thromboembolism in the days and weeks after\\u000a surgery. Consequently, thromboprophylaxis after major orthopaedic surgery, including total hip arthroplasty (THA) and total\\u000a knee arthroplasty (TKA), is regarded as a standard element of the post-surgical care of such patients. A range of agents are\\u000a available for use as thromboprophylaxis, including low

  14. Dabigatran Etexilate: Pivotal Trials for Venous Thromboembolism Prophylaxis After Hip or Knee Arthroplasty

    Microsoft Academic Search

    Bengt I. Eriksson; Richard J. Friedman

    2009-01-01

    Dabigatran etexilate, an oral direct thrombin inhibitor, was investigated in 3 large phase III trials for the prevention of venous thromboembolism (VTE) after total hip arthroplasty (RE-NOVATE, N = 3494) or total knee arthroplasty (RE-MODEL, N = 2076 and RE-MOBILIZE, N = 2615). RE-NOVATE and RE-MODEL were conducted mainly in Europe, and RE-MOBILIZE was conducted predominantly in the United States

  15. Wear of the epiphysis-acetabulum in total hip arthroplasty: a review of the literature.

    PubMed

    Affatato, S; Cianci, R; Terzi, S; Toni, A; Giunti, A

    1996-01-01

    Problems related to the use of total hip arthroplasty and the properties of the materials used to make prostheses have encouraged wear phenomena of the epiphysis-acetabulum combination of international importance and acknowledgement. Based on a review of the literature, the authors analyze the most recent years of study of wear phenomena and discuss the choice of materials to be used in total hip arthroplasty implant, with particular interest in any potential defects. PMID:8968115

  16. Should Gram Stains Have a Role in Diagnosing Hip Arthroplasty Infections?

    Microsoft Academic Search

    Aaron J. Johnson; Michael G. Zywiel; D. Alex Stroh; David R. Marker; Michael A. Mont

    2010-01-01

    Background  The utility of Gram stains in diagnosing periprosthetic infections following total hip arthroplasty has recently been questioned.\\u000a Several studies report low sensitivity of the test, and its poor ability to either confirm or rule out infection in patients\\u000a undergoing revision total hip arthroplasty. Despite this, many institutions including that of the senior author continue to\\u000a perform Gram stains during revision

  17. Reverse total shoulder arthroplasty—from the most to the least common complication

    Microsoft Academic Search

    Mazda Farshad; Christian Gerber

    2010-01-01

    Reverse total shoulder arthroplasty (RTSA) has been reported to be associated with a complication rate that is four times\\u000a that of conventional total shoulder arthroplasty. It is the purpose of this article to identify and understand the most common\\u000a and most serious complications of RTSA and to review current methods of prevention and treatment. The current literature was\\u000a reviewed to

  18. Complications after total knee arthroplasty: how to manage patients with osteolysis.

    PubMed

    Scuderi, Giles R

    2012-01-01

    Total knee arthroplasty generally is a highly successful orthopaedic procedure, but mechanical failure sometimes occurs. Debris particles, especially from polyethylene, can affect the long-term durability of the implant. Revision total knee arthroplasty is complex, and preoperative planning must consider alignment, stability, fixation, and knee motion. The reason for failure must be identified before complex reconstruction in the presence of osteolysis, and the procedure must appropriately augment the defective bone and place a stable, well-fixed implant. PMID:22301248

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

    PubMed Central

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

    2014-01-01

    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

  20. GAP ACTIVITY TRACKING MATRIX

    EPA Science Inventory

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

  1. Which Achievement Gap?

    ERIC Educational Resources Information Center

    Anderson, Sharon; Medrich, Elliott; Fowler, Donna

    2007-01-01

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

  2. Confronting the Achievement Gap

    ERIC Educational Resources Information Center

    Gardner, David

    2007-01-01

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

  3. The Gender Pay Gap

    Microsoft Academic Search

    Francine D. Blau

    1996-01-01

    Empirical research on gender pay gaps has traditionally focused on the role of gender-specific factors, particularly gender differences in qualifications and differences in the treatment of otherwise equally qualified male and female workers (i.e., labor market discrimination). This paper explores the determinants of the gender pay gap and argues for the importance of an additional factor, wage structure, the array

  4. Senseless Extravagance, Shocking Gaps

    ERIC Educational Resources Information Center

    Weissbourd, Richard; Dodge, Trevor

    2012-01-01

    Although most people in the United States believe, at least theoretically, in educational equality, fewer and fewer appear to care about the resource gaps between affluent and poor schools, says Weissbourd. He illustrates these gaps with vivid descriptions of what he calls an "opulence arms race" among affluent independent schools, but points out…

  5. Advanced rapidity gap trigger

    E-print Network

    V. A. Abramovsky; A. V. Dmitriev

    2005-01-07

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

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

    PubMed Central

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

    2015-01-01

    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. PMID:25688349

  7. Cementless large-head metal-on-metal total hip arthroplasty in patients younger than 60 years--a multicenter early result.

    PubMed

    Wu, Po-Ting; Wang, Chih-Jen; Yen, Cheng-Yo; Jian, Ji-Shen; Lai, Kuo-An

    2012-01-01

    Large-head metal-on-metal total hip arthroplasty has the theoretical advantages of less wear and better range of motion than traditional polyethylene bearings and seems to be a better choice for young and active patients. We conducted a retrospective study and reported the early results of using such prostheses in 59 patients (70 hips) with a mean age of 43.1 years (range, 23-59 years) at the time of surgery. Osteonecrosis of the femoral head accounted for most diagnoses. Harris Hip Scores and hip range of motion both significantly improved (p<0.001) at an average follow-up of 32.6 months (range, 24-48 months). Only one intraoperative calcar fissure was encountered, and it was fixated by cerclage wiring; there was no infection, dislocation, or osteolysis around either the cup or the stem at the latest follow-up. A postoperative gap in the acetabular component was noted in 24 hips, with a mean depth of 1.11 mm, but this was not correlated with the functional score (p=0.291). Transient thigh pain, which resolved after 6 months, was observed in six patients but was not related to either the postoperative gap or cup inclination (p=1.000 and p=0.664, respectively). All patients resumed their original jobs and recreational activities with little discomfort. Thus far, large-head metal-on-metal total hip arthroplasty has shown excellent early results. The long-term results and the effects of metal debris and potentially elevated serum metal ion levels require further observation. PMID:22226059

  8. Femoral lengthening during hip resurfacing arthroplasty: A new surgical procedure.

    PubMed

    Vasseur, L; Ayoub, B; Mesnil, P; Pasquier, G; Migaud, H; Girard, J

    2015-04-01

    Correction of leg length discrepancy during hip arthroplasty is a technical challenge. Although resurfacing proposed to young subjects presents a number of advantages (stability, bone stock, etc.), it does not correct leg length discrepancy. We propose an original femoral lengthening technique concomitant to resurfacing performed through the same approach, consisting in a Z-shaped subtrochanteric osteotomy. Resurfacing was performed first and the femoral and acetabular reaming material was used for autografting. The series comprised five cases followed for a mean 42.2 months (range, 33-64 months). The mean surgical time was 100min (range, 76-124min). Weightbearing was authorized in all cases at the 8th week. The mean lengthening was 32mm (range, 25-40mm). Healing was observed in all cases. This surgical technique, reserved for very young subjects who accept an 8-week postoperative period without weightbearing, can be proposed in cases with substantial preoperative leg length discrepancy. PMID:25755066

  9. Alumina-on-Polyethylene Bearing Surfaces in Total Hip Arthroplasty

    PubMed Central

    Jung, Yup Lee; Kim, Shin-Yoon

    2010-01-01

    The long-term durability of polyethylene lining total hip arthroplasty (THA) mainly depends on periprosthetic osteolysis due to wear particles, especially in young active patients. In hip simulator study, reports revealed significant wear reduction of the alumina ceramic-on-polyethylene articulation of THA compared with metal-on-polyethylene bearing surfaces. However, medium to long-term clinical studies of THA using the alumina ceramic-on-polyethylene are few and the reported wear rate of this articulation is variable. We reviewed the advantages and disadvantages of ceramicon- polyethylene articulation in THA, hip simulator study and retrieval study for polyethylene wear, in vivo clinical results of THA using alumina ceramic-on-polyethylene bearing surfaces in the literature, and new trial alumina ceramic-onhighly cross linked polyethylene bearing surfaces. PMID:20224739

  10. How to measure wear following total hip arthroplasty.

    PubMed

    Grillini, Laura; Affatato, Saverio

    2013-01-01

    Total hip arthroplasty has yielded excellent results in decreasing pain and enhancing function in patients with hip degenerative disease. However, the problems associated with prosthetic failure and the consequent need for revision surgery still represent a major clinical issue. The most common reasons for revision surgery include implant loosening, periprosthetic osteolysis, infection, malalignment, stiffness, implant failure or fracture, and wear. The need for eliminating or reducing wear plays a crucial role in refining prosthesis composition and design. In this regard, it is important to develop new techniques for more accurate and reproducible measurement of wear. This should allow earlier detection of increased wear and thus permit earlier identification of patients who are at risk, and also help to identify faulty implant designs.?This work is aimed at discussing the most common in vivo and in vitro methods used for evaluating the wear of hip prosthesis components. PMID:23760744

  11. The fundamentals of biotribology and its application to spine arthroplasty

    PubMed Central

    Harper, Megan L.; Dooris, Andrew; Paré, Philippe E.

    2009-01-01

    The biological effect of wear of articulating surfaces is a continued concern with large joint replacements and, likewise, of interest for total disc replacements. There are a number of important biotribological testing parameters that can greatly affect the outcome of a wear study in addition to the implant design and material selection. The current ASTM and ISO wear testing standards/guides for spine arthroplasty leave many choices as testing parameters. These factors include but are not limited to the sequence of kinematics and load, phasing, type of lubricant, and specimen preparation (sterilization and artificial aging). The spinal community should critically assess wear studies and be cognizant of the influence of the selected parameters on the test results.

  12. Cemented versus cementless fixation in total knee arthroplasty

    PubMed Central

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

    2013-01-01

    The question of whether to use cemented or cement-less fixation for a total knee arthroplasty (TKA) is still debated. Discouraging preliminary results of cement-less TKAs have determined the worldwide use of cemented implants. However, with the development of biotechnologies and new biomaterials with high osteoconductive properties, biological fixation is now becoming an attractive option for improving the longevity of TKAs, especially in young patients. There is no evidence in the current literature to support the use of one method of fixation. The extensive clinical experience with cemented implants gathered over the years justifies their widespread use. New randomized clinical trials are necessary to compare cementless fixation based on the new ingrowth surfaces with standard cemented implants. PMID:25606521

  13. One-Stage Revision Arthroplasty for Infected Hip Replacements

    PubMed Central

    Muñoz-Mahamud, Ernesto; Gallart, Xavier; Soriano, Alejandro

    2013-01-01

    Infection remains a serious complication after total hip arthroplasty (THA) and is a leading cause of hip revision surgery. It is currently accepted that removal of the prosthesis is essential to curing an infection when facing chronic PJIs with prosthesis loosening. In order to avoid the disadvantages of a two-stage approach, some authors have proposed a one-stage hip revision for the treatment of hip prosthesis infection in selected patients using not only antibiotic-loaded cemented components but also cementless implant. In the case of a one-stage procedure, the patient is exposed to a single major procedure and therefore lower cumulative perioperative risk. A functional prosthesis replacement is completed without exposure to the complications associated with spacers. In addition, there are also benefits both financially and in terms of resource allocation. PMID:23898350

  14. Smith-Petersen and early development of hip arthroplasty.

    PubMed

    Hernigou, Philippe

    2014-01-01

    Dr. Marius N. Smith-Petersen, in Boston, MA, USA, introduced the mould arthroplasty (1923). He used a reactive synovial-like membrane that he found had developed around a piece of glass he had removed from a workman's back, which had been imbedded there for a year. The original design was a ball-shaped, hollow hemisphere of glass that could fit over the femoral head of the hip joint. The objective was to stimulate cartilage regeneration on both sides of the moulded glass joint. Smith-Peterson intended to remove the glass after the cartilage had been restored. Glass provided a new, smooth surface for movement, and although proving biocompatible, it could not withstand the stresses of walking and quickly failed. Smith-Petersen succeeded in his endeavour by using Vitallium alloy. PMID:24173675

  15. Wear and loosening in total knee arthroplasty: a quick review.

    PubMed

    Fraser, James F; Werner, Steven; Jacofsky, David J

    2015-04-01

    Wear and osteolysis are common problems that often require revision surgery following total knee arthroplasty (TKA). Wear rates can be reduced through proper implant positioning and the use of modern, highly cross-linked polyethylene liners. More research is needed to identify medications that could prevent or treat the bone loss associated with osteolysis. Bone defects resulting from osteolysis can be managed with a variety of bone-preserving strategies and often require the use of structural augmentation, either in the form of bulk allografts or metal augments. Recently, porous metal augments such as tantalum cones have gained popularity among surgeons performing revision TKA for osteolytic bone defects with promising early clinical results. A megaprosthesis with a rotating hinge device may be used in salvage cases for severe bone deficiencies. PMID:25539400

  16. Bilateral hip arthroplasty: is 1-week staging the optimum strategy?

    PubMed

    Atkinson, Henry D; Bailey, Christopher A; Willis-Owen, Charles A; Oakeshott, Roger D

    2010-01-01

    Seventy-nine patients underwent bilateral hip arthroplasty staged either at 1 week (Group 1) or after greater intervals (as suggested by the patients, mean 44 weeks, range 16-88 weeks) (Group 2), over a five year period at one Institution. Sixty-eight patients (29 bilateral hip resurfacings and 39 total hip replacements) completed questionnaires regarding their post-operative recovery, complications and overall satisfaction with the staging of their surgery.There was no significant age or ASA grade difference between the patient groups. Complication rates in the two groups were similar and overall satisfaction rates were 84% in Group 1 (n = 32) and 89% in Group 2 (n = 36). Cumulative hospital lengths of stay were significantly longer in Group 1 patients (11.9 days vs 9.1 days)(p < 0.01); this was true for both hip resurfacing and total hip arthroplasty patients, however resurfacing patients stays were significantly shorter in both groups (p < 0.01). Postoperative pain resolved earlier in Group 1 patients at a mean of 20.9 weeks compared with a cumulative 28.9 weeks (15.8 and 13.1 weeks) for Group 2 patients (p = 0.03).The mean time to return to part-time work was 16.4 weeks for Group 1, and a cumulative 17.2 weeks (8.8 and 8.4 weeks) for Group 2. The time to return to full-time work was significantly shorter for Group 1 patients (21.0 weeks, compared with a cumulative 29.7 weeks for Group 2)(p < 0.05). The time to return to both full and part-time work was significantly shorter in total hip replacement patients with 1-week staging compared with delayed staging (22.0 vs 35.8 weeks (p = 0.02), and 13.8 vs 19.3 weeks (p = 0.03) respectively).Hip resurfacing patients in Group 2 had significantly shorter durations of postoperative pain and were able to return to part-time and full time work sooner than total hip arthroplasty patients. There was a general trend towards a faster recovery and resumption of normal activities following the second operation in Group 2 patients, compared with the first operation.Bilateral hip arthroplasty staged at a 1-week interval resulted in an earlier resolution of hip pain, and an earlier return to full-time work (particularly following total hip replacement surgery), with high levels of patient satisfaction and no increased risk in complications; however the hospital length of stay was significantly longer. The decision for the timing of staged bilateral surgery should be made in conjunction with the patient, making adjustments to accommodate their occupational needs and functional demands. PMID:21054889

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

    PubMed Central

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

    2015-01-01

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

  18. Recurrent total knee arthroplasty dislocation after dorsal meningioma diagnosed.

    PubMed

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

    2011-12-01

    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

  19. Variations in hospital billing for total joint arthroplasty.

    PubMed

    Stryker, Louis S; Odum, Susan M; Fehring, Thomas K

    2014-09-01

    Although regional variations in Medicare spending are known, it is not clear whether regional variations exist in hospital charges for total joint arthroplasty. Data from Centers for Medicare and Medicaid Services (CMS) on Diagnosis Related Groups 469 and 470 (Major Joint with and without Major Complicating or Comorbid Condition) from 2011 were analyzed for variation by region. Drastic variations in charges between institutions were apparent with significant differences between regions for hospital charges and payments. The median hospital charge nationwide was $71,601 and $46,219 for Diagnosis Related Groups 469 and 470, respectively, with corresponding median payments of $21,231 and $13,743. Weak to no correlation was found between hospital charges and payments despite adjustments for wage index, cost of living, low-income care and teaching institution status. PMID:24973930

  20. Total joint arthroplasty: trends in medicare reimbursement and implant prices.

    PubMed

    Belatti, Daniel A; Pugely, Andrew J; Phisitkul, Phinit; Amendola, Annunziato; Callaghan, John J

    2014-08-01

    Total joint arthroplasty (TJA) continues to be a popular target of cost control efforts. In order to provide a unique overview of financial trends facing TJA, we analyzed Medicare databases including 100% of beneficiaries, as well as industry surveys of implant list prices. Although there was a substantial increase in TJA utilization over the period 2000-2011 (+26.9%), growth has been stagnant since 2005. New coding schemes have made complicated cases more lucrative for hospitals (+2.5% to 6.5% per year), while reimbursements for uncomplicated cases have fallen (-0.7% to -0.6%). Physician reimbursements have declined on all case types (-2.5% to -2.1% per year), while list prices of orthopedic implants have risen (+4.8% to 5.5%). These trends should be kept in mind while contemplating future changes to TJA payment. PMID:24736291

  1. Outcome of total knee arthroplasty in hemophilic arthropathy.

    PubMed

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

    2014-04-01

    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

  2. Glenohumeral pressure with surface replacement arthroplasty versus hemiarthroplasty.

    PubMed

    Petraglia, Carmen A; Ramirez, Miguel A; Tsai, Michael A; Parks, Brent G; Murthi, Anand M

    2014-10-01

    It is not known whether significant differences in the glenohumeral center of pressure and contact pressure exist between surface replacement arthroplasty and hemiarthroplasty compared with the native joint. Twelve fresh-frozen cadaveric shoulders were dissected free of soft tissue, and the joint capsule was removed. The scapula was potted with the glenoid parallel to the ground. A pressure-sensitive sensor was placed in the glenohumeral joint, and each specimen was tested in sequence: intact, surface replacement, and hemiarthroplasty. Loading was done with a 440-N compression load at 0.5 Hz with the shoulder in 4 different positions. The center of pressure and contact pressure were measured at each position. The glenohumeral contact pressure with surface replacement was not different from intact pressure in 2 arm positions. Pressure with hemiarthroplasty was significantly different compared with the intact shoulder at all 4 arm positions and compared with the surface replacement group at 2 arm positions (P?.05). Change in the anterior-posterior center of pressure from intact was significantly smaller with surface replacement compared with hemiarthroplasty with the humerus at 0° flexion/0° abduction and at 0° flexion/90° abduction (1.11±0.89 mm vs 2.38±1.62 mm, P=.02, and 0.68±0.50 mm vs 2.37±2.0 mm, P=.01, respectively). Change in the superior-inferior center of pressure was significantly smaller with surface replacement vs hemiarthroplasty at 0° flexion/0° abduction and at 90° flexion/90° abduction (0.98±1.16 mm vs 2.33±1.38 mm, P=.02, and 1.50±1.28 mm vs 2.90±1.92 mm, P=.04, respectively). Compared with hemiarthroplasty, surface replacement arthroplasty more closely replicated the contact pressure and center of pressure in the intact glenohumeral joint. PMID:25275976

  3. Spontaneous modular femoral head dissociation complicating total hip arthroplasty.

    PubMed

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

    2014-06-01

    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

  4. SURGICAL SKILLS TRAINING FOR PRIMARY TOTAL HIP ARTHROPLASTY

    PubMed Central

    HASEGAWA, YUKIHARU; AMANO, TAKAFUMI

    2015-01-01

    ABSTRACT A total of 483 hips treated by primary total hip arthroplasty (THA) were investigated to evaluate the surgical skill of the performing surgeon. Surgical trainees operated on 259 hips and instructors on 224 hips. The average age of the patients at the time of THA in the trainee and instructor group was 61.9 and 60.8 years old, respectively. The average follow-up duration was 5.1 years. The operative time in the trainee group and instructor group was 87.0 and 73.1 min, respectively (p=0.031). Complications were noted in 11 hips (3.5%) in the trainee group; acetabular fracture, 3 hips; dislocation, 3 hips; femoral artery lacerations that needed repair surgery, 2 hips; sciatic nerve palsy, 2 hips; and skin necrosis, 1 hip. Complication were noted in three hips (1.3%) in the instructor group; femoral fracture, 1 hip; acetabular fracture, 1 hip; dislocation, 1 hip. Complication rate in the trainee group was higher than in the instructor group. The monitored quality of the surgeries performed by trainees and instructors was not significantly different. Poor quality was identified in 14 hips in the trainee group and 6 hips in instructor group. No significant difference was found in the hip score between the trainees and instructors before and after surgery. Revision arthroplasty was defined as the end-point for primary THA. Kaplan-Meier survivorship at 5 years after primary THA was 97.2% in trainee group and 97.3% in the instructor group. Short-term clinical and radiographic results of primary THA in the trainee and instructor groups were considered safe and satisfactory. PMID:25797970

  5. Traditions and myths in hip and knee arthroplasty

    PubMed Central

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

    2014-01-01

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

  6. Cryocompression therapy after elective arthroplasty of the hip.

    PubMed

    Leegwater, Nick C; Willems, Jore H; Brohet, Richard; Nolte, Peter A

    2012-01-01

    Pneumatic compression and cryotherapy have been successfully being employed in the management of acute tissue damage. The Game Ready System (GRS) combines cyclic compression and cryotherapy. No randomised controlled trial has been performed on the effects of combined cyclic compression and cryotherapy in total hip arthroplasty (THA). We observed postoperative pain, morphine usage, blood loss, wound discharge, patient and medical staff satisfaction, together with the feasibility of a cryocompression machine, total hospital admission time, infection rate, deep vein thrombosis, and short-term prosthesis related problems in this context. Thirty patients, mean age 68 yrs (range 31-83 yrs) undergoing elective hip arthroplasty for end-stage osteoarthritis were included. Control patients (n = 15) received a tricot compression bandage alone, and patients studied received a tricot compression bandage plus intermittent cryocompression therapy 15 times for 30 minutes. Haemoglobin levels on postoperative day (POD) 1 dropped 2.34 mmol/L in the control group and 1,87 mmol/L in the intervention group (p = 0,027). At POD 3 haemoglobin levels were reduced by 2,63 and 2,16 respectively (p = 0,646). A trend occurred towards lower morphine usage, shorter hospital admission time and less wound discharge in the study group. No difference was found in postoperative pain scores. One event of deep venous thrombosis occurred in the control group. Intermittent cryocompression therefore appears to reduce postoperative blood loss. A trend towards less analgesic use, shorter hospital stay, less wound discharge and less pain at 6 weeks postoperatively was also observed. PMID:23112075

  7. Radial head, radiocapitellar and total elbow arthroplasties: a review of recent literature.

    PubMed

    Giannicola, Giuseppe; Sacchetti, Federico M; Antonietti, Giorgio; Piccioli, Andrea; Postacchini, Roberto; Cinotti, Gianluca

    2014-02-01

    The outcome of prosthetic elbow surgery is continually evolving. We thoroughly reviewed the literature on this issue to analyse the indications, outcomes and complications of the numerous types of implants currently in use. Radial head replacement is recommended in comminuted fractures of the radial head and in post-traumatic conditions. Medium- and long-term results prove to be satisfactory in the majority of cases, with no evidence to indicate that some prostheses (monopolar vs. bipolar; cemented vs. press-fit) are more effective than others; nonetheless, the bipolar-cemented implant was found to be associated with a lower revision rate than other prostheses. Unicompartmental arthroplasty has recently been used for the treatment of osteoarthritis and rheumatoid arthritis when the lateral compartment is prevalently involved; the results reported to date have been encouraging, although further studies are warranted to confirm the validity of these implants. Total elbow arthroplasty is performed in a range of conditions, including distal humerus fractures in the elderly and elbow arthritis. In the former condition, linked elbow replacement yields excellent results with few complications and a low revision rate. In elbow arthritis, total elbow arthroplasty is indicated when patients suffer from disabling pain, stiffness and/or instability that prevent them from performing daily activities. Unlinked elbow arthroplasty, which is used above all in rheumatoid arthritis, also yields satisfactory results, although the risk of instability persists. The use of linked elbow arthroplasty, which yields similar results but lower revision rates, has consequently increased. Lastly, the results yielded by linked elbow prosthesis in post-traumatic conditions are good, although not quite as good as those obtained in rheumatoid arthritis. Early mechanical failure may occur in younger and more active patients after elbow arthroplasty. However, the careful selection of patients who are prepared to accept functional limitations imposed by elbow implants will enable indications for elbow arthroplasty to be extended to young subjects, particularly when no other therapeutic options are available. PMID:24112701

  8. Fiber optic gap gauge

    DOEpatents

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

    2006-11-14

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

  9. Generation gaps in engineering?

    E-print Network

    Kim, David J. (David Jinwoo)

    2008-01-01

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

  10. 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...

  11. Rapidity Gaps Between Jets

    Microsoft Academic Search

    J. M. Butterworth; M. E. Hayes; M. H. Seymour; L. E. Sinclair

    1996-01-01

    An excess of events with a rapidity gap between jets, over what would be\\u000aexpected from non-diffractive processes, has been observed at HERA. A process\\u000abased on a perturbative QCD calculation of colour singlet exchange has been\\u000aadded to HERWIG. With this addition, HERWIG is able to describe the number of\\u000aevents with a gap between jets over the number

  12. Primary hip arthroplasty costs are greater in low-volume than in high-volume Canadian hospitals.

    PubMed

    Martineau, Paul; Filion, Kristian B; Huk, Olga L; Zukor, David J; Eisenberg, Mark J; Antoniou, John

    2005-08-01

    Despite the widespread success of total hip arthroplasties for treatment of arthritis of the hip, the procedure continues to be targeted for cost control. Our objective was to compare the total in-hospital cost of primary total hip arthroplasties in high-volume and low-volume hospitals. Data concerning the patient-level in-hospital costs of 940 consecutive primary total hip arthroplasties were extracted from the cost accounting system of three Canadian hospitals. Mean in-hospital costs for patients having total hip arthroplasties in a high-volume institution (> or = 300 total hip arthroplasties/year) compared with two low-volume Canadian institutions (< 300 total hip arthroplasties/year) were: overhead costs 1380 US dollars +/- 35 US dollars versus 2432 US dollars +/- 49 US dollars; direct costs 3023 US dollars +/- 93 US dollars versus 4952 US dollars +/- 91 US dollars and total costs 4403 US dollars +/- 117 US dollars versus 7385 US dollars +/- 1 US dollar 38, respectively (all comparisons in US dollars). Lower overhead and direct and total costs were found for primary total hip arthroplasties done in a high-volume Canadian hospital compared with the low-volume centers. Differences in direct costs, made up in large part by the implant cost, accounted for most of the disparity. As total hip arthroplasties continue to be scrutinized for cost containment, doing the procedure in a high-volume center seems to be an effective method of controlling costs. PMID:16056043

  13. The effect of intraoperative intravenous fixed-dose heparin during total joint arthroplasty on the incidence of fatal pulmonary emboli

    Microsoft Academic Search

    Jeffrey M. Nassif; Merrill A. Ritter; John B. Meding; E. Michael Keating; Philip M. Faris

    2000-01-01

    All patients who underwent primary total knee arthroplasty (TKA), revision TKA, primary total hip arthroplasty (THA), and revision THA between January 1, 1990, and December 31, 1996, were retrospectively reviewed to determine the incidence of fatal pulmonary emboli. All TKA patients received 1,000 U of intravenous heparin sodium before the tourniquet was inflated and an additional 500 U of intravenous

  14. The Inferior Vena Cava Filter is Effective in Preventing Fatal Pulmonary Embolus After Hip and Knee Arthroplasties

    Microsoft Academic Search

    Matthew S. Austin; Javad Parvizi; Seth Grossman; Camilo Restrepo; Gregg R. Klein; Richard H. Rothman

    2007-01-01

    Thromboembolic disease is a relatively common and potentially devastating complication of joint arthroplasty. Mechanical and chemical prophylaxes are effective in reducing the incidence of this complication. Inferior vena cava (IVC) filters have been used to prevent the propagation and\\/or migration of venous emboli into the pulmonary circulation. This article reports on a cohort of joint arthroplasty patients either with confirmed

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

    PubMed Central

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

    2015-01-01

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

  16. Total knee arthroplasty with retention of both cruciate ligaments. A 9 to 11 year follow-up study

    Microsoft Academic Search

    J. M. Cloutier; P. Sabouret; A. Deghrar

    2001-01-01

    This is a prospective assessment of 163 total knee arthroplasties in 130 patients with the retention of both cruciate ligaments of which 107 knees in 89 patients have been followed for ten years. The patients were 34 men and 96 women whose average age, at the time of the index arthroplasty, was 67 years (range: 40 to 84 years). The

  17. Intraoperative flexion against gravity as an indication of ultimate range of motion in individual cases after total knee arthroplasty

    Microsoft Academic Search

    D. C. Lee; D. H. Kim; R. D. Scott; K. Suthers

    1998-01-01

    To assess a method of predicting the final postoperative flexion in individual cases after total knee arthroplasty, 364 primary posterior cruciate-retaining total knee arthroplasties were reviewed retrospectively. The knees were subdivided into three preoperative flexion groups—I: poor motion (0° to 85°), II: intermediate motion (90° to 110°), and III: good motion (115° to 140°). There were 302 cases of osteoarthritis

  18. Clinical Outcomes After Simultaneous Bilateral Total Knee Arthroplasty: Comparison to Unilateral Total Knee Arthroplasty and Healthy Controls

    PubMed Central

    Zeni, Joseph A; Snyder-Mackler, Lynn

    2009-01-01

    The purpose of this study was to evaluate the functional outcomes of persons who underwent simultaneous bilateral total knee arthroplasty (TKA) compared to subjects who underwent unilateral TKA and a healthy control group. Fifteen subjects who underwent primary bilateral TKA and 15 sex, age, and body mass index-matched subjects who underwent primary unilateral TKA were observed prospectively for 2 years. Subjects in both surgical groups showed significant improvement in Knee Outcome Scores, Short Form 36 physical component scores, Timed Up and Go, and stair-climbing tasks (P ? .004). No differences in final outcomes were found between surgical groups. In addition, most 2-year clinical measures were no different between the surgical and control groups. Subjects medically appropriate for bilateral TKA should be afforded this option. PMID:19356894

  19. There Are GAPS and There Are GAPS

    NSDL National Science Digital Library

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

    1997-01-03

    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.

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

    PubMed

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

    2014-11-01

    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

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

    PubMed

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

    2014-09-01

    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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  4. Uncertainties in Gapped Graphene

    E-print Network

    Eylee Jung; Kwang S. Kim; DaeKil Park

    2012-03-20

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

  5. Precision gap particle separator

    DOEpatents

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

    2004-06-08

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

  6. Erraticity of Rapidity Gaps

    E-print Network

    Rudolph C. Hwa; Qing-hui Zhang

    1999-12-08

    The use of rapidity gaps is proposed as a measure of the spatial pattern of an event. When the event multiplicity is low, the gaps between neighboring particles carry far more information about an event than multiplicity spikes, which may occur very rarely. Two moments of the gap distrubiton are suggested for characterizing an event. The fluctuations of those moments from event to event are then quantified by an entropy-like measure, which serves to describe erraticity. We use ECOMB to simulate the exclusive rapidity distribution of each event, from which the erraticity measures are calculated. The dependences of those measures on the order of $q$ of the moments provide single-parameter characterizations of erraticity.

  7. Erraticity of rapidity gaps

    SciTech Connect

    Hwa, Rudolph C. [Institute of Theoretical Science and Department of Physics, University of Oregon, Eugene, Oregon 97403-5203 (United States)] [Institute of Theoretical Science and Department of Physics, University of Oregon, Eugene, Oregon 97403-5203 (United States); Zhang, Qing-hui [Institute of Theoretical Science and Department of Physics, University of Oregon, Eugene, Oregon 97403-5203 (United States)] [Institute of Theoretical Science and Department of Physics, University of Oregon, Eugene, Oregon 97403-5203 (United States)

    2000-07-01

    The use of rapidity gaps is proposed as a measure of the spatial pattern of an event. When the event multiplicity is low, the gaps between neighboring particles carry far more information about an event than multiplicity spikes, which may occur very rarely. Two moments of the gap distribution are suggested for characterizing an event. The fluctuations of those moments from event to event are then quantified by an entropy-like measure, which serves to describe erraticity. We use ECOMB to simulate the exclusive rapidity distribution of each event, from which the erraticity measures are calculated. The dependences of those measures on the order q of the moments provide single-parameter characterizations of erraticity. (c) 2000 The American Physical Society.

  8. Skills Gaps in Australian Firms

    ERIC Educational Resources Information Center

    Lindorff, Margaret

    2011-01-01

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

  9. Measured resection: an outdated technique in total knee arthroplasty.

    PubMed

    Dennis, Douglas A

    2008-09-01

    Multiple methods may be used to determine correct femoral component rotation during TKA. Numerous reports document surgeon inability to precisely identify critical bone landmarks when deciding correct femoral component rotation using a measured resection methodology. While the author recommends using all available methods in combination, use of gap balancing provides a more accurate and reproducible way to obtain satisfactory flexion gap stability. PMID:18814622

  10. Clinical experience with less invasive surgery techniques in total knee arthroplasty: a comparative study.

    PubMed

    Kashyap, Shankar N; van Ommeren, J W

    2008-06-01

    We compared 25 consecutive cases of total knee arthroplasty performed through less invasive techniques with 25 cases of age and BMI matched cases of standard knee replacements. Early experience suggests functional recovery is earlier with less invasive technique as compared with open access. Patients in less invasive group had better knee flexion (an average of 116 degrees compared to 97 degrees ), walking ability and stair climbing at 6 months than those with standard technique at 6 months. At 2 years this difference was maintained to a lesser extent. More patients with less invasive group could kneel and could do "normal up and down" the stairs at 6 months and also at 2 years. There was no significant difference in alignment and component sizing between the two groups. This should translate to similar long term results after less invasive knee arthroplasty as after open access total knee arthroplasty. PMID:18365178

  11. Tibial baseplate fracture associated with polyethylene wear and osteolysis after total knee arthroplasty?

    PubMed Central

    Cankaya, Deniz; Yilmaz, Serdar; Deveci, Alper; Ozkurt, Bulent

    2013-01-01

    INTRODUCTION Fracture of the tibial baseplate following total knee arthroplasty is very rare given the developments in modern prosthesis design. Tibial baseplate fracture secondary to polyethylene wear, osteolysis and component malalignment in an elderly obese patient is reported in the present article. PRESENTATION OF CASE A 69-year-old woman had undergone total knee arthroplasty eleven years prior to presentation and reported nine months of chronic pain, which was caused by a neglected fracture of the baseplate. DISCUSSION We discuss the prevention of implant fracture after total knee arthroplasty and address the risk factors associated with this complication. CONCLUSION The present case emphasizes the importance of properly informing patients and encouraging them to report such complaints immediately to allow for early revision and prevention of component fracture, especially in patients with risk factors such as obesity and component, malalignment. PMID:24441434

  12. Patient Expectation Is the Most Important Predictor of Discharge Destination After Primary Total Joint Arthroplasty.

    PubMed

    Halawi, Mohamad J; Vovos, Tyler J; Green, Cindy L; Wellman, Samuel S; Attarian, David E; Bolognesi, Michael P

    2014-11-01

    The purpose of this study was to identify preoperative predictors of discharge destination after total joint arthroplasty. A retrospective study of three hundred and seventy-two consecutive patients who underwent primary total hip and knee arthroplasty was performed. The mean length of stay was 2.9days and 29.0% of patients were discharged to extended care facilities. Age, caregiver support at home, and patient expectation of discharge destination were the only significant multivariable predictors regardless of the type of surgery (total knee versus total hip arthroplasty). Among those variables, patient expectation was the most important predictor (P < 0.001; OR 169.53). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a high concordance index of 0.969. PMID:25468779

  13. The impact of total joint arthroplasty on sexual function in young, active patients.

    PubMed

    Nunley, Ryan M; Nam, Denis; Bashyal, Ravi K; Della Valle, Craig J; Hamilton, William G; Berend, Michael E; Parvizi, Javad; Clohisy, John C; Barrack, Robert L

    2015-02-01

    There is limited information regarding sexual function following total hip (THA) and knee arthroplasty (TKA). A multicenter study of 806 THA, 542 TKA, and 181 control patients less than 60 years of age was conducted using an independent survey center to question subjects about their sexual function. Only 1.3% of THA and 1.6% of TKA patients stated they were not sexually active due to their operation. No significant differences were noted in sexual function based on the bearing surface, femoral head size, or use of surface replacement arthroplasty in the hip cohort. Multivariate analysis revealed no difference in the percentage of patients sexually active following a THA or TKA (OR 1.19, P=0.38). Most young active patients return to sexual activity after hip and knee arthroplasty. PMID:25449592

  14. The treatment of femoral neuropathy due to pseudotumour caused by metal-on-metal resurfacing arthroplasty.

    PubMed

    Harvie, P; Giele, H; Fang, C; Ansorge, O; Ostlere, S; Gibbons, M; Whitwell, D

    2008-01-01

    Concerns now exist about the long-term biological effects of exposure to orthopaedic metal alloys, particularly serum cobalt and chromium ions derived from metal-on-metal wear debris in these patients. A pseudotumour mass complicating metal-on-metal resurfacing arthroplasty has been recognized by orthopaedic oncologists and specialist hip units. Pseudotumours may also present with a major nerve palsy. Two cases of femoral neuropathy due to pseudotumour masses caused by metal-on-metal resurfacing arthroplasty are presented. Preoperative neurophysiological studies showed severe and irreversible pathological changes to nerve function with neurohistopathological evidence of complete nerve destruction with a previously unreported pathological appearance. This may represent a previously unrecognized pathological process, possibly 'toxic' in nature, resulting from metal-on-metal wear debris. Prolonged follow-up and detailed clinical assessment of patients after hip resurfacing arthroplasty is advocated with planned and expeditious revision of any patient in whom evidence of femoral neuropathy develops. PMID:19097010

  15. What is the true incidence of dental pathology in the total joint arthroplasty population?

    PubMed

    Barrington, John W; Barrington, Thomas A

    2011-09-01

    One million total joint arthroplasties (TJAs) are performed annually in the United States. The incidence of oral disease has not been documented in this population. To understand the scope of disease, a descriptive longitudinal population-based study sought to define the true incidence of dental pathology in the TJA population. One hundred consecutive TJA patients from a dedicated arthroplasty practice were sent for dental clearance, including oral examination, cleaning, radiographs, and treatment of active decay. The incidence of pathology was documented. Of 10 patients, 23 (23%) were treated before being cleared for arthroplasty. Sixty-six procedures were performed--2.9 problems per patient. No patient developed TJA infection. Routine preoperative dental clearance revealed 23% incidence of pathology, and no patient developed TJA infection. PMID:21723698

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

    PubMed Central

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

    2013-01-01

    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

  17. Closing the Health Gap

    NSDL National Science Digital Library

    2001-01-01

    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."

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

    PubMed Central

    2014-01-01

    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

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

    PubMed Central

    2013-01-01

    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

  20. Results of direct exchange or debridement of the infected total knee arthroplasty.

    PubMed

    Silva, Mauricio; Tharani, Ravi; Schmalzried, Thomas P

    2002-11-01

    In this literature review, 30 reports provided outcome data on 37 direct exchange arthroplasties, 530 open debridements, and 23 arthroscopic debridements. The average followup was approximately 4 years, but the range was broad (range, 0.02-14 years). Infection was controlled in 33 of the 37 infected total knee arthroplasties (89.2%) treated by direct exchange arthroplasty, in only 173 of the 530 infected total knee arthroplasties (32.6%) treated by open debridement and retention of the prosthetic components, and in 12 of the 23 infected total knee arthroplasties (52.2%) treated by arthroscopic debridement. There was wide variability in associated antibiotic therapy. Factors associated with successful direct exchange included infections by gram-positive organisms, absence of sinus formation, use of antibiotic-impregnated bone cement for the new prosthesis, and 12 weeks of antibiotic therapy. Direct exchange arthroplasty failed in four of 37 knees; two were in patients with rheumatoid arthritis who were taking corticosteroids. Factors associated with successful debridements included those done within 4 months of the index procedure, or in patients with less than 4 weeks of symptoms, antibiotic sensitive gram-positive organisms, well-fixed components with no radiologic evidence of osteitis, and in young healthy patients. Factors associated with the failed debridements included postoperative drainage for more than 2 weeks, sinus tracts present at the time of the debridement, a hinged prosthesis, and an immunocompromised host. Direct exchange can be successful with a sensitive organism in a healthy host with prolonged antibiotic therapy. Debridement can be successful in early infections in a healthy host. PMID:12439250

  1. The assessment of outcome after total knee arthroplasty: are we there yet?

    PubMed

    Hossain, F S; Konan, S; Patel, S; Rodriguez-Merchan, E C; Haddad, F S

    2015-01-01

    The routine use of patient reported outcome measures (PROMs) in evaluating the outcome after arthroplasty by healthcare organisations reflects a growing recognition of the importance of patients' perspectives in improving treatment. Although widely embraced in the NHS, there are concerns that PROMs are being used beyond their means due to a poor understanding of their limitations. This paper reviews some of the current challenges in using PROMs to evaluate total knee arthroplasty. It highlights alternative methods that have been used to improve the assessment of outcome. PMID:25568406

  2. The Need for Guidelines in Asplenic Patients Undergoing Total Joint Arthroplasty: A Case Report

    PubMed Central

    Shaarani, S. R.; Collins, D.; O'Byrne, J. M.

    2012-01-01

    There are currently no guidelines for splenectomy patient undergoing total joint arthroplasty. We present a case history of a 63-year-old man with a history of splenectomy that underwent a total knee arthroplasty with standard intravenous antibiotic prophylaxis. Two weeks postoperatively, he developed a prosthetic joint infection and followed the standard antimicrobial management with intravenous and oral antibiotics prior to having revision surgery. We propose that there are guidelines to properly manage these patients in the pre- and perioperative setting following an orthopaedic procedure. PMID:23259109

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

    PubMed

    Gladnick, Brian P; Gonzalez Della Valle, Alejandro

    2014-10-01

    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

  4. Inflammatory Pseudotumor Complicated by Recurrent Dislocations after Revision Total Hip Arthroplasty

    PubMed Central

    Lee, Jason; Schwarzkopf, Ran

    2014-01-01

    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

  5. Preoperative Aspiration Culture for Preoperative Diagnosis of Infection in Total Hip or Knee Arthroplasty

    PubMed Central

    Qu, Xinhua; Zhai, Zanjing; Wu, Chuanlong; Jin, Fangchun; Li, Haowei; Wang, Lei; Liu, Guangwang; Liu, Xuqiang; Wang, Wengang; Li, Huiwu; Zhang, Xiaoyu

    2013-01-01

    This meta-analysis evaluated preoperative aspiration culture for diagnosing prosthetic joint infection (PJI) in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The pooled sensitivity and specificity were 0.72 (95% confidence interval, 0.65 to 0.78) and 0.95 (0.93 to 0.97), respectively. Subgroup analyses revealed nonsignificant worse diagnostic performance for THA than for TKA (sensitivity, 0.70 versus 0.78; specificity, 0.94 versus 0.96). Preoperative aspiration culture has moderate to high sensitivity and very high specificity for diagnosing PJI. PMID:23946521

  6. Total knee arthroplasty with a novel navigation system within the surgical field.

    PubMed

    Scuderi, Giles R; Fallaha, Michel; Masse, Vincent; Lavigne, Patrick; Amiot, Louis-Philippe; Berthiaume, Marie-Josee

    2014-04-01

    Total knee arthroplasty is a common procedure, and current navigation systems are gradually gaining acceptance for improving surgical accuracy and clinical outcomes. A new navigation system used within the surgical field, iAssist, has demonstrated reproducible accuracy in component alignment. All orientation information is captured by small electronic pods and transmitted via a local wireless network, which directs the surgical workflow automatically to the femoral and tibial resection instruments. This simple and accurate navigation system used completely in the surgical field, without optical trackers or preoperative imaging, seems to be the latest generation of smart instrumentation for total knee arthroplasty. PMID:24684910

  7. GAP TESTS; COMPARISON BETWEEN UN GAP TEST AND CARD GAP TEST

    E-print Network

    Paris-Sud XI, Université de

    98-36 GAP TESTS; COMPARISON BETWEEN UN GAP TEST AND CARD GAP TEST by R. BRANKA and C. MICHOT, FRANCE (tel.: 33 3 44 55 65 19, fax: 33 3 44 55 65 10) ABSTRACT: UN gap test, type 1(a) or 2(a), is the recommended test in the acceptance procedure for transport of explosives in class 1. Up to the revision

  8. Overcoming the Income Gap. The Achievement Gap: Overcoming the Income Gap. Info Brief. Number 47

    ERIC Educational Resources Information Center

    Nelson, Anne

    2006-01-01

    One of the most complex aspects of the achievement gap--one that, by and large, is out of the direct control of educational leaders--is the income gap. Broadly defined, the income gap is the standard of living difference between rich and poor, but in the education system, the gap permeates deeply into many dimensions of a student's progression…

  9. Bridging the Generation Gap

    ERIC Educational Resources Information Center

    Johnson, Susan Moore; Kardos, Susan M.

    2005-01-01

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

  10. Crossing the Gap

    ERIC Educational Resources Information Center

    Lockette, Tim

    2009-01-01

    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…

  11. The Teaching Gap

    ERIC Educational Resources Information Center

    Feldman, Sandra

    2004-01-01

    One of the most comprehensive studies to highlight the achievement gap between students in the United States and those in many other countries is the Third International Mathematics and Science Study (TIMSS). TIMSS showed that a handful of countries (with Japan near the top) consistently outperformed the others studied (including the United…

  12. STEMMING the Gap

    ERIC Educational Resources Information Center

    Kahler, Jim; Valentine, Nancy

    2011-01-01

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

  13. Confronting the Autonomy Gap

    ERIC Educational Resources Information Center

    Adamowski, Steven; Petrilli, Michael J.

    2007-01-01

    "The Autonomy Gap," a recent study by the American Institute for Research and the Thomas B. Fordham Institute, found that many public elementary school principals feel constrained by a bureaucracy that impedes their ability to raise student achievement. Unfortunately, those principals are still held accountable for their school's results--even…

  14. Diastema (Gap between Teeth)

    MedlinePLUS

    ... big for the jaw, teeth will be crowded. Spaces develop for a few other reasons as well. Sometimes some teeth are missing ... the permanent teeth and the jaw size, the spaces can be expected to remain throughout life. Gaps caused by a tongue thrust habit or ...

  15. The Latino Achievement Gap

    ERIC Educational Resources Information Center

    Madrid, E. Michael

    2011-01-01

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

  16. The Academic Generation Gap

    ERIC Educational Resources Information Center

    Dronzek, Anna

    2008-01-01

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

  17. Closing the Performance Gap.

    ERIC Educational Resources Information Center

    Riggins, Cheryl G.

    2002-01-01

    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)

  18. Estimating Gender Wage Gaps

    ERIC Educational Resources Information Center

    McDonald, Judith A.; Thornton, Robert J.

    2011-01-01

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

  19. Rotation flaps for coverage after total knee arthroplasty

    PubMed Central

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

    2013-01-01

    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

  20. Primary posterior stabilized total knee arthroplasty: analysis of different instrumentation

    PubMed Central

    2014-01-01

    Background Intercondylar femoral bone removal during posterior stabilized (PS) total knee arthroplasty (TKA) makes many cruciate substituting implant designs less appealing than cruciate retaining implants. Bone stock conservation is considered fundamental in the prevision of future revision surgeries. The purpose of this study was to compare the quantity of intercondylar bone removable during PS housing preparation using three contemporary PS TKA instrumentations. Method We compared different box cutting jigs which were utilized for the PS housing of three popular PS knee prostheses. The bone removal area from every PS box cutting jig was three-dimensionally measured. Results Independently from the implant size, the cutting jig for a specific PS TKA always resected significantly less bone than the others: this difference was statistically significant, especially for small- to medium-sized total knee femoral components. Conclusion This study does not establish a clinical relevance of removing more or less bone at primary TKA, but suggests that if a PS design is indicated, it is preferable to select a model which possibly resects less distal femoral bone. PMID:25037275

  1. Is preoperative staphylococcal decolonization efficient in total joint arthroplasty.

    PubMed

    Moroski, Nathan M; Woolwine, Spencer; Schwarzkopf, Ran

    2015-03-01

    Intranasal carrier status of Methicillin-sensitive Staphylococcus aureus (MSSA), and Methicillin-resistant Staphylococcus aureus (MRSA) has been shown to be a significant risk factor for developing surgical site infections. To determine if current treatment protocol for positive nasal screen was effective at decolonizing carriers 289 consecutive patients undergoing primary or revision total joint arthroplasty were screened preoperatively. Those patients with positive cultures were treated with a 5-day course of intranasal mupirocin. Preoperatively 44 (15.2%) patients tested positive for MSSA colonization, and 12 (4.2%) patients for MRSA. Testing on the day of surgery revealed 15 (5.2%) patients with MSSA positive cultures, and 1 (0.35%) patient with a MRSA positive culture. Reduction of MSSA and MRSA colonization was statistically significant (P=0.0341, P=0.0073 respectively). Our overall results indicate that our current decolonization protocol with nasal mupirocin was effective in reducing MSSA and MRSA colonization, although a significant number of patients remained positive for MSSA. PMID:25453634

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

    PubMed

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

    2014-01-01

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

  3. Clinical Outcomes Assessment of Three Similar Hip Arthroplasty Bearing Surfaces

    PubMed Central

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

    2014-01-01

    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

  4. Human Gait and Postural Control after Unilateral Total Knee Arthroplasty

    PubMed Central

    STAN, Gabriel; ORBAN, Horia

    2014-01-01

    Introduction: This study assesses the changes in human gait in the early postoperative phase of unilateral TKA, by evaluating the variability of free moment. Materials and method: The study group consisted of 10 patients from the Orthopedic Department of the 'Elias' University Hospital in Bucharest who undergone unilateral knee arthroplasty with the same type of posterior cruciate ligament substituting prosthesis. For the evaluation of free moment an AMTI AccuGait force platform was used. Results: Regarding the free moment peaks, for the operated and non-operated limb, increased significantly (p <0.05) in the postoperative period. The stance time was higher post-surgery for both limbs. Discussion: In the early postoperative phase of unilateral TKA, free moment is higher on both the operated and the non-operated limbs, which means that the knees are subjected to higher torques. Shortly after TKA, patients tend to walk with lower speed, with small steps and reduced cadence. Stance time differences between the operated and the non-operated limbs can lead to overuse of the latter, worsening its condition. Conclusions: It is highly important to adopt a well-managed rehabilitation program in order to increase walking stability. The cost effectiveness of this procedure could be highly dependent on the rehab program. The parameters studied in this article are useful in assessing the rehabilitation protocol. PMID:25705305

  5. Is tantalum protective against infection in revision total hip arthroplasty?

    PubMed

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

    2015-01-01

    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. PMID:25568412

  6. Shoulder arthroplasty in the presence of posterior glenoid bone loss.

    PubMed

    Stephens, Scott P; Paisley, Kevin C; Jeng, Jeffrey; Dutta, Anil K; Wirth, Michael A

    2015-02-01

    ? Chronic osteoarthritis of the glenohumeral joint, traumatic injury, post-reconstruction arthropathy, and developmental conditions such as glenoid dysplasia can result in posterior glenoid bone loss and excessive retroversion of the glenoid. Shoulder replacement in this setting is technically challenging and characterized by higher rates of complications and revisions.? Current options that should be considered for managing glenoid bone loss that results in >15° of retroversion include bone-grafting, augmented glenoid components, and reverse total shoulder replacement.? Asymmetric reaming is commonly used to improve version but should be limited to correction of 10° to 15° of retroversion in order to preserve subchondral bone.? Bone-grafting of glenoid defects has had mixed results and has been associated with graft-related complications, periprosthetic radiolucencies, and glenoid component failure; however, it provides a biologic option for patients with severe bone loss.? Implantation of an augmented polyethylene glenoid component offers the potential to improve version while preserving subchondral bone, but the procedure is technically demanding and without clinical follow-up data at this point.? Reverse total shoulder arthroplasty offers improved fixation and stability compared with an anatomic prosthesis for elderly patients with severe glenoid bone loss but is associated with a high complication rate.? Glenoid dysplasia is defined as a deformity that results in >25° of glenoid retroversion. Advanced imaging needs to be obtained in order to ensure enough glenoid bone stock is present to allow anatomic glenoid component placement. PMID:25653326

  7. Revision in Cemented and Cementless Infected Hip Arthroplasty

    PubMed Central

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

    2013-01-01

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

  8. Femoral nerve infusion after primary total knee arthroplasty

    PubMed Central

    C. Wyatt, M.; Wright, T.; Locker, J.; Stout, K.; Chapple, C.; Theis, J. C.

    2015-01-01

    Objectives Effective analgesia after total knee arthroplasty (TKA) improves patient satisfaction, mobility and expedites discharge. This study assessed whether continuous femoral nerve infusion (CFNI) was superior to a single-shot femoral nerve block in primary TKA surgery completed under subarachnoid blockade including morphine. Methods We performed an adequately powered, prospective, randomised, placebo-controlled trial comparing CFNI of 0.125% bupivacaine versus normal saline following a single-shot femoral nerve block and subarachnoid anaesthesia with intrathecal morphine for primary TKA. Patients were randomised to either treatment (CFNI 0 ml to 10 ml/h 0.125% bupivacaine) or placebo (CFNI 0 ml to 10 ml/h normal saline). Both groups received a single-shot femoral nerve block (0.25% 20 ml bupivacaine) prior to placement of femoral nerve catheter and subarachnoid anaesthesia with intrathecal morphine. All patients had a standardised analgesic protocol. The primary end point was post-operative visual analogue scale (VAS) pain score over 72 hours post-surgery. Secondary outcomes were morphine equivalent dose, range of movement, side effects, and length of stay. Results A total of 86 patients were recruited. Treatment and placebo groups were comparable. No significant difference was found in VAS pain scores, total morphine equivalent requirements, side effects, range of movement, motor block, or length of hospital stay. Conclusion No significant advantage was found for CFNI over a single-shot femoral block and subarachnoid anaesthesia after TKA. Cite this article: Bone Joint Res 2015;4:11–16. PMID:25653286

  9. Postarthroscopic humeral head osteonecrosis treated with reverse total shoulder arthroplasty.

    PubMed

    Dilisio, Matthew F; Noble, Jeffrey S; Bell, Robert H; Noel, Curtis R

    2013-03-01

    Although postarthroscopic glenohumeral chondrolysis has become a well-known disastrous complication of arthroscopic shoulder surgery, little is known about postarthroscopic humeral head osteonecrosis. This article describes 3 patients who were referred to the authors' practice with end-stage osteonecrosis after an arthroscopic rotator cuff repair or debridement.Three patients (average age, 63.3 years) presented to the authors' practice reporting severe shoulder pain after a rotator cuff debridement or repair was performed at an outside facility. After an interval period of mild improvement, all patients experienced progressive pain and loss of shoulder range of motion at a mean of 4.8 months postoperatively. Plain radiographs and magnetic resonance imaging obtained prior to the index operation showed no evidence of osteonecrosis. Postoperatively, progressive clinical and radiographic evidence showed humeral head osteonecrosis and subsequent glenohumeral destruction with cuff tear arthropathy. The authors managed all patients with a reverse total shoulder arthroplasty due to severe glenohumeral arthrosis and massive rotator cuff tears not amendable to repair. Satisfactory results were achieved in all cases.Although many complications of arthroscopic shoulder surgery are documented, little is known about postarthroscopic humeral head osteonecrosis. Shoulder surgeons should be aware of this potential complication when performing arthroscopic rotator cuff surgery and when evaluating painful and stiff postarthroscopic shoulders. PMID:23464961

  10. Risk factors of delirium in patients undergoing total knee arthroplasty.

    PubMed

    Chung, Kyu Sung; Lee, Jin Kyu; Park, Jin Sik; Choi, Choong Hyeok

    2015-01-01

    Although postoperative delirium is a complicated disorder in elderly individuals, no study has been examined the risk factors associated with perioperative comorbidities and clinical laboratory data while specifically focusing on only total knee arthroplasty (TKA). In the present retrospective study, we aimed to evaluate the incidence and perioperative risk factors of postoperative delirium after TKA. Between April 2009 and May 2013, 287 patients (365 knees) aged >65 years who had undergone primary TKA were enrolled. These patients were assigned to the delirium group of 11 patients (11 knees) or the non-delirium group of 276 patients (354 knees). The incidence of delirium among the patients was 3.1% (11/365). Univariate logistic regression analysis indicated that a history of dementia, older age, lower body mass index (BMI) level, and a postoperative day 3 blood urea nitrogen (BUN) level of >14.9mg/dL were risk factors. However, multivariate logistic regression analysis indicated that a history of dementia (adjusted odds ratio [AOR]: 10.4, [1.09, 100]), older age (AOR: 1.15, [1.01, 1.31]), and a postoperative day 3 BUN level of >14.9mg/dL (AOR: 4.76, [1.15, 19.7]) were independent risk factors. Based on our findings, we believe that the surgeons should be careful to avoid the postoperative delirium and ensure the appropriate management for patients who have these risk factors. PMID:25704295

  11. Low manipulation prevalence following fast-track total knee arthroplasty

    PubMed Central

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

    2015-01-01

    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

  12. Multicenter determination of in vivo kinematics after total knee arthroplasty.

    PubMed

    Dennis, Douglas A; Komistek, Richard D; Mahfouz, Mohamed R; Haas, Brian D; Stiehl, James B

    2003-11-01

    A summation analysis of more than 70 individual kinematic studies involving normal knees and 33 different designs of total knee arthroplasty (TKA) was done with the objective of analyzing implant design variables that affect knee kinematics. Eight hundred eleven knees (733 subjects) were analyzed either during the stance phase of gait or a deep knee bend maneuver while under fluoroscopic surveillance. Fluoroscopic videotapes then were downloaded onto a workstation computer and anteroposterior (AP) femorotibial translational patterns were determined using an automated three-dimensional model fitting technique. The highest magnitude of translation was found in the normal and ACL-retaining TKA groups. Paradoxical anterior femoral translation during deep flexion was most commonly observed in PCL-retaining TKA. Substantial variability in kinematic patterns was observed in all groups. The least variability during gait was observed in mobile-bearing TKA designs, whereas posterior-stabilized TKA designs (fixed or mobile-bearing) showed the least variability during a deep knee bend. A medial pivot kinematic pattern was observed in only 55% of knees during deep knee flexion. Kinematic patterns of fixed versus mobile-bearing designs were similar with the exception of mobile-bearing TKA during gait in which femorotibial contact remained relatively stationary with minimal AP femorotibial translation. PMID:14646738

  13. The Advantage of a Total Knee Arthroplasty with Rotating Platform is Only Theoretical: Prospective Analysis of 1,152 Arthroplasties

    PubMed Central

    Delport, H.P.

    2013-01-01

    Background: The aim of total knee surgery is to provide patients with end-stage osteoarthritis of the knee with both pain relief and a functional range of motion with a securely fixed prosthesis for the long term. Many types of implants are designed to achieve these goals. Only clinical outcome studies are able to substantiate the superiority of one design over another. Our primary research question was to determine whether patients receiving a rotating platform implant had a better functional outcome. Methods: A total of 1,152 Performance Total Knee Arthroplastiesin 943 patients were studied prospectively. In 561 cases, the cruciate retaining model (CR) was used. In 591 cases the cruciate substituting with posterior-stabilized model (PS) was implanted (324 cases with a fixed bearing (PSFB) and 267 cases with a rotating platform (PSRP)). Results: The Clinical KSS score was similar for the three types at 1, 5, 10 and 15 years post-operatively. The Functional score also remained similar for all types until 10 years; at 15 years functional results of the CR group decreased. Conclusions: Neither clinically nor radiographically did the use of a rotating platform prove to be more advantageous than fixed bearing tibial components. Thus, the advantage of a Total Knee Arthroplasty with Rotating Platform remains theoretical. PMID:24339844

  14. Photonic Band Gap

    NSDL National Science Digital Library

    Ho, Seng-Tiong

    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.

  15. Air-gap heterostructures

    SciTech Connect

    Heyn, Ch.; Schmidt, M.; Schwaiger, S.; Stemmann, A.; Mendach, S.; Hansen, W. [Institut fuer Angewandte Physik und Zentrum fuer Mikrostrukturforschung, Jungiusstrasse 11, D-20355 Hamburg (Germany)

    2011-01-17

    We demonstrate the fabrication of thin GaAs layers which quasi hover above the underlying GaAs substrate. The hovering layers have a perfect epitaxial relationship to the substrate crystal lattice and are connected to the substrate surface only by lattice matched nanopillars of low density. These air-gap heterostructures are created by combining in situ molecular beam epitaxy compatible self-assembled droplet-etching and ex situ selective wet-chemical etching.

  16. Bridging the Gap

    NSDL National Science Digital Library

    Grace Eason

    2004-11-01

    A newly appointed joint hire in the College of Arts and Sciences, Department of Natural Sciences and the College of Education, Department of Middle/Secondary Education, was charged with the responsibility of bridging the communication gap between these two departments and colleges. To meet this challenge, four collaborative projects were developed between the Natural Sciences faculty and Middle/Secondary Education science students that will become formally established in future university courses.

  17. Filling the launch gap

    Microsoft Academic Search

    S. Hoeser

    1986-01-01

    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

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

    PubMed

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

    1988-01-01

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

  19. Benefits of an anatomical reconstruction of the humeral head during shoulder arthroplasty: a finite element analysis

    Microsoft Academic Search

    P. Büchler; A. Farron

    2004-01-01

    Objective. To study the influence of the shape of the prosthetic humeral head on shoulder biomechanics and then to evaluate the benefits of an anatomical reconstruction of the humeral head after shoulder arthroplasty.Design. A 3D numerical model of a healthy shoulder was reconstructed. The model included the proximal humerus, the scapula and, for stability purposes, the subscapularis, infraspinatus and supraspinatus

  20. The Prevalence of Thrombophilia and Venous Thromboembolism in Total Knee Arthroplasty

    Microsoft Academic Search

    Thanainit Chotanaphuti; Pipat Ongnamthip; Suthee Silpipat; Trakool Foojareonyos; Suwat Roschan; Anuchit Reumthantong

    Background: Venous thromboembolism (VTE) is a common and potential serious complication in lower extremity surgeries, especially in hip and knee arthroplasty. Pulmonary embolism is one of the most fatal complications. The recognition of VTE in the lower limb has been considered as an indication for anticoagu- lation. Many studies have shown that thrombophilia is one factor of VTE and the

  1. Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty.

    PubMed

    Sharrock, N E; Haas, S B; Hargett, M J; Urquhart, B; Insall, J N; Scuderi, G

    1991-04-01

    Epidural anesthesia has been reported to reduce the prevalence of deep-vein thrombosis after total hip arthroplasty compared with the prevalence after general anesthesia. However, the effect of epidural anesthesia on the rate of thrombosis after total knee arthroplasty has not been reported previously, to our knowledge. A review was conducted of 705 total knee arthroplasties (541 patients) that had been performed by a single surgeon between September 1984 and December 1988. During this period, the operative technique, the protocol for rehabilitation, and the regimen for prophylaxis against thromboembolism did not change meaningfully. The patients received either epidural or general anesthesia. Preoperative and postoperative perfusion scans of the lungs and a venogram of the lower limb or limbs that had been operated on were done for all patients. For the 227 patients who had received epidural anesthesia, the over-all rate of deep-vein thrombosis was 48 per cent, which was significantly lower than the 64 per cent incidence in the 264 patients who had received general anesthesia (p less than 0.0001). The greatest reduction was in the occurrence of proximal thrombosis, which was identified in 9 per cent of the patients who had had general anesthesia but in only 4 per cent of those who had had epidural anesthesia (p less than 0.05). The use of epidural anesthesia reduced the incidence of proximal thrombosis after both unilateral and one-stage bilateral arthroplasty. PMID:2013588

  2. Clinical Significance of Muscular Deep-vein Thrombosis after Total Knee Arthroplasty

    Microsoft Academic Search

    Ching-Jen Wang; Jun-Wen Wang; Lin-Hsiu Weng; Chung-Cheng Huang; Pao-Chu Yu

    Background: The definition of gastrocneumus and soleus deep-vein thrombosis (DVT) remains controversial. The purpose of this study was to evaluate the clinical significance of muscular deep-vein thrombosis after total knee arthroplasty (TKA). Methods: This study consisted of 359 consecutive patients undergoing TKA evaluated for DVT by ascending venography. Venographies were performed 5 to 7 days after surgery. Those patients showing

  3. Presence of Medical Comorbidities in Patients With Infected Primary Hip or Knee Arthroplasties

    Microsoft Academic Search

    Kafai Lai; Eric R. Bohm; Colin Burnell; David R. Hedden

    2007-01-01

    Many older patients undergoing primary hip or knee joint arthroplasty surgery have multiple medical problems. In this retrospective case-control study, the authors examined the individual and cumulative effects of various types of medical comorbidities on the risk of developing prosthetic joint infection after surgery. Case and control patients were matched by age, sex, and procedure. Analysis was undertaken using crude

  4. Semiconstrained total shoulder arthroplasty for glenohumeral arthritis and massive rotator cuff tearing

    Microsoft Academic Search

    Anthony C. Nwakama; Robert H. Cofield; Brian F. Kavanagh; J. F. Loehr

    2000-01-01

    Each of 6 patients (7 shoulders) underwent semiconstrained total shoulder arthroplasty for glenohumeral arthritis, subluxation, and extensive rotator cuff tearing to obtain a more balanced joint and achieve consistent pain relief. A hooded glenoid component (Neer 600%) was used to contain the humeral head within the joint. Patients were followed for an average of 69 months (range, 26-125 months) or

  5. Insufficiency Fracture in the Medial Wall of the Acetabulum After Total Hip Arthroplasty

    Microsoft Academic Search

    Arihiko Kanaji; Kenichi Ando; Masato Nakagawa; Eiichi Fukaya; Hideki Date; Harumoto Yamada

    2007-01-01

    Insufficiency fracture following total hip arthroplasty (THA) frequently occurs in the superior and inferior pubic ramus, the puboischial rami, or the ischium around the obturator foramen, while it rarely occurs in the medial wall of the acetabulum. Here, we report three cases showing insufficiency fracture in the medial wall of the acetabulum following THA. In our three cases, two fractures

  6. An unusual complication following total hip arthroplasty: median circumflex femoral artery pseudoaneurysm.

    PubMed

    Mutlu, Serhat; Güler, Olcay; Uçar, Adem; Mahiro?ullar?, Mahir

    2014-01-01

    We report a case of a pseudoaneurysm of the medial circumflex femoral artery that presented 4 months following cementless left total hip arthroplasty (THA). A successful embolization was achieved using super-selective catheterization and coil embolization. Arterial complications associated with THA are remarkably rare. Endovascular techniques have been shown to be effective and are considered a valid alternative to conventional surgery. PMID:24643110

  7. Results of revision total knee arthroplasty using press-fit cementless stem

    PubMed Central

    Iamaguchi, Maurício Masasi; de Castro, Fernando Bley Vicente; Gobbi, Riccardo Gomes; Tirico, Luis Eduardo Passarelli; Pécora, José Ricardo; Camanho, Gilberto Luis

    2013-01-01

    OBJECTIVE: To show our experience with press-fit cementless stem and metaphyseal fixation with cement in a selected series of patients who underwent revision total knee arthroplasty. METHODS: Thirty-four patients (35 knees) underwent revision total knee arthroplasty using the press-fit technique. Minimum follow-up was one year (mean 2.2 years) with a maximum length of three years. RESULTS: Of 34 patients, 20 were women and 14 were men. There was one death due to causes not related to arthroplasty and one patient dropout. There were no cases in which further review was necessary. Patients who underwent revision had clinical and functional improvement demonstrated by the results of the KSS, results of the SF-36 quality of life questionnaire, through gains in range of motion and improved limb alignment. CONCLUSION: There was postoperative clinical and functional improvement in comparison to the preoperative status in revision total knee arthroplasty with press-fit cementless stem. Level of Evidence IV, Case series. PMID:24453638

  8. Isobaric Versus Hypobaric Spinal Bupivacaine for Total Hip Arthroplasty in the Lateral Position

    Microsoft Academic Search

    Alexandre Faust; Roxane Fournier; Elisabeth Van Gessel; Anne Weber; Pierre Hoffmeyer; Zdravko Gamulin

    2003-01-01

    Total hip arthroplasty (THA) is frequently performed under spinal anesthesia using either isobaric or hypo- baric anesthetic solution. However, these two solutions have never been compared under similar surgical con- ditions. In the present study, we compared the anes- thetic and hemodynamic effects of isobaric and hypo- baric bupivacaine in 40 ASA physical status I-II patients undergoing THA in the

  9. An in vivo determination of total hip arthroplasty pistoning during activity

    Microsoft Academic Search

    Adolph V. Lombardi; Thomas H. Mallory; Douglas A. Dennis; Richard D. Komistek; Robert A. Fada; Eric J. Northcut

    2000-01-01

    The purpose of this study was to determine to what extent hip joint separation occurs during normal gait on a treadmill and an abduction\\/adduction leg-lift maneuver in patients who have undergone total hip arthroplasty (THA). Eight patients who had a total of 10 successful unconstrained THAs (Harris Hip Scores >90) performed successive gait motions on an electronically powered treadmill and

  10. Patellar polyethylene spinout after low-contact stress, high-congruity, mobile-bearing patellofemoral arthroplasty.

    PubMed

    Amanatullah, Derek F; Jamali, Amir A

    2012-02-01

    A low-contact stress, high-congruity, mobile-bearing patellofemoral joint arthroplasty decreases the contact force in the patellofemoral joint, theoretically reducing patellar polyethylene wear and increasing implant longevity. This article describes the case of a 47-year-old obese woman who presented with pain and loss of extension after a low-contact stress, high-congruity, mobile-bearing patellofemoral joint arthroplasty. Radiographs revealed dislocation (ie, spinout) of the patellar polyethylene. Patellar polyethylene spinout is a rare complication of metal-backed, mobile-bearing patellar resurfacing. Theoretically, patellar polyethylene spinout in low-contact stress, high-congruity, mobile-bearing patellofemoral arthroplasty is related to implant design and the placement of the metal base plate. Ultimately, the articulation of low-contact stress, high-congruity, mobile-bearing patellofemoral arthroplasty may be too congruent to resist the forces of the patellofemoral joint, particularly in patients who are obese, and the patellar rotation allowed by this articulation may not be sufficient for all patients. Should patellar spinout occur, replacement of the polyethylene is not sufficient to correct the problem; hence, revision of the patellar and trochlear components is required because it remains unclear whether failure is secondary to patellar or trochlear design deficiencies. PMID:22310419

  11. Numerical simulation of an osteoporotic Before and after total hip arthroplasty.

    E-print Network

    Paris-Sud XI, Université de

    osteoporosis. This disease weakens the bone structure and causes bone fractures. Among those fractures, femoral of the distal part at the end of the stem. KEY-WORDS : Osteoporosis, total hip arthroplasty, 3D- reconstruction like osteoporosis which deteriorates bone strength. In Europe, the most consequences of osteoporosis

  12. Total shoulder arthroplasty with the neer prosthesis: Long-term results

    Microsoft Academic Search

    Michael E Torchia; Robert H Cofield; Curtis R Settergren

    1997-01-01

    We determined the outcome of 113 total shoulder replacement arthroplasties performed with a Neer prosthesis between 1975 and 1981. The operations were performed for the treatment of osteoarthritis, rheumatoid arthritis, and old fractures or dislocations with traumatic arthritis. The probability of implant survival was 93% after 10 years and 87% after 15 years. Complications requiring reoperation developed in 14 shoulders.

  13. Revision to reverse shoulder arthroplasty with retention of the humeral component

    PubMed Central

    2013-01-01

    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

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

    PubMed Central

    Wenger, Markus; Markwalder, Thomas-Marc

    2010-01-01

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

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

    PubMed

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

    2015-03-01

    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

  16. Treatment of severe sequelae of infantile hip sepsis with trochanteric arthroplasty.

    PubMed

    Wang, En B; Ji, Shi J; Zhao, Qun; Zhang, Li J

    2007-03-01

    We retrospectively reviewed 30 hips in 30 patients with complete destruction of the femoral head and neck from infantile septic arthritis to investigate the result and the ideal age for performance of trochanteric arthroplasty. All patients were treated with a 1-stage trochanteric arthroplasty at age from 11 to 98 months. We measured the range of motion of the hip, and we used the modified Harris hip score to evaluate pain and hip function and the multiplier growth-remaining method to assess predicted limb-length discrepancy. At a mean 7-year follow-up, we found that the modified Harris hip scores were negatively correlative--and the predicted limb-length discrepancy positively correlative--with the age at surgery in months. Range of motion in flexion and abduction of the hips of patients operated on at age older than 4 years were worse than that of the hips of patients operated on at age younger than 4 years. Therefore, we recommend that trochanteric arthroplasty should be performed as early as age 1 year for children with Hunka type V deformities after infantile septic arthritis of hip. Children older than 4 years might be contraindicated for trochanteric arthroplasty. PMID:17314641

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    The aim of this study was to examine patient satisfaction with rehabilitation after total knee arthroplasty (TKA). Fifty-six patients, aged 45-77 years, were enrolled in a post-TKA comprehensive therapy program focusing on knee strengthening and functional activities. The program lasted 3 months and was conducted for 1 h, twice a day, 5 days per…

  18. Factor V Leiden and the risk of proximal venous thrombosis after total hip arthroplasty

    Microsoft Academic Search

    Steven T. Woolson; James L. Zehnder; William J. Maloney

    1998-01-01

    Deep vein thrombosis (DVT) remains a major cause of morbidity in patients undergoing total hip arthroplasty (THA). Despite postoperative DVT prophylaxis, 20–50% of THA patients still develop DVT. Currently, there is no accurate way of predicting which patients will develop DVT despite standard prophylaxis. The presence of factor V Leiden is the most common cause of inherited DVT risk. It

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

    Microsoft Academic Search

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

    1993-01-01

    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

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

    PubMed

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

    2015-01-01

    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

  1. Knee range of motion after total knee arthroplasty: How important is this as an outcome measure?

    Microsoft Academic Search

    Andrew L. Miner; Elizabeth A. Lingard; Elizabeth A. Wright; Clement B. Sledge; Jeffrey N. Katz

    2003-01-01

    We investigated the relationship of knee range of motion (ROM) and function in a prospective, observational study of primary total knee arthroplasty (TKA). Preoperative and 12-month data were collected on 684 patients, including knee ROM, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function questionnaire scores, patient satisfaction, and perceived improvement in quality of life (QOL). Only modest

  2. 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

  3. Preoperative quadriceps femoris neuromuscular electrical stimulation in total knee arthroplasty : a clinical and molecular analysis

    Microsoft Academic Search

    Raymond John Walls

    2009-01-01

    Patients with knee osteoarthritis (OA) have asymmetrical muscle weakness due to neuromuscular activation deficits and muscle atrophy. Quadriceps muscle (QFM) strength declines after total knee arthroplasty (TKA) with associated functional impairment. The ultimate purpose of this investigation was to determine the effects of preoperative neuromuscular electrical stimulation (NMES) on quadriceps muscle strength and functional recovery after TKA. Patients undergoing TKA

  4. A new arthroscopic technique for revision of the posterior compartment in symptomatic total knee arthroplasty

    Microsoft Academic Search

    Franz Landsiedl; Nicolas Aigner; Michael Hexel; Christian Krasny; Siegfried Schenk; Gunter Steinböck

    2005-01-01

    Arthroscopy is effective in treating the symptomatic knee following total knee arthroplasty. A small number of patients complain about postoperative pain in the posterior compartment. Loose bodies and degenerated remnants of the menisci are the main reasons for this pain. We present a new technique for diagnostic and therapeutic arthroscopy of the posterior compartments in patients with symptomatic total knee

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

    PubMed

    Lew, Eric; Nicolosi, Nicole; McKee, Patrick

    2014-11-13

    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

  6. Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials

    Microsoft Academic Search

    Catherine J Minns Lowe; Karen L Barker; Michael E Dewey; Catherine M Sackley

    2009-01-01

    BACKGROUND: Physiotherapy has long been a routine component of patient rehabilitation following hip joint replacement. The purpose of this systematic review was to evaluate the effectiveness of physiotherapy exercise after discharge from hospital on function, walking, range of motion, quality of life and muscle strength, for osteoarthritic patients following elective primary total hip arthroplasty. METHODS: Design: Systematic review, using the

  7. Functional improvement after Total Knee Arthroplasty Revision: New observations on the dimensional nature of outcome

    Microsoft Academic Search

    Kevin J Mulhall; Hassan M Ghomrawi; Boris Bershadsky; Khaled J Saleh

    2007-01-01

    BACKGROUND: Despite the numerous outcomes measures described it remains unclear what aspects of patient outcome are important in determining actual improvement following total knee arthroplasty revisions (TKAR). We performed a prospective cohort study of TKAR to determine the components of clinical improvement and how they are related and best measured. METHODS: An improvement scale was devised utilizing data from 186

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

    Microsoft Academic Search

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

    2005-01-01

    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

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

    Microsoft Academic Search

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

    2008-01-01

    BACKGROUND: Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP) – and report post-surgical outcomes. METHODS: 74 candidates for a primary TKA

  10. Prevention of venous thromboembolic disease after total hip and knee arthroplasty.

    PubMed

    Lieberman, Jay R; Hsu, Wellington K

    2005-09-01

    Patients undergoing total hip and knee arthroplasty are at increased risk for the development of venous thromboembolic disease, and there is general agreement that these patients require prophylaxis. The selection of a prophylactic agent involves a balance between efficacy and safety and often needs to be individualized for specific patients and institutions. Despite extensive research, the ideal agent for prophylaxis against deep venous thrombosis has not been identified. The results of randomized trials indicate that low-molecular-weight heparin, warfarin, and fondaparinux are the most effective prophylactic agents after total hip arthroplasty and that low-molecular-weight heparin, warfarin, fondaparinux, and pneumatic compression boots are the most effective agents after total knee arthroplasty. The duration of prophylaxis against deep venous thrombosis after total hip and knee arthroplasty remains controversial. Prophylaxis should be continued beyond hospital discharge. In the future, the determination of the duration of prophylaxis will be based on the risk stratification of individual patients. The practice of discharging patients from the hospital without prophylaxis, even when the decision is based on negative results of procedures that screen for the presence of deep venous thrombosis, is not cost-effective. PMID:16140827

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

    Microsoft Academic Search

    Erik Hohmann; Kevin Tetsworth; Stefanie Hohmann; Adam L Bryant

    2010-01-01

    BACKGROUND: Total knee arthroplasty is reported to improve the patient's quality of life and mobility. However loss of mobility and pain prior to surgery often results in disuse atrophy of muscle. As a consequence the baseline functional state prior to surgery may result in poorer outcome \\

  12. Periarticular regional analgesia in total knee arthroplasty: a review of the neuroanatomy and injection technique.

    PubMed

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

    2015-01-01

    Postoperative 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

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

    PubMed Central

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

    2015-01-01

    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

  14. Comparison of matching procedures applied on conventional X-ray images of total hip arthroplasty

    Microsoft Academic Search

    F. BaruffaldiI; R. Bedinil; A. Cappello; A. Toni

    1996-01-01

    In this work the authors compare the results of two matching methods for the alignment of X-ray images of Total Hip Arthroplasty (THA). The application of Singular Value Decomposition (SVD) on these type of images may encounter some problems related to the identification of the marker points. The authors developed an alternative iterative procedure, based on the linearization of the

  15. Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Tali, Maie; Maaroos, Jaak

    2010-01-01

    The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

  16. Revision of total hip arthroplasty: clinical outcome of extended trochanteric osteotomy and intraoperative femoral fracture.

    PubMed

    Lerch, Matthias; von Lewinski, Gabriela; Windhagen, Henning; Thorey, Fritz

    2008-01-01

    In femoral revision arthroplasty the orthopaedic surgeon frequently has to decide between performing an extended trochanteric osteotomy or trying to remove the femoral stem without an osteotomy and taking the risk of an intraoperative fracture. As this decision is often hard to make this study compared intraoperative femoral fractures during stem removal with extended trochanteric osteotomies in femoral revision arthroplasties. Twenty-eight femoral revision arthroplasties with an extended trochanteric osteotomy were compared with forty-five intraoperative fractures during revision hip arthroplasty. Preoperatively and after a follow-up of 2.8 years the patients were examined clinically and radiologically. We found no osteosynthesis related complication in the extended trochanteric osteotomy group, but six in the fracture group. Furthermore fewer re-revisions were observed in the osteotomy group. Additionally, a significant better clinical and radiological outcome can be found in the extended trochanteric osteotomy group compared to the fracture group. The results of this study suggest that a well conducted extended femoral osteotomy should be discussed in special cases to prevent femoral fractures during stem and cement removal which would probably lead to a poor postoperative outcome. PMID:18776606

  17. Retrograde intramedullary nailing of supracondylar femur fractures above total knee arthroplasty

    Microsoft Academic Search

    Felix F. Jabczenski; Mark Crawford

    1995-01-01

    Four supracondylar fractures of the femur in three patients with total knee arthroplasties were treated by retrograde intramedullary nailing using an interlocking reamed nail (GSH Nail, Smith and Nephew Richards, Memphis, TN) specifically designed for fractures of the distal femur. Three cases were acute fractures and one was a refracture through a screw hole of a previously plated supracondylar fracture.

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

    PubMed

    Roux, Anne-Laure; El Sayed, Faten; Duffiet, Pascal; Bauer, Thomas; Heym, Beate; Gaillard, Jean-Louis; Herrmann, Jean-Louis; Rottman, Martin

    2015-04-01

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

  19. The Journal of Arthroplasty Vol. 14 No. 7 1999 Case Report

    E-print Network

    associated with a metal-on-metal bearing couple is small, and the contact stresses are high compared articulations, several trials of modern metal-on-metal bearings are currently under- way [4]. The following case was debrided, and the hip was revised to an uncemented porous-coated arthroplasty with a cobalt-chrome 28-mm

  20. Bridging Gaps Between Refractory Tiles

    NASA Technical Reports Server (NTRS)

    Haney, J. W. J.

    1982-01-01

    Excessively large gaps between tiles on Space Shuttle eliminated without time-consuming and costly procedure of removing and replacing tiles. Ceramic tile silver is bonded in gap. Bonded silver prevents airframe under gap from getting too hot during reentry and presents aerodynamically smooth exterior surface.

  1. Dabigatran versus enoxaparin for prevention of venous thromboembolism after hip or knee arthroplasty: A pooled analysis of three trials

    Microsoft Academic Search

    R. J. Friedman; O. E. Dahl; N. Rosencher; J. A. Caprini; A. A. Kurth; C. W. Francis; A. Clemens; S. Hantel; J. M. Schnee; B. I. Eriksson

    2010-01-01

    BackgroundThree randomized, double-blind trials compared dabigatran, an oral direct thrombin inhibitor, with enoxaparin for the primary prevention of venous thromboembolism (VTE) in patients undergoing elective total hip and knee arthroplasty.

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

    ClinicalTrials.gov

    2015-01-06

    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

  3. Metal block augmentation for bone defects of the medial tibia during primary total knee arthroplasty

    PubMed Central

    2013-01-01

    Background Stable and well-aligned placement of tibial components during primary total knee arthroplasty is challenging in patients with bone defects. Although rectangular block-shaped augmentations are widely used to reduce the shearing force between the tibial tray and bone compared with wedge-shaped augmentations, the clinical result remains unclear. This study aimed to evaluate the outcome of primary total knee arthroplasty with metal block augmentation. Methods We retrospectively reviewed the 3- to 6-year follow-up results of 33 knees that underwent total knee arthroplasty with metal block augmentation (metal-augmented group) for bone defects of the medial tibia and 132 varus knees without bone defects as the control group. All surgeries were performed using posterior-stabilized cemented prostheses in both groups. Cemented stems were routinely augmented when the metal block was used. Results There were no differences in implant survival rates (100% in metal-augmented and 99.2% in control) or knee function scores (82 points in metal-augmented and 84 points in control) between the two groups at the final follow-up examination (P = 0.60 and P = 0.09, respectively). No subsidence or loosening of the tibial tray was observed. Of 33 metal-augmented total knee arthroplasties, a nonprogressive radiolucent line beneath the metal was detected in 10 knees (30.3%), and rounding of the medial edge of the tibia was observed in 17 knees (51.5%). Conclusions The clinical results of total knee arthroplasty with metal augmentation were not inferior to those in patients without bone defects. However, radiolucent lines were observed in 30.3%. PMID:24139483

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

    PubMed

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

    2015-04-01

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

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

    PubMed Central

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

    2014-01-01

    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

  6. Results of Revision Surgery and Causes of Unstable Total Knee Arthroplasty

    PubMed Central

    Sun, Doo-Hoon; Chon, Jae-Gyun; Jang, Sung-Won; Sun, Dong-Hyuk

    2014-01-01

    Background The aim of this study was to evaluate causes of unstable total knee arthroplasty and results of revision surgery. Methods We retrospectively reviewed 24 knees that underwent a revision arthroplasty for unstable total knee arthroplasty. The average follow-up period was 33.8 months. We classified the instability and analyzed the treatment results according to its cause. Stress radiographs, postoperative component position, and joint level were measured. Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score and range of motion. Results Causes of instability included coronal instability with posteromedial polyethylene wear and lateral laxity in 13 knees, coronal instability with posteromedial polyethylene wear in 6 knees and coronal and sagittal instability in 3 knees including post breakage in 1 knee, global instability in 1 knee and flexion instability in 1 knee. Mean preoperative/postoperative varus and valgus angles were 5.8°/3.2° (p = 0.713) and 22.5°/5.6° (p = 0.032). Mean postoperative ?, ?, ?, ? angle were 5.34°, 89.65°, 2.74°, 6.77°. Mean changes of joint levels were from 14.1 mm to 13.6 mm from fibular head (p = 0.82). The mean HSS score improved from 53.4 to 89.2 (p = 0.04). The average range of motion was changed from 123° to 122° (p = 0.82). Conclusions Revision total knee arthroplasty with or without a more constrained prosthesis will be a definite solution for an unstable total knee arthroplasty. The solution according to cause is very important and seems to be helpful to avoid unnecessary over-constrained implant selection in revision surgery for total knee instability. PMID:24900897

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

    PubMed Central

    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

    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

  8. Osteolysis around total knee arthroplasty: a review of pathogenetic mechanisms.

    PubMed

    Gallo, J; Goodman, S B; Konttinen, Y T; Wimmer, M A; Holinka, M

    2013-09-01

    Aseptic loosening and other wear-related complications are some of the most frequent late reasons for revision of total knee arthroplasty (TKA). Periprosthetic osteolysis (PPOL) pre-dates aseptic loosening in many cases, indicating the clinical significance of this pathogenic mechanism. A variety of implant-, surgery- and host-related factors have been delineated to explain the development of PPOL. These factors influence the development of PPOL because of changes in mechanical stresses within the vicinity of the prosthetic device, excessive wear of the polyethylene liner, and joint fluid pressure and flow acting on the peri-implant bone. The process of aseptic loosening is initially governed by factors such as implant/limb alignment, device fixation quality and muscle coordination/strength. Later, large numbers of wear particles detached from TKA trigger and perpetuate particle disease, as highlighted by progressive growth of inflammatory/granulomatous tissue around the joint cavity. An increased accumulation of osteoclasts at the bone-implant interface, impairment of osteoblast function, mechanical stresses and increased production of joint fluid contribute to bone resorption and subsequent loosening of the implant. In addition, hypersensitivity and adverse reactions to metal debris may contribute to aseptic TKA failure, but should be determined more precisely. Patient activity level appears to be the most important factor when the long-term development of PPOL is considered. Surgical technique, implant design and material factors are the most important preventative factors, because they influence both the generation of wear debris and excessive mechanical stresses. New generations of bearing surfaces and designs for TKA should carefully address these important issues in extensive preclinical studies. Currently, there is little evidence that PPOL can be prevented by pharmacological intervention. PMID:23669623

  9. Patient satisfaction with mobile compression devices following total hip arthroplasty.

    PubMed

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

    2014-08-01

    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

  10. Endocannabinoids and acute pain after total knee arthroplasty.

    PubMed

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

    2015-02-01

    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

  11. Diagnosis and management of the infected total joint arthroplasty

    SciTech Connect

    Cuckler, J.M.; Star, A.M.; Alavi, A.; Noto, R.B. (Hospital of the University of Pennsylvania, Philadelphia (USA))

    1991-07-01

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

  12. Calcium phosphate cement composites in revision hip arthroplasty.

    PubMed

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

    2005-12-01

    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

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

    PubMed

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

    2014-11-27

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

  14. [Ceramic-on-Ceramic Bearings in Total Hip Arthroplasty (THA)].

    PubMed

    Sentürk, U; Perka, C

    2015-04-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  17. Predictive value of robotic-assisted total hip arthroplasty.

    PubMed

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

    2015-01-01

    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. PMID:25611417

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

    PubMed

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

    2015-03-01

    Ceramic-on-metal (CoM) is a relatively new bearing combination for total hip arthroplasty (THA) with few reported outcomes. A total of 287 CoM THAs were carried out in 271 patients (mean age 55.6 years (20 to 77), 150 THAs in female patients, 137 in male) under the care of a single surgeon between October 2007 and October 2009. With the issues surrounding metal-on-metal bearings the decision was taken to review these patients between March and November 2011, at a mean follow-up of 34 months (23 to 45) and to record pain, outcome scores, radiological analysis and blood ion levels. The mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268 hips (95%) had mild/very mild/no pain, the mean angle of inclination of the acetabular component was 44.8(o) (28(o) to 63(o)), 82 stems (29%) had evidence of radiolucent lines of > 1 mm in at least one Gruen zone and the median levels of cobalt and chromium ions in the blood were 0.83 ?g/L (0.24 ?g/L to 27.56 ?g/L) and 0.78 ?g/L (0.21 ?g/L to 8.84 ?g/L), respectively. The five-year survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than expected levels of metal ions in the blood, we would not recommend the use of CoM THA without further long-term follow-up. We plan to monitor all these patients regularly. Cite this article: Bone Joint J 2015;97-B:300-5. PMID:25737511

  19. Glenoid perforation with pegged components during total shoulder arthroplasty.

    PubMed

    Hsu, Jason E; Namdari, Surena; Baron, Matthew; Kuntz, Andrew F; Abboud, Joseph A; Huffman, G Russell; Williams, Gerald R; Glaser, David L

    2014-06-01

    A subset of patients undergoing primary total shoulder arthroplasty (TSA) have a medialized joint line secondary to glenoid wear. In some cases, the central pegs or peripheral pegs of a peg design glenoid component may violate the medial cortex of the glenoid vault. It is unknown whether this leads to early failure. The objectives of this study were to determine (1) whether glenoid components with uncontained pegs would be associated with a high rate of failure and (2) whether peg perforation would be associated with inferior clinical outcomes. The authors performed a case-control retrospective review comparing 25 TSAs in which one or multiple pegs perforated the medial glenoid vault (uncontained group) with 25 TSAs without peg perforation (contained group). Implant survival was calculated with revision for glenoid component loosening as the primary outcome variable. Clinical outcomes were determined using American Shoulder and Elbow Surgeons (ASES) and Penn Shoulder Scores. Average follow-up was more than 5 years. No patient in either group had symptomatic glenoid loosening. Two (8%) patients in the uncontained group required revision for rotator cuff tears. Penn and ASES scores were significantly lower in the uncontained group (Penn, P=.002; ASES, P=.004). Pain and satisfaction subscores were similar between the groups, but function subscores were significantly lower in the uncontained group (Penn, P=.002; ASES, P=.005). Uncontained pegs of an anchor peg glenoid component are not associated with early glenoid loosening. Similar pain relief is obtained when compared with contained glenoid components, but shoulder function is significantly lower in patients with uncontained pegs. PMID:24972442

  20. Femoral head diameter considerations for primary total hip arthroplasty.

    PubMed

    Girard, J

    2015-02-01

    The configuration of total hip arthroplasty (THA) implants has constantly evolved since they were first introduced. One of the key components of THA design is the diameter of the prosthetic femoral head. It has been well established that the risk of dislocation is lower as the head diameter increases. But head diameter impacts other variables beyond joint stability: wear, cam-type impingement, range of motion, restoration of biomechanics, proprioception and groin pain. The introduction of highly cross-linked polyethylene and hard-on-hard bearings has allowed surgeons to implant large-diameter heads that almost completely eliminate the risk of dislocation. But as a result, cup liners have become thinner. With femoral head diameters up to 36 mm, the improvement in joint range of motion, delay in cam-type impingement and reduction in dislocation risk have been clearly demonstrated. Conversely, large-diameter heads do not provide any additional improvements. If an "ecologically sound" approach to hip replacement is embraced (e.g. keeping the native femoral head diameter), hip resurfacing with a metal-on-metal bearing must be carried out. The reliability of large-diameter femoral heads in the longer term is questionable. Large-diameter ceramic-on-ceramic bearings may be plagued by the same problems as metal-on-metal bearings: groin pain, squeaking, increased stiffness, irregular lubrication, acetabular loosening and notable friction at the Morse taper. These possibilities require us to be extra careful when using femoral heads with a diameter greater than 36 mm. PMID:25596984

  1. A Mouse Model of Post-Arthroplasty Staphylococcus aureus Joint Infection to Evaluate In Vivo the Efficacy of Antimicrobial Implant Coatings

    Microsoft Academic Search

    Nicholas M. Bernthal; Alexandra I. Stavrakis; Fabrizio Billi; John S. Cho; Thomas J. Kremen; Scott I. Simon; Ambrose L. Cheung; Gerald A. Finerman; Jay R. Lieberman; John S. Adams; Lloyd S. Miller; Paul J. Planet

    2010-01-01

    BackgroundPost-arthroplasty infections represent a devastating complication of total joint replacement surgery, resulting in multiple reoperations, prolonged antibiotic use, extended disability and worse clinical outcomes. As the number of arthroplasties in the U.S. will exceed 3.8 million surgeries per year by 2030, the number of post-arthroplasty infections is projected to increase to over 266,000 infections annually. The treatment of these infections

  2. Distal femoral bone mineral density decreases following patellofemoral arthroplasty: 1-year follow-up study of 14 patients

    Microsoft Academic Search

    Hans-Peter W van Jonbergen; Kenneth Koster; Luc Labey; Bernardo Innocenti; Albert van Kampen

    2010-01-01

    BACKGROUND: The bone mineral density (BMD) of the distal femur decreases by 16-36% within one year after total knee arthroplasty (TKA) because of the femoral component's stress-shielding effect. The aim of this prospective study was to determine the quantitative change from the baseline BMD in the distal femur 1 year after patellofemoral arthroplasty using dual-energy X-ray absorptiometry (DXA). METHODS: Between

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

    NASA Astrophysics Data System (ADS)

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

    2015-02-01

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

  4. Ileal interposition reduces blood glucose levels and decreases insulin resistance in a type 2 diabetes mellitus animal model by up-regulating glucagon-like peptide-1 and its receptor

    PubMed Central

    Sun, Xu; Zheng, Meizhu; Song, Maomin; Bai, Rixing; Cheng, Shi; Xing, Ying; Yuan, Huisheng; Wang, Pilin

    2014-01-01

    This study is to explore the possible mechanism of ileal interposition (IT) treatment of glycemic control of the type 2 diabetes mellitus (T2DM) by establishing an IT animal model. Twelve T2DM rats (GK rats) of 8-week old were divided into GK IT surgery group (GK-IT) and GK sham group (GK-Sham). Six Wistar rats were used as the non-T2DM sham group (WS-Sham). Enzyme-linked immunosorbent assay was used to detect plasma insulin concentration and fasting pancreas glucagon-like peptide-1 (GLP-1) concentration changes. Homeostasis model assessment of insulin resistance was used to quantitatively measure insulin resistance. Glucagon-like peptide-1 receptor (GLP-1R) expression was detected by Western blotting. IT significantly decreased fasting blood glucose level and the oral glucose tolerance, and reduced insulin resistance of GK rats by increasing GLP-1 concentration and GLP-1R levels. The postoperative pancreatic ?-cell apoptosis rate of GK-Sham group was significantly higher than those in the GK-IT group and the WS-Sham group. IT significantly reduces blood glucose and decreases insulin resistance by up-regulating GLP-1 concentrations and GLP-1R levels, which may contribute to insulin secretion of pancreatic ?-cells and decreases apoptosis of pancreatic ?-cell. PMID:25120793

  5. Outcomes of total knee arthroplasty following high tibial osteotomy

    PubMed Central

    Gupta, Himanshu; Dahiya, Vivek; Vasdev, Attique; Rajgopal, Ashok

    2013-01-01

    Background: Total knee arthroplasty (TKA) following high tibial osteotomy (HTO) is a technically demanding procedure with varying results. The purpose of our study was to analyze the clinicoradiological results of TKA following HTO and to identify the factors that may influence the final outcome. Materials and Methods: 55 patients (58 knees) who had undergone a previous HTO were treated with a TKA from 1991 to 2009. There were 34 female and 21 male patients. The average age was 61.9 years (range 52-82 years) and the average weight was 79.5 kg (range 54-106 kg), with an average body mass index of 29.6 (range 21.8-34.6) at the time of TKA. The knee society scores (KSSs) and knee society functional scores were evaluated for every patient pre and postoperatively and the results evaluated. Results: The mean period of followup was 11.2 years (range 3-18 years) and the patients were followed up every year. The average KSS score at final followup improved from 38.5 (range 0-80 points) preoperatively to 88.5 postoperatively (range 35-95 points) (P < 0.05). The mean femorotibial angle corrected from 6.8 degrees (range 5-12°) varus preoperatively to a valgus of 4.4 (2-8°) degrees postoperatively. The average joint line height improved to an average of 9.6 mm (range 4.4-22 mm) (P < 0.01) at the last followup. The average Insall Salvatti Ratio also improved (average 1.11 preoperative - 1.21 average postoperative) (P < 0.05). The average range of motion improved to 108° (range 85°-125°) from 76° preoperative (range 55°-100°) (P < 0.01). Conclusion: Although TKA postHTO is a demanding surgery however, with newer component designs, results are comparable to primary TKA. Technical difficulties in exposure can sometimes lead to component malpositioning, which can affect the final outcome. Inadequate soft tissue balancing and limb malalignment should always be kept in mind. Regular followup to look for evidences of loosening is advised in such patients]. PMID:24133306

  6. Effort Gap Database

    NSDL National Science Digital Library

    Maintained by the Biological Resources Research Center (BRRC) at the University of Nevada, Reno, the Effort Gap Database organizes information on biological research efforts in the Great Basin. Users may search the database (by multiple topics) for current and past projects, or they may add new information to the database. Typical returns provide information such as project title, scientific goals, available data, Principal Investigators, temporal and spatial scale of research, habitats in study area, types of organisms, source of funding, and finished products. Designed as an interactive Web application to allow and encourage researchers to share research foci and learn about other conservation biology projects in Nevada, this database is an excellent example of how to facilitate collaboration across multiple ecological scales and agencies.

  7. Filling the launch gap

    NASA Astrophysics Data System (ADS)

    Hoeser, S.

    1986-05-01

    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.

  8. Gap and stripline combined monitor

    DOEpatents

    Yin, Y.

    1986-08-19

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

  9. Gap and stripline combined monitor

    DOEpatents

    Yin, Yan (Palo Alto, CA)

    1986-01-01

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

  10. Management of temporomandibular joint reankylosis in syndromic patients corrected with joint prostheses: surgical and rehabilitation protocols.

    PubMed

    Clauser, Luigi C; Consorti, Giuseppe; Elia, Giovanni; Tieghi, Riccardo; Galiè, Manlio

    2014-03-01

    Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. There are three main surgical procedures for the treatment of TMJA: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Various authors have described reankylosis as a frequent event after treatment. Treatment failure could be associated with surgical errors and/or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success. PMID:24624260

  11. Randomized trial of computer-assisted knee arthroplasty: impact on clinical and radiographic outcomes.

    PubMed

    Hiscox, Christina M; Bohm, Eric R; Turgeon, Thomas R; Hedden, David R; Burnell, Colin D

    2011-12-01

    Computer-assisted surgery in knee arthroplasty is gaining popularity; however, the resulting outcome improvement is controversial. A double-blinded trial was performed with subjects randomized to undergo surgery with either computer-assisted or nonassisted instruments. Postoperatively, limb and implant alignment and rotation were assessed using both full-length radiographs and computed tomography in addition to clinical scores. One hundred twenty patients (141 knees) were randomized. No differences in Western Ontario MacMaster Osteoarthritis Score, Short Form-36, or flexion were seen. More varus limb alignment was seen in the computer-assisted group (1.9°) vs the nonassisted group (0.9°, P = .04) with no improvement in alignment precision. Rotational alignment of the components did not differ between groups. Computer-assisted surgery appeared to have minimal effect on knee implant arthroplasty with no improvement in limb alignment or early functional outcome. PMID:21592721

  12. Magnetic resonance imaging with metal suppression for evaluation of periprosthetic osteolysis after total knee arthroplasty.

    PubMed

    Vessely, Michael B; Frick, Matthew A; Oakes, Daniel; Wenger, Doris E; Berry, Daniel J

    2006-09-01

    Osteolysis around total knee arthroplasty (TKA) can be difficult to identify and quantitate on plain radiographs. This study reports on magnetic resonance imaging (MRI) with metal suppression for the evaluation of suspected periprosthetic osteolysis around TKA. We retrospectively reviewed 11 patients referred for MRI with suspected periprosthetic osteolysis. Radiographic and MRI findings and findings at revision arthroplasty were correlated. The presence of osteolysis was identified or suspected radiographically in all of the 11 patients. Osteolysis was confirmed in 10 patients by MRI. In 9 of 11 patients, the extent of osteolysis was greater on MRI than estimated radiographically. In 5 of 11 patients, MRI demonstrated additional osteolytic lesions which were radiographically occult. In one case, the amount of osteolysis on MRI was less than on initial radiographs, and in one case, osteolysis was felt to be present radiographically but was not confirmed on MRI. In all 7 of 11 patients subsequently treated with revision TKA, MRI findings were confirmed at revision. PMID:16950034

  13. Cost-effective prophylaxis against venous thromboembolism after total joint arthroplasty: warfarin versus aspirin.

    PubMed

    Mostafavi Tabatabaee, Reza; Rasouli, Mohammad R; Maltenfort, Mitchell G; Parvizi, Javad

    2015-02-01

    Although recent guidelines suggest aspirin for venous thromboembolism (VTE) prophylaxis in low risk patients following total hip arthroplasty (THA) and total knee arthroplasty (TKA), there are no cost-effectiveness studies comparing aspirin and warfarin. In a Markov cohort cost-effectiveness analysis, we found that aspirin cost less and saved more quality-adjusted life-years (QALYs) than warfarin in all age groups. Cost per QALY gained by aspirin was $24,506.20 at age of 55 and $47,148.10 at the age of 85 following THA and $15,117.20 and $24,458.10 after TKA, which were greater than warfarin. In patients undergoing THA/TKA without prior VTE, aspirin is more cost-effective prophylactic agent than warfarin. Warfarin might be a better prophylaxis in TKA patients with high probability of VTE and very low probability of bleeding. PMID:25534862

  14. Patient versus Provider Characteristics Impacting Hospital Lengths of Stay Following Total Knee or Hip Arthroplasty

    PubMed Central

    Styron, Joseph F.; Koroukian, Siran; Klika, Alison; Barsoum, Wael K.

    2010-01-01

    Introduction This study aims to identify whether patient-level or provider-level characteristics are most influential on a patient’s length of stay in the acute care hospital. Materials and Methods A dataset containing a nationally representative sample of inpatient discharge abstracts was used. Multi-level linear regression models were used to evaluate the associations between patient- and provider-level characteristics on patients’ lengths of stay. Results The target population included 322,894 discharges with a primary procedure code for primary total knee arthroplasty and 193,553 discharges for total hip arthroplasty. The variables associated with the greatest increases in length of stay were a higher co-morbidity level among patient level attributes (+17.4%) and low surgeon volume among provider-level characteristics (+18.8%). Discussion Provider-level characteristics, particularly provider volume, had a greater impact on length of stay. PMID:21277159

  15. A prospective analysis of glove perforation in primary and revision total hip and total knee arthroplasty.

    PubMed

    Carter, Aaron H; Casper, David S; Parvizi, Javad; Austin, Matthew S

    2012-08-01

    Literature in regard to glove perforation rates in revision total joint arthroplasty (TJA) is scarce. Our purpose was to determine the incidence of perforation in revision TJA. Gloves from all scrubbed personnel were tested based on the American Society for Testing and Materials. A total of 3863 gloves were collected from 58 primary and 36 revision arthroplasty cases. Surgeons had a 3.7% outer-glove perforation rate in primary TJA compared with 8.9% in revision TJA. When both gloves were perforated, the outer-glove perforation was recognized intraoperatively 100% of the time, and the inner-glove perforation was noted only 19% of the time. The surgeon has the highest rate of glove perforation. Outer-glove perforations should prompt careful inspection of the inner glove. PMID:22425303

  16. Squeaking in a Delta ceramic-on-ceramic uncemented total hip arthroplasty.

    PubMed

    Buttaro, Martin A; Zanotti, Gerardo; Comba, Fernando M; Piccaluga, Francisco

    2012-06-01

    Squeaking is one of the main concerns related to the use of ceramic-on-ceramic total hip arthroplasty. Although it has received much recent publicity, most of the previous reports on this complication have been related to the use of the second generation of alumina ceramics combined with a cup having an elevated metal rim to protect the ceramic liner from neck impingement. We report a patient with a third-generation Biolox Delta (CeramTec AG, Plochingen, Germany) ceramic-on-ceramic uncemented total hip arthroplasty without an elevated metal rim in the cup who presented with a squeaking hip at 23 months postoperative. Although this complication was mainly related to a specific design in the literature, this case demonstrates that newer generation of ceramics can also present squeaking. PMID:22397859

  17. A computerized morphometric evaluation of x-ray films for preoperative planning of hip arthroplasty.

    PubMed

    Baruffaldi, F; Cianci, R; Fabbri, F; Mulazzani, M; Fanton, F; Toni, A; Affatato, S; Giunti, A

    1994-01-01

    Methods for measuring metric size on radiograms constitute an instrument of proven utility. For example, when preoperatively evaluating hip arthroplasty the diameter of the medullary canal and the cervicodiaphyseal angle, must be measured in order to determine the center of rotation of the femoral head, and to establish the flare index of the diaphyseal canal. These results may be obtained by using a computer-controlled graphic table to place the coordinates for the areas of greater anatomical and physiological importance on the radiologic image. Thus, a calculation of distances, anatomical axes and angles is obtained immediately, accurately defining the morphometry of the joint. In this study, the anteroposterior preoperative radiographic views of 87 femurs in 84 patients were evaluated by this method. The values provided by the morphometric analysis were then related to sex, age and weight. The diaphyseal canal was classified by typology for the preoperative planning of hip arthroplasty. PMID:7842840

  18. Leg length measurement: a new method to assure the correct leg length in total hip arthroplasty.

    PubMed

    Affatato, S; Toni, A

    2000-07-01

    The precise measurement of leg length plays an important role in total hip arthroplasty. Leg length inequality occurs frequently after total hip arthroplasty and may cause patient discomfort. Current clinical methods used for measuring leg length are not accurate enough to meet the demands of precision required for hip replacement. The aim of this study was to examine the validity of determining leg length differences using an ultrasound system. The proposed system measures the distance between three points, in millimetres, so that the difference between preoperative and postoperative measurements gives an indication about the leg length. The mean ultrasound variation observed in in vitro measurements showed a relative error of 1.7% (range: 52-133 mm) that means a leg length inequality of about 0.4 mm (range: 52-133 mm). The method is non-invasive (ultrasound is not limited by radiation hazards), easy, quick to use, and can be used for standard clinical screening. PMID:11086255

  19. Beneficial effects of continuous passive motion after total condylar knee arthroplasty.

    PubMed Central

    Johnson, D. P.; Eastwood, D. M.

    1992-01-01

    A randomised, controlled study of the use of postoperative continuous passive motion (CPM) and immobilisation regimen after total condylar knee arthroplasty was performed. CPM resulted in a significant increase in both the early and late range of knee flexion. This increase occurred in both rheumatoid and osteoarthritic patients. The improvement of 10 degrees at 12 months allowed additional important function to be attained. CPM resulted in significantly earlier discharge from hospital. It did not increase the clinical incidence of wound healing problems, nor did it significantly increase the postoperative fixed flexion deformity or the extension lag. CPM can be recommended as a safe and effective modality to achieve more rapid and more successful postoperative rehabilitation after knee arthroplasty. Images Figure 1 PMID:1471839

  20. [Treatment for a chronic proximal interphalangeal fracture-dislocation with hemi-hamate arthroplasty].

    PubMed

    Bigorre, N; Rabarin, F; Jeudy, J; Césari, B

    2014-04-01

    Fracture-dislocations of the proximal interphalangeal (PIP) joint are complex and challenging to manage once they become chronic. We report a case of PIP joint fracture-dislocation treated by hemi-hamate arthroplasty. An 18-year-old male polytrauma patient presented with a neglected PIP joint fracture-dislocation in the third finger of the left hand. After four months of follow-up, he remained disabled due to clinodactyly and stiffness. After performing a cadaver study to evaluate the feasibility of grafting, we resurfaced the bone-cartilage defect with a hemi-hamate arthroplasty. The range of motion at the last follow-up was 65° without pain; the DASH score was 2.27. The patient was able to return to heavy manual labour work at 5 months postoperative. PMID:24582158

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

    PubMed

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

    2015-04-01

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

  2. Association between body mass index change and outcome in the first year after total knee arthroplasty.

    PubMed

    Mackie, Alasdair; Muthumayandi, Karthikeyan; Shirley, Mark; Deehan, David; Gerrand, Craig

    2015-02-01

    There is an association between obesity, osteoarthritis and total knee arthroplasty (TKA), but little is known about how postoperative weight change influences outcomes. Primary TKA patients were identified from an institutional arthroplasty registry. BMI and patient reported outcome measures (PROMs, specifically WOMAC and SF36) were recorded for 1545 patients preoperatively and up to 3 years postoperatively. Mixed effects modelling showed postoperative BMI change had no impact on postoperative WOMAC scores. However, weight gain over 10% had a negative impact on SF36 pain and functional scores although postoperative weight loss was not associated with improved PROMs. Men showed greater improvement in postoperative SF36 function and pain scores, whilst older patients were slower to improve. Postoperative weight gain has a negative association with SF36 pain and function. PMID:25311165

  3. Severe metallosis following total knee arthroplasty: a case report and review of radiographic signs.

    PubMed

    Helito, Camilo Partezani; Buarque de Gusmão, Carlos Vinícius; Angelini, Fabio Janson; Tirico, Luis Eduardo Passarelli; Pécora, José Ricardo

    2014-08-01

    Metallosis is an uncommon complication following total knee arthroplasty that leads to osteolysis and implant loosening due to chronic inflammatory reaction. Abrasion between the metallic surfaces of the implant releases metallic debris that interacts with the periprosthetic soft tissues and causes chronic synovitis. Here we present a case of a 65-year-old man who had undergone total knee arthroplasty 10 years ago and developed implant loosening associated with severe metallosis and varus instability. Radiographs show the three typical signs of metallosis: metal-line sign, bubble sign, and cloud sign. This patient was subjected to revision surgery consisting of debridement and primary implant replacement by a hinged endoprosthesis. Knowledge of the typical radiographic and clinical findings of metallosis is important to rapidly diagnose this complication and avoid progressive joint destruction. PMID:24664480

  4. Catastrophic failure of a metal-on-metal total hip arthroplasty secondary to metal inlay dissociation.

    PubMed

    Alaia, Michael J; Dayan, Alan J

    2011-09-01

    Metal-on-metal bearing surfaces in total hip arthroplasty have been recently shown to have acceptable survivorship properties (J Bone Joint Surg Am. 2006;88:1183; J Bone Joint Surg Am. 2006;88:1173), and they have certain advantages and disadvantages when compared to conventional metal-on-polyethylene bearing surfaces. Like traditional metal-on-polyethylene bearings, these metal-on-metal implants may also suffer from catastrophic failure. This case report represents an unusual situation in a 57-year-old man in which dissociation of a metal inlay in a metal-on-metal total hip arthroplasty resulted in articulation of the inferior aspect of the inlay with the femoral neck, leading to femoral neck notching, extensive periprosthetic soft tissue metallosis, osteolysis, and subsequent prosthetic catastrophic failure. PMID:20875944

  5. Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture.

    PubMed

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

    2015-05-01

    Post-traumatic arthritis of the hip can develop in 12-57% of patients after an acetabular fracture. Once it develops, salvage treatment options include arthroplasty or arthrodesis. Delayed total hip arthroplasty (THA) has been shown to be a viable treatment option to decrease pain, improve stability and increase functional outcomes. Using cemented designs, earlier long-term studies reported satisfactory functional outcomes of delayed THA used to treat previously failed acetabular fractures. However, high aseptic loosening rates were also observed. Recent advances in cementless acetabular designs have shown comparable functional outcomes and loosening rates compared to those undergoing THA for non-traumatic arthritis. However, even with improvements in functional and radiographic outcomes, unique complications are commonly encountered in patients with previous acetabular fractures, including heterotopic bone around the hip, increased operative times and blood loss, aseptic loosening, sciatic nerve injury and dislocation. The outcomes and complications of delayed THA in patients with previous acetabular fracture will be reviewed. PMID:25850558

  6. The classic: modular total knee-replacement arthroplasty. A review of eighty-nine patients. 1976.

    PubMed

    Laskin, Richard S

    2008-11-01

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

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

    PubMed

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

    2014-09-26

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

  8. Proximal interphalangeal joint silicone replacement arthroplasty: clinical results using an anterior approach.

    PubMed

    Lin, H H; Wyrick, J D; Stern, P J

    1995-01-01

    Sixty-nine proximal interphalangeal joint silicone arthroplasties in 36 patients inserted through an anterior approach were reviewed. Average followup time was 3.4 years. The average extension deficit was slightly improved from 17 degrees to 8 degrees, but the total active motion (active flexion minus active extension) did not significantly increase (44 degrees to 46 degrees). Coronal plane deformities were not successfully corrected. Pain relief was obtained in 67 of 69 digits. There were 12 digits with complications, and five implants fractured. The anterior approach allows preservation of the central slip insertion and initiation of immediate active and passive joint motion. With proper indications, careful surgical technique, and a supervised therapy protocol, proximal interphalangeal joint silicone arthroplasty is a useful operation for pain relief and functional gain. PMID:7722251

  9. Dental clearance prior to elective arthroplasty may not be needed for everyone.

    PubMed

    Tokarski, Anthony T; Patel, Raj G; Parvizi, Javad; Deirmengian, Gregory K

    2014-09-01

    We investigated the prevalence and risk factors for preoperative dental clearance failure in joint arthroplasty patients. Over a 5-month period, all patients scheduling total joint arthroplasty completed a dental questionnaire. Data collected included demographics, medical and dental history, dental hygiene practices, frequency of dental care, and results of dental clearance. Of the 300 patients, 35 (12%) failed dental clearance. Risk factors included tobacco use, poor flossing habits, history of tooth extraction, age, narcotic use, and lack of a dentist visit within 12 months. Of 189 patients who lacked the 3 least prevalent risk factors (tobacco use, narcotic use, no dental visit within 12 months), 11 (6%) failed dental clearance. Selective dental clearance based on patient risk stratification may be a reasonable approach. PMID:24851786

  10. Trichosporon asahii infection after total knee arthroplasty: A case report and review of the literature

    PubMed Central

    Zuo, Qiang; Dong, Lele; Mu, Weidong; Zhou, Lingyun; Hu, Tongping; Zhang, Hua

    2015-01-01

    Reports of fungal infection after total knee arthroplasty are extremely rare. In most reports, the infecting organism is a Candida species. The present report describes a case involving a 73-year-old immunocompetent woman who underwent total knee arthroplasty and presented one month later with signs of prosthetic infection. She underwent joint debridement and the fluid was sent for culture and sensitivity testing. The culture showed growth of Trichosporon asahii. The patient was administered intravenous and intra-articular injections of amphotericin B, followed by antifungal treatment with voriconazole for one year. At 26 months of follow-up, there was no evidence of infection and the patient was ambulating with a walker. To the authors’ knowledge, the present case is the first report of T asahii infection following knee replacement. Early detection, prompt institution of the appropriate antibiotics and regular follow-up are recommended.

  11. Failure of total hip arthroplasties. Numerical modeling of debris formation through plastic strains.

    PubMed

    Baudriller, Haimad; Chabrand, Patrick; Dubois, Frédéric

    2004-08-01

    The life span of a total hip prosthesis is one of the main points on which the long-term success of arthroplasties depends. It is, by now, widely recognized that hip arthroplasty failure is mainly due to the aseptic loosening resulting from the presence of wear debris forming at the contact interface between the femoral head and the cup of the acetabulum. The size of these particles varies from a few micrometers to some tens of micrometers or more. The main aim of this study was therefore to investigate the formation of debris in the microscopic size range. For this purpose, a numerical study was carried out on various mechanisms leading to plastic deformations, which can lead to damage and wear in material. Numerical analyses were performed with a laboratory software program LMGC90, on the evolution of the plastic strains involved in various wear mechanisms on the microscopic scale. PMID:15512766

  12. Surface replacement arthroplasty of the proximal interphalangeal and metacarpophalangeal joints: The current state

    PubMed Central

    Singh, Harvinder; Dias, Joseph J.

    2011-01-01

    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

  13. Angiographic findings in patients with postoperative soft tissue defects following total knee arthroplasty

    Microsoft Academic Search

    Christian Herold; Andreas Steiert; Karsten Knobloch; Marc N. Busche; Mehmet A. Altintas; Peter M. Vogt

    Purpose  A postoperative defect of the surrounding soft tissue is one main risk factor for implant exposure and infection following\\u000a total knee arthroplasty (TKR). The main factors that promote infection, tissue ischemia, and hypoxia are strongly associated\\u000a with arterial insufficiency and the prevalence of impaired peripheral perfusion. We hypothesized that vascular malperfusion\\u000a is the predisposing reason for soft tissue complications following

  14. Deep Vein Thrombosis Prevention in Joint Arthroplasties Continuous Enhanced Circulation Therapy vs Low Molecular Weight Heparin

    Microsoft Academic Search

    Yael Gelfer; Hovav Tavor; Amir Oron; Amir Peer; Nahum Halperin; Dror Robinson

    Deep vein thrombosis prevention efficacy using a new, miniature, mobile, battery-operated pneumatic system (continuous enhanced circulation therapy (CECT) system) combined with low-dose aspirin was compared to enoxaparin. One hundred twenty-one patients who underwent total hip or knee arthroplasty were prospectively randomized into 2 groups. The study group was treated by the CECT system starting immediately after the induction of anesthesia.

  15. Early, incapacitating instability of posterior cruciate ligament-retaining total knee arthroplasty

    Microsoft Academic Search

    Gary L. Waslewski; Blake M. Marson; James B. Benjamin

    1998-01-01

    Numerous studies indicate that total knee arthroplasty (TKA) achieves excellent long-term success whether the posterior cruciate ligament (PCL) is saved or excised. In 13 patients, 16 PCL-retaining TKAs were identified with incapacitating instability secondary to early PCL deficiency. Patients with clinical PCL insufficiency present with a triad of subjective complaints: persistent swelling\\/effusions, anterior knee pain, and giving-way or instability episodes

  16. Patient satisfaction and outcome after septic versus aseptic revision total knee arthroplasty

    Microsoft Academic Search

    Robert L. Barrack; Gerard Engh; Cecil Rorabeck; Jaswin Sawhney; Michael Woolfrey

    2000-01-01

    A consecutive series of revision total knee arthroplasties performed at 3 university-affiliated centers by 3 surgeons was prospectively studied. The same implant was used in all cases. The evaluation included a Knee Society clinical score (KSCS); SF-36; satisfaction survey; and radiographs preoperatively, at 6 and 12 months postoperatively, and annually thereafter. Follow-up averaging 36 months (range, 24-60 months) was obtained

  17. Randomized Trial of Computer-Assisted Knee Arthroplasty: Impact on Clinical and Radiographic Outcomes

    Microsoft Academic Search

    Christina M. Hiscox; Eric R. Bohm; Thomas R. Turgeon; David R. Hedden; Colin D. Burnell

    2011-01-01

    Computer-assisted surgery in knee arthroplasty is gaining popularity; however, the resulting outcome improvement is controversial. A double-blinded trial was performed with subjects randomized to undergo surgery with either computer-assisted or nonassisted instruments. Postoperatively, limb and implant alignment and rotation were assessed using both full-length radiographs and computed tomography in addition to clinical scores. One hundred twenty patients (141 knees) were

  18. The New Demands by Patients in the Modern Era of Total Joint Arthroplasty

    Microsoft Academic Search

    J. Bohannon Mason

    2008-01-01

    Historians have the opportunity of viewing events, people, and their epoch through an aperture in time. With retrospective\\u000a clarity, change and the forces effecting change can be appropriately categorized, emphasized, and interpreted. Sociologists\\u000a see change in a forward-focused manner. When we examine our patients today, it is clear our current patients having total\\u000a joint arthroplasty are different from those in

  19. Prediction of post-operative urinary retention in hip and knee arthroplasty in a male population

    Microsoft Academic Search

    J. J. Cronin; F. J. Shannon; E. Bale; W. Quinlan

    2007-01-01

    Urinary retention is an important complication of hip and knee arthroplasty. The insertion of a urinary catheter has been\\u000a associated with an increased incidence of implant infection in previous studies (David and Vrahas in J Am Acad Orthop Surg\\u000a 8(1):66–74, 2000; Haase and Harding in Compan Surg 1(4):1–6, 1984). The purpose of this study was to assess the rates of

  20. Ceramic-On-Ceramic Total Hip Arthroplasty in Patients Younger Than 20 Years

    Microsoft Academic Search

    Patrick R. Finkbone; Eric P. Severson; Miguel E. Cabanela; Robert T. Trousdale

    Total hip arthroplasty (THA) in the adolescent patient has historically shown relatively poor survivorship. This study reports the results of THA in young patients using contemporary ceramic bearings. Twenty-four THAs were performed using ceramic bearing surfaces in patients 20 years old or younger (mean, 16.4; range, 12-20). Average follow-up was 52 months (range, 25-123 months). The survival rate was 96%,

  1. Effect of shed blood retransfusion on pulmonary perfusion after total knee arthroplasty: a prospective controlled study

    Microsoft Academic Search

    Levent Altinel; Eser Kaya; Kamil Cagri Kose; Fatma Fidan; Volkan Ergan; Hüseyin Fidan

    2007-01-01

    Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method following major surgical operations,\\u000a such as total knee arthroplasty (TKA). The systemic effects of shed blood are still unclear. We studied the effect of residual\\u000a substances in the retransfused shed blood, on lung perfusion after TKA. Fifteen unilateral and one bilateral TKAs were performed\\u000a with autotransfusion (the study group)

  2. Combined pharmacological and mechanical prophylaxis for DVT following hip and knee arthroplasty

    Microsoft Academic Search

    B. Moretti; V. Patella; V. Pesce; C. Simone; M. Ciccone; M. De Nicolò

    2002-01-01

    Intermittent pneumatic compression (IPC) is an attractive method for prophylaxis of deep venous thromboembolism (DVT) because\\u000a there is no risk of haemorrhagic complications. However, IPC has not been studied as thoroughly as other methods in orthopaedic\\u000a and traumatologic surgery. We monitored 328 patients undergoing total hip or knee arthroplasty (THA, TKA) treated with combined\\u000a pharmacological and mechanical prophylaxis or with

  3. Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study

    Microsoft Academic Search

    Stavros G. Memtsoudis; Melanie C. Besculides; Licia Gaber; Spencer Liu; Alejandro González Della Valle

    2009-01-01

    Pulmonary embolism (PE) is a cause of death after total hip and knee arthroplasty (THA, TKA). We characterised the patient\\u000a population suffering from in-hospital PE and identified perioperative risk factors associated with PE using nationally representative\\u000a data. Data from the National Hospital Discharge Survey between 1990 and 2004 on patients who underwent primary or revision\\u000a THA\\/TKA in the United States

  4. TWO-STAGE EXCHANGE OF INFECTED KNEE ARTHROPLASTY WITH AN PROSTHESIS-LIKE INTERIM CEMENT SPACER

    Microsoft Academic Search

    T. SIEBEL; J. KELM; M. PORSCH; T. REGITZ; W. H. NEUMANN

    2002-01-01

    Two-stage revision in infected knee arthroplasty is standard practice. One problem during the interim period is soft tissue fibrosis. Attempts have been made to preserve leg length and ligament length by introducing spacers, usually made out of antibiotic- loaded bone cement. We present a new interim prosthesis, which is made intra-operatively out of polymethylmethacrylate (PMMA). Antibiotic-loaded cement provides a thera-

  5. Metal-backed patellar component failure in total knee arthroplasty presenting as a giant calf mass

    Microsoft Academic Search

    Fang-Yeng Chang; Kuo-Fung Tseng; Wei-Ming Chen; Ching-Kuei Huang; Tain-Hsiung Chen; Wai-Hee Lo

    2003-01-01

    Failure of total knee arthroplasty (TKA) caused by wear of the polyethylene-bearing surface of a metal-backed tibial platform or a metal-backed patellar component is a recognized complication. We present a case of a 78-year-old woman with a cystic mass in the left calf caused by metal wear debris from the failure of a Miller-Galante I TKA. The patient received a

  6. Failure of metal-backed patellar components after total knee arthroplasty

    Microsoft Academic Search

    DG Lewallen; JA Rand

    1995-01-01

    All revision total knee arthroplasties for failure of a metal-backed patellar component during a 4-year period were reviewed. Twenty-five revisions, representing six designs, were performed in 24 patients. The failure mode included wear or fragmentation of the patellar polyethylene in 20 knees, polyethylene separation from the metal baseplate in 3, and metal peg-baseplate fracture in 2. Time to revision averaged

  7. Results after Late Polymicrobial, Gram-negative, and Methicillin-resistant Infections in Knee Arthroplasty

    PubMed Central

    Esteban, Jaime; García-Rey, Eduardo

    2010-01-01

    Background Previous studies of knee arthroplasty infections caused by high-virulence organisms suggest poor outcomes. Polymicrobial and Gram-negative infections are less studied. Questions/purposes This study compared the results of treatment of knee arthroplasty infections by single versus polymicrobial isolates, Gram-positive versus Gram-negative, and methicillin-resistant versus -sensitive Staphylococci. Methods We prospectively followed 47 patients with late knee arthroplasty infections. The mean age was 72 years (range, 20–87 years). The treatment protocol included two-stage exchange and a combination of two oral antibiotics given for 6 months. Minimum followup was 1 year (average, 4.8 ± 3 years; range, 1–12 years). Control of the infection was judged by absence of clinical, serologic, and radiologic signs of infection. The functional outcome was evaluated by Knee Society score at the last followup. Results Infection was controlled in all 15 patients with polymicrobial and in 28 of 32 (88%) with monomicrobial infections, in eight of nine patients with Gram-negative and in 35 of 38 (92%) with Gram-positive isolates. Control was also achieved in 22 of 25 patients (88%) infected by methicillin-resistant Staphylococci and in 14 of 14 by methicillin-sensitive Staphylococci. The Knee Society scores averaged 81-63 in patients with polymicrobial infections and were higher than in monomicrobial infections (75-52). The mean KSS was 85-59 in Gram-negative infections compared to 75-55 in Gram-positive infections. The mean KSS was similar in methicillin-resistant (78-54) and methicillin-sensitive Staphylococci (73-56) infections. Conclusions Polymicrobial and Gram-negative infections can be controlled in late knee arthroplasty infections. On the other hand, infections by methicillin-resistant Staphylococci are less likely to be controlled by the regimens we used. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:20087702

  8. Total hip arthroplasty in the young: special emphasis on post-SCFE patients.

    PubMed

    Nelms, Nathaniel J; Lewallen, Laura W; McIntosh, Amy L; Sierra, Rafael J

    2013-01-01

    Slipped capital femoral epiphysis (SCFE) is a hip disorder of adolescence, which has the potential for profound implications into adulthood. SCFE patients are at risk of early joint degeneration and subsequent need for arthroplasty. The rate at which arthroplasty is required is not precisely known, but is estimated to be approximately 45% by 50 years after a slip. The femoral neck and shaft displace anteriorly and rotate externally relative to the femoral epiphysis, which remains fixed in the acetabulum. Stabilization of the physis is the goal of acute management. Despite such efforts, accelerated joint degeneration may occur over time. This progression is due to avascular necrosis, chondrolysis, or following years of femoroacetabular impingement. Total hip arthroplasty (THA) and total hip resurfacing (THR) are options for end-stage hip arthritis due to SCFE. THR is technically more challenging, with very limited ability to address deformity-related issues of impingement, decreased hip offset, and trochanteric malposition. THR, as in any metal on metal arthroplasty, may be associated with local metal sensitivity or systemic metal toxicity. Given the limited utility and potential risks, THR is currently not recommended in the majority of cases. THA, although historically demonstrating poor long-term implant performance in the young patient, has become a more reliable option recently. The potential benefits of THA are considerable, even for the young patient with end-stage hip degeneration. Certain cemented and many cementless stem designs show good long-term survival, as do current cementless cups. Advances in bearing surfaces promise to minimize wear and extend implant longevity. Ceramic on ceramic, metal on highly cross-linked polyethylene, and ceramic on highly cross-linked polyethylene bearing couples offer promise. PMID:23764787

  9. Metal-on-metal bearings in cementless primary total hip arthroplasty

    Microsoft Academic Search

    Christian P. Delaunay

    2004-01-01

    One hundred cementless titanium primary total hip arthroplasties with 28 mm Metasul bearings were prospectively studied (osteoarthritis in 76% of hips, mean age 59.6 years). Ninety-eight were reviewed after a 6-year average follow-up (range, 17–126 months) with clinical results graded excellent and good in 97%. One femoral component was revised for aseptic loosening at 7.8 years. Postoperative cobalt level was

  10. Removal of well-fixed, cementless, acetabular components in revision hip arthroplasty.

    PubMed

    Mitchell, P A; Masri, B A; Garbuz, D S; Greidanus, N V; Wilson, D; Duncan, C P

    2003-09-01

    Removal of well-fixed, cementless, acetabular components during revision arthroplasty remains a challenging problem. Further damage to host bone may limit options for reconstruction and compromise the long-term result of the revision operation. We report the results of 31 hips with well-fixed, cementless sockets which were removed using a new cup extraction system. In all hips the socket was removed without difficulty and with minimal further bone loss. PMID:14516024

  11. The Mark Coventry Award: In Vivo Knee Forces During Recreation and Exercise After Knee Arthroplasty

    Microsoft Academic Search

    Darryl D. D’Lima; Nikolai Steklov; Shantanu Patil; Clifford W. Colwell Jr

    2008-01-01

    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

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

    PubMed Central

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

    2014-01-01

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

  13. Does Concomitant Low Back Pain Affect Revision Total Knee Arthroplasty Outcomes?

    Microsoft Academic Search

    Wendy M. Novicoff; David Rion; William M. Mihalko; Khaled J. Saleh

    2009-01-01

    \\u000a Abstract  The number of revision total knee arthroplasties (rev-TKA) is increasing every year. These cases are technically difficult\\u000a and add considerable burden on the healthcare system. Many patients have concomitant low back pain that may interfere with\\u000a functional outcome. We asked whether having low back pain at baseline would influence amount and rate of improvement on standardized\\u000a outcomes measures after rev-TKA.

  14. Pseudoaneurysm of the Distal Thigh Following Manipulation of a Total Knee Arthroplasty: A Case Report

    Microsoft Academic Search

    Chris Sambaziotis; Mickey Plymale; Andrew Lovy; Kevin O’Halloran; Kenneth McCulloch; David S. Geller

    The authors describe a unique complication following manipulation of a stiff total knee arthroplasty in a 47-year-old male. Four days after undergoing manipulation under anesthesia, the patient presented with increasing pain and swelling of the affected knee, and decreased hemoglobin\\/hematocrit. CT angiogram revealed a ruptured pseudoaneurysm of a segmental branch of the deep femoral artery that was treated with embolization

  15. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty

    Microsoft Academic Search

    H Schmied; A Reiter; A Kurz; D. I Sessler; S Kozek

    1996-01-01

    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

  16. Cementless total hip arthroplasty in Paget’s disease of bone: a retrospective review

    Microsoft Academic Search

    Julien Wegrzyn; Vincent Pibarot; Roland Chapurlat; Jean-Paul Carret; Jacques Béjui-Hugues; Olivier Guyen

    2010-01-01

    Paget’s disease of bone (PDB) is a localised chronic osteopathy leading to bone deformities, bone hypervascularity, structural\\u000a weakness and altered joint biomechanics. The pelvis and upper femur are frequently involved, resulting in disabling hip disease,\\u000a and total hip arthroplasty (THA) may be required. We performed a retrospective study on the management and the outcome of\\u000a 39 uncemented hydroxyapatite fully-coated THA

  17. Wear of polyethylene cups in total hip arthroplasty: a parametric mathematical model

    Microsoft Academic Search

    Riccardo Pietrabissa; Manuela Raimondi; Elena Di Martino

    1998-01-01

    This paper presents a parametric mathematical model of the head-cup wear coupling in total hip arthroplasty (THA). The model evaluates the dependence of acetabular volumetric wear upon the characteristic parameters of patient and hip prosthesis. Archard's law is assumed to calculate the wear coupling behaviour. The wear factor is taken from pin-on-disc wear tests as a function of materials and

  18. Activation of plasma coagulation by retransfusion of unwashed drainage blood after hip joint arthroplasty

    Microsoft Academic Search

    Jochen Duchow; Michael Ames; Thomas Hess; Ulrich Seyfert

    2001-01-01

    Twelve patients undergoing cementless hip joint arthroplasty were retransfused with unwashed drainage blood collected postoperatively. Global coagulation parameters, coagulation factors (factor V:C, factor VIII:C, activated factor XII, and factor XIII) and markers of thrombin generation (F1+2 Fibrin split products, thrombin-antithrombin complexes), fibrin generation (fibrinogen and fibrin degradation products), and fibrinolysis (D-dimers, thrombin degradation products, plasminogen) were determined. High levels of

  19. Patient-reported outcome after fast-track hip arthroplasty: a prospective cohort study

    Microsoft Academic Search

    Kristian Larsen; Torben B Hansen; Kjeld Søballe; Henrik Kehlet

    2010-01-01

    BACKGROUND: A fast-track intervention with a short preoperative optimization period and short postoperative hospitalization has a potential for reduced convalescence and thereby a reduced need for postoperative rehabilitation. The purpose of this study was to describe patient-related outcomes, the need for additional rehabilitation after a fast-track total hip arthroplasty (THA), and the association between generic and disease specific outcomes. METHODS:

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

    PubMed Central

    2012-01-01

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

  1. Looks Good But Feels Bad: Factors That Contribute to Poor Results After Total Knee Arthroplasty

    Microsoft Academic Search

    David A. Fisher; Brian Dierckman; Melanie R. Watts; Kenneth Davis

    2007-01-01

    The purpose of this study was to evaluate patient factors that might contribute to a poor result after total knee arthroplasty (TKA). Seventy-one knees (6.9%) of 1024 primary TKAs were identified at 1 year follow-up as having a poor result because of either stiffness or pain. Radiographs demonstrated well-fixed and aligned implants. This group was compared with a matched control

  2. Molecular detection of transcriptionally active bacteria from failed prosthetic hip joints removed during revision arthroplasty

    Microsoft Academic Search

    M. P. Riggio; Kate E. Dempsey; Allan Lennon; David Allan; Gordon Ramage; Jeremy Bagg

    2010-01-01

    The purpose of this study was to use microbiological culture and bacterial 16S rRNA gene sequencing methods to detect transcriptionally\\u000a active bacteria present on the surface of failed prosthetic hip joints removed during revision arthroplasty. Five failed prosthetic\\u000a hip joints were sonicated to dislodge adherent bacteria and subjected to microbiological culture. Bacterial RNA was extracted\\u000a from each sonicate, cDNA prepared

  3. Reinfusion of postoperative wound drainage in total joint arthroplasty. Red blood cell survival and coagulopathy risk.

    PubMed

    Wixson, R L; Kwaan, H C; Spies, S M; Zimmer, A M

    1994-08-01

    Fifty patients with total joint arthroplasties (28 total hip arthroplasties, 11 total knee arthroplasties, and 11 bilateral total knee arthroplasties) received autotransfusions from their postoperative wound drainage. The blood was collected in a closed sterile drainage system without any additional anticoagulant. Pre- and postoperative measurements were made of the patient's hemoglobin, platelets, fibrinogen, haptoglobin, fibrin degradation products, and D-dimer (a specific type of fibrin degradation product). Red blood cell survival was assessed in 16 of the patients by labeling the shed blood with 51Cr sodium chromate prior to reinfusion. To control for fluid shifts, continued bleeding, and dilution effects of further transfusions in the immediate postoperative period, 10 patients also had their native blood labeled with 111In oxime. In this study, the mean estimated blood loss was 1,062 mL (+/- 1,247) with a mean wound drainage of 836 mL (+/- 338). Of this, a mean of 450 mL (+/- 261) of blood was was given back to the patient in addition to routine, preoperative autologous donated blood. Six (12%) patients experienced transient fevers at the time of retransfusion. Detailed hematologic studies were performed on the shed blood in 19 patients. The collected blood was completely defibrinated, but did contain fibrin degradation products, as indicated by the D-dimer level, and hemolyzed blood as the haptoglobin was reduced. Even though the blood containing the above breakdown products was reinfused to the patients, there were no clinical manifestations of disseminated intravascular coagulation. Both the hemolyzed and defibrinated products were subsequently cleared by the body.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7964765

  4. 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

    Marie D. Westby; Catherine L. Backman

    2010-01-01

    BACKGROUND: There is worldwide variation in rehabilitation practices after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and no agreement on which interventions will lead to optimal short and long term patient outcomes. As a first step in the development of clinical practice guidelines for post-acute rehabilitation after THA and TKA, we explored experiences and attitudes about rehabilitation practices

  5. Gap or GapsChallenging the Singular Definition of the Achievement Gap

    Microsoft Academic Search

    Dick M. Carpenter; Al Ramirez; Laura Severn

    2006-01-01

    For decades, researchers examined the “achievement gap” between minority and nonminority students. This singular definition of achievement gap ignores important within-group differences. This article uses National Education Longitudinal Study (NELS:88) data to examine within-group differences and compares those across Latino, African American, and White populations. Results question the singular definition of achievement gap. Given the importance of how issues are

  6. Glass ionomer as an expander of allograft in revision arthroplasty of the hip.

    PubMed

    Eldridge, J D J; Cunningham, J L; Samuels, A; Blunn, G W; Lawes, T J; Learmonth, I D; Goodship, A E

    2003-02-01

    The use of glass ionomer as a bone graft expander was investigated in an in vivo model of revision hip arthroplasty. Bone grafts of pure allograft and allograft + glass ionomer particles in a 50:50 by weight mixture were implanted in an ovine hemi-arthroplasty model. Post-operative assessments of locomotor function, radiographic appearance and quantitative changes in mineralisation around the graft were made at 2, 4 and 6 months. Post-mortem assessments of radiographic and histologic appearance of the grafts were made at 6 months. No significant differences were noted in any of the measured or assessed parameters between the two graft types. The glass ionomer particles seemed to be well tolerated within the matrix of new bone, smaller sized particles appearing to be better incorporated than larger ones. The use of particles of glass ionomer as a bone graft expander, in this in vivo model of revision hip arthroplasty, would therefore appear to offer no detriment in performance over pure allograft in the short to medium term. PMID:12423605

  7. Systemic review of published literature on Candida infection following total hip arthroplasty.

    PubMed

    Kim, Seung-Ju; Huh, Jeungmin; Odrobina, Robert; Kim, Jong Hun

    2015-04-01

    Candida species (Candida spp.) infection following total hip arthroplasty (THA) is a rare but potentially devastating complication. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of Candida spp. infection after THA. We conducted a systemic review of the literature and pooled analysis of Candida spp. infection after THA published between 1950 and 2014. A total of 20 articles with 37 patients were identified. Median time between THA and readmission for Candida spp. infection was 25 months (range 0.5-184 months). Thirty-two patients (87 %) underwent removal of the prosthesis for initial surgical treatment. All patients were treated with systemic antifungal medication therapy for various durations after the surgical procedure or primary therapy without surgical procedures except for one patient who was treated with only amphotericin B joint cavity irrigation after removal of the prosthesis. Relapse of the infection occurred in three patients who had retention of the original prosthesis. There were three deaths related to the Candida spp. infection following THA owing to uncontrolled Candida spp. infection and deteriorating candidemia sepsis. Of note, among 15 patients who underwent two-stage exchange arthroplasty, there was one patient (7 %) who developed complication (death) while other 14 patients had uncomplicated recovery. In conclusion, surgical debridement with removal of the original prosthesis or two-stage exchange arthroplasty with combination of adequate systemic antifungal therapy is highly recommended in the treatment of Candida spp. infection following THA. PMID:25547374

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Xin, H; Shepherd, DET; Dearn, KD

    2012-01-01

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

  10. More intramedullary nails and arthroplasties for treatment of hip fractures in Sweden

    PubMed Central

    2010-01-01

    Background and purpose The surgical methods for treatment of femoral neck fractures and trochanteric hip fractures vary. We describe the changes in Sweden over the period 1998–2007 and the regional differences in treatment. Patients and methods Data on 144,607 patients were drawn from the National Patient Register. Results The proportion of femoral neck fractures treated with arthroplasty increased from 10% in 1998 to 52% in 2007. The use of intramedullary (IM) nails for pertrochanteric fractures increased from 5% to 20%, at the expense of the use of different sliding hip screws. In subtrochanteric fractures, the use of IM nails increased from 32% to 72%. Re-admissions within 180 days due to hip complications were more common after internal fixation for femoral neck fractures than after arthroplasty, and more common after intramedullary nailing of pertrochanteric fractures than after use of sliding hip screws. Treatment varied substantially within Sweden, particularly regarding the use of IM nails. Interpretation An increase in arthroplasties reflects an evidence-based treatment rationale for femoral neck fractures, whereas the increase in use of IM nails in pertrochanteric fractures lacks scientific support. The geographic variations call for national treatment guidelines. Further clinical trials are needed to solve the treatment issues regarding per- and subtrochanteric fractures. PMID:20860442

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

    PubMed

    Tan, Shi Ming; Chin, Pak Lin

    2015-03-18

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

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

    PubMed Central

    Breugem, Stéfanus Jacob Martinus; Haverkamp, Daniël

    2014-01-01

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

  13. P-Selectin: An Unpredicted Factor for Deep Vein Thrombosis after Total Hip Arthroplasty

    PubMed Central

    Shi, Dongquan; Xu, Xingquan; Xu, Zhihong; Nakamura, Takahiro; Pang, Yong; Yao, Chen; Wang, Feng; Chen, Dongyang; Dai, Jin; Jiang, Qing

    2014-01-01

    Introduction. Deep vein thrombosis (DVT) is a severe complication after total hip arthroplasty (THA). It leads to acute pulmonary embolism, a life-threatening disease. P-selectin is a 140-kDa transmembrane glycoprotein. Elevated P-selectin was associated with 1.7-fold increase in the risk of venous thrombosis. Materials and Methods. To confirm the association, a total of 91 subjects who received primary total hip arthroplasty using lateral approach performed by one skilled orthopedic surgeon were studied. All the patients were consecutively enrolled at the Center of Diagnosis and Treatment for Joint Diseases, Drum Tower Hospital affiliated to the Medical School of Nanjing University from 2010 to 2012. All the subjects received venography 3–5 days after operation. We measured P-selectin by means of a highly sensitive sandwich ELISA technique and a commercially available test reagent set. Results. No significant association was detected between P-selectin and DVT (all P??values > 0.05). ?sP-selectin was correlated with weight, APTT after operation, history of DVT, and diagnosis of primary disease ( P values were 0.03, 0.03, 0.04, and 0.02, resp.). Conclusion. P-selectin may not be a predicted factor for deep vein thrombosis after total hip arthroplasty. PMID:25057500

  14. Preoperative Diagnostic for Periprosthetic Joint Infection Prior to Total Knee Revision Arthroplasty

    PubMed Central

    Radtke, Kerstin; Ettinger, Max; Plaass, Christian; von Lewinski, Gabriela

    2014-01-01

    Periprosthetic joint infection (PJI) after total knee arthroplasty remains a challenging problem. The aim of this study was to evaluate the accuracy of diagnostic knee aspiration and serum inflammatory markers in diagnostic of a PJI after total knee arthroplasty. Within 2011 and 2012, 46 patients received a one- or two-stage revision arthroplasty of the knee joint. These patients received a total number of 77 operations. A preoperative aspiration was performed in each case. We analyzed the microbiological and histological examinations of the samples from the aspiration and from the revision operation and additionally estimated serum inflammatory markers. The diagnostic aspiration had a specificity of 0.87, a sensitivity of 0.39, a positive predictive value of 0.67 and a negative predictive value of 0.68. For C-reactive protein the specificity was 0.61 and the sensitivity was 0.48, the serum white blood cell count had a specificity of 0.98 and a sensitivity of 0.23. Our data queries whether diagnostic joint aspiration or serum inflammatory markers are sufficient to verify or exclude a PJI. PMID:25317311

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

    PubMed Central

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

    2015-01-01

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

  16. Proximal interphalangeal joint arthroplasty with Neuflex® implants: relevance of the volar approach and early rehabilitation.

    PubMed

    Bouacida, S; Lazerges, C; Coulet, B; Chammas, M

    2014-10-01

    Proximal interphalangeal joint arthroplasty through a volar approach preserves the extensor apparatus, which allows for early active rehabilitation. Here, we report on the results of 28 silicone implants in patients suffering from rheumatoid arthritis (12 joints) or osteoarthritis (16 joints) with a mean follow-up of 39 months. Pain was reduced significantly after arthroplasty. Range of motion increased significantly by 29° with a mean postoperative value of 58°; the mean extension deficit was reduced from 14° to 5°. There were 18 cases of preoperative ulnar drift with a mean value of 13°, compared with 13 cases postoperatively with a mean value of 7°. Three cases (10%) of implant fracture were noted on the radiology reports. The mean DASH score at follow-up was 35/100. Immediate active mobilization led to significant shortening in recovery time. The improvement in mobility and extension seems to be higher than that obtained with other approaches. Clinodactyly remains problematic no matter the type of arthroplasty. PMID:25257987

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

    PubMed Central

    Tan, Shi Ming; Chin, Pak Lin

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  19. Trunnionosis: the latest culprit in adverse reactions to metal debris following hip arthroplasty.

    PubMed

    Shulman, Ryan M; Zywiel, Michael G; Gandhi, Rajiv; Davey, J Roderick; Salonen, David C

    2015-03-01

    The imaging findings of periprosthetic soft tissue lesions (pseudotumours) have been typically defined in the context of newer second-generation metal-on-metal hip arthroplasty. More recently, similar findings have been described in the setting of non-metal-on-metal prostheses. Although uncommon, wear and corrosion between the metal surfaces at the head-neck ('trunnionosis') and neck-stem interfaces are the potential culprits. With modular junctions containing at least one cobalt chromium component frequently present in hip arthroplasty prostheses, the incidence of this mode of adverse wear may be higher than previously thought (irrespective of the specific bearing couple used). In the present report, we described a case of a severe adverse local tissue reaction secondary to suspected corrosion at the head-neck taper in a metal-on-polyethylene total hip arthroplasty and reviewed the literature. Knowledge of this topical entity should help radiologists facilitate early diagnosis and ensure early management of this potentially serious complication. PMID:25109382

  20. Preoperative diagnostic for periprosthetic joint infection prior to total knee revision arthroplasty.

    PubMed

    Claassen, Leif; Radtke, Kerstin; Ettinger, Max; Plaass, Christian; von Lewinski, Gabriela

    2014-08-01

    Periprosthetic joint infection (PJI) after total knee arthroplasty remains a challenging problem. The aim of this study was to evaluate the accuracy of diagnostic knee aspiration and serum inflammatory markers in diagnostic of a PJI after total knee arthroplasty. Within 2011 and 2012, 46 patients received a one- or two-stage revision arthroplasty of the knee joint. These patients received a total number of 77 operations. A preoperative aspiration was performed in each case. We analyzed the microbiological and histological examinations of the samples from the aspiration and from the revision operation and additionally estimated serum inflammatory markers. The diagnostic aspiration had a specificity of 0.87, a sensitivity of 0.39, a positive predictive value of 0.67 and a negative predictive value of 0.68. For C-reactive protein the specificity was 0.61 and the sensitivity was 0.48, the serum white blood cell count had a specificity of 0.98 and a sensitivity of 0.23. Our data queries whether diagnostic joint aspiration or serum inflammatory markers are sufficient to verify or exclude a PJI. PMID:25317311