Sample records for interpositional gap arthroplasty

  1. Gap Arthroplasty versus Interpositional Arthroplasty for Temporomandibular Joint Ankylosis: A Meta-Analysis

    PubMed Central

    Ma, Junli; Liang, Limin; Jiang, Hua; Gu, Bin

    2015-01-01

    Gap arthroplasty (GA) and interpositional arthroplasty (IA) are widely used for the treatment of temporomandibular joint ankylosis (TMJA). However, controversy remains as to whether IA is superior to GA. PubMed, EMBASE, the Cochrane Library, the Web of science and the China National Knowledge Infrastructure were searched for literature regarding these procedures (published from 1946 to July 28, 2014). A study was included in this analysis if it was: (1) a randomized controlled trial or non-randomized observational cohort study; (2) comparing the clinical outcomes between GA and IA with respect to the maximal incisal opening (MIO) and reankylosis; (3) with a follow-up period of at least 12 months. The methodological quality of the included studies was evaluated according to the Newcastle-Ottawa Scale Eight non-randomized observational cohort studies with 272 patients were included. All the statistical analyses were performed using the RevMan 5.3 and Stat 12. The pooled analysis showed no significant difference in the incidence of reankylosis between the IA group (13/120) and the GA group (29/163) (RR= 0.67, 95% CI=0.38 to 1.16; Z=1.43, p=0.15). The IA group showed a significantly larger MIO than the GA group (MD=1.96, 95% CI=0.21 to 3.72, Z=2.19, p=0.03, I2=0%). In conclusion, patients with TMJA could benefit more from IA than GA, with a larger MIO and a similar incidence of reankylosis. IA shows to be an adequate option in the treatment of TMJA based on the results of maximal incisal opening. PMID:26010224

  2. 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

  3. [Corion Interposition Arthroplasty after Post-Traumatic Metacarpophalangeal Cartilage Defects - Two Case Reports].

    PubMed

    Fatzer, L; Moron, M A; Sanchez, T

    2015-06-01

    We report on the long-term results of 2 patients after saw injury by restoration of metacarpophalangeal joint II with bone graft from the iliac crest and interposition arthroplasty of the corion. Clinical and radiological controls were performed in the 6(th) and 8(th) post-operative years, respectively. The DASH scores (11.6 and 18.3, respectively) and range of motion (60 and 70° respectively) were associated with no pain and satisfaction with the results of the operation for both patients. In summary, the reconstruction of selected cases of metacarpophalangeal joint defects with iliac crest and corium interposition arthroplasty is a good treatment option. PMID:25634526

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

    PubMed

    Roukis, Thomas S

    2010-01-01

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

  5. 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

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

    PubMed

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

    2013-01-01

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

  7. Computer-assisted gap equalization in total knee arthroplasty.

    PubMed

    Viskontas, Darius G; Skrinskas, Tomas V; Johnson, James A; King, Graham J; Winemaker, Mitchell J; Chess, David G

    2007-04-01

    This in vitro biomechanical study compared a conventional balancing technique in knee arthroplasty to a technique using computer assistance. The experimental technique used a soft tissue tensioner instrumented with computer-monitored load cells to quantify soft tissue tension. To assess outcome, a tibial load transducer measured medial and lateral compartment forces and tibial rotation. An electromagnetic tracking system quantified knee position under simulated muscle loading. The computer-assisted technique improved knee balance before insertion of components. However, once components were implanted, there was no difference in knee load balance between the 2 techniques. No correlation was shown between compartmental load balance and tibial rotation or mechanical axis misalignment. Although computer-assisted surgery may improve technical accuracy, further work is necessary to achieve an optimal final knee load balance. PMID:17400087

  8. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  13. Intraoral approach for arthroplasty for correction of TMJ ankylosis.

    PubMed

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

    2009-12-01

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

  14. Caveat Arthroplasty

    Microsoft Academic Search

    Muyibat A. Adelani; Daniel G. Stover; Jennifer L. Halpern; Herbert S. Schwartz; Ginger E. Holt

    2009-01-01

    Caveat arthroplasty is arthroplasty undertaken to treat a presumed nonneoplastic disorder, which is later determined to be secondary to an extraarticular tumor. We identified 6 patients who had caveat arthroplasty before referral to our orthopedic oncology center. Three patients had completed arthroplasties at an average of 29 weeks before discovery of a neoplasm. Three arthroplasties were aborted after a neoplasm

  15. Obliteration of Intercondylar Notch Mimicking Flexion-Extension Gap Imbalance in a Cruciate Retaining Total Knee Arthroplasty

    PubMed Central

    Gungor, Harun Resit; Kiter, Esat; Akkaya, Semih; Ok, Nusret; Yorukoglu, Cagdas

    2015-01-01

    Following total knee arthroplasty (TKA), the most frequent cause of extension deficit and limitation of range of motion in early postoperative period is related to improper tensioning of soft tissues and failure to balance extension and flexion gaps. If a cruciate retaining (CR) prosthesis is the planned implant, then attention should be given to balancing the posterior cruciate ligament (PCL), and any factor that alters this balance may also cause deterioration of knee balance in postoperative period. Here, we report on an unusual case referred from another hospital because of continuous pain and restriction of knee motion in early postoperative period following CR-designed TKA that was initially thought to be due to flexion-extension imbalance. However, during the revision procedure, extruded cement to the intercondylar notch was found to be both mechanically blocking terminal extension and limiting flexion by possible mechanism of irritation of the synovial nerve endings around the stretched anterior fibers of PCL during flexion. This case was successfully treated by removal of extruded cement from intercondylar notch to decompress PCL, polyethylene exchange, and secondary patellar resurfacing. PMID:26185697

  16. Gastric interposition following transhiatal esophagectomy: CT evaluation

    SciTech Connect

    Gross, B.H.; Agha, F.P.; Glazer, G.M.; Orringer, M.B.

    1985-04-01

    Transhiatal esophagectomy without thoracotomy (THE) but with gastric interposition results in less morbidity and mortality than standard transpleural esophagectomy with thoracotomy. Barium examination has been the primary radiographic study following THE for detecting postoperative complications. The authors reviewed computed tomography (CT) scans of 21 patients who had undergone THE and correlated CT appearance with clinical status and with findings of the barium studies. Local mediastinal recurrent neoplasm was detected by CT in seven patients; barium study within 2 weeks of the CT scan failed to detect tumor recurrence in three of these patients. CT is the modality of choice for detecting locally recurrent neoplasm and distant metastases following THE and may also be helpful in patients with postoperative mediastinal abscess. Normal mediastinal CT anatomy after esophagectomy is reviewed in order to warn against pitfalls in scan interpretation.

  17. Long-Term Results of Ileum Interposition for Ureteral Obstruction

    Microsoft Academic Search

    Frank J. H Verduyckt; John P. F. A Heesakkers; Frans M. J Debruyne

    2002-01-01

    Objective: To present the long-term results of ileum interposition in the ureter for uni- or bilateral ureteral obstruction.Patients and Methods: Between 1981 and 2000, a total of 22 patients received an ileal segment interposition as a substitution for the ureter, of whom 18 were available for analysis. The mean age was 54 years (range 29–73). Patients were followed for a

  18. [Jejunal pouch interposition and distal gastrectomy].

    PubMed

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

    1997-06-01

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

  19. Hip resurfacing arthroplasty

    PubMed Central

    2010-01-01

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

  20. [Problems of autologic incus interposition in cholesteatoma operations (author's transl)].

    PubMed

    Koch, U; Faude, J

    1979-01-01

    Our clinical study proves whether or not the warning is justified not to reimplantate autologic ossicula in cholesteatoma operations in order to avoid recidives. After interposition of the autologic incus in 18 patients we found cholesteatome recidives--originating from the incus--in two cases. According to histological studies, even the most careful preparation cannot avoid that some cells of the epithelium remain on the ossicula, from which a cholesteatoma recidive may develop. Clinical studies show rather low rates of recidives compared with the histological findings. Possibly remaining squamous epithelium cells in autologic ossicles need not always cause recidives. Clinical and histological studies lead to the demand that because of the possibility of cholesteatoma recidives autologic ossicula should not be reimplated in cholesteatoma operations. PMID:763048

  1. Total hip arthroplasty.

    PubMed Central

    Siopack, J S; Jergesen, H E

    1995-01-01

    Total hip arthroplasty, or surgical replacement of the hip joint with an artificial prosthesis, is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. In this review we briefly summarize the evolution of total hip arthroplasty, the design and development of prosthetic hip components, and the current clinical indications for this procedure. The possible complications of total hip arthroplasty, its clinical performance over time, and future directions in hip replacement surgery are also discussed. Images PMID:7725707

  2. Cervical Total Disc Arthroplasty

    PubMed Central

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

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

  3. Saphenous vein interposition as a salvage technique for complex vascular situations during renal transplantation.

    PubMed

    Oertl, A J; Jonas, D; Oremek, G M; Jones, J

    2007-01-01

    The shortage of donor organs for renal transplantation leads to the necessity of accepting organs with vascular disadvantages, such as venous difficulties (eg, shortness, disrupted vein after explantation) or arterial problems (eg, iatrogenic vascular accidents, arterial plaques, hemodynamically relevant polar arteries) and horseshoe kidneys. Consequently, such organs may not be considered for transplantation. Surgeons still have the ability to use such organs by saphenous vein interposition. This study focused on the frequency of vascular difficulties in 100 randomly selected kidney transplantations and their outcomes after arterial or venous saphenous vein interposition. PMID:17275492

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

    PubMed

    Santoro, Sergio; de Aquino, Caio G Gaspar

    2015-08-01

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

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

    PubMed

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

    2014-12-17

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

  6. A Product Machine Model for Anomaly Detection of Interposition Attacks on Cyber-Physical Systems

    Microsoft Academic Search

    Carlo Bellettini; Julian L. Rrushi

    2008-01-01

    In this paper we propose an anomaly intrusion detection model based on shuffle operation and product machines targeting persistent\\u000a interposition attacks on control systems. These at actuallyareundetectable by the most advanced system call monitors as they\\u000a issue no system calls and are stealthy enough to transfer control to hijacked library functions without letting their saved\\u000a instruction pointers get stored on

  7. Lid lengthening by sclera interposition for eyelid retraction in Graves' ophthalmopathy

    Microsoft Academic Search

    M P Mourits; L Koornneef

    1991-01-01

    The efficacy of scleral grafts for eyelid lengthening in patients with thyroid related upper and\\/or lower lid retraction was evaluated in 62 consecutive patients with Graves' ophthalmopathy who underwent lid surgery in the last 3.5 years. Seventy-eight upper and 30 lower lids were lengthened by scleral interposition. A good or acceptable result was achieved in 50% of all operated upper

  8. 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

  9. Ideal reconstruction after total gastrectomy by the interposition of a jejunal pouch considered by emptying time.

    PubMed

    Tono, Chiriro; Terashima, Masanori; Takagane, Akinori; Abe, Karoru

    2003-10-01

    To establish the ideal form of the pouch for jejunal pouch interposition reconstruction (JPI) after total gastrectomy, the postoperative gastrointestinal function and symptoms were investigated in comparison with jejunal interposition reconstruction (JI). A total of 20 patients who underwent curative surgery for gastric cancer were enrolled in this study. In the JI group (n = 9), an isoperistaltic jejunum about 40 cm in length was interposed between the esophagus and the duodenum. In the JPI group n = 11), a proximal pouch about 15 cm in length with a 10-cm conduit was also interposed between the esophagus and the duodenum. At follow-up 6 months postoperatively, food transit was evaluated using a radiolabeled semisolid test meal. The half-emptying time was 6.9 minutes in the JI group and 46 minutes in the JPI group. The reservoir function influenced the recovery of the patients' body weight and development of the serum total protein in the early postoperative period. An early half-emptying time caused dumping symptoms in JI group. In the JPI group, there were no dumping symptoms; however, extended food clearance of pouch causes postprandial symptoms such as reflux (1 patient), vomiting (2 patients), and discomfort (2 patients). In those patients with symptoms, half-emptying times were longer than 60 minutes. There was a statistically significant correlation between the pouch length and the half-emptying time of the gastric substitute in JPI group (p = 0.0039, r = 0.789). If we estimate that the appropriate half-emptying time is 20 to 60 minutes, correlation of the pouch length and the half-emptying time shows that the ideal pouch length is about 12-15 cm in JPI. In jejunal pouch interposition reconstruction after total gastrectomy, an adequate procedure leads to nutritional advantage and prevents postoperative symptoms. PMID:12925904

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

    PubMed

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

    2014-07-21

    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

  11. Sport after total hip arthroplasty

    Microsoft Academic Search

    L. Dubs; N. Gschwend; U. Munzinger

    1983-01-01

    Up to now, sporting activity after total hip arthroplasty has been limited or terminated completely because of the risk of failure. In the case of younger patients, it is desirable to know whether this attitude is justified. Consequently, an analysis has been made of 110 patients (all male, average age at the time of the operation 55 years, 42 bilateral).

  12. Reconstruction of a Severely Crushed Leg with Interpositional Vessel Grafts and Latissimus Dorsi Flap

    PubMed Central

    Park, Chan Woo; Hwang, Kyu Tae; Kim, Jeong Tae

    2012-01-01

    We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time. PMID:22872848

  13. Mycobacterium chelonae infection following a total knee arthroplasty

    Microsoft Academic Search

    Maya Pring; Donald G. Eckhoff

    1996-01-01

    Infection following total knee arthroplasty is a major cause of implant failure, with an incidence of infections between 1 and 12%. Although there have been no previously reported cases of infection with Mycobacterium chelonae following total knee arthroplasty, this mycobacterium appears to be a potential pathogen in arthroplasty. When infection following total knee arthroplasty is evident but standard cultures come

  14. 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

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

    PubMed Central

    2010-01-01

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

  16. 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

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

    SciTech Connect

    Sutton, R.; Sutton, H.; Ackery, D.M.; Freeman, N.V. (Southampton General Hospital (England))

    1989-09-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. 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

  20. Mini-incision for total hip arthroplasty

    Microsoft Academic Search

    John M Wright; Heber C Crockett; Sam Delgado; Stephen Lyman; Mike Madsen; Thomas P Sculco

    2004-01-01

    A group of 42 primary total hip arthroplasties performed through an abridged surgical incision (group 1) was prospectively compared to a cohort of 42 primary total hip arthroplasties performed through a standard surgical incision (group 2). The length of the incision was 8.8 ± 1.5 cm for group 1 and 23.0 ± 2.1 cm for group 2. The groups were

  1. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    ClinicalTrials.gov

    2012-05-16

    Revision Total Knee Arthroplasty Because of; Loosening; Instability; Impingement; or Other Reasons Accepted as Indications for TKA Exchange.; The Focus is to Determine the Precision of Joint Line Restoration in Navigated vs. Conventional Revision Total Knee Arthroplasty

  2. Polyethylene in knee arthroplasty: A review.

    PubMed

    Chakrabarty, Gautam; Vashishtha, Mayank; Leeder, Daniel

    2015-06-01

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

  3. The Kaiser Permanente Shoulder Arthroplasty Registry

    PubMed Central

    Ake, Christopher F; Burke, Mary F; Singh, Anshuman; Yian, Edward H; Paxton, Elizabeth W; Navarro, Ronald A

    2015-01-01

    Background and purpose Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. Patients and methods Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. Results During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. Interpretation Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases. PMID:25727949

  4. 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

  5. Gait Analysis of Patients with Resurfacing Hip Arthroplasty Compared with Hip Osteoarthritis and Standard Total Hip Arthroplasty

    Microsoft Academic Search

    Michael A. Mont; Thorsten M. Seyler; Phillip S. Ragland; Roland Starr; Jochen Erhart; Anil Bhave

    2007-01-01

    Patients with standard total hip arthroplasties may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips. In comparison, patients after resurfacing total hip arthroplasty appear to have a near-normal gait. The authors evaluated temporal-spatial parameters, hip kinematics, and kinetics in hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral standard total hip arthroplasties.

  6. Patellar Fracture Following Patellofemoral Arthroplasty.

    PubMed

    King, Alexander H; Engasser, William M; Sousa, Paul L; Arendt, Elizabeth A; Dahm, Diane L

    2015-07-01

    This study aims to report the incidence of patellar fracture after patellofemoral arthroplasty (PFA) and to determine associated factors as well as outcomes of patients with and without this complication. 77 knees in 59 patients with minimum two-year follow-up were included. Seven (9.1%) patients experienced a patellar fracture at a mean of 34 (range 16-64) months postoperatively. All were treated nonoperatively. Lower BMI (P = 0.03), change in patellar thickness (P < 0.001), amount of bone resected (P = 0.001), and larger trochlear component size (P = 0.01) were associated with a greater incidence of fracture. Fewer fractures occurred when the postoperative patellar height exceeded the preoperatively measured height. No statistically significant differences were found in outcome scores between groups at mean four-year follow-up. PMID:25737384

  7. Instability following total knee arthroplasty.

    PubMed

    Rodriguez-Merchan, E Carlos

    2011-10-01

    Background Knee prosthesis instability (KPI) is a frequent cause of failure of total knee arthroplasty. Moreover, the degree of constraint required to achieve immediate and long-term stability in total knee arthroplasty (TKA) is frequently debated. Questions This review aims to define the problem, analyze risk factors, and review strategies for prevention and treatment of KPI. Methods A PubMed (MEDLINE) search of the years 2000 to 2010 was performed using two key words: TKA and instability. One hundred and sixty-five initial articles were identified. The most important (17) articles as judged by the author were selected for this review. The main criteria for selection were that the articles addressed and provided solutions to the diagnosis and treatment of KPI. Results Patient-related risk factors predisposing to post-operative instability include deformity requiring a large surgical correction and aggressive ligament release, general or regional neuromuscular pathology, and hip or foot deformities. KPI can be prevented in most cases with appropriate selection of implants and good surgical technique. When ligament instability is anticipated post-operatively, the need for implants with a greater degree of constraint should be anticipated. In patients without significant varus or valgus malalignment and without significant flexion contracture, the posterior cruciate ligament (PCL) can be retained. However, the PCL should be sacrificed when deformity exists particularly in patients with rheumatoid arthritis, previous patellectomy, previous high tibial osteotomy or distal femoral osteotomy, and posttraumatic osteoarthritis with disruption of the PCL. In most cases, KPI requires revision surgery. Successful outcomes can only be obtained if the cause of KPI is identified and addressed. Conclusions Instability following TKA is a common cause of the need for revision. Typically, knees with deformity, rheumatoid arthritis, previous patellectomy or high tibial osteotomy, and posttraumatic arthritis carry higher risks of post-operative instability and are indications for more constrained TKA designs. Instability following TKA usually requires revision surgery which must address the cause of the instability for success. PMID:23024625

  8. Poor outcome of revised resurfacing hip arthroplasty

    PubMed Central

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

    2010-01-01

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

  9. Hepatic artery reconstruction with gonodal vein interposition: First case in patients receiving liver from the living donor

    PubMed Central

    Dinckan, Ayhan; Gurkan, Alihan; Ozkan, Omer; Dinc, Bulent; Yuksel, Yucel; Akgul, Nedim; Saracoglu, Mustafa; Colak, Taner

    2012-01-01

    Summary Background: Technical problems such as graft and vascular size are more common in living donor liver transplantation (LDLT) than in deceased donor liver transplantation. It is usually possible to get enough length of vessels on the graft, but the opposite situation is devastating. Finding the suitable vessel graft is life-saving in those situations. In this paper we present a case of gonodal vein interpositioning for hepatic artery reconstruction in an LDLT recipient. To the best of our knowledge, this is the first such case to be reported in the literature. Case Report: A 36-year-old man with cirrhosis secondary to hepatitis B underwent LDLT. Within minutes after completing the anastomosis, the artery was thrombosed. Disrupting the anastomosis showed subintimal dissection of the recipient right hepatic artery extending to the gastro-duodenal junction. A 4 cm segment of gonodal vein, which matched the diameter of the recipient hepatic artery, was used as a bridge. The patient’s postoperative recovery was excellent and Doppler ultrasonography demonstrated sufficient hepatic arterial blood flow. At long-term follow-up (18th months), the patient’s graft is still functioning. Conclusions: Gonodal vein interposition for hepatic artery reconstruction in living donor liver transplantation has not been previously reported. In light of the urgency of this situation, we believe it can be a life-saving reconstruction. PMID:23569527

  10. 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

  11. Management of complications after total shoulder arthroplasty.

    PubMed

    Eichinger, Josef K; Galvin, Joseph W

    2015-03-01

    The outcomes of total shoulder arthroplasty (TSA) for painful arthritis of the glenohumeral joint are excellent with significant improvement in pain and function. Increased use of total shoulder arthroplasty over the past decade has led to identification of common complications. Although the complication rate is low, accurate and timely diagnosis, appropriate management, and implementation of methods for prevention are critical to a successful long-term outcome. The most common complications include infection, glenoid and humeral component loosening, rotator cuff tear, periprosthetic fracture, and neurologic injury. The purpose of this review is to outline the best practices for diagnosing, managing, and preventing these complications. PMID:25672497

  12. 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

  13. 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

  14. Influence of Intraoperative Soft Tissue Balance on Postoperative Active Knee Extension in Posterior-Stabilized Total Knee Arthroplasty.

    PubMed

    Nagai, Kanto; Muratsu, Hirotsugu; Matsumoto, Tomoyuki; Takahara, Shunsuke; Kuroda, Ryosuke; Kurosaka, Masahiro

    2015-07-01

    We evaluated the influence of intraoperative soft tissue balance on postoperative active knee extension using Offset Repo-Tensor® among 73 varus osteoarthritic knees underwent primary posterior-stabilized total knee arthroplasty. The joint center gap between osteotomized surfaces and the component gap after femoral trial component placement were measured using a joint distraction force of 40lb. The active knee extension angle was measured 4weeks after surgery. The postoperative extension angle was not correlated with the joint center gap at 0°, but positively correlated with the component gap at 0°, and the joint looseness at 0° which was calculated by subtracting insert thickness from the component gap. Thus, intraoperative soft tissue measurement with femoral trial component placement would be useful to predict the postoperative knee extension angle. PMID:25697891

  15. 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

  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. Stemless shoulder arthroplasty: a literature review

    PubMed Central

    PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

    2015-01-01

    The design of humeral implants for shoulder arthroplasty has evolved over the years. The new-generation modular shoulder prostheses have an anatomical humeral stem that replicates the three-dimensional parameters of the proximal humerus. An anatomical reconstruction is the best way to restore stability and mobility of the prosthetic shoulder and improve implant durability. However, a perfect anatomical match is not always possible in, for example, patients with post-traumatic osteoarthritis of the shoulder and deformities in the metaphyseal region. To avoid stem-related complications while retaining the advantages of the fourth generation of shoulder implants, different stemless implants have been developed. The stemless shoulder prosthesis is a new concept in shoulder arthroplasty. The authors review the indications, surgical technique, clinical and radiological midterm results, and complications of these humeral implants.

  18. Unicompartmental knee arthroplasty for lateral gonarthrosis

    Microsoft Academic Search

    Toshihiro Ohdera; Junichi Tokunaga; Akira Kobayashi

    2001-01-01

    Thirty-eight lateral compartment arthroplasties were performed in 22 years. Eighteen joints in 17 patients with an average age of 64.5 years were evaluated with minimum 5-year follow-up. Using the Hospital for Special Surgery knee score, 16 of 18 joints had satisfactory results in terms of function and pain relief. The average preoperative alignment on standing was 14.9° of valgus angulation,

  19. Three cases of pseudogout complicated with unicondylar knee arthroplasty

    Microsoft Academic Search

    Hirokazu Kobayashi; Shaw Akizuki; Tsutomu Takizawa; Yukihiro Yasukawa; Jyun Kitahara

    2002-01-01

    Pseudogout is an uncommon complication of arthroplasty, so it is important to distinguish pseudogout from infection. We experienced three patients with the acute onset of pseudogout after unicondylar knee arthroplasty (UKA). Treatment with nonsteroidal anti-inflammatory drugs (NSAID) and cooling improved the symptoms of all three patients, and there have been no further episodes. Because there is a large area uncovered

  20. MBARS: Mini Bone Attached Robotic System for Joint Arthroplasty

    Microsoft Academic Search

    Alon Wolf; Branislav Jaramaz

    2006-01-01

    A mini bone attached robotic system (MBARS) was developed for shaping of the bone cavity in joint arthroplasty. While the system is designed for a general use in joint replacement procedures, the initial implementation was for patellofemoral arthroplasty (PFA) procedure. The current application is image-based, with the plans to develop an image-free approach in which all data collection and planning

  1. Improvement of voluntary quadriceps muscle activation after total knee arthroplasty

    Microsoft Academic Search

    Alexander Berth; Dietmar Urbach; Friedemann Awiszus

    2002-01-01

    Berth A, Urbach D, Awiszus F. Improvement of voluntary quadriceps muscle activation after total knee arthroplasty. Arch Phys Med Rehabil 2002;83:1432-6. Objective: To evaluate the maximal voluntary contraction (MVC) force and the voluntary activation of the quadriceps femoris muscle in patients with knee osteoarthritis (OA) before and after total knee arthroplasty (TKA). Design: A prospective intervention study. Setting: University hospital

  2. Predicting quality-of-life outcomes following total joint arthroplasty

    Microsoft Academic Search

    Francis X. McGuigan; William J. Hozack; Lisa Moriarty; Kenneth Eng; Richard H. Rothman

    1995-01-01

    A group of 114 patients undergoing total hip and knee arthroplasty were evaluated to assess the effect of total joint arthroplasty on quality of life, as measured by the SF-36 Health Status Questionnaire, and to determine the predictive relationship between preoperative and postoperative scores. A highly significant improvement was seen comparing preoperative with postoperative scores at 2 years for physical

  3. Cervical Kinematics After Fusion and Bryan Disc Arthroplasty

    Microsoft Academic Search

    Rick C. Sasso; Natalie M. Best

    2008-01-01

    Introduction: Disc arthroplasty has been shown to provide short- term clinical results that are comparable with those attained with traditional anterior cervical discectomy and fusion. One proposed benefit of arthroplasty is the ability to prevent or delay adjacent level operations by retaining motion at the target level and eliminating abnormal adjacent activity. This paper com- pares motion parameters for single-level

  4. 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

  5. Periprosthetic Fractures Following Total Knee Arthroplasty

    PubMed Central

    Kim, Nam Ki

    2015-01-01

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

  6. Periprosthetic fractures around total knee arthroplasty

    PubMed Central

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

    2012-01-01

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

  7. Arthroplasty for fifth carpometacarpal joint arthritis.

    PubMed

    Yang, Yong; Scheker, Luis R; Kumar, Kannan K

    2015-05-01

    Background?Fifth-carpometacarpal (CMC)-joint fractures and dislocations can produce carpometacarpal joint arthritis. The purpose of this study was to evaluate the radiographic and clinical outcomes of arthroplasty for fifth carpometacarpal joint arthritis. Material and Methods?A series of six patients who had symptomatic advanced fifth-CMC arthritis and had failed to respond to conservative treatment. All patients underwent Dupert's technique of fifth-CMC arthroplasty with a mean follow-up of 17.6 months. Results were reviewed clinically and radiographically. Results?Union between the fourth and fifth metacarpals was observed at an average of 6.2 weeks after surgery. Grip strength improved. Range of motion (ROM) of the fifth metacarpophalangeal (MCP) joint and the fifth metacarpal height remained unchanged. Visual analog scale (VAS) results improved significantly. Conclusion?Despite the medium-term follow-up and small number of patients, our results suggest fifth-CMC arthroplasty with arthrodesis of the fourth and fifth metacarpal bases may be a reliable procedure for fifth-CMC arthritis. PMID:25945295

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  10. Orthopaedic crossfire--can we justify unicondylar arthroplasty as a temporizing procedure? in opposition.

    PubMed

    Sculco, Thomas P

    2002-06-01

    The indications for unicompartmental arthroplasty are quite specific. Overall, there should be involvement of 1 tibiofemoral compartment, mild malalignment, and ligamentous stability. In a review of 250 osteoarthritic knees, these pathologic findings were present in 19 patients (8%). Technique, despite improvement in instrumentation, still is more demanding than tricompartmental knee arthroplasty, and failure to achieve an optimal arthroplasty occurs more frequently. In the literature, long-term results with unicompartmental arthroplasty have been inferior to tricompartmental arthroplasty. The concept that unicompartmental arthroplasty is a temporizing procedure is not a valid one in that the patient has to undergo another arthroplasty with all the risks of revision arthroplasty surgery. Many of these revision procedures require bone grafting or component augmentation. Tibial osteotomy remains the procedure of choice in younger, active patients with unicompartmental arthritis (in highly selected patients), and tricompartmental arthroplasty is preferred in older, lower demand patients. PMID:12068406

  11. 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

  12. Unusual cases of pigmented villonodular synovitis after arthroplasty.

    PubMed

    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 2(th) year after hip arthroplasty with bone cement prosthesis. The specimen was brown and like usual PVNS in tissue. The third case had PVNS in the 8(th) after arthroplasty with human bone prosthesis because of the recurrence of PVNS. The proliferated synovium became black from brown. There was brown and many groups black pigment in the tissue. The fourth one had PVNS in the 4(th) year after knee arthroplasty with polyethylene prosthesis. The specimen was yellow. There was no pigment in the tissue but multinucleated giant cells with unstained foreign body. The fifth patient had PVNS in the 10(th) month after the left hip arthroplasty with metal prosthesis. The macroscopy was yellow. There were hemosiderin particles in the tissue but black metal particles. This indicates that arthroplasty with prosthesis could cause some new disease or PVNS had new etiology with different pathological show. PMID:24955198

  13. Hip arthroplasty in failed intertrochanteric fractures in elderly

    PubMed Central

    Pachore, Javahir A; Shah, Vikram I; Sheth, Ashish N; Shah, Kalpesh P; Marothi, Dhiraj P; Puri, Rahul

    2013-01-01

    Background: Failed intertrochanteric fractures in elderly patients are surgical challenge with limited options. Hip arthroplasty is a good salvage procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. Materials and Methods: 30 patients of failed intertrochanteric fractures where hip arthroplasty was done between May 2008 and December 2011 were included in study. 13 were males and 17 were females with average age of 67.3 years. There were 2 cemented bipolar arthroplasties, 19 uncemented bipolar, 4 cemented total hip arthroplasty and 5 uncemented total hip arthroplasties. 16 patients had a trochanteric nonunion, which was treated by tension band principles. Total hip was considered where there was acetabular damage due to the penetration of implant. Results: The average followup was 20 months (range 6-48 months). Patients were followed up from 6 to 48 months with average followup of 20 months. None of the patients were lost to followup. There was no dislocation. All patients were ambulatory at the final followup. Conclusion: A predictable functional outcome can be achieved by hip arthroplasty in elderly patients with failed intertrochanteric fractures. Though technically demanding, properly performed hip arthroplasty can be a good salvage option for this patient group. PMID:24379462

  14. Optimizing perioperative management of total joint arthroplasty.

    PubMed

    Johnson, Rebecca L; Kopp, Sandra L

    2014-12-01

    Clinical pathways for total joint arthroplasty have been shown to reduce costs and significantly impact perioperative outcomes mainly through reducing provider variability. Effective clinical pathways link evidence to individual practice and balance costs with local experience, outcomes, and access to resources for responsible perioperative management. Common components of clinical pathways with major impact on perioperative outcomes are: 1) implementing pathways designed to include multimodal analgesia with regional anesthesia, 2) use of tranexamic acid to reduce blood loss, and 3) preconditioning followed by participation in early, accelerated rehabilitation programs to prevent postoperative complications related to immobility. PMID:25453667

  15. 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.

  16. 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

  17. Shoulder arthroplasty in patients with osteoarthritis and dysplastic glenoid morphology.

    PubMed

    Edwards, T Bradley; Boulahia, Aziz; Kempf, Jean-François; Boileau, Pascal; Némoz, Chantal; Walch, Gilles

    2004-01-01

    Fifteen shoulders with primary osteoarthritis and dysplastic glenoid morphology underwent shoulder arthroplasty (eleven total shoulder arthroplasties and four hemiarthroplasties). Patients were evaluated at a mean of 37 months after replacement with clinical examination, Constant score, subjective patient opinion, and radiographic examination. One glenoid component was loose, necessitating removal; the remainder of the prostheses were in place at latest follow-up. Significant improvement was observed in Constant score (32 points preoperatively vs 71 points postoperatively) and active mobility (anterior elevation, 89 degrees preoperatively vs 146 degrees postoperatively; external rotation, 7 degrees preoperatively vs 45 degrees postoperatively) after arthroplasty. This study demonstrates that the rare scenario of osteoarthritis coupled with a dysplastic glenoid can be treated successfully with shoulder arthroplasty. PMID:14735065

  18. Complications and surgical revision for failed disc arthroplasty

    Microsoft Academic Search

    John P. Kostuik

    2004-01-01

    This review will outline the indications and options for revision of failed disc arthroplasty. Such indications may include implant loosening, malposition, displacement, early wear, and infection. Each indication will likely require different preoperative planning, testing, and strategies.

  19. Wound problems in total knee arthroplasty.

    PubMed

    Vince, Kelly G; Abdeen, Ayesha

    2006-11-01

    Wound problems can often be prevented with careful planning. When transverse incisions are used for knee surgery many years prior to any anticipated knee arthroplasty, no major problems are typically encountered with a conventional, anterior longitudinal incision. We recommend lateral incisions (eg, after a previous lateral tibial plateau fracture) be reused for TKA. When confronted with multiple previous incisions, surgeons would best use the most recently healed or the most lateral. We prefer soft tissue reconstruction with expanders or a gastrocnemius flap if there are multiple incisions, if the skin and scar tissue are adherent to underlying tissue, or if wound healing seems questionable. Deep infection must be determined by aspiration. When present, we believe treatment must include irrigation, débridement, polyethylene exchange if acute, and resection arthroplasty if chronic. Poor wound healing is a potentially devastating complication that may result in multiple reconstructive procedures and even amputation. Early recognition followed by expeditious débridement and soft tissue reconstruction should be used for managing wound complications after TKA. PMID:17079990

  20. Early Failure of Articular Surface Replacement XL Total Hip Arthroplasty

    Microsoft Academic Search

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

    2011-01-01

    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.

  1. Comprehensive gait analysis in posterior-stabilized knee arthroplasty

    Microsoft Academic Search

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

    1996-01-01

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

  2. Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis

    PubMed Central

    Voorde, Pia C ten; Rasmussen, Jeppe V; Olsen, Bo S; Brorson, Stig

    2015-01-01

    Background and purpose There is no consensus on which type of shoulder prosthesis should be used in patients with rheumatoid arthritis (RA). We describe patients with RA who were treated with shoulder replacement, regarding patient-reported outcome, prosthesis survival, and causes of revision, and we compare outcome after resurfacing hemi-arthroplasty (RHA) and stemmed hemi-arthroplasty (SHA). Patients and methods We used data from the national Danish Shoulder Arthroplasty Registry and included patients with RA who underwent shoulder arthroplasty in Denmark between 2006 and 2010. Patient-reported outcome was obtained 1-year postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), and rates of revision were calculated by checking revisions reported until December 2011. The patient-reported outcome of RHA was compared to that of SHA using regression analysis with adjustment for age, sex, and previous surgery. Results During the study period, 167 patients underwent shoulder arthroplasty because of rheumatoid arthritis, 80 (48%) of whom received RHA and 34 (26%) of whom received SHA. 16 patients were treated with total stemmed shoulder arthroplasty (TSA), and 24 were treated with reverse shoulder arthroplasty (rTSA). 130 patients returned a completed questionnaire, and the total mean WOOS score was 63. The cumulative 5-year revision rate was 7%. Most revisions occurred after RHA, with a revision rate of 14%. Mean WOOS score was similar for RHA and for SHA. Interpretation This study shows that shoulder arthroplasty, regardless of design, is a good option in terms of reducing pain and improving function in RA patients. The high revision rate in the RHA group suggests that other designs may offer better implant survival. However, this should be confirmed in larger studies. PMID:25673155

  3. Utility of polymer cerclage cables in revision shoulder arthroplasty.

    PubMed

    Edwards, T Bradley; Stuart, Kyle D; Trappey, George J; O'Connor, Daniel P; Sarin, Vineet K

    2011-04-01

    Revision shoulder arthroplasty often requires humeral osteotomy for stem extraction or is complicated by periprosthetic fracture. In these situations, various modes of fixation are used, including cerclage wires, cable plates, and allograft strut augmentation. The use of metal wires and cables, however, has been associated with soft tissue irritation, sharps injuries, and accelerated wear of joint arthroplasty bearing surfaces. As an alternative to traditional metal cables, the SuperCable (Kinamed Inc, Camarillo, California) contains braided ultra-high molecular-weight polyethylene fibers surrounding a nylon core. To date, no studies have examined the use of nonmetallic cerclage cables in shoulder arthroplasty.A retrospective review was performed of 11 patients who underwent shoulder arthroplasty for which nonmetallic cerclage cables were used. Clinical and radiographic data were examined regarding patient age, procedure performed, indication for cerclage cabling, time to healing of osteotomy or fracture, and any complications associated with the use of these cerclage cables. Minimum follow-up was 1 year. Ten patients underwent reverse total shoulder arthroplasty, and 1 patient underwent revision unconstrained total shoulder arthroplasty. Mean follow-up was 20.5 months. Ten patients required humeral osteotomy for stem or cement removal. Allograft augmentation was performed in 7 patients. Mean time to healing was 3.2 months. No patients experienced loosening or migration of hardware or allograft, and no complications directly related to the use of nonmetallic cerclage cables were identified. PMID:21469627

  4. Hybrid Total Knee Arthroplasty Revisited: Midterm Followup of Hybrid versus Cemented Fixation in Total Knee Arthroplasty

    PubMed Central

    Pelt, Christopher E.; Gililland, Jeremy M.; Doble, Justin; Stronach, Benjamin M.; Peters, Christopher L.

    2013-01-01

    The optimal method of fixation in total knee arthroplasty is still debated. Hybrid total knee arthroplasty (TKA), with cemented tibial and cementless femoral components, is a proposed method of fixation to improve outcomes. Although several studies have shown favorable outcomes, there is still lack of consensus in the literature. We hypothesized that hybrid TKA yields similar clinical, radiographic, and survivorship results compared to fully cemented TKA. The clinical and radiographic outcomes of 304 cruciate retaining TKAs with minimum two-year followup, including 193 hybrid (mean followup of 4.1 years) and fully cemented TKAs (mean followup of 3.2 years) were evaluated. Knee society scores were similar between the two groups. The total number of femoral radiolucencies was also similar between the two groups, while a greater number of femoral Zone 4 radiolucencies were seen in the cemented group (9% versus 1.6%, P = 0.005). The hybrid group demonstrated a 99.2% survival rate of the femoral component out to seven years for aseptic loosening. No significant difference in survivorship was seen between the groups for all cause or aseptic failure at seven years. We conclude that hybrid fixation leads to similar intermediate-term outcomes as fully cemented components and remains a viable option in total knee arthroplasty. PMID:24224179

  5. Health and quality of life before and after hip or knee arthroplasty

    Microsoft Academic Search

    Pekka Rissanen; Seppo Aro; Pär Slätis; Harri Sintonen; Pekka Paavolainen

    1995-01-01

    The impact of hip and knee arthroplasty based on the patients' own evaluations of their health, quality of life, and physical ability was assessed using a cross-sectional study design. The eligibility criteria were a diagnosis of primary arthrosis, primary operation, and total joint arthroplasty. Preoperative hip and knee patient groups were compared with similar groups who underwent arthroplasty 2 or

  6. 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

  7. Acute pasteurella multocida in total knee arthroplasty.

    PubMed

    Stiehl, James B; Sterkin, Lawrence A; Brummitt, Charles F

    2004-02-01

    Pasturella multocida is a rare cause of joint sepsis in total joint arthroplasty, and all case reports have identified a distant source of infection from an animal bite that has caused potential hematogenous seeding of the prosthesis. We report a case in which no potential distal wound source was found and the only likely etiology was local wound seeding from an old injury. In that injury, a saddle stirrup had caused a severe traumatic soft tissue injury as a horse had rolled over the patient. We draw attention to the fact that this particular bacteria is virulent in producing septic contamination of a total joint prosthesis, and aggressive treatment is indicated when such infection is identified. PMID:14973872

  8. Total hip arthroplasty after rotational acetabular osteotomy.

    PubMed

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

    2015-03-01

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

  9. Simultaneous Bilateral Anterior Approach Total Hip Arthroplasty.

    PubMed

    Gondusky, Joseph S; Pinkos, Kevin A; Choi, Leera; Patel, Jay J; Barnett, Steven; Gorab, Robert S

    2015-07-01

    Simultaneous bilateral total hip arthroplasty (THA) has been performed successfully, with good outcomes and low complication rates reported. Most published studies on the topic used anterolateral or posterior surgical approaches. The anterior approach is performed under live fluoroscopy with the patient supine, obviating the need for patient repositioning during bilateral surgery. The authors report their experience with simultaneous bilateral anterior approach total hip arthroplasty. The authors retrospectively reviewed data for 75 patients (150 hips). Mean follow-up was 26 months (range, 5-60 months). Mean patient age was 59 years and the majority were American Society of Anesthesiology class 2 (range, 1-3). Mean total surgical time was 144 minutes (72 minutes per hip). Mean blood loss was 565 mL. Mean hospital length of stay was 2.75 days (range, 1-4 days). Ninety-six percent of patients were able to ambulate on postoperative day 1. Sixty-eight percent of patients were discharged to home. Mean Harris Hip Score improved from 50 to 97. All patients noted a return to preoperative level of activity or higher. Complications included 1 atraumatic minimally displaced trochanteric fracture occurring 2 weeks postoperatively, 1 pulmonary embolism on postoperative day 3 treated without sequelae, 1 episode of postoperative atrial fibrillation, and 4 minor local wound complications. No readmission, infection, nerve palsy, dislocation, reoperation, or death occurred. Anterior approach THA has the advantage of a single supine position for bilateral simultaneous surgery and the current study supports its use in appropriate patients. [Orthopedics. 2015; 38(7):e611-e615.]. PMID:26186324

  10. The role of the popliteus tendon in total knee arthroplasty: a cadaveric study

    PubMed Central

    COTTINO, UMBERTO; BRUZZONE, MATTEO; ROSSO, FEDERICA; DETTONI, FEDERICO; BONASIA, DAVIDE EDOARDO; ROSSI, ROBERTO

    2015-01-01

    Purpose this study was conducted to investigate the influence of the popliteus tendon (PT) on the static stability of total knee arthroplasty (TKA). Methods twenty knees were used. In 10 right knees, a cruciate-retaining (CR) TKA trial prosthesis was implanted; in the other ten knees (left knees), the posterior cruciate ligament was cut and a posterior substitution (PS) TKA trial prosthesis was implanted. Lamina spreaders were set at 100 N of tension, one on the medial and one on the lateral articular space. Gaps were then measured with a caliper before and after PT sectioning. Results the correlation between femoral dimensions and popliteus insertion distance from articular surfaces was measured with the Pearson correlation index and considered significant. In the CR-TKA group, medial and lateral gap measurements showed a significant increase after PT sectioning both in flexion and in extension. In the PS-TKA group, lateral gap measurements showed a significant increase after PT sectioning both in flexion and in extension, while the medial gap measurements increased significantly only in flexion. Conclusions PT sectioning destabilized both the lateral and the medial aspects of the knee. A greater effect was observed in the lateral compartment. The most statistically reliable effect was observed with the knee in flexion. In addition, we observed that preserving the PCL does not prevent lateral gap opening after PT sectioning. Clinical relevance PT should always be preserved when performing a TKA, because its resection can affect gap balancing, in flexion and in extension. Type of study controlled laboratory study.

  11. A review of ceramic bearing materials in total joint arthroplasty.

    PubMed

    Bal, B S; Garino, J; Ries, M; Rahaman, M N

    2007-01-01

    Bearings made of ceramics have ultra-low wear properties that make them suitable for total hip arthroplasty (THA) and total knee arthroplasty (TKA). When compared to cobalt chrome (CoCr)-on-polyethylene (PE) articulations, ceramics offer drastic reductions in bearing wear rates. Lower wear rates result in fewer wear particles produced by the articulating surfaces. In theory, this should reduce the risk of periprosthetic osteolysis and premature implant loosening, thereby contributing to the longevity of total joints. In addition to ceramics, other alternative bearing couples, such as highly cross-linked PE (XLPE) and metal-on-metal also offer less wear than CoCr-on-PE articulations in total joint arthroplasty. Alumina and zirconia ceramics are familiar to orthopaedic surgeons since both materials have been used in total joints for several decades. While not new in Europe, alumina-on-alumina ceramic total hips have only recently become available for widespread use in the United States from various orthopaedic implant manufacturers. As the search for the ideal total joint bearing material continues, composite materials of existing ceramics, metal-on-ceramic articulations, and new ceramic technologies will offer more choices to the arthroplasty surgeon. The objective of this paper is to present an overview of material properties, clinical applications, evolution, and limitations of ceramic materials that are of interest to the arthroplasty surgeon. PMID:19197839

  12. 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. PMID:25745573

  13. Revision reverse shoulder arthroplasty in failed shoulder arthroplasties for rotator cuff deficiency

    PubMed Central

    RANDELLI, PIETRO; RANDELLI, FILIPPO; COMPAGNONI, RICCARDO; CABITZA, PAOLO; RAGONE, VINCENZA; PULICI, LUCA; BANFI, GIUSEPPE

    2015-01-01

    Purpose the aim of this systematic literature review is to report clinical outcomes of reverse shoulder arthroplasty (RSA) used as a revision surgery following failure of the primary implant due to rotator cuff insufficiency. Methods a systematic review was performed using the following key words: revision, shoulder, rotator cuff deficiency, outcome assessment, treatment outcome, complications. Studies eligible for inclusion in the review were clinical trials investigating patients in whom a primary shoulder arthroplasty implant with an incompetent rotator cuff was replaced with a reverse shoulder prosthesis. Results nine articles were identified and further reviewed. The results refer to a total of 226 shoulders that were treated with RSA as revision surgery. The patients in the studies had a mean age ranging from 64 to 72 years and the longest follow-up was 3.8 years. Improvements in function and reduction of pain were shown by many studies, but the mean Constant score ranged from 44.2 to 56. High complication rates (of up to 62%) were recorded, and a mean reoperation rate of 27.5%. Conclusions RSA as revision surgery for patients with rotator cuff deficiency is a valid option, and often the only solution available, but it should be limited to elderly patients with poor function and severe pain. Level of evidence level IV, systematic review of level I–IV studies. PMID:26151037

  14. Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project

    PubMed Central

    2013-01-01

    Background and purpose Total elbow replacement (TER) is used in the treatment of inflammatory arthropathy, osteoarthritis, and posttraumatic arthrosis, or as the primary management for distal humeral fractures. We determined the annual incidence of TER over an 18-year period. We also examined the effect of surgeon volume on implant survivorship and the rate of systemic and joint-specific complications. Methodology We examined a national arthroplasty register and used linkage with national hospital episode statistics, and population and mortality data to determine the incidence of complications and implant survivorship. Results There were 1,146 primary TER procedures (incidence: 1.4 per 105 population per year). The peak incidence was seen in the eighth decade and TER was most often performed in females (F:M ratio = 2.9:1). The primary indications for surgery were inflammatory arthropathy (79%), osteoarthritis (9%), and trauma (12%). The incidence of TER fell over the period (r = –0.49; p = 0.037). This may be due to a fall in the number of procedures performed for inflammatory arthropathy (p < 0.001). The overall 10-year survivorship was 90%. Implant survival was better if the surgeon performed more than 10 cases per year. Interpretation The prevalence of TER has fallen over 18 years, and implant survival rates are better in surgeons who perform more than 10 cases per year. A strong argument can be made for a managed clinic network for total elbow arthroplasty. PMID:23485072

  15. 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

  16. Acetabular blood flow during total hip arthroplasty

    PubMed Central

    ElMaraghy, Amr W.; Schemitsch, Emil H.; Waddell, James P.

    2000-01-01

    Objective To determine the immediate effect of reaming and insertion of the acetabular component with and without cement on periacetabular blood flow during primary total hip arthroplasty (THA). Design A clinical experimental study. Setting A tertiary referral and teaching hospital in Toronto. Patients Sixteen patients (9 men, 7 women) ranging in age from 30 to 78 years and suffering from arthritis. Intervention Elective primary THA with a cemented (8 patients) and noncemented (8 patients) acetabular component. All procedures were done by a single surgeon who used a posterior approach. Main outcome measure Acetabular bone blood-flow measurements made with a laser Doppler flowmeter before reaming, after reaming and after insertion of the acetabular prosthesis. Results Acetabular blood flow after prosthesis insertion was decreased by 52% in the noncemented group (p < 0.001) and 59% in the cemented group (p < 0.001) compared with baseline (prereaming) values. Conclusion The significance of these changes in periacetabular bone blood flow during THA may relate to the extent of bony ingrowth, periprosthetic remodelling and ultimately the incidence of implant failure because of aseptic loosening. PMID:10851413

  17. Emerging technologies in arthroplasty: additive manufacturing.

    PubMed

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

    2014-06-01

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

  18. 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

  19. 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

  20. The association between metal allergy, total knee arthroplasty, and revision

    PubMed Central

    Münch, Henrik J; Jacobsen, Stig S; Olesen, Jens T; Menné, Torkil; Søballe, Kjeld; Johansen, Jeanne D

    2015-01-01

    Background and purpose It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty. Patients and methods The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020). Results 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery. Interpretation While we could not confirm that a positive patch test reaction to common metals is associated with complications and revision surgery after knee arthroplasty, metal allergy may be a contributor to the multifactorial pathogenesis of implant failure in some cases. In cases with multiple revisions, cobalt and chromium allergies appear to be more frequent. PMID:25582229

  1. Surgical navigation for total knee arthroplasty: A perspective

    Microsoft Academic Search

    Robert A. Siston; Nicholas J. Giori; Stuart B. Goodman; Scott L. Delp

    2007-01-01

    A new generation of surgical tools, known as surgical navigation systems, has been developed to help surgeons install implants more accurately and reproducibly. Navigation systems also record quantitative information such as joint range of motion, laxity, and kinematics intra-operatively. This article reviews the history of surgical navigation for total knee arthroplasty, the biomechanical principles associated with this technology, and the

  2. Total elbow arthroplasty in primary osteoarthritis of the elbow

    Microsoft Academic Search

    Tomasz K. W. Kozak; Robert A. Adams; Bernard F. Morrey

    1998-01-01

    Primary osteoarthritis of the elbow is an infrequent condition typically managed by some form of debridement. There is no comment in the literature regarding prosthetic replacement for this condition. We report 5 patients (mean age, 68), with a minimum assessment of 3 years (range, 37–125 years) after total elbow arthroplasty. Complications in 4 patients included subluxation, fracture of a humeral

  3. MBARS: mini bone-attached robotic system for joint arthroplasty

    Microsoft Academic Search

    Alon Wolf; Branislav Jaramaz; Brad Lisien; Anthony DiGioia

    2005-01-01

    A report on a new active, miniature bone-attached, robotic system including its design, high level and low level control, is given together with a description of the system implementation and first experimental use. The system is capable of preparing the bone cavity for an implant during joint arthroplasty procedures. Without loss of generality, the report describes the implementation of the

  4. The association between metal allergy, total knee arthroplasty, and revision.

    PubMed

    Münch, Henrik J; Jacobsen, Stig S; Olesen, Jens T; Menné, Torkil; Søballe, Kjeld; Johansen, Jeanne D; Thyssen, Jacob P

    2015-06-01

    Background and purpose - It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty. Patients and methods - The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020). Results - 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery. Interpretation - While we could not confirm that a positive patch test reaction to common metals is associated with complications and revision surgery after knee arthroplasty, metal allergy may be a contributor to the multifactorial pathogenesis of implant failure in some cases. In cases with multiple revisions, cobalt and chromium allergies appear to be more frequent. PMID:25582229

  5. 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

  6. Long-term results of the GSB III elbow arthroplasty

    Microsoft Academic Search

    N. Gschwend; N. H. Scheier; A. R. Baehler

    1999-01-01

    since more young patients undergo joint replacement and revision surgery, particularly with the exchange of a pros- thesis, has many technical problems with a reduced pros- pect of success. Replacement arthroplasty of the elbow is not a common operation. The number has increased in the last ten years, and the results are improving, but the percentage of compli- cations and

  7. Fatal pulmonary embolism following shoulder arthroplasty: a case report

    Microsoft Academic Search

    Thayur R Madhusudhan; Sanath K Shetty; Savitha Madhusudhan; Amit Sinha

    2009-01-01

    INTRODUCTION: Fatal pulmonary embolism following a shoulder joint replacement is a rare event. The exact prevalence of shoulder arthroplasties is not clear. Unlike hip and knee joint replacements where some form of thromboprophylaxis is routinely prescribed, no such guidelines and practice exist for shoulder replacements. Other case reports have confirmed fatal and non-fatal pulmonary embolisms following shoulder replacements, but particular

  8. Smart instrumentation for determination of ligament stiffness and ligament balance in total knee arthroplasty.

    PubMed

    Hasenkamp, W; Villard, J; Delaloye, J R; Arami, A; Bertsch, A; Jolles, B M; Aminian, K; Renaud, P

    2014-06-01

    Ligament balance is an important and subjective task performed during total knee arthroplasty (TKA) procedure. For this reason, it is desirable to develop instruments to quantitatively assess the soft-tissue balance since excessive imbalance can accelerate prosthesis wear and lead to early surgical revision. The instrumented distractor proposed in this study can assist surgeons on performing ligament balance by measuring the distraction gap and applied load. Also the device allows the determination of the ligament stiffness which can contribute a better understanding of the intrinsic mechanical behavior of the knee joint. Instrumentation of the device involved the use of hall-sensors for measuring the distractor displacement and strain gauges to transduce the force. The sensors were calibrated and tested to demonstrate their suitability for surgical use. Results show the distraction gap can be measured reliably with 0.1mm accuracy and the distractive loads could be assessed with an accuracy in the range of 4N. These characteristics are consistent with those have been proposed, in this work, for a device that could assist on performing ligament balance while permitting surgeons evaluation based on his experience. Preliminary results from in vitro tests were in accordance with expected stiffness values for medial collateral ligament (MCL) and lateral collateral ligament (LCL). PMID:24405737

  9. Early catastrophic failure of Birmingham acetabular dysplasia cup in revision arthroplasty: a case report

    PubMed Central

    Port, Andrew

    2009-01-01

    Introduction Revision acetabulum arthroplasty is one of the common procedures, which has been on the rise recently. Many implants are available in the market with variable results. Aseptic loosening is the most common indication for revision acetabulum arthroplasty. Birmingham dysplasia cup has been used occasionally in these complex procedures. We know that these implants have provided good results in resurfacing dysplastic hips with bone loss. Literature review failed to answer whether these implants were as effective in revision acetabulum arthroplasty. Case presentation We herby, present a case of revision acetabulum arthroplasty performed with Birmingham dysplasia acetabular cup, which unfortunately failed within a period of eight months. Surgical technique appeared to be adequate. On further analysis, significant differences were identified between dysplastic hips with bone loss and revision hips with bone loss. Conclusion Therefore results obtained with dysplasia cups in resurfacing dysplastic hips does not seem to be applicable to revision hip arthroplasty. Hence these cups should be restricted to primary arthroplasty. PMID:19830096

  10. 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

  11. Kinematically versus mechanically aligned total knee arthroplasty.

    PubMed

    Dossett, H Gene; Swartz, George J; Estrada, Nicolette A; LeFevre, George W; Kwasman, Bertram G

    2012-02-01

    The purpose of this study was to compare 2 alignment methods for total knee arthroplasty (TKA): kinematic alignment with the use of patient-specific guides and mechanical alignment with conventional instruments. A randomized, controlled trial of 41 kinematically aligned and 41 mechanically aligned patients was conducted with the patient, radiographic evaluator, and clinical evaluator blinded to the alignment technique. Radiographic measurements were made from long-leg computer tomography scanograms. Clinical outcome scores and motion were measured preoperatively and 6 months postoperatively. The hip-knee-ankle angle (0.3° difference; P=.693) and anatomic angle of the knee (0.8° difference; P=.131) were similar for both groups. In the kinematically aligned group, the angle of the femoral component was 2.4° more valgus (P<.000) and the angle of the tibial component was 2.3° more varus (P<.000) than the mechanically aligned group. At 6 months postoperatively, the Western Ontario and McMaster Universities Osteoarthritis Index score was 16 points better (P<.000), Oxford Score was 7 points better (P=.001), combined Knee Society Score was 25 points better (P=.001), and flexion was 5.0° greater (P=.043) in the kinematically aligned group than in the mechanically aligned group.Our findings suggest that the risk of early failure related to limb or knee alignment should be similar in kinematic and mechanically aligned TKA. More anatomic alignment of the implant was associated with better flexion and better clinical outcome scores in the kinematically aligned group. PMID:22310400

  12. computational group theory with GAP 1 GAP in Sage

    E-print Network

    Verschelde, Jan

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

  13. Use of indomethacin as an adjuvant to surgery for recurrent temporomandibular joint ankylosis in adults

    PubMed Central

    Bhatt, Krushna; Pandey, Sandeep; Bhutia, Ongkila; Roychoudhury, Ajoy

    2014-01-01

    Two cases with multiple recurrences of temporomandibular joint ankylosis and multiple failed interposition/gap arthroplasty procedures are presented here. Heterotopic bone formation was thought to be the reason. Indomethacin prophylaxis for prevention of heterotopic new bone formation at the osteoarthrectomy site was used as an adjuvant to surgery, in dosages of 75 mg/day for six weeks. Indomethacin is used frequently in hip and elbow arthroplasties to prevent heterotopic ossification, but its use in temporomandibular joint is not routine. The presented cases did not develop further recurrence and attained stable mouth opening over two-year follow-up after osteoarthrectomy and oral indomethacin. PMID:25937735

  14. Quantification of effect of sequential posteromedial release on flexion and extension gaps: a computer-assisted study in cadaveric knees.

    PubMed

    Mullaji, Arun; Sharma, Amit; Marawar, Satyajit; Kanna, Raj

    2009-08-01

    A novel sequence of posteromedial release consistent with surgical technique of total knee arthroplasty was performed in 15 cadaveric knees. Medial and lateral flexion and extension gaps were measured after each step of the release using a computed tomography-free computer navigation system. A spring-loaded distractor and a manual distractor were used to distract the joint. Posterior cruciate ligament release increased flexion more than extension gap; deep medial collateral ligament release had a negligible effect; semimembranosus release increased the flexion gap medially; reduction osteotomy increased medial flexion and extension gaps; superficial medial collateral ligament release increased medial joint gap more in flexion and caused severe instability. This sequence of release led to incremental and differential effects on flexion-extension gaps and has implications in correcting varus deformity. PMID:18534536

  15. Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register

    PubMed Central

    Garellick, Göran; Kärrholm, Johan

    2010-01-01

    Background and purpose Since the introduction of total hip arthroplasty (THA) in Sweden, both components have most commonly been cemented. A decade ago the frequency of uncemented fixation started to increase, and this change in practice has continued. We therefore analyzed implant survival of cemented and uncemented THA, and whether the modes of failure differ between the two methods of fixation. Patients and methods All patients registered in the Swedish Hip Arthroplasty Register between 1992 and 2007 who received either totally cemented or totally uncemented THA were identified (n = 170,413). Kaplan-Meier survival analysis with revision of any component, and for any reason, as the endpoints was performed. Cox regression models were used to calculate risk ratios (RRs) for revision for various reasons, adjusted for sex, age, and primary diagnosis. Results Revision-free 10-year survival of uncemented THA was lower than that of cemented THA (85% vs. 94%, p < 0.001). No age or diagnosis groups benefited from the use of uncemented fixation. Cox regression analysis confirmed that uncemented THA had a higher risk of revision for any reason (RR = 1.5, 95% CI: 1.4–1.6) and for aseptic loosening (RR = 1.5, CI: 1.3–1.6). Uncemented cup components had a higher risk of cup revision due to aseptic loosening (RR = 1.8, CI: 1.6–2.0), whereas uncemented stem components had a lower risk of stem revision due to aseptic loosening (RR = 0.4, CI: 0.3–0.5) when compared to cemented components. Uncemented stems were more frequently revised due to periprosthetic fracture during the first 2 postoperative years than cemented stems (RR = 8, CI: 5–14). The 5 most common uncemented cups had no increased risk of revision for any reason when compared with the 5 most commonly used cemented cups (RR = 0.9, CI: 0.6–1.1). There was no significant difference in the risk of revision due to infection between cemented and uncemented THA. Interpretation Survival of uncemented THA is inferior to that of cemented THA, and this appears to be mainly related to poorer performance of uncemented cups. Uncemented stems perform better than cemented stems; however, unrecognized intraoperative femoral fractures may be an important reason for early failure of uncemented stems. The risk of revision of the most common uncemented cup designs is similar to that of cemented cups, indicating that some of the problems with uncemented cup fixation may have been solved. PMID:20180715

  16. Complication, Survival, and Reoperation Rates Following Girdlestone Resection Arthroplasty.

    PubMed

    Malcolm, Tennison L; Gad, Bishoy V; Elsharkawy, Karim A; Higuera, Carlos A

    2015-07-01

    Failed hip arthroplasty patients unsuitable for reimplantation may be offered Girdlestone resection arthroplasty (GRA). The purpose of this study was to detail complication and failure rates following GRA. Our results show that 66% (25/38), 34% (13/38), and 76% (29/38) of GRA patients experienced minor, major, and overall complications, respectively. Within 90 days of surgery, three patients required additional surgery and four died. Reoperation or death occurred an average of 26.3 (SD=3.5) and 55.6 (SD=76) months after surgery, respectively. Male gender and increasing comorbidity significantly predicted higher reoperation and mortality rates, P=0.01 and P=0.04, respectively. Complication and mortality rates following GRA are among the highest reported succeeding elective hip surgery for non-traumatic etiology. PMID:25754256

  17. Total patellar skin loss from cryotherapy after total knee arthroplasty.

    PubMed

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

    2013-02-01

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

  18. Modularity of the femoral component in total hip arthroplasty.

    PubMed

    Srinivasan, Anand; Jung, Edward; Levine, Brett Russell

    2012-04-01

    Modular femoral components have been developed to aid in recreating native femoral version, limb length, and offset in total hip arthroplasty. Use of modular implants results in cost savings, as well. Inventory can be reduced while allowing intraoperative flexibility and options. With modular implants, the femoral prosthesis can be built in situ, which is helpful in minimizing incision length and surgical dissection. However, additional modular junctions are associated with increased concern for component failure through taper fretting, fatigue fracture, and local corrosion, which may contribute to elevated serum metal ion levels. The recent trend toward using larger diameter femoral heads may impart higher loads and stress than were seen previously. Although modular components offer a plethora of intraoperative options in primary and revision total hip arthroplasty, the long-term effects of these additional junctions remains unknown. PMID:22474091

  19. Are drains required following a routine primary total joint arthroplasty?

    PubMed Central

    Penematsa, Subbaraju; Parekh, Sailesh

    2006-01-01

    The purpose of this study was to evaluate the benefits of suction drainage following primary total joint arthroplasty. We reviewed primary total hip and knee replacements separately and together in 126 consecutive patients. There were 63 patients each in the drainage and no drainage groups. Sex distribution and anticoagulant use were similar in the two groups. All patients underwent the same operative technique and method of closure. The mean postoperative fall in haemoglobin was 3.2 and 3.3 gm/dl in the drainage and no drainage groups respectively. There was no statistically significant difference between the two groups with regard to blood transfusion requirements, rehabilitation time, postoperative complications such as hypotension and wound infections (p>0.05). The average rehabilitation time in both groups was 8–9 days. The routine use of a suction drain is unnecessary after an uncomplicated total joint arthroplasty. PMID:17033763

  20. [Modern tribology in total hip arthroplasty: pros and cons].

    PubMed

    Gómez-García, F

    2014-01-01

    The wear products and adverse reactions that occur on bearing surfaces represent one of the greatest challenges in prosthetic replacements, as the latter experience increasing demands due to the large number of young and older adult patients that have a long life expectancy and remarkable activity. The purpose of this review is to analyze the pros and cons of the new advances in the bearing components of the articular surfaces of current total hip arthroplasties. We also discuss the strategies used historically, their problems, results and the surgeon's role in prescribing the tribologic couple that best fits each patient's needs. We conclude with practical recommendations for the prescription and management of the latest articular couples for total hip arthroplasty. PMID:26021098

  1. Topical versus intravenous tranexamic acid in total knee arthroplasty.

    PubMed

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

    2015-03-01

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

  2. Knitted outer gloves in primary hip and knee arthroplasty.

    PubMed

    Tanner, J; Wraighte, P; Howard, P

    2006-01-01

    A randomised trial was carried out to determine the rate of perforation to inner gloves when comparing latex with knitted gloves during hip and knee arthroplasty. Members of the surgical team were randomised to wear either two pairs of latex gloves (standard double gloving) or a knitted glove on top of a latex glove. In addition, participants completed a visual analogue assessment of their overall satisfaction with the gloves. A total of 406 inner gloves were tested for perforations over a four-month period: 23% of inner gloves were perforated when latex outer gloves were used and 6% of inner gloves were perforated when knitted outer gloves were used. In total, there were 64 perforations to the inner gloves; only one of these perforations was detected by the glove wearer. Wearing knitted outer gloves during hip and knee arthroplasty statistically significantly reduces the risk of perforation to inner latex gloves (p<0.0001). PMID:19219780

  3. 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

  4. Results of different surgical procedures on total knee arthroplasty infections

    Microsoft Academic Search

    Ray C. Wasielewski; Regina M. Barden; Aaron G. Rosenberg

    1996-01-01

    Seventy-six consecutive infected total knee arthroplasties in 74 patients were treated between December 1981 and March 1990. The average follow-up period was 57 months (range, 24–121 months). No patients were lost to follow-up evaluation and 12 patients died from unrelated causes. Patients were classified, based on the duration of their symptoms prior to treatment, as acutely infected ( 2 weeks).

  5. Stress analyses of glenoid components in total shoulder arthroplasty

    Microsoft Academic Search

    Kenneth D. Stone; John J. Grabowski; Robert H. Cofield; Bernard F. Morrey; Kai N. An

    1999-01-01

    Finite element analysis was used to characterize the local stresses at the bone-implant interface of 2 different types of glenoid components presently used in unconstrained total shoulder arthroplasty. A series of 2-dimensional finite element meshes was developed to model the glenoid in 2 mutually perpendicular planes with and without implanted components. One of the implants modeled was a cemented all-polyethylene

  6. Loss of bone stock with cementless hip arthroplasty

    Microsoft Academic Search

    I. D. Learmonth; G. P. Grobler; D. M. Dall; V. Jandera

    1995-01-01

    One hundred four porous-coated anatomic cementless hip arthroplasties followed from 2 to 6.5 years (mean, 50 months) were studied. Ninety-four percent had excellent clinical results. Thigh pain occurred in 23% of patients, but was severe in only two. “Cancelization” and rounding off of the calcar were noted in 83% of hips, whereas localized osteolysis occurred in 24 femurs and one

  7. Acute gouty arthritis in a patient after total knee arthroplasty.

    PubMed

    Fokter, Samo K; Repse-Fokter, Alenka

    2010-06-01

    Symptomatic gout in an artificial joint is exceptionally rare. We present a 68-year-old male patient who developed progressive knee pain and swelling one year after the cemented total arthroplasty of his left knee. The diagnosis was confirmed by crystal identification in the synovial fluid. Beside thorough workout to rule out infection in a painful and inflamed prosthetic knee, specific history of gout should be sought and fluid aspirate examined cytologically and under polarised light for crystal arthropathy. PMID:20552289

  8. Total Hip Arthroplasty: A Comparison of Current Approaches

    Microsoft Academic Search

    Martin Krismer

    Several approaches to the hip joint have been described. Five of them are regularly used for total hip arthroplasty (THA),\\u000a others are seldom used for primary THA (e.g., Ganz trochanteric flip, medial Ludloff approach) or are only used for minimally-invasive\\u000a surgery (2-incision approach) [1]. The fi ve approaches (Table 1) can be executed either mini-mally-invasively or conventionally,\\u000a either supine or

  9. Three-dimensional gait analysis in women with a total hip arthroplasty

    Microsoft Academic Search

    Marc Perron; Francine Malouin; Hélène Moffet; Bradford J McFadyen

    2000-01-01

    Objectives. The purposes of this study were: (1) to identify the primary (hip) and secondary (neighboring joints) impairments during gait in subjects with a total hip arthroplasty total hip arthroplasty, (2) to determine which impairments persist when controlling for gait speed and (3) to study the relationships between primary and secondary impairments in order to describe the locomotor strategies used

  10. Posterior cruciate ligament removal contributes to abnormal knee motion during posterior stabilized total knee arthroplasty

    Microsoft Academic Search

    Melinda J. Cromie; Robert A. Siston; Nicholas J. Giori; Scott L. Delp

    2008-01-01

    Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20-608) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing

  11. Semiconstrained total elbow arthroplasty in the context of treated previous infection

    Microsoft Academic Search

    Ken Yamaguchi; Robert A Adams; Bernard F Morrey

    1999-01-01

    Previous infection has been considered a strict contraindication to implantation or reimplantation of an elbow prosthesis. The purpose of this study was to investigate whether these patients can in fact be successfully treated with a prosthetic arthroplasty given previous treatment of the infection. Ten consecutive prosthetic arthroplasties performed in patients with documented infections in the elbow were retrospectively reviewed. Seven

  12. Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty

    Microsoft Academic Search

    Richard L. Worland; Jorge Arredondo; Francesesc Angles; Francisco Lopez-Jimenez; Douglas E. Jessup

    1997-01-01

    Thigh pain following tourniquet application is a common patient complaint in the early postoperative period following total knee arthroplasty. Postoperative thigh pain was evaluated in 28 consecutive simultaneous bilateral total knee arthroplasty patients between April 1996 and October 1996. A prospective, doubleblind, randomized clinical trial was performed. Tourniquet pressure of 350 mmHg was used on 1 thigh (thigh 1) and

  13. Ten-year Survivorship of the Anatomique Benoist Girard I Total Hip Arthroplasty

    Microsoft Academic Search

    Filippo Castoldi; Roberto Rossi; Massimo La Russa; Pierro Sibelli; Paolo Rossi; Amar S. Ranawat

    2007-01-01

    The Anatomique Benoist Girard (ABG) I total hip arthroplasty has been widely used in Europe since 1989. Two recent midterm reports have shown high rates of component failure secondary to polyethylene wear. To further investigate this issue, our study prospectively follows 157 consecutive primary total hip arthroplasties using the ABG I prosthesis at an average follow-up of 10 years. Clinical

  14. Effectiveness of clinical pathways for total knee and total hip arthroplasty

    Microsoft Academic Search

    Stephen Kim; Elena Losina; Daniel H. Solomon; John Wright; Jeffrey N. Katz

    2003-01-01

    Although many hospitals have implemented clinical pathways to standardize the process of care, the effectiveness of clinical pathways for total hip and knee arthroplasties has not been reviewed critically. We searched for articles comparing outcomes of total hip or knee arthroplasty for patients who were treated using clinical pathways as opposed to patients treated without these pathways. Eleven studies met

  15. An alternative to the classical nerve graft for the management of the short nerve gap.

    PubMed

    Dellon, A L; Mackinnon, S E

    1988-11-01

    Reconstruction of a short nerve gap by a nerve graft produces donor-site scarring, loss of donor nerve function, and neuroma formation. This study compared the regeneration achieved after 1 year in 16 monkeys across a 3-cm upper arm ulnar nerve gap with a bioabsorbable polyglycolic acid nerve conduit with the regeneration achieved with a classical interfascicular interpositional sural nerve graft. The results demonstrated electrophysiologic and histologic evidence of neural regeneration across the gaps in all experimental groups. The bioabsorbable nerve conduit groups and the sural nerve graft group had mean fiber diameters, amplitudes, and conduction velocities each significantly less than those of normal control ulnar nerves. There was, however, no significant difference between any of the experimental groups. Electromyography demonstrated recovery of 19 of the 28 (68 percent) intrinsic muscles studied. These results demonstrate that the primate peripheral nerve can regenerate across short nerve gaps when guided by an appropriate nerve conduit, suggesting that a single-stage biodegradable polyglycolic acid conduit may be used as an alternative to a short interfascicular nerve graft. PMID:2845455

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

    PubMed

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

    2014-12-01

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

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

    PubMed Central

    2012-01-01

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

  18. Birmingham Mid-Head Resection hip arthroplasty in a young man with gigantism.

    PubMed

    Murphy, Michael T; Shillington, Mark P; Mogridge, Damon R; Journeaux, Simon F

    2012-02-01

    The Birmingham Mid-Head Resection (Smith & Nephew Ltd, Warwick, United Kingdom) arthroplasty is a new bone-conserving procedure that, like hip resurfacing, is used in younger, active patients. We present the case of a young man with Sotos syndrome (cerebral gigantism) with associated extraordinary stature (height, 2.16 m; weight, 157 kg) who underwent Birmingham Mid-Head Resection arthroplasty. The large stature of this patient required a custom manufactured prosthesis (a femoral head 68 mm in diameter with an acetabular cup 76 mm in diameter). We believe this to be the largest metal-on-metal resurfacing articulation and hip arthroplasty reported to date. PMID:21704481

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

    PubMed

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

    2014-06-01

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

  20. Alternation of trunk movement after arthroplasty in patients with osteoarthritis of the knee

    Microsoft Academic Search

    Qi Zhong Chang; Makoto Sohmiya; Naoki Wada; Masayuki Tazawa; Naoki Sato; Shinya Yanagisawa; Kenji Shirakura

    Objective  Trunk movement is important but still little understood after total knee arthroplasty. The alternation of trunk movement was\\u000a analyzed for use in a postoperative rehabilitation program in the short-term after arthroplasty.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  The subjects were 25 patients with knee osteoarthritis (4 males, 21 females). The femorotibial angle was evaluated on standing\\u000a anteriorposterior radiographs and recorded at pre- and post-arthroplasty.

  1. Treatment of 50 Deep Infections After Total Knee Arthroplasty.

    PubMed

    Matsumoto, Tomoyuki; Ishida, Kazunari; Tsumura, Nobuhiro; Nagai, Kanto; Muratsu, Hirotsugu; Hida, Yuichi; Hiranaka, Takafumi; Kuroda, Ryosuke; Kurosaka, Masahiro

    2015-06-01

    The prevalence of infections caused by methicillin-resistant organisms has increased, causing difficulty in the treatment of prosthetic joint infection. A multicenter study was performed to review 50 patients with deep infections with or without a resistant organism, such as methicillin-resistant Staphylococcus aureus, at the site of total knee arthroplasty. A group of 13 patients with early deep infections and 4 patients with acute hematogenous infections underwent treatment with debridement, antibiotic therapy, and retention of the prosthesis with revision of the polyethylene insert. Thirty-three patients with late chronic infections were treated with challenging prosthesis retention for prostheses that had not loosened or 2-stage exchange arthroplasty for prostheses that had loosened. Mean duration of follow-up was 4.7±1.8 years. No significant differences in resultant functional knees and mean number of operations were observed between 7 patients with resistant early deep infections and 6 patients with nonresistant early deep infections. However, 24 patients with nonresistant chronic infections showed significant improvement in resultant functional knees (24 of 24; 100%) and fewer mean operations (2.8 times) compared with 9 patients with resistant chronic infections (1 of 9, 11%, and 4.3 times, respectively). The remaining 8 patients with resistant chronic infections (89%) had arthrodesis (3 patients) or underwent above-the-knee amputation (1 patient) or spacer arthroplasty (4 patients). Although patients with resistant early postoperative deep infections showed good results that were similar to those in patients with nonresistant early infections, those with resistant late chronic infections had a significantly inferior success rate compared with those who had nonresistant late chronic infections. [Orthopedics. 2015; 38(6):e529-e535.]. PMID:26091228

  2. Sensitivity to implant materials in patients with total knee arthroplasties.

    PubMed

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

    2008-04-01

    Materials used for total knee arthroplasty (TKA), may elicit an immune response whose role in the outcome of the arthroplasty is still unclear. The aim of this study was to evaluate the frequency of sensitization in patients who had undergone TKA, and the clinical impact of this event on the outcome of the implant. Ninety-four subjects were recruited, including 20 patients who had not yet undergone arthroplasty, 27 individuals who had a well-functioning TKA, and 47 patients with loosening of TKA components. Sensitization was detected by using patch testing including haptens representative of cobalt-based alloys (CoCrMo), titanium-based alloys (TiAlV), and bone cements. The frequency of positive skin reactions to metals increased significantly after TKA, either stable or loosened (No Implant 20%; Stable TKA 48.1%, p=0.05; Loosened TKA 59.6%, p=0.001, respectively). We found a higher frequency of positive patch testing to vanadium in patients who had a Stable TKA with at least one TiAlV component (39.1%, p=0.01). The medical history for metal allergy seems to be a risk factor, because the TKA failure was fourfold more likely in patients who had symptoms of metal hypersensitivity before TKA. The prognostic value was supported by survival analysis, because in these individuals the outcome of the implant was negatively influenced (the logrank test Chi square 5.1, p=0.02). This study confirms that in patients with a TKA the frequency of positive patch testing is higher than in the normal population, although no predictive value is attributable to the sensitization because patch testing was not able to discriminate between stable and loose implants. On the contrary, the presence of symptoms of metal allergy before implantation should be taken into account as a potential risk factor for TKA failure. PMID:18155140

  3. Outcome of iatrogenic collateral ligaments injuries during total knee arthroplasty.

    PubMed

    Dragosloveanu, Serban; Cristea, Stefan; Stoica, Cristian; Dragosloveanu, Calin

    2014-12-01

    Soft tissue balance is an essential step in total knee arthroplasty by providing a good knee stability and an even distribution of load over the prosthesis components. During surgery, because of the need of having a good balance in most cases is necessary to do some soft tissue release in the medial compartment. Lateral release is far more rare and is generally needed for patients with valgus knees after high tibial osteotomy. Our purpose is to evaluate the complications that arise during soft tissue release and how to manage this unfortunate events for getting the best functional results for the patients. In this study, we analyzed 434 knee arthroplasties that were operated in our clinic in the past 8 years by the same knee team (2005-2012). Average age was 64.8 years. Eight of this patients had medial collateral ligament injuries during surgery, and two had lateral collateral ligament rupture. Average age of patients who suffered from medial collateral ligaments injuries was 62.8 years and for lateral collateral ligaments was 72.5 years. Body mass index was 34 for both groups. We used for evaluation the knee society pain and functional scores, and X-rays obtained after the surgery with a calibrated Siemens machine. Seven patients with MCL repair were satisfied with after surgery (Knee Society score was 87.7, and functional score was 80). One complained of knee instability associated with pain and needed revision. In LCL group, all patients had excellent results (Knee Society score was 91.5, and functional score was 85). We found that repair to collateral ligaments injuries must be obtained during surgery, especially complete ruptures of the MCL. There are several approaches to collateral ligaments ruptures during total knee arthroplasty that will be discussed during the article. PMID:24121794

  4. Clinical Biomechanics of Wear in Total Hip Arthroplasty

    PubMed Central

    Callaghan, John J; Pedersen, Douglas R; Johnston, Richard C; Brown, Thomas D

    2003-01-01

    Complementary clinical and laboratory studies were performed to identify variables associated with polyethylene wear following total hip replacement, and to elucidate the mechanisms responsible for accelerated wear in the total hip arthroplasty construct. Observational cohort studies were performed using a prospective clinical database of more than 4000 consecutive primary total hip arthroplasties performed by a single surgeon, to identify wear-related variables. These variables included head size, acetabular/femoral component impingement, and third body debris. Novel digital edge detection techniques were developed and employed to accurately measure wear, and to determine the relationships of head size and third body debris to acceleration of wear. A novel slidingdistance-coupled finite element model was formulated and employed to examine the mechanisms responsible for wear. The long-term cohort studies demonstrated smaller head sizes to be associated with less wear. Third body debris generated from cable fretting was associated with an increase in wear, osteolysis, and acetabular loosening, especially with larger head sizes. The sliding-distance-coupled finite element model replicated the wear rates occurring in vitro and in vivo, demonstrating the importance of sliding distance on polyethylene wear following total hip arthroplasty. It also demonstrated substantial increases in wear associated with femoral head scratching from third body debris. Further extension of the finite element formulation demonstrated the potential for acetabular component rim damage from impingement wear, and the enhanced potential for third body ingress to the bearing surface with larger head sizes. Edge detection wear measurement techniques demonstrated that early wear rates were predictive of long-term wear rates. These complementary clinical and laboratory investigations have provided insight into 1) the significance of sliding distance and physiologic loci of motion as contributing factors in minimizing wear, 2) the deleterious effects of third body particulates in accelerating wear, 3) the potential for, and factors related to, impingement wear, and 4) the potential advantages and compromises related to the use of larger head sizes in the bearing surface construct. PMID:14575243

  5. Patellofemoral arthroplasty with a custom-fit femoral prosthesis.

    PubMed

    Butler, James E; Shannon, Robert

    2009-02-01

    We reviewed the outcomes of a series of patellar arthroplasty operations with custom-fit femoral prostheses to examine the effectiveness of this procedure in relieving pain and restoring function in the knee. Twenty-two patellofemoral arthroplasty operations were performed in 21 patients (mean age, 48.6 years) at 2 institutions between 1994 and 2002. All patients had advanced patellofemoral arthritis and had undergone an average of 2.5 previous patellofemoral operations. The prosthesis, consisting of a custom-fit chrome cobalt trochlear component and an all-polyethylene patellar button, was implanted in a procedure designed to minimize bone resection. Patients later underwent three-view radiography of the knee to confirm that the prosthesis was positioned correctly. One patient required revision of an undersized patellar button 18 months postoperatively, and 2 other patients had postoperative arthrofibrosis necessitating arthroscopic debridement. No patient required revision of the trochlear component, and no loosening or migration of any component has been found since the first procedure was performed. However, the polyethylene patellar button has worn in 3 patients, and the patella broke in 1 patient. An average of 60 months postoperatively, patients used the Western Ontario and McMaster Universities Osteoarthritis Index to rate their preoperative and present joint pain, stiffness, and function. Patients' mean overall ratings (potential range, 24-96) were significantly lower for their present symptoms (28.4) than for their preoperative symptoms (63.4). Mean scores on each subscale also decreased: from 13.0 to 5.5 for pain, from 5.4 to 2.4 for stiffness, and from 45.0 to 20.6 for function. We conclude that, in carefully selected patients, patellofemoral arthroplasty with a custom-fit prosthesis is a viable surgical treatment for isolated patellofemoral arthritis. PMID:19301809

  6. Tourniquet use in total knee arthroplasty: a meta-analysis

    Microsoft Academic Search

    Ta-Wei Tai; Chii-Jeng Lin; I-Ming Jou; Chih-Wei Chang; Kuo-An Lai; Chyun-Yu Yang

    2011-01-01

    Purpose  The use of an intraoperative tourniquet for total knee arthroplasty (TKA) is a common practice. However, the effectiveness\\u000a and safety are still questionable. A systematic review was conducted to examine that whether using a tourniquet in TKA was\\u000a effective without increasing the risk of complications.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A comprehensive literature search was done in PubMed Medicine, Embase, and other internet database. The

  7. Role of gentamicin-impregnated cement in total joint arthroplasty.

    PubMed

    Garvin, K L; Salvati, E A; Brause, B D

    1988-07-01

    Palacos-Gentamicin (PG) was used in 130 joint arthroplasties at The Hospital for Special Surgery. At an average follow-up of 2.5 years (range, 2 to 5), the overall recurrence rate of infection was 3.8 per cent. Only one (2.0 per cent) infection occurred where the bacteria were sensitive to PG and there were no infections in the two-stage reimplantation group. There have been no adverse effects from the gentamicin and the inferior intrusion properties of the PG have not been reflected in the clinical or radiographic results. PMID:3132670

  8. Physical rehabilitation after total joint arthroplasty in companion animals.

    PubMed

    Marcellin-Little, Denis J; Doyle, Nancy D; Pyke, Joanna Freeman

    2015-01-01

    Patients who have total joint arthroplasty have varying needs related to rehabilitation. In the short term, rehabilitation should be used in all dogs to identify high-risk patients and to minimize the likelihood of postoperative complications. Many patients undergoing total hip replacement recover uneventfully without needing long-term physiotherapy. All patients undergoing total knee replacement and total elbow replacement need rehabilitation to restore limb use and maximize their functional recovery. This article presents rehabilitation considerations for companion animals undergoing total hip replacement, total knee replacement, and total elbow replacement; postoperative complications and how to mitigate risks; and anticipated patient outcomes. PMID:25432684

  9. Dacron collateral ligament reconstruction with proximal interphalangeal joint arthroplasty.

    PubMed

    Hunter, J M; Sattel, A; Kirkpatrick, W H

    1991-04-01

    A porous Dacron (Phoenix Bioengineering, Bridgeport, PA) tendon is described for collateral ligament reconstruction and augumentation with proximal interphalangeal joint implant arthroplasty. Eight cases with a minimum follow-up of 15 months are reviewed. Diagnoses include posttraumatic arthritis and osteoarthritis, as well as rheumatoid arthritis. The porous Dacron tendon is constructed as a collagen-like weave. It has been useful in patients who have insufficient local tissue to achieve lateral proximal interphalangeal joint stability. In selected cases, it can obviate the need for a tendon graft and provide an alternative to arthrodesis. PMID:10171175

  10. Excision arthroplasty for management of coxofemoral luxation in pet birds.

    PubMed

    MacCoy, D M

    1989-01-01

    Coxofemoral luxation, although not a common injury, can cause considerable pelvic limb dysfunction in pet birds. Luxation usually is craniodorsal, as it is in dogs. Previously recommended treatments have not always been effective in managing the injury. Sequelae can include dorsolateral deviation of the pelvic limb, with loss of function and bumblefoot in the nonluxated limb, owing to abnormal weight-bearing. Excision arthroplasty combined with a muscular sling constructed from a segment of the iliofibularis muscle was used to treat coxofemoral luxation in a hyacinth macaw, a moluccan cockatoo, and an African gray parrot. The outcome was excellent in 2 of the 3 birds. PMID:2914805

  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. Analysis of the Flexion Gap on In Vivo Knee Kinematics Using Fluoroscopy.

    PubMed

    Nakamura, Shinichiro; Ito, Hiromu; Yoshitomi, Hiroyuki; Kuriyama, Shinichi; Komistek, Richard D; Matsuda, Shuichi

    2015-07-01

    There is a paucity of information on the relationships between postoperative knee laxity and in vivo knee kinematics. The correlations were analyzed in 22 knees with axial radiographs and fluoroscopy based 3D model fitting approach after a tri-condylar total knee arthroplasty. During deep knee bend activities, the medial flexion gap had significant correlations with the medial contact point (r=0.529, P=0.011) and axial rotation at full extension. During kneeling activities, a greater medial flexion gap caused larger anterior translation at complete contact (r=0.568, P=0.011). Meanwhile, the lateral flexion gap had less effect. In conclusion, laxity of the medial collateral ligament should be avoided because the magnitude of medial flexion stability was crucial for postoperative knee kinematics. PMID:25680453

  13. Processing gapped verbs.

    PubMed

    Kaan, Edith; Overfelt, Carlie; Tromp, Do; Wijnen, Frank

    2013-08-01

    The time course was investigated of the processing of "missing" verbs in gapping constructions, such as John ate the hamburger, and Bill __ the hotdog. Native speakers of Dutch silently read Dutch sentences with and without gapping while their EEG was recorded. A left anterior negativity (LAN) was found at the first possible position at which the gapped verb could be detected, at least, for in participants who performed poorly in an end-of-sentence acceptability judgment task. This suggests that some readers do not anticipate the gapped verb, but infer the gapped verb in a bottom-up fashion, resulting in a LAN. Second, a P600 effect was observed for gapping versus no-gapping conditions, the early part of which was unaffected by plausibility. This suggests that the semantic and syntactic integration of a gapped verb is a relatively late process, and involves mechanisms similar to integrating a wh-phrase object with its verb. PMID:22538968

  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. 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

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

    PubMed

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

    2014-01-01

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

  17. 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 ...

  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. Orthopaedic crossfire--can we justify unicondylar arthroplasty as a temporizing procedure? in the affirmative.

    PubMed

    Engh, Gerard A

    2002-06-01

    In 1972, unicondylar knee arthroplasty (UKA) was introduced, along with total knee arthroplasty (TKA), as an option for managing gonarthrosis. Although the early clinical results with the first generation of implants were equivalent to those of total knee arthroplasty, little interest in UKA was sustained. If unicondylar arthroplasty is to realize a role in the management of degenerative arthritis, even as a temporizing procedure, the results must be predictable and reproducible. Patient satisfaction must be equivalent to or better than that of TKA. Finally, the conversion of UKA to TKA must be uncomplicated, avoiding complex reconstructive procedures and the use of revision implants. As documented in the literature, UKA achieves these goals. Therefore, we cannot only justify UKA as a temporizing procedure, but also as a definitive procedure with long-term results that are comparable to TKA for gonarthrosis. PMID:12068405

  20. The effect of acetabular inclination on metal ion levels following metal-on-metal hip arthroplasty.

    PubMed

    Emmanuel, Andrew R; Bergin, Karen M; Kelly, Gabrielle E; McCoy, Gerald F; Wozniak, Andrew P; Quinlan, John F

    2014-01-01

    Acetabular inclination angles have been suggested as a principal determinant of circulating metal ion levels in metal-on-metal hip arthroplasties. We aimed to determine whether inclination angle correlates with ion levels in arthroplasties using the Articular Surface Replacement (ASR) system. Patients undergoing ASR arthroplasties had blood metal ion levels and radiograph analysis performed a mean of 3.2 years after surgery. Inclination angle showed only a weak correlation with cobalt (r=0.21) and chromium (r=0.15) levels. The correlation between inclination angle and cobalt levels was significant only with small femoral components, although it was still weak. Multiple regression showed a complex interaction of factors influencing ion levels but inclination angle accounted for little of this variation. We conclude that the acetabular inclination angle is not a meaningful determinant of metal ion levels in ASR arthroplasties. PMID:23759116

  1. Dealing with the predicted increase in demand for revision total knee arthroplasty: challenges, risks and opportunities.

    PubMed

    Hamilton, D F; Howie, C R; Burnett, R; Simpson, A H R W; Patton, J T

    2015-06-01

    Worldwide rates of primary and revision total knee arthroplasty (TKA) are rising due to increased longevity of the population and the burden of osteoarthritis. Revision TKA is a technically demanding procedure generating outcomes which are reported to be inferior to those of primary knee arthroplasty, and with a higher risk of complication. Overall, the rate of revision after primary arthroplasty is low, but the number of patients currently living with a TKA suggests a large potential revision healthcare burden. Many patients are now outliving their prosthesis, and consideration must be given to how we are to provide the necessary capacity to meet the rising demand for revision surgery and how to maximise patient outcomes. The purpose of this review was to examine the epidemiology of, and risk factors for, revision knee arthroplasty, and to discuss factors that may enhance patient outcomes. Cite this article: Bone Joint J 2015; 97-B:723-8. PMID:26033049

  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. 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

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

    PubMed Central

    Razak, Arif; Ebinesan, Ananthan Dave

    2013-01-01

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

  5. [Treatment of extensor mechanism rupture after total knee arthroplasty].

    PubMed

    Bieger, R; Kappe, T; Wernerus, D; Reichel, H

    2013-10-01

    Disruption of the extensor mechanism is one of the most devastating complications in knee arthroplasty with a reported incidence between 0.17 and 2.5 %. Due to a high rate of subsequent complications and poor clinical results, every effort should be made to avoid extensor mechanism disruption. In cases of disruption however, the orthopaedic surgeons must be aware of non-operative and surgical treatment options and their indications, timing, outcome and limitations. Non-operative treatment is feasible in cases of incomplete disruption of the quadriceps tendon with an extension deficit of less than 20°. Complete disruption of the quadriceps tendon or rupture of the patellar tendon should be treated operatively. Therapeutic strategies include direct repair of the tendon in acute disruption without retraction. Retraction as well as soft tissue damage necessitates augmentation of the tendon. Frequently used endogenous augments are the semitendinosus tendon as well as the gastrocnemius muscle. Exogenous options are allografts of the Achilles tendon or structured extensor mechanism grafts and synthetic augments to support endogenous tendon repair. The clinical results after extensor mechanism failure following total knee arthroplasty are less favourable compared to ruptures in native knee joints. The most common complications are postoperative stretching and the maintenance of an active extensor lag. PMID:24129717

  6. 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

  7. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty.

    PubMed

    Jackson, Keith L; Hire, Justin M; Jacobs, Jeremy M; Key, Charles C; DeVine, John G

    2015-06-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO. PMID:26097664

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

    PubMed

    Amstutz, H C

    2000-09-01

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

  9. Patellofemoral crepitus after total knee arthroplasty: etiology and preventive measures.

    PubMed

    Conrad, David N; Dennis, Douglas A

    2014-03-01

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

  10. Bacterial contaminants and antibiotic prophylaxis in total hip arthroplasty.

    PubMed

    Al-Maiyah, M; Hill, D; Bajwa, A; Slater, S; Patil, P; Port, A; Gregg, P J

    2005-09-01

    We have investigated the contaminating bacteria in primary hip arthroplasty and their sensitivity to the prophylactic antibiotics currently in use. Impressions (627) of the gloved hands of the surgical team in 50 total hip arthroplasties were obtained on blood agar. The gloves were changed after draping, at intervals of 20 minutes thereafter, and before using cement. Changes were also undertaken whenever a visible puncture was detected. The culture plates were incubated at 37 degrees C for 48 hours. Isolates were identified and tested for sensitivity to flucloxacillin, which is a recognised indicator of sensitivity to cefuroxime. They were also tested against other agents depending upon their appearance on Gram staining. We found contamination in 57 (9%) impressions and 106 bacterial isolates. Coagulase-negative staphylococci were seen most frequently (68.9%), but we also isolated Micrococcus (12.3%), diphtheroids (9.4%), Staphylococcus aureus (6.6%) and Escherichia coli (0.9%). Of the coagulase-negative staphylococci, only 52.1% were sensitive to flucloxacillin and therefore to cefuroxime. We believe that it is now appropriate to review the relevance of prophylaxis with cefuroxime and to consider the use of other agents. PMID:16129753

  11. Glove perforation and contamination in primary total hip arthroplasty.

    PubMed

    Al-Maiyah, M; Bajwa, A; Mackenney, P; Port, A; Gregg, P J; Hill, D; Finn, P

    2005-04-01

    We conducted a randomised, controlled trial to determine whether changing gloves at specified intervals can reduce the incidence of glove perforation and contamination in total hip arthroplasty. A total of 50 patients were included in the study. In the study group (25 patients), gloves were changed at 20-minute intervals or prior to cementation. In the control group (25 patients), gloves were changed prior to cementation. In addition, gloves were changed in both groups whenever there was a visible puncture. Only outer gloves were investigated. Contamination was tested by impression of gloved fingers on blood agar and culture plates were subsequently incubated at 37 degrees C for 48 hours. The number of colonies and types of organisms were recorded. Glove perforation was assessed using the water test. The incidence of perforation and contamination was significantly lower in the study group compared with the control group. Changing gloves at regular intervals is an effective way to decrease the incidence of glove perforation and bacterial contamination during total hip arthroplasty. PMID:15795210

  12. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty

    PubMed Central

    Jackson, Keith L.; Jacobs, Jeremy M.; Key, Charles C.; DeVine, John G.

    2015-01-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO.

  13. Cellular mediators secreted by interfacial membranes obtained at revision total hip arthroplasty

    Microsoft Academic Search

    Arun S. Shanbhag; Joshua J. Jacobs; Jonathan Black; Jorge O. Galante; Tibor T. Glant

    1995-01-01

    The interfacial membrane between implant and host—bone in aseptically loose total hip arthroplasties has a potential role in the etiology of local bone resorption and loosening of the prosthetic component. Inflammatory\\/potential “bone-resorbing” agents (cytokines\\/mediators) released by the cells of the interfacial membranes of loosened uncemented and cemented total hip arthroplasties were measured. Synovial tissues from patients with acute femoral neck

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

    Microsoft Academic Search

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

    2009-01-01

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

  15. 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

  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. Readmission Rates in Total Hip Arthroplasty: A Granular Analysis?

    PubMed

    Lavernia, Carlos J; Villa, Jesus M

    2015-07-01

    A deeper understanding of readmissions in arthroplasty is warranted. We wanted to determine in primary THA patients: readmission rates; baseline characteristics of patients with/without readmissions; and readmission reasons. 201 consecutive patients were studied. Preoperative characteristics, patient-perceived-outcomes, and hip-scores were compared between patients with and without readmissions. Rates were 1% (readmitted n=2; 15-days), 3.5% (7; 30-days), 6.5% (13; 90-days), and 16.9% (34; 1-year). Readmitted patients had significantly worse preoperative comorbidities/outcome-scores when compared to non-readmitted patients. "Surgical-site infection" was the most frequent readmission reason within 30/90days. Within 1year, it was another elective joint. Fifty percent of readmissions were not related to the index-surgery (15-days). Preoperative health status affects rates. Many rehospitalizations are not related to the index-surgery and probably unpreventable. PMID:25979189

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

    PubMed

    Rajgopal, Ashok; Vasdev, Attique; Dahiya, Vivek

    2014-09-24

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

  19. Acute Patellar Tendon Rupture after Total Knee Arthroplasty Revision.

    PubMed

    Rhee, Seung Joon; Pham, The Hien; Suh, Jeung Tak

    2015-06-01

    Patellar tendon rupture is a catastrophic complication following total knee arthroplasty (TKA). Though revision TKA has been suspected of being a predisposing factor for the occurrence of patellar tendon rupture, there are few reports on patellar tendon rupture after revision TKA. Here, we present a case of acute patellar tendon rupture that occurred after TKA revision. In the patient, the patellar tendon was so thin and could not be repaired, and accordingly was sutured end to end. We used the anterior tibialis tendon allograft to augment the poor quality patellar tendon tissue. Fixation of the allograft was done by using the bone tunnel created through tibial tuberosity and suturing the allograft to the patellar tendon and quadriceps tendon. The patient was instructed to wear a full extension knee splint and was kept non-weight bearing for 6 weeks after operation. Full knee extension could be achieved 6 weeks postoperatively. PMID:26060612

  20. 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

  1. MBARS: mini bone-attached robotic system for joint arthroplasty.

    PubMed

    Wolf, A; Jaramaz, B; Lisien, B; DiGioia, A M

    2005-01-01

    A report on a new active, miniature bone-attached, robotic system including its design, high level and low level control, is given together with a description of the system implementation and first experimental use. The system is capable of preparing the bone cavity for an implant during joint arthroplasty procedures. Without loss of generality, the report describes the implementation of the system for a Patellofemoral Joint Replacement procedure. The system is image-free and all planning is performed intra-operatively in the robot coordinate system, eliminating the need for external tracking systems in the operating room. Experiments were conducted using the first robot prototype and the results supported the feasibility of the concept. The methodology which is presented can be modified to other orthopaedic procedures and could improve the results in terms of accuracy and operational time. Moreover, it enables minimally invasive procedures and use of the next generation of more anatomically shaped implants. PMID:17518383

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

    PubMed Central

    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

  3. Management of failed metal-on-metal total hip arthroplasty

    PubMed Central

    Griffin, Justin W; D’Apuzzo, Michele; Browne, James A

    2012-01-01

    The theoretical advantages of metal-on-metal (MOM) bearing couples in total hip arthroplasty (THA) have been recently balanced by concerns regarding adverse local and systemic effects. Higher than anticipated early revision rates have been reported by several joint registries. Failed MOM hips present with a spectrum of symptoms and findings and traditional methods of failure must be considered in addition to the failure modes that appear to be unique to the MOM bearing couple. Metal hypersensitivity and soft tissue immune reactions remain incompletely understood and require careful ongoing study. The tools available to evaluate MOM THAs and the indications for revision surgery remain to be defined. Outcomes following revision of MOM hips appear to depend on appropriate evaluation, early identification, and appropriate surgical management. PMID:22720266

  4. Femoral-head vascularity after hip surface arthroplasty

    PubMed Central

    Kannan, Arun; Bal, Chandra Sekhar; Kumar, Vijay; Mittal, Ravi; Damle, Nishikant

    2010-01-01

    Background Iatrogenic devascularization of the femoral head is as an area of concern following hip resurfacing arthroplasty, with probable implications on short-term failure and long-term survival of the implant. Materials and methods We assessed the vascularity of 25 resurfaced femoral heads in 20 patients by comparison with preoperative and postoperative Tc-99m methylene diphosphonate (MDP) bone scintigraphy images, the postoperative scans being done 9 months after the surgery. Results Eight out of 25 hips (32%) showed <55% of their preoperative uptake at a mean of 9 months after surgery and were categorized as showing reduced vascularity. Conclusion Our study reveals reduction in vascularity of the femoral-head remnant as a frequent occurrence after hip resurfacing. Our study also highlights the role of bone scintigraphy as tool in assessing the vascularity of resurfaced femoral heads. PMID:20957405

  5. 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

  6. [Total hip arthroplasty through anterior "minimal invasive" approach].

    PubMed

    Moerenhout, Kevin G; Cherix, Stéphane; Rüdiger, Hannes A

    2012-12-19

    Total hip replacement has seen a tremendous development and has become one of the most successful surgical interventions in orthopaedics. While during the first decades of development of total hip arthroplasty the fixation of the implant into the bone was the main concern, the focus has shifted towards surgical technique and soft tissue handling. In order to avoid permanent soft tissue damage, muscular dysfunction and concerns in regards to cosmetics, minimal invasive and anatomic approaches have been developed. We here provide a short overview on various methods of total hip replacements and we describe our technique through a minimal invasive direct anterior approach. While muscle and nerve damage is minimal, this technique allows for a rapid rehabilitation and is associated with an excellent functional outcome and a minimal risk for dislocation. PMID:23346746

  7. 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

  8. Current surgical strategies for total arthroplasty in valgus knee

    PubMed Central

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

    2015-01-01

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

  9. Current surgical strategies for total arthroplasty in valgus knee.

    PubMed

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

    2015-07-18

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

  10. Current concepts in total knee arthroplasty: Patient specific instrumentation.

    PubMed

    Sadoghi, Patrick

    2015-07-18

    Patient specific instrumentation (PSI) in total knee arthroplasty (TKA) promises faster operation time (by using less instruments and individual cutting jigs), less blood loss, faster rehabilitation, better implant sizing and accuracy, superior overall outcome, and at the end - less costs. However, as evident for every new development, its superiority remains to be proven over the conventional systems. Whilst dissatisfaction is reported to be eminent in up to 30% of patients having undergone conventional TKA, it is unclear, whether PSI can address to these patients as a suitable option in the future. The author believes that the current evidence does not support superiority of PSI in TKA over conventional systems. However, future long-term level I and II studies might aid to show its cost-effectiveness stating same results, accuracy, and overall outcome with less operation time. PMID:26191490

  11. Current concepts in total knee arthroplasty: Patient specific instrumentation

    PubMed Central

    Sadoghi, Patrick

    2015-01-01

    Patient specific instrumentation (PSI) in total knee arthroplasty (TKA) promises faster operation time (by using less instruments and individual cutting jigs), less blood loss, faster rehabilitation, better implant sizing and accuracy, superior overall outcome, and at the end - less costs. However, as evident for every new development, its superiority remains to be proven over the conventional systems. Whilst dissatisfaction is reported to be eminent in up to 30% of patients having undergone conventional TKA, it is unclear, whether PSI can address to these patients as a suitable option in the future. The author believes that the current evidence does not support superiority of PSI in TKA over conventional systems. However, future long-term level I and II studies might aid to show its cost-effectiveness stating same results, accuracy, and overall outcome with less operation time.

  12. Gross trunnion failure after primary total hip arthroplasty.

    PubMed

    Banerjee, Samik; Cherian, Jeffrey J; Bono, James V; Kurtz, Steven M; Geesink, Rudolph; Meneghini, R Michael; Delanois, Ronald E; Mont, Michael A

    2015-04-01

    Unfavorable outcomes from trunnion fretting and corrosion damage have been reported in the literature, gross failures of tapers in primary total hip arthroplasties have been less frequently reported. We report on 5 patients, who presented with gross trunnion failures of modular metal-on-polyethylene or ceramic-on-polyethylene bearings from 5 implant manufacturers, all necessitating revision surgery. None of these patients had an antecedent history of trauma, and the majority presented with pain or instability. No common factor was identified that may be predictive of these type of failures. Since there were 5 different stem designs, this suggests that it may be a rare generic phenomenon occurring with multiple designs. Currently, further investigations are necessary, including retrieval analysis, to identify risk factors that may predispose to such failures. PMID:25499678

  13. Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

    PubMed Central

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

    2009-01-01

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

  14. Acute Patellar Tendon Rupture after Total Knee Arthroplasty Revision

    PubMed Central

    Rhee, Seung Joon; Pham, The Hien

    2015-01-01

    Patellar tendon rupture is a catastrophic complication following total knee arthroplasty (TKA). Though revision TKA has been suspected of being a predisposing factor for the occurrence of patellar tendon rupture, there are few reports on patellar tendon rupture after revision TKA. Here, we present a case of acute patellar tendon rupture that occurred after TKA revision. In the patient, the patellar tendon was so thin and could not be repaired, and accordingly was sutured end to end. We used the anterior tibialis tendon allograft to augment the poor quality patellar tendon tissue. Fixation of the allograft was done by using the bone tunnel created through tibial tuberosity and suturing the allograft to the patellar tendon and quadriceps tendon. The patient was instructed to wear a full extension knee splint and was kept non-weight bearing for 6 weeks after operation. Full knee extension could be achieved 6 weeks postoperatively. PMID:26060612

  15. Variation of Medicare payments for total knee arthroplasty

    PubMed Central

    Li, Yue; Lu, Xin; Wolf, Brian R.; Callaghan, John J.; Cram, Peter

    2013-01-01

    We analyzed the 2009 Medicare inpatient claims data and other databases to estimate Medicare payments for primary or revision total knee arthroplasty (TKA). The average Medicare hospital payment per procedure was $13464 for primary TKA (n=227587) and $17331 for revision TKA (n=18677). For both primary and revision TKA Medicare payments varied substantially across patients, hospitals and healthcare markets. Less than one percent of primary TKA cases but seven percent of revision TKA cases triggered Medicare “outlier” payments, which were $10000 or higher per case beyond regular diagnosis-related-group payments. Urban and major teaching hospitals were more likely to treat these unusually expensive cases. Hospitals in the Northeast and West regions tended to receive higher Medicare payments than hospitals in the Midwest. PMID:23845765

  16. Tantalum cones and bone defects in revision total knee arthroplasty.

    PubMed

    Boureau, F; Putman, S; Arnould, A; Dereudre, G; Migaud, H; Pasquier, G

    2015-04-01

    Management of bone loss is a major challenge in revision total knee arthroplasty (TKA). The development of preformed porous tantalum cones offers new possibilities, because they seem to have biological and mechanical qualities that facilitate osseointegration. Compared to the original procedure, when metaphyseal bone defects are too severe, a single tantalum cone may not be enough and we have developed a technique that could extend the indications for this cone in these cases. We used 2 cones to fill femoral bone defects in 7 patients. There were no complications due to wear of the tantalum cones. Radiological follow-up did show any migration or loosening. The short-term results confirm the interest of porous tantalum cones and suggest that they can be an alternative to allografts or megaprostheses in case of massive bone defects. PMID:25755068

  17. 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

  18. Safety and utility of computer-aided shoulder arthroplasty.

    PubMed

    Edwards, T Bradley; Gartsman, Gary M; O'Connor, Daniel P; Sarin, Vineet K

    2008-01-01

    This study evaluated the safety and utility of a novel, image-free, shoulder navigation system in a cadaver and in an initial cohort of shoulder arthroplasty patients. Shoulder arthroplasty was performed on a cadaver and 27 patients using an image-free navigation system (NaviProtrade mark; Kinamed Navigation Systems LLC, Camarillo, CA). Optical trackers were attached to the proximal humerus and the coracoid process. Prior to and following humeral head resection, the anatomic neck axis (retroversion, inclination) and humeral head diameter were measured with the navigation system. Native glenoid surface orientation was registered, and a navigation tracker was attached to the glenoid reamer. The navigation system recorded change in inclination and version relative to the native glenoid during reaming. The cadaver results demonstrated that the trackers did not impede surgical performance and that system accuracy was 2.6 degrees +/- 2.5 degrees . In the clinical series, the navigation system reported the anatomic humeral neck measurements (retroversion 30.0 degrees +/- 16.0 degrees ; inclination 137.0 degrees +/- 11.7 degrees ), the humeral head diameters (major axis 46.2 mm +/- 4.8 mm; minor axis 43.2 mm +/- 3.8 mm), the humeral neck resection angles (retroversion 29.9 degrees +/- 15.1 degrees and inclination 135.6 degrees +/- 9.1 degrees ), and glenoid reaming orientation relative to the native glenoid (+3.0 degrees +/- 6.3 degrees of version; -6.7 degrees +/- 4.4 degrees of inclination). This initial clinical experience with computer-aided shoulder navigation demonstrates that the procedure is safe and can provide valuable intraoperative measurements. With an anatomic humeral implant system, the navigation system provides real-time feedback on the humeral resection as it relates to anatomic neck geometry. The system also provides real-time angulation of the glenoid reamer relative to preoperative glenoid deformity. PMID:18262802

  19. In Vitro Assessment of Allowable Bone Loss for Implantation of a Zweymuller Stem for Total Hip Arthroplasty Revision Surgery

    E-print Network

    Valero-Cuevas, Francisco

    Abstract: Total hip arthroplasty patients typically experience some degree of stress shieldingIn Vitro Assessment of Allowable Bone Loss for Implantation of a Zweymuller Stem for Total Hip Arthroplasty Revision Surgery J. M. Inouye1 , E. Ebramzadeh2 , S. Sangiorgio2 1 Department of Biomedical

  20. In Vitro Assessment of Allowable Bone Loss for Implantation of a Zweymuller Stem for Total Hip Arthroplasty Revision Surgery

    E-print Network

    Valero-Cuevas, Francisco

    Introduction Total hip arthroplasty patients typically experience some degree of stress shieldingIn Vitro Assessment of Allowable Bone Loss for Implantation of a Zweymuller Stem for Total Hip Arthroplasty Revision Surgery J. M. Inouye1, E. Ebramzadeh2, S. Sangiorgio2 1Department of Biomedical

  1. Extreme variations in racial rates of total hip arthroplasty for primary coxarthrosis: a population-based study in San Francisco

    Microsoft Academic Search

    F T Hoaglund; C S Oishi; G G Gialamas

    1995-01-01

    OBJECTIVES--To compare the incidence of all total hip arthroplasty, and total hip arthroplasty for primary coxarthrosis, among the Asian, black, Hispanic, and white populations living in one locale. METHODS--We identified all San Francisco residents who underwent total hip replacements (THR) in the 17 hospitals for adults within or near San Francisco County during a five year period. Preoperative pelvic radiographs

  2. Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty

    Microsoft Academic Search

    Brian J. McGrory; Bernard F. Morrey; James A. Rand; Duane M. Ilstrup

    1996-01-01

    Questionnaires are commonly used in orthopaedic outcome studies. This study sought to determine if responses to a simple standardized questionnaire correlated with responses obtained during a physician interview in evaluation of clinical outcome following hip and knee arthroplasty. One hundred sixty-two patients with 201 hip and knee arthroplasties were asked to fill out a questionnaire prior to returning for routine

  3. A prospective analysis of the need for urinary catheterisation in the first 24 h post-primary arthroplasty

    Microsoft Academic Search

    G. Weekes; J. F. Quinlan; G. C. O’Toole; J. M. O’Byrne

    2006-01-01

    Urinary retention following total hip and knee arthroplasty is a common problem, frequently requiring catheterisation in the immediate post-operative period. The direct relationship between urinary tract instrumentation and deep sepsis in total hip replacements is well documented. This prospective study analysed 164 male patients who underwent primary arthroplasty between September 2004 and March 2005 inclusive. Upon admission and prior to

  4. Use of a Turndown Quadriceps Tendon Flap for Rupture of the Patellar Tendon After Total Knee Arthroplasty

    Microsoft Academic Search

    Po-Chun Lin; Jun-Wen Wang

    2007-01-01

    Patellar tendon rupture is a devastating complication after total knee arthroplasty. The results of surgical treatment of this complication were discouraging in most of the reports. We describe a case of rupture of patellar tendon 7 weeks after total knee arthroplasty treated with a turndown quadriceps flap and circumferential wiring. Two years and 6 months after operation, the patient had

  5. 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

  6. Static Versus Dynamic Splinting for Proximal Interphalangeal Joint Pyrocarbon Implant Arthroplasty: A Comparison of Current and Historical Cohorts

    Microsoft Academic Search

    Susan L. Murphy

    2011-01-01

    Study DesignNonrandomized mixed current and historical cohort follow-up study. The purpose of the study was to test the effectiveness of static splinting after arthroplasty in patients with osteoarthritis. Dynamic splinting is recommended after proximal interphalangeal joint pyrocarbon implant arthroplasty; however, static splinting may be more feasible to deliver. Nine consecutive patients received static splinting in this study. These patients were

  7. Confronting the Achievement Gap

    ERIC Educational Resources Information Center

    Gardner, David

    2007-01-01

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

  8. 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…

  9. The complexity gap

    Microsoft Academic Search

    L. B. S. Raccoon

    1995-01-01

    The Complexity Gap defines a new way to think about software development. We have all heard that developers need to be more productive and to work harder. But what does this mean exactly? The Complexity Gap defines a structure in which to explore concepts of process and productivity and to show how these concepts relate to conventional software development issues

  10. Gap year volunteer tourism

    Microsoft Academic Search

    Stephen Wearing; John Neil

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

  11. The acetabular component in total hip arthroplasty. Evaluation of different fixation principles.

    PubMed

    Thanner, J

    1999-08-01

    Initial stability is necessary for permanent fixation of acetabular cups. Biologic reactions to submicron particles such as localized bone resorption may lead to implant failure. The aim of the study was to evaluate different fixation principles of acetabular components. Four randomized studies and one case-control study were performed to evaluate different bone cements, different cup designs, use of ceramic coating or not, different type of screws and the need of additional screw fixation or not. Radiostereometry (RSA) makes it possible to analyze small translations and rotations of implants with a high accuracy. This method is suitable for evaluation of early stability and was used in four of the studies. Clinical and radiological follow-up were performed regularly. The cements were tested in the laboratory. 30 patients (mean age 71 years, range: 63-76) received total hip arthroplasties and were randomised to fixation with Boneloc (14) or Palacos cum gentamicin (16) bone cement. The curing temperature was 23 degrees lower for the Boneloc cement but the tensile strength was reduced and the elastic modulus was lower compared to Palacos. The proximal cup migration was greater in the Boneloc group up to 12 months (p 0.04) and these cups migrated medially in contrast to a small lateral migration seen in the Palacos group (p 0.04). Radiolucencies were more pronounced in the Boneloc group at 12 months (p 0.04). 155 patients (171 hips, mean age 50 years, range: 24-64) received uncemented hip arthroplasties. 84 hips were randomised to the PCA and 87 to the Harris-Galante I designs. The 10-year survival rates were 85% for the PCA and 99% for the Harris-Galante I cups (revision as end-point). The wear and clinical results did not differ. 43 patients (mean age 60 years, range 44-68) received uncemented porous cups with a titanium mesh in pure titanium (Harris-Galante II) and were randomised to additional fixation with either biodegradable screws (23, poly-L-lactic acid, PLLA) or screws made of titanium alloy (20). Increased proximal and medial-lateral translations (p 0.02, 0.04) but less rotation around the longitudinal axis (p 0.04) were seen in the PLLA group up to 2 years. There were also more pronounced radiolucencies anteriorly in this group at 2 years. The clinical results did not differ. 23 uncemented porous cups (Harris-Galante II) with hydroxyapatite-tricalciumphosphate coating (HA/TCP) were pair-wise matched to uncoated cups. Up to 2 years, decreased rotations around the horizontal axis were recorded in the HA/TCP-coated cups. Central postoperative gaps were more frequently seen in the HA/TCP group (p < 0.01), but at 2 years radiolucencies were more pronounced in the uncoated group (p < 0.01). The wear and clinical results did not differ. 62 patients (64 hips, mean age 56 years, range: 32-75) were randomized to porous Trilogy cups with (30) and without (34) cluster holes for additional screw fixation. Up to 2 years there were no differences in migration, wear, radiographic findings or clinical results. In conclusion Boneloc cement was associated with poor fixation due to inferior mechanical properties. The PLLA screws did not provide sufficient stability. Unacceptably high failure rates were recorded for the PCA cup. HA/TCP coating improved the fixation and the interface of porous cups. HA/TCP coated porous cups can be fixed without adjunctive screw fixation. PMID:10572504

  12. 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

  13. Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference?

    PubMed Central

    Karaguven, Dogac; Guclu, Berk; Kaya, Alper; Armangil, Mehmet; Cetin, Ilker

    2013-01-01

    Purpose. The use of uncemented unicompartmental knee prostheses has recently increased. However, few studies on the outcomes of uncemented unicompartmental knee prostheses have been performed. The purpose of this study was to compare the outcomes of cemented and uncemented Oxford unicompartmental knee arthroplasty. Materials and Methods. This retrospective observational study evaluated the clinical and radiological outcomes of 263 medial Oxford unicompartmental prostheses (141 cemented, 122 uncemented) implanted in 235 patients. The mean follow-up was 42 months in the cemented group and 30 months in the uncemented group. Results. At the last follow-up, there were no significant differences in the clinical results or survival rates between the two groups. However, the operation time in the uncemented unicompartmental knee arthroplasty group was shorter than that in the cemented unicompartmental knee arthroplasty group. In addition, the cost of uncemented arthroplasty was greater. Conclusion. Despite the successful midterm results in the uncemented unicompartmental knee arthroplasty group, a longer follow-up period is required to determine the best fixation mode. PMID:24383006

  14. Porous-coated uncemented components in experimental total hip arthroplasty in dogs. Effect of plasma-sprayed calcium phosphate coatings on bone ingrowth.

    PubMed

    Jasty, M; Rubash, H E; Paiement, G D; Bragdon, C R; Parr, J; Harris, W H

    1992-07-01

    The effect of a thin plasma-sprayed, calcium phosphate ceramic coating on bone ingrowth into titanium fiber mesh porous-surfaced prostheses was examined in a controlled canine cementless total hip arthroplasty model. Bone ingrowth was quantified using backscattered scanning electron microscopy of undemineralized sections. When good contact between the bone and porous coating was present, the calcium phosphate-coated prostheses contained significantly higher amounts of bone ingrowth at three weeks postimplantation than the uncoated control prostheses. At six weeks, however, there was no significant difference in the amount of bone ingrowth between the coated prostheses and uncoated prostheses. The ingrown bone seemed to be more intimately associated with the calcium phosphate-coated porous surfaces than the uncoated porous surfaces. When gaps at the bone-porous coating interface occurred, the calcium phosphate coating did not enhance bone ingrowth across those gaps. Plasma-sprayed calcium phosphate coatings may be useful in enhancing the early ingrowth of bone into porous-surfaced joint replacement prostheses, but they may lack long-term effectiveness. The coatings were not effective in enhancing bone ingrowth across gaps between the porous surface and the bone bed prepared at surgery. PMID:1611761

  15. 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

  16. Thermally induced strains and total shrinkage of the polymethyl-methacrylate cement in simplified models of total hip arthroplasty.

    PubMed

    Griza, Sandro; Ueki, Marcelo M; Souza, Dárcio H G; Cervieri, André; Strohaecker, Telmo R

    2013-02-01

    An evaluation of transient and stabilized strains in the cement mantle during polymerization was carried out in simplified cemented total hip arthroplasty (THA) model. A mathematical approach combined with a simple finite element simulation was used to compare measured and calculated stabilized strain values and to provide the Von Mises stresses at the stem/cement interface due to shrinkage related to temperature decrease after exothermal reaction. A second similar model was carried out to measure stem/cement/mold interfacial shear strength and dimensional changes of the cement mantle to obtain total shrinkage due to temperature decrease plus cement polymerization. The results indicated that positive strain peaks found during the exothermic stage of polymerization have the potential to produce pre-loading cracking. After the initial expansion, it was observed a progressive strain decrease pattern down to stabilized values that takes place near 2h after the cementation. Even though there is a great deal of dispersion in the measured stabilized strain values, in average those values match quite well with the numerical simulations, indicating 4,7 MPa von Mises interfacial stress due to thermal shrinkage. The total cement shrinkage leads to a negative radial stress of 11 MPa and 14 MPa von Mises interfacial stress. Finally, total shrinkage has the potential to enhance gaps in the cement/mold interface. PMID:23237878

  17. Bridging The Inferential Gap

    PubMed Central

    Stewart, Walter F.; Shah, Nirav R.; Selna, Mark J.; Paulus, Ronald A.; Walker, James M.

    2009-01-01

    Most clinical decisions involve bridging the inferential gap: Clinicians are required to “fill in” where they lack knowledge or where no knowledge yet exists. In this context we consider how the inferential gap is a product, in part, of how knowledge is created, the limits to gaining access to such knowledge, and the variable ways in which knowledge is translated into decisions. We consider how electronic health records (EHRs) will help narrow this gap by accelerating the creation of evidence relevant to everyday practice needs and facilitating real-time use of knowledge in practice. PMID:17259202

  18. Impact of declining reimbursement and rising hospital costs on the feasibility of total hip arthroplasty.

    PubMed

    Boardman, D L; Lieberman, J R; Thomas, B J

    1997-08-01

    Total hip arthroplasty, although a very successful clinical treatment, remains an expensive procedure in an era of constrained health care resources. Hospitalization cost, charge, and reimbursement data were compared between all patients who underwent elective, primary, unilateral total hip arthroplasty in 1988 and 1993 at the UCLA Medical Center. Although length of hospitalization decreased by 36%, increases both in unit supply costs and in the intensity of hospital services prevented a statistically significant reduction in total hospitalization cost. Reimbursement declined by 27% after calculating inflation with the Consumer Price Index for Medical Care. Further, the margin by which reimbursement exceeded cost decreased from 66% in 1988 to 8% in 1993. These trends constitute a serious threat to the financial feasibility of total hip arthroplasty. PMID:9268792

  19. Total hip arthroplasty after contralateral hip disarticulation: a challenging "simple primary".

    PubMed

    Murphy, Colin G; Bonnin, Michel P; A?t Si Selmi, Tarik

    2015-05-01

    Patients with lower limb amputation have a high incidence of hip and knee osteoarthritis in both the residual limb and the contralateral limb. Hip disarticulation is a radical surgery usually performed in younger patients after malignancy or trauma. Compliance is poor with existing prostheses, resulting in increased dependency on and use of the remaining sound limb. We describe a case of a crutch-walking 51-year-old woman who presented with severe left hip arthritis 25 years after a right hip disarticulation, and was treated with total hip arthroplasty. Total hip arthroplasty without a contralateral hip joint is challenging. We discuss the complex technical considerations associated with the patient's arthroplasty, in particular the selection of prostheses and bearing surfaces, and the preoperative and intraoperative assessment of limb length and offset. PMID:25950539

  20. Hip Arthroplasty and its Revision in a Child: Case Report and Literature Review

    PubMed Central

    Gharehdaghi, Mohammad; Rahimi, Hasan; Eshraghi, Reza; Mousavian, Alireza; Assadian, Maryam

    2015-01-01

    Juvenile idiopathic arthritis is the leading cause of hip replacement in young children. However, arthroplasty in this population is challenging with several concerns about quality of the growing bone, young age for revision surgery, and difficulties in potential several revisions. In this study we introduce a case of a 12-year old who is one of the youngest patients to undergo revision hip arthroplasty. The index operation was done as a hybrid replacement, cemented for stem and press fit for acetabular component. Two years later revision was done with severe femoral deficiency. This second procedure was challenging but with short-term promising results. So we reviewed the literature for arthroplasty in this young population regarding recent findings and trends. According to the literature survival of the prosthesis is longer with a cemented acetabular component and press fit stem; however, there are evidences that show poor outcome of joint replacement after the first revision in juvenile idiopathic arthritis patients.

  1. The Effect of BMI on 30 Day Outcomes Following Total Joint Arthroplasty.

    PubMed

    Alvi, Hasham M; Mednick, Rachel E; Krishnan, Varun; Kwasny, Mary J; Beal, Matthew D; Manning, David W

    2015-07-01

    Hip and knee arthroplasty (THA, TKA) are safe, effective procedures with reliable, reproducible outcomes. We aim to investigate obesity's effect on complications following arthroplasty surgery. Using the American College of Surgeons-National Surgical Quality Improvement Program database, 13,250 subjects were stratified into 5 groups based on BMI and matched for gender, age, surgery type and ASA class. Matched, multivariable generalized linear models adjusting for demographics and comorbidities demonstrated an association between elevated BMI and overall (P<0.001), medical (P=0.005), surgical complications (P<0.001), including superficial (P=0.019) and deep wound infection (P=0.040), return to OR (P=0.016) and time from OR to discharge (P=0.003). Elevated BMI increases risk for post-operative complications following total joint arthroplasty. PMID:25683294

  2. The Impact of Study Period on Perioperative Outcomes Following Hip Arthroplasty.

    PubMed

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

    2015-07-01

    We hypothesized that the time period studied would have a greater impact on perioperative outcomes than the hip arthroplasty procedure performed, demonstrating concerns with studies comparing new techniques to "historical" controls. One hundred total hip arthroplasty (THA) and 100 surface replacement arthroplasty (SRA) patients performed between 2004 and 2010 ("historical" period) were matched and compared to 50 THA and 50 SRA patients performed between 2010 and 2012 ("recent" period). Time to discharge was significantly improved for both the THA and SRA groups in the recent versus historical period by 16hours (P<0.001). At both periods, THA patients were discharged earlier by 9hours versus SRAs (P<0.0001). Study time frame had a greater impact than the operative procedure on perioperative metrics. PMID:25682207

  3. 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

  4. Functional outcomes for 2 years comparing hip resurfacing and total hip arthroplasty.

    PubMed

    MacKenzie, James R; O'Connor, Gregory J; Marshall, Deborah A; Faris, Peter D; Dort, Leslie C; Khong, Hoa; Parker, Robyn D; Werle, Jason R; Beaupre, Lauren A; Frank, Cyril B

    2012-05-01

    This prospective observational study of 499 patients with hip resurfacing and 255 patients with total hip arthroplasty compared outcomes for 2 years. We used propensity scores to identify matched cohorts of 118 patients with hip resurfacing and 118 patients with total hip arthroplasty. We used these cohorts to compare improvements in the Western Ontario and McMaster University (WOMAC) osteoarthritis index and Medical Outcomes Short-Form 36 physical function component (SF-36 PF) scores at 3 months and at 1 and 2 years postsurgery. Both groups demonstrated significant improvements from baseline in WOMAC and SF-36 PF. Improvements in SF-36 PF were greater for patients with hip resurfacing than for patients with total hip arthroplasty 1 and 2 years postsurgery; improvements in WOMAC were similar for both groups. The clinical significance of this observation needs further investigation. PMID:22285258

  5. Unusual mechanical complications of unicompartmental low contact stress mobile bearing patellofemoral arthroplasty: a cause for concern?

    PubMed

    Arumilli, B R B; Ng, A B Y; Ellis, D J; Hirst, P

    2010-10-01

    The Low Contact Stress Patellofemoral Arthroplasty (LCS PFA) is a newer design belonging to the second generation of inlay type implants, addressing the problems encountered in the first generation models (Lubinus & Richard's). The cemented mobile bearing metal backed patellar component in this system is "modular"; allowing interchangeable usage with either the trochlear component in a PFA or the femoral component of a total knee arthroplasty, thus obviating the need for patellar revision during conversion of PFA to TKA. The younger active patient with a PFA may exert extreme joint reaction forces on their patellar implant, rendering early loosening of the patellar implant. The endurance of this implant with repeated flexion beyond 90 degrees is also a concern. We describe a series of three unusual mechanical failures associated with this particular design of metal backed patellar component of the unicompartmental LCS patellofemoral arthroplasty. PMID:19897372

  6. Management of pelvic discontinuity in revision total hip arthroplasty: a review of the literature.

    PubMed

    Abdelnasser, Mohammad K; Klenke, Frank M; Whitlock, Patrick; Khalil, Aly M; Khalifa, Yaser E; Ali, Hassan M; Siebenrock, Klaus A

    2015-04-20

    Pelvic discontinuity is a complex problem in revision total hip arthroplasty. Although rare, the incidence is likely to increase due to the ageing population and the increasing number of total hip arthroplasties being performed. The various surgical options available to solve this problem include plating, massive allografts, reconstruction rings, custom triflanged components and tantalum implants. However, the optimal solution remains controversial. None of the known methods completely solves the major obstacles associated with this problem, such as restoration of massive bone loss, implant failure in the short- and long-term and high complication rates. This review discusses the diagnosis, decision making, and treatment options of pelvic discontinuity in revision total hip arthroplasty. PMID:25385048

  7. 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...

  8. Total hip arthroplasty in young adults, with focus on Perthes' disease and slipped capital femoral epiphysis

    PubMed Central

    2012-01-01

    Background and purpose Pediatric hip diseases account for 9% of all primary hip arthroplasties in the Norwegian Arthroplasty Register. We wanted to validate the diagnosis as reported to the register and to assess the quality of life of these patients after hip replacement. Patients and methods 540 patients accepted to participate in this follow-up study (634 hips). All were less than 40 years of age and had been reported to the Norwegian Arthroplasty Register as having undergone a primary total hip arthroplasty (THA) between 1987 and 2007. The underlying diagnosis, age at diagnosis, and type of treatment given prior to the hip replacement were recorded from the original hospital notes. Results The diagnoses reported to the Norwegian Arthroplasty Register were confirmed to be correct in 91% of all cases (538/592). For the 94 hips that had been treated due to Perthes' disease or slipped capital femoral epiphysis (SCFE), the diagnosis was verified in 95% of cases (89/94). The corresponding proportion for inflammatory hip disease was 98% (137/140) and it was only 61% for primary osteoarthritis (19/31). The self reported quality of life (EQ-5D) was poorer for these young patients with THA than for persons in age-matched cohorts from Great Britain and Sweden, except for those with an underlying SCFE. Interpretation The diagnoses reported to the Norwegian Arthroplasty Register as the underlying cause of THA were correct in 91% of cases. Individuals who undergo THA before the age of 40 have a reduced quality of life, except for those requiring a hip replacement because of SCFE. PMID:22112152

  9. Rab GEFs and GAPs

    PubMed Central

    Barr, Francis; Lambright, David G.

    2010-01-01

    Rabs are GTP-binding proteins with conserved functions in membrane trafficking. They are regulated by a diverse group of structurally unrelated GDP-GTP exchange factors (GEFs), and a family of GTP-hydrolysis activating proteins (GAPs) containing the conserved TBC domain. Recent structural and cell biological studies shed new light on the mechanisms of Rab GEF and GAP action, and the cellular trafficking pathways they act in. PMID:20466531

  10. 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

  11. Orthopaedic crossfire--Stem modularity is unnecessary in revision total hip arthroplasty: in the affirmative.

    PubMed

    Barrack, Robert L

    2003-04-01

    Numerous options are available for femoral stem fixation in revision total hip arthroplasty, including cemented stems, proximally-coated cementless stems, extensively coated cementless stems, impaction grafting cemented stems, and modular cementless stems. In terms of versatility, ease of insertion, use with an extended trochanteric osteotomy, and clinical results, extensively coated cementless stems remain the gold standard. Modular cementless stems have not matched the clinical results of extensively coated cementless stems. In addition, modular stems introduce increased complexity, cost, and potential complications and are therefore, rarely, if ever, necessary in revision total hip arthroplasty. PMID:12730940

  12. The Salto Total Ankle Arthroplasty: Survivorship and Analysis of Failures at 7 to 11 years

    Microsoft Academic Search

    Michel Bonnin; Fabrice Gaudot; Jean-Raphael Laurent; Scott Ellis; Jean-Alain Colombier; Thierry Judet

    2011-01-01

    Background  Despite the appearance of new-generation, mobile-bearing, cementless prostheses, total ankle arthroplasty remains controversial.\\u000a Among the criteria guiding the choice between arthrodesis and arthroplasty, the long-term survival and postoperative function\\u000a are of critical importance. The mobile-bearing Salto prosthesis has been used in Europe since 1997, but only 2 to 5 years\\u000a of followup data have been reported.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We analyzed the longer-term survivorship

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

    PubMed

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

    2014-11-01

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

  14. Analgesic Techniques in Hip and Knee Arthroplasty: From the Daily Practice to Evidence-Based Medicine

    PubMed Central

    Anastase, Denisa Madalina; Cionac Florescu, Simona; Munteanu, Ana Maria; Ursu, Traian; Stoica, Cristian Ioan

    2014-01-01

    Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are major orthopedic surgery models, addressing mainly ageing populations with multiple comorbidities and treatments, ASA II–IV, which may complicate the perioperative period. Therefore effective management of postoperative pain should allow rapid mobilization of the patient with shortening of hospitalization and social reintegration. In our review we propose an evaluation of the main analgesics models used today in the postoperative period. Their comparative analysis shows the benefits and side effects of each of these methods and guides us to how to use evidence-based medicine in our daily practice. PMID:25484894

  15. 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.

  16. Osseointegration of Fitmore stem in total hip arthroplasty.

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. 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

  20. 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

  1. Ceramic on ceramic hip arthroplasty in fused hips

    PubMed Central

    Park, Kyung-Soon; Yoon, Taek-Rim; Lee, Tae-Min; Ahn, Yeong-Seub

    2015-01-01

    Background: Most literature in the field of total hip arthroplasty (THA) for fused hips, until date has reported the results of using metal on polyethylene and ceramic on polyethylene bearings. Results of THA using ceramic on ceramic (CoC) bearings in fused hips have not been published in literature. This study reports the results of cementless THA using CoC articulation perfomed in fused hips. Materials and Methods: Twenty-three patients (25 hips) with fused hips underwent conversion to THA using CoC bearings and were followed up for a mean 5.4 years. The conventional posterolateral approach was used in 15 hips, a modified two incision technique in 7 hips and a direct lateral approach with greater trochanteric osteotomy in 3 hips. Postoperatively, range of motion exercises were encouraged after 2–3 days of bed rest and subsequent gradual weight bearing using crutches was begun. Results: Mean Harris hip score improved from 42.4 to 84.2 and mean leg lengthening of 36.6 mm was achieved. In the average 5.4 years (range 2.8-9.1 years) followup there were no cases with osteolysis around acetabular cup and femoral stem. In this study, there was no case of ceramic fracture. There was one case of squeaking. Conclusion: This study suggests that cementless THA performed for fused hips with CoC bearings can provide good early clinical results. PMID:26015635

  2. Indoor and Outdoor Mobility following Total Knee Arthroplasty

    PubMed Central

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

    2013-01-01

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

  3. 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

  4. Patient activity after total hip arthroplasty declines with advancing age.

    PubMed

    Kinkel, Stefan; Wollmerstedt, Nicole; Kleinhans, Jennifer A; Hendrich, Christian; Heisel, Christian

    2009-08-01

    Evaluation of patient activity is essential for clinical decision making before THA. To correlate age progression to patient activity after THA, we determined the number of walking cycles of 105 patients in different age groups by decades. Patients on average performed 6144 walking cycles per day (2.24 million cycles per year). Men were more active than women. The highest activity occurred in patients between 50 and 59 years of age, with a constant decrease in activity with advancing age. However, within age groups, we observed up to sixfold differences in the number of walking cycles per day. In addition to declining activity with advancing age, higher body mass index correlated with lower step counts. The high mean measured number of walking cycles, which were even higher than those reported for subjects without an arthroplasty, suggests patients benefit from THA. Female gender, advanced age, and obesity correlated with lower activity. Owing to the high intragroup variability of our results, preoperative evaluation of patient activity levels, individual patient factors, and patient demands, should be considered in clinical practice. PMID:19247729

  5. Testing of silicon nitride ceramic bearings for total hip arthroplasty.

    PubMed

    Bal, B Sonny; Khandkar, Ashok; Lakshminarayanan, R; Clarke, Ian; Hoffman, Aaron A; Rahaman, Mohamed N

    2008-11-01

    Modern ceramic bearings used in total hip arthroplasty (THA) consist of a femoral head (ball) articulating inside a hemispherical acetabular cup (socket); the ball and socket are made of alumina (Al(2)O(3)) and Al(2)O(3)-based composite materials. In the present study, total hip bearings were made from a different ceramic material, silicon nitride (Si(3)N(4)), by sintering and hot isostatic pressing of powders. The resulting material had improved mechanical properties over modern Al(2)O(3) THA bearings, with a flexural strength of 920 +/- 70 MPa, a Weibull modulus of 19, and a fracture toughness of 10 +/- 1 MPa m(1/2). Unlike zirconia-based ceramics that have also been used in THA, accelerated aging of Si(3)N(4) did not adversely affect the flexural strength. In simulated wear tests, Si(3)N(4) acetabular cups produced low-volumetric wear whether articulating against Si(3)N(4) or cobalt-chromium (CoCr) femoral heads. The results of this investigation suggest that Si(3)N(4) may allow improved THA bearings that combine the reliability of metal femoral heads with the low wear advantages of ceramic materials. PMID:18491410

  6. Fixed or mobile-bearing total knee arthroplasty

    PubMed Central

    Huang, Chun-Hsiung; Liau, Jiann-Jong; Cheng, Cheng-Kung

    2007-01-01

    Fixed and mobile-bearing in total knee arthroplasty are still discussed controversially. In this article, biomechanical and clinical aspects in both fixed and mobile-bearing designs were reviewed. In biomechanical aspect, the mobile-bearing design has proved to provide less tibiofemoral contact stresses under tibiofemoral malalignment conditions. It also provides less wear rate in in-vitro simulator test. Patients with posterior stabilized mobile-bearing knees had more axial tibiofemoral rotation than patients with posterior stabilized fixed-bearing knees during gait as well as in a deep knee-bend activity. However, in clinical aspect, the mid-term or long-term survivorship of mobile-bearing knees has no superiority over that of fixed-bearing knees. The theoretical advantages for mobile-bearing design to provide a long-term durability have not been demonstrated by any outcome studies. Finally, the fixed-bearing design with all-polyethylene tibial component is suggested for relatively inactive, elder people. The mobile-bearing design is suggested for younger or higher-demand patients due to the potential for reduced polyethylene wear and more normal kinematics response after joint replacement. For younger surgeon, the fixed-bearing design is suggested due to less demand for surgical technique. For experienced surgeon, one familiar surgical protocol and instrumentation is suggested rather than implant design, either fixed-bearing or mobile-bearing. PMID:17204165

  7. Calibration Markers for Digital Templating in Total Hip Arthroplasty

    PubMed Central

    Boese, Christoph Kolja; Lechler, Philipp; Rose, Leonard; Dargel, Jens; Oppermann, Johannes; Eysel, Peer; Geiges, Hansjörg; Bredow, Jan

    2015-01-01

    Digital templating with external calibration markers is the standard method for planning total hip arthroplasty. We determined the geometrical basis of the magnification effect, compared magnification with external and internal calibration markers, and examined the influence on magnification of the position of the calibration markers, patient weight, and body mass index (BMI). A formula was derived to calculate magnification with internal and external calibration markers, informed by 100 digital radiographs of the pelvis. Intraclass correlations between the measured and calculated values and the strength of relationships between magnification, position and distance of calibration markers and height, weight, and BMI were sought. There was a weak correlation between magnification of internal and external calibration markers (r = 0.297–0.361; p < 0.01). Intraclass correlations were 0.882–1.000 (p = 0.000) for all parameters. There were also weak correlations between magnification of internal and external calibration markers and weight and BMI (r = 0.420, p = 0.000; r = 0.428, p = 0.000, respectively). The correlation between external and internal calibration markers was poor, indicating the need for more accurate calibration methods. While weight and BMI weakly correlated with the magnification of markers, future studies should examine this phenomenon in more detail. PMID:26168410

  8. Meniscal Bearing Dislocation of Unicompartmental Knee Arthroplasty with Faint Symptom

    PubMed Central

    Fujii, Tadashi; Matsui, Yoshio; Noboru, Marehoshi; Inagaki, Yusuke; Kadoya, Yoshinori; Tanaka, Yasuhito

    2015-01-01

    We experienced two cases of atypical lateral dislocations of meniscal bearing in UKA (unicompartmental knee arthroplasty) without manifest symptoms. The dislocated bearing, which jumped onto the wall of tibial components, was found on radiographs in periodic medical examination although they could walk. Two thicker size bearing exchanges were promptly performed before metallosis and loosening of components. Continual examination is important to mobile bearing type of UKA because slight or less symptoms may disclose such unique dislocation. One case showed malrotation of the femoral component on 3D image. Anteroposterior view hardly disclosed the malrotation of the femoral component. Epicondylar view is an indispensable view of importance, and it can demonstrate the rotation of the femoral component. The the femoral distal end is wedge shaped and is wider posteriorly. If the femoral component is set according to the shape of medial condyle, the femoral component shifts to medial site compared with tibial component in flexion. It can account for such rare dislocation as follows. If excessive force applies on most medial side of the bearing during flexion, the lateral part of the bearing pops and the force squeezes it laterally simultaneously. Finally, the bearing jumps onto the lateral wall of the tibial component. PMID:26137336

  9. Non-arthroplasty treatment of osteoarthritis of the knee.

    PubMed

    Sanders, James O; Murray, Jayson; Gross, Leeaht

    2014-04-01

    The American Academy of Orthopaedic Surgeons has developed an Appropriate Use Criteria (AUC) on the Non-Arthroplasty Treatment of Osteoarthritis of the Knee (OAK). Evidence-based information, in conjunction with clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The OAK AUC clinical scenarios were derived from patient indications that generally accompany OAK as well as from the current evidence-based clinical practice guidelines and its supporting literature. The 576 patient scenarios and 10 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, the Review Panel, a separate group of volunteer physicians, independently reviewed these materials to ensure that they were representative of patient scenarios clinicians are likely to encounter in daily practice. Finally, the multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3). The final appropriateness ratings assigned by the voting panel can be accessed online via the AAOS OAK AUC web-based mobile application at: www.aaos.org/aucapp. PMID:24668355

  10. Polyethylene Oxidation in Total Hip Arthroplasty: Evolution and New Advances

    PubMed Central

    Gómez-Barrena, Enrique; Medel, Francisco; Puértolas, José Antonio

    2009-01-01

    Ultra-high molecular weight polyethylene (UHMWPE) remains the gold standard acetabular bearing material for hip arthroplasty. Its successful performance has shown consistent results and survivorship in total hip replacement (THR) above 85% after 15 years, with different patients, surgeons, or designs. As THR results have been challenged by wear, oxidation, and liner fracture, relevant research on the material properties in the past decade has led to the development and clinical introduction of highly crosslinked polyethylenes (HXLPE). More stress on the bearing (more active, overweighted, younger patients), and more variability in the implantation technique in different small and large Hospitals may further compromise the clinical performance for many patients. The long-term in vivo performance of these materials remains to be proven. Clinical and retrieval studies after more than 5 years of in vivo use with HXLPE in THR are reviewed and consistently show a substantial decrease in wear rate. Moreover, a second generation of improved polyethylenes is backed by in vitro data and awaits more clinical experience to confirm the experimental improvements. Also, new antioxidant, free radical scavengers, candidates and the reinforcement of polyethylene through composites are currently under basic research. Oxidation of polyethylene is today significantly reduced by present formulations, and this forgiving, affordable, and wellknown material is still reliable to meet today’s higher requirements in total hip replacement. PMID:20111694

  11. Prosthesis design and placement in reverse total shoulder arthroplasty.

    PubMed

    Ackland, David C; Patel, Minoo; Knox, David

    2015-01-01

    The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty (RSA) was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy. While this procedure has been known to reduce pain, improve strength and increase range of motion in shoulder elevation, scapular notching, rotation deficiency, early implant loosening and dislocation have attributed to complication rates as high as 62 %. Patient selection, surgical approach and post-operative management are factors vital to successful outcome of RSA, with implant design and component positioning having a significant influence on the ability of the shoulder muscles to elevate, axially rotate and stabilise the humerus. Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability. Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function. This review discusses the behaviour of the shoulder after RSA and the influence of implant design, component positioning and surgical technique on post-operative joint function and clinical outcome. PMID:26135298

  12. 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

  13. Bone healing of severe acetabular defects after revision arthroplasty

    PubMed Central

    Sörensen, Jens; Nilsson, Olle

    2009-01-01

    Background and purpose Healing of acetabular bone grafts may be difficult to assess in conventional radiographs. We used PET to analyze healing of morselized bone allografts, impacted in large osteolytic acetabular defects at revision arthroplasty. Patients and methods 7 cases had a cup revision because of loosening, with repair of a segmental defect using a perforated, wide and thin plate. The osteolytic acetabulum was impacted with morselized bone allograft before cementing a polyethylene cup. [18F]-fluoride PET scans were used to monitor bone healing inside the graft bed 1 week, 4 weeks, and 12 months after surgery. The contralateral pelvic bone above the acetabulum was used as reference. A second group of 4 cases was analyzed for bone-forming activity in the state of mechanical loosening of an acetabular component of a THA. Results Preoperatively, the uptake was raised by 64% compared to the reference. 1 week after surgery it was increased by 77% in segmental regions, while the uptake was at the reference level in cavitary regions. After 4 months the uptake was increased by 91% in cavitary regions and by 117% in segmental regions. 1 year after surgery, the increase in uptake was 20% in both regions. All implants were stable on radiographs. InterpretationWe found PET to be a sensitive and useful method for evaluation of the spatial and temporal development of bone formation. PMID:19404799

  14. Arthroplasty in young adults: options, techniques, trends, and results.

    PubMed

    Mody, Bharat S; Mody, Kshitij

    2014-06-01

    Total knee arthroplasty (TKA) has been established as a very successful and commonly performed procedure for primary and secondary osteoarthritis, and also for inflammatory arthropathies of the knee in all age groups and both genders. It has predominantly been used as a procedure in the age group of patients 65 years and above. Consequently, the literature is replete with data relevant to various issues associated with TKA in the above 65 years age group population. Although there is reasonable clarity and consensus on the broad parameters of the use of TKA in the above 65 years age group (older), this cannot be said for the same issue as relevant to the below 65 years age group (young adults). Over the last 2 decades there has been an increasing tendency toward the use of TKA in young adults, with some countries reporting a 5-fold increase in the last 10 years [1]. The present article is designed to review the most recent literature specific to this subject and assess it vis-à-vis various issues as listed in the subsequent text, with the aim of highlighting evolving thoughts and trends, which could be useful for decision making by clinicians practicing in the community. PMID:24677185

  15. 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

  16. Thermal necrosis after simultaneous tibial osteotomy and total knee arthroplasty using press-fit extension-stem.

    PubMed

    Ishida, Kazunari; Tsumura, Nobuhiro; Takayama, Koji; Fukase, Naomasa; Kitagawa, Atsushi; Chin, Takaaki; Iguchi, Tetsuhiro; Matsumoto, Tomoyuki; Kubo, Seiji; Kurosaka, Masahiro; Kuroda, Ryosuke

    2011-01-01

    One-staged tibial corrective osteotomy and total knee arthroplasty is a challenging but effective treatment for arthritic knees with extra-articular deformity. Although osteocutaneous thermal necrosis is accepted as a complication of intramedullary reamed nailing following long bone fractures, only 15 cases have been reported in the English literature at present. This report illustrates a rare case of thermal necrosis in a patient undergoing tibial corrective osteotomy coincident with long-stemmed total knee arthroplasty. Excessive reaming with a machine reamer is hypothesized as the cause of this serious complication. In this report, we highlight this rare but serious complication after long-stemmed total knee arthroplasty. PMID:20532867

  17. Bariatric Surgery Prior to Total Joint Arthroplasty May Not Provide Dramatic Improvements In Post Arthroplasty Surgical Outcomes

    PubMed Central

    Paxton, Elizabeth W.; Fisher, David; Li, Robert A.; Barber, Thomas C.; Singh, Jasvinder A.

    2014-01-01

    This study compared the total joint arthroplasty (TJA) surgical outcomes of patients who had bariatric surgery prior to TJA to TJA patients who were candidates but did not have bariatric surgery. Patients were retrospectively grouped into: Group 1 (n=69), those with bariatric surgery >2 years prior to TJA, Group 2 (n=102), those with surgery within 2 years of TJA, and Group 3 (n=11,032), those without bariatric surgery. In Group 1, 2.9% (95%CI 0.0–6.9%) had complications within 1 year compared to 5.9% (95%CI 1.3–10.4%) in Group 2, and 4.1% (95%CI 3.8–4.5%) in Group 3. 90-day readmission (7.2%, 95%CI 1.1–13.4%) and revision density (3.4/100 years of observation) was highest in Group 1. Bariatric surgery prior to TJA may not provide dramatic improvements in post-operative TJA surgical outcomes. PMID:24674730

  18. 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

  19. GAP PROGRAM SIX YEAR REVIEW

    E-print Network

    Ronquist, Fredrik

    GAP PROGRAM SIX YEAR REVIEW Background for $250,000 request for FY 2011-12 budget year 10/1/2013 1 to take 10-15 years. #12;GAP HISTORY ­ 6 years in · 11 Competitions (69 proposals). 6 years · 37 Projects down by GAP committee #12;Learning As We Go · Members of GAP Committee Assigned as Year Long Mentor

  20. Tunable photonic band gap fiber

    Microsoft Academic Search

    R. T. Bise; R. S. Windeler; K. S. Kranz; C. Kerbage; B. J. Eggleton; D. J. Trevor

    2002-01-01

    The ability to change the photonic band gap structure continuously and reversibly by modifying the index thermally allows the band gap features to be sensitively tuned, allowing for a thorough investigation of the various band gap guiding properties. Furthermore, it may be possible to use this type of band gap fiber as a tunable filter. Investigations of the dispersion properties

  1. [Gap junctions and secretion].

    PubMed

    Haefliger, Jacques-Antoine; Allagnat, Florent; Krattinger, Nathalie; Martin, David; Waeber, Gérard; Nicod, Pascal; Meda, Paolo

    2005-04-27

    The emergence of multicellular organisms has necessitated the development of mechanisms for interactions between adjacent and distant cells. A consistent feature of this network is the expression of gap junction channels between the secretory cells of all glands so far investigated in vertebrates. Here, we reviewed the distribution of the gap junctions proteins, named connexins, in a few mammalian glands, and discussed the recent evidence pointing to the participation of these proteins in the functioning of endocrine and exocrine cells. Specifically, available data indicate the importance of gap junctions for the proper control of glucose-induced insulin secretion. Understanding the functions of beta-cell connexins are crucial for the engineering of surrogate cells, which is necessary for implementation of a replacement cell therapy in diabetic patients. PMID:15943000

  2. 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.

  3. 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.

  4. [Gap functions and diseases].

    PubMed

    Allagnat, Florent; Krattinger, Nathalie; Nicod, Pascal; Meda, Paolo; Haefliger, Jacques-Antoine

    2005-04-27

    Gap junctions are highly conserved structures that provide cells with a direct pathway for sharing ions, nutrients and other intracellular messengers, thus participating to the homeostasis of various tissues. Research on transgenic mice has revealed a major involvement of gap junctions proteins (connexins) in several cellular functions. At the same time, an increasing number of mutations of connexin genes has been linked to several hereditary diseases, including peripheral neuropathies, skin diseases, genetic deafness, cataracts and some forms of epilepsy. This review summarizes the state of knowledge about the implication of connexins in human pathologies. PMID:15942999

  5. 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."

  6. Incidence and Time Course of Thromboembolic Outcomes Following Total Hip or Knee Arthroplasty

    Microsoft Academic Search

    Richard H. White; Patrick S. Romano; Hong Zhou; Juan Rodrigo; William Bargar

    boembolism was made after hospital discharge in 76% and 47% of the total hip and total knee arthroplasty cases, respectively (P,.001), with a median time of diagnosis of 17 days and 7 days after surgery, respectively (P,.001). Questionnaire results indicated that 95% of all cases re- ceived thromboprophylaxis and that the frequency, type, and duration of thromboprophylaxis was virtually iden-

  7. Eccentricity Error Correction for Automated Estimation of Polyethylene Wear after Total Hip Arthroplasty

    E-print Network

    St Andrews, University of

    Eccentricity Error Correction for Automated Estimation of Polyethylene Wear after Total Hip Arthroplasty Stuart Kerrigana, Stephen J. McKennab , Ian W. Rickettsb and Carlos Wigderowitzc a 9SY Abstract. Acetabular wear of total hip replacements can be estimated from radiographs based

  8. The effect of total knee arthroplasty design on extensor mechanism function

    Microsoft Academic Search

    Ormonde M. Mahoney; Christian D. McClung; Mylene A. dela Rosa; Thomas P. Schmalzried

    2002-01-01

    The effect of total knee arthroplasty design on extensor mechanism function was evaluated prospectively in a consecutive, single-surgeon series. Group 1 knees (n = 83) were implanted with a prosthesis that has a multiradius femoral component, and group 2 knees (n = 101) were implanted with a femoral prosthesis that has a single flexion-extension axis. Group 2 knees gained flexion

  9. Intraoperative passive kinematics of osteoarthritic knees before and after total knee arthroplasty

    Microsoft Academic Search

    Robert A. Siston; Nicholas J. Giori; Stuart B. Goodman; Scott L. Delp

    2006-01-01

    Totalkneearthroplastyisasuccessfulproceduretotreatpainandfunctionaldisability duetoosteoarthritis. However,preciselyhowatotalkneearthroplasty changesthekinematics of an osteoarthritic knee is unknown. We used a surgical navigation system to measure normal passive kinematics from 7 embalmed cadaver lower extremities and in vivo intraoperative passive kinematics on 17 patients undergoing primary total knee arthroplasty to address two questions: How do the kinematics of knees with advanced osteoarthritis differ from normal knees?; and, Does

  10. Effects of acetabular abduction on cup wear rates in total hip arthroplasty

    Microsoft Academic Search

    H. Del Schutte; Andrew J. Lipman; Stephen M. Bannar; John T. Livermore; Duane Ilstrup; Bernard F. Morrey

    1998-01-01

    This study was designed to determine the effect of acetabular abduction on the polyethylene wear rates of the acetabular component. The hypothesis of this study is that acetabular placement, in particular abduction, effects contact forces and therefore polyethylene wear. A total of 364 total hip arthroplasties that were performed between 1974 and 1976 were included in this study. The cemented

  11. Total Elbow Arthroplasty in Patients Forty Years of Age or Less

    Microsoft Academic Search

    Bernard F. Morrey

    2009-01-01

    Background: It is generally accepted that prosthetic elbow replacement should be avoided in young patients because of an anticipated high rate of early failure. The purpose of this paper was to define the success, prosthetic survival rate, and problems encountered in patients who were treated with a semiconstrained total elbow arthroplasty when they were forty years of age or less.

  12. Effects of Prosthesis Stem Tapers on Stress Distribution of Cemented Hip Arthroplasty

    Microsoft Academic Search

    Abdul Halim Abdullah; Mohd Asri Mohd Nor; Alias Mohd Saman; Mohd Nasir Tamin; Mohammed Rafiq Abdul Kadir

    2010-01-01

    Aseptic loosening effects are critical issues in encouraging long term stability of cemented hip arthroplasty. Stress shielding is believed to be an important factor that contributes to the aseptic loosening problems. The numerous changes in the prosthesis stem design are intended to minimize the stress shielding and aseptic loosening problems and to improve the long term performance of the implants.

  13. Stress and Strain Distribution in Cemented Total Hip Arthroplasty for Walking Load Case

    Microsoft Academic Search

    Abdul Halim Abdullah; Mohd Asri Mohd Nor; Alias Mohd Saman

    2009-01-01

    Aseptic loosening is the critical reason for the failure of the cemented total hip arthroplasty. It occurs due to bone remodeling triggered by stress shielding and cement mantle fracture. In this study, stress shielding and bone thickening phenomenon of the cemented THA femur was analysed using three dimensional finite element method for walking load case. The intact femur is modeled

  14. Suture Anchor Repair of Quadriceps Tendon Rupture After Total Knee Arthroplasty

    Microsoft Academic Search

    Tae Won B. Kim; Atul F. Kamath; Craig L. Israelite

    2011-01-01

    Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the

  15. The Incidence of Venous Emboli During Extramedullary Guided Total Knee Arthroplasty

    Microsoft Academic Search

    Jonathan L. Parmet; Jan C. Horrow; Gregory Pharo; Lawrence Collins; Arnold T. Berman; Henry Rosenberg

    1996-01-01

    During total knee arthroplasty (TKA), instrumenta- tion of the marrow cavity with an intramedullary guide appears responsible for fatal intraoperative pulmonary embolism. Transesophageal echocardi- ography demonstrates venous emboli (VE) after tourniquet deflation during intramedullary guided TKA. Extramedullary guides avoid manipulating the marrow cavity. We determined the incidence of VE in 20 patients undergoing extramedullary guided TKA. Recordings of hemodynamic variables,

  16. The Incidence of Large Venous Emboli During Total Knee Arthroplasty Without Pneumatic Tourniquet Use

    Microsoft Academic Search

    Jonathan L. Parmet; Jan C. Horrow; Arnold T. Berman; Francis Miller; Gregory Pharo; Lawrence Collins

    1998-01-01

    Echogenic venous emboli accompany tourniquet defla- tion during total knee arthroplasty. Two types of echo- genie emboli appear in the central circulation: small ve- nous emboli (miliary emboli) and large venous emboli (masses of echogenic material superimposed on miliary emboli). Presumably, medullary cavity trespass re- leases small and large echogenic emboli. However, pa- tients undergoing lower extremity procedures with a

  17. The effects of early rollback in total knee arthroplasty on stair stepping

    Microsoft Academic Search

    Louis F. Draganich; G. A. Piotrowski; John Martell; L. A. Pottenger

    2002-01-01

    We investigated the effects of early compared with late (ie, in flexion) rollback on quadriceps efficiency during stair stepping. We studied 10 patients with the IB II (Zimmer, Warsaw, IN) total knee arthroplasty (TKA), designed to enforce rollback at 73° of knee flexion; 9 patients with the Maxim PS (Biomet, Inc, Warsaw, IN) TKA, designed to enforce rollback between 20°

  18. Mismatched wear couple zirconium oxide and aluminum oxide in total hip arthroplasty

    Microsoft Academic Search

    Michael Morlock; Roman Nassutt; Rolf Janssen; Gerd Willmann; Matthias Honl

    2001-01-01

    A patient complained about a squeaking noise in his total hip arthroplasty. Clinical evaluation revealed good function, and there were no signs of loosening on the radiograph. Physiotherapy did not alter this phenomenon, and ultimately a revision was performed 42 months after the first surgery. The analysis of the retrievals revealed that a zirconium oxide ceramic head had been paired

  19. Imaging of ceramic liner fractures in total hip arthroplasty: the value of CT.

    PubMed

    Endo, Yoshimi; Renner, Lisa; Schmidt-Braekling, Tom; Mintz, Douglas N; Boettner, Friedrich

    2015-08-01

    Fracture of a ceramic liner of a total hip arthroplasty is rare and is radiographically occult if not displaced. We report on two patients in whom ceramic liner fracture was radiographically occult but was diagnosed on subsequent CT scan through appropriate windowing. PMID:25744811

  20. 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

  1. Posterior decompression salvages Bryan total disc arthroplasty in post-operatively recurrent uncoforaminal stenosis.

    PubMed

    Wenger, Markus; Markwalder, Thomas-Marc

    2014-05-01

    We report on 69 retrospectively reviewed patients who received 73 Bryan (Medtronic Sofamor Danek, Memphis, TN, USA) total disc arthroplasties for recent soft cervical disc herniations over a 9.3year period. Three patients returned with radiculopathy due to the redevelopment of uncoforaminal stenosis at the Bryan segment and later underwent posterior decompression of the uncoforaminal area without modification to the prosthesis. They recovered from the radiculopathy after decompression; however, one patient later required adjacent segment fusion to recover from concomitant cervicalgia. After posterior decompression, all prostheses continued to function normally. In one patient, however, bony bridging of the prosthesis is imminent, despite being currently asymptomatic. We normally exclude patients with uncoforaminal stenosis from Bryan arthroplasty. Analysis of three of these patients (4.3% of patients, 4.1% of prostheses) revealed that they received a prosthesis despite slight uncoforaminal stenosis (slight stenosis was known prior to surgery in one instance, two others were only discovered intra-operatively). Our observation raises the suspicion that slight uncoforaminal stenosis could also recur in physiologically working arthroplasty segments, and that in some instances this spur formation may progress into prosthesis bridging. However, more research is required to confirm the significance of uncoforaminal stenosis discovered pre- or intra-operatively in arthroplasty patients. Posterior minimally invasive decompression using the Frykholm-Scoville keyhole approach successfully treats uncoforaminal stenosis without revising the prosthesis. PMID:24256884

  2. Relationship between length of stay and manipulation rate after total knee arthroplasty

    Microsoft Academic Search

    David R. Mauerhan; Jeffrey G. Mokris; An Ly; Gary M. Kiebzak

    1998-01-01

    We hypothesized that a pattern of decreasing postoperative length of stay (LOS) in the hospital could lead to an increased rate of manipulation after total knee arthroplasty (TKA). The decision to manipulate is based on the patient's ability to perform normal physical activities, which may in large part be dependent on adequate knee flexion (ie, range of motion [ROM]). Decreased

  3. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study

    Microsoft Academic Search

    K Huch; K A C Mu?ller; T Stu?rmer; H Brenner; W Puhl; K-P Gu?nther

    2005-01-01

    Objective: To analyse sports activities of patients with hip or knee osteoarthritis (OA) over lifetime, preoperatively, and 5 years after arthroplasty.Methods: In a longitudinal four centre study, 809 consecutive patients with advanced OA of the hip (420) or the knee (389) joint under the age of 76 years who required total joint replacement were recruited. A completed questionnaire about sports

  4. Posttraumatic Monocondylar Gonarthrosis: Does Monocondylar Sleigh Arthroplasty Increase Joint Function and Quality of Life?

    Microsoft Academic Search

    Andreas H. Thiemann; Christian Schmidt; Gert Muhr; Christoph Josten

    2001-01-01

    Background: The aim of this study was to evaluate if monocondylar knee arthroplasty increases the range of motion and life quality in patients with monocondylar posttraumatic gonarthrosis. Patients and Methods: 38 patients with monocondylar posttraumatic gonarthrosis were treated between January 1990 and December 1995. Gonarthrosis was predominantly caused by fractures of the lower leg (50.0%) following by fractures of the

  5. In vivo contact stresses during activities of daily living after knee arthroplasty

    Microsoft Academic Search

    Darryl D. D'Lima; Nikolai Steklov; Benjamin J. Fregly; Scott A. Banks; Clifford W. Colwell Jr

    2008-01-01

    We implanted an electronic knee prosthesis to measure tibial forces in vivo during activities of daily living after total knee arthroplasty. We used tibial forces and knee kinematic data collected in vivo to calculate contact stresses using finite element analysis. The polyethylene insert was modeled as an elastoplastic material, and predicted contact stresses were validated using pressure sensitive sensors. Peak

  6. Average and peak contact stress distribution evaluation of total knee arthroplasties

    Microsoft Academic Search

    John A. Szivek; Philip L. Anderson; James B. Benjamin

    1996-01-01

    Seven total knee arthroplasty systems were tested to determine contact stress patterns and contact areas using a calibrated Fuji film stress analysis technique. Knees were loaded to 2,000 N (204 kg) at 15°, 60°, 90°, and 135° flexion at 24 and 37°C. Evaluation of stresses at 37°C at 15° and 60° using an average contact stress assessment technique indicated that

  7. Orthopaedic crossfire ®—All patellae should be resurfaced during primary total knee arthroplasty: In opposition

    Microsoft Academic Search

    Robert L. Barrack

    2003-01-01

    After more than 20 years of debate, the decision on whether to resurface the patella in primary total knee arthroplasty (TKA) remains controversial. Laboratory testing suggests that performing a TKA alters knee kinematics. Every study to date has suggested that kinematics are more abnormal when the patella is resurfaced than when it is retained. In addition, patellofemoral contact areas are

  8. Orthopaedic crossfire ®—stem modularity is unnecessary in revision total hip arthroplasty: In the affirmative

    Microsoft Academic Search

    Robert L. Barrack

    2003-01-01

    Numerous options are available for femoral stem fixation in revision total hip arthroplasty, including cemented stems, proximally-coated cementless stems, extensively coated cementless stems, impaction grafting cemented stems, and modular cementless stems. In terms of versatility, ease of insertion, use with an extended trochanteric osteotomy, and clinical results, extensively coated cementless stems remain the gold standard. Modular cementless stems have not

  9. Recurrent dislocation following total hip arthroplasty treated a.m. Olerud.

    PubMed

    Falkenberg-Nielsen, B; Andersen-Ranberg, F

    1989-01-01

    We present a case of recurrent dislocation after total hip arthroplasty in a patient where no malalignment of the prosthetic components was found. The patient was successfully treated with the fixation of an additional sector to the acetabular component. PMID:2801067

  10. 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

  11. Lower-limb joint mechanics after total hip arthroplasty during sitting and standing tasks.

    PubMed

    Lamontagne, Mario; Beaulieu, Mélanie L; Varin, Daniel; Beaulé, Paul E

    2012-10-01

    While the effect of total hip arthroplasty on the operated limb mechanics is well documented, little is known on its effect on the contralateral limb. The purpose of this study was to measure the joint mechanics of both lower limbs during the tasks of sit-to-stand and stand-to-sit. Twenty total hip arthroplasty patients and 20 control participants performed three trials of each task from which 3D lower-limb joint kinematics and kinetics were obtained. Total hip arthroplasty patients exhibited lower operated-hip joint flexion, extension moments, and power, occurring most frequently near seat-on and seat-off. Despite these reduced kinetic variables in the operated hip, the joints of the non-operated limb generated similar joint kinetics as the matched control participants. These results indicated the patients who underwent total hip arthroplasty could adopt a strategy that allowed them to reduce moments and power generated at the operated lower-limb joints without overcompensating with the non-operated leg. Although such a strategy may be desirable given that higher loads can increase friction and accelerate wear of the prosthesis, reduced loading may be an indication of inadequate muscle strength that needs to be addressed. PMID:22508467

  12. Reorganization of equilibrium and movement control strategies after total knee arthroplasty

    Microsoft Academic Search

    J.-M. Viton; L. Atlani; S. Mesure; J. Massion; J.-P. Franceschi; A. Delarque; A. Bardot

    2002-01-01

    This work was aimed at identifying changes in posturomo- tor control strategies in patients with unilateral total knee arthroplasty. Using kinetic and kinematic data, a previous study had revealed that, during a side step, patients with unilateral knee arthritis showed a shortened monopodal phase and a lengthened postural phase when the affected leg was the supporting one. It was expected

  13. Impact of a clinical pathway and implant standardization on total hip arthroplasty

    Microsoft Academic Search

    William L. Healy; Michael E. Ayers; Richard Iorio; Douglas A. Patch; David Appleby; Bernard A. Pfeifer

    1998-01-01

    This study evaluates the impact of a clinical pathway (CP) and a hip implant standardization program (HISP) on the quality and cost of total hip arthroplasty (THA). Two hundred six unilateral THA operations for osteoarthritis were evaluated: 89 operations were performed in 1991 without a CP or HISP (4-year follow-up period); 117 operations were performed in 1993 with a CP

  14. 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

  15. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients

    Microsoft Academic Search

    P. S. Ray; K. Kakarlapudi; C. Rajsekhar; M. S. Bhamra

    2000-01-01

    Distal humeral fractures are difficult to treat. In the elderly population, the problems are compounded by osteoporosis and gross comminution. Open reduction and internal fixation for such fractures is sometimes difficult and may be associated with poor results. Total elbow arthroplasty has been suggested as a last-ditch effort to salvage functional use for such difficult fractures in the elderly. We

  16. ECE 331 -Biomedical Instrumentation Department of Electrical & Computer Engineering, UBC Implant Design & Total Hip Arthroplasty

    E-print Network

    Pulfrey, David L.

    ECE 331 - Biomedical Instrumentation Department of Electrical & Computer Engineering, UBC Lab #6 Implant Design & Total Hip Arthroplasty Due: Start of NEXT Class (collect all data during lab) A) Prepare. 5. Measure the dimensions of your femur. C) Design implant 1. Download the SolidWorks femur model

  17. 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

  18. Cementless surface replacement arthroplasty (Copeland CSRA) for osteoarthritis of the shoulder

    Microsoft Academic Search

    Ofer Levy; Stephen A Copeland

    2004-01-01

    Clinical experience with the Copeland cementless surface replacement arthroplasty (CSRA) of the shoulder now spans 17 years. Between 1986 and 1997, 79 CSRAs (42 total shoulder replacements and 37 hemiarthroplasties) were performed for primary osteoarthritis of the shoulder. Total shoulder replacement was done in 12 men and 30 women with a mean age of 71.5 years (range, 50-87 years). Hemiarthroplasty

  19. 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

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

    PubMed

    Lew, Eric; Nicolosi, Nicole; McKee, Patrick

    2015-01-01

    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

  1. 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…

  2. 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

  3. Forest Spatial Dynamics with Gap Expansion: Total Gap Area and Gap Size Distribution

    Microsoft Academic Search

    Takuya Kubo; Yoh Iwasa; Naoki Furumoto

    1996-01-01

    Recent studies on forest dynamics in diverse forested ecosystems suggest that forest stands are disturbed more frequently if they are next to existing gaps, and that gaps once formed tend to expand their area in subsequent years. We examine total gap area and the size distribution of gaps at equilibrium in a lattice-structured forest model. Each site undergoes transition between

  4. 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…

  5. 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…

  6. 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…

  7. Graphene: Mind the gap

    Microsoft Academic Search

    Kostya Novoselov

    2007-01-01

    Research now shows that interaction with silicon carbide substrate leads to the opening of a semiconductor gap in epitaxial graphene. This is an important first step towards bandgap engineering in this two-dimensional crystal, and its incorporation in electronic devices.

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

    ClinicalTrials.gov

    2015-06-04

    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

  9. Which factors affect the duration of inpatient rehabilitation after total knee arthroplasty in the absence of complications?

    Microsoft Academic Search

    M. Dauty; X. Smitt; P. Menu; C. Dubois

    2009-01-01

    ObjectiveThe aim of this study was to determine which preoperative factors might predict the duration of inpatient rehabilitation for total knee arthroplasty (TKA) patients in the absence of complications.

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

    PubMed

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

    2015-06-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-06-01

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

  13. 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

  14. 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

  15. Endoplasmic reticulum stress activation during total knee arthroplasty

    PubMed Central

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

    2013-01-01

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

  16. Effect of femoral stiffness on bone remodeling after uncemented arthroplasty.

    PubMed

    Sychterz, C J; Topoleski, L D; Sacco, M; Engh, C A

    2001-08-01

    The current study examined the relationships among femoral stiffness, implant stiffness, and bone remodeling in 40 femurs retrieved at autopsy from 20 patients with unilateral uncemented hip replacements. The purpose of the study was to determine if the magnitude of periprosthetic bone loss after arthroplasty was correlated with, and could be predicted from, stem and femoral stiffness terms. For analysis, the contralateral normal femur was used as a control to represent the unremodeled condition of the in vivo implanted femur. Bone loss attributable to remodeling was quantified by video-densitometric analysis. Stiffness terms were calculated as the product of the elastic modulus and geometric properties digitized from cross-sectional slab radiographs. Femoral stiffness calculations accounted for variations in modulus attributable to patient differences in bone mineral density and geometric properties attributable to differences in the shape of individual femurs. Similarly, calculations of implant stiffness accounted for variations in implant shape. Results showed axial bone stiffness was the variable most strongly correlated with bone loss. Individual stem stiffness terms were not significantly correlated with bone loss. Multiple linear regression analysis, using stem-to-bone stiffness ratios as independent variables, accounted for 46% of the variance in bone loss data. In the regression analysis, the axial stem-to-bone stiffness ratio was the strongest correlate with bone loss. Although these results show the influence of mechanical stiffness factors on bone remodeling, other factors (hormonal status, drugs, disease, activity level) could represent the variance in bone loss data not accounted for in the study. PMID:11501814

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

    PubMed

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

    2015-01-01

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

  18. 10-year experience with short stem total hip arthroplasty.

    PubMed

    von Lewinski, Gabriela; Floerkemeier, Thilo

    2015-03-01

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

  19. Short stem total hip arthroplasty in patients with rheumatoid arthritis.

    PubMed

    Bause, Ludwig

    2015-03-01

    Total hip arthroplasty (THA) has proven successful in patients with rheumatoid arthritis (RA). Patients with RA often require multiple revisions, and bone conservation is mandatory. A variety of short stems is currently available with mid-term results for osteoarthritis. This retrospective study evaluated mid-term clinical results of short stem THA in a series of patients with RA. Between 2005 and 2009, a total of 105 cementless short stems were implanted in patients with RA. Average patient age at the time of the index THA was 44.2 years, and average length of follow-up was 5 years. Clinical evaluation included physical examination and documentation of potential adverse events during the postoperative period. No radiographic failures occurred. Femoral and cup components showed some minor radiolucencies with sclerotic lines, but none involved 100% of the bone-prosthesis interface. Complications included femoral component subsidence in 2 hips after initial full weight bearing; 1 case resolved after 3 months, and the other case was revised to a standard shaft. One intraoperative dorsolateral stem tip perforation occurred with revision to a conventional length stem. Migration in 1 cup led to revision without removal of the short stem implant. No infections or joint dislocations were observed. The transfer of the short stem concept to an additional treatment option for patients with RA proved successful in the early to mid-term postoperative period. Complications and revisions were limited to early migration and early loosening of the implants in line with the results reported in the literature of cementless conventional THA in patients with RA. PMID:25826632

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

    PubMed Central

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

    2015-01-01

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

  1. Comparative responsiveness of outcome measures for total knee arthroplasty

    PubMed Central

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

    2014-01-01

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

  2. Patient satisfaction after total knee arthroplasty: an Asian perspective

    PubMed Central

    Thambiah, Matthew Dhanaraj; Nathan, Sahaya; Seow, Branden ZX; Liang, Shen; Lingaraj, Krishna

    2015-01-01

    INTRODUCTION Total knee arthroplasty (TKA) is an effective method for alleviating pain and restoring knee function in patients with severe osteoarthritis. However, despite the improvements in surgical technique and postoperative care, it has been reported that up to 19% of patients are dissatisfied after their operations. The aim of this study was to evaluate patient satisfaction levels after TKA in an Asian cohort, as well as assess the correlation between patient satisfaction levels and the results of traditional physician-based scoring systems. METHODS The medical data of 103 Asian patients who underwent 110 TKAs between December 2008 and June 2009 were obtained from our hospital’s Joint Replacement Registry. The minimum follow-up period was one year and patient expectations were assessed before TKA. Patient satisfaction was assessed postoperatively using a 5-point Likert scale. Reasons for patient dissatisfaction were recorded. Standardised instruments (e.g. the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and the generic Short Form-36 health survey) were used to assess the patient’s functional status and the severity of symptoms pre- and postoperatively. RESULTS Among the 110 TKAs performed, 92.8% resulted in patient satisfaction. Patient satisfaction correlated with postoperative WOMAC function scores (p = 0.028), postoperative WOMAC final scores (p = 0.040) and expectations being met (p = 0.033). CONCLUSION Although there was a high level of patient satisfaction following TKA in our cohort of Asian patients, a significant minority was dissatisfied. Patient satisfaction is an important outcome measure and should be assessed in addition to traditional outcome scores. PMID:26034317

  3. 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

  4. Catastrophic thinking about pain as a predictor of length of hospital stay after total knee arthroplasty: a prospective study

    Microsoft Academic Search

    Erik Witvrouw; E. Pattyn; K. F. Almqvist; G. Crombez; C. Accoe; D. Cambier; R. Verdonk

    2009-01-01

    This study prospectively investigates whether catastrophizing thinking is associated with length of hospital stay after total\\u000a knee arthroplasty. Forty-three patients who underwent primary total knee arthroplasty were included in this study. Prior to\\u000a their operation all patients were asked to complete the pain catastrophizing scale, and a Western Ontario McMaster Universities\\u000a Osteoarthritis index. A multiple regression analysis identified pain catastrophizing

  5. Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure—midterm results

    Microsoft Academic Search

    Matthias P. Flury; Philipp Frey; Joerg Goldhahn; Hans-Kaspar Schwyzer; Beat R. Simmen

    2011-01-01

    Our goal was to evaluate the objective and subjective midterm outcome after revision of a failed shoulder arthroplasty with\\u000a a reverse design prosthesis. Twenty consecutive patients with 21 revisions of a primary shoulder arthroplasty using reverse\\u000a shoulder prosthesis Delta III® were followed up postoperatively for a mean of 46 months including clinical and radiological examination. Complications were\\u000a recorded and Constant score,

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

    E-print Network

    Lan, Tian

    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 ...

  7. Photonic band gap materials

    NASA Astrophysics Data System (ADS)

    Cassagne, D.

    Photonic band gap materials Photonic band gap materials are periodic dielectric structures that control the propagation of electromagnetic waves. We describe the plane wave method, which allows to calculate the band structures of photonic crystals. By symmetry analysis and a perturbative approach, we predict the appearance of the low energy photonic band gaps of hexagonal structures. We propose new two-dimensional structures called graphite and boron nitride. Using a transfer matrix method, we calculate the transmission of the graphite structure and we show the crucial role of the coupling with external modes. We study the appearance of allowed modes in the photonic band gap by the introduction of localized defects in the periodicity. Finally, we discuss the properties of opals formed by self-organized silica microspheres, which are very promising for the fabrication of three-dimensional photonic crystals. Les matériaux à bandes interdites photoniques sont des structures diélectriques périodiques qui contrôlent la propagation des ondes électromagnétiques. Nous décrivons la méthode des ondes planes qui permet de calculer les structures de bandes des cristaux photoniques. Par une analyse de la symétrie et une approche perturbative, nous précisons les conditions d'existence des bandes interdites de basse énergie. Nous proposons de nouvelles structures bidimensionnelles appelées graphite et nitrure de bore. Grâce à une méthode de matrices de transfert, nous calculons la transmission de la structure graphite et nous mettons en évidence le rôle fondamental du couplage avec les modes extérieurs. Nous étudions l'apparition de modes permis dans la bande interdite grâce à l'introduction de défauts dans la périodicité. Enfin, nous discutons les propriétés des opales constituées de micro-billes de silice auto-organisées, qui sont très prometteuses pour la fabrication de cristaux photoniques tridimensionnels.

  8. 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.

  9. Gender gaps within management.

    PubMed

    Ronk, L L

    1993-05-01

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

  10. Mind the gap

    E-print Network

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

    2006-12-06

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

  11. Mind the gap.

    SciTech Connect

    Bhagwat, M. S.; Krassnigg, A.; Maris, P.; Roberts, C. D.; Physics; Univ. Graz; Univ. of Pittsburgh

    2007-03-01

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

  12. Understanding readmission after primary total hip and knee arthroplasty: who's at risk?

    PubMed

    Saucedo, James M; Marecek, Geoffrey S; Wanke, Tyler R; Lee, Jungwha; Stulberg, S David; Puri, Lalit

    2014-02-01

    Readmission has been cited as an important quality measure in the Patient Protection and Affordable Care Act. We queried an electronic database for all patients who underwent Total Hip Arthroplasty or Total Knee Arthroplasty at our institution from 2006 to 2010 and identified those readmitted within 90 days of surgery, reviewed their demographic and clinical data, and performed a multivariable logistic regression analysis to determine significant risk factors. The overall 90-day readmission rate was 7.8%. The most common readmission diagnoses were related to infection and procedure-related complications. An increased likelihood of readmission was found with coronary artery disease, diabetes, increased LOS, underweight status, obese status, age (over 80 or under 50), and Medicare. Procedure-related complications and wound complications accounted for more readmissions than any single medical complication. PMID:23958236

  13. Perioperative solutions for rapid recovery joint arthroplasty: get ahead and stay ahead.

    PubMed

    Sculco, Peter K; Pagnano, Mark W

    2015-04-01

    Rapid recovery after total joint arthroplasty requires patients to get ahead and stay ahead or the four impediments to early rehabilitation and discharge: volume depletion, blood loss, pain, and nausea. Adequate volume resuscitation starts before entering the operating room and focuses on intravenous fluids rather than red blood cell transfusion. Tranexamic acid limits blood loss and reduces the need for most other blood management systems. Rapid recovery pain management focuses on minimizing parenteral opioids. A short-acting spinal with a peri-articular local anesthetic injection is reliable, reproducible, and safe. Patients at risk for post-operative nausea are treated with anti-emetic medications and perioperative dexamethasone. These interventions reflect a transition from the sick-patient model to the well-patient model and make rapid recovery joint arthroplasty a reality in 2015. PMID:25680452

  14. 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. PMID:25798156

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

    PubMed

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

    2014-10-01

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

  16. Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in opposition.

    PubMed

    Barrack, Robert L

    2003-04-01

    After more than 20 years of debate, the decision on whether to resurface the patella in primary total knee arthroplasty (TKA) remains controversial. Laboratory testing suggests that performing a TKA alters knee kinematics. Every study to date has suggested that kinematics are more abnormal when the patella is resurfaced than when it is retained. In addition, patellofemoral contact areas are higher and contact stresses are lower with the native patella compared with the resurfaced patella after TKA. Virtually every clinical study of bilateral knee arthroplasty in which one patella has been resurfaced and the other has not has shown either equivalent results or a preference for the unresurfaced side. Laboratory and clinical data indicate that not resurfacing the patellar is a viable if not preferable option in most TKA patients. PMID:12730926

  17. Pseudotumor from modular neck corrosion after ceramic-on-polyethylene total hip arthroplasty.

    PubMed

    Hsu, Andrew R; Gross, Christopher E; Levine, Brett R

    2012-09-01

    Pseudotumor formation after hip arthroplasty is a rare complication that can occur with various head-liner articulation couples. Adverse local tissue reactions and pseudotumors have been shown to present as prosthetic infections or implant failures with a broad array of laboratory and imaging findings. We report a case of pseudotumor formation resulting from modular neckstem corrosion in a well-fixed ceramic-on-polyethylene total hip arthroplasty. The patient underwent successful revision surgery using an extended trochanteric osteotomy, long-stem revision femoral component, and headliner exchange. It is critical that surgeons are aware of the potential complications with increased component modularity and the possibility of adverse local tissue reactions resulting from fretting and crevice corrosion at modular junctions. PMID:23365811

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2011-06-01

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

  20. [Soft-tissue management in primary knee arthroplasty: common techniques, navigation and force-sensing devices].

    PubMed

    Schmidt, F; Lampe, F; Elfring, R; Nebelung, S; Mumme, T; Andereya, S; Radermacher, K; Niethard, F U; Müller-Rath, R

    2007-01-01

    Soft-tissue management is essential for the outcome in total knee arthroplasty. In combination with osseous resections and component positioning, correction of the underlying ligamentous dysbalance should yield a stable joint throughout the flexion arc. Different "philosophies" with regard to technique, timing and tactics in ligament balancing are described. So far, surgeons have not been provided with standardised devices that allow the objective measurement of this complex issue. Moreover, knowledge concerning the "ideal" soft-tissue stability following knee arthroplasty is still sparse. As part of the scientific project "OrthoMIT" (minimal invasive orthopaedic therapy) an approach to combine conventional soft-tissue management with navigation and force-sensing devices should be realized technically. The aim is to develop an instrument for the objective measurement of soft-tissue management in scientific and clinical applications. PMID:17939070

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

    PubMed Central

    Trieb, Klemens; Stadler, Nicola

    2015-01-01

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

  2. Postoperative limb alignment and its determinants after minimally invasive Oxford medial unicompartmental knee arthroplasty.

    PubMed

    Mullaji, Arun B; Shetty, Gautam M; Kanna, Raj

    2011-09-01

    One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-knee-ankle (HKA) angle of 172.2° ± 3.1° improved to 177.1° ± 2.9° postoperatively. In 75% of the limbs, the HKA angle was restored to within an acceptable alignment of 177° ± 3°, 14% of the limbs were in excessive varus (<174°), and 11% were in valgus (>180°). Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preoperative varus deformity had a tendency to remain in excessive varus, and limbs with lesser preoperative varus deformity had a greater tendency to go into valgus postoperatively. PMID:21498039

  3. Radiographic parameters associated with pain following total hip and surface arthroplasty.

    PubMed

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

    2015-03-01

    Pain following total hip arthroplasty (THA) and surface arthroplasty (SRA) remains a significant source of patient dissatisfaction. Two hundred twenty-four SRA and 196 THA patients completed a pain drawing questionnaire and postoperative radiographic measurements of component positioning were performed. In the SRA cohort, 11 of 21 patients (52%) with acetabular uncoverage of ?5 mm versus 43 of 147 (29%) with acetabular uncoverage of ?4.9 mm reported groin pain (P=.03). In the THA cohort, an increased distal-third canal fill ratio and a lower canal calcar ratio trended towards a higher incidence of thigh pain (P=.10 and .06), while a decreased mid-third canal fill ratio was associated with increased severity of thigh pain (P=.04). This study identifies associations between radiographic findings and pain following THA and SRA. PMID:25456636

  4. The Impact of Blood Management on Length of Stay After Primary Total Knee Arthroplasty

    PubMed Central

    Monsef, Jad B; Della Valle, Alejandro G; Mayman, David J; Marx, Robert G; Ranawat, Amar S; Boettner, Friedrich

    2014-01-01

    The current study investigates the impact of patient factors, surgical factors, and blood management on postoperative length of stay (LOS) in 516 patients who underwent primary total knee arthroplasty. Age, gender, type of anticoagulation, but not body mass index (BMI) were found to be highly significant predictors of an increased LOS. Allogeneic transfusion and the number of allogeneic units significantly increased LOS, whereas donation and/or transfusion of autologous blood did not. Hemoglobin levels preoperatively until 48 hours postoperatively were negatively correlated with LOS. After adjusting for confounding factors through Poisson regression, age (p = 0.001) and allogeneic blood transfusion (p = 0.002) were the most significant determinants of LOS. Avoiding allogeneic blood plays an essential role in reducing the overall length of stay after primary total knee arthroplasty. PMID:24894715

  5. Mortality following hip arthroplasty--inappropriate use of National Joint Registry (NJR) data.

    PubMed

    Whitehouse, Sarah L; Bolland, Benjamin J R F; Howell, Jonathan R; Crawford, Ross W; Timperley, A John

    2014-09-01

    Mortality following hip arthroplasty is affected by a large number of confounding variables each of which must be considered to enable valid interpretation. Relevant variables available from the 2011 NJR data set were included in the Cox model. Mortality rates in hip arthroplasty patients were lower than in the age-matched population across all hip types. Age at surgery, ASA grade, diagnosis, gender, provider type, hip type and lead surgeon grade all had a significant effect on mortality. Schemper's statistic showed that only 18.98% of the variation in mortality was explained by the variables available in the NJR data set. It is inappropriate to use NJR data to study an outcome affected by a multitude of confounding variables when these cannot be adequately accounted for in the available data set. PMID:24857335

  6. Changes in the medial and lateral posterior condylar offset in total knee arthroplasty.

    PubMed

    Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro; Ishii, Hisanori; Toyabe, Shin-Ichi

    2011-02-01

    The purpose of this study was to clarify the changes between preoperation and postoperation in each posterior condylar offset (PCO) using computed tomography (CT) and to compare them to conventional radiographic (x-ray) evaluation in total knee arthroplasty. One hundred nine knees in 97 patients were evaluated. The medial PCO was significantly larger before surgery. The lateral PCO was significantly larger after surgery. Changes in the PCO on x-ray showed no significant correlation with the changes observed in the CT-evaluated medial (R = 0.028) and lateral PCO (R = 0.190). Changes in PCO observed by x-ray did not reflect those of the medial or lateral condyles on CT. We recommend CT-based evaluation of PCO by condyle when assessing the influence of PCO on range of motion following total knee arthroplasty. PMID:20663641

  7. Gapped domain walls, gapped boundaries, and topological degeneracy.

    PubMed

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

    2015-02-20

    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 W(ia), 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. PMID:25763965

  8. Clinical and radiological outcome of hydroxyapatite-coated femoral stem in revision hip arthroplasty

    Microsoft Academic Search

    T. Gosens; E. J. van Langelaan

    2005-01-01

    We used a proximally hydroxyapatite-coated femoral stem in revision arthroplasty of 48 cases with aseptic loosening and Paprosky defect class 1 or 2. We reviewed the outcome after 6.1 (4–9.3) years. The clinical outcome was good, with a mean postoperative HHS of 90 (51–100) points. There were five reoperations all on the acetabular side and none for the femoral stem.

  9. Cementless Mallory-Head HA-coated hip arthroplasty for osteoarthritis in hip dysplasia

    Microsoft Academic Search

    T Gosens; E. J van Langelaan; A. J Tonino

    2003-01-01

    Sixty-three cementless Mallory-Head HA-coated femoral prostheses (Biomet, Warsaw, IN) were used in primary total hip arthroplasty in 50 patients with osteoarthritic hips because of congenital hip dysplasia. The implanted cup was also cementless (41 Harris Galante and 22 Ringlock). The patients were followed up for a mean period of 75.1 months (range, 44–110). Clinical and radiologic analysis were performed. Harris

  10. Changes in circulatory indices of thrombosis and fibrinolysis during total knee arthroplasty performed under tourniquet

    Microsoft Academic Search

    N. E. Sharrock; G. Go; T. P. Sculco; C. S. Ranawat; M. J. Maynard; P. C. Harpel

    1995-01-01

    Deep vein thrombosis may begin during surgery with the tourniquet inflated. Arterial levels of fibrinopeptide A, thrombin—antithrombin complexes, D-dimer, tissue plasminogen activator (t-PA) activity, and t-PA antigen were measured before surgery, during surgery with the tourniquet inflated, and following deflation of the tourniquet in 12 patients undergoing total knee arthroplasty. Minimal increases in fibrinopeptide A, thrombin—antithrombin complexes, and D-dimer were

  11. Total knee arthroplasty after an artificial femoral-popliteal arterial bypass graft

    Microsoft Academic Search

    Yuichiro Maruyama; Toshihide Ochiai; Shinichiro Kobayasi; Kazuo Kaneko

    2009-01-01

    We experienced one case of left knee total knee arthroplasty (TKA) after artificial vascular bypass surgery for both femoral\\u000a arteries from the right inguinal region. Patients requiring TKA after arterial bypass surgery to report a thrombosis are very\\u000a rare, but the incidence of thrombosis in the cases of TKA after arterial bypass surgery was reported to be higher when compared

  12. Bilateral extensor mechanism disruption after total knee arthroplasty in two morbidly obese patients.

    PubMed

    Goldstein, Zachary H; Yi, Paul H; Haughom, Bryan D; Hellman, Michael D; Levine, Brett R

    2015-05-01

    Disruption of the extensor mechanism as a result of patellar tendon or quadriceps tendon rupture is an uncommon but devastating complication after total knee arthroplasty. Treating a disrupted extensor mechanism can be challenging, particularly in patients who are morbidly obese, due to an increased risk of postoperative complications. Therefore, despite the debilitating nature of extensor mechanism disruption, many community surgeons do not feel comfortable pursuing more complex cases like revision total knee arthroplasty with extensor mechanism allograft on morbidly obese patients, and consequently many of these patients are referred to tertiary-care centers for reconstruction secondary to the complexity of this patient cohort. The authors report 2 cases of bilateral extensor mechanism disruption after total knee arthroplasty in patients who are morbidly obese. One patient experienced trauma leading to her initial rupture; however, her contralateral atraumatic disruption was subsequently diagnosed at a later date. The second patient did not experience trauma leading to either of her extensor mechanism disruptions. Despite substantial medical comorbidities and morbid obesity, revision total knee arthroplasties with extensor mechanism allografts were recommended in both cases in a staged bilateral fashion. The surgical technique is described and the unique challenges afforded by the marked obesity are detailed. The current literature on this subject is reviewed. Despite early complications related to recumbency, this report serves as an example of successful repairs of extensor mechanism disruptions in patients who are morbidly obese, suggesting that extensor mechanism allograft is viable even in patients with high risk of complications. [Orthopedics. 2015; 38(5):e443-e446.]. PMID:25970375

  13. Resurfacing hip arthroplasty in neuromuscular hip disorders – A retrospective case series

    PubMed Central

    Tudor, Francois; Ariamanesh, Amir; Potty, Anish; Hashemi-Nejad, Aresh

    2013-01-01

    Background Management of the degenerate hip in patients with neuromuscular conditions should be aimed at improving quality of life and ease of nursing care. Arthroplasty poses a significant challenge with predisposition to dislocation and loosening due to anatomical abnormalities, soft tissue contractures and impaired muscle tone. Methods We present a series of 11 hips (9 patients) following total hip resurfacing arthroplasty for painful osteoarthritis in patients with differing neuromuscular conditions. Patients were assessed clinically and radiographically and also for satisfaction of their carers due to improved ability to provide nursing care. Mean patient age was 33.1 years (range 13–49 years) with mean follow up at publication 63.7 months (41–89 months). All patients were operated by a single surgeon (AHN) and received the required post operative care and physiotherapy. Soft tissue releases were performed when necessary. All hips were assessed clinically and radiographically at 6 weeks and 6 months and 1 year post-operatively. Six month follow-up also included a questionnaire with scoring of care-provider satisfaction. Results Ten hips had good clinical results with improvement in pain and function and radiologically showed no signs of loosening. One hip required revision to proximal femoral excision due to dislocation and loose acetabular component with severe pain. None of the other hips dislocated. Analysis of care provider satisfaction assessing ability to provide personal care, positioning and transferring, comfort, interaction and communication scored excellent to good in 10 patients and satisfactory in one. Conclusion We believe hip resurfacing arthroplasty to be a viable option in the treatment of the complex problem of osteoarthritis in the hips of patients with neuromuscular disease. The improved biomechanics confer greater stability when compared to conventional total hip arthroplasty. Although technically demanding, a successful result has been shown to improve patient pain, function and ease of nursing care. Level of evidence Level IV. PMID:24396224

  14. Use of a Functional Antibiotic Spacer in Treating Infected Shoulder Arthroplasty.

    PubMed

    Levy, Jonathan C; Triplet, Jacob; Everding, Nathan

    2015-06-01

    Management of an infected shoulder arthroplasty remains challenging. Treatment goals include resolution of the infection, improvement in pain, and restoration of function. Two-stage revision with an antibiotic spacer and subsequent revision has shown variable success in achieving these goals. The practice of using a hemiarthroplasty and coating the stem with antibiotic cement without cementing the implant to the humerus (functional antibiotic spacer) during the first stage has the potential to achieve treatment goals without the need for a second revision. The goal of this study was to examine the outcomes of a maintained functional antibiotic spacer without a second revision for the management of infected shoulder arthroplasty. Fourteen patients with an infected shoulder arthroplasty underwent implantation of a functional antibiotic spacer, extensive surgical debridement, and a minimum of 6 weeks of treatment with postoperative intravenous antibiotics. The 9 patients who elected not to undergo revision surgery were included in this analysis. Pain scores, functional outcome scores, range of motion, strength, and patient satisfaction were measured for these patients at last follow-up and compared with preoperative scores. At an average follow-up of 25 months (range, 12-48 months), significant improvements were observed in functional outcome scores, shoulder abduction, and elevation, with a trend toward improvement in pain scores. One patient was unsatisfied with the result. No recurrent infection, progressive radiolucency, or change in position of the functional antibiotic spacer was observed. A functional antibiotic spacer effectively manages the infected shoulder arthroplasty while achieving significant improvements in function and motion. Patient satisfaction was high, with a relatively low rate of conversion to second-stage revision. [Orthopedics. 2015; 38(6):e512-e519.]. PMID:26091225

  15. Bioball universal modular neck adapter as a salvage for failed revision total hip arthroplasty

    PubMed Central

    Vaishya, Raju; Sharma, Mrinal; Chaudhary, Rajeev Raj

    2013-01-01

    Management of recurrent dislocation of total hip arthroplasty is often a challenging and daunting task. Re-revision of such a total hip prosthesis may not be easy as the removal of a well-fixed, fully coated stem is extremely difficult. We managed to salvage instability in three revision hip cases in which the fully coated stem had subsided by using a bioball universal neck adapter without changing the femoral stem or acetabular cup. PMID:24133315

  16. Silent soft tissue pathology is common with a modern metal-on-metal hip arthroplasty

    PubMed Central

    2011-01-01

    Background and purpose Adverse reactions to metal debris have been reported to be a cause of pain in metal-on-metal hip arthroplasty. We assessed the incidence of both symptomatic and asymptomatic adverse reactions in a consecutive series of patients with a modern large-head metal-on-metal hip arthroplasty. Methods We studied the early clinical results and results of routine metal artifact-reduction MRI screening in a series of 79 large-head metal-on-metal hip arthroplasties (ASR; DePuy, Leeds, UK) in 68 patients. 75 hips were MRI scanned at mean 31 (12–52) months after surgery. Results 27 of 75 hips had MRI-detected metal debris-related abnormalities, of which 5 were mild, 18 moderate, and 4 severe. 8 of these hips have been revised, 6 of which were revised for an adverse reaction to metal debris, diagnosed preoperatively with MRI and confirmed histologically. The mean Oxford hip score (OHS) for the whole cohort was 21. It was mean 23 for patients with no MRI-based evidence of adverse reactions and 19 for those with adverse reactions detected by MRI. 6 of 12 patients with a best possible OHS of 12 had MRI-based evidence of an adverse reaction. Interpretation We have found a high early revision rate with a modern, large-head metal-on-metal hip arthroplasty. MRI-detected adverse rections to metal debris was common and often clinically “silent”. We recommend that patients with this implant should be closely followed up and undergo routine metal artifact-reduction MRI screening. PMID:21504335

  17. Home program of physical therapy: Effect on disabilities of patients with total hip arthroplasty

    Microsoft Academic Search

    Hironobu Sashika; Yoshiko Matsuba; Yuka Watanabe

    1996-01-01

    Objective: To study the effect of a home program of physical therapy.Design: Nonrandomized control trial.Setting: Home based.Patients: Subjects had total hip arthroplasty (THA) for hip osteoarthritis (hip-OA) without THA failure, or cardiopulmonary, neurological, or cognitive problems. Twenty-three subjects (mean age 63.4 years; mean post-THA period 793 days, 6 to 48 months) were divided into 3 groups matching with age, gender,

  18. A kinematic model for calculating cup alignment error during total hip arthroplasty

    Microsoft Academic Search

    Alon Wolf; Andrew B. Mor; Branislav Jaramaz

    Reduced range of motion, prosthetic impingement, and joint dislocation can all result from misalignment of the acetabular component (i.e. cup alignment) in patients undergoing total hip arthroplasty. Most methods for acetabular component alignment are designed to provide 45-501 abduction and 15-251 of operative anteversion (also known as flexion) with respect to the anterior pelvic plane coordinate system. Yet in most

  19. Le frottement métal-métal en arthroplastie de hanche : aspect de matériovigilance

    Microsoft Academic Search

    N. Passuti; S. Terver

    2007-01-01

    This study is dedicated to the problems met with metal-metal bearing prostheses. We have analysed the results of the reports sent to the AFSSAPS relating incidents described with this interface.Only 11 incidents were reported during the last 4 years by surgeons from different centers in France. At a mean follow-up of 7 years, we collected 2614 total hip arthroplasties with

  20. The C-reactive protein (CRP) in patients with long bone fractures and after arthroplasty

    Microsoft Academic Search

    S. I. Yoon; S. S. Lim; J. D. Rha; Y. H. Kim; J. S. Kang; G. H. Baek; K. H. Yang

    1993-01-01

    Between March 1991 and February 1992 serial serum C-reactive protein (CRP) levels were measured prospectively for three weeks in 57 consecutive patients with fractures of long bones, and also in 11 patients who had undergone primary total hip or knee arthroplasty. A semi-quantitative capillary floculation method was used for measuring the CRP level. The highest values were usually recorded 2–3

  1. Patellofemoral complications after posterior-stabilized total knee arthroplasty: A comparison of 2 different implant designs

    Microsoft Academic Search

    Michael J. Anderson; David L. Becker; Travis Kieckbusch

    2002-01-01

    We conducted a retrospective review of 2 consecutive series of posterior-stabilized total knee arthroplasties (TKAs) to evaluate patellofemoral complications, in particular, significant patellofemoral crepitance or patellar clunk syndrome. Twenty posterior-stabilized Axiom PSK (Wright Medical Technology, Arlington, TN) TKAs (group 1) were compared with 20 posterior cruciateNsacrificed Advance medial pivot (Wright Medical Technology, Arlington, TN) TKAs (group 2). The average age

  2. Primary ileus after total hip arthroplasty: rare complication or sentinel event?

    Microsoft Academic Search

    Alberto Vannelli; Domenico LaVeneziana; Mario Rampa; Luigi Battaglia; Ermanno Leo

    The incidence of hip dislocation after primary total hip arthroplasty (THA) has been reported to range from 1 to 25% in THA\\u000a revision. Here, we explore the hypothesis that there is a correlation between postoperative ileus (POI) and THA dislocation,\\u000a with POI after THA possibly representing a sentinel event. We retrospectively identified a cohort of 529 consecutive patients\\u000a who underwent

  3. Melioidosis-induced septic arthritis of the knee joint after total knee arthroplasty

    Microsoft Academic Search

    Sung-Chun Lin; Hsin-Pai Lee; Chih-Ju Chen; Zhi-Hong Wen; Yen-Hsuan Jean

    2011-01-01

    Melioidosis-induced septic arthritis of the knee joint is a rare condition. To date, no study has reported a case of melioidosis-induced septic arthritis of the knee joint after a total knee arthroplasty (TKA). We report a case of a 68-year-old man who presented with pain and swelling in the right knee for 1 week. He had undergone a TKA because

  4. Postoperative osteomyelitis following implant arthroplasty of the foot: diagnosis with indium-111 white blood cell scintigraphy

    SciTech Connect

    Bakst, R.H.; Kanat, I.O.

    1987-11-01

    Many complications can occur following insertion of silicone elastomer implants into the foot. Postoperative infection may be difficult to distinguish from other conditions such as dislodgment, fracture, ectopic and heterotopic new bone formation, synovitis, and bursitis. White blood cell scintigraphy, in conjunction with the clinical scenario, may prove to be an invaluable tool in the diagnosis of postoperative osteomyelitis, subsequent to implant arthroplasties. 32 references.

  5. Shear Properties of Bilaminar Polymethylmethacrylate Cement Mantles in Revision Hip Joint Arthroplasty

    Microsoft Academic Search

    Patrick C. Weinrauch; Cameron Bell; Lance Wilson; Ben Goss; Cameron Lutton; Ross W. Crawford

    2007-01-01

    Although cement-within-cement revision arthroplasty minimizes the complications associated with removal of secure PMMA, failure at the interfacial region between new and old cement mantles remains a theoretical concern. This article assesses the variability in shear properties of bilaminar cement mantles related to duration of postcure and the use of antibiotic cements.Bilaminar cement mantles were 15% to 20% weaker than uniform

  6. Management of Temporomandibular Joint Reankylosis in Syndromic Patients Corrected with Joint Prostheses: Surgical and Rehabilitation Protocols

    PubMed Central

    Clauser, Luigi C.; Consorti, Giuseppe; Elia, Giovanni; Tieghi, Riccardo; Galiè, Manlio

    2013-01-01

    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

  7. Tibial plateau stress fracture: a complication of unicompartmental knee arthroplasty using 4 guide pinholes.

    PubMed

    Brumby, Scott A; Carrington, Richard; Zayontz, Shay; Reish, Tim; Scott, Richard D

    2003-09-01

    Unicompartmental knee arthroplasty has gained popularity recently as a treatment for unicompartmental tibiofemoral non inflammatory arthritis. Tibial plateau stress fracture after unicompartmental knee arthroplasty (UKA) through guide pin holes placed in the proximal tibia has not been previously reported. In each case in this report, the compressive strength of the proximal tibia was reduced by the drilling of multiple holes for the placement of guide pins and holes for the lugs of the tibia component resulting in fracture through these holes between 3 and 18 weeks (median 8 weeks) post-operatively. In at least one case, the medial tibial cortex was violated by one pin. All cases required revision total knee arthroplasty (TKA). It is intuitive to caution against the use of multiple guide holes in the proximal tibia in UKA. If 3 or more hole pins are deemed necessary, surgeons must be aware of the potential for stress fracture and monitor patients accordingly. Peripheral pins that infract the medial tibial cortex should also be avoided. PMID:14513460

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

    PubMed

    Breugem, Stéfanus Jacob Martinus; Haverkamp, Daniël

    2014-07-18

    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

  9. The management of extensor mechanism complications in total knee arthroplasty. AAOS exhibit selection.

    PubMed

    Nam, Denis; Abdel, Matthew P; Cross, Michael B; LaMont, Lauren E; Reinhardt, Keith R; McArthur, Benjamin A; Mayman, David J; Hanssen, Arlen D; Sculco, Thomas P

    2014-03-19

    Complications involving the knee extensor mechanism and patellofemoral joint occur in 1% to 12% of patients following total knee arthroplasty and have major negative effects on patient outcomes and satisfaction. The surgeon must be aware of intraoperative, postoperative, and patient-related factors that can increase the rate of these problems. This review focuses on six of the most commonly encountered problems: patellar tendon disruption, quadriceps tendon rupture, patellar crepitus and soft-tissue impingement, periprosthetic patellar fracture, patellofemoral instability, and osteonecrosis of the patella. The goals of this report are to (1) review the relevant anatomy of the knee extensor mechanism, (2) present risk factors that may lead to extensor mechanism complications, (3) provide a diagnostic and treatment algorithm for each of the aforementioned problems, and (4) review the specific surgical techniques of Achilles tendon allograft reconstruction and synthetic mesh augmentation. Extensor mechanism disorders following total knee arthroplasty remain difficult to manage effectively. Although various surgical techniques have been used, the results in patients with a prior total knee arthroplasty are inferior to the results in the young adult without such a prior procedure. Surgical attempts at restoration of the knee extensor mechanism are usually warranted; however, the outcomes of treatment of these complications are often poor, and management of patient expectations is important. PMID:24647514

  10. Impact on red blood cell immunity patterns in postoperative phase following total hip arthroplasty

    PubMed Central

    Yu, Defu; Fu, Changma; Yu, Runze

    2014-01-01

    Objective In this study, we aimed to measure changes in red blood cell (RBC) immunity and cytokine levels after performing total hip replacement surgery. Material and methods Twenty patients receiving total hip arthroplasty were investigated by measuring presurgical and postoperative RBC natural tumor erythrocyte rosette rate (NTERR), RBC C3b receptor rosette rate (RC3bRR), RBC membrane CD35, CD58 and CD59 expression and cytokine levels [including tumor necrosis factor ? (TNF-?), interleukin 2 (IL-2), interferon ? (IFN-?), interleukin 10 (IL-10) and prostaglandin E2 (PGE2)]. Blood samples were collected on the day before surgery and on the first day after hip arthroplasty. Results Postoperative NTERR and RC3bRR were significantly lower than presurgical levels (p < 0.05). The RBC membrane CD35, CD58 and CD59 expressions were significantly decreased in the postoperative phase compared to pre-operative levels. Importantly, RBC promoting lymphocyte proliferation rates were significantly reduced after surgery. In addition, postoperative TNF-?, IL-2 and IFN-? levels in RBC and lymphocyte culture fluid were lower than those pre-operation, whereas IL-10 and PGE2 were significantly increased compared to presurgical levels (p < 0.05). Conclusions The modification of RBC immune function may be involved in the occurrence and development of the infection following hip arthroplasty, and this suggests a novel strategy to prevent such infection.

  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. 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

  13. Tranexamic acid for the reduction of blood loss in total knee arthroplasty.

    PubMed

    Oremus, Kresimir

    2015-05-01

    The Journal of Arthroplasty recently published a paper entitled "The Efficacy of Combined Use of Intraarticular and Intravenous Tranexamic Acid on Reducing Blood Loss and Transfusion Rate in Total Knee Arthroplasty". Tranexamic acid (TXA) is an antifibrinolytic drug whose administration during the perioperative period either by intravenous route or topically applied to the surgical field has been shown to reliably reduce blood loss and need for transfusion in patients undergoing total knee arthroplasty (TKA). Although randomized trials and meta-analyses did not show an increase in thromboembolic events, concerns remain about its repeated systemic application. The authors of the study introduced a novel regimen of TXA administration combining a preoperative intravenous bolus followed by local infiltration at the end of surgery with the idea of maximizing drug concentration at the surgical site while minimizing systemic antifibrinolytic effects. The combined dosage regimen appears to be more effective than single dose local application in reducing blood loss and transfusion rate without any complications noted. PMID:26046088

  14. Ten-year survivorship of the Anatomique Benoist Girard I total hip arthroplasty.

    PubMed

    Castoldi, Filippo; Rossi, Roberto; La Russa, Massimo; Sibelli, Pierro; Rossi, Paolo; Ranawat, Amar S

    2007-04-01

    The Anatomique Benoist Girard (ABG) I total hip arthroplasty has been widely used in Europe since 1989. Two recent midterm reports have shown high rates of component failure secondary to polyethylene wear. To further investigate this issue, our study prospectively follows 157 consecutive primary total hip arthroplasties using the ABG I prosthesis at an average follow-up of 10 years. Clinical outcomes have been excellent, although the incidence of thigh pain was 7.2%. Radiographic evaluation of the cup showed eccentric polyethylene wear in 93.6% of the patients. The average polyethylene linear wear was 2.40 mm, whereas the average annual wear rate was 0.25 mm/y. There were 7 hips (5.6%) with severe periacetabular osteolysis. Nine revisions were performed for loosening or wear. The overall component survival rate was 92.6%. The overall survival rate was 92.6% (confidence interval, 78.55-96.47) for the acetabular component and 96.3% (confidence interval, 85.67-100) for the femoral component. Although the clinical and radiographic results of the ABG I total hip arthroplasty in this series have been acceptable, high rates of polyethylene wear, most likely related to sterilization by gamma-irradiation in air, have been the limiting factor in the long-term success of this design. PMID:17400092

  15. Indwelling versus Intermittent Urinary Catheterization following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

    PubMed Central

    Xue, Deting; Li, Chao; Zhang, Kai; Ma, Honghai; Yan, Shigui; Pan, Zhijun

    2015-01-01

    Objective The purpose of this study is to compare the rates of urinary tract infection (UTI) and postoperative urinary retention (POUR) in patients undergoing lower limb arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization. Methods We conducted a meta-analysis of relevant randomized controlled trials (RCT) to compare the rates of UTI and POUR in patients undergoing total joint arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization. A comprehensive search was carried out to identify RCTs. Study-specific risk ratios (RR) with 95% confidence intervals (CI) were pooled. Additionally, a meta-regression analysis, as well as a sensitivity analysis, was performed to evaluate the heterogeneity. Results Nine RCTs with 1771 patients were included in this meta-analysis. The results showed that there was no significant difference in the rate of UTIs between indwelling catheterization and intermittent catheterization groups (P>0.05). Moreover, indwelling catheterization reduced the risk of POUR, versus intermittent catheterization, in total joint surgery (P<0.01). Conclusions Based on the results of the meta-analysis, indwelling urinary catheterization, removed 24-48 h postoperatively, was superior to intermittent catheterization in preventing POUR. Furthermore, indwelling urinary catheterization with removal 24 to 48 hours postoperatively did not increase the risk of UTI. In patients with multiple risk factors for POUR undergoing total joint arthroplasty of lower limb, the preferred option should be indwelling urinary catheterization removed 24-48 h postoperatively. Level of Evidence Level I. PMID:26146830

  16. Outcomes of Dual Modular Cementless Femoral Stems in Revision Hip Arthroplasty

    PubMed Central

    Broadhead, Matthew L.; Morley, John; Tavares, Shawn; McDonald, David

    2014-01-01

    With an increasing number of primary hip replacements being performed every year, the burden of revision hip arthroplasty, for septic and aseptic loosening, recurrent dislocation or periprosthetic fracture, is also increasing. In recent years, different approaches to revising the femoral prosthesis have emerged; including both cemented and cementless techniques. With a stable cement mantle and good bone quality, or through the use of impaction bone grafting when bone stock is lacking, it is possible to re-cement a femoral prosthesis. Alternatively, a cementless modular femoral prosthesis may be used, providing the surgeon with further options for restoring leg length, hip offset, anteversion and stability. Studies evaluating the use of modular cementless prostheses have so far been limited to midterm studies, with results comparable to primary hip arthroplasty. There are some concerns, however, regarding tribological complications such as stem fracture, corrosion, and failure, and long-term studies are required to further evaluate these concerns. This review outlines the current evidence for the use of both cemented and cementless modular femoral prostheses in the setting of revision hip arthroplasty. Results of prospective and retrospective studies will be outlined, along with results obtained from national joint registries. PMID:24822088

  17. Arthroscopic Sternoclavicular Joint Resection Arthroplasty: A Technical Note and Illustrated Case Report

    PubMed Central

    Warth, Ryan J.; Lee, Jared T.; Campbell, Kevin J.; Millett, Peter J.

    2014-01-01

    Open resection arthroplasty of the sternoclavicular (SC) joint has historically provided good long-term results in patients with symptomatic osteoarthritis of the SC joint. However, the procedure is rarely performed because of the risk of injury to vital mediastinal structures and concern regarding postoperative joint instability. Arthroscopic decompression of the SC joint has therefore emerged as a potential treatment option because of many recognized advantages including minimal tissue dissection, maintenance of joint stability, avoidance of posterior SC joint dissection, expeditious recovery, and improved cosmesis. There are, however, safety concerns given the proximity of neurovascular structures. In this article we demonstrate a technique for arthroscopic SC joint resection arthroplasty in a 26-year-old active man with bilateral, painful, idiopathic degenerative SC joint osteoarthritis. This case also highlights the pearls and pitfalls of arthroscopic resection arthroplasty for the SC joint. There were no perioperative complications. Four months postoperatively, the patient had returned to full activities, including weightlifting, without pain or evidence of SC joint instability. One year postoperatively, the patient showed substantial improvements in the American Shoulder and Elbow Surgeons score; Single Assessment Numeric Evaluation score; Quick Disabilities of the Arm, Shoulder and Hand score; and Short Form 12 Physical Component Summary score over preoperative baseline values. PMID:24749040

  18. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact

    PubMed Central

    Pinto, Patrícia R; McIntyre, Teresa; Ferrero, Ramón; Araújo-Soares, Vera; Almeida, Armando

    2013-01-01

    This study compares the incidence, nature, and impact of persistent post-surgical pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and investigates differences between these procedures, with the focus on potential presurgical and post-surgical issues that could be related to the distinct persistent post-surgical pain outcomes between these two groups. A consecutive sample of 92 patients was assessed prospectively 24 hours before, 48 hours, and 4–6 months after surgery. The data show that TKA patients had a higher likelihood of developing persistent post-surgical pain, of reporting higher pain levels, and of using more neuropathic descriptors when classifying their pain. In addition, TKA patients more often reported interference from pain on functional domains, including general activity, walking ability, and normal work. Demographic factors, like gender and age, along with presurgical clinical factors like disease onset, existence of medical comorbidities, and other pain problems, may have contributed to these differences, whereas baseline psychologic factors and functionality levels did not seem to exert an influence. Heightened acute post-surgical pain experience among TKA patients could also be related to distinct outcomes for persistent post-surgical pain. Future prospective studies should therefore collect TKA and THA samples wherein patients are homogeneous for demographic and presurgical clinical issues. Overall, these findings contribute to a small but growing body of literature documenting persistent post-surgical pain after major arthroplasty, conducted in different countries and across different health care settings. PMID:24072977

  19. Tranexamic acid for the reduction of blood loss in total knee arthroplasty

    PubMed Central

    2015-01-01

    The Journal of Arthroplasty recently published a paper entitled “The Efficacy of Combined Use of Intraarticular and Intravenous Tranexamic Acid on Reducing Blood Loss and Transfusion Rate in Total Knee Arthroplasty”. Tranexamic acid (TXA) is an antifibrinolytic drug whose administration during the perioperative period either by intravenous route or topically applied to the surgical field has been shown to reliably reduce blood loss and need for transfusion in patients undergoing total knee arthroplasty (TKA). Although randomized trials and meta-analyses did not show an increase in thromboembolic events, concerns remain about its repeated systemic application. The authors of the study introduced a novel regimen of TXA administration combining a preoperative intravenous bolus followed by local infiltration at the end of surgery with the idea of maximizing drug concentration at the surgical site while minimizing systemic antifibrinolytic effects. The combined dosage regimen appears to be more effective than single dose local application in reducing blood loss and transfusion rate without any complications noted. PMID:26046088

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

    PubMed Central

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

    2015-01-01

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

  1. A note on gaps

    E-print Network

    Hisanobu Shinya

    2011-09-11

    Let $p_{k}$ denote the $k$-th prime and $d(p_{k}) = p_{k} - p_{k - 1}$, the difference between consecutive primes. We denote by $N_{\\epsilon}(x)$ the number of primes $\\leq x$ which satisfy the inequality $d(p_{k}) \\leq (\\log p_{k})^{2 + \\epsilon}$, where $\\epsilon > 0$ is arbitrary and fixed, and by $\\pi(x)$ the number of primes less than or equal to $x$. In this paper, we first prove a theorem that $\\lim_{x \\to \\infty} N_{\\epsilon}(x)/\\pi(x) = 1$. A corollary to the proof of the theorem concerning gaps between consecutive squarefree numbers is stated.

  2. Domain walls in gapped graphene

    E-print Network

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

    2008-05-31

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

  3. Domain walls in gapped graphene

    E-print Network

    Semenoff, G W; Zhou, Fei

    2015-01-01

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

  4. 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.

  5. 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.

  6. Patient-Reported Allergies Are Associated With Poorer Patient Satisfaction and Outcomes After Lower Extremity Arthroplasty: A Retrospective Cohort Study.

    PubMed

    McLawhorn, Alexander S; Bjerke-Kroll, Benjamin T; Blevins, Jason L; Sculco, Peter K; Lee, Yuo-Yu; Jerabek, Seth A

    2015-07-01

    Anecdotal evidence suggests that patient-reported allergies (PRAs) may exhibit prognostic value for patient-reported outcomes after lower extremity arthroplasty. This study's purpose was to investigate associations between PRAs, patient satisfaction and outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA). PRAs in 274 patients undergoing primary THA and 257 patients receiving primary TKA were reviewed retrospectively. Satisfaction scores, baseline Western Ontario and McMaster Universities Arthritis Index (WOMAC), 2-year postoperative WOMAC and length-of-stay (LOS) were analyzed with PRAs. Increasing number of PRAs was significantly associated with worse satisfaction scores and worse WOMAC scores for TKA and THA, and it was significantly associated with increased LOS for TKA. These results may have implications for patient counseling and risk-adjusted outcome models. PMID:25702595

  7. Clinical Usefulness of SPECT-CT in Patients with an Unexplained Pain in Metal on Metal (MOM) Total Hip Arthroplasty.

    PubMed

    Berber, Reshid; Henckel, Johann; Khoo, Michael; Wan, Simon; Hua, Jia; Skinner, John; Hart, Alister

    2015-04-01

    SPECT-CT is increasingly used to assess painful knee arthroplasties. The aim of this study was to evaluate the clinical usefulness of SPECT-CT in unexplained painful MOM hip arthroplasty. We compared the diagnosis and management plan for 19 prosthetic MOM hips in 15 subjects with unexplained pain before and after SPECT-CT. SPECT-CT changed the management decision in 13 (68%) subjects, Chi-Square=5.49, P=0.24. In 6 subjects (32%) pain remained unexplained however the result reassured the surgeon to continue with non-operative management. SPECT-CT should be reserved as a specialist test to help identify possible causes of pain where conventional investigations have failed. It can help reassure surgeons making management decisions for patients with unexplained pain following MOM hip arthroplasty. PMID:25583682

  8. ISABELLE cavity gap assemblies

    SciTech Connect

    Plotkin, M

    1981-01-01

    In a storage ring, where beam lifetime is measured in hours, it is necessary to keep the longitudinal impedance, as seen by the beam, very low, even into the gigahertz region. This is necessary to prevent the excitation of longitudinal instabilities. These impedances are due to the resistive wall effect and any deviation from a smooth vacuum chamber such as at pick-up electrodes, vacuum pump stations, rf cavities, etc. At low frequencies, up to 10 to 20 MHz, the low impedance requirement for the cavities can be satisfied by designing the driving power amplifiers with a very low output impedance. For ISABELLE a method has been designed for building a network into the cavity accelerating gaps which will satisfy the impedance criteria to at least 1300 MHz. The maximum allowable impedance at any frequency, f, is given in the form Z/n where n = f/f/sub rotation/. For the ISABELLE accelerating cavity, operating at 235.5 KHz, Z/n must be less than 10 ohms. For the stacking cavity, operating at 4.45 MHz, Z/n < 1 ohm.

  9. Gap solitons due to cascading

    NASA Astrophysics Data System (ADS)

    Kivshar, Yuri S.

    1995-02-01

    It is shown analytically that gap solitons can occur in materials with ?(2) susceptibility due to cascaded second-order nonlinearities. Families of bright and dard spatial gap solitons are described in the framework of asymptotic expansions that are valid, in particular, for nonzero phase mismatch between the first and second harmonics; effective coefficients of self- and cross-phase modulation are calculated.

  10. Compartment syndrome due to massive leg hematoma after primary total hip arthroplasty: a previously unreported complication of fondaparinux.

    PubMed

    Hannon, Michael G; Lamont, Justin G

    2012-08-01

    Fondaparinux is an accepted form of deep venous thrombosis prophylaxis after hip arthroplasty. Cited advantages of its use include once-daily administration, standard dosage, and superiority as compared with enoxaparin. However, there have been several case reports of serious associated bleeding complications. We describe the case of a 77-year-old woman who developed a massive leg hematoma in the operative extremity nearly 3 weeks after a primary total hip arthroplasty while on fondaparinux. The patient developed a compartment syndrome requiring decompression of the hematoma, fasciotomy, and subsequent additional plastic surgery for split thickness skin grafting. PMID:22177799

  11. Energy gaps in ?-graphdiyne nanoribbons

    NASA Astrophysics Data System (ADS)

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

    2014-04-01

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

  12. Energy gaps in graphene nanoribbons.

    PubMed

    Son, Young-Woo; Cohen, Marvin L; Louie, Steven G

    2006-11-24

    Based on a first-principles approach, we present scaling rules for the band gaps of graphene nanoribbons (GNRs) as a function of their widths. The GNRs considered have either armchair or zigzag shaped edges on both sides with hydrogen passivation. Both varieties of ribbons are shown to have band gaps. This differs from the results of simple tight-binding calculations or solutions of the Dirac's equation based on them. Our ab initio calculations show that the origin of energy gaps for GNRs with armchair shaped edges arises from both quantum confinement and the crucial effect of the edges. For GNRs with zigzag shaped edges, gaps appear because of a staggered sublattice potential on the hexagonal lattice due to edge magnetization. The rich gap structure for ribbons with armchair shaped edges is further obtained analytically including edge effects. These results reproduce our ab initio calculation results very well. PMID:17155765

  13. Energy gaps in ?-graphdiyne nanoribbons

    SciTech Connect

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

    2014-04-14

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

  14. Changes in von Willebrand factor and ADAMTS-13 in patients following arthroplasty.

    PubMed

    Liu, Ling; Ling, Jing; Ma, Zhenni; Yuan, Quan; Pan, Jun; Yang, Huilin

    2015-04-01

    The glycoprotein, von Willebrand factor (VWF) is a carrier protein for factor VIII. When bound to platelets and the extracellular matrix, it promotes aggregation or adhesion of platelets to areas of vascular damage. A disintegrin and metalloproteinase with thrombospondin motif, member 13 (ADAMTS13) cleaves between the tyr1605 and met1606 residues in the central A2 domain of VWF decreasing its activity. The levels of ADAMTS13 and VWF are positively correlated with the risk of developing thrombosis and inversely correlated with the risk of bleeding. A total of 93 patients were observed, who underwent total hip arthroplasty or total knee arthroplasty. Blood samples were collected preoperatively and on postoperative days (PODs) 1, 2, 3, 5 and 7. Plasma levels of the ADAMTS13 antigen were determined using western blotting. The proteolytic activity was validated with the FRETS?VWF73 assay. VWF:Ag and VWF:RCo activity were measured using an enzyme?linked immunosorbent assay. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), antithrombin III and plasma fibrinogen levels were measured on a Sysmex® CA500 system with corresponding reagents. D?dimer levels were measured on a STA?R fully automated coagulation analyzer. The results demonstrated that, the levels of VWF antigen and activity in the patient increased from postoperative day (POD) 1. By contrast, the level of the ADAMTS13 antigen and its activity in the patients decreased significantly. Starting on POD1, fibrinogen and D?dimer levels increased. No significant changes were observed in PT, APTT and TT. It was concluded that the ADAMTS13 and VWF levels exhibited a marked association with thrombosis risk. The levels of ADAMTS13 and VWF may be potentially useful as markers for predicting thrombotic complications following arthroplasty and inhibiting the activity of VWF may be a novel prophylaxis to reduce postoperative deep venous thrombosis and pulmonary embolism. PMID:25482054

  15. Overweight and obesity in hip and knee arthroplasty: Evaluation of 6078 cases

    PubMed Central

    Guenther, Daniel; Schmidl, Stefan; Klatte, Till O; Widhalm, Harald K; Omar, Mohamed; Krettek, Christian; Gehrke, Thorsten; Kendoff, Daniel; Haasper, Carl

    2015-01-01

    AIM: To evaluate a possible association between the various levels of obesity and peri-operative charac-teristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHODS: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intra-and perioperative complications increased for such patients. We evaluated all patients with body mass index (BMI) ? 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score (HHS), Hospital for Special Surgery score (HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated. RESULTS: Six thousand and seventy-eight patients with a BMI ? 25 were treated with a primary THA or TKA. Age decreased significantly (P < 0.001) by increasing obesity in both the THA and TKA. HHS and HSS were at significantly lower levels at the time of treatment in the super-obese population (P < 0.001). Distribution patterns of the type of endoprostheses used changed with an increasing BMI. Peri- and postoperative complications were similar in form and quantity to those of the normal population. CONCLUSION: Higher BMI leads to endoprosthetic treat-ment in younger age, which is carried out at significantly lower levels of preoperative joint function. PMID:25621218

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Al-Omran, Abdallah S.

    2014-01-01

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

  19. Pneumatic gap sensor and method

    DOEpatents

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

    1992-01-01

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

  20. Mild to Moderate Hip OA: Joint Preservation or Total Hip Arthroplasty?

    PubMed

    Peters, Christopher L

    2015-07-01

    Treatment of structural hip disease such as FAI and acetabular dysplasia has increased dramatically over the past decade with the goal of preservation of the native hip joint. A number of patient and disease specific parameters including the amount of underlying hip osteoarthrosis can help predict success with joint preservation surgery. Total hip arthroplasty remains a very good option in young patients who are not ideal candidates for joint preservation surgery. Future developments will help to better identify ideal surgical candidates and improve understanding of the disease processes. PMID:25842248

  1. Pituitary apoplexy during general anesthesia in beach chair position for shoulder joint arthroplasty.

    PubMed

    Koga, Tokito; Miyao, Mariko; Sato, Masami; Hirota, Kiichi; Kakuyama, Masahiro; Tanabe, Hiroko; Fukuda, Kazuhiko

    2010-06-01

    Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of pituitary adenoma secondary to infarction and/or hemorrhage. It may be the first presentation of previously undiagnosed pituitary adenoma. Although various precipitating factors of pituitary apoplexy are indicated, the pathogenesis remains unknown. In this report, we describe for the first time a case of pituitary apoplexy developed explicitly during general anesthesia supplemented with interscalene brachial plexus block in beach chair or barbershop position for shoulder joint arthroplasty. PMID:20339880

  2. Anaesthetic management of hip arthroplasty in an individual with trisomy 21 and Eisenmenger's syndrome

    PubMed Central

    Bilak, Joanna M; Saddler, John

    2013-01-01

    A 49-year-old man with trisomy 21 and Eisenmenger's syndrome presented for hip arthroplasty. Eisenmenger's syndrome is defined by the presence of obstructive pulmonary vascular disease secondary to long-standing left-to-right shunt causing pulmonary hypertension, eventually leading to shunt reversal in to right-to-left direction. Patients with Eisenmenger's syndrome pose a significant perioperative risk because of the physiological alterations induced by anaesthetic agents. The choice of anaesthetic technique in these patients is therefore not straightforward. A successful outcome was achieved with general anaesthesia supplemented with nerve blocks. PMID:23580670

  3. Patellar tendon rupture and marked joint instability after total knee arthroplasty

    Microsoft Academic Search

    Takatomo Mine; Hiroshi Tanaka; Tosihiko Taguchi; Koichiro Ihara; Tohru Moriwaki; Shinya Kawai

    2004-01-01

    Background  Patellar tendon rupture is a rare complication of total knee arthroplasty (TKA). Multiple repair methods have been described\\u000a in the literature.\\u000a \\u000a \\u000a \\u000a Methods  A 66-year-old woman suffered a patellar tendon re-rupture and marked joint instability within 6 months after revision TKA.\\u000a She underwent re-revision TKA and extensor mechanism reconstruction with femoral quadriceps tendon and augmentation by a Leeds-Keio\\u000a ligament.\\u000a \\u000a \\u000a \\u000a Result  It was fairly difficult

  4. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty.

    PubMed

    Kim, Tae Won B; Kamath, Atul F; Israelite, Craig L

    2011-08-01

    Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA. PMID:21397449

  5. Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study

    PubMed Central

    Choy, Won-Sik; Lee, Sang Ki; Bae, Kyoung Wan; Hwang, Yoon Sub; Park, Chang Kyu

    2013-01-01

    Background This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. Methods We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. Results The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. Conclusions The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications. PMID:24009902

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

    PubMed Central

    Frølich, Christina; Hansen, Torben Bæk

    2015-01-01

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

  7. Retrospective study of facial nerve function following temporomandibular joint arthroplasty using the endaural approach.

    PubMed

    Liu, Frederick; Giannakopoulos, Helen; Quinn, Peter D; Granquist, Eric J

    2015-06-01

    The aim of this retrospective case-control study is to evaluate the incidence of facial nerve injury associated with temporomandibular joint (TMJ) arthroplasty using the endaural approach for the treatment of TMJ pathology. The sample consisted of 36 consecutive patients who underwent TMJ arthroplasty. A total of 39 approaches were performed through an endaural incision. Patients undergoing total joint replacement and/or with preexisting facial nerve dysfunction were excluded from the study. Five patients were lost to follow-up and were excluded from the study. Facial nerve function of all patients was clinically evaluated by resident physicians preoperatively, postoperatively, and at follow-up appointments. Facial nerve injury was determined to have occurred if the patient was unable to raise the eyebrow or wrinkle the forehead (temporalis branch), completely close the eyelids (zygomatic branch), or frown (marginal mandibular branch). Twenty-one of the 36 patients or 22 of the 39 approaches showed signs of facial nerve dysfunction following TMJ arthroplasty. This included 12 of the 21 patients who had undergone previous TMJ surgery. The most common facial nerve branch injured was the temporal branch, which was dysfunctional in all patients either as the only branch injured or in combination with other branches. By the 18th postoperative month, normal function had returned in 19 of the 22 TMJ approaches. Three of the 22 TMJ approaches resulted in persistent signs of facial nerve weakness 6 months after the surgery. This epidemiological study revealed a low incidence of permanent facial nerve dysfunction. A high incidence of temporary facial nerve dysfunction was seen with TMJ arthroplasty using the endaural approach. Current literature reveals that the incidence of facial nerve injury associated with open TMJ surgery ranges from 12.5 to 32%. The temporal branch of the facial nerve was most commonly affected, followed by 4 of the 22 approaches with temporary zygomatic branch weakness. Having undergone previous TMJ surgery did not increase the incidence of facial nerve injury using the endaural approach. This information is important for patients and surgeons in the postoperative period, as a majority of patients will experience recovery of nerve function. PMID:26000077

  8. Sex differences in the morphological failure patterns following hip resurfacing arthroplasty

    PubMed Central

    2011-01-01

    Background Metal-on-metal hybrid hip resurfacing arthroplasty (with a cementless acetabular component and a cemented femoral component) is offered as an alternative to traditional total hip arthroplasty for the young and active adult with advanced osteoarthritis. Although it has been suggested that women are less appropriate candidates for metal-on-metal arthroplasty, the mechanisms of prosthesis failure has not been fully explained. While specific failure patterns, particularly osteonecrosis and delayed type hypersensitivity reactions have been suggested to be specifically linked to the sex of the patient, we wished to examine the potential influence of sex, clinical diagnosis, age of the patient and the size of the femoral component on morphological failure patterns in a large cohort of retrieved specimens following aseptic failure of hip resurfacing arthroplasty. Methods Femoral remnants retrieved from 173 hips with known patient's sex were morphologically analyzed for the cause of failure. The results were compared with the control group of the remaining 31 failures from patients of unknown sex. The odds ratios (OR) and 95% confidence intervals (CI) of the following morphologically defined variables were calculated using logistic regression analysis: periprosthetic fractures (n = 133), osteonecrosis (n = 151), the presence of excessive intraosseous lymphocyte infiltration (n = 11), and interface hyperosteoidosis (n = 30). Logistic regression analysis was performed both unadjusted and after adjustment for sex, age, the size of the femoral component, and preoperative clinical diagnosis. Results Femoral remnants from female patients had a smaller OR for fracture (adjusted OR: 0.29, 95% CI 0.11, 0.80, P for difference = 0.02) and for the presence of osteonecrosis (adjusted OR: 0.16, 95% CI 0.04, 0.63, P for difference = 0.01). However, women had a higher OR for both the presence of excessive intraosseous lymphocyte infiltration (adjusted OR: 10.22, 95% CI 0.79, 132.57, P for difference = 0.08) and interface hyperosteoidosis (adjusted OR: 4.19, 95% CI 1.14, 15.38, P for difference = 0.03). Conclusions Within the limitations of this study, we demonstrated substantial sex differences in distinct failure patterns of metal-on-metal hip resurfacing. Recognition of pathogenically distinct failure modes will enable further stratification of risk factors for certain failure mechanisms and thus affect future therapeutic options for selected patient groups. PMID:21992554

  9. A comparison of distal canal restrictors in primary cemented femoral hip arthroplasty.

    PubMed

    Smith, Eric L; Wohlrab, Kurt P; Matzkin, Elizabeth G; Providence, Bertram C

    2004-08-01

    A retrospective study evaluated 75 total hip arthroplasties performed over a 4-year period using 4 different cement restrictors. A harvested bone restrictor, polyethylene restrictor (Smith & Nephew, Richards Inc, Memphis, Tenn), Biostop G (Depuy Orthopaedics, Warsaw, Ind), and polymethylmethacrylate (PMMA) (Wright Medical Technology, Arlington, Tex) were compared for the percentage of failures, the average length of the cement mantle, and the width of the femoral canal compared to the cement grade. Patient age, sex, and cement type were also evaluated for their influence on cement grade. The PMMA restrictor and bone performed better than the Richards plug and Biostop G restrictor. PMID:15369006

  10. Evaluation and treatment of painful total hip arthroplasties with modular metal taper junctions.

    PubMed

    Meneghini, R Michael; Hallab, Nadim J; Jacobs, Joshua J

    2012-05-01

    Modern primary total hip arthroplasty femoral components have evolved to include modular necks. Subsequently, the additional taper junction provides another interface as a potential source for mechanically assisted crevice corrosion, which is a complex process involving fretting and crevice corrosion. Furthermore, it is becoming evident that an adverse local tissue reaction may result in some patients due to the mechanically assisted crevice corrosion. This article details the clinical, radiographic, and laboratory evaluation of patients with these components who present with persistent pain. The relevant surgical strategies and techniques to address this pathology in symptomatic patients are addressed. PMID:22588392

  11. Prophylactic use of antibiotic-loaded bone cement in primary total knee arthroplasty: Justified or not?

    PubMed Central

    Srivastav, Amit K; Nadkarni, Biren; Srivastav, Shekhar; Mittal, Vivek; Agarwal, Shekhar

    2009-01-01

    Background: The routine use of antibiotic-loaded bone cement (ABLC) during primary or uninfected revision arthroplasty remains controversial. Many studies quote the total joint arthroplasty (TJA) infection rate to be less than 1%. Total knee arthroplasty (TKA) has a higher infection rate than total hip arthroplasty (THA). Based on both animal and human studies in the past, ABLC has been found effective in reducing the risk of infection in primary TJA. We are presenting retrospective analysis of results in terms of infection rate in 659 TKA performed by a single surgeon under similar conditions during 2004–2007 using CMW1 (Depuy, Leeds, UK) with premixed 1 g of gentamicin. Patients and Methods: We did primary TKA in 659 knees of 379 patients during 2004–2007 using CMW1 (Depuy, Leeds, UK) cement containing 1 g of gentamicin in 40 g of cement in a premixed form. Standard OT conditions were maintained using laminar air flow, isolation suits for the operating team, pulse lavage and disposable drapes in each patients. Midvastus approach was used in all the patients to expose the knee joint. A systemic antibiotic (third-generation cephalosporin and aminoglycoside) was used preoperatively and 48 h postoperatively. We observed the patients in terms of infection in the high-risk and low-risk group till the recent follow-up with a mean of 20.6 months (9–38 months). Results: We had deep infection in six knees in six patients and all of them required two-stage revision surgery later in the high-risk group. Infection occurred at a mean of 20.5 months after surgery earliest at 9 months and latest at 36 months after surgery. The infection rate in our study was 0.91% which is comparatively less than the reported incidence of 1–2% in reported studies. Conclusion: We conclude that the use of antibiotic loaded bone cement is one of the effective means in preventing infection in primary TJA. PMID:19838348

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

    PubMed

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

    2007-01-01

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

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

    PubMed Central

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

    2007-01-01

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

  14. Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty

    Microsoft Academic Search

    Milena Pachowsky; Johannes Gusinde; Andrea Klein; Siegfried Lehrl; Stefan Schulz-Drost; Philipp Schlechtweg; Johannes Pauser; Kolja Gelse; Matthias H. Brem

    Purpose  The purpose of this study was to evaluate the use of negative pressure wound therapy (NPWT) to improve wound healing after\\u000a total hip arthroplasty (THA) and its influence on the development of postoperative seromas in the wound area.\\u000a \\u000a \\u000a \\u000a \\u000a Materials  The study is a prospective randomised evaluation of NPWT in patients with large surgical wounds after THA, randomising patients\\u000a to either a

  15. Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

    Microsoft Academic Search

    Kevin L. Ong; Edmund Lau; Jeremy Suggs; Steven M. Kurtz; Michael T. Manley

    2010-01-01

    Background  Revision is technically more demanding than primary total joint arthroplasty (TJA) and requires more extensive use of resources.\\u000a Understanding the relative risk of rerevision and risk factors can help identify patients at high risk who may require closer\\u000a postsurgical care.\\u000a \\u000a \\u000a \\u000a \\u000a Objectives\\/purposes  We therefore evaluated the risk of subsequent revision after primary and revision TJA in the elderly (65 years or older) patient

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

    PubMed

    Frølich, Christina; Hansen, Torben Bæk

    2015-01-01

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

  17. Management of Contained Medial [Protrusiol] Acetabular Defects in Revision Total Hip Arthroplasty.

    PubMed

    Ries, Michael D

    2000-10-01

    Medial migration of the acetabular cup and protrusio of the medial wall is a well recognized failure mechanism of acetabular fixation in cemented total hip arthroplasty. In the protruded acetabulum, a medialized position of the acetabular component is associated with increased medial cortical bone stresses, while more lateral positioning reduces the medial stresses. Use of a protrusio ring or medial wire mesh may limit medial migration. However, late failure of acetabular revision reconstructions can occur when cemented protrusio rings or wire mesh reinforcement are used without bone grafting. PMID:12219311

  18. Management of contained medial [protrusiol] acetabular defects in revision total hip arthroplasty.

    PubMed

    Ries, M D

    2000-01-01

    Medial migration of the acetabular cup and protrusio of the medial wall is a well recognized failure mechanism of acetabular fixation in cemented total hip arthroplasty. In the protruded acetabulum, a medialized position of the acetabular component is associated with increased medial cortical bone stresses, while more lateral positioning reduces the medial stresses. Use of a protrusio ring or medial wire mesh may limit medial migration. However, late failure of acetabular revision reconstructions can occur when cemented protrusio rings or wire mesh reinforcement are used without bone grafting. PMID:21136419

  19. [Research progress of polyethylene inserts wear measurement and evaluation in total knee arthroplasty].

    PubMed

    Zhao, Feng; Wang, Chuan; Fan, Yubo

    2015-01-01

    Wear of polyethylene (PE) tibial inserts is a significant cause of implant failure of total knee arthroplasty (TKA). PE inserts wear measurement and evaluation is the key in TKA researches. There are many methods to measure insert wear. Qualitative methods such as observation are used to determine the wear and its type. Quantitative methods such as gravimetric analysis, coordinate measuring machines (CMM) and micro-computed tomography (micro-CT) are used to measure the mass, volume and geometry of wear. In this paper, the principle, characteristics and research progress of main insert wear evaluation method were introduced and the problems and disadvantages were analyzed. PMID:26027291

  20. Serum C-Reactive Protein Distribution in Minimally Invasive Total Knee Arthroplasty Do Not Differ with Distribution in Conventional Total Knee Arthroplasty

    PubMed Central

    Yombi, Jean Cyr; Schwab, Pierre Emmanuel; Thienpont, Emmanuel

    2015-01-01

    Minimally invasive total knee arthroplasty (MITKA) has been developed to reduce surgical trauma and facilitate rehabilitation after arthroplasty. A plausible hypothesis is that this reduced trauma results in lower concentrations of circulating inflammatory biomarkers, such as C-reactive protein (CRP). In this study, we compared CRP concentrations in patients undergoing MITKA to those undergoing conventional TKA (CTKA). Eight hundred and seven patients undergoing MITKA were prospectively recruited. CRP was measured before operation and on days 2, 4, 21, and 42 after operation. Two hundred and forty-seven patients who had CTKA were collected retrospectively, with the same inclusion and exclusion criteria as those who had MITKA. We found in both groups, that CRP values rose abruptly after operation, with peak values reached on day 2 or 4. Values then declined so that by days 21 and 42 they were only modestly above baseline values. Throughout the entire study period, mean CRP in MITKA patients did not differ significantly from those in CTKA patients. However, a significantly higher proportion of CTKA patients than of MITKA patients had peak CRP values at day 4 rather than at day 2 (76.8% vs 42.5%), a difference that was more pronounced in women. Also, by day 42, CRP values were still above baseline in 18.5% of MITKA patients and 28.8% of CTKA patients without known complications. In conclusion, CRP distribution pattern was similar in patients who received MITKA or CTKA,. CRP values remained slightly elevated in both MITKA and CTKA patients for as long 42 days after operation. These findings suggest that MITKA is no less traumatic than CTKA, as determined by CRP values, and the patterns of postoperative CRP may be useful in the management of TKA patients. PMID:25910083

  1. The Effect of Age on Pain, Function, and Quality of Life After Total Hip and Knee Arthroplasty

    Microsoft Academic Search

    C. Allyson Jones; Donald C. Voaklander; D. William; C. Johnston; Maria E. Suarez-Almazor

    2001-01-01

    Background: As utilization rates for total joint arthro- plasty increase, there is a hesitancy to perform this sur- gery on very old patients. The objective of this prospec- tive study was to compare pain, functional, and health- related quality-of-life outcomes after total hip and total knee arthroplasty in an older patient group ($80 years) and a representative younger patient group

  2. Expression of epidermal growth factor and transforming growth factor ? in interfacial membranes retrieved at revision total hip arthroplasty

    PubMed Central

    Xu, J.; Ma, J.; Li, T.; Waris, E.; Alberty, A.; Santavirta, S.; Konttinen, Y.

    2000-01-01

    BACKGROUND—The interfacial membrane between bone and implant has been shown to be a key tissue in the process of aseptic loosening of total hip arthroplasty. The cells within the interfacial membrane produce numerous inflammatory mediators which, through complex mechanisms, cause periprosthetic osteolysis and aseptic loosening. Both epidermal growth factor (EGF) and transforming growth factor ? (TGF?) have similar biological functions. They have been found to stimulate bone resorption.?OBJECTIVE—To investigate the presence, cellular localisation, and extent of expression of EGF and TGF? in interfacial membrane retrieved from revision total hip arthroplasty and compare it with that in synovial membrane from primary total hip arthroplasty.?METHODS—Ten interfacial membranes and 10 synovial membranes were stained with avidin-biotin-peroxidase complex for EGF and TGF?. The staining process was done using the Lab Vision Autostainer. The results were measured by a semiautomatic VIDAS image analysis system.?RESULTS—Immunoreactivity for both EGF and TGF? was found in the endothelial cells of blood vessels, macrophages, and fibroblasts, both in interfacial membranes and synovial membranes. However, the number of EGF (980 (370)) and TGF? (1070 (360)) positive cells per mm2 was greater in interfacial membranes than in the synovial membranes (220 (200), 270 (100); p<0.01).?CONCLUSION—It is suggested that owing to their increased expression in interfacial membrane, EGF and TGF? may have an important pathogenetic role in stimulating periprosthetic bone resorption in aseptic loosening of total hip arthroplasty.?? PMID:11005785

  3. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty

    Microsoft Academic Search

    E. J. Harvey; J. Leclerc; C. E. Brooks; D. L. Burke

    1997-01-01

    Tourniquet time and its relationship to blood loss and deep vein thrombosis were studied in 80 cases of unilateral total knee arthroplasty. These data were part of a prospective multicenter double-blind study on thromboprophylaxis for knee surgery. This study reports on the cases done at one institution in which the tourniquet was used in three different ways: group 1, no

  4. Surveillance Venous Duplex Is Not Clinically Useful after Total Joint Arthroplasty When Effective Deep Venous Thrombosis Prophylaxis Is Used

    Microsoft Academic Search

    Thomas H. Schwarcz; Marc R. Matthews; James M. Hartford; Rhonda C. Quick; Christopher J. Kwolek; David J. Minion; Eric D. Endean; Robert M. Mentzer

    2004-01-01

    The early detection of deep venous thrombosis (DVT) and treatment with systemic anticoagulation to prevent pulmonary embolism (PE) are essential in the management of patients undergoing total joint arthroplasty (TJA). However, improvements in prophylactic measures have significantly decreased the occurrence of DVT in these patients. The purpose of this study was to determine whether routine postoperative duplex surveillance for DVT

  5. Laboratory Investigations Effect of Zoledronate on Bone Quality in the Treatment of Aseptic Loosening of Hip Arthroplasty in the Dog

    Microsoft Academic Search

    L. M. Wise; S. D. Waldman; M. Kasra; R. Cheung; A. Binnington; R. A. Kandel; L. M. White; M. D. Grynpas

    2005-01-01

    Periprosthetic bone loss, which is a direct cause of aseptic loosening in total hip arthroplasty (THA), can be suppressed by bisphosphonates. It is unknown how the quality of this bone is affected in the presence of both wear debris (from implant) and bis- phosphonates. The objective of this study was to eval- uate the effect of zoledronate (ZLN) on bone

  6. Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis

    Microsoft Academic Search

    Daigo Matsunaga; Shaw Akizuki; Tsutomu Takizawa; Ikuya Yamazaki; Joji Kuraishi

    2007-01-01

    This study compared the healing of articular cartilage and the clinical outcome after osteotomy with or without marrow stimulation microfracture or abrasion arthroplasty for osteoarthritis of the knee. Patients with osteoarthritis of the medial compartment of the knee were divided into a group undergoing high tibial osteotomy alone (HTO group: 37 knees), a group undergoing osteotomy plus microfracture (MF group:

  7. Comparison of Immediate Postoperative Walking Ability in Patients Receiving Minimally Invasive and Standard-Incision Hip Arthroplasty

    Microsoft Academic Search

    Damien Bennett; Luke Ogonda; David Elliott; Lee Humphreys; Marie Lawlor; David Beverland

    2007-01-01

    Minimally invasive hip arthroplasty is thought to result in less soft tissue damage, earlier ambulation, and improved rehabilitation. This prospective blinded cohort study objectively analyzed early functional walking ability by stride analysis 2 days postoperatively. Ninety-five patients were analyzed, 43 of who received the minimal incision and 52 the traditional incision. Patients, physiotherapists, and assessors were blinded to the incision

  8. A striated pattern of wear in ultrahigh-molecular-weight polyethylene components of Miller-Galante total knee arthroplasty

    Microsoft Academic Search

    Markus A. Wimmer; Thomas P. Andriacchi; Raghu N. Natarajan; Joachim Loos; Matthias Karlhuber; Jürgen Petermann; Erich Schneider; Aaron G. Rosenberg

    1998-01-01

    Wear of the polyethylene tibial components is a potential cause of failure in total knee arthroplasty. In addition to pitting, burnishing, and scratching, subtle striations on the bearing portion of the tibial surface have been observed in components retrieved relatively early after implantation. The striated pattern most typically occurred in areas centrally located within the articulating surface. The striations were

  9. Freehand resection of the patella in total knee arthroplasty referencing the attachments of the quadriceps tendon and patellar tendon

    Microsoft Academic Search

    Adolph V. Lombardi; Thomas H. Mallory; Paul D. Maitino; Stephen M. Herrington; Cheryl A. Kefauver

    1998-01-01

    A freehand technique of patellar resurfacing using anatomic references was prospectively evaluated. This technique utilizes an osteotomy beginning at the inferior pole of the patella just posterior to the insertion of the patellar tendon and is carried proximally posterior to the insertion of the quadriceps tendon. Evaluation of 55 total knee arthroplasties in 41 patients showed an average restored patellar

  10. Reverse Total Shoulder Replacement with Minimal ACJ Excision Arthroplasty for Management of Massive ACJ Cyst - A Case Report

    PubMed Central

    Shaarani, Shahril R; Mullett, Hannan

    2014-01-01

    Massive acromioclavicular joint (ACJ) cysts are an extremely rare cause of shoulder impairment and with limited consensus in its management. We present the first published case report of a patient with a massive ACJ cyst treated with a reverse total shoulder replacement with minimal ACJ excision arthroplasty. PMID:25279019

  11. Lack of impact of intravenous lidocaine on analgesia, functional recovery, and nociceptive pain threshold after total hip arthroplasty

    E-print Network

    Paris-Sud XI, Université de

    in 10 min followed by a 1.5 mg.kg-1 .h-1 IV infusion and other patients received saline (control group was provided exclusively by patient-controlled IV morphine. Pain scores, morphine consumption, operative hip; Introduction Patients experience moderate to severe pain after total hip arthroplasty. Adequate control

  12. Technology of fast spark gaps

    NASA Astrophysics Data System (ADS)

    Standler, Ronald B.

    1989-09-01

    To protect electronic systems from the effects of electromagnetic pulse (EMP) form nuclear weapons and high-power microwave (HPM) weapons, it is desirable to have fast responding protection components. The gas-filled spark gap appears to be an attractive protection component, except that it can be slow to conduct under certain conditions. This report reviews the literature and presents ideas for construction of a spark gap that will conduct in less than one nanosecond. The key concept to making a fast-responding spark gap is to produce a large number of free electrons quickly. Seven different mechanisms for production of free electrons are reviewed, and several that are relevant to miniature spark gaps for protective applications are discussed in detail. These mechanisms include: inclusion of radioactive materials, photoelectric effect, secondary electrode emission from the anode, and field emission from the cathode.

  13. Trading indicators with information-gap uncertainty

    E-print Network

    Guttman, Tony

    1 Trading indicators with information-gap uncertainty Colin J. Thompson ARC Centre of Excellence. Practical implications ­ An additional technical trading tool for applying Information ­ Gap theory trading indicators, Information gaps, Uncertainty, Robustness, Financial modelling Paper type Research

  14. Eight electrode optical readout gap

    DOEpatents

    Boettcher, Gordon E. (Albuquerque, NM); Crain, Robert W. (Albuquerque, NM)

    1985-01-01

    A protective device for a plurality of electrical circuits includes a pluity of isolated electrodes forming a gap with a common electrode. An output signal, electrically isolated from the circuits being monitored, is obtained by a photosensor viewing the discharge gap through an optical window. Radioactive stabilization of discharge characteristics is provided for slowly changing voltages and carbon tipped dynamic starters provide desirable discharge characteristics for rapidly varying voltages. A hydrogen permeation barrier is provided on external surfaces of the device.

  15. Pneumatic gap sensor and method

    SciTech Connect

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

    1992-03-03

    This patent describes in a casting system which including an apparatus for monitoring the gap between a casting nozzle and a casting surface of a substrate during casting of molten material, wherein the molten material is provided through a channel of the casting nozzle for casting onto the casting surface of the substrate for solidification. It comprises: a pneumatic gap mounted at least partially within a cavity in the casting nozzle adjacent the channel and having a sensor face located within the gap between the nozzle and the casting surface of the substrate, means for supply gas under predetermined pressure to the inlet orifice; and means for measuring the pressure of the gas within the sensor chamber during casting procedures, whereby relative changes in the gap can be determined by corresponding changes in the measured pressure. This patent also describes a method for monitoring the gap between a casting nozzle and a casting surface of a substrate for continuous casting of molten material. It comprises: providing a casting nozzle with a channel for directing the flow of molten material, locating the nozzle and the casting surface is proximity with one another and having a predetermined gap there-between, and dressing the sensor face to correspond in conformation to the casting surface and to adjust the predetermined distance as desired; providing a molten material to the nozzle for casting onto and casting surface; supplying gas at a predetermined pressure to the inlet orifice of the sensor during casting procedures.

  16. A comprehensive analysis of medicare trends in utilization and hospital economics for total knee and hip arthroplasty from 2005 to 2011.

    PubMed

    Nwachukwu, Benedict U; McCormick, Frank; Provencher, Matthew T; Roche, Martin; Rubash, Harry E

    2015-01-01

    The purpose of this study was to determine annual Medicare utilization and hospital reimbursement rates for total knee arthroplasty (TKA) and total hip arthroplasty (THA). A PearlDiver review of the entire Medicare database was conducted: 2,040,667 TKAs and 855, 899 THAs performed between 2005 and 2011 were identified. There was a +0.05% and +1.3% year over year growth in the utilization in hospital reimbursement for TKA and THA respectively. There has only been a modest increase in joint arthroplasty utilization for Medicare beneficiaries. Supply side issues, insurance mix and possible prior over-projection may explain this finding. Reimbursement trends suggest that joint arthroplasty may not be a major cost driver for the healthcare system. PMID:25267535

  17. NHS Scotland reduces the postcode lottery for hip arthroplasty: an ecological study of the impact of waiting time initiatives

    PubMed Central

    Kirkwood, Graham; Howie, Colin; Wild, Sarah

    2014-01-01

    Objectives Following the election of the Labour government in 1997, policies were developed in England to reduce waiting times for NHS treatment with commitments to reduce health inequalities. Similar policies were adopted in Scotland but with less emphasis on the use of the private sector to deliver NHS treatments than in England. This study uses routinely collected NHS Scotland data to analyse geographical and socioeconomic inequalities in elective hip arthroplasty treatment before and after the introduction of the waiting time initiatives in Scotland in 2003. Design Ecological study design. Setting Scotland. Participants NHS-funded patients receiving elective hip arthroplasty delivered by the NHS and private hospitals between 1 April 1998 and 31 March 2008. Main outcome measures Directly standardised treatment rates and incidence rate ratios calculated using Poisson regression. Results There was a 42% increase in NHS-funded hip arthroplasties carried out in Scotland from 4095 in 2002–2003 (1 April 2002–31 March 2003) to 5829 in 2007–2008. There is evidence of a statistically significant reduction in geographical inequality (likelihood ratio test p?arthroplasties undertaken privately rose from 1.1% in 2002–2003 to 2.9% in 2007–2008, whereas the NHS Golden Jubilee National Hospital increased its share from 3.3% to 10.6% over the same period. Conclusions The reduction in geographical inequality, or ‘postcode lottery’, in hip arthroplasty treatment in Scotland may be due to increased NHS capacity, in particular the development of the NHS Golden Jubilee National Hospital in Clydebank, Greater Glasgow as a dedicated centre to reduce surgery waiting times. PMID:24566936

  18. Changes in bone mineral density of the acetabulum and proximal femur after total hip resurfacing arthroplasty.

    PubMed

    Huang, Qiang; Shen, Bin; Yang, Jing; Zhou, Zong-ke; Kang, Peng-de; Pei, Fu-xing

    2013-12-01

    Our aim was to investigate the changes in bone mineral density (BMD) of acetabulum and proximal femur after total hip resurfacing arthroplasty. A comparative study was carried out on 51 hips in 48 patients. Group A consisted of 25 patients (26 hips) who had undergone total hip resurfacing and group B consisted of 23 patients (25 hips) who had had large-diameter metal-on-metal total hip arthroplasty (THA). BMDs around the acetabulum and proximal femur were measured using dual-energy x-ray absorptiometry (DEXA) at 2 weeks, 6 months, 1 year and annually thereafter during the 3 years after surgery. At final follow-up, the acetabular net mean BMD decreased by 11% in group A and 10% in group B with no differences between two groups (P = .35). For the femoral side, in Gruen zone 1, the mean BMD increased by 4% in group A, whereas it decreased by 11% in group B (P = .029). In Gruen zone 7, the mean BMD increased by 8% at the final follow-up in group A, whereas it decreased by 13% in group B (P = .02). In both groups the mean BMD increased by 3% in Gruen zones 3, 4, 5, and 6. Stress-related bone loss of the acetabulum was comparable for MOM THA and resurfacing devices, but proximal femoral bone density increased in the resurfacing group and decreased in the THA group. PMID:23618750

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

    PubMed

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

    2015-01-01

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

  20. Total Hip Arthroplasty for Posttraumatic Osteoarthritis of the Hip Fares Worse Than THA for Primary Osteoarthritis.

    PubMed

    Khurana, Sonya; Nobel, Tamar B; Merkow, Justin S; Walsh, Michael; Egol, Kenneth A

    2015-07-01

    We conducted a study to evaluate differences between patients who had total hip arthroplasty (THA) for posttraumatic osteoarthritis (OA) and patients who had THA for primary OA. Using a prospective database, we followed 3844 patients who had THA for OA. Those who had THA for secondary causes of hip OA, developmental hip dysplasia, or inflammatory processes were excluded. Of the remaining 1199 patients, 62 (63 fractures) had THA for posttraumatic OA after previous acetabular or proximal femur fracture fixation, and 1137 had THA for primary OA and served as the control group. In the posttraumatic OA group, mean time between fracture repair and conversion to THA was 74 months. Compared with the control patients, the posttrauma patients lost more blood, were transfused more units of blood, had longer operating room times, and had more complications (all Ps < .001). Posttrauma patients had a mean follow-up of 4.44 years and a mean postoperative modified Harris Hip Score of 81.3 at latest follow-up. Of these patients, 12.5% required revision a mean of 3.5 years after initial arthroplasty. THA in patients with posttraumatic hip OA after an acetabular or proximal femur fracture is a longer and more complicated procedure with a higher rate of early failure. PMID:26161760

  1. Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty.

    PubMed

    Mercier, Numa; Wimsey, Simon; Saragaglia, Dominique

    2010-12-01

    The purposes of this study were to investigate the mode of failure and survivorship of an independently performed series of medial Oxford unicompartmental knee arthroplasties. The study included 43 knees in 40 patients with a mean follow-up of 14.88 years: 13 knees (11 patients) had revision surgery (30%), and ten patients required conversion to total knee prosthesis. The mean International Knee Society (IKS) scores at the time of the revision were 145.52 [standard deviation (SD): 39.90, range: 167-200]. The overall alignment of the knee was restored to neutral, with a hip-knee-ankle (HKA) angle average of 178° (SD: 3.21°, range: 170-186°). Survivorship, as defined by an endpoint of failure for any reason, showed that the survival rate at five years was 90%, at ten years 74.7% and at 15 years 70%. Excluding inappropriate patient selection and surgeon-associated failures, our survival analysis plot is much improved: survivorship at five years is 94.5%, at ten years 85.7% and at 15 years 80.4%. The Oxford meniscal bearing arthroplasty offers long-term pain relief with good knee function. Unfortunately, we demonstrated a high complication rate, with some of the failures encountered indicating that the surgical technique is very demanding. PMID:19838707

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

    PubMed Central

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

    2015-01-01

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

  3. Cost drivers in total hip arthroplasty: effects of procedure volume and implant selling price.

    PubMed

    Kelly, Michael P; Bozic, Kevin J

    2009-01-01

    Total hip arthroplasty (THA), though a highly effective procedure for patients with end-stage hip disease, has become increasingly costly, both because of increasing procedure volume and because of the introduction and widespread use of new technologies. Data regarding procedure volume and procedure costs for THA were obtained from the National Inpatient Sample and other published sources for the years 1995 through 2005. Procedure volume increased 61% over the period studied. When adjusted for inflation, using the medical consumer price index, the average selling price of THA implants increased 24%. The selling price of THA implants as a percentage of total procedure costs increased from 29% to 60% during the period under study. The increasing cost of THA in the United States is a result of both increased procedure volume and increased cost of THA implants. No long-term outcome studies related to use of new implant technologies are available, and short-term results have been similar to those obtained with previous generations of THA implants. This study reinforces the need for a US total joint arthroplasty registry and for careful clinical and economic analyses of new technologies in orthopedics. PMID:19238268

  4. [Anxiety in patients undergoing fast-track knee arthroplasty in the light of recent literature].

    PubMed

    Zi?tek, Pawe?; Zi?tek, Joanna; Szczypiór, Karina

    2014-01-01

    The rapid progress in knee implants technology and operational techniques go together with more and more modem medical programs, designed to optimize the patients' care and shorten their stay in hospital. However, this does not guarantee any elimination ofperioperative stress in patients. Anxiety is a negative emotional state arising from stressful circumstances accompanied by activation of the autonomous nervous system. Anxiety causes negative physiological changes, including wound healing, resistance to anesthetic induction, it is associated with an increased perioperative pain and prolong recovery period. The purpose of this work is to present the current state of knowledge on the preoperative anxiety and discuss its impact on pain and other parameters in patients undergoing fast-track arthroplasty of big joints. The work also shows selected issues of anxiety pathomechanism, and actual methods reducing preoperative anxiety in hospitalized patients. The common prevalence of anxiety in patients undergoing surgery induces the attempt to routinely identify patients with higher anxiety, which may be a predictive factor of worse results after TKA. Undertaking widely understood psychological support in these patients before and after the operation could be a favorable element, which would influence thefinal result of the treatment of patients after big joints arthroplasties. PMID:25639020

  5. Lifestyle and health-related quality of life in Asian patients with total hip arthroplasties.

    PubMed

    Fujita, Kimie; Xia, Zhenlan; Liu, Xueqin; Mawatari, Masaaki; Makimoto, Kiyoko

    2014-09-01

    Total hip arthroplasty reduces pain and restores physical function in patients with hip joint problems. This study examined lifestyle and health-related quality of life before and after total hip arthroplasty in Japanese and Chinese patients. Two hospitals in China recruited 120 patients and 120 Japanese patients matched by age and operative status were drawn from a prospective cohort database. Oxford Hip Score, EuroQol, and characteristics of Asian lifestyle and attitudes toward the operation were assessed. There were no differences between patients from the two countries in quality-of-life-scale scores: postoperative patients had significantly better quality-of-life scores than preoperative patients in both countries. In China, patients who reported that living at home was inconvenient had significantly worse Oxford Hip Scores than those who did not. Mean scores for anxiety items concerning possible dislocation and durability of the implant were significantly higher in Japanese than in Chinese subjects. Our findings suggest that providing information about housing conditions and lifestyles would result in improved quality of life and reduced anxiety in patients with implanted joints. PMID:24845456

  6. Late Nontraumatic Dissociation of the Femoral Head and Trunnion in a Total Hip Arthroplasty

    PubMed Central

    Parker, Simon J. M.; Khan, Wasim; Mellor, Simon

    2015-01-01

    Background. Modular total hip arthroplasties are increasingly popular because customisation allows optimal restoration of patient biomechanics. However, the introduction of component interfaces provides greater opportunities for failure. We present a case of late nontraumatic dissociation of the head-neck interface, more than 10 years after insertion. Case Description. A 58-year-old woman had a left metal-on-metal total hip arthroplasty in 2002 for hip dysplasia. Following an uneventful 10-year period, she presented to hospital in severe pain after standing from a seated position, and radiographs demonstrated complete dissociation of the modular femoral head from the stem, with the femoral head remaining in its cup. There was no prior trauma or infection. Mild wear and metallosis were present on the articulating surface between the femoral head and trunnion. Soft tissues were unaffected. Discussion and Conclusions. This is the latest occurrence reported to date for nontraumatic component failure in such an implant by more than 7 years. The majority of cases occur in the context of dislocation and attempted closed reduction. We analyse and discuss possible mechanisms for failure, aiming to raise awareness of this potential complication and encouraging utmost care in component handling and insertion, as well as the long term follow-up of such patients.

  7. 10-Year Survival of Acetabular Reinforcement Rings/Cages for Complex Hip Arthroplasty

    PubMed Central

    Ewers, Alexander; Spross, Christian; Ebneter, Lukas; Külling, Fabrice; Giesinger, Karlmeinrad; Zdravkovic, Vilijam; Erhardt, Johannes

    2015-01-01

    Introduction : Acetabular reinforcement rings/ cages (AR) are commonly used for reconstruction of bone defects in complex hip arthroplasty. The aim of this study was to retrospectively investigate the 10-year survival rate of Ganz reinforcement rings and Burch-Schneider cages used in a single institution. Material and Methods : Between September 1999 and June 2002 all ARs, implanted in one institution, were identified. All patients had regular clinical and radiographic follow-up and were included in this study. Their prospectively collected clinical and radiographic data was retrospectively analyzed. In case of death before the 10-year follow-up examination, patient’s families or their general practitioner was contacted by telephone. The main outcome measures were survival of the ARs and kind of revision surgery. Results : The 10-year survival rate was 77.7%. At 10-year follow-up, 5/60 (8,3%) patients could not be located and had to be excluded therefore. 27/55 (49,1%) were dead, whereof 22 had no revision of the ARs before death (after a mean of 66 months; range: 0 - 123). Of the remaining 28/55 (50,9%) patients, 23 patients (24 ARs) had no revision of the ARs. Conclusion : Despite the high mortality rate of this study’s collective, ARs for complex primary or revision total hip arthroplasty provided predictable long term results. Level of Evidence : Clinical investigation.

  8. Saline-Coupled Bipolar Sealing in Simultaneous Bilateral Total Knee Arthroplasty

    PubMed Central

    Austin, Daniel C.; Derman, Peter B.; Clement, R. Carter; Garino, Jonathan P.; Lee, Gwo-Chin

    2014-01-01

    Background The efficacy of saline-coupled bipolar sealing devices in joint arthroplasty is uncertain, and the utility in simultaneous bilateral total knee arthroplasty (TKA) has not been reported. Methods This study compares the use of bipolar sealing and conventional electrocautery in 71 consecutive patients. The experimental and control groups were matched for age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, and preoperative hemoglobin. Variables of interest included blood loss, transfusion requirements, and operative characteristics. Results In comparison to patients treated with conventional electrocautery, those treated with the bipolar sealer were 35% less likely to require transfusion. The median number of transfusions per case was also significantly lower in the experimental group. Hemoglobin change, total blood loss, and length of stay were not significantly different between the groups. The experimental group had longer operative times. Conclusions Bipolar sealing shows promise as a blood loss reduction tool in simultaneous bilateral TKA. The marginal savings attributed to reduced transfusion rates with use of the bipolar sealer did not exceed the additional per-case expense of using the device. The decision to use the device with the goal of less blood loss must come with the additional expense associated with its use. PMID:25177455

  9. Prevalence of self-reported metal allergy in patients undergoing primary total knee arthroplasty.

    PubMed

    Bloemke, Adam D; Clarke, Henry D

    2015-06-01

    No validated screening method exists to identify patients at risk for metal allergy complications following total knee arthroplasty (TKA). Select use of implants that do not contain nickel, cobalt, and chromium may be considered in patients at risk. This study was performed to determine the rate of self-reported cutaneous metal allergy, or sensitivity, in patients undergoing knee replacement, and to evaluate whether there is a higher prevalence in females. A retrospective chart review was performed on 194 consecutive patients who underwent primary knee arthroplasty with a single surgeon between 2010 and 2011. During this period, all patients, except those with a previous well-functioning orthopedic device, were asked preoperatively about a history of metal allergy or sensitivity. The prevalence of self-reported cutaneous metal allergy, or sensitivity, was 14%; 22% (19/86) of females and 2% (1/53) of males reported a positive history. Fourteen percent of patients undergoing TKA self-identify as having a cutaneous metal allergy or sensitivity. Until validated screening tests are developed to identify patients "at risk" of symptomatic metal allergy after TKA, selective use of prostheses that do not contain cobalt, chromium, or nickel in individuals who self-identify with metal sensitivity may be considered. As most of these patients are female, manufacturers should consider optimizing availability of these implants in smaller sizes. PMID:24949984

  10. Reverse total shoulder arthroplasty-from the most to the least common complication.

    PubMed

    Farshad, Mazda; Gerber, Christian

    2010-12-01

    Reverse total shoulder arthroplasty (RTSA) has been reported to be associated with a complication rate that is four times that of conventional total shoulder arthroplasty. It is the purpose of this article to identify and understand the most common and most serious complications of RTSA and to review current methods of prevention and treatment. The current literature was reviewed to identify type and prevalence of reported complications and to identify risk factors, preventive measures as well as technical details for management strategies for complications of RTSA. The variable accuracy of reporting and the heterogeneity of methodology in the literature limited our study, however, a definitive ranking of most to least common complication emerged. The currently identified most common complication is scapular notching. The clinically most relevant complications are infection, instability and acromial fractures. Haematoma formation used to be very frequent but can be controlled, glenoid component loosening, however, is rare when compared with conventional total shoulder replacement. In conclusion, RTSA is associated with a high rate of complications. Their incidence and the results of their treatment are inconsistently reported. To document and then prevent complications, a standardised monitoring tool including clear definitions and assessment instructions appears necessary. PMID:20865260

  11. Complications after hip arthroplasty and the association with hospital procedure volume

    PubMed Central

    2011-01-01

    Background and purpose It has been suggested that a higher procedure volume is associated with less complications after hip arthroplasty. In order to investigate the incidence of serious negative outcomes and a possible association with procedure volume, we performed a retrospective nationwide cohort study on total hip replacements in all Dutch hospitals. Methods All total hip replacements (n = 50,080) that were identified as primary intervention in all general and university medical centers between January 1, 2002 and October 1, 2004 were included. Primary endpoints of follow-up were mortality and complications during admission, and re-admission within 3 months due to complications. Variables that were assessed as potential risk factor were age, sex, duration of (preoperative) admission, specific diagnosis, acute/non-planned admission, co-morbidity, and hospital procedure volume. Results Age, sex, and comorbidity were associated with complications and mortality. Additionally, acute admission was a risk factor for mortality but not for complications. There was no linear trend indicating that decreasing volume led to an increasing number of complications, and no statistically sginificant effect for mortality was found. Interpretation After adjustment for several risk factors, we found that the hospitals performing most hip procedures every year had fewer complications during index admission, but that they did not have a lower mortality than groups performing fewer procedures. The lack of a linear trend may be explained by the fact that almost all Dutch hospitals perform a high number of hip arthroplasties each year. PMID:21895498

  12. Bisphosphonate treatment for osteolysis in total hip arthroplasty. A report of four cases

    PubMed Central

    Trevisan, Carlo; Nava, Veronica; Mattavelli, Marta; Parra, Cleber Garcia

    2013-01-01

    Summary Aseptic loosening due to wear debris is the most frequent modality of failure in total hip arthroplasty. Bisphosphonates, a class of molecules which inhibit bone resorption showed an inhibitory effects on particles-induced osteolysis in vitro and in animal models. We report the clinical, radiographic and densitometric outcome of four postmenopausal women with total hip arthroplasty affected by peri-prosthetic osteolysis treated with neridronate due to their unwillingness to be operated. After neridronate treatment, there was general improvement in pain and function: VAS decrease 13 points (15%), the Harris Hip Score increase 9 points (15%). An average number of 3.3 x-ray per patients with an average follow-up of 23 months (range 12–34) were collected and evaluated. In all the patients except one, serial radiographs didn’t show any progression of radioluciencies lines or periprosthetic osteolysis. Bone density was evaluated by Dual energy X-ray absorptiometry after an average follow-up of 21 months (range 6–46 mo): periprosthetic BMD around the whole stem and the cup increased respectively 2.4% and 7.1%. Treatment was well tolerated and no significant side effects were registered. This retrospective collection of a small group of patients suggest that bisphosphonates should be clinically useful in preventing periprosthetic wear debris mediated osteolysis and claim for dedicated clinical trials. PMID:23858314

  13. Intra-articular correction of extra-articular tibial deformities with total knee arthroplasty

    PubMed Central

    Chua, W.; Wang, W.

    2012-01-01

    INTRODUCTION Extra-articular leg deformities may occur in the femur or tibia from mal-unions from previous trauma or metabolic bone disease. Secondary osteoarthritis at the knee occurs due to loss of mechanical alignment of the limb. At surgery for total knee arthroplasty, mechanical alignment can be restored intra-articularly with appropriate bone cuts and soft tissue balancing. PRESENTATION OF CASE We describe 2 case studies with extra-articular tibial deformities (9° and 24° varus deformity) which were corrected with a 1 stage procedure of total knee arthroplasty with intra-articular deformity correction. DISCUSSION Patient selection, pre-operative considerations and surgical technique are discussed with reference to the literature. CONCLUSION One stage intra-articular correction of extra-articular deformity is suitable for mild degrees of varus deformities (<30°). Staged corrective procedures with larger deformities in the tibia or femur can be performed with extra-articular osteotomies on top of intra-articular corrections. Consideration should be given to the use of computer navigation when conventional jigs cannot be applied to deformed bone. PMID:23353706

  14. Are leg length and hip offset comparable after hip resurfacing and cementless total hip arthroplasty?

    PubMed Central

    Patel, S; Thakrar, RR; Bhamra, J; Hossain, F; Tengrootenhuysen, M; Haddad, FS

    2011-01-01

    INTRODUCTION The purpose of this study was to determine if hip resurfacing arthroplasty (HRA) and cementless total hip arthroplasty (THA) were comparable in correcting leg length and hip offset in patients with primary osteoarthritis. METHODS A retrospective analysis was performed of 80 patients who underwent either HRA or cementless THA for primary osteoarthritis (40 in each group) between 2006 and 2008. Standardised anteroposterior radiographs taken pre-operatively and at one year following surgery were used to calculate the total offset and leg length in both hips. RESULTS At one year following surgery, no leg length discrepancy was identified in either group. A difference of 0.39cm (p=0.046) remained between the mean total offset of the operated hip and the contralateral non-operated hip in the HRA group. No difference in offset was observed between the two hips after surgery in the THA group (p=0.875). CONCLUSIONS Leg length is restored by HRA and THA. A difference remains in offset after HRA although we attribute this to intentional medialisation of the acetabular cup. PMID:21929917

  15. Highly Crosslinked Polyethylene is Safe for Use in Total Knee Arthroplasty

    PubMed Central

    Hodrick, Jeffrey T.; Severson, Erik P.; McAlister, Deborah S.; Dahl, Brian

    2008-01-01

    Highly cross-linked polyethylene (XLPE) has been used with good initial success in hip arthroplasty to reduce wear. However, the process of crosslinking reduces fracture toughness, raising concerns as to whether it can be safely used in total knee arthroplasty (TKA). We therefore asked whether XLPE can be used safely in TKA. We performed a retrospective review of 100 subjects receiving XLPE and compared them to 100 subjects who received standard polyethylene in the setting of TKA. The standard polyethylene group had a mean age of 70 with a minimum follow up of 82 months. The highly cross-linked polyethylene group had a mean age of 67 and a minimum follow up of 69 months (mean, 75 months; range, 69–82 months). On radiographic review, the standard group demonstrated 20 TKAs with radiolucencies; 4 of these had evidence of a loose tibial component. The standard group required three revisions related to loose tibial components. The XLPE group had 2 subjects that demonstrated radiolucencies on radiograph and no subjects with evidence of tibial loosening. There were no reoperations related to osteolysis. The data suggest XLPE in TKA can be used safely at least short- to midterm. Our study provides an impetus for further long-term investigation. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18781371

  16. Total joint arthroplasty in transplant recipients: in-hospital adverse outcomes.

    PubMed

    Cavanaugh, Priscilla K; Chen, Antonia F; Rasouli, Mohammad R; Post, Zachary D; Orozco, Fabio R; Ong, Alvin C

    2015-05-01

    This study aims to determine in-hospital complications and mortality in transplant recipients following total joint arthroplasty. The Nationwide Inpatient Sample database was queried for patients with history of transplant and joint arthroplasty (primary or revision) from 1993 to 2011. Kidney transplant increased risk of surgical site infection (SSI) and wound infections (OR=2.03), systemic infection (OR=2.85), deep venous thrombosis (OR=2.07), acute renal failure (ARF) (OR=3.48), respiratory (OR=1.34), and cardiac (OR=1.21) complications. Liver transplant was associated with SSI/wound infections (OR=2.32), respiratory complications (OR=1.68), cardiac complications (OR=1.34), and ARF (OR=4.48). Other transplants grouped together were associated with wound complications (OR=2.13), respiratory complications (OR=2.06), and ARF (OR=4.42). Our study suggests these patients may be at increased risk of in-hospital complications, particularly ARF in renal and liver transplant patients. PMID:25540994

  17. Complete slippage of capital femoral epiphysis: total hip arthroplasty with custom-made stem.

    PubMed

    Raaijmaakers, Martijn; Steenbrugge, Franky; Mulier, Michiel

    2010-01-01

    Slipped capital femoral epiphysis occurs in adolescents, most often shortly after the onset of puberty. In patients suffering form renal osteodystrophy, the incidence is higher and the condition usually occurs at a younger age. Metabolic changes induce weakening of the bone, which makes the hip joint vulnerable. The initial treatment consists of phosphate-restricted diet, lanthanum carbonate, cinacalcet (a calcimimetic), calcium carbonate and oral calcitriol, aiming at restoration of bone quality. The use of several surgical treatment options has been reported. In this case, which was diagnosed at a later age because no radiographic work-up was performed in the patient's homeland, the only possible treatment option was a total hip arthroplasty. The use of a commercially available femoral stem was impossible because of the abnormal anatomy of the proximal femur. This patient was treated with a custom stem prosthesis manufactured intraoperatively. Six weeks post surgery, HHS and VAS were improved. Ten weeks post surgery a fracture of the femoral diaphysis was treated with revision surgery using a 20 cm long custom-made stem. At 12 weeks post surgery progressive physical therapy is being instituted. Timely detection of slipped capital femoral epiphysis is a cornerstone of adequate management. In this specific case, the diagnosis was missed and salvage treatment required total hip arthroplasty with a stem prosthesis adapted to the patient's anatomy. PMID:20453255

  18. Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty.

    PubMed

    Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W Angus

    2015-03-18

    To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score. PMID:25793164

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

    PubMed Central

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

    2012-01-01

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

  20. Long-term results of simple hemiresection arthroplasty in the rheumatoid distal radio-ulnar joint.

    PubMed

    Lee, C H; Chung, U S; Lee, B G; Shim, J H; Lee, K H

    2013-09-01

    We retrospectively studied the radiological and clinical results of a simple hemiresection arthroplasty, a modification of previous oblique distal ulnar resections, in 62 patients with rheumatoid arthritis (68 wrists) over a mean follow-up of 103 (range 60-173) months. Fourteen wrists (20%) became fused at the radiocarpal joint and 28 wrists fused (41%) at the midcarpal joints during follow-up. Severe ulnar translocation of the carpus was observed in two wrists (3%), radio-ulnar convergence in five wrists (7%), as well as a significant decrease of carpal height ratio, without any radiological findings of stylocarpal impingement. Improvements in forearm pronation and supination, and reduction in pain were maintained at the last follow-up. Grip strength was not significantly improved. The Jebsen-Taylor hand function test showed improvements in writing, card turning, and simulated feeding. Fifty-two patients (58 wrists, 85%) were satisfied with the results at the last follow-up. Simple hemiresection arthroplasty showed good long-term results with few complications. PMID:23303834

  1. Acute delayed infection: increased risk in failed metal on metal total hip arthroplasty.

    PubMed

    Prieto, Hernan A; Berbari, Elie F; Sierra, Rafael J

    2014-09-01

    Adverse local tissue reactions occurring in metal-on-metal total hip arthroplasty (MoM THA) could potentially lead to secondary failure modes such as dislocation or infection. The authors report a series of 124 patients treated with MoM hip arthroplasty between 2006 and 2010 with a minimum follow-up of 3 years. Eight hips presented with acute delayed or late periprosthetic joint infection (PJI) (defined as an infection occurring after 3 months in an otherwise well functioning implant). The rate of infection observed was higher than expected, almost 4 times higher (5.6%) compared to previous historical cohorts from our institution (1.3%). This high risk of infection in patients with DePuy ASR implants requires further study but we theorize that the increased prevalence of infection could be due to a combination of particulate debris, molecular (rather than particulate) effects of Co and Cr ions on soft tissues, and/or products of corrosion that may change the local environment predisposing to infection. PMID:24851788

  2. Contemporary Ceramic Total Hip Arthroplasty in Patients with Cerebral Palsy: Does It Work?

    PubMed Central

    Yoon, Byung-Ho; Ha, Yong-Chan; Koo, Kyung-Hoi

    2015-01-01

    Background Adult patients with cerebral palsy (CP), who have advanced degenerative arthritis of the hip, have been treated with resection arthroplasty and arthrodesis. Although total hip arthroplasty (THA) has also been used as one of the alternative options, there are few studies on contemporary bearings used in THA. Therefore, we evaluated the results of the contemporary ceramic-on-ceramic THA in adult patients with CP. Methods From January 2005 to December 2007, five adult CP patients (5 hips) underwent THA using contemporary ceramic-on-ceramic bearings. All patients were able to stand or ambulate with intermittent use of assistive devices at home. We retrospectively reviewed the series to determine the results of THA in terms of pain relief, improved function, and durability of prosthesis. Results There were 3 men and 2 women with a mean age of 35.9 years. All patients had pain relief without decline in mobility postoperatively. One hip was dislocated, which was treated successfully with closed reduction and an abduction brace for 2 months. There was no ceramic fracture, loosening, or osteolysis during the mean follow-up of 6.8 years (range, 5.8 to 8.3 years). Conclusions Cementless THA using contemporary ceramic-on-ceramic bearings is a useful option for the treatment of advanced degenerative arthritis of the hip in ambulatory adults with CP. PMID:25729517

  3. Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty

    PubMed Central

    Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W Angus

    2015-01-01

    To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score. PMID:25793164

  4. Incus interposition and ossiculoplasty with hydroxyapatite prostheses.

    PubMed

    Wehrs, R E

    1994-08-01

    This article traces the evolution of transplant material in ossicular reconstruction of the middle ear. The first transplant consisted of the body and short process of the homograft incus. It was repositioned or wedged between the stapes head and the manubrium of the malleus. Further modification consisted of the sculpture of prostheses from homograft incudes; these were known as the notched incus with short or long process. By means of a notch in the short process, they were locked in place. The final phase is the use of hydroxyapatite as a biocompatible material from which similar prostheses may be precisely manufactured. These hydroxyapatite prostheses, known as the incus and incus-stapes replacement prosthesis, appear to be well tolerated and to produce excellent hearing results. PMID:7984369

  5. Field induced gap infrared detector

    NASA Technical Reports Server (NTRS)

    Elliott, C. Thomas (inventor)

    1990-01-01

    A tunable infrared detector which employs a vanishing band gap semimetal material provided with an induced band gap by a magnetic field to allow intrinsic semiconductor type infrared detection capabilities is disclosed. The semimetal material may thus operate as a semiconductor type detector with a wavelength sensitivity corresponding to the induced band gap in a preferred embodiment of a diode structure. Preferred semimetal materials include Hg(1-x)Cd(x)Te, x is less than 0.15, HgCdSe, BiSb, alpha-Sn, HgMgTe, HgMnTe, HgZnTe, HgMnSe, HgMgSe, and HgZnSe. The magnetic field induces a band gap in the semimetal material proportional to the strength of the magnetic field allowing tunable detection cutoff wavelengths. For an applied magnetic field from 5 to 10 tesla, the wavelength detection cutoff will be in the range of 20 to 50 micrometers for Hg(1-x)Cd(x)Te alloys with x about 0.15. A similar approach may also be employed to generate infrared energy in a desired band gap and then operating the structure in a light emitting diode or semiconductor laser type of configuration.

  6. Crop yield gaps in Cameroon.

    PubMed

    Yengoh, Genesis T; Ardö, Jonas

    2014-03-01

    Although food crop yields per hectare have generally been increasing in Cameroon since 1961, the food price crisis of 2008 and the ensuing social unrest and fatalities raised concerns about the country's ability to meet the food needs of its population. This study examines the country's potential for increasing crop yields and food production to meet this food security challenge. Fuzzy set theory is used to develop a biophysical spatial suitability model for different crops, which in turn is employed to ascertain whether crop production is carried out in biophysically suited areas. We use linear regression to examine the trend of yield development over the last half century. On the basis of yield data from experimental stations and farmers' fields we assess the yield gap for major food crops. We find that yields have generally been increasing over the last half century and that agricultural policies can have significant effects on them. To a large extent, food crops are cultivated in areas that are biophysically suited for their cultivation, meaning that the yield gap is not a problem of biophysical suitability. Notwithstanding, there are significantly large yield gaps between actual yields on farmers' farms and maximum attainable yields from research stations. We conclude that agronomy and policies are likely to be the reasons for these large yield gaps. A key challenge to be addressed in closing the yield gaps is that of replenishing and properly managing soil nutrients. PMID:23925855

  7. Tunneling magnetoresistance through a vacuum gap

    Microsoft Academic Search

    W. Wulfhekel; H. F. Ding; J. Kirschner

    2002-01-01

    We studied the tunneling magnetoresistance (TMR) effect through a vacuum barrier using spin-polarized scanning tunneling microscopy on Co(0001). By varying the gap width at a fixed bias voltage or by varying the bias voltage at a fixed gap width, the fundamental behaviour of the TMR across the vacuum gap was investigated. At large gap widths the TMR is constant with

  8. ABORT GAP CLEANING IN RHIC.

    SciTech Connect

    DREES,A.; AHRENS,L.; III FLILLER,R.; GASSNER,D.; MCINTYRE,G.T.; MICHNOFF,R.; TRBOJEVIC,D.

    2002-06-03

    During the RHIC Au-run in 2001 the 200 MHz storage cavity system was used for the first time. The rebucketing procedure caused significant beam debunching in addition to amplifying debunching due to other mechanisms. At the end of a four hour store, debunched beam could account for approximately 30%-40% of the total beam intensity. Some of it will be in the abort gap. In order to minimize the risk of magnet quenching due to uncontrolled beam losses at the time of a beam dump, a combination of a fast transverse kicker and copper collimators were used to clean the abort gap. This report gives an overview of the gap cleaning procedure and the achieved performance.

  9. Gap junctions in cardiovascular disease.

    PubMed

    Jongsma, H J; Wilders, R

    2000-06-23

    Connexins, the protein molecules forming gap junction channels, are reduced in number or redistributed from intercalated disks to lateral cell borders in a variety of cardiac diseases. This "gap junction remodeling" is considered to be arrhythmogenic. Using a simple model of human ventricular myocardium, we found that quantitative remodeling data extracted from the literature gave rise to only small to moderate changes in conduction velocity and the anisotropy ratio. Especially for longitudinal conduction, cytoplasmic resistivity (and thus cellular geometry) is much more important than commonly realized. None of the remodeling data gave rise to slow conduction on the order of a few centimeters per second. PMID:10864907

  10. Stacked insulator induction accelerator gaps

    SciTech Connect

    Houck, T.I.; Westenskow, G.A.; Kim, J.S.; Eylon, S.; Henestroza, E.; Yu, S.S.; Vanecek, D.

    1997-05-01

    Stacked insulators, with alternating layers of insulating material and conducting film, have been shown to support high surface electrical field stresses. We have investigated the application of the stacked insulator technology to the design of induction accelerator modules for the Relativistic-Klystron Two-Beam Accelerator program. The rf properties of the accelerating gaps using stacked insulators, particularly the impedance at frequencies above the beam pipe cutoff frequency, are investigated. Low impedance is critical for Relativistic-Klystron Two-Beam Accelerator applications where a high current, bunched beam is trsnsported through many accelerating gaps. An induction accelerator module designs using a stacked insulator is presented.

  11. Nubac Disc Arthroplasty: Preclinical Studies and Preliminary Safety and Efficacy Evaluations

    PubMed Central

    Songer, Matthew; Pimenta, Luis; Werner, Dieter; Reyes-Sanchez, Alejandro; Balsano, Massimo; Agrillo, Umberto; Coric, Domagoj; Davenport, Kenneth; Yuan, Hansen

    2007-01-01

    Background Disc arthroplasty is gaining popularity for treatment of low-back pain caused by degenerative disc disease (DDD). It can involve total disc replacement or partial disc or nucleus replacement (or augmentation). Compared with total disc replacement, nucleus replacement is less invasive, has less surgical risk, has faster postoperative recovery, and doesn't “burn bridges” should further surgery be required. However, nucleus replacement has a high risk of implant expulsion because the device is not fixed to the vertebrae. Nubac is the first polyetheretherketone (PEEK)-on-PEEK articulated disc arthroplasty device designed to optimally restore the lumbar anatomy and biomechanics. Methods ISO 10993 standards were used to evaluate the biocompatibility of the PEEK material. Chemical and thermal–mechanical tests and in vivo study assessed PEEK's biostability after exposure to high g irradiation and harsh oxidative conditions. Biomechanical tests to evaluate kinematic properties and anatomical restoration of the implanted lumbar motion segments and implant expulsion risk assessments were performed with a human cadaveric model. Because of the novelty of PEEK-on-PEEK as a self-mating articulating material, extensive wear tests were conducted with unidirectional and coupled motions. Static and fatigue strength also were tested. Animal study with a baboon model was conducted with gross, radiographic, biomechanical, and histological evaluations at 6 and 12 months postoperatively. Preliminary clinical data were collected through a prospective multicenter cohort study. Results PEEK demonstrated exceptional biocompatibility and biodurability. Nubac restored disc height and motion segment range of motion. The unique articulating design of the Nubac demonstrated low risk of implant expulsion in a human cadaveric model. Wear tests showed that the Nubac has minimal wear and compares favorably to other disc arthroplasty materials. The Nubac also had excellent static and fatigue properties for the intended application. The animal study showed that the Nubac caused no adverse local or systematic tissue reaction and there was no detectable wear debris. The preliminary clinical data showed no major intraoperative vascular and neurological complications. There was significant Visual Analog Scale and Oswestry Disability Index score improvement. Conclusions The preclinical data supported the design rationale, and the preliminary clinical data (level II evidence) on safety and efficacy were encouraging. Clinical Relevance The Nubac could be a viable first surgical option for patients with back pain caused by DDD. PMID:25802577

  12. Mass gap from pressure inequalities

    E-print Network

    Tamas S. Biro; Andras Laszlo; Peter Van

    2006-12-07

    We prove that a temperature independent mass distribution is identically zero below a mass threshold (mass gap) value, if the pressure satisfies certain inequalities. This supports the finding of a minimal mass in quark matter equation of state by numerical estimates and by substitution of analytic formulas. We present a few inequalities for the mass distribution based on the Markov inequality.

  13. Multiple input electrode gap controller

    DOEpatents

    Hysinger, C.L.; Beaman, J.J.; Melgaard, D.K.; Williamson, R.L.

    1999-07-27

    A method and apparatus for controlling vacuum arc remelting (VAR) furnaces by estimation of electrode gap based on a plurality of secondary estimates derived from furnace outputs. The estimation is preferably performed by Kalman filter. Adaptive gain techniques may be employed, as well as detection of process anomalies such as glows. 17 figs.

  14. Multiple input electrode gap controller

    DOEpatents

    Hysinger, Christopher L. (Austin, TX); Beaman, Joseph J. (Austin, TX); Melgaard, David K. (Albuquerque, NE); Williamson, Rodney L. (Albuquerque, NE)

    1999-01-01

    A method and apparatus for controlling vacuum arc remelting (VAR) furnaces by estimation of electrode gap based on a plurality of secondary estimates derived from furnace outputs. The estimation is preferably performed by Kalman filter. Adaptive gain techniques may be employed, as well as detection of process anomalies such as glows.

  15. GAP JUNCTION FUNCTION AND CANCER

    EPA Science Inventory

    Gap Junctions (GJs) provide cell-to-cell communication (GJIC) of essential metabolites and ions. Js allow tissues to average responses, clear waste products, and minimize the effects of xenobiotics by dilution and allowing steady-state catabolism. any chemicals can adversely affe...

  16. Electromagnetically induced photonic band gap

    Microsoft Academic Search

    Yuri V. Rostovtsev; Andrey B. Matsko; Marlan O. Scully

    1999-01-01

    A nonlinear propagation of electromagnetic waves has been investigated in a heterostructure formed by spatially modulated density of ladder-type (Xi) three-level atoms. The appearance of a forbidden band gap for an electromagnetic field induced by another electromagnetic field has been found. An alternative concept of an optical transistorlike device based on this effect has been proposed.

  17. Comparison of Patient-Reported Outcome from Neck-Preserving, Short-Stem Arthroplasty and Resurfacing Arthroplasty in Younger Osteoarthritis Patients

    PubMed Central

    Dettmer, Marius; Pourmoghaddam, Amir; Kreuzer, Stefan W.

    2015-01-01

    Hip resurfacing has been considered a good treatment option for younger, active osteoarthritis patients. However, there are several identified issues concerning risk for neck fractures and issues related to current metal-on-metal implant designs. Neck-preserving short-stem implants have been discussed as a potential alternative, but it is yet unclear which method is better suited for younger adults. We compared hip disability and osteoarthritis outcome scores (HOOS) from a young group of patients (n = 52, age 48.9 ± 6.1 years) who had received hip resurfacing (HR) with a cohort of patients (n = 73, age 48.2 ± 6.6 years) who had received neck-preserving, short-stem implant total hip arthroplasty (THA). Additionally, durations for both types of surgery were compared. HOOS improved significantly preoperatively to last followup (>1 year) in both groups (p < 0.0001, ?2 = 0.69); there were no group effects or interactions. Surgery duration was significantly longer for resurfacing (104.4?min ± 17.8) than MiniHip surgery (62.5?min ± 14.8), U = 85.0, p < 0.0001, ?2 = 0.56. The neck-preserving short-stem approach may be preferable to resurfacing due to the less challenging surgery, similar outcome, and controversy regarding resurfacing implant designs.

  18. Center of Mass Compensation during Gait in Hip Arthroplasty Patients: Comparison between Large Diameter Head Total Hip Arthroplasty and Hip Resurfacing

    PubMed Central

    Bouffard, Vicky; Nantel, Julie; Therrien, Marc; Vendittoli, Pascal-André; Lavigne, Martin; Prince, François

    2011-01-01

    Objective. To compare center of mass (COM) compensation in the frontal and sagittal plane during gait in patients with large diameter head total hip arthroplasty (LDH-THA) and hip resurfacing (HR). Design. Observational study. Setting. Outpatient biomechanical laboratory. Participants. Two groups of 12 patients with LDH-THA and HR recruited from a larger randomized study and 11 healthy controls. Interventions. Not applicable. Main Outcome Measures. To compare the distance between the hip prosthetic joint center (HPJC) and the COM. The ratio (RHPJC-COM) and the variability (CVHPJC-COM) were compared between groups. Hip flexor, abductor, and adductor muscle strength was also correlated between groups while radiographic measurements were correlated with the outcome measures. Results. In the frontal plane, HR shows less variability than healthy controls at push-off and toe-off and RHPJC-COM is correlated with the muscle strength ratios (FRABD) at heel contact, maximal weight acceptance, and mid stance. In the sagittal plane, LDH-THA has a higher RHPJC-COM than healthy controls at push-off, and CVHPJC-COM is significantly correlated with FRFLEX. Conclusions. One year after surgery, both groups of patients, LDH-THA and HR, demonstrate minor compensations at some specific instant of the gait cycle, in both frontal and sagittal planes. However, their locomotion pattern is similar to the healthy controls. PMID:22110976

  19. Plain film and arthrographic findings in painful total hip arthroplasties with surgical correlation.

    PubMed

    Cain, T M; Fon, G T; Brumby, S; Howie, D W

    1990-08-01

    The plain films and arthrograms performed on 42 painful cemented hip arthroplasties in 40 patients were reviewed and the radiological findings compared to the surgical assessment of component stability. All radiography, which included Judet views in the plain films, was reviewed without knowledge of the surgical findings and without comparison with previous studies. Criteria for the detection of loosening of cemented femoral and acetabular components were predetermined. The accuracy of plain film assessment of acetabular component stability was increased significantly (p less than 0.05) by including oblique views in the plain film assessment. The accuracy of assessment of acetabular component stability on plain films was 88%, on arthrography 90% and, with both studies combined, was 98%. Femoral component stability was assessed accurately on 90% of plain films and 90% of arthrograms, and this was not improved by combining the studies. The difficulty of detecting low grade infections is discussed with results of pseudocapsule aspiration. PMID:2275678

  20. Rivaroxaban Versus Enoxaparin for Venous Thromboembolism Prophylaxis after Hip and Knee Arthroplasty.

    PubMed

    Charters, Michael A; Frisch, Nicholas B; Wessell, Nolan M; Dobson, Christopher; Les, Clifford M; Silverton, Craig D

    2015-07-01

    The oral Factor Xa inhibitor rivaroxaban (Xarelto) has been the pharmacologic agent used for venous thromboembolism (VTE) prophylaxis after primary hip and knee arthroplasty (THA/TKA) at our institution since February 2012. The purpose of our study was to compare rates of VTE and major bleeding between rivaroxaban and our previous protocol of enoxaparin after THA/TKA. A retrospective cohort study was performed including 2406 consecutive patients at our institution between 1/1/11 and 9/30/13. Patients who did not have unilateral primary THA/TKA or who received other anticoagulants were excluded. Of the 1762 patients included, 1113 patients (63.2%) received enoxaparin and 649 patients (36.8%) received rivaroxaban. This study found no demonstrable differences between these two anticoagulants in rates of VTE, infection, reoperation, transfusion, or major bleeding. Therapeutic, Retrospective comparative study, Level III. PMID:25724111

  1. Femoral component rotation in total knee arthroplasty: an MRI-based evaluation of our options.

    PubMed

    Patel, Anay R; Talati, Rushi K; Yaffe, Mark A; McCoy, Brett W; Stulberg, S David

    2014-08-01

    Proper femoral component rotation is crucial in successful total knee arthroplasty. Rotation using anatomic landmarks has traditionally referenced the transepicondylar axis (TEA), Whiteside's Line (WSL), or posterior condylar axis (PCA). TEA is thought to best approximate the flexion-axis of the knee, however WSL or PCA are common surrogates in the operating room. This study evaluated 560 knees using MRI-based planning software to assess the relationship of WSL and PCA to the TEA and determine if the relationships were influenced by pre-operative coronal deformity. Results showed the WSL-TEA relationship has more variability than PCA-TEA and that the PCA is more internally rotated in females and valgus knees. Axis options and historical assumptions about axis relationships may need to be reassessed as imaging technology advances. PMID:24746490

  2. Femoral vein blood flow during a total hip arthroplasty using a modified heuter approach.

    PubMed

    Mednick, Rachel E; Alvi, Hasham M; Morgan, Courtney E; Stover, Michael D; Manning, David W

    2015-05-01

    Several modifications to traditional surgical approaches for total hip arthroplasty (THA) have been introduced in an attempt to improve upon minimally invasive approaches and enhance short-term recovery. However, minimally invasive approaches are not without risk, including that of postoperative venous thromboembolism (VTE). There has been no published literature evaluating the femoral vein during an anterior approach. We aimed to study femoral vein blood flow using duplex ultrasonography during THA performed through a modified Heuter approach. Peek flow and vessel cross-sectional area were affected by limb position as well as acetabular and femoral retractor placement. No VTE was observed, but there was observed femoral vein compression, which may represent a risk of postoperative VTE similar to that seen in standard surgical approaches for THA. PMID:25660612

  3. Bone mineral density of the femur in autopsy retrieved total knee arthroplasties.

    PubMed

    Lavernia, Carlos J; Rodriguez, Jose A; Iacobelli, David A; Hungerford, David S; Krackow, Kenneth A

    2014-08-01

    Bone mineral density (BMD), as measured by DEXA, can vary depending on bone rotation and fat content of soft tissues. We performed DEXA measurements, under controlled positioning, on 24 autopsy-retrieved femora from patients who had fully functional and asymptomatic successful TKA to determine periprosthetic BMD changes and compared results to 24 normal cadaveric femora. In TKA specimens, BMD was affected by gender, preoperative diagnosis, and zone under analysis. The lowest mean BMD was in the anterior femoral condylar zone. Males had higher mean BMD at all zones while patients with preoperative diagnosis of osteoarthritis had higher BMD in the posterior condylar zone. The mean BMD in the anterior femoral condylar zone in TKA specimens was significantly lower than in normal specimens without arthroplasties, most likely due to stress shielding. PMID:24747004

  4. The Sterile Elastic Exsanguination Tourniquet vs. the Pneumatic Tourniquet for Total Knee Arthroplasty.

    PubMed

    Brin, Yaron S; Feldman, Viktor; Ron Gal, Itai; Markushevitch, Michael; Regev, Amit; Stern, Abraham

    2015-04-01

    We compared the sterile elastic exsanguination tourniquet and the pneumatic tourniquet for total knee arthroplasty. 145 patients were operated on using a pneumatic tourniquet and 166 with the sterile elastic exsanguination tourniquet. Patients with the sterile elastic exsanguination tourniquet had a smaller decrease in hemoglobin on post-operative days one (P<0.028) and three (P<0.045). The amount of blood collected from drains at 24h was significantly lower in the sterile elastic exsanguination group. A trend towards a higher rate of wound complications within 3months following the operation was found in the pneumatic tourniquet group. The sterile elastic exsanguination tourniquet works at least as good as the pneumatic one. PMID:25496927

  5. Tourniquet Release Prior to Dressing Application Reduces Blistering Following Total Knee Arthroplasty.

    PubMed

    Heller, Snir; Chen, Antonia; Restrepo, Camilo; Albert, Emily; Hozack, William J

    2015-07-01

    Skin blisters occur in up to 20% of patients after total knee arthroplasty (TKA). Tourniquet release results in a limb volume increase of 10%. We hypothesized that releasing tourniquet before application of circumferential dressing will decrease blister formation. A prospective study was conducted on 135 consecutive primary TKAs. The tourniquet was released immediately after wound closure to allow for re-perfusion and then a dressing was applied. These patients were compared to a historical cohort of 200 primary TKAs, where the tourniquet was released after application of dressing. There was a significant difference in the incidence of blisters between the two groups [Late 7.5% (15/200) vs early release 2.2% (3/135) P=0.028]. Releasing the tourniquet prior to dressing application has reduced the incidence of blistering following TKA. PMID:25770863

  6. Risk versus reward: total joint arthroplasty outcomes after various solid organ transplantations.

    PubMed

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

    2014-08-01

    Clinical outcomes were retrospectively reviewed for 76 primary total hip (THA) and total knee arthroplasties (TKA) performed after kidney, liver, cardiac, and lung transplantation with follow-up of 30.2 and 41.2 months, respectively. For the THA and TKA cohorts, there were a high rate of medical complications (29% and 33%), increased hospital length of stay (4.2 and 3.7 days), and more reoperations (7.2% and 9.1%). Only 1 (1.8%) periprosthetic infection was documented for THAs but 3 (14.2%) TKAs required two-stage revisions for infection. All transplant cohorts demonstrated significant increases (P < 0.05) in HHS and KSS scores with majority of patients reporting overall good or excellent outcomes (82%-100%). These results suggest that various organ transplant patients may accept higher surgical risks for rewarding outcomes. PMID:24768542

  7. Standard Transgluteal versus Minimal Invasive Anterior Approach in hip Arthroplasty: A Prospective, Consecutive Cohort Study

    PubMed Central

    Ilchmann, Thomas; Gersbach, Silke; Zwicky, Lukas; Clauss, Martin

    2013-01-01

    A minimally invasive anterior approach (MIS) was compared to a standard lateral approach in primary total hip arthroplasty. Clinical and radiological outcomes were analyzed 6 weeks, 12 weeks, one year and two years after surgery. The duration of surgery was longer, mobility one week after surgery was better and time of hospitalization was shorter for minimally invasive-treated patients. They had less pain during movement, limping, better Harris Hip Score and satisfaction after 6 weeks, which remained after 12 weeks and 1 year, but not after two years. There were two deep infections in the MIS group. Radiological results were not affected. The infections might be a point of concern, but there were no other disadvantages of the MIS approach. In fact, early rehabilitation was facilitated and clinical results were improved. Our results encourage the continuous use of the MIS anterior approach instead of the lateral approach. PMID:24416475

  8. Displacement of a cemented femoral stem during attempted closed reduction of a dislocated total hip arthroplasty.

    PubMed

    Haq, Rehan-Ul; Park, Kyung Soon; Yang, Hyun Kee; Lee, Keun Bae; Yoon, Taek Rim

    2010-06-01

    Displacement of a cemented femoral stem during attempted closed reduction of a dislocated total hip arthroplasty has been anecdotally described in the literature. All these reports involved use of cemented, highly polished, tapered stems. We report, the first to our knowledge, a case of displacement of a cemented, textured femoral stem, during attempted closed reduction. The case is being reported not only for its rarity but also to alert treating surgeons of this devastating complication which can expose the patient to the risks of open surgery. Gentle reduction, using the gravity method of Stimpson, under fluoroscopy control, may be safer and prevent this complication from occurring. If the cement mantle is intact, cement-within-cement is a reliable, quick, and simple technique to overcome this difficult problem. PMID:19464845

  9. Detection of gentamicin emission from bone cement in the early postoperative period following total hip arthroplasty.

    PubMed

    Bálint, Lehel; Koós, Zoltán; Horváth, Gábor; Szabó, György

    2006-05-01

    This article describes the characteristics of gentamicin emission from the bone cement-antibiotic complex in the early postoperative period following total hip arthroplasty. Gentamicin levels of the drain fluid taken at 6, 24, and 48 hours postoperatively were measured with a fluorescent polarization immunoassay method. Mean gentamicin concentrations were 2.6, 1.2, and 0.6 mcg/mL, respectively. Age, sex, and body mass index had no significant influence on the outcome. Results showed that the amount of gentamicin in the wound fluid is inversely proportional to the total amount excreted. Twenty-four hours postoperatively, the average gentamicin concentrations in the drain fluid taken from around the endoprosthesis implanted with Palacos-R bone cement (Zimmer Warsaw, Ind), diminished, yet remained above the minimal inhibitory concentration level. PMID:16729744

  10. Acute adrenal insufficiency following arthroplasty: a case report and review of the literature

    PubMed Central

    2013-01-01

    Background Acute adrenal insufficiency is a potentially lethal condition rarely caused by bilateral adrenal haemorrhage due to heparin use. Most of the times, it is difficult to establish the diagnosis, as symptoms are not specific. Few cases have been reported in the literature. Case presentation A 52-year-old Caucasian woman presented with abdominal pain, vomiting and weakness nine days after arthroplasty and heparin use. Hyperkalemia, low cortisol and high adrenocorticotropic hormone levels were found, indicating adrenal insufficiency. Magnetic resonance imaging of the upper abdomen was compatible with preceding adrenal haemorrhage. Hydrocortisone and fludrocortisone were administered. Review of the literature revealed 36 cases of postoperative adrenal haemorrhage which are presented briefly. Conclusion Postoperative acute adrenal insufficiency due to haemorrhage is a rare condition. If patients are treated based on clinical suspicion, they have good chances to survive. Hydrocortisone is given permanently in the majority of the patients. PMID:24028157

  11. Transfusion cost savings with tranexamic acid in primary total knee arthroplasty from 2009 to 2012.

    PubMed

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

    2015-03-01

    Tranexamic acid (TXA) has proven to be very advantageous to the total knee arthroplasty (TKA) population. With TXA, the need for allogeneic blood transfusion is reduced and thus hospital costs are reduced. In our hospital system, before TXA was used, facility cost was an estimated $84.90/TKA for blood transfusion and required 0.13 man-hours/TKA (transfusion rate 6.5%); after incorporating intravenous TXA, cost was $82.59/TKA for blood transfusion and TXA medication and 0.007 man-hours/TKA (transfusion rate 0.3%). There were no transfusions when TXA was applied topically, and the facility cost was $39.14/TKA and no employee hours consumed. Topical TXA has the potential to significantly reduce blood transfusions and decrease hospital man-hours/TKA as well as achieve larger cost saving. PMID:25458093

  12. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes.

    PubMed

    Petis, Stephen; Howard, James L; Lanting, Brent L; Vasarhelyi, Edward M

    2015-04-01

    Total hip arthroplasty (THA) has revolutionized the treatment of hip arthritis. A number of surgical approaches to the hip joint exist, each with unique advantages and disadvantages. The most commonly used approaches include the direct anterior, direct lateral and posterior approaches. A number of technical intricacies allow safe and efficient femoral and acetabular reconstruction when using each approach. Hip dislocation, abductor insufficiency, fracture and nerve injury are complications of THA, although their relative risk varies by approach. Numerous clinical trials have sought to elicit differences in patient-reported outcomes, complication rates and return to function among the surgical approaches. This review outlines some of the technical pearls of performing a THA through either a direct anterior, direct lateral or posterior approach. A literature review outlines the impact of surgical approach on clinical outcomes and clinically relevant complication rates. PMID:25799249

  13. Implication of femoral stem on performance of articular surface replacement (ASR) XL total hip arthroplasty.

    PubMed

    Cip, Johannes; von Strempel, Archibald; Bach, Christian; Luegmair, Matthias; Benesch, Thomas; Martin, Arno

    2014-11-01

    Taper junctions of large diameter metal-on-metal femoral heads and femoral stems were described as metal ion generator due to accelerated wear and corrosion. However, literature about the Articular Surface Replacement (ASR) total hip arthroplasty (THA) invariably deals with stems manufactured by DePuy Orthopedics (Warsaw, IN, USA). Nothing is known whether different stems with common 12/14 mm tapers affect failure rate or ion release. 99 ASR THA (88 patients) implanted with CoxaFit or ARGE Geradschaft stems (K-Implant, Hannover, Germany) were retrospectively analyzed. After a mean follow-up of 3.5 years revision rate was 24.5%, mostly due to adverse reaction to metal debris (ARMD). CT scan revealed component loosening in 10.3% and pseudotumoral lesions in 12.6%. Elevated ion concentrations (>7 ?g/l) were found in 38.6%. PMID:25108735

  14. MRI diagnosis of recurrent pigmented villonodular synovitis following total joint arthroplasty.

    PubMed

    Friedman, Talia; Chen, Timothy; Chang, Anthony

    2013-02-01

    Pigmented villonodular synovitis (PVNS) can recur after complete synovectomy and even after total joint replacement. In the authors' experience, there is a misconception that MRI may not be useful to diagnose PVNS in the setting of a total joint replacement due to dephasing artifact from metal. While there are case reports of PVNS in patients with total joint replacement diagnosed surgically, to our knowledge, diagnosis of recurrent PVNS by MRI following total joint replacement has not been reported. This report illustrates the utility of MRI in the diagnosis of recurrent PVNS following total joint replacement by reviewing two cases of pathologically correlated PVNS recurrence following arthroplasty, and two cases in which PVNS recurrence is strongly suspected, though pathological correlation is not available. PMID:24426852

  15. Retrieval analysis of new-generation yttria-stabilized zirconia femoral heads after total hip arthroplasty.

    PubMed

    Fukui, Kiyokazu; Kaneuji, Ayumi; Sugimori, Tanzo; Ichiseki, Toru; Matsumoto, Tadami

    2014-10-01

    Zirconia femoral heads were introduced for total hip arthroplasty (THA) with the expectation of lower polyethylene (PE) wear and better clinical results. Because several studies reported poor survivorship of yttria-stabilized zirconia-PE THA, we investigated a new-generation yttria-stabilized zirconia head (diameter, 26 mm) manufactured by NGK Spark Plug. We retrieved six zirconia heads at revision THA after they had been in place for a mean of 8.6 years and measured their surface roughness and mean monoclinic content. Although their mean monoclinic content was higher than that of the unused head, surface roughness in the implanted heads was as low as that of the unused head, indicating that wear reduction may be possible with the selection of a suitable zirconia femoral head. PMID:24378655

  16. Cognitive Function in Patients Undergoing Arthroplasty: The Implications for Informed Consent

    PubMed Central

    Demosthenous, N.; St Mart, J. P.; Jenkins, P.; Chappel, A.; Cheng, Kenneth

    2011-01-01

    Obtaining informed consent for an operation is a fundamental daily interaction between orthopaedic surgeon and patient. It is based on a patient's capacity to understand and retain information about the proposed procedure, the potential consequences of having it, and the alternative options available. We used validated tests of memory on 59 patients undergoing lower limb arthroplasty to assess how well they learned and recalled information about their planned procedure. All patients showed an ability to learn new material; however, younger age and higher educational achievement correlated with better performance. These results have serious implications for orthopaedic surgeons discussing planned procedures. They identify groups of patients who may require enhanced methods of communicating the objectives, risks, and alternatives to surgery. Further research is necessary to assess interventions to improve communication prior to surgery. PMID:21991411

  17. Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in the affirmative.

    PubMed

    Hanssen, Arlen D

    2003-04-01

    Patients with inflammatory arthritis, crystalline deposition disease, or severe patellofemoral arthritis have superior functional results with patellar resurfacing as compared with patellar retention. The only remaining issue is whether there is any advantage to resurfacing or retention in patients with osteoarthritic knees in the absence of severe patellofemoral arthritis. Although the answer is still unclear from available prospective randomized clinical trials, the evidence leans toward routine resurfacing of the patella during primary total knee arthroplasty in osteoarthritic knees too. Evidence exists that the results of patellar retention in osteoarthritic knees deteriorate with longer follow-up study. Long-term follow-up evaluations of available prospective clinical trials will be needed to assess this controversy more definitively. PMID:12730925

  18. Changes of bone mineral density after cementless total hip arthroplasty with two different stems.

    PubMed

    Sano, Keiji; Ito, Kouji; Yamamoto, Kengo

    2008-04-01

    Cementless total hip arthroplasty has achieved reliable long-term results since porous coatings were developed, but postoperative changes around the stem remain poorly documented. In this study, changes of the bone mineral density (BMD) were compared between two types of cementless stem. In group B (28 patients with 31 hips), a straight tapered stem with porous plasma spray coating on the proximal 1/4 was used, while group S (24 patients with 26 hips) was given a fluted, tri-slot stem with porous hydroxyapatite coating on the proximal 1/3. In group B, there was an early decrease of BMD, which recovered after 12 months, indicating that stress shielding was minimal. In group S, however, BMD continued to decrease without recovery. The stem shape and radiological findings suggested that the cause of stress shielding in group S was distal fixation. PMID:17225187

  19. Physical and rehabilitation medicine (PRM) care pathways: "patients after total knee arthroplasty".

    PubMed

    Ribinik, P; Le Moine, F; de Korvin, G; Coudeyre, E; Genty, M; Rannou, F; Yelnik, A; Calmels, P

    2012-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total knee arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients. PMID:22455993

  20. Physical and rehabilitation medicine (PRM) care pathways: "patients after total hip arthroplasty".

    PubMed

    Ribinik, P; Le Moine, F; de Korvin, G; Coudeyre, E; Genty, M; Rannou, F; Yelnik, A; Calmels, P

    2012-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total hip arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients. PMID:22459134