The necessity of tendon interposition for the maintenance of joint space after basal joint resection arthroplasty with ligament reconstruction has not been established. A prospective, randomized study was performed. In Group I (nine patients), ligament reconstruction was performed to suspend the first metacarpal in addition to placement of a rolled tendon interposition to fill the void created by resection of the trapezium. In Group II (11 patients), ligament reconstruction alone was performed, with use of a Mitek suture anchor. No tendon interposition was performed. This allowed use of a more limited incision and shorter length of tendon graft. Average followup was 23 months. There was no difference between the two groups in range of motion of the thumb, grip strength, lateral pinch strength, the ability to perform activities of daily living, or subjective satisfaction with the procedure. Two- and three-point pinch strength was statistically significantly greater in Group II. Lateral radiographs of the basal joint at followup, at rest and with pinch, showed maintenance of the joint space, and no difference between the two groups. Tendon interposition is not necessary for maintenance of joint space after basal joint resection arthroplasty if ligament reconstruction is performed. PMID:9308523
Gerwin, M; Griffith, A; Weiland, A J; Hotchkiss, R N; McCormack, R R
The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate.
Papatheodorou, Loukia K.; Rubright, James H.; Kokkalis, Zinon T.; Sotereanos, Dean G.
Resection arthroplasty—known as the Keller procedure—is used for the treatment of severe hallux rigidus. As a modification of this procedure, resection arthroplasty is combined with cheilectomy and interposition of the dorsal capsule and extensor hallucis brevis tendon, which are then sutured to the flexor hallucis brevis tendon on the plantar side of the joint (capsular interposition arthroplasty). In this study the clinical and radiological outcome of 22 feet treated by interposition arthroplasty were investigated and compared with those of 30 feet on which the Keller procedure was performed. The mean follow-up period was 15 months. No statistically significant difference was found between either group concerning patient satisfaction, clinical outcome and increase in range of motion of the first metatarsophalangeal joint. At follow-up, patients who had undergone interposition arthroplasty did not show statistically significantly better American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores than those of the Keller procedure group. A high rate of osteonecrosis of the first metatarsal head was found in both groups. These radiological findings did not correlate with the clinical outcome at follow-up. In conclusion, no significant benefit in clinical or radiological outcome was found for capsular interposition arthroplasty compared with the Keller procedure.
Meizer, Roland; Kramer, Rudolf; Aigner, Nicolas; Landsiedl, Franz; Steinboeck, Gunther
Arthrodesis or autologous tendon interposition can relieve pain associated with arthritis of the carpo-metacarpal joint of\\u000a the first ray (CMC-I), but has its limitations. The aim of this study was to assess whether trapezium resection and fascia\\u000a lata allograft (Tutoplast) interposition is a good alternative. Thirty-eight such combined CMC-I arthroplasties in 36 patients\\u000a with a median age of 57 years and
F. J. C. van der Veen; S. D. Strackee; R. B. Karim; J. J. Hage
Hallux rigidus is a term used to describe painful, limited motion and localized arthritis at the hallux metatarsophalangeal (MTP) joint. With early hallux rigidus, a dorsal cheilectomy can decrease pain and improve motion. With later stage disease, a hallux MTP arthrodesis is commonly chosen to decrease pain, sacrificing motion by fusing the hallux MTP joint. We present an alternative technique to arthrodesis for late stage hallux rigidus-the modified oblique Keller capsular interposition arthroplasty (MOKCIA). With this operation, the dorsal capsule of the hallux MTP joint is interposed into the joint, offering pain relief without sacrificing range of motion. Level of Evidence: Level V, expert opinion. PMID:24699945
Johnson, Jeffrey E; McCormick, Jeremy J
A long-term follow-up was made of 12 elbows operated upon between 1971 and 1986, with more than 20 years’ follow-up, in nine males and three females, age at the time of surgery between 10 and 19 years . Eight right and four left elbows were involved, and there were three aetiological causes. Seven cases were sequelae of elbow fractures, of which five were supracondylar and two were of the olecranon. There were four cases of juvenile rheumatoid arthritis and one was post-osteomyelitis. The surgical technique involved a modification made by Vainio of MacAusland’s technique (wider resection of the osseous ends and total covering of the bloody surfaces) [5, 9]. After extirpating the tissue blocking the joint, we proceeded to remodel the distal humerus in a wide V shape, the proximal end of the ulnar and, if necessary, the radial head. The proximal end of the ulna was sectioned transversely. All surgery was carried out sub-periosteally. Then, an interposition material was placed in one piece and sutured over the distal humerus and cut ends of the ulna and radius. The articular ends were brought together, and the capsule was closed using equidistant stitching, as is the skin. A small compression bandage was applied, and the arm was immobilised with a collar and cuff sling, with the forearm flexed to slightly less than a right angle. In ten cases, the interposition material was fascia lata grafts; in one case, skin graft and in one case, Gelfoam graft. Early rehabilitation began when post-operative pain allowed. Follow-up ranged from 25 to 32 years. Pre-surgical movement ranged between 90° and 120° of flexion and 30° and 90° of extension. Post-operative range varied between 90° and 150° of flexion. The five cases of full pre-operative ankylosis achieved between 90° and 150° of flexion and between 0° and 70° of extension. The total range of motion at the latest follow-up varied from 35° to 150°. Patients who were able to perform flexion of 120° or more were considered to be excellent, those between 90° and 119° were graded good, from 60° to 89° fair and those 59° or less poor. The ability to attain a hand to mouth position requires a mobility of 120°. We obtained excellent results in two patients, good results in three, fair results in four and poor results in three. The fascia lata was used in 83% of cases, obtaining excellent to good results in five patients (41%). Elbow interposition arthroplasty has its indications in children and adolescents where arthrodesis or total joint replacement cannot be performed.
Rodriguez, Janeth; Oliver, Guillermo
Ankylosis of the temporomandibular joint (TMJ) is a severe disorder that leads to jaw function impairment and restricted mouth opening. Management of TMJ ankylosis poses a challenge to surgeons concerned because of the high rate of recurrence. The surgical approach to TMJ ankylosis can be performed according to different techniques and modalities. This report presents a case of a bilateral posttraumatic TMJ ankylosis that showed limited mouth opening (27 mm) along with dental occlusion abnormalities, and both TMJs showed severe fibro-osseous ankylosis. Bilateral gap arthroplasty was performed, and passive interincisal mouth opening of at least 47 mm was achieved after 15 days of physiotherapy. Eight months later, bilateral split ramus osteotomy was performed to correct the residual retrognathia and malocclusion. The outcome of the patient's treatment was satisfactory. Wide gap arthroplasty if followed by vigorous physiotherapy may be sufficient in treating TMJ ankylosis and prevent recurrence in adults. PMID:20647844
Abdelrahman, Tarek Ftohy; Takahashi, Katsu; Bessho, Kazuhisa
We describe a simplified capsular interpositional technique for the Keller bunionectomy that uses a Kirschner wire to interpose the capsule into the first metatarsophalangeal joint without requiring sutures. The capsule acts as a biologic spacer in the first metatarsophalangeal joint, allowing for fibrosis to fill the void created, with the Kirschner wire maintaining the distance between the metatarsal head and the stump of the proximal phalanx. This creation of a nonpainful pseudarthrosis prevents shortening of the hallux and retraction of the base of the proximal phalanx on the metatarsal head. PMID:18685056
Becerro de Bengoa Vallejo, Ricardo; Losa Iglesias, Marta Elena; Viejo Tirado, Fermin; Prados Frutos, Juan Carlos; Jules, Kevin T
Cartilage grafts were implanted as interpositional materials (IPMs) around the stems of silicone finger joint prostheses to protect their surfaces from abrasion with the local bone tissue. The knee joints of New Zealand White rabbits were implanted with finger joint prostheses and grafted with preserved auto- and allografts as well as fresh xenografts. Data were obtained after one month and compared to controls that received only the silicone prostheses. The grafting procedures did not cause any variations in joint function or differences in the amount of lipids absorbed by the prosthesis. A thin fibrous capsule formed about the control implants, whereas the capsules of the grafted legs were greater in thickness and area. Gross examination of the implant surfaces, weight analyses, and light microscopic studies of the number of wear particles found in the surrounding tissue capsules all indicated a reduction in prosthetic wear with grafting. The cartilage grafts were surrounded by inflammatory cells and were losing their proteoglycans. As expected, the xenografts exhibited the most degradation. No differences were noted between the preserved grafts. These results indicate that at one month, cartilage has provided protection for early implant motion. The biodegradable graft was being replaced by fibrous connective tissue. Long-term protection needs to be studied in additional experiments. PMID:3700442
Powers, D L; Gaisser, D M; Barton, Q
Purpose To evaluate the long-term clinical and radiographic outcomes of trapeziectomy with abductor pollicis longus tendon interposition arthroplasty for moderate to severe osteoarthritis of the thumb carpometacarpal joint (Eaton stages III-IV). Methods We evaluated 13 patients (15 thumbs) who underwent trapeziectomy and abductor pollicis longus tendon interposition arthroplasty for end-stage osteoarthritis of the thumb carpometacarpal joint, at an average follow-up of 15 years. Subjective clinical outcomes evaluated included visual analogue scale scores and disability of arm shoulder and hand score questionnaires. Objective clinical evaluation included lateral pinch and grip tests, and a range of active and passive thumb movements. All patients underwent a radiological assessment by two independent senior radiologists. Wherever possible, results obtained from the operated thumbs were compared to the non-operated side. Results At a mean of 15 years post operation (range 15–17 years), there was no statistical difference between the operated and non-operated hands with regards to grip and pinch strength. In all cases CMC and MCPJ range of motion in the operative hand was either equal to or greater than non-operative counterparts. Mean visual analogue scale score was 2.13 and mean DASH score was 16.85. Mean carpal height was 0.52 and mean trapezial space ratio was 0.163. There were no early or late complications recorded and no revision surgery was required. Conclusion It is the opinion of these authors that abductor pollicis longus tendon interposition arthroplasty is able to provide high-quality long-term results for patients who suffer from moderate to severe osteoarthritis of the thumb carpometacarpal joint. Level of evidence Therapeutic Level IV.
Avisar, Erez; Elvey, Michael; Wasrbrout, Ziv; Aghasi, Maurice
Intrathoracic colonic interposition in children with esophageal atresia has been used for the past 36 years. The preferred routes have been via the left pleural cavity and retrosternally. Over the past 13 years the author has developed a method using the posterior mediastinum (normal esophageal route) for the colonic interposition. An analysis of 19 personal cases using this method is presented. A further nine cases using either the retrosternal or the Waterston routes and six cases using a modified neonatal operation are included. The evolution of the method currently used by the author is traced. Major problems remain, and further modifications relating to the optimal timing for the colonic interposition, length of colon graft, and sitting of the lower cologastric anastomosis continue to be tried and are discussed. The function of the graft has been studied with ten patients using 99Tc-labeled milk. The results of this study (unpublished) are presented. Gravity is shown to be the major factor influencing the onward passage of milk and food between the colon and stomach. PMID:3081963
Freeman, N V
To describe a technique termed Suture Anchor Arthroplasty' (SAA), for thumb carpometacarpal joint osteoarthritis and to report the clinical results. SAA is a surgical technique similar to Ligament Reconstruction Tendon Interposition' (LRTI) Arthroplasty, ...
N. L. Taylor R. Strauch
Anconeus interpositional arthroplasty has been used in the treatment of radiocapitellar and radioulnar joint problems occurring after trauma. We performed anconeus interposition arthroplasty in a 31-year-old male patient who developed heterotopic ossification (HTO) in the elbow following surgical treatment of an isolated radial neck fracture. Treatment with implant removal and excision of the radial head resulted in recurrent HTO and a stiff elbow. The patient underwent excision of the heterotrophic new bone and mobilization of the proximal radius. The anconeus muscle was mobilized and interposed between the proximal radius and ulna. Sixteen months after the operation, forearm rotation, elbow flexion and extension increased by 80 degrees , 45 degrees , and 60 degrees , respectively. Control X-rays showed maintenance of the radiohumeral gap without any signs of HTO. PMID:19293618
Seyahi, Aksel; Atalar, Ata Can; Demirhan, Mehmet
Two surgical strategies are possible in total knee arthroplasty (TKA): a measured resection technique, in which bone landmarks\\u000a are used to guide resections equal to the distal and posterior thickness of the femoral component, or a gap-balancing approach,\\u000a in which equal collateral ligament tension in flexion and extension is sought before and as a guide to final bone cuts. In
Domenico Tigani; G. Sabbioni; R. Ben Ayad; M. Filanti; N. Rani; N. Del Piccolo
Silicone has been used in numerous health care roles, from catheters to finger joint arthroplasties, with proven success. Its use as an interpositional membrane for the prevention of adhesions has been attempted in various anatomic sites with unpredictable results. We present a case report of a patient with recurrent arthrofibrosis requiring multiple operative procedures including manipulations under anesthesia, arthroscopies, and unicompartmental and eventual total knee replacement. After developing stiffness after total knee arthroplasty, the patient received placement of a silicone interpositional membrane with the goal of minimizing scar formation. Arthrofibrosis recurred, and only eventual removal of the membrane and correction of the underlying overstuffed patellofemoral compartment has allowed for maintained functional improvement in motion after 3 years. PMID:21329259
Meehan, John P; Abbi, Gaurav
Purpose The purpose of this study is to examine the joint component gap and its relationship with post-operative flexion angles in\\u000a posterior cruciate-retaining (CR) total knee arthroplasty (TKA). In posterior-stabilized (PS) TKA, an inverse correlation\\u000a between the joint component gap and the post-operative flexion angle was reported. However, the kinematics of the joint component\\u000a gap has a different pattern in PS
Koji Takayama; Tomoyuki Matsumoto; Seiji Kubo; Hirotsugu Muratsu; Kazunari Ishida; Takehiko Matsushita; Masahiro Kurosaka; Ryosuke Kuroda
We re-examined experimental model results using half-body specimens with intact extensor mechanisms and navigation to evaluate cruciate-retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA) component gaps through an entire range of motion. Six sequential testing regimens were conducted with the knee intact, with a CR TKA in place, and with a PS TKA in place, with and without 22 N traction in place at each stage. Each of 10 knees was taken through six full ranges of motion from 0° to 120° at every stage using a navigated knee system to record component gapping. No significant difference was found between loaded and unloaded component gaps, and no significant differences were found in component gapping between CR and PS TKAs throughout a full range of motion. Flexion-extension gap measurements were significantly different from previously published data (at 90° flexion). No difference was found in kinematics when comparing CR and PS TKA component designs. Our results suggest that intact extensor mechanisms may be required to perform proper kinematic studies of TKA. Our findings provide evidence that the extensor mechanism may play a major role in the flexion-extension gaps in cadaveric knees. PMID:24474152
Matthews, Joshua; Chong, Alexander; McQueen, David; O'Guinn, Justin; Wooley, Paul
During total knee arthroplasty in fifty consecutive cases, the distal femur and proximal tibia were initially cut. After posterior cruciate ligament excision, the femorotibial joint was expanded by a Tensor/balancer device with 30 inch-pounds of torque (in.lbs) both in extension and flexion, and ligament balancing was obtained in full extension. Then the knee was flexed at 90 degrees, and the femoral rotational axis was decided so that the axis was parallel to the tibial cut surface and the joint gap was the same between extension and flexion. The relationship between the distance of the joint gap expanded by a Tensor/balancer device with 30 in.lbs and the size of the bearing insert was assessed. The results showed that a 24 or 25-mm joint gap expanded by a Tensor/balancer device in full extension was optimal for a 10-mm bearing insert. Therefore, if the resection level of the tibia is set 24 or 25 mm from the femoral cut surface, a 10-mm bearing insert can be used. In 49 cases, the size of the femoral component was one size (4 mm) larger than that predicted based on the bony structure shown in the radiographs of the knee. With this procedure, ligament balancing and optimal joint gap both in extension and flexion can be obtained based on the predicted bearing insert in the knee. PMID:14689881
Nagamine, Ryuji; Kondo, Keiichi; Ikemura, Satoshi; Shiranita, Atsushi; Nakashima, Satoshi; Ihara, Hidetoshi; Sugioka, Yoichi
Achieving correct soft tissue balance and preparing equal and rectangular extension and flexion joint gaps are crucial goals of TKA. Intraoperative gap balances would change postoperatively; however, changes in joint gap balances between pre- and postoperation remain unclear. To explore these changes associated with TKA, we prospectively investigated 21 posterior cruciate ligament retaining TKAs for varus knees. Intraoperative extension gap balance (iEGB) was 2.6 ± 2.0° varus versus postoperative extension gap balance (pEGB) of 0.77 ± 1.8° valgus (P < 0.01), while no significant difference between intraoperative flexion gap balance (iFGB) and postoperative flexion gap balance (pFGB) was observed. We also explored correlations between intraoperative and postoperative gap balances but found no significant correlations. These observations indicate that (i) surgeons should avoid excessive release of the medial soft tissue during TKA for varus knees and (ii) intraoperative gap balance may not be necessarily reflected on postoperative gap balance.
Aoki, Yasuchika; Murakami, Masazumi
...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...
...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...
Recently, we developed a new tensor for total knee arthroplasty (TKA) procedures enabling soft tissue balance assessment throughout\\u000a the range of motion while reproducing post-operative joint alignment with the patello-femoral (PF) joint reduced and the tibiofemoral\\u000a joint aligned. Using the tensor with a computer-assisted navigation system, we investigated the relationship between various\\u000a intra-operative joint gap values and their post-operative flexion
Tomoyuki Matsumoto; Kiyonori Mizuno; Hirotsugu Muratsu; Nobuhiro Tsumura; Naomasa Fukase; Seiji Kubo; Shinichi Yoshiya; Masahiro Kurosaka; Ryosuke Kuroda
Measurement of knee joint gaps without bone resection: "physiologic" extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes.
General agreement is that flexion and extension gaps should be equal and symmetrical in total knee arthroplasty (TKA) procedures. However, comparisons using a standard TKA approach to normal knee joints that have not undergone bone resection are currently unavailable. Since bony preparation can influence capsule and ligament tension, our purpose was to perform measurements without this influence. Ten normal cadaveric knees were assessed using a standard medial parapatellar TKA approach with patellar subluxation. Gap measurements were carried out twice each alternating 100 and 200 N per compartment using a prototypical force-determining ligament balancer without the need for bony resection. Initial measurements were performed in extension, followed by 908 of flexion. The ACL was then resected, and finally the PCL was resected, and measurements were carried out in an analogous fashion. In general, the lateral compartment could be stretched further than the medial compartment, and the corresponding flexion gap values were significantly larger. ACL resection predominantly increased extension gaps, while PCL resection increased flexion gaps. Distraction force of 100 N per compartment appeared adequate; increasing to 200 N did not improve the results. PMID:22416291
Nowakowski, Andrej Maria; Majewski, Martin; Müller-Gerbl, Magdalena; Valderrabano, Victor
Background: Complications following colon interposition may be acute or chronic and often devastating. Creative strategies are needed to preserve the conduit or develop alternatives when the conduit cannot be salvaged. Methods: The records of patients undergoing revision surgery of colon interposition between 1965 and 2005 were reviewed. Results: Thirty-five patients underwent 48 operative revisions. Nineteen patients underwent one operation, nine
Pierre E. de Delva; Christopher R. Morse; William Gerald Austen; Henning A. Gaissert; Michael Lanuti; John C. Wain; Cameron D. Wright; Douglas J. Mathisen
Purpose To evaluate the influence of thigh weight in different hip flexion positions on the knee flexion gap in total knee arthroplasty (TKA). Materials and Methods We evaluated 20 patients (25 knees) with osteoarthritis of the knee that underwent TKA using a navigation system from May 2010 to April 2011. After posterior cruciate ligament sacrificing, complete soft tissue balancing, and fixation of all components with cement, the flexion gaps were measured with the patello-femoral joint reduced. Medial and lateral flexion gaps were measured separately in both the 90°-90° and 45°-90° flexion positions of the hip-knee joints. Results The medial and lateral flexion gaps in the 45°-90° flexion position of the hip-knee joints were 13.02±2.17 mm and 13.12±2.21 mm, respectively. The medial and lateral flexion gaps in the 90°-90° flexion position were 12.92±2.03 mm and 13.08±2.29 mm, respectively. The flexion gaps showed no significant (p>0.05) differences between the two different hip flexion positions. Conclusions Flexion gaps in TKA were not influenced by hip flexion positions (45° or 90° of flexion). Therefore, soft tissue balancing and polyethylene thickness should not be affected by hip flexion positions during TKA.
Lee, Jin Kyu; Chung, Kyu-Sung; Kim, Bo-Hyun
Temporomandibular ankylosis is a disabling condition that affects hygiene and cosmetic appearance. Several interpositional grafts such as meniscus, muscle, fascia, skin, cartilage, fat, dura, alloplastic materials and xenografts have been used to prevent recurrence of ankylosis. We studied the advantages and disadvantages of dermis fat graft as an interposition material after arthroplasty and compared it with temporalis fascia interposition. Seventeen patients with temporomandibular ankylosis involving 20 joints were randomly divided into two groups; the first group had operations for interposition of dermis-fat graft that was taken from the groin. Patients in control group had operations to interpose temporalis fascia and muscle from the same surgical site. All were assessed by age, sex, etiology, clinical features and post surgical complications. The groups were matched in age and the male: female ratio was 0.89:1.The median duration of ankylosis was 7.3 (range 2-11) years. Postoperative and follow up interincisal mouth opening was satisfactory with good healing of the dermis-fat graft donor site. We conclude that the use of dermis fat grafts has minimal donor site morbidity, and is a safe and effective interposition material to prevent the recurrence of temporomandibular ankylosis. PMID:18420320
Mehrotra, D; Pradhan, R; Mohammad, S; Jaiswara, C
The structures that were released to balance the extension gap were recorded during 1500 consecutive TKA procedures, and the amount of femoral component external rotation (ER) necessary to balance the flexion gap was measured with a tensiometer. The amount of ER necessary to balance the flexion gap significantly decreased as more medial structures were released (1 structure=4.7°, 2=4.1°, 3=2.8°, 4 or more=1.1°, P<0.012), whereas significantly greater ER was necessary when three or more lateral structures were released (1 structure=5.3°, 2=5.5°, 3 or more=8.6°, P<0.03). Soft tissue releases affected the amount of femoral component ER necessary to balance the flexion gap, bringing into question the ability of techniques utilizing bony landmarks to properly align the femoral component in rotation. PMID:23507068
Christensen, Christian P; Stewart, Allison H; Jacobs, Cale A
Surgical options for treatment of the hallux valgus deformity in the rheumatoid forefoot are numerous, but long-term results of many of these procedures have been less than satisfactory. Controversy exists as to whether excision or fusion is preferred for the treatment of the hallux metatarsophalangeal (MTP) joint. The role of replacement arthroplasty needs to be evaluated. The available surgical options for treatment of the arthritic first MTP joint in rheumatoid arthritis include arthrodesis, excision of the metatarsal head with or without interposition of the soft tissues, excision of the proximal phalanx, and silicone hinge replacement. This article discusses the various types of arthroplasty of the first MTP joint and the reported outcomes in the rheumatoid forefoot. PMID:17765836
Kumar, C Senthil; Holt, G
Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.
Firstenberg, M. S.; Azoury, F.; Lytle, B. W.; Thomas, J. D.
The present study aims to introduce a transvaginal interposition of polypropylene mesh as a reproducible procedure for women with vaginal vault prolapse following cystectomy due to bladder carcinoma. No recurrent prolapse occurred in two cases 16 and 4 months after the operation. With apical fixation of the mesh, vaginal length can be maintained. No perioperative complications appeared. Performing the technique in a reproducible way seems feasible irrespective of differing anatomical conditions. PMID:22955251
Graefe, Flora; Beilecke, Kathrin; Tunn, Ralf
The Keller procedure has been used during the past century for the treatment of first metatarsophalangeal joint pathology. Many modifications to the procedure have been made, including interposition of the joint capsule into the first metatarsophalangeal joint space. Capsular interposition is often the most difficult step in performing the Keller bunionectomy. This article describes a new, simplified technique for capsular interposition with the use of a dorsal capsular flap and soft-tissue anchors. PMID:15778479
Cook, Keith D
Osteoarthritis of the trapeziometacarpal joint is a common pathology. When the trapezium is not large enough to allow using a total joint arthroplasty or in case of peritrapezial osteoarthrosis, the authors used a trapeziectomy with interposition of an absorbable L-polylactic acid anchovy (Arex(®)615R). This technique is simple and fast. From 2006 to 2010, out of 68 implants, nine displayed a prolonged inflammatory reaction, both clinically and radiologically abnormal, leading the patients to undergo revision surgery for removal of the implant before the end of the third postoperative year. Histological analysis highlighted in all the cases a resorptive gigantocellular immune foreign body reaction. PMID:23665309
Semere, A; Forli, A; Corcella, D; Mesquida, V; Loret, M G; Moutet, F
This study reports a case of revision of a failed Swanson silastic interpositional wrist replacement to a Universal 2 (KMI Medical Inc., San Diego, CA, Jan 2009) total wrist arthroplasty, in a 68-year-old woman with rheumatoid arthritis and pyrophosphate arthropathy. At the 2-year follow-up, the patient was pain-free and was able to perform all activities of daily living, documented by subjective assessment and objective scores. The disabilities of the arm, shoulder, and hand (DASH) scores improved from 98.3 preoperatively to 55.1 postoperatively. A failed Swanson silastic interpositional wrist replacement may be successfully revised to an uncemented primary wrist replacement with good functional results at early follow-up. PMID:24025028
Khan, Yasmin; Konan, Sujith; Sorene, Elliot
ABSTRACT Background: Assuming that ileal stimulation by food may increase incretin secretion, we aimed to investigate whether ileal interposition obtains adequate pancreatic islet viability and function after intramuscular islet transplantation in diabetic rats. Methods: We investigated four groups of eight Wistar rats: ileal interposition + islet transplantation, islet transplantation, ileal interposition, and diabetic control. All rats were subjected to streptozotocin-induced diabetes. We used the C-peptide/glucose ratio and islet image to investigate beta cell mass, and plasma glucagon like peptide-1 (GLP-1) measure. Results: Ileal interposition was effective in preserving function and increasing islet mass in animals with islets transplanted into alginate microcapsules. The plasma GLP-1 level in the diabetic control rats was a basal concentration (4.1 ± 1.2 pM). GLP-1 level after ileal interposition + islet transplantation (12.3 ± 3.3 pM) was significantly higher (p < .05) than in the islet transplantation group (8.2 ± 2.4 pM) and ileal interposition group rats (7.6 ± 1.8 pM). Conclusions: Ileal interposition positively influenced beta cell viability after intramuscular transplantation of pancreatic islets in diabetic rats. PMID:24377965
Araújo-Filho, Irami; Rêgo, Amália Cínthia Meneses; Azevedo, Italo Medeiros; Carvalho, Marília Daniela Ferreira; Medeiros, Aldo Cunha
The authors present analysis of dislocation following hip arthroplasty based on their own clinical material of 1985-2005 year. It contain 2712 cases of total hip arthroplasty, 2171 (80.1%) cases were cemented including 64 (2.4%) cases of revised arthroplasty, 541 (19.9%) cases were cement-free stabilized including 7 (0.2%) cases of revised arthroplasty. Obtained outcomes of analysis permit to make assertion that dislocation following hip arthroplasty occurred during first three month after surgery, more frequently in case of revised arthroplasty and following fractures of femoral neck. Requirement of success is appropriate steady of implant and right done supervision of rehabilitation with learned necessary motoric behaviors. PMID:17131724
Golec, Edward; Nowak, Sebastian; Golec, Joanna; Abrowski, Janusz; Jasiak-Tyrkalska, Bozena
The objective of our study was to determine the effect of continuous jejunal interposition on gastrointestinal hormones after distal gastrectomy, and lay a foundation for surgical management.Distal subtotal gastrectomy experimental model were established on 24 adult Beagle dogs. Digestive tract reconstruction of the dogs was randomly divided into continuous jejunal interposition group, Billroth II anastomosis group and isolated jejunum interposition group. The content of serum gastrin, plasma motilin and cholecystokinin after different digestive tract reconstructions was detected and compared by enzyme-linked immunosorbent assay. In the dogs which received continuous jejunal interposition, postoperative serum gastrin level was significantly lower than before surgery either in fasting or postprandial state (all p<0.05). The serum gastrin level of continuous jejunal interposition group was significantly higher than the other groups in postprandial state (all p<0.05), and was significantly higher than Billroth II -type anastomosis group in fasting state (p<0.05). Furthermore, the postoperative plasma motilin and cholecystokinin levels were significantly higher than before surgery either in fasting or postprandial in dogs received continuous jejunal interposition (all p<0.05). The postoperative plasma motilin level of continuous jejunal interposition group was significantly higher than the other groups in postprandial state (all p<0.05), and was significantly higher than Billroth II -type anastomosis group in fasting state (p<0.05). However, the postoperative cholecystokinin level of continuous jejunal interposition group was significantly lower than the other groups (all p <0.05).Continuous jejunal interposition after distal gastrectomy could maintain the postoperative plasma motilin and serum gastrin in a relatively high level, while cholecystokinin in a low level. PMID:22364297
Lv, Zhen-Ye; Ye, Zai-Yuan; Shao, Qin-Shu; Zhang, Wei; Zhang, Qin; Sun, Yuan-Shui; Li, Shu-Guang; Wang, Yuan-Yu; Xu, Ji
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
Siopack, J S; Jergesen, H E
The aim of this retrospective study is to review long term results of full-thickness cartilage palisade tympanoplasty (FTCPT) with malleus head interposition performed on 51 patients (56 ears); 36 women and 15 men (7-73 years, 44 years average). The pathology of ears which encourages this technique of tympanoplasty is presented. On average 12 years after surgery we have elaborated anatomic and functional results. Anatomic results were categorized based on empiric evaluation of the new tympanic membrane status: 40 (71%) tympanic membranes without anatomic irregularities, 14 (25%) with irregularities and 2 (4%) with secondary perforation. Functional results (tonal audiogram) are based on pure tone average air-bone gap (PTA-ABG) at 4 frequencies. Main functional results of 51 ears (51 audiograms performed): pre- and post-operative average PTA-ABGs were 27.07 +/- 9.98 and 10.77 +/- 7.85 dB (t = 10.36; p < 0.001). In the group of ears with a tympanic membrane with no anatomic irregularities, pre- and post-operative average PTA-ABGs were 27.30 +/- 10.56 and 10.82 +/- 8.33 dB (t = 8.09; p < 0.001). In the group of ears with cartilage resorption, pre- and post-operative PTA-ABGs were 24.92 +/- 8.19 and 9.33 +/- 6.58 dB (t = 6.21; p < 0.001). The differences between the two groups are irrelevant. Postoperative PTA-ABG values of ears after first surgery (N = 34) and revision surgery (N = 17) was significantly different (8.75 +/- 5.75 and 15.16 +/- 9.62 dB) (t = 2.60; p = 0.016). In spite of the thickness of the new tympanal membrane, FTCPT is a successful technique for solving advanced ear pathology. PMID:24851631
Velepic, Marko M; Manestar, Dubravko; Starcevi?, Radan; Velepic, Barbara Cesnik; Velepic, Sanja Zubovi?; Linsak, Zeljko
Background and Aim: The urinary bladder becomes small, contracted and is associated with excess pelvic fat in long standing cases of vesico-vaginal fistulas (VVFs). The aim of this new technique was to use this excess pelvic fat for harvesting an interposition flap. Materials and Methods: An interposition flap of peri-vesical fat was raised from the anterior, superior and posterior surfaces of the urinary bladder and was interposed between the right angle closed vaginal vault and the urinary bladder to strengthen the repair. This technique was used in two patients of VVFs. Results: Both the patients had successful outcome and were able to retain sufficient quantity of urine at 3 months follow-up. Conclusions: Peri-vesical fat flap proved an effective interposition flap in the repairs of VVFs in selected cases.
Singh, R. B.; Dalal, S.; Nanda, S.
Balancing of the joint gap in extension and flexion is a prerequisite for success of a total knee arthroplasty. The joint\\u000a gap is influenced by patellar position. We therefore hypothesized the state of the knee extensor mechanism (including the\\u000a patellar tendon) would influence the joint gap. In 20 knees undergoing posterior-stabilized type total knee arthroplasties,\\u000a we measured the joint gap
Ryuichi Gejo; Yuji Morita; Isao Matsushita; Kazuhito Sugimori; Tomoatsu Kimura
Control of the disease activity is enabled due to the progress of drug therapy for rheumatoid arthritis. However, surgical treatments are necessary for unresponsive cases to the drug or for achieving higher QOL, and we can attain more tight control or cure by combination of drug therapy and surgical treatments. Total joint arthroplasty provides indolence, mobility, stability and is an useful joint reconstruction method. Shoulder and elbow joint work as a reach function together, and total joint arthroplasty become adaptation when extensive joint destruction or severe pain occurrs. With the usage of biologic agents joint repair is possible in small joints, but if the joint destruction progress in weight-bearing joints, repair is impossible and total joint arthroplasty can be required. PMID:23961679
Mibe, Junya; Yamamoto, Kengo
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.
Basho, Rahul; Hood, Kenneth A.
Frey syndrome (FS) is a commonly documented postoperative complication following parotidectomy. The aim of this study was to clinically evaluate the efficacy of superficial temporal fascia (STF) as interpositioning barrier between the overlying skin flap and the parotid bed for the prevention of FS following superficial parotidectomy. A retrospective study was designed involving a population of patients from a single institution who underwent superficial parotidectomy for parotid tumours and refractory chronic sialadenitis from 2008 to 2011. Forty-eight cases were identified and divided into two groups: group I (n=25) had undergone STF interpositioning between the skin flap and the parotid bed after extending the modified Blair's incision in the temporal region, and group II (n=23) had undergone a superficial parotidectomy using the modified Blair's incision without any interpositioning. In group I, one of 25 cases (4%) developed mild FS; in group II, nine of 23 cases (39.1%) developed FS of varying severity. There were no cases of permanent facial palsy in either group. Alopecia along the temporal extension of the incision line was imperceptible in all group I cases. The use of an STF interpositioning barrier between the overlying skin flap and the parotid bed is a safe and effective procedure for the prevention of FS following superficial parotidectomy. PMID:24461587
The Lapidus procedure has received wide acceptance as a valuable operation for correcting moderate to severe hallux valgus, especially in the presence of hypermobility. However, shortening of the first ray inherently occurs as the first metatarsocuneiform joint cartilage and subchondral bone are resected in preparation for arthrodesis. The purpose of this study was to radiographically compare the degree of shortening of the first ray with and without the use of the first metatarsal medial eminence as an interpositional autograft at the site of metatarsocuneiform fusion. Preoperative and postoperative radiographs were measured in 35 consecutive patients who underwent 37 modified Lapidus procedures for hallux valgus repair. In group A, 20 surgeries were performed without use of the interpositional autograft, and served as the control. In group B, 14 surgeries were performed using the medial eminence as an interpositional autograft. The mean amount of first ray shortening was 5.3 ± 1.66 mm in group A and 2.69 ± 1.56 mm in group B, and this difference was statistically significant (P < .001). All patients progressed to complete union, and the median follow-up was 6 months (range, 4-60). Based on these results, the use of the medial eminence as an interpositional autograft in conjunction with Lapidus arthrodesis resulted in a 49.2% reduction in the amount of shortening of the first ray and proved to be a useful source of readily available bone graft. PMID:21513868
Fleming, Lee; Savage, Thomas J; Paden, Matthew H; Stone, Paul A
A patient had radical excision of type II diaphyseal radioulnar synostosis and interposition of a radial forearm adipofascial flap. Neither adjuvant nonsteroidal anti-inflammatory medications nor radiation therapy were used. Three years after surgery the patient showed 90 degrees of pronation and 90 degrees of supination without any evidence of recurrence. PMID:15576229
Jones, Neil F; Esmail, Adil; Shin, Eon K
Imaging studies are central to the evaluation of persistent or recurrent symptoms after hip arthroplasty. The evaluation starts with radiographs and may be followed by arthrography, aspiration, scintigraphy, sonography, computed tomography, and MR imaging. Common etiologies of a painful or dysfunctional hip arthroplasty are mechanical loosening, polyethylene wear-induced osteolysis, adverse local tissue reaction to metal wear products, infection, fractures, heterotopic ossification, tendinopathy, and nerve injury. MR imaging with optimized protocols and dedicated techniques for metal artifact reduction is the most comprehensive imaging modality. In this article, we discuss and illustrate the imaging appearances of these conditions with a focus on the MR imaging evaluation. PMID:23787986
Fritz, Jan; Lurie, Brett; Miller, Theodore T
Background Randomized controlled trials comparing different vasectomy occlusion techniques are lacking. Thus, this multicenter randomized trial was conducted to compare the probability of the success of ligation and excision vasectomy with, versus without, fascial interposition (i.e. placing a layer of the vas sheath between two cut ends of the vas). Methods The trial was conducted between December 1999 and June 2002 with a single planned interim analysis. Men requesting vasectomies at eight outpatient clinics in seven countries in North America, Latin America, and Asia were included in the study. The men were randomized to receive vasectomy with versus without fascial interposition. All surgeons performed the vasectomies using the no-scalpel approach to the vas. Participants had a semen analysis two weeks after vasectomy and then every four weeks up to 34 weeks. The primary outcome measure was time to azoospermia. Additional outcome measures were time to severe oligozoospermia (<100 000 sperm/mL) and vasectomy failure based on semen analyses. Results We halted recruitment after the planned interim analysis, when 841 men had been enrolled. Fascial interposition decreased time to azoospermia (hazard ratio [HR], 1.35; P < 0.0001) and time to severe oligozoospermia (HR, 1.32; P < 0.0001) and reduced failures based on semen analysis by about half, from 12.7% (95% confidence interval [CI], 9.7 to 16.3) to 5.9% (95% CI, 3.8 to 8.6) (P < 0.0001). Older men benefited less from fascial interposition than younger men in terms of the speed of achieving azoospermia. However, the number of vasectomy failures was reduced to a similar degree in all age groups. Slightly more adverse events occurred in the fascial interposition group, but the difference was not significant. These failure rates may appear high to practitioners in countries such as the USA, but they are similar to results from other careful studies of ligation and excision techniques. Conclusion Fascial interposition significantly improves vasectomy success when ligation and excision is the method of vas occlusion. A limitation of this study is that the correlation between postvasectomy sperm concentrations and risk of pregnancy is not well quantified.
Sokal, David; Irsula, Belinda; Hays, Melissa; Chen-Mok, Mario; Barone, Mark A
Irreducibility of the knee following complete dislocation is a rare event determined by the interposition of various capsulo-ligamentous\\u000a structures in the joint space. Such cases often require urgent surgical treatment. We report the case of a healthy 70-year-old\\u000a man with a sprain of the left knee that occurred after a sports trauma. The patient showed knee dislocation with multiple\\u000a ligamentous
Alessandro Bistolfi; Giuseppe Massazza; Federica Rosso; Stefano Ventura; Enzo Cenna; Luca Drocco; Maurizio Crova
15 to 20 years after Keller-Brandes-procedure in therapy of hallux valgus there is often an increasingly degeneration of nearthrosis. Among biomechanical aspects the problems are decrease of correction, shortening and loss of substance of the residue base-phalanx. Toelenght and functional importance can be restored with an interpositioning arthrodesis of MTP-nearthrosis with a tricortical autogen splinter of iliac crest. PMID:10484911
Moeller, K; Edelmann, H
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
Carlo Bellettini; Julian L. Rrushi
Introduction Arthritis in the trapeziometacarpal joint of the thumb can cause swelling and loss of motion. Treatment options include arthrodesis, replacement arthroplasty and interposition arthroplasty. Our objective in this clinical study was to determine outcomes after trapezial arthroplasty with a silicone rubber implant and the relationship between self-reported and measured outcomes. Methods At the Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ont., a tertiary care centre, we reviewed a series of 26 patients with advanced osteoarthritis who underwent silicone rubber trapezial arthroplasty. The follow-up averaged 6.5 years. We assessed the outcomes subjectively, and by clinical, functional and radiographic examination. Results Although 88% of patients reported some improvement in pain and satisfaction, when quantified the improvement was less impressive: only 5.7 (on a visual analogue scale of 1–10, poor–excellent) for pain and 5.6 for satisfaction. Superior subjective results were reported by patients older than 60 years. Osteoarthritic changes had caused pronounced functional impairment in the hands of patients who underwent surgery and those who did not, so that any long-term benefit of surgery was not measurable. Patients had difficulty manipulating both small and large objects on the Jebsen's hand function test. Peri-implant and carpal radiographic lytic changes were observed in 90% of patients. Six patients (20%) required revision surgery (3 early, 3 late), including 1 with a pathologic scaphoid fracture. Conclusions Although clinical, functional and radiographic results were poor, they did not predict either satisfaction or pain improvement reported by patients, illustrating the need for a comprehensive standardized outcome evaluation to make informed decisions on the value of surgical intervention for osteoarthritis of the trapeziometacarpal joint.
MacDermid, Joy C.; Roth, James H.; Rampersaud, Y. Raj; Bain, Gregory I.
The reverse shoulder arthroplasty is considered to be one of the most significant technological advancements in shoulder reconstructive surgery over the past 30 years. It is able to successfully decrease pain and improve function for patients with rotator cuff-deficient shoulders. The glenoid is transformed into a sphere that articulates with a humeral socket. The current reverse prosthesis shifts the center of rotation more medial and distal, improving the deltoid's mechanical advantage. This design has resulted in successful improvement in both active shoulder elevation and in quality of life. PMID:23827841
Jarrett, Claudius D; Brown, Brandon T; Schmidt, Christopher C
The authors present the internet based Hungarian Arthroplasty Registry that was introduced in 2007. All departments involved in prosthesis implantation in Hungary have already registered and, therefore, data entry is available. However, data entry is far from 100 percent. The fully completed registry would be very important in order to be recognised at international forums. Until now 51 387 cases have been entered into the database. The datasheets can be saved after completion, the data and the correlations can be analysed and graphically displayed. This is a good tool to have data on prosthesis survival, surgical interventions and complications. PMID:24796783
Böröcz, István; Molnár, Péter
Background and Objective: We conducted this study to evaluate the feasibility and efficacy of immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula (VVF) developing after total abdominal hysterectomy (TAH), which causes not only social and economic misery for the patient but also considerable stress to the physicians who perform the surgery. Methods: We performed a retrospective review of 5 women who underwent immediate laparoscopic nontransvesical repair without omental interposition for VVFs, developing after TAH from October 2007 to March 2009. In terms of laparoscopic procedure, cystoscopy was performed to confirm the location of fistula and ureteral openings, initially. Without opening the bladder, the fistula tract was identified, and the bladder was dissected from the vagina. The bladder defect was closed by using intracorporeal, continuous, and double-layer suturing, laparoscopically. The vaginal defect was closed using interrupted and single-layer suturing, vaginally. A Foley catheter was inserted for 2 weeks and removed after bladder integrity was confirmed with a retrograde cystogram. Results: The median age and body mass index of the patients were 47 years and 22.3 kg/m2, respectively. Operating time, hemoglobin change, and hospital stay were 95 minutes, 1.1 g/dL, and 5 days, respectively. There were no complications or laparoconversions. During follow-up (median 56.1 weeks; range 26.6 to 74.0), there was no evidence of recurrence. Conclusions: Immediate laparoscopic nontransvesical repair without omental interposition might be an effective, feasible alternative to the traditional methods in select patients with small sized (<1 cm) VVF developing after TAH.
Lee, Jung Hun; Lee, Kyo Won; Han, Jong Sul; Choi, Pil Cho; Hoh, Jeong-Kyu
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.
Kitajima, Toshihiro; Momose, Kota; Lee, Seigi; Haruta, Shusuke; Shinohara, Hisashi; Ueno, Masaki; Fujii, Takeshi; Udagawa, Harushi
Arthritis in the small joints of the hand can be treated with arthrodesis or arthroplasty. Arthrodesis has known risks of infection, pain, and nonunion. Distal interphalangeal (DIP) arthroplasty has been successful in preserving motion and alleviating pain for distal DIP, proximal interphalangeal, and metacarpophalangeal joints. Unfortunately, complications arise that limit the success of surgery. Silicone implants have been reliable for many years but still present with the risks of infection, implant breakage, stiffness, and pain. Newer implant designs may limit some of these complications, but present with unique problems such as dislocations and loosening. It is not yet clear as to which type of implant provides the most reliable results, although implant arthroplasty appears to give better function than arthrodesis. Silicone arthroplasty does not lead to silicone synovitis and is a reliable procedure. Pyrocarbon implants are showing some promise, particularly in the osteoarthritic patient. PMID:20494746
Drake, Matthew L; Segalman, Keith A
Summary Total hip arthroplasty (THA) has been indicated as the surgical intervention with greatest improvement in pain and physical function. However some patients continue to experience hip pain after elective surgery. We investigate prognostic factors that negatively affect treatment effectiveness and the patient outcome. The “hip region” constitutes the groin, buttock, upper lateral thigh, greater trochanteric area, and the iliac crest. Pain originating from various sources and not directly linked to prosthesis may be perceived here and includes the lumbosacral spine, referred pain from abdominal organs and soft tissue sources such as trochanteric bursitis, tendinitis, hip abductor dysfunction, and inguinal hernia. An accurate assessment of the pain cause is extremely difficult to construct and a complete differential diagnosis is fundamental. We assess all the possible causes of hip pain after THA and we divide them depending on the presence or absence of radiographic signs.
Ferrata, Paolo; Carta, Serafino; Fortina, Mattia; Scipio, Daniele; Riva, Alberto; Di Giacinto, Salvatore
Over a 17-year period, 92 patients with esophageal disease underwent colon interposition or bypass, with each operation performed by the same surgeon. The indication was cure of cancer in 20 patients, relief of dysphagia in 55 (cancer in 17 patients and benign in 38), loss of gastrointestinal (G.I.) continuity in ten, and tracheoesophageal fistula in seven patients (malignant in five, benign in 2). The thirty-day operative mortality rate was 5%, and the hospital mortality rate was 9%. Graft necrosis occurred in seven of 92 patients, four of whom later underwent a successful second reconstruction. Thirteen patients required subsequent revisional surgery. In 85 patients, the left colon based on the inferior mesenteric artery was used, and in seven, the right colon was used. Technical insights were gained to help preserve the blood supply to the graft and improve its function in transporting food. Thirty-four patients were available for interview 2-17 years after operation (median of 5 years) 28 of whom had benign disease, and six of whom had malignant disease); 82% of the patients felt they were cured of their preoperative symptoms, 18% improved, and none worsened. Eighty-eight per cent of the patients were able to receive an unrestricted diet. All patients except one were satisfied with the results of surgery, and, asked what they would do if they had to make the choice again, all responded that they would have the operation. Twenty-six of the interviewed patients had their eating ability evaluated with a test meal and the transit time of a liquid and solid barium bolus measured. Compared to controls, patients with colon interpositions consumed a smaller capacity meal over a longer period of time and were not dependent on liquids to flush the food through the colon graft. A colon interposition provides good quality of deglutition, is very durable, and is the organ of choice for patients who require an esophageal substitute and are potential candidates for long survival. Images Figs. 3A and B.
DeMeester, T R; Johansson, K E; Franze, I; Eypasch, E; Lu, C T; McGill, J E; Zaninotto, G
Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires thorough evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. Non-operative management is often successful if the components are well-fixed and correctly positioned in the absence of neurocognitive disorders. If conservative management fails, surgical options include revision of malpositioned components; exchange of modular components such as the femoral head and acetabular liner; bipolar arthroplasty; tripolar arthroplasty; use of a larger femoral head; use of a constrained liner; soft tissue reinforcement and advancement of the greater trochanter. PMID:22919568
Werner, Brian C; Brown, Thomas E
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.
Park, Chan Woo; Hwang, Kyu Tae; Kim, Jeong Tae
Treatment goals in the operative management of talus fractures include prompt, anatomic, open reduction with rigid internal fixation; functional outcome is measured by degree of arthrosis, pain, range of motion, limb length, cosmesis, and return to premorbid activities. If restoration of the articular surfaces is precluded secondary to comminution, immediate and/or staged reconstructive salvage procedures must be considered. This report describes an immediate reconstructive procedure for salvage after a comminuted talus fracture with an ipsilateral tibia fracture. A standard antegrade tibial nail extending into the calcaneus was selected to stabilize both fracture sites. The technique of tibiocalcaneal arthrodesis using interposition fibular autograft and intramedullary fixation is presented as a unique treatment option. PMID:10714788
Ptaszek, A J
There is a steady increase in the number of patients with chronic renal insufficiency undergoing long-term hemodialysis, and an increasing number of these patients have exhausted veins due to multiple vascular access and salvage procedures. These patients may be candidates for an alternative vascular access procedure, the brachioaxillary interposition arteriovenous graft. This graft was used in 13 patients with a 100% patency rate and no significant complications at 81 patient months. The results indicate that the large axillary vein, which provides an adequate runoff, and a narrow graft-to-vein inflow angle may lessen the turbulence inherent in the more conventional grafts and may contribute to an improved long-term patency. If these assumptions prove correct, this graft may find more frequent application in the future. PMID:8209940
Bittner, H B; Weaver, J P
This study was conducted to determine the effect of waiting times for total hip arthroplasty in terms of loss in quality-adjusted life years and additional burden perceived. A second goal was to study the effect of waiting times and preoperative function scores on postoperative outcome scores. Data were collected prospectively from a cohort of 161 patients waiting for total hip
Marieke Ostendorf; Erik Buskens; Henk van Stel; Augustus Schrijvers; Louis Marting; Wouter Dhert; Abraham Verbout
Functional assessment of patients before and after prosthetic knee arthroplasty is based on clinical examination, which is usually summarized in various knee scores. The present study proposes a different and more subject orientated assessment for functional grading of these patients by measuring their maximal distance of walking ability, which is not apparent from the conventional outcome scores.Eighteen consecutive patients with
N. Rosenberg; G. Nierenberg; R. Lenger; M. Soudry
Arthroplasty in the haemophiliac patient is associated with higher rates of infection and is traditionally performed in a younger age group. Despite this there is little evidence in the literature regarding revision arthroplasty in this cohort of patients. We describe the case of a periprosthetic fracture in a haemophiliac patient requiring revision arthroplasty, who did not consent to receiving blood products due to religious beliefs, with a successful outcome.
Molloy, A. P.; O'Neill, B. J.; Molloy, L.; White, B.; Smyth, H.; Carthy, T. Mc.
Total hip arthroplasty was originally indicated for older, sedentary patients because of concerns that catastrophic wear and failure would occur in younger and more active patients. With advances in implant design, tribology, and surgical technique, total hip arthroplasty has now become a viable option for younger patients seeking excellent pain relief and improvement in function. Long-term studies are needed to evaluate the outcome of hip arthroplasty in younger patients using the modern generation of implants and bearing surfaces. PMID:16958450
Sharkey, Peter F; Austin, Matthew S; Hozack, William
A total knee arthroplasty can be completed using two techniques; measured resection or gap balancing. A prospective blinded randomized controlled trial was completed with 103 patients randomized to measured resection (n=52) or gap balancing (n=51). Primary outcome measure was femoral component rotation. Secondary outcome measures were joint-line change, gap symmetry and function and quality-of-life outcomes. Gap balancing resulted in a significantly raised joint-line compared to measured resection. Gap symmetry was significantly better using gap balancing. Functional outcomes and quality-of-life were not significantly different at 24months. Using computer navigation, gap balancing significantly raises the joint-line in order to improve gap symmetry. This does not result in a clinical difference in function or quality of life at 24months. PMID:24183325
Babazadeh, Sina; Dowsey, Michelle M; Stoney, James D; Choong, Peter F M
Background: Rotator cuff reconstructions may be improved by adding growth factors, cells, or other biologic factors into the repair zone. This usually requires a biological carrier (scaffold) to be integrated into the construct and placed in the area of tendon-to-bone healing. This needs to be done without affecting the constructs mechanics.Hypothesis\\/Purpose: The hypothesis was that scaffold placement, as an interposition,
Knut Beitzel; David M. Chowaniec; Mary Beth McCarthy; Mark P. Cote; Ryan P. Russell; Elifho Obopilwe; Andreas B. Imhoff; Robert A. Arciero; Augustus D. Mazzocca
Nowadays, a general negative evaluation of sportive activity regarding different kinds of sport following arthroplasty is at present no more scientifically supported. However, at present no valid guidelines regarding sportive activity of patients after implantation of shoulder joint arthroplasty exist. The question regarding the ability of performing winter sports activities of patients treated with shoulder joint endoprothesis has not been answered so far. Therefore the aim of the presented work was to identify winter sports-specific risks for patients treated with shoulder joint endoprothesis as well as to critically discuss the actual literature in refer to winter sport activities. Criteria for the education of patients with shoulder joint endoprothesis as well as consultation regarding winter sport activities will be provided for the orthopaedic surgeon. PMID:18814057
Kirchhoff, C; Imhoff, A B; Hinterwimmer, S
A patient with severe irreducible open fracture dislocation of the ankle was admitted to our emergency department. After wound irrigation and debridement, skeletal traction was applied to the calcaneus to minimize soft tissue injury and swelling. The patient was followed in traction for 1 week, after which reduction and fixation of the fibula was attempted but not achieved. We extended the incision distally, visualized the ankle, and located the tibialis posterior tendon between the distal tibia and fibula, thereby inhibiting the reduction. The tendon coursed into the tibiotalar joint anteriorly and pushed the talus anterolaterally. After manipulation of the tendon to its anatomically correct location, the ankle was easily reduced. The wound at the medial side was closed with a fasciocutaneous rotational flap. The ankle was then immobilized for 6 weeks postoperatively. The patient regained her full range of motion, and there were no problems with the tibialis posterior tendon, such as rupture or insufficiency. Isolated tibialis posterior tendon interposition between the distal tibiofibular and tibiotalar joints has rarely been reported, and can inhibit anatomical reduction of the fractured ankle. PMID:20022525
Ermis, Mehmet Nurullah; Yagmurlu, Mehmet Firat; Kilinc, Ahmet Sadi; Karakas, Eyup Selahattin
Over the past 60 years, many surgical techniques have been developed for the repair of nasoseptal perforations. This study describes a safe and practical technique involving the 5-layer repair of symptomatic nasoseptal perforations without mucosal flaps. The present study involved 23 patients (17 men and 6 women) who had symptomatic nasoseptal perforations in the Otorhinolaryngology and Head Neck Surgery Department of Haseki Research and Training Hospital. Patients were treated using the mucosal regeneration technique. Follow-up examinations were performed at 3 and 6 months postoperatively. The surgery was considered successful if total closure was achieved. Nasal mucosal physiology was also assessed preoperatively and at 3 and 6 months postoperatively by measuring the nasal mucociliary clearance time by means of the saccharin test. The most common etiological factor was former nasal surgery (56.5%), followed by nasal trauma (26%). In 4 patients (17.5%), the perforations were idiopathic. The average preoperative perforation size was 1.74 ± 0.87 cm. Total closure of the perforation was achieved in 21 patients (91.3%), and only 2 patients had subtotal healing. The mean preoperative mucociliary clearance time was 19.3 ± 4.15 minutes, which significantly improved to 12.4 ± 3.53 minutes and 10.1 ± 3.21 minutes at 3 and 6 postoperative months, respectively. Mucosal regeneration technique with interpositional grafts can be used to safely and reliably repair medium-to-large nasoseptal perforations. PMID:24240769
Ozkul, Haluk M; Balikci, Hasan Huseyin; Karakas, Mustafa; Bayram, Ozlem; Bayram, Ali Alper; Kara, Nejla
AIM: To compare the short-term outcomes of patients who underwent proximal gastrectomy with jejunal interposition (PGJI) with those undergoing total gastrectomy with Roux-en-Y anastomosis (TGRY). METHODS: From January 2009 to January 2011, thirty-five patients underwent PGJI, and forty-one patients underwent TGRY. The surgical efficacy and short-term follow-up outcomes were compared between the two groups. RESULTS: There were no differences in the demographic and clinicopathological characteristics. The mean operation duration and postoperative hospital stay in the PGJI group were statistically longer than those in the TGRY group (P = 0.00). No anastomosis leakage was observed in two groups. No statistically significant difference was found in endoscopic findings, Visick grade or serum albumin level. The single-meal food intake in the PGJI group was more than that in the TGRY group (P = 0.00). The PG group showed significantly better hemoglobin levels in the second year (P = 0.02). The two-year survival rate was not significantly different (PGJI vs TGRY, 93.55% vs 92.5%, P = 1.0). CONCLUSION: PGJI is a safe, radical surgical method for proximal gastric cancer and leads to better outcomes in terms of the single-meal food intake and hemoglobin level, compared with TGRY in the short term.
Zhao, Ping; Xiao, Shuo-Meng; Tang, Ling-Chao; Ding, Zhi; Zhou, Xiang; Chen, Xiao-Dong
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.
Sutton, R.; Sutton, H.; Ackery, D.M.; Freeman, N.V. (Southampton General Hospital (England))
Stiffness is a relatively uncommon complication after total knee arthroplasty. It has been defined as a painful limitation\\u000a in the range of movement (ROM). Its pathogenesis is still unclear even if some risk factors have been identified. Patient-related\\u000a conditions may be difficult to treat. Preoperative ROM is the most important risk factor, but an association with diabetes,\\u000a reflex sympathetic dystrophy,
Alfredo Schiavone Panni; Simone Cerciello; Michele Vasso; Mario Tartarone
This paper investigates the application of a soft layer in one of the bearing surfaces of cervical and lumbar total disc arthroplasty devices. The disc arthroplasty was analytically modelled as a ball and socket joint, with the ball made from a metal and the socket made from an elastomer. The peak contact pressure and the minimum film thickness between the
J. P. Clewlow; T. Pylios; D. E. T. Shepherd
A Tensor/Balancer device has been recently developed in order to assess soft tissue balancing in total knee arthroplasty (TKA) under more physiological conditions. This device allows us to measure the joint gap with a trial femoral component in place with the patella reduced. The purpose of this study was to clarify whether the placement of the component changes the intraoperative gap difference (flexion gap distance minus extension gap distance). We prospectively investigated the extension (0°) and flexion (90°) gaps in 73 posterior-stabilized TKAs under 30 lb of joint distraction force. Then, we compared the gap difference with and without the trial femoral component in place. Our results showed that the intraoperative gap difference with the trial femoral component in place was larger than the intraoperative gap difference without the trial component (p=0.00003; with the trial component: mean 4.7 mm (standard deviation (SD): 3.0mm); without the trial component: mean 2.7 mm (SD: 3.3mm)). We consider that the change in gap difference with or without femoral component was caused by a relative difference in the elasticity and/or tightness of the soft tissue in extension versus flexion. Surgeons should be aware of this effect of the femoral component when considering intraoperative soft tissue balancing which leads to postoperative stability of the knee joint consequently. PMID:21889347
Hananouchi, Takehito; Yamamoto, Kengo; Ando, Wataru; Fudo, Kazumasa; Ohzono, Kenji
Periprosthetic fractures after total knee arthroplasty present substantial challenge if associated with poor bone stock, fracture comminution, and loose or damaged components. Revision total knee arthroplasty with distal femoral arthroplasty is often necessary in these injuries. We reviewed 20 patients (22 knees) with a mean age of 69.5 years who underwent revision with distal femoral arthroplasty fracture. Patients were followed for an average of 58.6 months. At the latest follow-up, the mean Knee Society knee and functional score were 82.8 and 40, and the Short Form 36 mean physical functioning and mental functioning scores were 55.8 and 65.6, respectively. There were 10 postoperative complications with 5 patients requiring additional surgery. Distal femoral arthroplasty seems to be a viable option for complex periprosthetic femoral fractures after total knee arthroplasty. However, considering the relatively high rate of complications, this procedure should be reserved for patients where alternative treatments are not possible. PMID:20171053
Mortazavi, S M Javad; Kurd, Mark F; Bender, Benjamin; Post, Zachary; Parvizi, Javad; Purtill, James J
INTRODUCTION Acquired post-traumatic tracheoesophageal fistula (TEF) is an uncommon entity requiring early diagnosis. Among the many strategies in surgical management, we report a case successfully treated with a single-stage tracheal resection and esophageal repair with platysma myocutaneous interposition flap. PRESENTATION OF CASE A 24-year-old man had a motor vehicle accident with head injury and cerebral contusion who required mechanical ventilation support. Three weeks later, he developed hypersecretion, and recurrent episodes of aspiration pneumonia. The chest computed tomography, esophagogastroduodenoscopy, and bronchoscopy revealed a large TEF diameter of 3 cm at 4.5 cm from carina. Single-stage tracheal resection with primary end-to-end anastomosis and esophageal repair with platysma myocutaneous interposition flap was performed. A contrast esophagography was done on post-operative day 7 and revealed no leakage. He was discharged on post-operative day 10. Esophagogastroduodenoscopy at 1 month revealed patient esophageal lumen. At present he is doing well without any evidence of complications such as esophageal stricture or fistula. DISCUSSION There are many choices of myocutaneous muscle flaps in trachea and esophageal closure or reinforcement. The platysma myocutaneous flap interposition is simple with the advantage of reduced bulkiness. Concern on the vascular supply is that flap should be elevated with the deep adipofascial tissue under the platysma to ensure that the flap survival is not threatened. CONCLUSION The treatment of acquired TEF with platysma myocutaneous flap is an alternative procedure for a large uncomplicated TEF as it is effective, technically ease, minimal donor site defect and yields good surgical results.
Akaraviputh, Thawatchai; Angkurawaranon, Chotirot; Phanchaipetch, Teerawit; Lohsiriwat, Visnu; Nimmanwudipong, Thanyadej; Chinswangwatanakul, Vitoon; Metasate, Asada; Trakarnsanga, Atthaphorn; Swangsri, Jirawat; Taweerutchana, Voraboot
Most problems encountered in complex revision total knee arthroplasty can be managed with the wide range of implant systems currently available. Modular metaphyseal sleeves, metallic augments and cones provide stability even with significant bone loss. Hinged designs substitute for significant ligamentous deficiencies. Catastrophic failure that precludes successful reconstruction can be encountered. The alternatives to arthroplasty in such drastic situations include knee arthrodesis, resection arthroplasty and amputation. The relative indications for the selection of these alternatives are recurrent deep infection, immunocompromised host, and extensive non-reconstructible bone or soft-tissue defects. PMID:23118402
Jones, R E; Russell, R D; Huo, M H
Patients with familial adenomatous polyposis (FAP) oftentimes have extracolonic polyps. The patient discussed in this case report had innumerable gastric polyps which were significantly affecting his ability to tolerate oral intake and his overall nutrition. Medical management was not sufficiently controlling his symptoms; therefore we proceeded with surgical intervention. We discuss the use of a total gastrectomy with an Isoperistaltic jejunal interposition flap for the symptomatic management of gastric polyposis. We describe the technique used and benefits to this specific procedure when it comes to long term outcome, complications, and monitoring. PMID:24490047
Srinivasa, Dhivya; Wray, Curtis J
Background: Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. Methods: This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Results: Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Conclusion: Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing.
Moatz, Bradley; Tortolani, P. Justin
Aim: Combination of laparoscopic ileal interposition (II) with sleeve gastrectomy (SG) is an upcoming procedure, which offers good metabolic improvement and weight reduction without causing significant malabsorption. The objective of this study was to evaluate the results of this novel procedure for control of type 2 diabetes, obesity, hypertension, and related metabolic abnormalities. Materials and Methods: The II and SG was performed in 43 patients (M:F = 25:18) from February 2008. Participants had a mean age of 47.2 ± 8.2 years (range 29–66 years), mean duration of diabetes of 10.1 ± 9.2 years (range 1–32 years), and mean preoperative body mass index (BMI) of 33.2 ± 7.8 kg/m2. All patients had poorly controlled type 2 diabetes mellitus (DM) [mean glycated hemoglobin (HbA1C) 9.6 ± 2.1%] despite use of oral hypoglycemic agents (OHAs) and/or insulin. Thirty (70%) patients had hypertension, 20 (46%) had dyslipidemia, and 18 (42%) had significant microalbuminuria. The primary outcome was remission of diabetes (HbA1C < 6.5% without OHAs/insulin) and the secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome. Results: Mean follow-up was for 20.2 ± 8.6 months (range 4–40 months). Postoperatively, glycemic parameters (fasting and post-lunch blood sugar, HbA1C improved in all patients (P < 0.05) at all intervals. Twenty (47%) patients had remission in diabetes and the remaining patients showed significantly decreased OHA requirement. All patients had weight loss between 15 and 30% (P < 0.05). Twenty-seven (90%) patients had remission in hypertension. At 3 years, the mean fall in HbA1C (34%) was more than reduction in BMI (25%). There was a declining trend in lipids and microalbuminuria postoperatively, though it was significant for microalbuminuria only. Conclusions: The laparoscopic II with SG seems to be a promising procedure for control of type 2 DM, hypertension, weight reduction, and associated metabolic abnormalities. A multicenter study with larger number of patients and a longer follow-up period is needed to substantiate our preliminary findings.
Kota, Sunil Kumar; Ugale, Surendra; Gupta, Neeraj; Naik, Vishwas; Kumar, K. V. S. Hari; Modi, Kirtikumar D.
Summary To examine the influence of intra- and post-operative blood loss and operative trauma on erythropoietin (EPO) production we studied patients undergoing endoprothetic surgery of the hip. Immunoreactive plasma EPO was determined in ten patients (seven male, three female, aged 39–68 years), undergoing surgery for hip arthroplasty (n=8) or revision hip arthroplasty (n=2). EPO levels had already been determined during
A. Lorentz; K.-U. Eckardt; P. M. Osswald; C. Kruse
Because of improvements in surgical technique, anesthesia, and rehabilitation, mortality after hip arthroplasty may be on\\u000a the decline. The purpose of this study was to determine the 90-day mortality rate after uncemented total hip arthroplasty\\u000a (THA) performed under regional anesthesia. We retrospectively reviewed 7478 consecutive patients undergoing cementless primary\\u000a or revision THA between January 2000 and July 2006. Patient survivorship
Michael Aynardi; Luis Pulido; Javad Parvizi; Peter F. Sharkey; Richard H. Rothman
Professor Grammont revolutionised shoulder surgery with his reverse shoulder arthroplasty design. Patients who had poor results from a conventional shoulder replacement because of cuff deficiency can now be treated effectively. Although designed for cuff tear arthropathy, indications continue to evolve and broaden. The initial results look very promising and the implant has gained much popularity over the years. The article provides an extensive literature review of the indications, results and complications for reverse shoulder arthroplasty.
Mahmood, Aatif; Malal, Joby Jacob George; Waseem, Mohammed
An extensive database search was completed to perform a meta-analysis of outcomes of mobile-bearing total knee arthroplasty. Nineteen manuscripts encompassing 3506 total knee arthroplasty met criteria for analysis (average follow-up, 8.6 years). Data were subdivided based on design type and included rotating platform, meniscal bearing, and anterior-posterior glide-rotation subgroups. Fifteen-year survivorship of rotating platform designs (96.4%) was greater than meniscal
Joshua T. Carothers; Raymond H. Kim; Douglas A. Dennis; Carleton Southworth
Retrograde tibiotalocalcaneal nailing arthrodesis has proved to be a viable salvage procedure; however, extended bone loss around the ankle has been associated with high rates of nonunion and considerable shortening of the hindfoot. We present the surgical technique and the first 2 cases in which a trabecular metal™ interpositional spacer, specifically designed for tibiotalocalcaneal nailing arthrodesis, was used. The spacer can be implanted using either an anterior or a lateral approach. An integrated hole in the spacer allows a retrograde nail to be inserted, which provides excellent primary stability of the construct. Trabecular metal™ is a well-established and well-described material used to supplement deficient bone stock in surgery of the spine, hip, and knee. It has shown excellent incorporation and reduces the need for auto- and allografts. The trabecular metal™ interpositional ankle spacer is the first trabecular metal spacer designed specifically for ankle surgery. Its shape and variable size will make it a valuable tool for reconstructing bone loss in tibiotalocalcaneal nailing arthrodesis. PMID:24666978
Horisberger, Monika; Paul, Jochen; Wiewiorski, Martin; Henninger, Heath B; Khalifa, Muhammad S; Barg, Alexej; Valderrabano, Victor
Background. The optimal surgical treatment for Kienböck's disease with stages IIIB and IV remains controversial. A cadaver study was carried out to evaluate the use of coiled extensor carpi radialis longus tendon for tendon interposition and a strip obtained from the same tendon for ligament reconstruction in the late stages of Kienböck's disease. Methods. Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity. Biomechanical tests were carried out in order to evaluate this new ligamentous reconstruction. Results. It was biomechanically confirmed that the procedure was effective against axial compression and distributed the upcoming mechanical stress to the distal row. Conclusion. Extensor carpi radialis longus tendon has not been used for tendon interposition and ligament reconstruction in the treatment of this disease before. In view of the biomechanical data, the procedure seems to be effective for the stabilization of scaphoid and carpal bones.
Karalezli, Naz?m; Uz, Aysun; Esmer, Ali F?rat; Demirtas, Mehmet; Tasc?, Arzu Gul; Kutahya, Harun; Ulusoy, Gurhan
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.
Chang, Moon Jong; Lim, Hyungtae; Lee, Na Rae
Instability following total knee arthroplasty is one of the major causes of revision surgery. In most cases, it can be prevented by using an appropriate prosthesis and a good surgical technique. Particular attention should be given to confirmation of diagnosis for which thorough history taking, complete physical examination and radiographic evaluation are needed. With regard to treatment, identification of the etiology of instability is crucial for establishing proper treatment plans; instability would persist without correction of the cause of the initial instability. For successful revision surgery, balanced medio-lateral and flexion-extension gaps should be achieved. Constrained or rotating-hinge total knee prosthesis should also be considered as an alternative option for certain subsets of patients with instability. PMID:24944970
Chang, Moon Jong; Lim, Hyungtae; Lee, Na Rae; Moon, Young-Wan
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
Total joint arthroplasty is commonly recommended as a definitive treatment for synovial chondromatosis refractory to other treatment. We describe a unique case of synovial chondromatosis developing after total joint arthroplasty in a patient presenting 5 years after total knee arthroplasty for osteoarthritis. This case illustrates that the diagnosis of synovial chondromatosis cannot be excluded in a patient with chronic, painful swelling of a joint, even after total joint arthroplasty. PMID:22704224
Crawford, Matthew D; Kim, Hubert T
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.
Nielsen, Morten Schak; Axelsen, Lene Nygaard; Sorgen, Paul L.; Verma, Vandana; Delmar, Mario; Holstein-Rathlou, Niels-Henrik
Sixty-five patients aged > 80 years were compared to 65 patients aged between 60 and 70 years to assess total knee arthroplasty (TKA) outcome using the octogenarian postoperative Knee Society knee and function scores. Knee Society knee scores showed excellent outcomes with no statistically significant difference in the younger cohort (preoperative score, P = .7156; 5-year score, P = -.0677). Knee Society function scores also showed good outcomes with no statistically significant difference between the groups (preoperative score, P = .1147; 5-year score, P = .1348). Average length of stay increased by 3 days for octogenarians. Octogenarians had more pre-existing medical conditions and suffered more postoperative confusion. All but 1 patient rated the result as good/excellent. Patients maintained their independence for approximately 3.5 years before requiring more social input. With careful preoperative planning and counseling, TKA is recommended for the octogenarian. PMID:14763527
Hilton, Andrew I; Back, Diane L; Espag, Marius P; Briggs, Timothy W R; Cannon, Stephen R
In France, the number of revisions for total shoulder arthroplasty (TSA) has increased by 29% between 2006 and 2010. Published studies have reported a revision rate of approximately 11% for hemi-arthroplasty and total anatomical implants, and 10% for reversed implants. The decision to revise or not revise a TSA requires that a rigorous, clinical, laboratory and imaging initial assessment be done in order to answer five questions. Is it infected? Is it unstable? Is it worn? Is it loosened? How is the rotator cuff? This assessment and an evaluation of the bone stock are required to decide whether or not to revise. If the problem is infection, the best solution is not always complete removal of the implant, which results in very poor shoulder function. In such a situation, a multidisciplinary consultation is essential in the decision-making. If the problem is instability, the cause must be identified and rectified. Instability is often caused by insufficient restoration of the humerus length. If the problem is loosening, the type of revision must take into account the patient's age, the rotator cuff status and the available bone stock. The possibilities to reimplant an anatomical glenoid are scarce, and only for cases with minor bone loss and an intact cuff. If a bone graft without reimplantation of a glenoid component is preferred, it should be a tricortical graft to resist wear and medialisation. In the other cases, a reversed shoulder implant with an autograft is preferable. Whether or not the humeral stem is loose, it must often be removed. However, its removal is very difficult, risky and it often causes complications, with humerus fracture being the most common. The possibility of reconstruction depends on the quality of the remaining bone stock. In all these risky situations, the patient should be duly informed and should take part in the decision-making process. PMID:23333127
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.
Michael A. Mont; Thorsten M. Seyler; Phillip S. Ragland; Roland Starr; Jochen Erhart; Anil Bhave
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.
Miller, Lisa N; Prosser, Gareth H; Graves, Stephen E; Davidson, David C; Stanford, Tyman E
There is a strong unscreened Coulomb repulsion between the electrons in the impurity band of a lightly doped compensated semiconductor. This can be divided into a long-ranged 1\\/r part and a short-ranged part between two electrons on the same site. Both of these interactions may lead to gaps in the density of single-particle states, the Coulomb gap and the Hubbard
J. H. Davies
The current gold standard for primary total hip arthroplasty is a cemented femoral component combined with a porous-coated acetabular component. Barrack and colleagues described a femoral cement mantle grading system which is increasingly being used to evaluate surgical technique and to compare arthroplasty results. The immediate postoperative radiographs of 100 primary total hip arthroplasty cases from five community surgeons were assessed by three observers to evaluate the overall quality of cement technique, the interobserver variability in cement mantle grading, and specific characteristics of the grading system. All three observers agreed on the grading in only 73% of the x-rays (anteroposterior view, 69%; lateral view, 77%). Compared with reports in the literature from specialized hip arthroplasty centers, a very high proportion of the cases had grade C mantles. To gain a balanced perspective of the global effectiveness and longevity of cemented total hip arthroplasty it is important that follow-up studies be reported upon from representative cross sections of the orthopaedic community. PMID:9645519
Harvey, E J; Tanzer, M; Bobyn, J D
As the incidence of shoulder arthroplasty continues to rise, the orthopedic shoulder surgeon will be increasingly faced with the difficult problem of evaluating a failed shoulder arthroplasty. The patient is usually dissatisfied with the outcome of the previous arthroplasty as a result of pain, but may complain of poor function due to limited range of motion or instability. A thorough and systematic approach is necessary so that the most appropriate treatment pathway can be initiated. A comprehensive history and physical examination are the first steps in the evaluation. Diagnostic studies are numerous and include laboratory values, plain radiography, computed tomography, ultrasound imaging, joint aspiration, nuclear scans, and electromyography. Common causes of early pain after shoulder arthroplasty include technical issues related to the surgery, such as malposition or improper sizing of the prosthesis, periprosthetic infection, neurologic injury, and complex regional pain syndrome. Pain presenting after a symptom-free interval may be related to chronic periprosthetic infection, component wear and loosening, glenoid erosion, rotator cuff degeneration, and fracture. Poor range of motion may result from inadequate postoperative rehabilitation, implant-related factors, and heterotopic ossification. Instability is generally caused by rotator cuff deficiency and implant-related factors. Unfortunately, determining the cause of a failed shoulder arthroplasty can be difficult, and in many situations, the source of pain and disability is multifactorial. PMID:24618199
Wiater, Brett P; Moravek, James E; Wiater, J Michael
Arthroplasty in patients with posttraumatic arthritis can be challenging due to joint instability, malalignment, osseous defects, non-union, contracture, scarring, low-grade infections and pathologies of the patellofemoral joint. Detailed preoperative planning is recommended concerning incisions, soft tissue management, osseous reconstruction, hardware removal, potential infections and type of prosthesis (e.g. type of constraint, stems and augments). Severe difficulties can occur with exposure of the knee with respect to the extensor mechanism so that quadriceps snip or osteotomy of the tibial tuberosity may be necessary. Postoperative functional results are inferior to arthroplasty for atraumatic gonarthritis. Patients are at increased risk for intraoperative and postoperative complications (e.g. infections, instability, loosening and patellofemoral problems). Reconstructive alternatives (e.g. osteotomy, ligament reconstruction and cartilage repair) should always be considered especially in younger patients; however, most patients show a significant improvement in function and relief of pain after arthroplasty for posttraumatic gonarthritis. PMID:23604339
The clinical incidence of squeaking has been reported with increasing frequency, with ceramic-on-ceramic bearings seemingly most affected. This study investigated potential causes of squeaking in hard-on-hard hip bearings through 2 sets of experimental conditions. Bearing clearance appeared to affect the incidence of squeaking in metal-on-metal surface arthroplasties. The addition of third-body particles to the interface for total hip arthroplasties also affected the incidence of squeaking. In both studies, the incidence of squeaking correlated well with elevated friction. The findings of this study suggest that a likely cause of squeaking in the hip arthroplasty is adverse tribological conditions caused by suboptimal lubrication. There are numerous factors that may cause the suboptimal lubrication, and therefore, it is unlikely that an individual cause for squeaking will be identified. PMID:22480525
Brockett, Claire L; Williams, Sophie; Jin, Zhongmin; Isaac, Graham H; Fisher, John
Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty.
Hyun, Yoon Suk; Huri, Gazi; Garbis, Nickolas G.
Background Knee arthroplasty is increasing exponentially due to the aging of the population and to the broadening of indications. We aimed to compare physical disability and its evolution over two years in people with knee arthroplasty to that in the general population. A secondary objective was to compare the level of disabilities of people with knee to people with hip arthroplasty. Methodology/Principal Findings 16,945 people representative of the French population were selected in 1999 from the French census and interviewed about their level of disability. This sample included 815 people with lower limb arthroplasty. In 2001, 608 of them were re-interviewed, among whom 134 had knee arthroplasty. Among the other participants re-interviewed, we identified 68 who had undergone knee arthroplasty and 145 hip arthroplasty within the last two years (recent arthroplasty). People with knee arthroplasty reported significantly greater difficulties than the general population with bending forward (odds ratio [OR]?=?4.7; 95% confidence interval [CI]: 1.7, 12.6), walking more than 500 meters (OR?=?6.0; 95% CI: 1.5, 24.7) and carrying 5 kg kilograms for 10 meters (OR?=?4.6; 95% CI: 1.3, 16.4). However, the two years evolution in disability was similar to that in the general population for most activities. The level of mobility was similar between people with recent knee arthroplasty and those with recent hip arthroplasty. Nevertheless, people with recent knee arthroplasty reported a lower level of disability than the other group for washing and bending forward (OR?=?0.3; 95% CI: 0.1, 0.6 and OR?=?0.4; 95% CI: 0.1, 0.9, respectively). Conclusions/Significance People with knee arthroplasty reported a higher risk of disability than the general population for common activities of daily living but a similar evolution. There was no relevant difference between recent knee and hip arthroplasties for mobility.
Dechartres, Agnes; Boutron, Isabelle; Nizard, Remy; Poiraudeau, Serge; Roy, Carine; Baron, Gabriel; Ravaud, Philippe; Ravaud, Jean-Francois
The authors report a simple technique for effective management of surgical drains and their reliable removal in elective hip and knee arthroplasty. Many surgeons use surgical drains for elective total hip and knee arthroplasties and instruct residents in their use despite limited evidence to support routine use of surgical drains in noninfected cases. There are many different types of drains and equally varied methods for implantation, monitoring, and removal. Technical issues regarding use of closed suction surgical drainage postoperatively deal primarily with the questions of when to remove the surgical drain and how to manage difficulties with drain removal or breakage. PMID:24683648
Jaafar, Sami; Vigdorchik, Jonathan; Markel, David C
Purpose There has been a resurgence of interest in unicompartmental knee arthroplasty (UKA) for the treatment of medial unicompartmental\\u000a knee osteoarthritis (OA). Improved prosthetic design, minimally invasive surgical techniques, and strict patient selection\\u000a criteria have resulted in improved survivorship and functional outcomes.\\u000a \\u000a \\u000a \\u000a \\u000a Methods A review of orthopedic literature was conducted regarding the advantages of UKA versus total knee arthroplasty (TKA); UKA\\u000a indications;
The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success.
Danoff, Jonathan R.; Geller, Jeffrey A.
Limb salvage surgery for primary malignant bone tumors of the lower limbs requires complete resection of the tumor, followed by a reconstruction to restore function. In contrast to the abundant information on total knee arthroplasty, data on the recovery pattern of limb salvage surgery is largely limited. With the aim of guiding patient expectations and optimizing care, we retrospectively compared the clinical outcomes among patients following oncologic knee reconstruction, primary total knee arthroplasty, and revision total knee arthroplasty. From January, 2001 to June, 2009, we identified a cohort of 503 primary total knee arthroplasties, 55 revision knee arthroplasties, and 15 oncologic reconstructions. Outcomes were assessed by the validated Short Form-36 (SF-36) health questionnaire. We found that oncologic patients significantly improved their Physical Component Score at one and minimum two-year follow up compared to baseline (p< 0.05) with the majority of improvement (90%) made within the first year following surgery. This is a similar pattern to that observed following primary and revision total knee arthroplasty.
Nguyen, Mai P; Buckwalter, Joseph A; Miller, Benjamin J
All metal implants release metal ions because of corrosion. This has been studied and debated, especially in metal-on-metal total hip arthroplasties. Total knee arthroplasty implants have large metal surface areas and therefore substantial potential for corrosion. We determined changes in serum levels of metal ions in 41 patients after cemented unconstrained total knee arthroplasty without patellar resurfacing, 18 with unilateral total knee arthroplasty (median, 66 months after surgery) and 23 patients with bilateral total knee arthroplasties (75 and 50 months after first and second surgeries, respectively). Serum concentrations of chromium, cobalt, and molybdenum were analyzed and related to the number of total knee arthroplasties and compared with those of 130 control patients without implants. The median chromium, cobalt, and molybdenum concentrations were 0.92, 3.28, and 2.55 microg/L, respectively, in the unilateral total knee arthroplasty sample and 0.98, 4.28, and 2.40 microg/L, respectively, in the bilateral total knee arthroplasty sample. We observed no difference between the serum levels in patients with unilateral and bilateral arthroplasties, but the serum levels of chromium and cobalt of both study groups were greater than those of the control group (less than 0.25 microg/L). The patients who had total knee arthroplasty had molybdenum profiles that were similar to those of the control group (median, 2.11 microg/L). PMID:17438467
Luetzner, Joerg; Krummenauer, Frank; Lengel, Attila Michael; Ziegler, Joerg; Witzleb, Wolf-Christoph
We are exposing the case of a 22 year-old patient presenting a wound of the right cheek, with a palsy of the right corner of the mouth. He has been sent to us 6 days after the trauma for secondary exploration. A section of the buccal branch of the right facial nerve with a 1cm gap has been brought out. We have bypassed the loss of substance with a collagen absorbable biological conduit. The 6-months clinical and electromyographic follow-up has shown a clear improvement of the function of the orbicularis oris, as well as its reinnervation by the buccal branch of the right facial nerve. PMID:24698336
Semere, A; Morand, B; J Loury; Vuillerme, N; Bettega, G
Osteoarthritis of the knee is one of the most common problems in the orthopedic practice and its surgical technique is still challenging. This Mini-Review presents patient specific cutting blocks for the implantation of a total knee arthroplasty. PMID:24169482
Dao Trong, Mai Lang; Helmy, Näder
Specialized magnetic resonance imaging (MRI) was performed in 42 painful shoulder arthroplasties, 22 of which underwent subsequent revision surgery, allowing surgical confirmation of the pathology identified on MRI. One hemiarthroplasty was excluded because of motion artifact, leaving 21 studies (19 patients) to be correlated retrospectively to the surgical findings. At the time of revision surgery, there were full-thickness rotator cuff
John W Sperling; Hollis G Potter; Edward V Craig; Evan Flatow; Russell F Warren
We have analyzed the operation of knee arthroplasty using the Whiteside Mark II prosthesis, and found that it could be broken down into 42 steps, some of which are more important than others and can be considered as critical. We have identified 4 criteria to evaluate a critical step: 1) it must be necessary to complete the procedure, 2) it
M. J. Dunbar; M. Gross
Although metal-on-metal total hip arthroplasty (MOM THA) has been used for over 3 decades, substantial improvements in manufacturing and design have led to improved durability with modern implants. Reported advantages of the use of MOM THA include very low wear and subsequent osteolysis, increased range of motion to impingement secondary to the availability of larger diameter femoral heads, and the
Raymond H. Kim; Douglas A. Dennis; Joshua T. Carothers
Between 1985 and 1991, 15 patients underwent structural allografting as part of revision total knee arthroplasty. All patients had large segmental, cavitary, or combination defects of the femur and\\/or tibia. Seven distal femurs and 12 proximal tibias required allografting. Patients were evaluated with physical examination, radiographs, and The Hospital for Special Surgery knee rating scale. Three patients died, leaving 15
Christopher S. Mow; Jerome D. Wiedel
Objective: To observe the accuracy of femoral preparation and the position of the cementless prosthesis in femoral cavity, and to compare the results between the computer-assisted surgical group (CASPAR) and the conventional group. Methods: Ten femoral components were implanted either manually or by CASPAR in cadaver femurs. The specimens were cut to 3 mm thick slices. Microradiograms of every slice were sent to a computer for analysis with special software (IDL). The gaps and the medullary cavities between component and bone, the direct bone contact area of the implant surface, the gap width and the percentage of gap and bone contact area were measured in every slice. Results: In the proximal implant coated with HA of the CASPAR group, the average percentage of bone contact reached 93.2% (ranging from 87.6% to 99.7%); the average gap percentage was 2.9% (ranging from 0.3% to 7.8%); the maximum gap width was 0.81 mm and the average gap width was only 0.20 mm. While in the conventional group, the average percentage of bone contact reached 60.1% (ranging from 49.2% to 70.4%); the average gap percentage was 32.8% (ranging from 25.1% to 39.9%); the maximum gap width was 2.97 mm and the average gap width was 0.77 mm. The average gap around the implant in the CASPAR group was only 9% of that in the manual group; the maximum and average gap widths were only about 26% of those in the manual group. On the other hand, the CASPAR group showed 33% higher bone contact than the manual group. Conclusion: With the use of robotics-assisted system, significant progress can be achieved for femoral preparation in total hip arthroplasty.
Wu, Li-dong; Hahne, HJ; Hassenpflug, J
Background Vagal nerve–preserving distal gastrectomy reconstructed by interposition of a jejunal J pouch with a jejunal conduit (hereinafter\\u000a called DGP) is a function-preserving operation for early gastric cancer. However, some patients after DGP have suffered from\\u000a postprandial stasis in the substitute stomach, and postprandial stasis leads to abdominal symptoms. To clarify the significance\\u000a of mosapride citrate (MS) for prevention of food
Ryouichi Tomita; Taro Ikeda; Shigeru Fujisaki; Tugumichi Koshinaga; Katsuhisa Tanjoh
Dislocations after total hip arthroplasties are one of the most common complications of the procedure. According to registers, recurrent hip dislocations account for up to 30 % of the indications for a revision operation. The incidence of a dislocation is influenced by indication-associated, patient-dependent and operation-specific risk factors. 50 % of the dislocations occur within the first 3 months which confirms the high relevance of operation-specific influencing factors. The diagnosis is almost always made with the help of computed tomography, as this is the only method to determine the three-dimensional relationship of the components. A dynamic fluoroscopic examination can verify an increased translation (reduced soft-tissue tension) and thus enables a functional examination to determine the mechanism of the dislocation. By means of a classification of dislocations into five types under consideration of the implant position, the sufficiency of the pelvitrochantar musculature, the presence of an impingement, the congruence of head and acetabular liner as well as combinations of these factors it is possible to plan an adequate therapy. From the therapeutic point of view the correct positioning of the stem and head is of decisive importance. In addition therapeutic success can be realized by using larger head diameters through to tripolar sockets, reconstruction of soft tissues and, last but not least, an adequate postoperative immobilization. Even so, this treatment is associated with a high rate of complications and in the literature failure rates of up to one third, i.e., the reoccurrence of a dislocation, are reported. PMID:22498843
Perka, C; Haschke, F; Tohtz, S
Dislocation of a total knee arthroplasty is a rare but serious complication. In previous literature, when dislocation does occur, it is usually in the posterior direction in cases with a posterior stabilized total knee arthroplasty due to cam jump. We report an unusual case of anterior dislocation of an 11-year-old posterior stabilized total knee arthroplasty in a 55-year-old woman with rheumatoid arthritis occurred after a slip. PMID:21641178
Lee, Su Chan; Jung, Kwang Am; Nam, Chang Hyun; Hwang, Seung Hyun; Lee, Won Jun; Park, Il Seok
An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.
Shin, Young-Soo; Hwang, Yeok-Gu; Savale, Abhijit Prakash
Recent literature suggests patients achieve substantial short-term functional improvement after combined bicompartmental implants\\u000a but longer-term durability has not been documented. We therefore asked whether (1) bicompartmental arthroplasty (either combined\\u000a medial unicompartmental knee arthroplasty (UKA) and femoropatellar arthroplasty (PFA) or medial UKA\\/PFA, or combined medial\\u000a and lateral UKA or bicompartmental UKA) reliably improved Knee Society pain and function scores; (2) bicompartmental
Sebastien Parratte; Vanessa Pauly; Jean-Manuel Aubaniac; Jean-Noel A. Argenson
Total shoulder arthroplasty is commonly considered a good option for treatment of the rheumatoid shoulder. However, when the\\u000a rotator cuff and glenoid bone stock are not preserved, the clinical outcome of arthroplasty in the rheumatoid patients remains\\u000a unclear. Aim of the study is to explore the prognostic value of multiple preoperative and peroperative variables in total\\u000a shoulder arthroplasty and shoulder
Piet M. Rozing; Jochem Nagels; Maarten P. Rozing
The authors describe a step-by-step technique for reverse total shoulder arthroplasty using arthrotomy via the enlarged transacromial superior approach. This technique seems ideal for reinsertion of the tuberosities and to ensure adequate postoperative tensional balance of the infraspinatus and the subscapularis, which is critical for the rotator cuffs to function properly and to achieve optimal arthroplasty stability. Reviewing these different steps helps understanding each rotator cuff individual component's contribution to achieve optimal arthroplasty stability and external rotation with a reverse shoulder arthroplasty.
Poignard, Alexandre; Bouhou, Mohamed; Homma, Yasuhiro; Hernigou, Philippe
The purpose of this study was to extend previous work to detect migration of total wrist arthroplasty non-invasively, and with greater accuracy. Two human cadaverous arms, each with a cemented total wrist implant, were used in this study. In one of the arms, 1 mm tantalum balls were implanted, six in the carpal bones and five in the radius. Five CT scans of each arm were acquired, changing the position of the arm each time to mimic different positions patients might take on repeated examinations. Registration of CT volume data sets was performed using an extensively validated, 3D semi-automatic volume fusion tool in which co-homologous point pairs (landmarks) are chosen on each volume to be registered. Three sets of ten cases each were obtained by placing landmarks on 1) bone only (using only arm one), 2) tantalum implants only, and 3) bone and tantalum implants (both using only arm two). The accuracy of the match was assessed visually in 2D and 3D, and numerically by calculating the distance difference between the actual position of the transformed landmarks and their ideal position (i.e., the reference landmark positions). All cases were matched visually within one width of cortical bone and numerically within one half CT voxel (0.32 mm, p = 0.05). This method matched only the bone/arm and not the prosthetic component per se, thus making it possible to detect prosthetic movement and wear. This method was clinically used for one patient with pain. Loosening of the carpal prosthetic component was accurately detected and this was confirmed at surgery.
Alcala, Yvonne; Olivecrona, Henrik; Olivecrona, Lotta; Noz, Marilyn E.; Maguire, Gerald Q., Jr.; Zeleznik, Michael P.; Sollerman, Christer
The farnesoid X receptor (FXR) and the liver x receptors (LXRs) are bile acid-activated receptors that are highly expressed in the enterohepatic tissues. The mechanisms that support the beneficial effects of bariatric surgery are only partially defined. We have investigated the effects of ileal interposition (IT), a surgical relocation of the distal ileum into the proximal jejunum, on FXR and LXRs in rats. Seven months after surgery, blood concentrations of total bile acids, taurocholic acid, an FXR ligand, and taurohyocholic acid, an LXR? ligand, were significantly increased by IT (P < 0.05). In contrast, liver and intestinal concentrations of conjugated and nonconjugated bile acids were decreased (P < 0.05). These changes were associated with a robust induction of FXR and FXR-regulated genes in the intestine, including Fgf15, a negative regulator of bile acid synthesis. IT repressed the liver expression of glucose-6-phosphatase (G6PC) and phosphoenolpyruvate carboxykinase (Pepck), two gluconeogenetic genes, along with the expression of LXR? and its target genes sterol regulatory element-binding protein (Srebp) 1c and fatty acid synthase (Fas) in the liver. Treating IT rats with chenodeoxycholic acid ameliorated insulin signaling in the liver. Whether confirmed in human settings, these results support the association of pharmacological therapies with bariatric surgeries to exploit the selective activation of intestinal nuclear receptors. PMID:23835330
Mencarelli, Andrea; Renga, Barbara; D'Amore, Claudio; Santorelli, Chiara; Graziosi, Luigina; Bruno, Angela; Monti, Maria Chiara; Distrutti, Eleonora; Cipriani, Sabrina; Donini, Annibale; Fiorucci, Stefano
Chilaiditi syndrome refers to a medical condition that is indicated by the presence of Chilaiditi sign, the radiological observation of a colonic interposition between the liver and the diaphragm, and is associated with other clinical symptoms. Chilaiditi syndrome is a rare entity and therefore, is often misdiagnosed in clinical practice, however, it may be accompanied by a series of severe complications, such as bowel obstruction and perforation. The current study describes a 47-year-old male who presented with repeated abdominal pain and acute intestinal obstruction. The patient was diagnosed with Chilaiditi syndrome via radiological observation and was cured by conservative treatment. The clinical data of seven additional patients with Chilaiditi syndrome, which was reported in the Chinese literature between January 1990 and January 2013, were also collected. The pathogenesis, clinical manifestation, diagnosis and treatment of this syndrome have been reviewed and analyzed. The current study may be useful to familiarize clinical practitioners with Chilaiditi syndrome, in order to avoid a misdiagnosis during clinical treatment.
WENG, WEI-HONG; LIU, DA-REN; FENG, CHENG-CHENG; QUE, RI-SHENG
We performed a systematic review of all MEDLINE-published studies of biomarkers in arthroplasty. Thirty studies met the inclusion criteria; majority evaluated biomarkers for osteolysis, aseptic prosthetic loosening, and prosthetic infections. Four studies reported an elevated Cross-linked N-telopeptides of type I collagen (urine or serum) in patients with osteolysis or aseptic prosthetic loosening when compared to appropriate controls. Two or more studies each found elevated C-reactive protein, erythrocyte sedimentation rate, and interleukin-6 in patients with infected prosthetic joints compared to controls. Most other biomarkers were either examined by single studies or had inconsistent or insignificant associations with outcomes. We conclude that the majority of the biomarkers currently lack the evidence to be considered as biomarkers for arthroplasty outcomes. Further studies are needed.
Mertens, Marty T; Singh, Jasvinder A
It is far from clear how best to define the proper strength of soft-tissue tensioning in total knee arthroplasty (TKA). We attached a torque driver to the Monogram balancer/tensor device and measured soft-tissue tension in full extension and 90 degrees flexion during TKA. In our surgical procedure, when we felt proper soft-tissue tension was being applied, the mean distraction force was noted to be 126N in extension and 121N in flexion. There was no significant correlation between soft-tissue tension and the postoperative flexion angle finally achieved. To the best of our knowledge, this is the first study to assess the actual distraction forces in relation to soft-tissue tension in TKA. Further study may reveal the most appropriate forces to achieve proper soft-tissue tension in the wide variety of circumstances presenting at knee arthroplasty. PMID:15284975
Asano, Hiroshi; Hoshino, Akiho; Wilton, Tim J
Nerve injury occurs in 1% to 2% of patients who undergo total hip arthroplasty and is more frequent in patients who need acetabular reconstruction for dysplasia and those undergoing revision arthroplasty. Injury to the peroneal division of the sciatic nerve is most common, but the superior gluteal, obturator, and femoral nerves can also be injured. Nerve injury can be classified as neurapraxia, axonotmesis, or neurotmesis. The worst prognosis is seen in patients with complete motor and sensory deficits and in patients with causalgic pain. Prevention is of overriding importance, but use of ankle-foot orthoses and prompt management of pain syndromes can be useful in the treatment of patients with nerve injury. Electrodiagnostic studies hold promise in complex cases; however, their intraoperative role requires objective, prospective, controlled scientific study before routine use can be recommended. PMID:10217818
DeHart, M M; Riley, L H
In this thesis, different aspects that are related to the survivorship and clinical outcome in uncemented total hip arthroplasty are analysed. In Chapter 2, the survival rate, Harris Hip score and radiographic features of a proximally hydroxyapatite coated titanium alloy femoral stem (Bi-Metric, Biomet) was evaluated. In conclusion, at an average follow-up of 8 years, this proximally HA-coated femoral component
J. H. M. Goosen
Objective. This study was performed to determine the biomechanics of chair rising by patients after successful total knee arthroplasty (TKA).Design. Relative full body joint positions and ground reaction forces were measured by a motion analysis system and two force plates.Background. Chair-rise produces increased joint forces and moments compared with level walking, and it is difficult to rise from a chair
F. C. Su; K. A. Lai; W. H. Hong
The use of intramedullary plugs in cemented total joint arthroplasty is currently considered standard practice by most surgeons. In this in vitro study, the authors evaluated the holding power, migration, and leakage of four commonly used plug types--bone, acrylic bone cement, and two polymeric plugs from different manufacturers. Only acrylic bone cement plugs prevented distal leakage of cement and did not migrate under the influences of pressurized cement injection. PMID:2746246
Beim, G M; Lavernia, C; Convery, F R
This paper explores the cost utility of metalon-metal hip resurfacing arthroplasty (MOM) as an alternative intervention to\\u000a total hip replacement or ‘watchful waiting’ for patients with advanced hip disease. Early implant failure among younger and\\u000a more active elderly patients can mean that the use of total hip replacement (THR) is delayed, with patients managed through\\u000a ‘watchful waiting’, a combination of
L. McKenzie; L. Vale; S. Stearns; K. McCormack
OBJECTIVE. The purpose of this article is to explain the basic physics of imaging patients with metal implants, explain conflicting information regarding MRI scanning of "MR Conditional" devices, and relate our experience of scanning total joint arthroplasty (TJA) at our institution. CONCLUSION. MRI near TJA is effective with appropriate imaging protocols and standardized safety precautions. Strict adherence to MR Conditional labeling may preclude broad use of MRI for TJA assessment. PMID:24951209
Koff, Matthew F; Shah, Parina; Potter, Hollis G
We present the case of a 39-year-old man with bilateral piriformis syndrome 4 and 6 years after two cementless total hip\\u000a arthroplasties, respectively. During surgical exploration, each sciatic nerve was found to be entrapped by a tense piriformis\\u000a muscle and hypertrophic posterior hip capsule. The sciatic-type pain was relieved after sectioning each piriformis muscle\\u000a with external neurolysis. This is the
Y. Uchio; U. Nishikawa; M. Ochi; N. Shu; K. Takata
We are entering a new era with governmental bodies taking an increasingly guiding role, gaining control of registries, demanding direct access with release of open public information for quality comparisons between hospitals. This review is written by physicians and scientists who have worked with the Swedish Knee Arthroplasty Register (SKAR) periodically since it began. It reviews the history of the register and describes the methods used and lessons learned. Cite this article: Bone Joint Res 2014;3:217-22. PMID:24986492
Robertsson, O; Ranstam, J; Sundberg, M; W-Dahl, A; Lidgren, L
PURPOSE. To evaluate outcome in 20 patients treated for periprosthetic fractures after total knee arthroplasty (TKA). METHODS. Records of 14 women and 6 men aged 45 to 85 (mean, 67) years who underwent operative (n=18) or conservative (n=2) treatment for periprosthetic fractures of the supracondylar femur (n=15), patella (n=3), and tibia (n=2) following minor falls (n=18) or high-velocity injury (n=2) were reviewed. The mean time from TKA to fracture was 43 (range, 14-98) months. Of the 15 supracondylar femoral fractures, 2 were managed with immobilisation in a long leg cast, 11 with internal fixation using locked compression plating, and 2 with revision arthroplasty. All 3 patellar fractures were managed with tension band wiring. Both tibial fractures were managed with revision arthroplasty. Radiographic and functional outcomes (the Knee Society scores) were assessed. RESULTS. The mean follow-up was 35 (range, 24-48) months. All fractures healed after a mean of 15 (range, 12-38) weeks. One patient had delayed union. Postoperative alignment was satisfactory in all patients except one (with 5º varus). The mean tibiofemoral angle was 4º valgus. The mean range of motion was 98.5º. The mean Knee Society knee score was 85 (range, 75-89) and the functional score was 76 (range, 70-85). No patient had implant failure, loss of reduction, deep infection, deep vein thrombosis, or pulmonary embolism. CONCLUSION. The locked compression plate is effective in managing periprosthetic femoral fractures. Periprosthetic patellar and tibial fractures are uncommon. The latter often warrant revision arthroplasty owing to the loose implant. PMID:24781608
Agarwal, S; Sharma, R K; Jain, J K
Total shoulder arthroplasty is commonly considered a good option for treatment of the rheumatoid shoulder. However, when the rotator cuff and glenoid bone stock are not preserved, the clinical outcome of arthroplasty in the rheumatoid patients remains unclear. Aim of the study is to explore the prognostic value of multiple preoperative and peroperative variables in total shoulder arthroplasty and shoulder hemiarthroplasty in rheumatoid patients. Clinical Hospital for Special Surgery Shoulder score was determined at different time points over a mean period of 6.5 years in 66 rheumatoid patients with total shoulder arthroplasty and 75 rheumatoid patients with shoulder hemiarthroplasty. Moreover, radiographic analysis was performed to assess the progression of humeral head migration and glenoid loosening. Advanced age and erosions or cysts at the AC joint at time of surgery were associated with a lower postoperative Clinical Hospital for Special Surgery Shoulder score. In total shoulder arthroplasty, status of the rotator cuff and its repair at surgery were predictive of postoperative improvement. Progression of proximal migration during the period after surgery was associated with a lower clinical score over time. However, in hemiarthroplasty, no relation was observed between the progression of proximal or medial migration during follow-up and the clinical score over time. Status of the AC joint and age at the time of surgery should be taken into account when considering shoulder arthroplasty in rheumatoid patients. Total shoulder arthroplasty in combination with good cuff repair yields comparable clinical results as total shoulder arthroplasty when the cuff is intact.
Nagels, Jochem; Rozing, Maarten P.
A prospective study of 40 shoulder arthroplasties in patients with rheumatoid arthritis was performed to evaluate the results of rotator cuff repair at the time of arthroplasty. A large cuff tear was present in 21 shoulders, and good repair of the cuff was performed in 9. In the other shoulders the repair was considered insufficient. All patients were clinically evaluated
P. M. Rozing; R. Brand
Background. The problem of metal sensitivity (Ni, Cr, and Co) in arthroplasty is still unsolved. To prevent the risk of allergy in cases with proved metal allergy in an epicutaneous test, a Natural Knee total knee arthroplasty, made totally from titanium (Ti-6Al-4V) and polyethylene, can be implanted. The results of this device have to be compared to the results of
C. Pellengahr; W. Mayer; M. Maier; P. E. Müller; C. Schulz; H. R. Dürr; H. Trouillier; M. Steinborn; V. Jansson; H. J. Refior
Eight total hip and two total knee arthroplasties were performed from 1986 to 1991 in eight patients who had orthotopic liver transplantation. The indications for joint arthroplasty were avascular necrosis of the femoral head in five hips, pathologic femoral neck fracture caused by osteopenia in three hips, avascular necrosis of femoral and tibial condyles in one knee, and posttraumatic arthritis
Panpayiotis J. Papagelopoulos; J. Eileen Hay; Evanthia C. Galanis; Bernard F. Morrey
Two patients were evaluated for the possibility of hypersensitivity to a Metasul articulation (Centerpulse, Austin, Tex) coupled with total hip arthroplasty. Serum was tested with a lymphocyte proliferation assay, and the capsular tissues from the hip were examined for perivascular lymphocytes. The diagnosis of hypersensitivity to Metasul could not be confirmed in these patients, and ultimately, the painful hip arthroplasties
Cambize Shahrdar; Pat Campbell; Joseph Mirra; Lawrence D. Dorr
Materials used for total knee arthroplasty (TKA), may elicit an immune response whose role in the outcome of the arthroplasty is still unclear. The aim of this study was to evaluate the frequency of sensitization in patients who had undergone TKA, and the clinical impact of this event on the outcome of the implant. Ninety-four subjects were recruited, including 20
Donatella Granchi; Elisabetta Cenni; Domenico Tigani; Giovanni Trisolino; Nicola Baldini; Armando Giunti
This is a prospective randomized study comparing cefuroxime to 2 antistaphylococal agents (fusidic acid and vancomycin), for prophylaxis in total hip arthroplasty (THA) and total knee arthroplasty (TKA) in an institute, where methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE) prevalence exceeds 25% of orthopedic infections. There were 3 patient groups. Group A included the patients who received cefuroxime,
Minos E. Tyllianakis; Athanasios Ch. Karageorgos; Markos N. Marangos; Alkis G. Saridis; Elias E. Lambiris
Total elbow arthroplasty is challenging when there is extensive bone loss. We studied retrospectively the long-term (mean, 6.5 years) clinical and radiographic results of 10 patients in whom 14 massive allograft-prosthetic composites were used in such clinical situations. The mean arc of active flexion/extension was 92 degrees. The Bryan-Morrey and Hospital for Special Surgery elbow scoring systems were used and revealed a modest improvement in pain and stability but a disappointing return of function, with independent self-care possible in only 3 patients, household and employment activities in 2, and recreational pursuits in 2. Three patients claimed that they were unable to use the elbow. Multiple procedures (mean, 2.2) were sometimes required to optimize the result. The 79% rate of allograft-host union is similar to that of hip and knee arthroplasty. The use of massive allografts is a reasonable alternative in salvage situations involving total elbow arthroplasty with massive bone loss. PMID:15111902
Renfree, Kevin J; Dell, Paul C; Kozin, Scott H; Wright, Thomas W
This retrospective study evaluated the short-term functional outcome of patellofemoral arthroplasty using patient-based outcome measures. The study cohort included 17 patients who underwent patellofemoral arthroplasty (14 unilateral and 3 bilateral) between 1996 and 2005. Mean patient age was 56 years (range, 43-65 years), and mean follow-up was 52.5 months (range, 24-84 months). Clinical and radiographic assessment was performed using the Hospital for Special Surgery (HSS) knee score. Functional assessment was performed using the Short Form-36 (SF-36) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Mean HSS knee score was 64 (range, 51-79) preoperatively and 90 (range, 71-100) postoperatively. Mean postoperative SF-36 scores were compared with normative data compiled by the British Omnibus Survey in 1992. Scores for physical and social functioning, role limitation due to physical and emotional problems, and pain were poorer compared with mental health and energy/vitality. Mean postoperative scores for the 5 KOOS subscales ranged from 51% to 72%. These findings indicate patient-based outcome measures should be used routinely for functional assessment of patients undergoing patellofemoral arthroplasty. PMID:18979927
Utukuri, M M; Khanduja, V; Somayaji, H S; Dowd, G S E
Context: Total joint arthroplasty (TJA) is a common surgical option to treat painful degenerative joint disease. However, there is currently no consensus on the appropriate intensity of physical activity after TJA or how physical activity level affects the rate of revision surgery. Materials and Methods: A systematic review of the literature regarding physical or athletic activity after TJA was performed to determine current clinical opinion and recommendations regarding appropriate activity levels after TJA, as well as variables affecting successful surgery and improved outcomes. Results: Many studies in the literature regarding athletic activity after TJA focus on total hip arthroplasty and total knee arthroplasty. The literature reports contradictory results regarding rates of physical activity after TJA as well as the relationship between physical activity and rates of revision surgery. The current trend in expert opinion shows more liberal recommendations for patients to engage in athletic activity after TJA. Conclusions: Individual characteristics, lifestyle, and patient preferences must be taken into account when one considers appropriate recommendations for athletic activity after TJA. Current trends in clinical opinion favor a higher level of athletic activity after TJA, but clinicians should caution patients not to participate in contact sports or sports that create high joint loads in the replaced joint.
Vogel, Laura A.; Carotenuto, Giuseppe; Basti, John J.; Levine, William N.
Approximately 775,000 hip and knee arthroplasties are performed yearly in the United States, with a dramatic increase expected. Patients having hip and knee arthroplasties are at high risk of developing a venous thromboembolism. The American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS) have updated guidelines, which outline new prophylactic strategies. Factor Xa inhibitor rivaroxaban has a new recommendation by ACCP and is gradually being adopted by the joint arthroplasty community as an effective oral agent. Other more well-known agents including warfarin, low-molecular-weight heparin, aspirin, and fondaparinux continue to be options for prophylaxis. While the goal of prophylaxis continues to be the prevention of venous thromboemboli and pulmonary emboli, it is important to consider the increased bleeding risk associated with their use. The most recent ACCP and AAOS guidelines give clinicians a greater autonomy in choosing a prophylactic agent with greater emphasis placed on dialogue between the surgeon and patient as to the choice of prophylaxis.
Knesek, David; Peterson, Todd C.; Markel, David C.
Objective: Severe bone loss associated with failed revision total knee arthroplasty is a challenging scenario. The pedicled fibular flap is a method to obtain vascularized bone for use in knee arthrodesis after failure of a total knee arthroplasty, with substantial loss of bone. Methods: We report 2 successful knee arthrodeses using this method in patients with infected, failed multiply revised total knee arthroplasties. The failed prosthesis was removed, and the bones were aligned and stabilized. The fibular flap was then harvested, fed through a subcutaneous tunnel, and placed within the medullary canal at the arthrodesis site. The soft tissue was closed over the grafts and flaps. Results: Two elderly women presented with pain and drainage from previous total knee arthroplasties after multiple revisions. Arthrodeses were performed as described, and both patients were pain-free with the knee fused at 1 year. Conclusions: Thus, pedicled vascularized flaps are a viable alternative in the treatment of failed revision arthroplasty with large segmental bone loss.
Minear, Steve C.; Lee, Gordon; Kahn, David; Goodman, Stuart
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.
Ma, Xiao-Mei; Xia, Chun-Yan; Fu, Pei-Liang; Liu, Hui-Min; Yu, Hong-Yu; He, Jin
Pigmented Villonodular Synovitis (PVNS) is a relatively rare, benign proliferation lesion of the synovium of large joints. The etiology is varied and unclear. We had report a 79-year-old woman had PVNS after 14 years right hip arthroplasty with metal prosthesis. Here we report another 4 patients had PVNS after arthroplasty. The second one had PVNS in the 2(th) year after hip arthroplasty with bone cement prosthesis. The specimen was brown and like usual PVNS in tissue. The third case had PVNS in the 8(th) after arthroplasty with human bone prosthesis because of the recurrence of PVNS. The proliferated synovium became black from brown. There was brown and many groups black pigment in the tissue. The fourth one had PVNS in the 4(th) year after knee arthroplasty with polyethylene prosthesis. The specimen was yellow. There was no pigment in the tissue but multinucleated giant cells with unstained foreign body. The fifth patient had PVNS in the 10(th) month after the left hip arthroplasty with metal prosthesis. The macroscopy was yellow. There were hemosiderin particles in the tissue but black metal particles. This indicates that arthroplasty with prosthesis could cause some new disease or PVNS had new etiology with different pathological show. PMID:24955198
Ma, Xiao-Mei; Xia, Chun-Yan; Fu, Pei-Liang; Liu, Hui-Min; Yu, Hong-Yu; He, Jin
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.
Pachore, Javahir A; Shah, Vikram I; Sheth, Ashish N; Shah, Kalpesh P; Marothi, Dhiraj P; Puri, Rahul
Cervical total disk arthroplasty has proven to be an effective and safe alternative for anterior cervical diskectomy and fusion (ACDF) for the treatment of cervical disk degenerative disease. However, whether and when cervical disk arthroplasty is indicated for preoperative cervical spine kyphosis is unclear. In the authors' clinical experiences, preoperative kyphosis can generally be divided into reducible and irreducible forms according to the results of dynamic flexion-extension lateral radiographs. Reducible kyphosis is mostly related to local disk prolapse, clinical symptoms, and musculature weakness, but irreducible kyphosis is always associated with significant cervical degeneration or congenital bone malformation. In this study, 32 patients with preoperative reducible kyphosis were randomized in a 1:1 ratio to either single-level total cervical arthroplasty with the Discover cervical disk prosthesis (DePuy Spine, Raynham, Massachusetts) (arthroplasty group) or single-level ACDF with a polyetheretherketone cage and plate (ACDF group). No significant differences existed in clinical and radiological results at 2-year follow-up between the arthroplasty and ACDF groups. The global and functional spinal unit angles of the arthroplasty group were significantly lower than those of the ACDF group 6 months postoperatively, which was consistent with the result of the comparison in Neck Disability Index score. However, the sagittal alignment of the overall cervical spine and the treated segment and the Neck Disability Index score significantly improved after 6 months in the arthroplasty group but not in the ACDF group. Therefore, preoperative reducible kyphosis is not a contraindication for cervical total disk arthroplasty. However, neck strength-building exercises should be emphasized for the postoperative rehabilitation after cervical total disk arthroplasty. PMID:23823056
Chen, Yu; Wang, Xinwei; Lu, Xuhua; Yang, Haisong; Chen, Deyu
Unicompartmental knee arthroplasty is an underused procedure in orthopaedic surgery due to its level of difficulty and the unpredictability of results, which can be related to component malalignment. New robotic arm technology has been developed to assist the surgeon in accurately and reproducibly preparing the femur and the tibia for a minimally invasive bone-sparing unicompartmental knee arthroplasty. This new procedure provides comprehensive three-dimensional planning of unicompartmental knee arthroplasty components, including soft-tissue balancing, followed by accurate resection of the femur and the tibia. This paper reviews this new technology. PMID:19182027
Conditt, Michael A; Roche, Martin W
This study is a systematic literature review of outcomes following total knee arthroplasty with implants specifically designed to enable increased knee flexion. English language comparative studies without date restriction were identified through a computerised literature search and bibliography review. Nine studies met the inclusion criteria representing a total of 399 high-flexion knee arthroplasties in 370 patients. Five studies reported greater flexion or range of motion; however, the methodological rigour was questionable with inadequate blinding, flawed participant selection, short follow-up periods and functional outcomes which lacked sensitivity. There was insufficient evidence of improved range of motion or functional performance after high-flexion knee arthroplasty.
Journeaux, Simon; Russell, Trevor
This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty.\\u000a\\u000a \\u000a\\u000aBackground: Worldwide, approximately \\u000a\\u000a1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total knee arthroplasty are associated with a considerable amount of total blood loss. Postoperative anemia may seriously impede functional mobility
W. G. Horstmann
Replacement of the patellofemoral and medial tibiofemoral joints has been performed since the 1980s. Bicompartmental replacement was modified. Two different designs were developed: one custom implant and one with multiple predetermined sizes. The surgical technique and instruments are unique and training is helpful. There are no clinical reports for the custom design as of yet. The standard implant has several reports in the literature with only fair to good results and has subsequently been withdrawn from the market. Bicompartmental arthroplasty remains a questionable area of knee surgery. At present, the two separate implant technique is the best choice. PMID:23827832
Tria, Alfred J
The author gives a report on the indication, on the surgical technique and on the results of shoulder arthroplasty, following 30 porous coated, unconstrained, BIO-MODULAR total endoprothesis were implanted. The pain, which was uncurable with any other methods, was relieved by implanting the total shoulder prosthesis. The functional result is determined by the condition of rotator cuff and by the way of reconstruction, rehabilitation and cooperation of the patients. The experience in soft tissue surgery is absolute necessary to be successful. PMID:7833994
Computer assisted surgery (CAS) was used to improve the positioning of implants during total knee arthroplasty (TKA). Most studies have reported that computer assisted navigation reduced the outliers of alignment and component malpositioning. However, additional sophisticated studies are necessary to determine if the improvement of alignment will improve long-term clinical results and increase the survival rate of the implant. Knowledge of CAS-TKA technology and understanding the advantages and limitations of navigation are crucial to the successful application of the CAS technique in TKA. In this article, we review the components of navigation, classification of the system, surgical method, potential error, clinical results, advantages, and disadvantages.
Bae, Dae Kyung
The understanding of rotator cuff disease has increased exponentially since Codman drew attention to this pathology in the early 1900s. Although challenging, the surgical treatment of massive rotator cuff tears is rational, with treatment decisions based on physical examination, imaging, biologic, and patient factors. Arthroscopy can be used to treat ancillary pain generators, débride necrotic tissue, and possibly restore balance to the force couples about the shoulder. Tendon transfers may be effective in restoring functional strength to irreparable, ineffectual muscle units. Arthroplasty is both a primary treatment and a salvage option. PMID:20415384
Singh, Anshu; Jawa, Andrew; Morman, Monica; Sanofsky, Benjamin; Higgins, Laurence
Total Knee Arthroplasty (TKA) is one of the most successful procedures in Orthopaedic Surgery, with good clinical results and high survival rate in more than 90% of the cases at long-term follow-up. Since the increase of population's mean age, worsening of articular degenerative alterations, and articular sequelae related to previous fractures, there is a persistent growing of the number of knee arthroplasties in every country each year, with expected increase of complications rates. Painful TKA is considered an unusual complication, but several reports focus on this challenging clinical issue.Common causes of painful TKA may be divided as early or late, and in referred, periarticular or intra-articular. Among the early, we recall implant instability (related to surgical and technical mistakes) and problems of extensor mechanism (patella not resurfaced, malalignment of femoral, tibial, or patellar component, tendons failure or degeneration). Late causes of painful TKA are almost related to aseptic loosening and infection, but also, even if unusual, reflex sympathetic dystrophy, synovitis, and hypersensitivity to metal implants are represented.Hypersensitivity to metal is a clinical issue with significative increase, but to date without a specific characterization. The Authors report about incidence, clinical features, and diagnostic pathways of hypersensitivity to metal implants, focusing on the prevention of this challenging problem. PMID:22461811
Carulli, Christian; Villano, Marco; Bucciarelli, Giovanni; Martini, Caterina; Innocenti, Massimo
Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France. Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity. In this article, we review the use of dual mobility cup in total hip arthroplasty in terms of its history, biomechanics, outcomes and complications based on more than 20 years of medical literature.
De Martino, Ivan; Triantafyllopoulos, Georgios Konstantinos; Sculco, Peter Keyes; Sculco, Thomas Peter
Total reverse shoulder replacement is now a very common surgical procedure that has been shown to be effective in the treatment of rotator cuff tear arthropathies or massive rotator cuff tears with pseudo paralysis, even without arthritis. However, the survival curves of the oldest series decrease between 8 and 10 years after arthroplasty (events: implant survival, or worsening of clinical outcome) which explains why the indication for this type of arthroplasty is usually limited to patients over seventy. Moreover, details and technical modifications have been suggested to improve the surgical technique, the quality of fixation and the mechanical conditions of this non-anatomical prosthesis to improve clinical outcome and implant survival. Within the framework of primary surgery, excluding traumatic or revision surgery, the primary indications for this option are massive rotator cuff tears with (or without) osteoarthritis and primary osteoarthritis with rotator cuff tears and/or with severe glenoid wear and finally, rheumatoid arthritis. The purpose of this conference was to assess and describe the most important preoperative criteria and surgical conditions necessary for this procedure as well as specific technical details about the surgical procedure itself based on available options and options under evaluation such as the positioning of the glenoid component (lateralization, bone graft, orientation) and the association of muscle transfers. PMID:24461235
Nerot, C; Ohl, X
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
Vince, Kelly G; Abdeen, Ayesha
Wear of articulated surfaces can be a major lifetime-limiting factor in arthroplasty. In the natural joint, lubrication is effected by the body's natural synovial fluid. Following arthroplasty, and the subsequent reformation of the synovial membrane, a fluid of similar composition surrounds the artificial joint. Synovial fluid contains, among many other constituents, a substantial concentration of the readily adsorbing protein albumin. The ability of human serum albumin to act as a boundary lubricant in joint prostheses has been investigated using a pin-on-disc tribometer. Circular dichroism spectroscopy was employed to follow the temperature- and time-dependent conformational changes of human serum albumin in the model lubricant solution. Effects of protein conformation and polymer surface hydrophilicity on protein adsorption and the resulting friction in the boundary lubrication regime have been investigated. Unfolded proteins preferentially adsorb onto hydrophobic polymer surfaces, where they form a compact, passivating layer and increase sliding friction-an effect that can be largely suppressed by rendering the substrate more hydrophilic. A molecular model for protein-mediated boundary friction is proposed to consolidate the observations. The relevance of the results for in vivo performance and ex vivo hip-joint testing are discussed. PMID:15451636
Heuberger, M P; Widmer, M R; Zobeley, E; Glockshuber, R; Spencer, N D
Background: Enhanced recovery program (ERP) was implemented to optimize the hospital stay in total hip arthroplasty. This study assessed the effects of optimizing preoperative and perioperative care using enhanced recovery (ER) on patients undergoing Total hip arthroplasty. Materials and Methods: We compared a prospective group of 64 patients on the ER program with a historic cohort of 63 patients that received conventional care (non ER). Results: ER patients were discharged earliest from hospital [mean length of stay (LOS) 5.3 days, median 4; P < 0.001] as compared to a mean of 8.3 days among non ER patients. Comparison based on American Association of Anesthesiologists (ASA) grades, preoperative hemoglobin, and body mass index (BMI) revealed that patients with ASA grade 3, preoperative hemoglobin of <14 g/dl, and BMI >30 on ER program spent shorter time in hospital as compared to the non ER's conventionally treated patients with more favorable physiological parameters of ASA grade 1 and 2, preoperative hemoglobin of >14 g/dl, and BMI <30. Conclusion: The ER protocol is universally beneficial and confers an advantage regardless of the patients’ preoperative condition.
Dwyer, Amitabh J; Tarassoli, Payam; Thomas, William; Porter, Paul
Objective To analyze the experience with allograft transplantation of the extensor mechanism in total knee arthroplasty and compare results with the international experience. Methods We retrospectively evaluated three cases of extensor mechanism allograft after total knee arthroplasty performed in our hospital with the aid of one of the few tissue banks in Brazil and attempt to establish whether our experiences were similar to others reported in the world literature regarding patient indication, techniques, and outcomes. Results Two cases went well with the adopted procedure, and one case showed bad results and progressed to amputation. As shown in the literature, the adequate tension of the graft, appropriate tibial fixation and especially the adequate patient selection are the better predictors of good outcomes. Previous chronic infection can be an unfavorable predictor. Conclusion This surgical procedure has precise indication, albeit uncommon, either because of the rarity of the problem or because of the low availability of allografts, due to the scarcity of tissue banks in Brazil. Level of Evidence IV, Case Series.
Helito, Camilo Partezani; Gobbi, Riccardo Gomes; Tozi, Mateus Ramos; Felix, Alessandro Monterroso; Angelini, Fabio Janson; Pecora, Jose Ricardo
Current outcomes data on revision total hip arthroplasty focuses on specific implants and techniques rather than more general outcomes. We therefore examined a large consecutive series of failed THAs undergoing revision to determine if survivorship and modes of failure differ in comparison to the current data. We retrospectively reviewed the medical records of 1100 revision THAs. The minimum followup was 2 years (mean, 6 years; range, 0–20.4 years). Eighty-seven percent of revision total hips required no further surgery; however, 141 hips (13%) underwent a second revision at a mean of 3.7 years (range, 0.025–15.9 years). Seventy percent (98 hips) had a second revision for a diagnosis different from that of their index revision, while 30% (43 hips) had a second revision for the same diagnosis. The most common reasons for failure were instability (49 of 141 hips, 35%), aseptic loosening (42 of 141 hips, 30%), osteolysis and/or wear (17 of 141 hips, 12%), infection (17 of 141 hips, 12%), miscellaneous (13 of 141 hips, 9%), and periprosthetic fracture (three of 141 hips, 2%). Survivorship for revision total hip arthroplasty using second revision as endpoint was 82% at 10 years. Aseptic loosening and instability accounted for 65% of these failures. Level of Evidence: Level IV, therapeutic (retrospective) study. See the Guidelines for Authors for a complete description of levels of evidence.
Fehring, Thomas K.; Griffin, William L.; Odum, Susan M.; Masonis, John L.
Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients. PMID:24151951
Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor
Reverse shoulder arthroplasty is being used more frequently to treat irreparable rotator cuff tears in the presence of glenohumeral arthritis and instability. To date, however, design features and functions of reverse shoulder arthroplasty, which may be associated with subluxation and dislocation of these implants, have been poorly understood. We asked: (1) what is the hierarchy of importance of joint compressive force, prosthetic socket depth, and glenosphere size in relation to stability, and (2) is this hierarchy defined by underlying and theoretically predictable joint contact characteristics? We examined the intrinsic stability in terms of the force required to dislocate the humerosocket from the glenosphere of eight commercially available reverse shoulder arthroplasty devices. The hierarchy of factors was led by compressive force followed by socket depth; glenosphere size played a much lesser role in stability of the reverse shoulder arthroplasty device. Similar results were predicted by a mathematical model, suggesting the stability was determined primarily by compressive forces generated by muscles.
Gutierrez, Sergio; Keller, Tony S.; Levy, Jonathan C.; Lee, William E.
The objective of this retrospective study was to evaluate our results with one-stage revision using cementless femoral stem for infected hip arthroplasties. Twenty-four patients were included in the study. The acetabular component was cemented in 9 cases. In 2 patients a structured bone allograft was necessary to fill an acetabular defect. After a mean follow-up of 44.6 months, 23 patients showed no signs of infection (95.8%), the mean functional response according to the Merle d'Aubigné scale was 13.8 and the mean Harris Hip Score was 65.4. One-stage revision hip arthroplasty using cementless femoral stem was associated with a high success rate. PMID:24332970
Bori, Guillem; Muñoz-Mahamud, Ernesto; Cuñé, Jordi; Gallart, Xavier; Fuster, David; Soriano, Alejandro
Top walking speed (TWS) was used to compare UKA with TKA. Two groups of 23 patients, well matched for age, gender, height and weight and radiological severity were recruited based on high functional scores, more than twelve months post UKA or TKA. These were compared with 14 preop patients and 14 normal controls. Their gait was measured at increasing speeds on a treadmill instrumented with force plates. Both arthroplasty groups were significantly faster than the preop OA group. TKA patients walked substantially faster than any previously reported series of knee arthroplasties. UKA patients walked 10% faster than TKA, although not as fast as the normal controls. Stride length was 5% greater and stance time 7% shorter following UKA — both much closer to normal than TKA. Unlike TKA, UKA enables a near normal gait one year after surgery.
Wiik, Anatole V.; Manning, Victoria; Strachan, Robin K.; Amis, Andrew A.; Cobb, Justin Peter
Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpose of this study is to compare patients who failed plating techniques requiring subsequent revision to DFA to patients who underwent primary DFA. Of the 13 patients (9.2%) who failed primary ORIF, causes included nonunion (53.8%), infection (30.8%), loosening (7.7%), and refracture (7.7%). There were significantly more surgical procedures for ORIF revision to DFA compared to primary DFA. Complications for patients who underwent primary reconstruction with DFAs included extensor mechanism disruption (8.3%), infection (5.6%), and dislocation (2.8%). Primary reconstruction via ORIF is beneficial for preserving bone stock, but primary DFA may be preferred in osteopenic patients, or those at high risk for nonunion. PMID:23540541
Chen, Antonia F; Choi, Lisa E; Colman, Matthew W; Goodman, Mark A; Crossett, Lawrence S; Tarkin, Ivan S; McGough, Richard L
This retrospective study evaluates the health related quality of life (HRQL) of patients following unicompartmental knee arthroplasty (UKA) compared to total knee arthroplasty (TKA) for osteoarthritis treatment. The Western Ontario and McMaster Osteoarthritis index (WOMAC) and the Oxford Knee score (OKS) were recorded at baseline, 3 and 6 months. Analysis of 317 UKAs and 425 TKAs showed no significant differences in HRQL between the two groups at baseline, but the TKA group was significantly older and more likely to be male. Both groups showed an overall improvement in the total WOMAC and OKS over time, with males showing significant improvement over females. Adjusting for age and gender, there was no significant difference between UKA and TKA in HRQL over the first 6 months following surgery. PMID:23850408
Sweeney, Katie; Grubisic, Maja; Marra, Carlo A; Kendall, Richard; Li, Linda C; Lynd, Larry D
Each year millions of patients are treated for joint pain with total joint arthroplasty, and the numbers are expected to rise.\\u000a Comorbid disease is known to influence the outcome of total joint arthroplasty, and its documentation is therefore of utmost\\u000a importance in clinical evaluation of the individual patient as well as in research. In this paper, we examine the various
Kristian BjorgulWendy; Wendy M. Novicoff; Khaled J. Saleh
There has been a resurgence of interest in unicompartmental knee arthroplasty (UKA) for treatment of medial unicompartmental\\u000a knee osteoarthritis (OA). Improved prosthetic design, minimally invasive surgical techniques, and strict patient selection\\u000a criteria have resulted in improved survivorship and functional outcomes. A review of orthopedic literature was conducted regarding\\u000a the advantages of UKA versus total knee arthroplasty (TKA), UKA indications, survivorship,
This study reports the outcome of total hip arthroplasty with use of an uncemented, tapered stem with a 5- to 9-year follow-up. The first 200 consecutive patients (214 hips) undergoing total hip arthroplasty with the Accolade TMZF stem (Stryker Orthopaedics, Mahwah, NJ) were enrolled prospectively. Follow-up for these patients averaged 7.6 years and encompassed review of clinical records as well
David S. Casper; Gregory K. Kim; Camilo Restrepo; Javad Parvizi; Richard H. Rothman
Infection remains a devastating complication of joint replacement surgery causing a significant burden to both patient and\\u000a surgeon. However, despite exhaustive prophylactic measures, intraoperative contamination still occurs during cemented arthroplasty\\u000a with current infection rates of 1–2%. A study was undertaken to determine the incidence of perioperative contamination in\\u000a cemented arthroplasty patients, to identify contaminating organisms, to identify contaminated regions within
A. M. Byrne; S. Morris; T. McCarthy; W. Quinlan; J. M. O’Byrne
Metal-on-metal hip arthroplasty gained significant favor in the first decade of the millennium. However, the past several years have seen increasing reports of failure, pseudotumor and other adverse reactions. This study presents the results of a single center's 15-year experience with metal-on-metal total hip arthroplasty as strong evidence that metal-on-metal is going, going, gone. PMID:23118387
Berend, K R; Morris, M J; Adams, J B; Lombardi, A V
Radial head fractures without associated bony or ligamentous injury can be safely treated with internal fixation, if possible, or arthroplasty if nonreconstructable. However, nonreconstructable radial head fractures in association with elbow dislocation and/or ligamentous injury in the elbow or forearm represent a specific subset of injuries that requires restoration of the radiocapitellar articulation for optimal function. The purpose of this article was to summarize the indications for radial head arthroplasty and discuss the reported outcomes. PMID:23827844
Fowler, John R; Goitz, Robert J
Postoperative pseudogout after total knee arthroplasty is rare. If pseudogout attacks are misdiagnosed as periprosthetic sepsis, patients may undergo unnecessary surgical procedures. We report a case of pseudogout in the early postoperative period. The attack ensued shortly after a nonsteroidal antiinflammatory drug was discontinued. The diagnosis was confirmed by aspiration, and the patient improved after readministration of the nonsteroidal antiinflammatory drug. Although rare, pseudogout should be considered in the differential when approaching a suspected infection after total knee arthroplasty. PMID:22522109
Harato, Kengo; Yoshida, Hiroki
Sixteen patients implanted with a posterior-stabilized prosthesis (Insall-Burstein PS II, Zimmer, Warsaw, IN) and 32 age-matched control subjects were evaluated by isokinetic muscle testing and comprehensive gait analysis at a mean 46 months following the index arthroplasty. The contralateral knee was normal in 13 patients and an asymptomatic total knee arthroplasty in 3 patients. No significant differences (P > .05)
Stephen A. Wilson; Peter D. McCann; Robert S. Gotlin; H. K. Ramakrishnan; Mary E. Wootten; John N. Insall
The duration of hospitalization and subsequent length of recovery after elective knee arthroplasty have decreased. We hypothesized\\u000a same-day discharge following either a unicompartmental (UKA) or total knee arthroplasty (TKA) in an unselected group of patients\\u000a would not result in a higher perioperative complication rate than standard-length hospitalization when following a comprehensive\\u000a perioperative clinical pathway, including preoperative teaching, regional anesthesia, preemptive
Richard A. Berger; Sharat K. Kusuma; Sheila A. Sanders; Elizabeth S. Thill; Scott M. Sporer
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.
Pelt, Christopher E.; Gililland, Jeremy M.; Doble, Justin; Stronach, Benjamin M.; Peters, Christopher L.
Serum metal ion levels increase after primary total hip arthroplasty (THA) regardless of bearing surface. We conducted a study to determine the effect of a second joint arthroplasty on existing serum metal ion levels at long-term followup. Twelve patients underwent primary THA and then either another THA (8 patients) or total knee arthroplasty (TKA) (4 patients). The secondary procedures were performed a mean of 102.7 months (range, 36-144 months) after the index surgeries. The secondary THA group had significantly elevated levels of cobalt ion at 36 and 48 months, chromium ion at 12 and 24 months, and titanium ion at 48 and 72 months. The TKA group had no significant differences in cobalt, chromium, or titanium ion levels up to 72 months after surgery. Overall, when metal-polyethylene THA was performed after primary THA, there was a trend toward elevated serum metal ion levels at all follow-up intervals. This trend should be investigated with larger clinical trials. PMID:24278909
Hsu, Andrew R; Levine, Brett R; Skipor, Anastasia K; Hallab, Nadim J; Paprosky, Wayne G; Jacobs, Joshua J
Background: Some of the poor functional outcomes of knee arthroplasty may be due to pain in the contralateral, unreplaced knee. We investigated the relationship between the preoperative pain status of the contralateral knee and the risk of a poor postoperative functional outcome in patients who underwent knee arthroplasty. Methods: We analyzed data on 271 patients in the Multicenter Osteoarthritis Study who had undergone knee arthroplasty since the time of enrollment. Eighty-six percent of these patients were white, 72% were female, and the mean age was sixty-seven years. The severity of pain in the knee contralateral to the one that was replaced was measured before the knee arthroplasty with use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale, with the scores being grouped into four categories (0, 1 to 4, 5 to 9, and 10 to 20). Poor post-arthroplasty function six months or more after surgery was determined with use of the Patient Acceptable Symptom State (PASS) outcome tool and a clinical performance measure of walking speed. We evaluated the relationship between contralateral pain severity and the functional outcomes with use of Poisson regression. Results: Seventy-two (27%) of 264 patients demonstrated poor post-arthroplasty function by failing to attain the threshold PASS score, and seventy-six (30%) of 250 subjects had a slow walking speed. As the pre-arthroplasty pain in the contralateral knee increased, there was a steady increase in the proportion with poor post-arthroplasty function (p < 0.0001 for PASS and p = 0.04 for slow walking speed). Compared with patients who had no pre-arthroplasty pain in the contralateral knee, those in the highest category of contralateral pain severity had 4.1 times the risk (95% confidence interval, 1.5 to 11.5) of having poor self-reported post-arthroplasty function. Patients in whom both knees had been replaced at the time of outcome collection were less likely to have poor self-reported function than those in whom only one knee had been replaced. Conclusions: Preoperative pain in the contralateral knee is strongly associated with self-reported post-arthroplasty functional outcome and may therefore be a useful indicator of prognosis or a potential target of perioperative intervention. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Maxwell, Jessica; Niu, Jingbo; Singh, Jasvinder A.; Nevitt, Michael C.; Law, Laura Frey; Felson, David
Objective. The number of individuals ages >100 years in the US is expected to increase considerably in the future along with the need for arthroplasties. This report focuses on the poorly studied epidemiology and mortality outcomes of arthroplasty among these individuals. Methods. We describe the epidemiology of knee and hip arthroplasties among centenarians using data from a large hospital discharge
Eswar Krishnan; James F. Fries; C. Kent Kwoh
The General Antiparticle Spectrometer (GAPS) experiment is a novel approach for the detection of cosmic ray antiparticles. A prototype GAPS (pGAPS) experiment was successfully flown on a high-altitude balloon in June of 2012. The goals of the pGAPS experiment were: to test the operation of lithium drifted silicon (Si(Li)) detectors at balloon altitudes, to validate the thermal model and cooling concept needed for engineering of a full-size GAPS instrument, and to characterize cosmic ray and X-ray backgrounds. The instrument was launched from the Japan Aerospace Exploration Agency's (JAXA) Taiki Aerospace Research Field in Hokkaido, Japan. The flight lasted a total of 6 h, with over 3 h at float altitude (~33km). Over one million cosmic ray triggers were recorded and all flight goals were met or exceeded.
Mognet, S. A. I.; Aramaki, T.; Bando, N.; Boggs, S. E.; von Doetinchem, P.; Fuke, H.; Gahbauer, F. H.; Hailey, C. J.; Koglin, J. E.; Madden, N.; Mori, K.; Okazaki, S.; Ong, R. A.; Perez, K. M.; Tajiri, G.; Yoshida, T.; Zweerink, J.
Unicondylar knee arthroplasty (UKA) is a well-established treatment option for unicompartmental knee arthrosis. Although UKA achieves high success rates, surgeons should be aware of many potential sources of persistent postoperative pain. Common causes include septic or aseptic loosening, a loose body, implant failure, and chronic regional pain syndrome. Tibial plateau stress fracture, meniscus rupture, and cement extrusion have also been reported as infrequent causes of persistent pain. We encountered 2 patients in whom persistent pain after UKA was attributed to synovial impingement mimicking a meniscus tear, and we refer to this as pseudomeniscal synovial impingement. This article presents the clinical histories and histologic findings of 2 patients fitted with a mobile-bearing UKA system and a fixed-bearing UKA system, respectively. These patients were successfully treated by arthroscopic excision. PMID:19472955
Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun
High tibial osteotomy may be indicated in the treatment of varus knee in young, active patients. The preservation of proprioception and native joint and biomechanics is crucial for functional recovery in these patients. However, deterioration of initial good results can occur with time. In such cases, revision with total knee arthroplasty is indicated. However, this is a more surgically demanding option compared with a primary prosthesis. Accurate preoperative planning is mandatory to decrease the risk of intraoperative complications. A precise surgical technique, which is crucial to improving functional outcomes, includes hardware removal, joint exposition, tibial deformities due to previous osteotomy, and managing soft tissue mismatches. Possible technical challenges and surgical solutions exist for each of these aspects. However, several studies report lower functional results compared with primary implants. Thus, patients should be informed before high tibial osteotomy about its failure rate, the difficult surgical aspects of an additional prosthesis, and less satisfactory clinical results. PMID:24762146
Cerciello, Simone; Vasso, Michele; Maffulli, Nicola; Neyret, Philippe; Corona, Katia; Panni, Alfredo Schiavone
Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007. The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination for the whole group were statistically significantly better at follow-up. There were no statistically significant differences between the rheumatoid and the non-rheumatoid patients except for motion, which was better in the non-rheumatoid group. The motion obtained depended on the preoperative motion. Implant survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier generations of total wrist arthroplasty.
Boeckstyns, Michel E H; Herzberg, Guillaume; Merser, S?ren
At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable. PMID:15190556
Hungerford, David S
Background and purpose In 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2–7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients. Patients and methods 118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009–2010. 55 patients (with 58 TKAs) had stated in 2003 that they were dissatisfied with their knees and 59 (with 60 TKAs) had stated that they were very satisfied with their knees. The patients were examined clinically and radiographically, and performed functional tests consisting of the 6-minute walk and chair-stand test. All the patients filled out a visual analog scale (VAS, 0–100 mm) regarding knee pain and also the Hospital and Anxiety and Depression scale (HAD). Results Mean VAS score for knee pain differed by 30 mm in favor of the very satisfied group (p < 0.001). 23 of the 55 patients in the dissatisfied group and 6 of 59 patients in the very satisfied group suffered from anxiety and/or depression (p = 0.001). Mean range of motion was 11 degrees better in the very satisfied group (p < 0.001). The groups were similar with regard to clinical examination, physical performance testing, and radiography. Interpretation The patients who reported poor response after TKA continued to be unhappy after 8–13 years, as demonstrated by VAS pain and HAD, despite the absence of a discernible objective reason for revision.
Ali, Abdulemir; Sundberg, Martin; Robertsson, Otto; Dahlberg, Leif E; Thorstensson, Carina A; Redlund-Johnell, Inga; Kristiansson, Ingvar; Lindstrand, Anders
The successful outcome of total knee arthroplasty (TKA) is very much dependent on precise positioning of the components. Inaccuracy may result in complaints as well as in early mechanical failure. Between March 2003 and September 2005, 69 TKA procedures were performed by the computer navigated technique. The postoperative outcome of this cohort was compared with the same number of TKAs done by the traditional technique. The lower limb anatomical axis was determined in all cases pre- and postoperatively by weight-bearing anteroposterior (AP) and lateral full length X-rays. The positions of femoral and tibial components were recorded. Comparing the data in the navigation group on the AP view, 96.6% of femoral and 96.9% of tibial components and on the lateral view in 95.4% of femoral and in 95.4% of tibial components, the overall postoperative axis in 95.4% fell in the range considered in the literature as optimal. In the traditional group on the AP view, 75.7% of femoral and 68.1% of tibial components and on the lateral view 81.8% of femoral and 63.6% of tibial components, the overall postoperative axis in 60.6% fell between the values considered optimal in the literature. It seems to be proven that the computer navigated total knee arthroplasty technique ensures positioning of components significantly more precisely compared with the traditional surgical method. Accuracy of navigation depends on the software used, on the correct detection of anatomical reference points, and on a potentially uneven thickness of the cement layer during final insertion of the components. The computer navigated technique does not substitute professional skill and experience, since it merely transmits information for the surgeon. The decision is in the hands of the doctor during the entire procedure. The real benefits of the computer navigated technique require further research and can be determined only after long-term analyses.
Solyom, Laszlo; Szendroi, Miklos
Background Interposition of a reversed jejunal loop in short bowel sydrome has previously been investigated in human along with animal models and seemed able to facilitate intestinal adaptation. However, it is unclear if growth hormone and insulin, well known for their implication in short bowel pathophysiology, intervene on this effect. Findings Porcine models were randomly allocated to two cohorts: (1) short bowel (SB) group (n?=?8) and (2) short bowel reverse jejunal segment (SB-RS) group (n?=?8). Amongst other parameters serum growth hormone and insulin were measured at baseline, as well as on postoperative day 30 and 60. Conclusion Both endogenous hormones failed to demonstrate significant difference in respect to potential direct effect to mechanisms of enhanced intestinal adaptation in reversed group
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 (...
This site provides the latest information on the Gap Analysis Program (GAP). The central goal of the GAP Program is to collect and integrate many levels of biological, physical, and policy information on a large scale, in order to identify gaps in current resource management plans. It is maintained by the USGS Biological Resources Division with the mission of "providing regional assessments of the conservation status of native vertebrate species and natural land cover types and to facilitate the application of this information to land management activities." This site is divided into eight sections: overview, the gap analysis handbook, state project information, gap reports/publications, a bulletin board, aquatic gap, nature mapping (an educational tool), and links to related sites. New press releases and conference poster contents are featured at the top of the site. Users can access state and regional GAP information or use the search engine to find other topics of interest.
Women have made remarkable gains in education during the past three decades, yet these achievements have resulted in only modest improvements in pay equity. The gender pay gap has become a fixture of the U.S. workplace and is so ubiquitous that many simply view it as normal. "Behind the Pay Gap" examines the gender pay gap for college graduates.…
Dey, Judy Goldberg; Hill, Catherine
Popliteus-tendon injury during total knee arthroplasty (TKA) may result in imbalanced soft-tissue tension; however, it is unclear whether complete popliteus-tendon resection is a factor which contributes to knee instability following TKA. We performed an isolated complete resection of the popliteus tendon during a standard posterior stabilised TKA (PS-TKA) in 14 normal knees of Thai female cadavers and measured gap differences
Saran Tantavisut; Aree Tanavalee; Srihatach Ngarmukos; Arak Limtrakul; Vajara Wilairatana; Yongsak Wangroongsub
Arthroplasty entails considerable exposure to allogenic blood transfusion. Cell salvage with washing is a contemporary strategy that is not universally used despite considerable potential benefits. We searched Embase and Medline to determine if blood salvage with washing during primary and/or revision hip and knee arthroplasty results in lower rates of transfusion and postoperative complications. We included 10 studies in our analysis, which we rated according to Downs and Black criteria. With primary knee arthroplasty, there was a reduction in transfusion rate from 22% to 76% and a 48% reduction in transfusion volume (n = 887). With primary hip arthroplasty, there was a reduction from 69% to 73% in transfusion rate and a 31% reduction in transfusion volume (n = 239). There was a significant decrease in length of hospital stay (9.6 v. 13.6 d). Studies of revision arthroplasty reported a 31%-59% reduction in transfusion volume (n = 241). The available evidence demonstrates reduced exposure to allogenic blood with the use of salvage systems. Studies have been underpowered to detect differences in infection rates and other postoperative complications. Future cost analysis is warranted. PMID:24461268
Dusik, Chris J; Hutchison, Carol; Langelier, David
Arthroplasty entails considerable exposure to allogenic blood transfusion. Cell salvage with washing is a contemporary strategy that is not universally used despite considerable potential benefits. We searched Embase and Medline to determine if blood salvage with washing during primary and/or revision hip and knee arthroplasty results in lower rates of transfusion and postoperative complications. We included 10 studies in our analysis, which we rated according to Downs and Black criteria. With primary knee arthroplasty, there was a reduction in transfusion rate from 22% to 76% and a 48% reduction in transfusion volume (n = 887). With primary hip arthroplasty, there was a reduction from 69% to 73% in transfusion rate and a 31% reduction in transfusion volume (n = 239). There was a significant decrease in length of hospital stay (9.6 v. 13.6 d). Studies of revision arthroplasty reported a 31%–59% reduction in transfusion volume (n = 241). The available evidence demonstrates reduced exposure to allogenic blood with the use of salvage systems. Studies have been underpowered to detect differences in infection rates and other postoperative complications. Future cost analysis is warranted.
Dusik, Chris J.; Hutchison, Carol; Langelier, David
Cervical arthroplasty has developed as an alternative to spinal fusion for the treatment of cervical radiculopathy and myelopathy. The popularity of artificial discs has grown as the evidence of complications following arthrodesis has increased, making the theoretical advantages (motion preservation, altering the natural history of disease, prevention of adjacent segment disease) of disc replacement more attractive. However, as more discs are implanted and the length of follow-up increases, reported complications such as heterotopic ossification, device migration and spontaneous fusion of arthroplasty devices are growing. As a result, surgeons and patients face a challenge when deciding between motion-preserving or fusion surgery. Currently, there is inadequate evidence to promote extensive use of artificial discs for cervical spondylosis, despite promising short-term and intermediate clinical outcomes. However, there is also insufficient evidence to cease using them completely. The use of arthroplasty over fusion in the long term can only be justified if the incidence of adjacent segment disease decreases as a result. Despite the level of investment and research into arthroplasty outcomes, long-term follow-up has yet to be completed and has not convincingly demonstrated the effect of artificial discs on adjacent segment disease. Further long-term randomised trials are necessary to determine whether cervical arthroplasty is able to reduce the incidence of adjacent segment disease and, in doing so, replace arthrodesis as the gold standard treatment for cervical spondylosis. PMID:21815734
Richards, O; Choi, D; Timothy, J
Background In North America, a two-stage exchange arthroplasty remains the preferred surgical treatment for chronic periprosthetic joint\\u000a infection (PJI). Currently, there are no proper indicators that can guide orthopaedic surgeons in patient selection for two-stage\\u000a exchange or the appropriate conditions in which to reimplant.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes To identify (1) the rate of recurrent PJI after two-stage exchange and (2) the role of 15
S. M. Javad Mortazavi; David Vegari; Anthony Ho; Benjamin Zmistowski; Javad Parvizi
Transplantation Surgery has undergone a great development during the last thirty years and the survival of solid organ recipients has increased dramatically. Osteo-articular diseases such as osteoporosis, fractures, avascular bone necrosis and osteoarthritis are relatively common in these patients and joint arthroplasty may be required. The outcome of hip arthroplasty in patients with osteonecrosis of the femoral head after renal transplantation has been studied and documented by many researchers. However, the results of joint arthroplasties other than the hip in solid organs recipients were only infrequently reported in the literature. A systematic review of the English literature was conducted in order to investigate the outcome of joint arthroplasties other than the hip in kidney, liver or heart transplant recipients. Nine pertinent articles including 51 knee arthroplasties, 8 shoulder arthroplasties and 1 ankle arthroplasty were found. These articles reported well to excellent results with a complication rate and spectrum comparable with those reported in nontransplant patients.
Sayed-Noor, Arkan S
Small gap Micromegas detectors ( < 50 ?m) are expected to be optimal for high pressure applications. Combining the microbulk manufacturing technique with a small gap can result in attractive detectors for rare event detection, in particular double beta decay or dark matter searches. We present novel results obtained with small gap microbulks (25 and 12.5 ?m) that have been manufactured recently. For the first time for this type of detectors, we show experimentally that for each amplification gap there is an optimal pressure and that smaller gaps are more suitable for higher pressures.
Attié, D.; Boilevin-Kayl, L.; Dafni, T.; Ferrer-Ribas, E.; Ferry, S.; Giomataris, Y.; Herrera, D. C.; Iguaz, F. J.; Irastorza, I. G.; Kebbiri, M.; Papaevangelou, T.; de Oliveira, R.; Seguí, L.; Tomás, A.
Total knee arthroplasty (TKA) has been shown to have excellent long-term outcomes and survivorship in numerous studies, however, with changes in patient demographics, questions have arisen about the use of conventional arthroplasties and their functionality in highly active, young patients. The recent interest in bicruciate-retaining prostheses is aimed to address the need for an implant that can mimic a natural knee during high activity levels. Although there are currently few of these prostheses which are being utilized, results from prior studies have demonstrated similar results to that of anterior cruciate ligament-sacrificing TKA in terms of function and survivorship. In this review, we will describe the history, kinematics, clinical outcomes, concerns, and future outlook of bicruciate-retaining arthroplasty. PMID:24764232
Cherian, Jeffrey J; Kapadia, Bhaveen H; Banerjee, Samik; Jauregui, Julio J; Harwin, Steven F; Mont, Michael A
Periprosthetic joint infection is now the leading cause of failure after a total knee arthroplasty, and Staphylococcus aureus, most commonly from the patient's own flora, typically is the infective agent. Several preoperative screening tests have been developed to identify patients who are carrying methicillin-resistant S aureus. Testing and decolonization programs have generally been effective in decreasing the incidence of surgical site infections, but the role of such programs in total joint arthroplasty has not been thoroughly investigated. Although recent studies found a tendency toward fewer methicillin-resistant S aureus infections after total joint arthroplasty when a testing and decolonization program was used, most of these studies were underpowered. Larger, randomized, controlled studies are needed. PMID:20415376
Parvizi, Javad; Matar, Wadih Y; Saleh, Khaled J; Schmalzried, Thomas P; Mihalko, William M
In view of the results of Swanson implants, particularly the long-term course of silicone implants, the authors studied and developed semi-constrained sliding arthroplasty designed for metacarpo-phalangeal and proximal interphalangeal joints. The preliminary study on bones and then on cadaver hands and finally on the knee of the rabbit allowed the design and experimentation of a prototype which led to the creation of a semi-constrained arthroplasty for which the elastic diaphyseal anchoring is ensured without cement and which possesses sliding surfaces composed of a metallic (proximal piece)--polyethylene (distal piece) interface. We therefore describe the principles of functioning of this arthroplasty, its technique of insertion, dorsal trans-tendon incision, its accessory (drill for diaphyseal preparations), its anatomical requirements (preservation of the palmar plate and lateral ligaments, bone section) and the postoperative course. To date, 52 arthroplasties have been inserted and we present the results of the first 36 cases for which the follow-up is equal to or a greater than one year (20 MP-16 PIP), indicating the technical modalities according to the various aetiologies (21 cases of rheumatoid arthritis--15 post-traumatic cases) and the complications. The average gain in mobility is 40 degrees with a mean range of movement of 64 degrees. In terms of pain, none of the arthroplasties were associated with pain apart from pain on cold in certain post-traumatic cases. The global and thumb-finger prehensile forces were evaluated to be an average of 90% in relation to the healthy side. Radiological assessment demonstrated fixation of the pieces in every case. Lastly, we discuss the outcome of this arthroplasty and its current indications in relation to the problems of instability essentially occurring in dislocated MP joints of rheumatoid arthritis. PMID:3233039
Condamine, J L; Benoit, J Y; Comtet, J J; Aubriot, J H
The use of large diameter metal bearing total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) increased in popularity in the last decade. More recent literature has highlighted the effect of head size in patient outcomes. Data was obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOA-NJRR) to evaluate the Birmingham (MoM) bearing surface when used with THA and HRA. There is no difference in the overall rate of revision between the THA and HRA but head size has a significant effect on revision rate. The data show that small diameter metal bearings in HRA (below 50mm) have a higher rate of revision than large diameter metal bearings in HRA (equal to and above 50mm) (P<.001). Conversely the large diameter metal bearings in THA have a higher rate of revision than the small diameter metal bearings in THA (P=.027). The revision rate for large diameter HRA compared to small diameter THA is not significantly different P=.670. We recommend caution when choosing either a large diameter (?50mm) metal on metal THA or small diameter (<50mm) HRA. PMID:23140992
Jack, Christopher M; Walter, William L; Shimmin, Andrew J; Cashman, Kara; de Steiger, Richard N
Since the 1960s total hip arthroplasty (THA) has represented one of the greatest accomplishments in orthopedic surgery. It improves the functionality, working ability and quality of life of patients with non-functional hip joint due to various reasons. This article reviews general and regional history of THA, current knowledge and concepts regarding the long-term outcomes of the procedure and emphasizes the need for establishing national (and international) THA registries as an essential way of gathering data critical for decision making in daily practice as well as in defining national healthcare policies in respect to arthroplasty procedures. PMID:22634928
Kolundži?, Robert; Trkulja, Vladimir; Orli?, Dubravko
The use of modular femoral stems in primary total hip arthroplasty has increased considerably in recent years. These modular components offer the surgeon the ability to independently alter version, offset, and length of the femoral component of a hip arthroplasty. This increases the surgeon's ability to accurately recreate the relevant anatomy but increases the possibilities of corrosion and fracture. Multiple case reports have highlighted fractures of these modular components. We present a case of a fracture of a modular design that has had no previously reported modular neck fractures. The patient was informed that data concerning the case would be submitted, and he consented. PMID:22658428
Sotereanos, Nicholas G; Sauber, Timothy J; Tupis, Todd T
This article presents the clinical features of crystal arthropathy after knee replacement. The current literature on pseudogout and gout after both total and partial knee replacement is summarized. A case of bilateral pseudogout 8 years after initial total knee arthroplasty (TKA) is used to highlight the clinical characteristics and treatment options for this underrecognized condition. Presentation mimicked a late septic joint arthroplasty with sudden onset of pain and effusion. The patient was treated successfully with an arthrotomy, debridement, synovectomy, polyethylene insert exchange, oral steroids, and nonsteroidal anti-inflammatories. There are no other reported cases of bilateral pseudogout after bilateral TKA. PMID:23102423
Levi, Gabriel S; Sadr, Kamran; Scuderi, Giles R
Fungal prosthetic joint infection after total knee arthroplasty (TKA) is a rare complication. Lacunae exist in the management of this complication. 62 year old lady presented with pain and swelling in left knee and was diagnosed as Candida tropicalis fungal infection after TKA. She underwent debridement, resection arthroplasty and antifungal plus antibiotic loaded cement spacer insertion, antifungal therapy with fluconazole followed by delayed revision TKA and further fluconazole therapy. Total duration of fluconazole therapy was 30 weeks. At 2 year followup, she has pain less range of motion of 10°-90° and there is no evidence of recurrence of infection.
Reddy, Kankanala J; Shah, Jay D; Kale, Rohit V; Reddy, T Jayakrishna
Gap genes are involved in segment determination during the early development of the fruit fly Drosophila melanogaster as well as in other insects. This review attempts to synthesize the current knowledge of the gap gene network through a comprehensive survey of the experimental literature. I focus on genetic and molecular evidence, which provides us with an almost-complete picture of the regulatory interactions responsible for trunk gap gene expression. I discuss the regulatory mechanisms involved, and highlight the remaining ambiguities and gaps in the evidence. This is followed by a brief discussion of molecular regulatory mechanisms for transcriptional regulation, as well as precision and size-regulation provided by the system. Finally, I discuss evidence on the evolution of gap gene expression from species other than Drosophila. My survey concludes that studies of the gap gene system continue to reveal interesting and important new insights into the role of gene regulatory networks in development and evolution.
Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10% of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique. PMID:24366186
Rossi, Roberto; Rosso, Federica; Cottino, Umberto; Dettoni, Federico; Bonasia, Davide Edoardo; Bruzzone, Matteo
ABSTRACT Acute pain during and immediately after total knee arthroplasty (TKA) can be well controlled by spinal anesthesia, local infiltration analgesia, and peripheral nerve blocks; this enables early or fast-track rehabilitation. However, about half of patients have clinically significant pain in the following weeks. Active movements and rehabilitation of joint function, muscle strength, and ability to maintain balance and prevent falls all become more difficult when the joint is painful on movement. Intensive analgesic and antihyperalgesic treatment during the first few weeks after TKA surgery may reduce the risk of chronic pain after this operation, which is itself intended to remove the patient's chronic osteoarthritis pain. Spinal cord stimulation may be an effective option for patients with mainly neuropathic pain after TKA surgery. This report is adapted from paineurope 2013; Issue 4, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com , at which European health professionals can register online to receive copies of the quarterly publication. PMID:24801974
Sauter, Axel; Breivik, Harald
Component malalignment remains a concern in total knee arthroplasty (TKA); therefore, a series of technologies have been developed to improve alignment. The authors conducted a systematic review to compare computer-assisted navigation with conventional instrumentation, and assess the current evidence for patient-matched instrumentation and robot-assisted implantation. An extensive search of the PubMed database for relevant meta-analyses, systematic reviews and original articles was performed, with each study scrutinised by two reviewers. Data on study characteristics and outcomes were extracted from each study and compared. In total 30 studies were included: 10 meta-analyses comparing computer-assisted navigation and conventional instrumentation, 13 studies examining patient-matched instrumentation, and seven investigating robot-assisted implantation. Computer-assisted navigation showed significant and reproducible improvements in mechanical alignment over conventional instrumentation. Patient-matched instrumentation appeared to achieve a high degree of mechanical alignment, although the majority of studies were of poor quality. The data for robot-assisted surgery was less indicative. Computer-assisted navigation improves alignment during TKA over conventional instrumentation. For patient-matched instrumentation and robot-assisted implantation, alignment benefits have not been reliably demonstrated. For all three technologies, clinical benefits cannot currently be assumed, and further studies are required. Although current technologies to improve alignment during TKA appear to result in intra-operative benefits, their clinical impact remains unclear, and surgeons should take this into account when considering their adoption. PMID:24034591
Thienpont, Emmanuel; Fennema, Peter; Price, Andrew
Computer-aided navigation in total knee arthroplasty (TKA) promises improved alignment, performance, and survivorship. Previous meta-analyses demonstrated that navigation yields better component alignment; however, they did not discuss other indicators of performance. This meta-analysis compares navigated (NAV) and conventional (CONV) TKAs and includes clinical outcomes and adverse events. Forty-seven studies (22 randomized trials) of varying methodological quality involving 7,151 TKAs created the sample population. Statistical analyses included analysis of variance of weighted means and random effects modeling. As seen in previous meta-analyses, NAV is favored over CONV TKA. Analysis of surgical characteristics found that length of surgery and tourniquet times were lower for CONV, but not significant. Meta-analysis found that tourniquet times favored CONV but not a strong relationship for length of surgery. Analysis of individual adverse events did not reveal any significant differences. However, when examining adverse events in their totality, the NAV experienced significantly fewer complications. TKA performed with imageless navigation improves component alignment, provides for lower blood loss, improves clinical outcomes as measured by Knee Society and WOMAC scores, and has fewer total adverse events. Published data are insufficient to determine any correlations between component alignment and outcomes. PMID:24234551
Moskal, Joseph T; Capps, Susan G; Mann, John W; Scanelli, John A
Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future. PMID:24764230
Banerjee, Samik; Kulesha, Gene; Kester, Mark; Mont, Michael A
Executive Summary Objective The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Clinical Need Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. The Technology Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a conventional THR with a small (28 mm) ball. First, the large femoral head reduces the chance of dislocation, so that rates of dislocation are less than those with conventional THR. Second, the range of motion with hip resurfacing arthroplasty is higher than that achieved with conventional THR. A variety of MOM hip resurfacing implants are used in clinical practice. Six MOM hip resurfacing implants have been issued licences in Canada. Review Strategy A search of electronic bibliographies (OVID Medline, Medline In-Process and Other Non-Indexed Citations, Embase, Cochrane CENTRAL and DSR, INAHTA) was undertaken to identify evidence published from Jan 1, 1997 to October 27, 2005. The search was limited to English-language articles and human studies. The literature search yielded 245 citations. Of these, 11 met inclusion criteria (9 for effectiveness, 2 for safety). The result of the only reported randomized controlled trial on MOM hip resurfacing arthroplasty could not be included in this assessment, because it used a cemented acetabular component, whereas in the new generation of implants, a cementless acetabular component is used. After omitting this publication, only case series remained. Summary of Findings Health Outcomes The Harris hip score and SF-12 are 2 measures commonly used to report health outcomes in MOM hip resurfacing arthroplasty studies. Other scales used are the Oxford hip score and the University of California Los Angeles hip score. The case series showed that the mean revision rate of MOM hip resurfacing arthroplasty is 1.5% and the incidence of femoral neck fracture is 0.67%. Across all studies, 2 cases of osteonecrosis were reported. Four studies reported improvement in Harris hip scores. However, only 1 study reported a statistically significant improvement. Three studies reported improvement in SF-12 scores, of which 2 reported a significant improvement. One study reported significant improvement in UCLA hip score. Two studies reported postoperative Oxford hip scores, but no preoperative values were reported. None of the reviewed studies r
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.
Ten patients with chronic dorsal fracture subluxation of the distal interphalangeal joint were managed over 5 years with volar plate advancement arthroplasty. The mean time from injury to definitive surgical treatment was 8 weeks (range, 2 weeks to 4 months). All injuries were characterized by volar comminution and impaction of the distal phalanx, with associated dorsal subluxation. Surgical treatment included
Michael E Rettig; Gabriel Dassa; Keith B Raskin
The anatomy and histology of the volar plate at the proximal interphalangeal joint and the mechanism of fracture\\/subluxation of the base of the middle phalanx in closed proximal interphalangeal joint injuries is reviewed. Our current technique of repair for these injuries and its evolution from Eaton’s original procedure is described. The results of 71 cases of volar plate arthroplasty performed
G. DURHAM-SMITH; G. M. MCCARTEN
The use of uncemented femoral stems in primary total hip arthroplasty (THA) has been slow to develop in the UK because of the lack of encouraging published long-term follow-up data, the continued success of the cemented primary THA, and the perceived excessive relative cost of the uncemented THA. In this article, we argue that the total costs of 3 “proven”
Piers Yates; Shelley Serjeant; Graham Rushforth; Robert Middleton
Total knee arthroplasty (TKA) is associated with persistent quadriceps dysfunction. Since quadriceps dysfunction impairs functional performance, minimizing quadriceps dysfunction by attenuating central activation deficits early after surgery may improve function later in life. Rehabilitation strategies incorporating neuromuscular electrical stimulation and early, aggressive quadriceps strengthening may prove beneficial. Further, surgical approaches such as minimally invasive TKA may minimize post-operative quadriceps dysfunction.
Thomas, Abbey C.; Stevens-Lapsley, Jennifer E.
In order to evaluate the efficacy of preoperative physical therapy for patients undergoing elective primary total knee arthroplasty, 10 patients completed 6 weeks of physical therapy before surgery (PT group). Ten patients served as controls (C group). Subjects were tested at baseline (PT only), before surgery, 6 weeks after surgery, and 3 months after surgery using the Hospital for Special
Jeffrey A. Rodgers; Kevin L. Garvin; Craig W. Walker; Dee Morford; Josh Urban; Joe Bedard
Recent guidelines have suggested that routine postoperative care of patients with metal-on-metal hip prostheses should involve metal ion analysis. This study sought to investigate the relationship between bearing surface wear rates of metal components and serum metal ion analysis and also to quantify the incidence of excessive increases in serum metal ion concentrations post-hip resurfacing arthroplasty. PMID:21435493
Langton, David J; Joyce, Thomas J; Mangat, Navjeet; Lord, James; Van Orsouw, Maarten; De Smet, Koen; Nargol, Antoni V F
We carried out 102 hip revision arthroplasties using an uncemented isoelastic femoral stem on 92 patients between 1985 and 1989. The proximal femoral bone stock had deteriorated in 45%. Eleven patients died during the mean follow up of 5.7 years. The femoral component has been revised again for loosening in 13, for infection in 5 and for dislocation in 3.
T. J. Niinimäki; J. P. Puranen; P. K. A. Jalovaara
Although total elbow arthroplasty is a reliable treatment method for the arthritic joint, revision is necessary if loosening, instability, wear, fracture or infection occurs. We report 12 patients with 19 months (10-29) follow-up after revision arthroplasty for painful loosening in six cases, periprosthetic fracture in three, gross instability in one and skin perforation with possible infection in two. All cases presented with severe metallosis. Fractures were seen in four, triceps insufficiency in three and skin perforation in two. All patients were treated with exchange arthroplasty using the Coonrad-Morrey prosthesis. Three patients had in addition strut-allografting. The two patients with skin perforation and possible infection had a staged procedure. Mayo Elbow Performance Score improved from 24 to 87 with uneventful healing, fracture consolidation and allograft incorporation. At follow-up, triceps insufficiency persisted in all three cases. Transient neuropathy was present in five patients (4 ulnar, 1 radial). Metallosis in total elbow arthroplasty may be associated with severe tissue damage. A staging method is presented. PMID:19205321
Degreef, Ilse; Sciot, Raf; De Smet, Luc
We present a case of severe metallosis after total elbow arthroplasty in a female patient presenting with manifestations resembling a septic loosening. We discuss the clinical and the operative findings as well as the outcome of this uncommon complication. A review of the literature regarding the pathogenesis, radiographic appearance, and management of metallosis in prosthetic joints is presented. PMID:19444525
Sayed-Noor, Arkan S; Sjödén, Göran O
The significance of achievement of soft tissue balancing in total knee arthroplasty is well recognized. There are few reports dealing with soft tissue tension in total knee arthroplasty. It is expected that the soft tissue tension will affect post-operative results such as postoperative ROM and stability. The purpose of this study was to evaluate tension properties of soft tissue complex of osteoarthritic knee in total knee arthroplasty. Sixty osteoarthritic knees that underwent primary total knee arthroplasty were investigated with a balancer and torque driver specially developed and adapted for this study. We gradually opened the extension and flexion space and measured the force to open it. We created a force-displacement curve in each case. Inclination of the curve indicated stiffness. We examined the stiffness average of all cases every 10 N. The stiffness was 8.9 and 8.5 N/mm (extension, flexion) in soft tissue tension of 60 N and 26.6 and 21.4 N/mm in 180 N. The stiffness became larger with an increase of soft tissue tension, and the stiffness of extension is significantly larger than that of flexion in each tension except for 60 N. Tension properties of soft tissue complex reveal that soft tissue can be easily extended in low soft tissue tension, and hardly extended in high tension. PMID:17661184
Asano, Hiroshi; Muneta, Takeshi; Hoshino, Akiho
In this prospective study we followed the bone mineral content (BMC) —changes over time at seven distinct well defined bone Zones (1–7), around the uncemented Zweymueller total hip arthroplasty (THA) components, using dual energy xray densitometry, and a roentgenographical analysis close to the tip of the Zweymueller stem, to measure any postoperative cortical thickness changes. A homogenous group of 36
P. Korovessis; P. Droutsas; G. Piperos; A. Michael; A. Baikousis; M. Stamatakis
Resource Purpose: The information collected serves the following purposes: (1) provides a summary of funds allocated by tribe for the GAP Program, (2) provides an overview in the types of activities the tribes are engaged in with GAP funds, and (3) allows OW to document the...
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…
Weissbourd, Richard; Dodge, Trevor
After reviewing recent literature on the treatment of displaced intracapsular fractures of the femoral neck (Garden types III and IV) and from personal experience, a number of conclusions can be made. Orthopedic surgeons and hospitals face the challenge of providing the treatment most beneficial to patients with intracapsular, subcapital hip fractures in the most cost-effective way. The numbers of patients will increase annually and exceed the 125,000 per year at present in the United States. Most authors agree that fractures with the least displacement and younger, more demanding patients will do well with a precise fracture reduction without delay and an accurately placed internal fixation system. However, an overall median risk for reoperation 2 years after internal fixation is 35%. A patient with a displaced intracapsular fracture will need to consider monopolar, bipolar, or THA as the treatment of choice. Monopolar and bipolar arthroplasty have a reduced survivorship compared to THA and are not as suitable for the younger, more active patient. A large femoral head implant leads to decreased motion from increased friction and an undersized head implant leads to reduced contact area with increased erosion and pain. Bipolar arthroplasties, while allowing early mobilization, may develop some of the characteristics of monopolar implants if motion is not mainly at the internal joint. The increased cost may not justify their use over monopolar arthroplasty. Should dislocation occur, monopolar implants are easier to reduce (closed) than bipolar. Ceramic heads on monopolar or bipolar arthroplasties offer reduced wear and less erosion of the acetabulum. Total hip arthroplasty provides early mobilization, long-term pain relief, and little additional morbidity at surgery. The increased rate of early dislocation may be related to surgeon skill rather than an inherent failure of the system. If the early dislocators are removed from consideration, the complication rate drops to equal that of monopolar and bipolar implants. Total hip arthroplasty also is cost effective. Total hip arthroplasty may be the only option if pre-existing arthritis, significant osteoporosis, or Paget's disease of the pelvis is present. PMID:12650332
The cardiopulmonary changes resulting from cemented arthroplasty procedures were monitored in 11 dogs with a single prosthesis implanted and nine dogs with a dual arthroplasty procedure. These changes were characterized by decreased BP, elevated PPA, and elevated PVR, associated with decreases in PaO2, cardiac output and mixed venous oxygen tension. All changes were more pronounced and prolonged in the dual component arthroplasty group. Histologic lung examination and morphometry demonstrated significant degrees of marrow (fat) microembolism in the dual arthroplasty model. Cardiopulmonary collapse has been associated with Guepar dual component arthroplasties clinically and these patients are at increased risk and should be monitored continuously. Prophylactic measures include meticulous lavage of the intramedullary cavity, increased FIO2, and maintenance of intravascular volume and cardiac output. The bilateral arthroplasty model is useful in investigating therapeutic interventions which may detect and prevent the marrow microembolism syndrome intraoperatively. PMID:3608047
Byrick, R J; Kay, J C; Mullen, J B
One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom implant longevity is paramount. Even though various new bearing surfaces have been investigated, research is still ongoing, and only short-term results have been reported from clinical trials. Future bearing surfaces can be developed in the following ways: (1) change in design, (2) further improvement of polyethylene, (3) surface modification of the metal, (4) improvement in the ceramic, and (5) use of alternative, new materials. One way to reduce wear and impingement in THA is to make changes in its design by using a large femoral head, a monobloc metal shell with preassembled ceramic liner, dual mobility cups, a combination of different bearing surfaces, etc. Polyethylene has improved over time with the development of highly crosslinked polyethylene. Further improvements can be made by reinforcing it with vitamin E or multiwalled carbon nanotubes and by performing a surface modification with a biomembrane. Surface modifications with titanium nitride or titanium niobium nitride are implemented to try to improve the metal bearings. The advance to the fourth generation ceramics has shown relatively promising results, even in young patients. Nevertheless, further improvement is required to reduce fragility and squeaking. Alternative materials like diamond coatings on surfaces, carbon based composite materials, oxidized zirconium, silicon nitride, and sapphire are being sought. However, long-term studies are necessary to confirm the efficacy of these surfaces after enhancements have been made with regard to fixation technique and implant quality. PMID:24605198
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
Lindeque, Bennie; Hartman, Zach; Noshchenko, Andriy; Cruse, Margaret
Introduction: This study aimed to determine the dislocation and reoperation rate, functional outcomes, and the survival rate of the unique subset of very old but lucid and independent patients with hip fractures following a total hip arthroplasty (THA) and geriatric team-coordinated perioperative care. Method: Between 2000 and 2006, previously independent ambulatory patients ?80 years old presenting with an intracapsular hip fracture were given THAs under the care of an integrated orthopedic surgery–geriatric service. Their fracture-related complications, ambulation, mental status, and survival were followed for 5 to 11 years postinjury. Results: Five years postinjury, 57 (61.3%) patients of the original study group were living. In all, 3 (3.2%) patients had postoperative hip dislocations (and 2 patients had dislocation twice) and 2 reoperations were needed within the first postoperative month. There were no hip dislocations or reoperations after the first year. Radiographs obtained on 88% of the surviving patients at 5 years postoperatively showed that all remained unchanged from their immediate postoperative images. Nearly half of the patients were still able to ambulate as they did preoperatively and their mixed-model equation was statistically unchanged. Conclusion: This study of patients >80 years old with previously good functional status demonstrates that with appropriate surgical (best prosthesis, good operating technique, and regional anesthesia) and geriatric (pre- and postoperative assessments, close follow-up, medication adjustments, and fall-prevention instruction) care, they have few hip dislocations and reoperations, survive postfracture at least as long as their noninjured contemporaries, and continue to function and ambulate as they did prior to their injury.
Monzon, Daniel Godoy; Iserson, Kenneth V.; Jauregui, Jose; Musso, Carlos; Piccaluga, Francisco; Buttaro, Martin
Background Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee arthroplasty. Methods A computerized search for relevant studies published up to September 2007 was performed in Medline and Embase using a search strategy that is highly sensitive to find nonrandomized studies. Included were observational studies in which patients had total knee arthroplasty performed after prior high tibial osteotomy. Studies that fulfilled these criteria, were assessed for methodologic quality by two independent reviewers using the critical appraisal of observational studies developed by Deeks and the MINORS instrument. The study characteristics and data on the intervention, follow-up, and outcome measures, were extracted using a pre-tested standardized form. Primary outcomes were: knee range of motion, knee clinical score, and revision surgery. The grade of evidence was determined using the guidelines of the GRADE working group. Results Of the 458 articles identified using our search strategy, 17 met the inclusion criteria. Fifteen studies were cohort study with a concurrent control group, one was a historical cohort study and one a case-control study. Nine studies scored 50% or more on both methodological quality assessments. Pooling of the results was not possible due to the heterogeneity of the studies, and our analysis could not raise the overall low quality of evidence. No significant differences between primary total knee arthroplasty and total knee arthroplasty after osteotomy were found for knee range of motion in four out of six studies, knee clinical scores in eight out of nine studies, and revision surgery in eight out of eight studies after a median follow-up of 5 years. Conclusion Our analysis suggests that osteotomy does not compromise subsequent knee replacement. However, the low quality of evidence precludes solid clinical conclusions.
van Raaij, Tom M; Reijman, Max; Furlan, Andrea D; Verhaar, Jan AN
An emerging concern with metal-on-metal total hip arthroplasty is metal-induced hypersensitivity. Currently, this is a diagnosis of exclusion in patients with groin pain after metal-on-metal total hip arthroplasty. We describe a patient presenting nearly a year after arthroplasty with incisional drainage. Infection was presumed; but preoperative studies were nondefinitive, and the wound was explored. The operative cultures were negative; the
Mark D. Earll; Patrick G. Earll; Russell S. Rougeux
There have been several attempts to reduce postoperative blood loss in patients undergoing total arthroplasty. Benoni et\\u000a al. reported the usefulness of tranexamic acid in total knee arthroplasty (TKA). We investigated its effect in TKA and total\\u000a hip arthroplasty (THA). Blood loss was significantly reduced in patients given tranexamic acid in both the TKA and THA groups,\\u000a and no severe
Kazuhiro Ido; Masashi Neo; Yoshiyuki Asada; Kei Kondo; Toru Morita; Takeshi Sakamoto; Ryoichi Hayashi; Shinichi Kuriyama
Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement.
Merolla, G; Nastrucci, G; Porcellini, G
A 68-year-old man with a previous right total hip arthroplasty presented with acute pain in the right hip, and no associated trauma was reported. The previous hybrid arthroplasty consisted of a ceramic femoral head articulating on an ultra-high-molecular-weight polyethylene liner. The unusual diagnosis of fractured ceramic femoral head was made and an urgent revision arthroplasty was performed to remove the ceramic bearing as well as all implants that may have come into contact with the ceramic. This case report highlights the material properties of ceramics in total hip arthroplasties as well as the importance of regular follow-up in these patients. PMID:24515234
Tucker, Damien; Acharya, Mehool
In vivo delivery of small interfering RNAs (siRNAs) to target cells via the extracellular space has been hampered by dilution effects and immune responses. Gap junction-mediated transfer between cells avoids the extracellular space and its associated limitations. Because of these advantages cell based delivery via gap junctions has emerged as a viable alternative for siRNA or miRNA delivery. Here we discuss the advantages and disadvantages of extracellular delivery and cell to cell delivery via gap junction channels composed of connexins. This article is part of a Special Issue entitled: The Communicating junctions, composition, structure and characteristics. PMID:21986484
Brink, Peter R; Valiunas, Virginijus; Gordon, Chris; Rosen, Michael R; Cohen, Ira S
ObjectiveTo translate and culturally adapt to the French Health care system a decision making tool for patient orientation after Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA), to inpatient rehabilitation or a direct return home.
E. Coudeyre; S. Descamps; J. Mc Intyre; S. Boisgard; S. Poiraudeau; M. M. Lefevre-Colau
A lightweight, small size, high sensitivity gauge for indirectly measuring displacement or absolute gap width by measuring axial strain in an orthogonal direction to the displacement/gap width. The gap gauge includes a preferably titanium base having a central tension bar with springs connecting opposite ends of the tension bar to a pair of end connector bars, and an elongated bow spring connected to the end connector bars with a middle section bowed away from the base to define a gap. The bow spring is capable of producing an axial strain in the base proportional to a displacement of the middle section in a direction orthogonal to the base. And a strain sensor, such as a Fabry-Perot interferometer strain sensor, is connected to measure the axial strain in the base, so that the displacement of the middle section may be indirectly determined from the measurement of the axial strain in the base.
Wood, Billy E. (Livermore, CA); Groves, Scott E. (Brentwood, CA); Larsen, Greg J. (Brentwood, CA); Sanchez, Roberto J. (Pleasanton, CA)
Construction of crowbar-spark gap, designed for formation of operation current impulse in induction loading of the thermonuclear installation TOR is described. To produce conditions of electric break-down used is the pulse induction decoupling circuit on ...
M. I. Kitaev A. I. Malyutin A. I. Markin
Access to the article is free, however registration and sign-in are required. Guanine nucleotide-binding proteins (G proteins) transduce a very large number of cellular regulatory signals. Several recent papers have shown that the larger heterotrimeric G proteins are regulated by a class of molecules known as the RGS proteins (regulators of G protein-signaling family) that are analogous to the GAPs (GTPase activating proteins), which regulate small monomeric G proteins. Iyengar summarizes this evidence and discusses the mechanism of action of the RGS proteins.
Ravi Iyengar (Mount Sinai School of Medicine;Department of Pharmacology)
Background Metal-on-metal (MOM) hip resurfacing arthroplasty (HRA) is in clinical use as an appropriate alternative to total hip arthroplasty in young patients. In this technique, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the acetabulum. Objectives The primary objective of this analysis was to compare the revision rates of MOM HRA using different implants with the benchmark set by the National Institute of Clinical Excellence (NICE). The secondary objective of this analysis was to review the literature regarding adverse biological effects associated with implant material. Review Methods A literature search was performed on February 13, 2012, to identify studies published from January 1, 2009, to February 13, 2012. Results The revision rates for MOM HRA using 6 different implants were reviewed. The revision rates for MOM HRA with 3 implants met the NICE criteria, i.e., a revision rate of 10% or less at 10 years. Two implants had short-term follow-ups and MOM HRA with one of the implants failed to meet the NICE criteria. Adverse tissue reactions resulting in failure of the implants have been reported by several studies. With a better understanding of the factors that influence the wear rate of the implants, adverse tissue reactions and subsequent implant failure can be minimized. Many authors have suggested that patient selection and surgical technique affect the wear rate and the risk of tissue reactions. The biological effects of high metal ion levels in the blood and urine of patients with MOM HRA implants are not known. Studies have shown an increase in chromosomal aberrations in patients with MOM articulations, but the clinical implications and long-term consequences of this increase are still unknown. Epidemiological studies have shown that patients with MOM HRA implants did not have an overall increase in mortality or risk of cancer. There is insufficient clinical data to confirm the teratogenicity of MOM implants in humans. Conclusions Metal-on-metal HRA can be beneficial for appropriately selected patients, provided the surgeon has the surgical skills required for performing this procedure. Plain Language Summary There are many young patients with hip diseases who need to have hip replacement surgery. Although a traditional hip replacement is an acceptable procedure for these patients, some surgeons prefer using a newer technique in young patients called hip resurfacing. In this technique, instead of removing the head of the femoral bone, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the hip socket, similar to the cups used in traditional hip replacement. The analysis of the revision rates (i.e., how soon and in how many patients the surgery needs to be redone) and safety of resurfacing implants showed that generally these implants can last 10 years or more for the majority of young people. Good outcomes can be expected when skilled surgeons perform the surgery in properly selected patients. However, since these implants are made of metal (cobalt and chromium alloy), there is concern about excess metal debris production due to friction between the 2 metal components leading to high levels of metal ions in the blood and urine of patients. The production of metal debris may result in inflammation in the joint or development of a benign soft tissue mass leading to implant failure. However, it has been shown that this risk can be reduced by proper positioning of the implant and the careful selection of patients for this procedure. Little is known about the long-term biological effects of high levels of metal ions in the blood and urine of patients who have received metal implants. There is concern about potential increases in the risk of cancer and the risk of fetal abnormalities, but these effects have not been established yet. However, since cobalt and chromium can pass the placental barrier, implants that are not metal-on-metal are recommended for women at childbearing ages if they
Sehatzadeh, S; Kaulback, K; Levin, L
Progressive saphenous vein graft (SVG) narrowing and occlusion remains a major limitation of coronary artery bypass grafting and is an important target for gene therapy. Ex vivo adenoviral gene transfer of tissue inhibitor of metalloproteinase 3 (TIMP-3) reduces adverse SVG remodelling postarterialization, but concerns remain over the use of viral vectors in patients. Ultrasound exposure (USE) in the presence of echocontrast microbubbles (ECM) substantially enhances nonviral gene delivery. We investigated the effects of ultrasound-enhanced gene delivery (UEGD) of TIMP-3 plasmid on vascular remodelling in porcine SVG. Maximal luciferase activity (3000-fold versus naked plasmid alone) and TIMP-3 transgene expression in porcine vascular smooth muscle cells in vitro was achieved using USE at 1 MHz, 1.8 mechanical index (MI), 6% duty cycle (DC) in the presence of 50% (v/v) BR14 ECM (Bracco). These conditions were therefore utilized for subsequent studies in vivo. Yorkshire White pigs received carotid interposition SVG that were untransfected or had undergone ex vivo UEGD of lacZ (control) or TIMP-3 plasmids. At 28 d postgrafting, lumen and total vessel area were significantly greater in the TIMP-3 group (10.1+/-1.2 and 25.5+/-2.2 mm2, respectively) compared to untransfected (6.34+/-0.5 and 20.8+/-1.9 mm2) or lacZ-transfected (6.1+/-0.7 and 19.7+/-1.2 mm2) controls (P<0.01). These data indicate that nonviral TIMP-3 plasmid delivery by USE achieves significant biological effects in a clinically relevant model of SV grafting, and is the first study to demonstrate the potential for therapeutic UEGD to prevent SVG failure. PMID:15829995
Akowuah, E F; Gray, C; Lawrie, A; Sheridan, P J; Su, C-H; Bettinger, T; Brisken, A F; Gunn, J; Crossman, D C; Francis, S E; Baker, A H; Newman, C M
Objectives To compare the clinical and cost effectiveness of total hip arthroplasty with resurfacing arthroplasty in patients with severe arthritis of the hip. Design Single centre, two arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation. Setting One large teaching hospital in the United Kingdom. Participants 126 patients older than 18 years with severe arthritis of the hip joint, suitable for resurfacing arthroplasty of the hip. Patients were excluded if they were considered to be unable to adhere to trial procedures or complete questionnaires. Interventions Total hip arthroplasty (replacement of entire femoral head and neck); hip resurfacing arthroplasty (replacement of the articular surface of femoral head only, femoral neck remains intact). Both procedures replaced the articular surface of the acetabulum. Main outcome measures Hip function at 12 months after surgery, assessed using the Oxford hip score and Harris hip score. Secondary outcomes were quality of life, disability rating, physical activity level, complications, and cost effectiveness. Results 60 patients were randomly assigned to hip resurfacing arthroplasty and 66 to total hip arthroplasty. Intention to treat analysis showed no evidence for a difference in hip function between treatment groups at 12 months (t test, P=0.242 and P=0.070 for Oxford hip score and Harris hip score, respectively); 95% of follow-up data was available for analysis. Mean Oxford hip score was 40.4 (95% confidence interval 37.9 to 42.9) in the resurfacing group and 38.2 (35.3 to 41.0) in the total arthroplasty group (estimated treatment effect size 2.23 (?1.52 to 5.98)). Mean Harris hip score was 88.4 (84.4 to 92.4) in the resurfacing group and 82.3 (77.2 to 87.5) in the total arthroplasty group (6.04 (?0.51 to 12.58)). Although we saw no evidence of a difference, we cannot definitively exclude clinically meaningful differences in hip function in the short term. Overall complication rates did not differ between treatment groups (P=0.291). However, we saw more wound complications in the total arthroplasty group (P=0.056) and more thromboembolic events in the resurfacing group (P=0.049). Conclusions No evidence of a difference in hip function was seen in patients with severe arthritis of the hip, one year after receiving a total hip arthroplasty versus resurfacing arthroplasty. The long term effects of these interventions remain uncertain. Trial registration Current Controlled Trials ISRCTN33354155, UKCRN 4093.
Purpose We devised an intraoperatively identifiable mechanical axis (IIMA) as a reference of alignment in total knee arthroplasty (TKA). Materials and Methods Between February 2010 and January 2011, primary TKAs were consecutively performed on 672 patients (1007 knees) using an IIMA as a reference in the coronal plane. Results The alignment of the lower extremity improved from a mean of 11.4±6.7° (-10.3-34.4°) of varus preop. to 0.7±3.5° (-5.2-8.6°) immediately after surgery. Mean alignment of the femoral component in the coronal plane was 89.3±2.3° (83.4-97.2°) postop. and mean alignment of the tibial component was 90.4±2.2° (85.1-94.2°) postop. Conclusion This study showed that IIMA could be of considerable value as a new guider of alignment that is easily accessible and highly effective during total knee arthroplasty.
Seo, Jai-Gon; Moon, Young-Wan; Kim, Sang-Min; Jo, Byung-Chul
A method for performing shoulder arthroplasty or hemiarthroplasty is provided. The method includes generating navigational reference information relating to position and orientation of a body part forming at least a portion of the shoulder joint. The reference information may be stored in a computer. Navigational references are attached to the body part and an object. Information is received regarding the position and orientation of the object with respect to the body part and the object is navigated according to this information. The body part may be modified using the object and the modification may be displayed on a monitor associated with the computer. The navigational references may be used to track a shoulder arthroplasty trial component. Information is received regarding the position and orientation of the trial component with respect to the body part. This information is used to navigate the trial component to the body part.
Heterotopic bone formation in soft tissues occurs commonly in Paget's disease patients following a primary total hip arthroplasty (THA). The nature of this heterotopic bone has not been documented. In this report, we show that the heterotopic bone removed 14 years after primary THA in a case of Paget's disease was sclerotic, contained prominent mosaic cement lines and showed increased remodelling activity on the bone surface. In addition to these typically Pagetic histological features, it was noted ultrastructurally that the osteoclasts contained characteristic intranuclear viral-like inclusions. In contrast, the foreign body macrophages found in the joint pseudocapsule and pseudomembrane, which are a population of mononuclear precursor cells from which osteoclasts can be formed, did not contain viral-like inclusions. These findings are of interest regarding the pathogenesis of heterotopic bone formation following hip arthroplasty and the ontogeny of Pagetic osteoclasts. PMID:15260016
Ferguson, D J P; Itonaga, I; Maki, M; McNally, E; Gundle, R; Athanasou, N A
The purpose of this study was to determine the results of modular unlinked bicompartmental knee arthroplasty (BiKA) for medial (or lateral) and patellofemoral arthritis. Twenty-nine modular BiKAs were followed prospectively, for a mean of 31 months (range, 24-46 months). Outcome measures included Knee Society Knee and Function Scores, KOOS, SF-12, and WOMAC, as well as radiographic assessments and implant survivorship. Two tail paired Student's t test was used to determine statistical differences between preoperative and postoperative scores. Mean range of motion (ROM) improved from 122° to 133° (P<0.001). There was a statistically significant improvement across all functional scores. One patient underwent conversion to total knee arthroplasty at 3 years for knee instability. There were no cases of patellar instability, implant loosening or wear, or progressive arthritis. PMID:23731787
Kamath, Atul F; Levack, Ashley; John, Thomas; Thomas, Beverly S; Lonner, Jess H
Between 2001 and 2011, 1168 revision hip arthroplasties were reviewed for "early" failures within 5 years of the primary total hip arthroplasty (THA). 24.1% underwent revision within 5 years of index THA. Aseptic loosening, infection, instability, metallosis, and fracture were common modes of failure. In our previous report from 1986 to 2000, 33% were "early" revisions, with instability and aseptic loosening accounting for over 70% of these early failures. While the proportion of "early" revisions decreased 9% from our previous report, this rate remains alarming. The emergence of metallosis and aseptic loosening of monoblock metal on metal shells as leading causes of early failures is concerning. This report suggests caution in the early adoption of new innovations before evidence based medicine is available to justify the risk of their use. PMID:24444568
Melvin, J Stuart; Karthikeyan, Tharun; Cope, Robert; Fehring, Thomas K
Total knee arthroplasty patients often have difficulty performing activities involving flexion beyond 130 degrees. The NexGen LPS Flex (Zimmer Inc, Warsaw, Ind) mobile bearing implant accommodates up to 155 degrees of flexion. Two hundred eighteen total knee arthroplasties were performed using this implant on 125 patients over a 2-year period with a minimum of 5 years follow-up. All data were collected prospectively. Forty-four percent of preoperative cases had full flexion (ie, 140 degrees active flexion and ability to kneel with thigh/calf contact for 1 minute). Five-year data showed an average flexion of 140 degrees +/- 11.5 degrees and flexion greater than 140 degrees in 103 knees (68%). There were no differences in patellofemoral pain levels, complications, or Knee Society scores despite our patients having, on average, an increase in flexion and function. PMID:19106030
Tarabichi, Samih; Tarabichi, Yasir; Hawari, Marwan
Due to the increasing number of total hip arthroplasties performed during the last three decades and the limited long-term survival, mainly because of wear, the number of revisions has increased during the last two years. If the implant itself is still considered to be stable, only head and inlay exchange is necessary. This requires comprehensive knowledge of the characteristics of the articulating materials by the surgeon as the wrong choice of wear couple can lead to early failure for a second time. The aim of this paper is to present considerations and strategies for head and inlay exchange in case of failure, either due to wear of the articulation material or of other indications for revision hip arthroplasty.
We reviewed 46 patients who underwent salvage hip arthroplasty (SHA) for revision of failed cannulated screws (CS), sliding hip screws (SHS), or intramedullary nails (IMN). The primary objective was to determine differences in operative difficulty. SHA after failed femoral neck fixation was associated with lower intra-operative demands than after failed peri-trochanteric fractures. Similarly, analysis by the index implant found that conversion arthroplasty after failed CSs was associated with lower intra-operative morbidity than failed SHSs or IMNs; differences between SHS and IMN were not as clear. Importantly, intra-operative data in cases of failed SHSs were similar regardless of the original fracture type, showing the device played a larger role than the fracture pattern. Complications and revision surgery rates were similar regardless of fracture type or fixation device. Our results suggest that operative demands and subsequent patient morbidity are more dependent on the index device than the fracture pattern during SHA. PMID:23489728
DeHaan, Alexander M; Groat, Tahnee; Priddy, Michael; Ellis, Thomas J; Duwelius, Paul J; Friess, Darin M; Mirza, Amer J
We report a case of a 63-year-old man who presented an end stage hip osteoarthritis 42?years after a proximal femoral osteotomy performed for the treatment of an intracapsular femoral neck fracture. A cemented total hip arthroplasty was implanted using a standard posterior approach. The osteotomy hardware was totally covered with a new cortical bone formation. A layer of bone tissue was removed, the screw heads were broken and the nail plate was also removed. The screw threaded portions were retained because they did not interfere with cemented femoral stem implantation. Fourteen years after total hip arthroplasty, the patient reported no pain and expressed high satisfaction with the surgery. The hip radiograph showed wear of the polyethylene cup and no periprosthetic osteolysis. Retention of hardware can be considered, especially in patients who have had hardware for several years, without any negative symptoms. PMID:24990849
Judas, Fernando Monteiro; Rodrigues, Joana Bento; Lucas, Francisco Manuel; Freitas, João Paulo
Candida glabrata infection following total hip arthroplasty is rare and, due to the insufficiency of standardized clinical and evidence-based guidelines, there is no appropriate therapeutic schedule. The present study reports the case of a 44-year-old patient with Candida glabrata infection following a total hip arthroplasty. The patient was successfully treated by administration of intravenous and oral voriconazole without removal of the prosthesis. This case illustrates the significance of postoperative follow-up, clinician experience and the choice of the correct antifungal agent. In this case, we found in the early stage of Candida glabrata infection, we were able to control the infection without surgery through thorough irrigation. This reduces patient suffering and economic burden.
ZHU, YUN; YUE, CHEN; HUANG, ZEYU; PEI, FUXING
A Tensor/Balancer device (Stryker Howmedica Osteonics, Allendale, NJ) was used to restore optimal stability and alignment during 83 consecutive total knee arthroplasties with a minimum of 6-week clinical and radiographic follow-up. The surgical technique is described. Mean flexion-extension symmetry was restored to within 1 degrees. Mean femoral rotation required to achieve symmetry in flexion differed between varus (4.38 degrees ) and valgus (6.0 degrees ) knees. Of 83 knees, 7 had >3 mm of subjective laxity during component trialing and were associated with a preoperative deformity of >15 degrees; 19 knees required femoral rotation of >6 degrees and were associated with greater preoperative malalignment. Postoperative knee alignment, range of motion, Knee Society score, and lateral release rate were similar between the 2 groups. The use of a Tensor/Balancer device in total knee arthroplasty can achieve outcomes comparable to existing techniques with potential for improved technical accuracy. PMID:11805918
Winemaker, M J
Total hip arthroplasty is increasing in incidence due to our aging population. However, this procedure has a high potential for increased blood loss, with allogeneic blood transfusions commonly used. However, due to potential transfusion-related risks such as immunosuppression or infections, attempts have been made to reduce the amount of blood loss and minimize transfusions. Therefore, our aim was to provide a broad overview of the widely used methods for reducing post-operative blood loss after total hip arthroplasty. These include antifibrinolytic agents, autologous blood transfusion drains, avoiding the use of drains, and modifications in drainage techniques. In addition, lowering the transfusion threshold is another method used to decrease the rates of allogeneic blood transfusion. Current evidence suggests that the use of some of these strategies-either alone, or in combination-may reduce the amount of blood loss and the need for allogeneic transfusions. However, further research is needed to create new, more standardized guidelines. PMID:24347484
Jauregui, Julio J; Issa, Kimona; Kapadia, Bhaveen H; Banerjee, Samik; Harwin, Steven F; Mont, Michael A
Total knee arthroplasty is an increasingly common procedure that provides safe and effective pain relief and function restoration in patients with arthritis and osteoarthrosis. The success of the procedure is multifactorial, with implant alignment as one of the major factors involved in a satisfactory and reliable result. Total knee arthroplasty with surgical navigation was designed with the purpose of helping the surgeon improve implant alignment and position while he maintains control over the cuts made and fixation. We reviewed this article on the origins of navigation, the technical details, the advantages and disadvantages, including a glance at future uses and the reason why its use in knee replacement surgery plays such an important role; it has multiple applications and a reproducibility that turn it into an increasingly common, safe and successful procedure. PMID:24707609
Ochoa-Cázares, R; Cuadra-Castillo, M
A 73-year-old female patient underwent total knee arthroplasty for arthrosis. After surgery, recurvatum instability over 55 degrees occurred. Two years later, primary endoprosthesis was removed and a revision endoprosthesis implanted. However, complete deformity occurred again. Two years later, the thickest revision polyethylene tibial implant was implanted on the same endoprosthesis. In spite of using knee orthosis, recurvatum deformity returned. Seven months later, new revision rotating hinge prosthesis was implanted. This procedure seems to have solved the problem. The knee deformity in this specific case was larger than the deformity in cases reported so far, and it was solved after three surgical procedures. Rotating hinge prosthesis seems to be the method of choice for immediate repair of recurvatum instability after total knee arthroplasty. PMID:23115953
Erceg, Marinko; Raki?, Mladen
Periprosthetic supracondylar femur fractures following total knee arthroplasty are infrequent, but challenging to clinicians. In this article, we present a 74-year-old female case of bilateral supracondylar femoral periprosthetic fractures which were treated with locking plates. The fractures were healed with osseous union, the range of motion was 0-110° for each knee, and there was a 6° residual varus deformity in the left knee. The functional results were excellent during two-year follow-up. Open reduction and locking plate fixation are effective treatment methods for periprosthetic supracondylar fractures following total knee arthroplasty in selected patients. If an anterior femoral notching accidentally develops during the intraoperative setting, using a femoral component with an attached intramedullary stem supports weakened distal part of the femur. PMID:24191885
Ozcan, Ozal; Boya, Hakan; Ate?, Ali; Do?ruöz, F?rat
Understanding the difference in perceived functional outcomes between whites and blacks and the influence of anxiety and pain\\u000a on functional outcomes after joint arthroplasty may help surgeons develop ways to eliminate the racial and ethnic disparities\\u000a in outcome. We determined the difference in functional outcomes between whites and blacks and assessed the influence of fear\\u000a and anxiety in total joint
Carlos J. Lavernia; Jose C. Alcerro; Mark D. Rossi
Psychologic status is associated with poor outcome after knee arthroplasty yet little is known about which specific psychologic\\u000a disorders or pain-related beliefs contribute to poor outcome. To enhance the therapeutic effect of a psychologic intervention,\\u000a the specific disorders or pain-related beliefs that contributed to poor outcome should be identified. We therefore determined\\u000a whether specific psychologic disorders (ie, depression, generalized anxiety
Daniel L. Riddle; James B. Wade; William A. Jiranek; Xiangrong Kong
BACKGROUND: The health-related quality of life (HRQoL) is currently weighted more heavily when evaluating health status, particularly regarding medical treatments and interventions. However, it is rarely used by physicians to compare responsiveness. Additionally, responsiveness estimates derived by the Harris Hip Score (HHS) and the Short Form 36 (SF-36) before and after revision total hip arthroplasty (THA) have not been clinically
Hon-Yi Shi; Je-Ken Chang; Chi-Yin Wong; Jun-Wen Wang; Yuan-Kun Tu; Herng-Chia Chiu; King-Teh Lee
The aim of the study is three-fold: (i) to analyze association between early subjective functional outcome of total joint arthroplasty (TJA) and patient-related risk factors; (ii) to evaluate the six-month subjective functional outcome of TJA as compared with subjective functional status of non-operated outpatients; (iii) to evaluate TJA self-perceived amelioration rates compared to the status of an age-matched sample from
B. Caracciolo; S. Giaquinto
The purpose of the current study was to evaluate the long-term result of a tapered, uncemented femoral component. We retrospectively reviewed the clinical and radiographic records of 121 patients (129 hips) who underwent primary total hip arthroplasty with the use of the Taperloc uncemented stem. Follow-up averaged 11 years (range, 6–15 years). The mean Harris Hip Score at the latest
Javad Parvizi; Kjell S Keisu; William J Hozack; Peter F Sharkey; Richard H Rothman
e have performed a clinical and radiological analysis of 105 shoulder arthroplasties in patients with rheumatoid arthritis. The clinical results showed improvements in the Constant-Murley and Association of Shoulder and Elbow Surgeons score of 21 and 35, respectively. Both were statistically significant (p < 0.001). This improvement was maintained over a period of 8.8 years. There was no statistically significant
I. A. Trail; D. Nuttall
A Kudo total elbow arthroplasty (TEA) was performed in 36 elbows in 35 patients with rheumatoid arthritis. Of those 35, 4 died, 6 prostheses were revised, and 2 were lost to follow-up. Twenty-four elbows with a mean follow-up of 58 months were radiologically and clinically reviewed. Sixteen were scored as excellent by use of the Mayo score and Hospital for
Karel Willems; Luc De Smet
OBJECTIVES: This paper proposes imaging with 3-dimensional vibroacoustography for postoperatively assessing the uncovered cup area after total hip arthroplasty as a quantitative criterion to evaluate implant fixation. METHODS: A phantom with a bone-like structure covered by a tissue-mimicking material was used to simulate a total hip arthroplasty case. Vibroacoustography images of the uncovered cup region were generated using a two-element confocal ultrasound transducer and a hydrophone inside a water tank. Topological correction based on the geometry of the implant was performed to generate a 3-dimensional representation of the vibroacoustography image and to accurately evaluate the surface. The 3-dimensional area obtained by the vibroacoustography approach was compared to the area evaluated by a 3-dimensional motion capture system. RESULTS: The vibroacoustography technique provided high-resolution, high-contrast, and speckle-free images with less sensitivity to the beam incidence. Using a 3-dimensional-topology correction of the image, we accurately estimated the uncovered area of the implant with a relative error of 8.1% in comparison with the motion capture system measurements. CONCLUSION: Measurement of the cup coverage after total hip arthroplasty has not been well established; however, the covered surface area of the acetabular component is one of the most important prognostic factors. The preliminary results of this study show that vibroacoustography is a 3-dimensional approach that can be used to postoperatively evaluate total hip arthroplasty. The favorable results also provide an impetus for exploring vibroacoustography in other bone or implant surface imaging applications.
Kamimura, Hermes A. S.; Wang, Liao; Carneiro, Antonio A. O.; Kinnick, Randall R.; An, Kai-Nan; Fatemi, Mostafa
Total hip arthroplasty with use of metal-on-metal bearings has been reintroduced as an alternative to metal-on-polyethylene\\u000a bearings because of theoretical advantages such as reduced wear and a lower prevalence of osteolysis. However, we have observed\\u000a early osteolysis in nine patients (ten hips) out of 165 patients (169 hips) who had been managed with total hip replacements\\u000a using a contemporary metal-on-metal
Y.-S. Park; Y.-W. Moon; S.-J. Lim
This study evaluates steady-state serum metal levels in patients with 4 different combinations of fixation modalities, materials, and bearing couples. Forty patients with a minimum of 5 years of follow-up and with well-functioning primary total hip arthroplasty were recruited to have serum metal levels measured. Serum chromium and cobalt levels in the metal-on-metal cohort were significantly higher (P < .05)
Vijay J. Rasquinha; Chitranjan S. Ranawat; Joanne Weiskopf; Jose A. Rodriguez; Anastasia K. Skipor; Joshua J. Jacobs
Total knee arthroplasty following complex fractures of the tibial plateau is considered a challenge for orthopaedic surgeons\\u000a and clinical outcomes may vary. A total of 29 total knee replacements were performed after a tibial plateau fracture: 25 patients\\u000a (16 women, 9 men; average age: 57 years; mean follow-up: 92 months) were available. We had two significative complications:\\u000a one partial avulsion
R. Civinini; Christian Carulli; F. Matassi; M. Villano; M. Innocenti
Fifty years have passed since the first total hip arthroplasty of the modern era was performed. At this, the vantage point,\\u000a it is reasonable to review these five decades, inquiring behind the single dominating observation that, in its current form,\\u000a this operation is one of the most successful of all surgical procedures for the management of end-stage human disease. What
William H. Harris
Background One of the most serious complications after major orthopedic surgery is deep wound or periprosthetic joint infection. Various risk factors for infection after hip and knee replacement surgery have been reported, including patients' comorbidities and surgical technique factors. We investigated whether hyperglycemia and diabetes mellitus (DM) are associated with infection that requires surgical intervention after total hip and knee arthroplasty. Methods We reviewed our computerized database for elective primary total hip and knee arthroplasty from 2000 to 2008. Demographic information, past medical history of patients, perioperative biochemistry, and postoperative complications were reviewed. Patients were divided into two groups: infected group (101 patients who had surgical intervention for infection at our institution within 2 years after primary surgery) and noninfected group (1847 patients with no intervention with a minimum of one year follow-up. The data were analyzed using t, chi-squared, and Fisher's exact tests. Results There were significantly more diabetes patients in the infected group compared with the noninfected group (22% versus 9%, p < .001). Infected patients had significantly higher perioperative blood glucose (BG) values: preoperative BG (112 ± 36 versus 105 ± 31 mg/dl, p = .043) and postoperative day (POD) 1 BG (154 ± 37 versus 138 ± 31 mg/dl, p < .001). Postoperative morning hyperglycemia (BG >200 mg/dl) increased the risk for the infection more than two-fold. Non-DM patients were three times more likely to develop the infection if their morning BG was >140 mg/dl on POD 1, p = .001. Male gender, higher body mass index, knee arthroplasty, longer operative time and hospital stay, higher comorbidity index, history of myocardial infarction, congestive heart failure, and renal insufficiency were also associated with the infection. Conclusions Diabetes mellitus and morning postoperative hyperglycemia were predictors for postoperative infection following total joint arthroplasty. Even patients without a diagnosis of DM who developed postoperative hyperglycemia had a significantly increased risk for the infection.
Mraovic, Boris; Suh, Donghun; Jacovides, Christina; Parvizi, Javad
Background and purpose The aim of short-stem total hip arthroplasty is to preserve proximal bone stock for future revisions, to improve biomechanical reconstruction, and to make minimally invasive approaches easier. It is therefore being increasingly considered to be a sound alternative to conventional total hip arthroplasty, especially for young and active patients. However, it is still unknown whether survival rates of short-stem hips match current standards. We made a systematic summary of reported overall survival after short-stem total hip arthroplasty. Materials and methods We conducted a systematic review of English, French, German, and Dutch literature. 2 assessors independently identified clinical studies on short-stem hip arthroplasty. After recalculating reported revision rates, we determined whether each implant had a projected revision rate of 10% or less at 10 years of follow-up or a revision rate per 100 observed component years of 1 or less. Stems were classified as “collum”, “partial collum”, or “trochanter-sparing”. Results and Interpretation We found 49 studies, or 51 cohorts, involving 19 different stems. There was a large increase in recent publications. The majority of studies included had a follow-up of less than 5 years. We found a large number of observational studies on “partial collum” and “trochanter-sparing” stems, demonstrating adequate survival rates at medium-term follow-up. Clinical evidence from “collum stem” studies was limited to a small number of studies with a medium-term follow-up period. These studies did not show a satisfactory overall survival rate.
van Oldenrijk, Jakob; Molleman, Jeroen; Klaver, Michel; Poolman, Rudolf W; Haverkamp, Daniel
Introduction: This study examined patient demographics, length of hospital stay, and discharge disposition in those undergoing non-elective revision total hip arthroplasty (ne-rTHA) versus elective rTHA (e-rTHA).Methods: Data from 23,000 patients with hip revisions from 2005 through 2007 were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. We examined patient admission status, demographics, length of stay, and
Jacob D. Sams; Mark L. Francis; Steve Scaife; Brooke S. Robinson; Wendy M. Novicoff; Khaled J. Saleh
A 59-year-old woman with bilateral congenital knee dislocation due to Larsen syndrome was treated by arthroplasty. To prevent neurovascular deficiency and major loss of bone substance, a continuous joint distraction was performed by unilateral external fixation. After a period of 25 days and a leg lengthening of 4.5 cm, a constrained total knee endoprosthesis was implanted. Both operations and their postoperative courses were free of complications. A previously planned lengthening of the Achilles tendon was unnecessary. PMID:20091295
Müller, M; Strecker, W
Asymmetric posterior glenoid wear caused by degenerative glenohumeral arthritis can be addressed by several techniques during\\u000a total shoulder arthroplasty. The purpose of this study was to evaluate the midterm outcome of a posterior augmented glenoid\\u000a component to determine the clinical and radiographic outcome, including complications and the need for revision surgery. Between\\u000a 1995 and 1999, 13 patients (14 shoulders) underwent
Robert S. Rice; John W. Sperling; Joseph Miletti; Cathy Schleck; Robert H. Cofield
BACKGROUND: Information on early recovery after arthroplasty is needed to help benchmark progress and make appropriate decisions concerning patient rehabilitation needs. The purpose of this study was to model early recovery of physical function in patients undergoing total hip (THA) and knee (TKA) arthroplasty, using physical performance and self-report measures. METHODS: A sample of convenience of 152 subjects completed testing,
Deborah M Kennedy; Paul W Stratford; Steven E Hanna; Jean Wessel; Jeffrey D Gollish
The results of a consecutive series of uncemented total hip arthroplasties in patients 50 years or younger are reviewed. There were 41 total hip arthroplasties in 36 patients at an average follow-up period of 5.3 years. Average patient age was 42 years at the time of implantation. Preoperative Harris hip score (HHS) averaged 39100; the final HHS averaged 93. Radiographic
Paul A. Dowdy; Cecil H. Rorabeck; Robert B. Bourne
This study was undertaken to determine whether patients with severe rheumatoid arthritis and irreparable rotator cuff rupture can be treated successfully with the Grammont shoulder arthroplasty. Seven patients with rheumatoid arthritis (8 shoulders) with nonreconstructible rotator cuff lesions and Larsen stage-V radiographic changes of the glenoid and the humeral head underwent a Grammont reverse shoulder arthroplasty. The Constant score improved
Markus Rittmeister; Fridun Kerschbaumer
The incidence of pseudotumor formation has been reported to be 1% in patients with metal-on-metal resurfacing arthroplasties. This complication is not exclusive to these patients. We report a case of pseudotumor formation secondary to femoral head-neck corrosion after a metal-on-polyethylene uncemented total hip arthroplasty. PMID:21955792
Mao, Xinzhan; Tay, Guan H; Godbolt, David B; Crawford, Ross W
We present a case involving the revision of a total knee arthroplasty with a metal femoral component using a ceramic implant due to metal hypersensitivity. A 58-year-old female patient underwent total knee arthroplasty (TKA) with a standard metal bicondylar knee system. She suffered from persistent pain and strong limitations in her range of motion (ROM) associated with flexion during the
Philipp Bergschmidt; Rainer Bader; Wolfram Mittelmeier
The incidence of postoperative complications following computer navigated total knee arthroplasty is unknown. There is no published evidence to support decreased morbidity compared to standard conventional technique. The Nationwide Inpatient Sample database was used to identify 101,596 patients who underwent total knee arthroplasty in 2005. Of these patients, 1156 were coded as having a computer-assisted procedure. Bivariate analysis and regression
James A. Browne; Chad Cook; Aaron A. Hofmann; Michael P. Bolognesi
Resurfacing hip arthroplasty is an alternative to conventional arthroplasty and it is indicated in young and active patients. Good results and the prevention of complications stem from a meticulous surgical technique and proper patient selection. We present herein the case of a 43 year-old patient who, after undergoing bilateral hip replacement with resurfacing prostheses, sustained a non-simultaneous fracture of both femoral necks due to avascular necrosis. He was treated by placing a metaphyseal anchoring stem. Postoperative X-rays showed proper implant placement without femoral notching, with a discrete 7 degrees valgus alignment of the femoral component. Both passive and active mobility was painful. X-rays showed cervical fracture of the right femur. The femoral head was attached to the implant, with no metallosis nor loosening of the femoral or acetabular components, but the bone had a fragmented and friable appearance that histopathologically was defined as avascular necrosis. Femoral neck fracture is the main complication after resurfacing hip arthroplasty. The effect of other factors like bone necrosis due to cement is unknown. PMID:22512114
Sanz-Ruiz, P; Chana-Rodríguez, F; Villanueva-Martínez, M; Vaquero-Martín, J
Background There is growing support in the literature that patient outcomes are adversely affected by physician fatigue in operator-dependent cognitive and technical tasks. Recent increases in total joint arthroplasty caseloads have resulted in longer operative days and increased surgeon fatigue. We sought to determine if time of day predicts perioperative complications and outcomes in total joint arthroplasty. Methods The records of all total hip and knee arthroplasties (THA; TKA) performed for primary osteoarthritis in one calendar year at one large university hospital were retrospectively reviewed. Demographic data, surgery start time and duration, intraoperative complications, radiographic component alignment and functional outcome scores (SF-12 and Western Ontario and McMaster Universities Osteoarthritis Index) were collected and analyzed using linear and nonparametric rank correlation statistics. Data were corrected for sex, body mass index, surgeon and postcall operating days. Results In the THA cohort (n = 341), a later surgery start time was significantly related to duration of surgery (p = 0.004, mean difference ?7.1 min). There was a trend toward significance between a later surgery start time and intraoperative femur fracture (p = 0.05). Postoperative complications, component alignment and functional outcome scores were not significantly affected by surgery start time. There were no significant findings for any of the intraoperative or postoperative outcomes in the TKA cohort (n = 292). Conclusion Duration of surgery and incidence of intraoperative complications for THA may increase with later surgery start time; however, the relatively small statistical differences observed imply that they likely are not clinically significant.
Peskun, Christopher; Walmsley, David; Waddell, James; Schemitsch, Emil
Infection remains a devastating complication of joint replacement surgery causing a significant burden to both patient and surgeon. However, despite exhaustive prophylactic measures, intraoperative contamination still occurs during cemented arthroplasty with current infection rates of 1-2%. A study was undertaken to determine the incidence of perioperative contamination in cemented arthroplasty patients, to identify contaminating organisms, to identify contaminated regions within the operative wound, to identify factors associated with increased contamination, and finally to assess the medium-term clinical outcome in patients with confirmed intraoperative wound contamination. Eighty consecutive patients undergoing hip and knee cemented arthroplasty were prospectively enrolled over a 6-month period. All scrubbed personnel wore total body exhaust isolation suits and procedures were carried out in ultra-clean air theatres. Of 441 samples, contamination was identified at 21 sites (4.8%) representing a cohort of 18 patients (22.5%). Longer duration of surgery predisposed to higher contamination rates while lower contamination rates were significantly related to fewer gowned personnel within the ultra-clean system, and fewer total personnel in theatre during the procedure. None of the patients developed clinical evidence of deep prosthetic infection at follow-up. We noted a high incidence of intraoperative contamination despite standard prophylaxis. However, this was not reflected by a similar rate of postoperative infection. This may be due to a small bacterial inoculum in each case or may be due to the therapeutic effect of perioperative intravenous antibiotic prophylaxis. PMID:16586132
Byrne, A M; Morris, S; McCarthy, T; Quinlan, W; O'byrne, J M
For various reasons the tapered, fluted, modular titanium (TFMT) stem has become our component of choice over cylindrical, nonmodular cobalt chrome (CNCC) components for THA revision. We therefore asked whether the TFMT femoral components better achieved three important goals of revision arthroplasty than CNCC stems: (1) improving quality of life; (2) avoiding complications; and (3) preserving or restoring femoral bone stock. We compared patients undergoing femoral component revision hip arthroplasty with either a CNCC (N = 105) component or a TFMT (N = 95) component to determine if the increased use of TFMT components is justified. We retrospectively reviewed all patients undergoing revision total hip arthroplasty between January 2000 and March 2006. All eligible patients completed outcome questionnaires (WOMAC, SF-12, Oxford-12, UCLA Activity Score, and Satisfaction Scores). Radiographs were evaluated for loosening and preservation or restoration of the proximal femur host bone. The TFMT and CNCC cohorts were comparable with respect to age, gender, diagnosis, and comorbidities. The TFMT cohort had worse preoperative bone defects (65% Paprosky 3B and 4). The TFMT cohort had higher outcome scores (WOMAC pain, WOMAC stiffness, Oxford-12, and Satisfaction), fewer intraoperative fractures, and better restoration of the proximal femur host bone. Our data suggest the TFMT stem provided improved clinical outcomes (improved quality of life, decreased complications, and preservation of bone stock) than the CNCC stem. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19847578
Richards, Corey J; Duncan, Clive P; Masri, Bassam A; Garbuz, Donald S
The stabilizing influence of radial head arthroplasty was studied in eight medial collateral ligament deficient anatomic specimen elbows. An elbow testing apparatus, which used computer controlled pneumatic actuators to apply tendon loading, was used to simulate active elbow flexion. The motion pathways of the elbow were measured using an electromagnetic tracking device, with the forearm in supination and pronation. As a measure of stability, the maximum varus to valgus laxity over the range of elbow flexion was determined from the difference between varus and valgus gravity loaded motion pathways. After transection of the medial collateral ligament, the radial head was excised and replaced with either a silicone or one of three metallic radial head prostheses. Medial collateral ligament transection caused a significant increase in the maximum varus to valgus laxity to 18.0 degrees +/- 3.2 degrees. After radial head excision, this laxity increased to 35.6 degrees +/- 10.3 degrees. The silicone implant conferred no increase in elbow stability, with a maximum varus to valgus laxity of 32.5 degrees +/- 15.5 degrees. All three metallic implants improved the valgus stability of the medial collateral ligament deficient elbow, providing stability similar to the intact radial head. The use of silicone arthroplasty to replace the radial head in the medial collateral ligament deficient elbow must be questioned. Metallic radial head arthroplasty provides improved valgus stability, approaching that of an intact radial head. PMID:10613159
King, G J; Zarzour, Z D; Rath, D A; Dunning, C E; Patterson, S D; Johnson, J A
Background A variety of femoral stem designs have been reported to be successful in revision total hip arthroplasty without consensus as to optimal design. We evaluated the clinical and radiographic outcomes in a consecutive series of femoral revisions using a wedge-shape, tapered-stem design at medium and long-term follow-up. Materials and methods We performed a retrospective review of clinical and radiographic outcomes of twenty-eight consecutive femoral revisions arthroplasties, which were done using the Zweymuller femoral stem. Results The mean follow-up was 7.4 years (range 2–15 years). No stem re-revision was necessary. All stems were judged to be stable by radiographic criteria at the most recent follow-up. The final mean Harris hip score was 90. There was no difference in Harris hip scores, implant stability, or radiological appearance (distal cortical hypertrophy or proximal stress shielding) of the implants between medium-term (mean 5.7 years) and long-term (mean 12.4 years) follow-up. Conclusions We found the Zweymuller femoral stem design to be durable for revision hip arthroplasty when there is an intact metaphyseal-diaphyseal junction for adequate press-fit stability at surgery.
Huo, Michael H.; Keggi, Kristaps J.
Porous tantalum is an alternative metal for total joint arthroplasty components that offers several unique properties. Its high volumetric porosity (70% to 80%), low modulus of elasticity (3 MPa), and high frictional characteristics make it conducive to biologic fixation. Tantalum has excellent biocompatibility and is safe to use in vivo. The low modulus of elasticity allows for more physiologic load transfer and relative preservation of bone stock. Because of its bioactive nature and ingrowth properties, tantalum is used in primary as well as revision total hip arthroplasty components, with good to excellent early clinical results. In revision arthroplasty, standard and custom augments may serve as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fibrous ingrowth properties and allows for substantial soft-tissue attachment, indicating potential for use in cases requiring reattachment of muscles and tendons to a prosthesis. Development of modular components and femoral stems also is being evaluated. The initial clinical data and basic science studies support further investigation of porous tantalum as an alternative to traditional implant materials. PMID:17077337
Levine, Brett; Della Valle, Craig J; Jacobs, Joshua J
Asymmetric posterior glenoid wear caused by degenerative glenohumeral arthritis can be addressed by several techniques during total shoulder arthroplasty. The purpose of this study was to evaluate the midterm outcome of a posterior augmented glenoid component to determine the clinical and radiographic outcome, including complications and the need for revision surgery. Between 1995 and 1999, 13 patients (14 shoulders) underwent a shoulder arthroplasty with an augmented glenoid component to treat posterior glenoid bone deficiency. All 14 shoulders had advanced osteoarthritis. The minimum followup for these 13 patients was 2 years (mean, 5 years; range, 2–8 years). The mean age of these patients was 66 years at the time of surgery (range, 52–78 years). The mean active elevation was 160° (range, 120°–180°) and external rotation was 56° (range, 30°–90°). According to a modified Neer result rating system, 36% of patients had an excellent result, 50% a satisfactory result, and 14% an unsatisfactory result. Our results suggest patients undergoing total shoulder arthroplasty with an asymmetric glenoid component for osteoarthritis achieve satisfactory mid-term pain relief and improvement in function; however, instability is not always corrected. The advantage of this component seems marginal, and its use has been discontinued. Level of Evidence: Level IV, retrospective review. See Guidelines for Authors for a complete description of levels of evidence.
Rice, Robert S.; Miletti, Joseph; Schleck, Cathy; Cofield, Robert H.
The purpose of this case report was to look at the long-term (average 17.8 years) results of total wrist arthroplasty. Of the 12 wrists (9 patients) available for evaluation, 7 wrists still had the arthroplasty in place whereas 5 wrists had been revised to an arthrodesis. The average age at time of arthroplasty for those requiring an arthrodesis was 17 years less than those not requiring an arthrodesis. This suggests that there is a higher incidence of loosening when total wrist arthroplasty is performed in younger patients, perhaps due to these younger patients having higher demands or having more severe rheumatoid arthritis. In this younger population, the implant metacarpal stem cut out in three wrists and ulnar drift occurred in two wrists. All patients said that if given the chance, they would have a total wrist arthroplasty again, despite their long-term results being poor and many of them being revised to a wrist arthrodesis.
Ekroth, Scott R.; Werner, Frederick W.; Palmer, Andrew K.
Experience with bone morphogenetic protein-2 and interpositional grafting of edentulous maxillae: a comparison of Le Fort I downfracture to full-arch (horseshoe) segmental osteotomy done in conjunction with sinus floor grafting.
This paper is a retrospective report of the treatment of six patients with severely resorbed maxillae. Patients were treated, based on the amount of maxillary retrognathia, with either a Le Fort I downfracture or a "horseshoe" interpositional sandwich osteotomy, along with sinus elevation. Recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier was used for grafting in all patients, either alone or in combination with other grafting materials. Implants were placed and the patients were restored with fixed prostheses. Both grafting techniques are described, and the treated patients are presented. PMID:24278951
Jensen, Ole T; Cottam, Jared R; Ringeman, Jason L; Leopardi, Aldo; Butler, Brian; Laviv, Amir; Fleissig, Yoram; Casap, Nardy
The 2002 issue of the Gap Analysis Bulletin is the eleventh in a series of annual publications produced by the National Gap - -- Analysis Program. Gap Analysis Bulletin No. 11 features 18 articles on various aspects of gap analysis methods and results. Th...
E. S. Brackney R. Brannon K. J. Gergely M. D. Jennings
The 2005 issue of the Gap Analysis Bulletin is the thirteenth in a series of annual publications produced by the Gap Analysis Program. Gap Analysis Bulletin No. 13 features 12 articles on various aspects of gap analysis methods and results. Articles in th...
J. Maxwell K. Gergely J. Aycrigg D. Beard T. Sajwaj
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.
Background In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. Methods A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. Results The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Conclusions Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.
NASA's General Aviation Propulsion (GAP) program is a cooperative program between government and industry. NASA's strategic direction is described by the "Three Pillars" and their Objectives as set forth by NASA Administrator Daniel S. Goldin. NASA's Three Pillars are: 1) Global Civil Aviation, 2) Revolutionary Technology Leaps, and 3) Access To Space.
This issue of "ETS Policy Notes" discusses gender differences in educational achievement. The first article--"The Gender Gap in Education: How Early and How Large?"--discusses the National Assessment of Educational Progress (NAEP), which first measures achievement at age 9 years. Gender differences at that age are generally small, but significant…
ETS Policy Notes, 1989
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…
Optical absorption and reflectivity measurements on synthetic forsterite show that this silicate has a wide band gap of the order of 8.4 electron volts; thus it resembles other pure insulating oxides such as MgO. For natural olivines, in which divalent ca...
T. J. Shankland
The current generation gap in academia is different--fundamentally shaped by the structural problems of academic employment. The job market has especially exacerbated tensions between senior and junior faculty by ratcheting up expectations and requirements at every stage of the academic career. The disparities have been mentioned often enough to…
Course research projects that use easy-to-access real-world data and that generate findings with which undergraduate students can readily identify are hard to find. The authors describe a project that requires students to estimate the current female-male earnings gap for new college graduates. The project also enables students to see to what…
McDonald, Judith A.; Thornton, Robert J.
The objective of this study was to compare comorbidity, functional ability, and health care utilization in veterans with total\\u000a knee arthroplasty (TKA) or total hip arthroplasty (THA) versus matched control populations. A cohort of veterans using Veterans\\u000a Affairs (VA) healthcare system reported limitations in six activities of daily living (ADLs; bathing, dressing, eating, walking,\\u000a transferring, and using the toilet), demographics,
Jasvinder A. Singh; Jeffrey Sloan
BACKGROUND: Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare
Wierd P Zijlstra; Nanne Bos; Jos JAM van Raaij
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…
Created by Boyang Liu and Professor Seng-Tiong Ho at Northwestern University, and presented by the NanoEd Resource Portal, this site covers the concept of the photonic band gap. Here, visitors will find a basic description of the concept, ideas of how to incorporate it into classroom activities, and a user's manual to walk students step-by-step through the concept. There is also a link to an interactive simulation (the link is labeled Open Visualization), which allows students to adjust the wavelength and color of the light source, particle size, and incident angle to view changes to the photonic band gap. This is a thorough and useful resource for any nanotechnology classroom.
Ho, Seng-Tiong; Liu, Boyang
Vehicles proposed to fill the gap in the U.S. space program's space transport needs for the next decade resulting from the January Challenger disaster, are discussed. Prior to the accident, the Air Force planned to purchase a Complementary Expendable Launch Vehicle system consisting of 10 single-use Titan-34D7 rockets. Another heavy lift booster now considered is the Phoenix H. Commercial launch
A new finding gets scientists one step closer to understanding what causes the gap in the Van Allen radiation belts. The discovery could help better predict fluxes of energetic particles that have the potential for damaging spacecraft and satellites and harming astronauts. An improved understanding could also give space physicists better insight into the radiation belts of other planets, including Jupiter, Saturn, Uranus, and Neptune, all of which have strong magnetic fields.
Abstract: Background: Anterior cervical discectomy and fusion (ACDF) is currently treatment of choice for managing medical therapy refractory cervical degenerative disc disease. Numerous studies have demonstrated the effectiveness of ACDF; patients generally experience rapid recoveries, and dramatic improvement in their pain and quality of life. However, as several studies reported symptomatic adjacent segment disease attributed to fusions’ altered kinematics, cervical disc arthroplasty emerged as a new motion-sparing alternative to fusion. Fusion at one level increases motion at adjacent levels along with increased intradiscal pressures. This phenomenon can result in symptomatic adjacent level degeneration, which can necessitate reoperation at these levels. The era of cervical arthroplasty began in Europe in the late 1990s. In recent years, artificial cervical disc arthroplasty (ACDA) has been increasingly used by spine surgeons for degenerative cervical disc disease. There have been several reports of safety, efficacy and indications of ACDA. Cervical arthroplasty offers several theoretical advantages over anterior cervical discectomy and fusion (ACDF) in the treatment of selected patients with medically refractory cervical radiculopathy. Preserving motion at the operated level, cervical TDR has the potential to decrease the occurrence of adjacent segment degeneration. There are a few studies on the efficacy and effectiveness of ACDA compared to cervical fusion. However, the true scenery of cervical arthroplasty yet to be identified. Objective: This study is intended to define patients' characteristics and outcomes of ACDA by a single surgeon in Iran. Methods: This retrospective study was performed in two general Hospitals in Tehran, Iran from 2005 To 2010. All patients were operated by one senior neurospine surgeon. One hundred fifty three patients were operated in this period. All patients signed the informed consent form prior to surgery. All patients presented with cervical discopathy who had myelopathy or radiculopathy and failed conservative management, undergoing cervical disc arthroplasty by ACDA were included, consecutively. Patients were followed for at least 2 years. Exclusion criteria was age greater than 60 years, non compliance with the study protocol, osteoporosis, infection, congenital or post traumatic deformity, malignancy metabolic bone disease, and narrow cervical canal (less than 12 mm). Heterotopic ossification and adjacent segment degenerative changes were assessed at 2 years follow up by means of neutral and dynamic xrays and CT/MRI if clinically indicated. Neck and upper extremity pain were assessed before the procedure and in the first post-operative visit and 3 months later by means of visual analogue scale. A standard approach was performed to the anterior cervical spine. Patients were positioned supine while holding neck in neutral position. A combination of sharp and blunt dissection was performed to expose longus coli musculature and anterior cervical vertebrae. Trachea and esophagus were retracted medially and carotid artery and jugular vein laterally. After a thorough discectomy, the intersomatic space is distracted in a parallel way by a vertebral distracter. Followed by Caspar distractor is applied to provide a working channel into posterior disc space. In this stage, any remnant disc materials as well as osteophytes are removed and foraminal decompression is done. Posterior longitudinal ligament (PLL) opening and removal, although discouraged by some, is done next. In order to define the size of the prosthesis, multiple trials are tested. It is important not to exceed the height of the healthy adjacent disc to avoid facet joint overdistraction. An specific insertor is applied to plant the prosthesis in disc space. Control X-rays are advised to check the precise positioning of the implant. Results: one hundred-fifty three patients including 87 females and 66 males were included. The mean age was 41 for females and 42 for males. Affected level was C5-C6 in 81 cases, C6-C7 in 72
Khadivi, Masoud; Rahimi Movaghar, Vafa; Abdollahzade, Sina
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.
Callaghan, John J; Pedersen, Douglas R; Johnston, Richard C; Brown, Thomas D
A case is presented illustrating the potential effect of Brennan Healing Science on pain following hip arthroplasty for avascular necrosis. A 54-year-old woman experienced anterior groin pain, numbness at the bottom of her foot, and occasional grinding at her hip 22 years after right total hip arthroplasty secondary to avascular necrosis. X-ray films showed signs of osteolysis behind the acetabular cup and asymmetric decreased polyethylene thickness of the acetabular prosthetic. Her orthopedic surgeon advised the patient to follow up every 6-9 months to avoid catastrophic failure of the implant, with plans for surgical revision to be scheduled at the next appointment. The patient sought alternative treatment to avoid an invasive procedure. On presentation, the patient had difficulty walking up the stairs into the treatment room due to pain which she rated a 9/10. She found it painful to rotate, flex, extend her hip, or to sit. Hands-on healing techniques based on the Brennan Healing Science method were initiated, starting at the feet, balancing the energy, and working the way up the joints. Once the work at the hip was completed, the hands-on techniques continued up the centerline of the body and the healing was brought to a close. On completion of a 60-minute healing, the patient was able to stand freely and rated her pain as a 4/10. Flexion, extension, and rotation at the hip were no longer distressing. She was able to walk up and down stairs without distress and denied instability, bursitis, or trochanteric or iliopsoas pain or swelling. Repeat X-rays showed decrease in bone spurs and no hardware problem, and her orthopedic surgeon recommended follow-up after 2 years. It is suggested that Brennan Healing Science techniques could play an effective and cost-efficient role in the treatment of pain following hip arthroplasty. PMID:24439097
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
Butler, James E; Shannon, Robert
Metal-on-metal bearings have been used in total hip arthroplasty for decades. Because younger patients with higher physical demands are now being treated with hip arthroplasty, the popularity and use of metal-on-metal bearings has increased over the past 10 years. New concerns, however, have emerged regarding the percentage of patients with a hypersensitivity reaction or pseudotumor formation after arthroplasty with these bearings. These concerns have raised questions concerning long-term outcomes for patients treated with metal-on-metal bearings. It is important for orthopaedic surgeons to review these issues so that better educated decisions can be made in treating their patients. PMID:21553777
Gonzalez, Mark H; Carr, Ryan; Walton, Sharon; Mihalko, William M
A 68-year-old woman with osteoarthritis had a ceramic-on-ceramic left total hip arthroplasty, including ceramic femoral head and acetabular liner. At 5 years after surgery, the patient developed onset of a very loud squeaking noise, which could be heard 25 m from her, associated with limited hip movement. Findings at revision surgery included a broken ceramic femoral head component, complete wear of the ceramic acetabular component, and black wear debris. Squeaking hip after ceramic-on-ceramic total hip arthroplasty may be associated with catastrophic failure of the arthroplasty components. PMID:23429031
Malem, David; Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik
In acute periprosthetic infection, irrigation and debridement with component retention has a high failure rate in some studies. We hypothesize that pulse lavage irrigation is ineffective at removing biofilm from total knee arthroplasty (TKA) components. Staphylococcus aureus biofilm mass and location was directly visualized on arthroplasty materials with a photon collection camera and laser scanning confocal microscopy. There was a substantial reduction in biofilm signal intensity, but the reduction was less than a ten-fold decrease. This suggests that irrigation needs to be further improved for the removal of biofilm mass below the necessary bioburden level to prevent recurrence of acute infection in total knee arthroplasty. PMID:24439797
Urish, Kenneth L; DeMuth, Peter W; Craft, David W; Haider, Hani; Davis, Charles M
Osteotomies of the proximal femur and proximal tibia in revision arthroplasty are well described while guidelines for distal femoral osteotomy are limited. Femoral stems are used with increasing frequency for fixation of revision components in knee arthroplasty and their removal is technically challenging particularly in the setting of infection. We describe a technique of anterior distal femoral osteotomy for revision knee arthroplasty to assist with removal of well-fixed long stemmed cemented or porous femoral components, as well as debridement of infection while preserving bone stock and soft tissue attachments. PMID:24581896
Merz, Michael K; Farid, Yasser R
Since its introduction, unicompartmental knee arthroplasty has been controversial because of poor early clinical outcomes due to implant design, bony fixation, surgical instrumentation, and technique. Improvements in surgical technique and implant design have resulted in improved results and greater survivorship. The ability to obtain accurate implant placement includes avoiding surgeon decisions leading to potential errors. These errors include alignment in the sagittal, coronal, and axial planes on each prepared condyle as well as the preservation of the joint line and the resulting overall limb alignment as something critical to obtaining a successful outcome. PMID:24274850
Background Total joint arthroplasty (TJA) is remarkably successful for treating osteoarthritis: most patients see substantial gains in\\u000a function. However, there are considerable geographic, racial, and gender variations in the utilization of these procedures.\\u000a The reasons for these differences are complex.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes We examined sex and gender disparities in TJA.\\u000a \\u000a \\u000a \\u000a Methods Through Medline\\/PubMed searches, we identified 632 articles and from these selected 61 for
Wendy M. Novicoff; Khaled J. Saleh
Many treatment options are available to manage bone loss associated with revision total knee arthroplasty. Selection of the best treatment method is based on many factors, including defect size and location and the patient's age, health, and ability to participate in the necessary postoperative rehabilitation. Metaphyseal sleeves and cones appear to be a promising addition in dealing with large, central, contained and noncontained defects. The use of stem extensions in cases of bone deficits is helpful in enhancing fixation and lessening stresses to weakened condylar bone. PMID:23395039
Daines, Brian K; Dennis, Douglas A
BACKGROUND: Shoulder arthritis of varied aetiology is often disabling and patients seek treatment for pain relief and restricted movements. Though non operative measures in the form of analgesics, physiotherapy and joint injections offer satisfactory results in the early stages; operative treatment in the form of joint replacements becomes necessary in late and advanced stages. The above operations are being performed more frequently in the recent years across the National Health Service [NHS] in the UK with increasing success in specialised units and the outcome of the operation is often rewarding. In addition to the other complications, risks of Deep vein thrombosis [DVT] and pulmonary embolism [PE] exists. Available evidence suggests a low incidence but the true risk has only been partially addressed. The final decision to consider thromboprophylaxis rests with the operating surgeon. It is important to carefully balance the clinical decision of thromboprophylaxis and bleeding with wound complications, which add considerable morbidity and mortality. To define the risk of DVT in this subgroup of patients is the initial step to enable better use of resources and achieve cost effectiveness. This we believe will provide robust evidence to help formulate guidelines for thromboprophylaxis in shoulder arthroplasty.Methods/design: The aim will be to determine whether shoulder arthroplasties carry a risk of DVT. A cohort of 100 consecutive patients being considered for shoulder arthroplasty for degenerative arthritis, rotator cuff arthropathy, inflammatory arthropathy including rheumatoid arthritis will be prospectively considered for the study. All eligible patients will be assessed clinically and screened for DVT in all 4 limbs both pre and postoperative with Doppler scans within a 6 week perioperative period. We aim to include the reasons for non inclusion of eligible patients and patient's perspective of their general well being in relation to DVT. DISCUSSION: We present the risk of DVT associated with shoulder arthroplasties to establish a good quality evidence for thromboprophylaxis. The study is underway and we would further be able to define whether the general risk factors for DVT are relevant to shoulder replacements. PMID:23597070
Madhusudhan, Thayur R; Sinha, Amit; Widdowson, David
Most surgeons believe that some level of modularity has a valuable role to play in primary total hip arthroplasty. However, all modular junctions carry some risk and recent problems with taper tribocorrosion have elevated concerns. These problems suggest that more rigorous preclinical testing should be undertaken before new types of modularity are widely used. Efforts to further optimize these junctions where they are needed, avoidance of gratuitous use of modular junctions where they provide only modest benefits, and a judicious approach to adopting new modularity are reasonable approaches to current concerns. PMID:24655609
Berry, Daniel J
Background Bacteria shed by operating room personnel is a source of wound contamination and postoperative infections. The personal protection\\u000a system (PPS) was designed to decrease airborne bacteria and intraoperative contamination in total joint arthroplasty.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes We determined the microbial contamination rate of the PPS and incidence of contamination with key pathogens, Staphylococcus\\u000a aureus and coagulase-negative staphylococci.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods We prospectively evaluated PPS
Kenneth A. Kearns; Dan Witmer; Junaid Makda; Javad Parvizi; Donald Jungkind
Background While most reports of audible squeaking in total hip arthroplasty (THA) have focused on ceramic bearings, squeaking can occur\\u000a in metal-on-metal bearings and may be an important clinical complication to consider during patient followup.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes We retrospectively identified 10 patients with squeaking metal-on-metal hip resurfacings.\\u000a \\u000a \\u000a \\u000a Methods This study reports acetabular inclination angles and patient satisfaction, and describes two patients with squeaking resurfacings:
Christina Esposito; William L. Walter; Pat Campbell; Anne Roques
Many early metal-on-polyethylene hip resurfacing arthroplasty designs were abandoned after reports of high short-term and\\u000a midterm failure rates. To investigate factors associated with failure, we retrospectively reviewed our experience with early-design\\u000a hip resurfacing implants in 75 patients during a 25-year period (median followup, 7.9 years; range, 0.1–25.2 years). Implant\\u000a failure was defined as revision for any reason. One of 75 patients was
Eric J. Yue; Miguel E. Cabanela; Gavan P. Duffy; Michael G. Heckman; Mary I. O’Connor
Objectives To review the current best surgical practice and detail a multi-disciplinary approach that could further reduce joint replacement infection. Methods Review of relevant literature indexed in PubMed. Results Surgical site infection is a major complication following arthroplasty. Despite its rarity in contemporary orthopaedic practice, it remains difficult to treat and is costly in terms of both patient morbidity and long-term health care resources. Conclusions Emphasis on education of patients and all members of the health-care team and raising awareness in how to participate in preventative efforts is imperative.
Johnson, R.; Jameson, S. S.; Sanders, R. D.; Sargant, N. J.; Muller, S. D.; Meek, R. M. D.; Reed, M. R.
A painful knee after total knee arthroplasty may have various causes. In addition to commonly occurring causes, such as infections, aseptic loosening, implant failure or typical anterior knee pain, rare causes also have to be taken into account. We report a previously unknown cause of knee pain after total knee replacement involving a non-resected medial meniscus, which was sandwiched between the medial condyle of the femur and the inlay of the prosthesis and caused pain typical for a medial meniscus. After arthroscopic meniscectomy the patient was symptom-free. PMID:24190241
Ramsauer, T; Seitlinger, G; Niederseer, D
Pseudoaneurysms of peripheral arteries are not an uncommon condition presenting to vascular surgeons. Perioperative injury and infection are two of the commonest causes. We describe a case of an 82-year-old lady, who presented 10?years following right shoulder joint replacement, with a sharply marginated erythematous cutaneous eruption over the right shoulder. Subsequent angiography revealed a pseudoaneurysm of the acromial branch of the thoracoacromial artery. Planned intervention was superseded by a further embolic episode, which prompted immediate percutaneous translumninal embolisation of the aneurysm. The aetiology of a pseudoaneurysm 10?years following shoulder arthroplasty is discussed. PMID:24973348
Wright, Anna Elizabeth; Wall, Michael; Slaney, Penny; Downing, Richard
Gap junctions are plasma membrane domains containing arrays of channels that exchange ions and small molecules between neighboring\\u000a cells. Gap junctional intercellular communication enables cells to directly cooperate both electrically and metabolically.\\u000a Several lines of evidence indicate that gap junctions are important in regulating cell growth and differentiation and for\\u000a maintaining tissue homeostasis. Gap junction channels consist of a family
Edward Leithe; Edgar Rivedal
This paper presents a method for extending operating system functionality in a way that is secure, efficient, simple, requires no kernel source changes, and is compatible with existing application binaries. Our approach is to enable extensions of the system call interface by loading a device driver into the kernel that redirects system calls to extension code running either in the
Douglas P. Ghormley; David Petrou; Thomas E. Anderson
Background Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potentially increased metal ion release. Patients and methods 71 patients (< 65 years old) were randomly assigned to receive either a resurfacing (R) hip arthroplasty (n = 38) or a conventional metal-on-metal (C) hip arthroplasty (n = 33). Functional outcomes were assessed preoperatively and at 6, 12, and 24 months. Cobalt and chromium blood levels were analyzed preoperatively and at 3, 6, 12, and 24 months. Results All functional outcome scores improved for both groups. At 12 and 24 months, the median UCLA activity score was 8 in the R patients and 7 in the C patients (p < 0.05). At 24 months, OHS was median 16 in C patients and 13 in R patients (p < 0.05). However, in spite of randomization, UCLA scores also appeared to be higher in R patients at baseline. Satisfaction was similar in both groups at 24 months. Cobalt concentrations were statistically significantly higher for R patients only at 3 and 6 months. Chromium levels remained significantly higher for R patients until 24 months. No pseudotumors were encountered in either group. One R patient was revised for early aseptic loosening and in 2 C patients a cup insert was exchanged for recurrent dislocation. Interpretation R patients scored higher on UCLA, OHS, and satisfaction at some time points; however, as for the UCLA, preoperative levels were already in favor of R. The differences, although statistically significant, were of minor clinical importance. Chromium blood levels were statistically significantly higher for R patients at all follow-up measurements, whereas for cobalt this was only observed up to 6 months. The true value of resurfacing hip arthroplasty over conventional metal-on-metal hip arthroplasty will be determined by longer follow-up and a possible shift of balance between their respective (dis)advantages.
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.
Bhagwat, M. S.; Krassnigg, A.; Maris, P.; Roberts, C. D.; Physics; Univ. Graz; Univ. of Pittsburgh
Severe metabolic acidosis in the setting of alcoholism raises diagnostic and therapeutic problems [Levinsky 1994]. Alcoholic ketoacidosis and toxic alcohol ingestion can be difficult to distinguish on initial presentation [Litovitz 1986]. A high osmolal gap associated with increased anion gap acidosis is said to be indicative of toxic alcohol poisoning though this is not at all specific [Salem and Mujais 1992]. Invasive therapeutic manoeuvers as for toxic alcohol poisoning have been recommended empirically before toxicological confirmation when very high osmolarity gaps are reached. Herein, we report two cases of high anion gap metabolic acidosis with very high osmolal gap due to alcoholic ketoacidosis without any evidence of toxic alcohol ingestion. PMID:9247780
Almaghamsi, A M; Yeung, C K
Pseudopseudohypoparathyroidism (PPH) is a rare genetic disorder characterized by multiple musculoskeletal anomalies and normal serum calcium, phosphate, and parathyroid hormone levels. Although the musculoskeletal manifestations of PPH are well known, little has been reported on the management of orthopedic problems. We report a case of total knee arthroplasty (TKA) performed in a patient with PPH. To our knowledge, this case is not only unique to the arthroplasty literature but is the first report of its kind. This report illustrates the unique pathoanatomy of PPH, the medical and surgical management required, and a previously unreported musculoskeletal abnormality associated with PPH: synovial osteochondromatosis of the knee. Common musculoskeletal anomalies associated with PPH include shortening/bowing of long bones; shortening of metacarpals, metatarsals, and/or phalanges; exostoses; calcification/ossification of subcutaneous and/or periarticular soft tissues; a thickened calvarium; microcephaly; bony coalitions of the hand; vertebral column abnormalities; cubitus valgus; radius/ulna curvus; coxa vara; coxa valga; and genu valgum. This case is the first to report an association of synovial osteochondromatosis with PPH. Because synovial osteochondromatosis and PPH share a common disorder of soft tissue calcification/ossification, as well as abnormal bone formation, this clinical finding does not seem merely coincidental. PMID:21815586
Fraser, Michael R; Sechriest, V Franklin
Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed. PMID:24122437
Banerjee, Samik; Kapadia, Bhaveen H; Issa, Kimona; McElroy, Mark J; Khanuja, Harpal S; Harwin, Steven F; Mont, Michael A
OBJECTIVES: To evaluate the correlation between radiographic parameters and functional assessments of patients with osteoarthritis of the shoulder who underwent shoulder arthroplasty and to describe the functional outcomes of this procedure in our institution. METHODS: We evaluated 21 patients (22 shoulders) who underwent shoulder arthroplasty between 1998 and 2010 and with a minimum follow-up of 12 months. Clinical evaluation was performed using the Constant-Murley scale, UCLA, EVA and by measuring the active motion. We analysed preoperative (distance between the top of the head and the humerus and the acromion, superior migration, neck angulation, medial "offset", subluxation, glenoid erosion) and postoperative radiographic parameters (rod inclination, migration of components and loosening). RESULTS: Patients showed significant improvement in all parameters: flexion (p = 0.0083), abduction (p = 0.0266), external rotation (p = 0.0062), Constant-Murley (p = 0.0001 ), UCLA (p <0.0001) and VAS (p = 0.0002). The superior migration of the humerus showed a significant correlation with UCLA and Constant-Murley scores (p = 0.0480 and p = 0.0110, respectively). The other radiographic parameters showed no correlation with the clinical outcomes. CONCLUSION: The superior migration of the humerus is related to worse clinical scores. Level of Evidence IV, Case Series.
Gracitelli, Mauro Emilio Conforto; Duarte, Fernando Aires; Toffoli, Rogerio Padovani; Burnato, Joao Henrique; Malavolta, Eduardo Angeli; Ferreira, Arnaldo Amado
Background and purpose Wear debris from conventional total hip arthroplasty (THA) induces chromosomal aberrations and DNA damage, which may promote cancerogenesis. A long latent period is required for solid tumors. We therefore re-analyzed a large THA cohort for cancer. Patients and methods We updated a cohort of 24,636 patients with primary osteoarthritis and metal-on-polyethylene THA who had been entered in the Finnish Arthroplasty Register between 1980 and 1995, and linked it to the Finnish Cancer Registry for cancer risk assessment up to 2005. The mean follow-up time was 13 years. The numbers of cancer cases observed were compared with expected rates based on incidence in the general population. Results The standardized incidence ratio (SIR) for the whole follow-up period was 0.95 (95% confidence interval (CI): 0.92–0.97). After 10 years of follow-up, the SIR was equal to that in the normal population (SIR = 0.98, 95% CI: 0.94–1.03). Incidence of lung cancer was low throughout the follow-up time and that of prostate cancer was slightly elevated. The incidence rates for all other forms of cancer did not deviate significantly from those in the normal population. Interpretation We found no increased cancer risk in patients with conventional THA after an average of 13 years and up to 25 years of follow-up.
Pulkkinen, Pekka; Paavolainen, Pekka; Pukkala, Eero
Introduction In patients who have undergone a total joint replacement, any mass occurring in or adjacent to the joint needs thorough investigation and a wear debris-induced cyst should be suspected. Case presentation An 81-year-old man presented with a painful and enlarging mass at the popliteal fossa and calf of his right knee. He had had a total right knee replacement seven years previously. Plain radiographs showed narrowing of the medial compartment. Magnetic resonance imaging showed a cystic lesion at the postero-medial aspect of the knee joint mimicking popliteal cyst or soft tissue sarcoma. Fine needle aspiration was non-diagnostic. A core-needle biopsy showed metallosis. Intraoperative findings revealed massive metallosis related to extensive polyethylene wear, delamination and deformation. Revision knee and patella arthroplasty was carried out after a thorough debridement of the knee joint. Conclusion Long-term follow-up is critical for patients with total joint replacement for early detection of occult polyethylene wear and prosthesis loosening. In these cases, revision arthroplasty may provide a satisfactory knee function.
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
Steele, Garen D; Fehring, Thomas K; Odum, Susan M; Dennos, Anne C; Nadaud, Matthew C
Fifty years have passed since the first total hip arthroplasty of the modern era was performed. At this, the vantage point, it is reasonable to review these five decades, inquiring behind the single dominating observation that, in its current form, this operation is one of the most successful of all surgical procedures for the management of end-stage human disease. What are the generic lessons that can be derived from the experience? Succinctly, five major observations appear valuable. They are “skunk works,” “Pasteur’s motto,” “the totally unexpected,” “research solutions,” and “the role of alternatives.” “Skunk works,” an industrial management term, might be characterized as an innovative endeavor that is offline and off-budget resulting from the relentless pursuit of a vivid dream by creative zealots who eschew defeat. Pasteur’s motto dealt with serendipity, which was crucial to total hip arthroplasty progress. The totally unexpected is represented by an entirely new manmade disease, “periprosthetic osteolysis.” The research solutions are represented by the complex, sophisticated contemporary research that has unraveled periprosthetic osteolysis and suggested modes of correction. Finally, the application of “alternatives” has characterized major progress. Importantly, these, or similar generic observations, may provide insights into important progress in the future.
A retrospective clinical and roentgenographic review was performed on 69 consecutive cementless total hip arthroplasties that had been in situ for an average of 64.4 months (range, 57-91 months). Four patients had bilateral operations. There were 23 men and 42 women. The Lord Madreporic prosthesis (Bacneux, France) was used in 49 cases, and the Link prosthesis (Waldemar Link, Hamburg, Germany) was used in 20 cases. Preoperative diagnoses were osteoarthritis (76.8%), rheumatoid arthritis (17.4%), and miscellaneous (5.8%). At the final follow-up examination, the median hip score, assessed according to a modification of the Mayo scoring system, was 86.7 points. Seventy-eight percent of the cases had a good result, 11% were fair, and 4.7% were poor. The overall revision rate was 6.3%. No significant correlation existed between the roentgenographic and clinical findings. Subsidence of the femoral component is not a definitive hallmark of loosening in the midrange interval, that is, between 2 and 5 years. The cementless hip arthroplasty is suitable for patients with rheumatoid arthritis. PMID:7699379
Lautiainen, I A; Joukainen, J; Mäkelä, E A
Background?The most common forms of salvage surgery for wrist arthritis of any stage are four corner fusion and proximal row carpectomy. Younger, high demand patients with early arthritis may not be candidates for this type of salvage surgery. We describe a technique and preliminary case series of a minimal radiocarpal arthroplasty aimed at patients with initial and isolated wrist arthritis (stage 1). This procedure does not preclude any procedure that may become necessary in the future. Patients?A series of nineteen male heavy laborers with scapholunate advanced collapse (SLAC grade 1–2) wrist osteoarthritis that felt the wrist arthritis was prohibiting their function enough to warrant surgery, but were unwilling to undergo a salvage procedure, were treated with the technique. The average age was 57.2 (±?7.7) years. The average follow up period was 40.3 months (9–63 months). All patients returned to heavy labor. No revision surgery was needed within the follow up period. Range of motion (ROM) and grip strength did not significantly improve. Patient satisfaction was high despite imperfect results. Conclusions?Minimal arthroplasty as described may provide a temporary solution for active patients with symptomatic early wrist arthritis who are not candidates for salvage wrist surgery. Longer -term follow up as well as investigation of additional stabilization procedures is necessary.
Wollstein, Ronit; Carlson, Lois
Appropriate femoral component positioning and sizing is essential for proper kinematic function in total knee arthroplasty (TKA). Anterior or posterior referencing (AR or PR) are two major techniques for setting center of rotation and for balancing the sagittal plane of the arthroplasty. Both techniques have advantages and disadvantages. Minimally invasive surgical (MIS) TKA has added yet another aspect to intraoperative techniques and postoperative outcomes. A total of 100 consecutive patients undergoing unilateral MIS TKA were prospectively randomized to either AR or PR. Knee Society Scores, range of motion, SF-12, and strength testing by Cybex dynamometer were evaluated at standardized intervals postoperatively for 2 years. There were no statistically significant differences in surgical (incision length, surgical release, blood loss, surgical time, and length of stay) or clinical outcomes between two groups at all postoperative intervals (2 and 6 weeks, 3 and 6 months, and 1 and 2 years). Results demonstrate that both AR and PR are effective and can be used successfully during MIS TKA. PMID:24285366
Fokin, Alexander A; Heekin, Richard D
Although there is no clear evidence, minimally invasive hip arthroplasty seems to be associated with slightly higher complication rates compared to standard procedures. Major nerve palsy is one of the least common but most distressing complications. The key for minimizing the incidence of nerve lesions is to analyze preoperative risk factors, accurate knowledge of the anatomy and minimally invasive techniques. Once clinical signs of nerve injury are evident, the first diagnostic steps are localization of the lesion and quantification of the damage pattern. Therefore, clinical assessment of the neurological deficits should be performed as soon as possible. Apart from rare cases of isolated transient conduction blockade or complete transection, the damage pattern is mostly combined. Thus, there can be evidence for dysfunction of nerve conduction (neuropraxia) and structural nerve damage (axonotmesis or neurotmesis) simultaneously. Because the earliest signs of denervation are detectable via electromyography after 1 week, it is not possible to make any reliable prognosis within the first days after nerve injury using electrophysiological methods. This review article should serve as a guideline for prevention, diagnostics and therapy of neural lesions in minimally invasive hip arthroplasty. PMID:22581146
Holzapfel, B M; Heinen, F; Holzapfel, D E; Reiners, K; Nöth, U; Rudert, M
We reviewed the experience of a dedicated orthopaedic elective service to determine whether we could establish a BMI group where arthroplasty was no longer effective as assessed by the patient’s functional outcome. This was a prospective observational study with retrospective analysis of data collected on 1439 total hip arthroplasty, 934 total knee arthroplasty and 326 unicompartment knee arthroplasty patients. Functional scores (WOMAC, Oxford hip and knee scores and HAAS) were obtained preoperatively and at 12 months post op. Patients had their BMI recorded at the preoperative assessment and were divided into BMI groups (BMI<25, BMI 25-30, BMI 30-35 and BMI > 35). Patients with a BMI of ? 30 had significantly better functional scores at 12 months post op compared to those with a BMI of > 35. The absolute gain in functional scores from pre op to 12 months post op did not differ significantly between BMI groups, the only significant difference we found for absolute gain showed patients with a BMI of > 35 have a greater increase in HAAS scores following total hip arthroplasty compared to patients with a BMI of 30 or less (p = 0.0435). Our patients with higher BMI’s had worse preoperative and post operative functional scores but their benefit from surgery measured by the change in functional scores showed no difference compared to patients with lower BMI. We could find no reason on the basis of the 12-month results to limit surgery to obese patients because of an expected poorer functional outcome.
Lash, H.; Hooper, G.; Hooper, N.; Frampton, C.
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.
Razak, Arif; Ebinesan, Ananthan Dave
Describes how nursing care measures important in preoperative, postoperative, and discharge planning care of the total hip arthroplasty patient. These include prevention of the dislocation, occupied bed-making, patient transfer, and positioning and exerci...
CT navigation has been shown to improve component positioning in total shoulder arthroplasty. The technique can be useful in achieving strong initial fixation of the metal backed glenoid in reverse shoulder arthroplasty. We report a 61 years male patient who underwent reverse shoulder arthroplasty for rotator cuff arthropathy. CT navigation was used intraoperatively to identify best possible glenoid bone and to maximize the depth of the fixation screws that anchor the metaglene portion of the metal backed glenoid component. Satisfactory positioning of screws and component was achieved without any perforation or iatrogenic fracture in the scapula. CT navigation can help in maximizing the purchase of the fixation screws that dictate the initial stability of the glenoid component in reverse shoulder arthroplasty. The technique can be extended to improve glenoid component position [version and tilt] with the availability of appropriate software.
Gavaskar, Ashok S; Vijayraj, K; Subramanian, SD Muthukumar
An audit of wound healing in patients undergoing total hip or knee arthroplasty in a Scottish hospital found that use of a barrier film made no difference to the effectiveness of a new Hydrofiber/hydrocolloid dressing combination. PMID:19131911
Clarke, J V; Deakin, A H; Dillon, J M; Emmerson, S; Kinninmonth, A W G
In this article, we present a 68 year-old female case admitted with complaints of a painful knee and walking difficulty with simultaneous advanced gonarthrosis and a huge osteochondroma in posterior distal femur which was adjacent to the vessel and nerve structures, who was treated with a single incision via posterior approach for tumor excision and arthroplasty. Simultaneous tumor excision and arthroplasty application were scheduled and the knee joint was reached via posterior popliteal approach. Hinged knee prosthesis was applied through the same incision following tumor excision. Two-stage surgical procedures can be an option for coexisting bone tumor and arthrosis. Arthroplasty can be performed following tumor excision. In our case, we managed two distinct different problems in a single session with a single approach. To the best of our knowledge, this is the first knee arthroplasty case performed with posterior approach. PMID:25036398
Keçeci, Burçin; Küçük, Levent
In an effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) and overall periprosthetic joint infections (PJI), we switched the perioperative prophylactic antibiotic during total knee arthroplasty and total hip arthroplasty from cefazolin to vancomycin in June 2008. We retrospectively reviewed the total and MRSA PJI in 5036 primary total joint arthroplasties, as well as the cure rate of PJI from January 2006 to June 2008 (Ancef Period) and June 2008 to December 2010 (Vanco Period). With vancomycin, total PJI was significantly reduced (1.0%-0.5%) and MRSA PJI (0.23%-0.07%). Periprosthetic joint infections that occurred were more successfully treated with irrigation and debridement only, not requiring spacer (76.9% vs 22.2%). The use of vancomycin as the perioperative prophylactic antibiotic for primary total joint arthroplasties appeared to be effective in decreasing the rate of PJI and may result, when they occur, in infections with less virulent organisms. PMID:22608685
Smith, Eric B; Wynne, Rachael; Joshi, Ashish; Liu, Hans; Good, Robert P
Osteoporosis is a common condition. As the population ages, more patients with osteoporosis will require orthopedic procedures, including arthroplasty. Adverse outcomes are more likely for patients with osteoporosis requiring orthopedic procedures, for example those with intraoperative fractures, periprosthetic osteolysis with implant migration, and postoperative periprosthetic fractures. Cemented prosthetic hip replacements may be more successful among patients with poor bone quality. Femoral neck fracture is a concern during hip resurfacing among patients with osteoporosis. Vitamin D deficiency is common among patients undergoing joint arthroplasty and the ideal vitamin D level for joint arthroplasty has yet to be determined. Both bisphosphonates and teriparatide may aide successful osteointegration among patients undergoing noncemented joint arthroplasty. Focusing on bone health perioperatively should result in better outcomes for orthopedic procedures. PMID:24085661
Russell, Linda A
Objective: To compare the use of uncemented implants in total hip arthroplasty in patients with rheumathologic diseases and mechanical osteoarthrosis. Methods: We retrospectively evaluated 196 patients who were operated by the Hip and Arthroplasty Surgery Group of the IOT-HCFMUSP between 2005 and 2009. Patients were divided into two groups: mechanical causes (165 patients) and rheumathologic causes (31 patients). Groups were compared between each other in age, gender and follow-up time. Osseointegration rate and percentage of failure in arthroplasty were evaluated. Results: No statistically significant difference was found in osseointegration rates (in both femoral and acetabular components) in both groups. The rates of revision surgery and implant survival also did not show statistically significant differences. Conclusion: The use of uncemented total hip arthroplasty did not show worse results in rheumathologic patients. Level of Evidence III, Retrospective Case Control Study.
Ejnisman, Leandro; Leonhardt, Nathalia Zalc; Fernandes, Laura Fillipini Lorimier; Leonhardt, Marcos de Camargo; Vicente, Jose Ricardo Negreiros; Croci, Alberto Tesconi
Periprosthetic fractures associated with total knee arthroplasty are rare but present a challenging problem particularly when associated with revision arthroplasty. Fractures around tibial stems are particularly difficult with no accepted technique in their management. This case describes a tibial periprosthetic fracture following a revision knee arthroplasty which was successfully managed with a Pulsed ElectroMagnetic Field bone stimulation device. We believe this to be first reported use of a bone stimulation device in this clinical environment.
Doorgakant, Ashtin; Marynissen, Hans
Femoral malrotation in total knee arthroplasty is correlated to an increased number of revisions. Anatomic landmarks such as Whiteside line, posterior condyle axis and transepicondylar axis are used for determining femoral component rotation. The femoral rotation achieved with the anatomical landmarks is compared to the femoral rotation achieved by a navigated ligament tension-based tibia-first technique. Ninety-three consecutive patients with gonarthritis were prospectively enrolled. Intraoperatively the anatomical landmarks for femoral rotation and the achieved femoral rotation using a navigated tension-based tibia-first technique were determined and stored for further comparison. A pre- and postoperative functional diagram displaying the extension and flexion and varus or valgus positions was also part of the evaluation. Using anatomical landmarks the rotational errors ranged from 12.2° of internal rotation to 15.5° of external rotation from parallel to the tibial resection surface at 90° flexion. A statistical significant improved femoral rotation was achieved using the ligament tension-based method with a rotational error ranged from 3.0° of internal rotation to 2.4° of external rotation. The functional analyses demonstrated statistical significant lower varus/valgus deviations within the flexion range and an improved maximum varus deviation at 90° flexion using the ligament tension-based method. Compared to the anatomical landmarks a balanced, almost parallel flexion gap was achieved using a navigation technique taking the ligament tension of the knee joint into account. As a result the improved femoral rotation was demonstrated by the functional evaluation. Unilateral overloading of the polyethylene inlay and unilateral instability can thus be avoided. PMID:20061156
Walde, T A; Bussert, J; Sehmisch, S; Balcarek, P; Stürmer, K M; Walde, H J; Frosch, K H
Limitation in daily physical activity is one of the reasons for total hip arthroplasty (THA) or total knee arthroplasty (TKA).\\u000a However, studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning.\\u000a We determined the effect of THA or TKA on patients’ actual physical activity and body function (pain, stiffness), capacity
Ingrid B. de Groot; Hans J. Bussmann; Henk J. Stam; Jan A. Verhaar
Background: The influence of two-incision total hip arthroplasty on muscular function has not been reported. We hypothesized that recovery could be different for the hip flexors and extensors because an intermuscular interval was used in the flexors but a trans-muscular approach was used for the extensors. Methods: Two-incision total hip arthroplasties were performed in 10 patients (8 men and 2
Shih-Wei Chou; Steve WN Ueng; Mel S. Lee
Our objective was to evaluate functional outcomes after surgery in a subgroup of patients presenting for hip and knee surgery who had low functional scores before surgery. One hundred twenty-seven unilateral total hip and knee arthroplasty patients were assessed preoperatively and 3 consecutive years after arthroplasty using: Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Short Form 36 (SF-36), and
Carlos Lavernia; Michele D'Apuzzo; Mark D. Rossi; David Lee
Neglected dislocations of the hip are uncommon and open reduction is usually followed by avascular necrosis and subsequent coxarthrosis. We present a rare case of neglected, locked, obturator type of inferior hip dislocation in a young adult presenting 6 months after initial trauma treated with a cementless total hip arthroplasty which, to the best of our knowledge, has not been reported previously. Technical aspects of total hip arthroplasty and other treatment options in this scenario are discussed. PMID:20567838
Pankaj, Amite; Sharma, Mrinal; Kochar, Vivek; Naik, V Anand
Thirty-nine cementless hip arthroplasties using metal-on-metal articulation were consecutively implanted in 30 patients less than 50 years of age and compared with a matched control group (by age, diagnosis, Devane activity, and Harris hip scores) of cementless arthroplasties using ceramic-on-polyethylene articulation. The Harris hip score at follow-up (minimum 5 years) for the metal-on-metal was 94.9 (range, 74–100). After the same
Henri Migaud; Alexandre Jobin; Christophe Chantelot; François Giraud; Philippe Laffargue; Antoine Duquennoy
Navigated freehand bone cutting (NFC) is introduced as a concept to eliminate alignment jigs and facilitate smaller arthroplasty incisions. We compare experimental cuts with this technique to conventional jigs. Using an in-house–built computer-aided orthopedic surgery system directly navigating a bone saw, users with different levels of surgical skills were timed performing full sets of distal femoral total knee arthroplasty cuts
Hani Haider; O. Andres Barrera; Kevin L. Garvin
Revision total knee arthroplasty in patients with rheumatoid arthritis can be challenging. We asked whether we could confirm\\u000a previously reported high failure rates following revision total knee arthroplasty in patients with rheumatoid arthritis. We\\u000a therefore determined the Knee Society knee score and function scores, radiographic evidence of failure, and overall survival\\u000a of the revision procedure in these patients. We retrospectively
Ryan M. Garcia; Brian T. Hardy; Matthew J. Kraay; Victor M. Goldberg
The present investigation aims to evaluate periprosthetic bone remodelling after total knee arthroplasty by the use of dual-energy\\u000a X-ray absorptiometry (DXA). Twelve patients affected by osteoarthrosis of the knee joint underwent primary total knee arthroplasty\\u000a at an average age of 70.5 years. None of them had received a knee prosthesis before on the contralateral side. Anteroposterior\\u000a and lateral DXA measurements
A. Karbowski; M. Schwitalle; A. Eckardt; J. Heine
The resurgence of metal-on-metal articulating surfaces for hip arthroplasty has also heightened concerns about the degree and magnitude of metal particle generation and the accompanying increase in circulating metal ion concentrations. In this study, we measured the concentration of chromium in serum and urine and the concentration of cobalt in serum in twenty-five patients with modern metal-on-metal surface arthroplasty of
Anastasia K. Skipor; Patricia A. Campbell; Leslie M. Patterson; Harlan C. Anstutz; Thomas P. Schmalzried; Joshua J. Jacobs
At present, no consensus exists on the best spacer alternative for the management of two-stage exchange arthroplasty of infected knee arthroplasties. In this retrospective study, patient records of 24 patients, who had undergone two-stage revisions in which resterilised prosthetic components were used as spacers, were reviewed. The outcome was compared to that of operations performed during the same period (1993–2003)
E. Jämsen; P. Sheng; P. Halonen; M. U. K. Lehto; T. Moilanen; J. Pajamäki; T. Puolakka; Y. T. Konttinen
Various knee balancers have been developed to assist surgeons in balancing the flexion and extension spaces during total knee arthroplasty. Devices typically are designed to measure the distance between spaces during total knee arthroplasty at a given force level. We analyzed the accuracy of one type of these devices. We found that the devices accurately measure distances, but are quite inaccurate at demonstrating reproducible forces. PMID:20580189
Kesman, Thomas J; Kane, Paul H; Kaufman, Kenton R; Trousdale, Robert T
Background and purpose The use of hip arthroplasties is evidently increasing, but there are few published data on the incidence in young patients. Methods We used data on total and resurfacing hip arthroplasties (THAs and RHAs) from the Finnish Arthroplasty Register and population data from Statistics Finland to analyze the incidences of THA and RHA in patients aged 30–59 years in Finland, for the period 1980 through 2007. Results The combined incidences of THAs and RHAs among 30- to 59-year-old inhabitants increased from 9.5 per 105 inhabitants in 1980 to 61 per 105 inhabitants in 2007. Initially, the incidence of THA was higher in women than men, but since the mid-90s the incidences were similar. The incidence increased in all age groups studied (30–39, 40–49, and 50–59 years) but the increase was 6-fold and 36-fold higher in the latter two groups than in the first. The incidence of THA was constant; the increased incidence of overall hip arthroplasty was due to the increasing number of RHAs performed. Interpretation We have found a steady increase in the incidence of hip arthroplasty in patients with primary hip osteoarthritis in Finland, with an accelerating trend in the past decade, due to an increase in the incidence of RHA. As the incidence of hip osteoarthritis has not increased, the indications for hip arthroplasty appear to have become broader.
The efficaciousness of topical tranexamic acid use at the end of knee arthroplasty surgery to reduce blood loss and transfusion requirements has previously been shown. The aim of this study was to retrospectively assess the effectiveness of topical tranexamic acid use, comparing 155 patients undergoing hip and knee arthroplasty surgery in which tranexamic acid was routinely used, to a group of 149 patients from a similar time frame prior to the introduction of tranexamic acid use. The transfusion rate fell from 19.3% to 2.3% for hip arthroplasty patients and from 13.1% to 0% for knee arthroplasty patients; these differences were significant. We also found significant reductions in haemoglobin loss, blood loss and length of stay of 8 g/L, 244 mL and 1.0 days respectively for hip arthroplasties and 15 g/L, 527 mL and 1.2 days respectively for knee arthroplasties following the introduction of tranexamic acid. PMID:24095586
Gilbody, Julian; Dhotar, Herman S; Perruccio, Anthony V; Davey, J Roderick
Originally developed in Scandinavia, national arthroplasty registers have spread worldwide during the last decade. The value of registers for quality improvement in arthroplasty has frequently been documented. However, for the development of a successful register a few key points should be taken into account. Uncontrolled loss of patients from the registry area should be avoided. Registers should form an integral part of a country’s medical system. To realise the potential for improvement, it is crucial that physicians deal with the results in detail. Thus it is absolutely essential to involve the specialty societies in the interpretation and dissemination of results. With respect to revision rates, register data are usually more valid than meta-analyses of clinical studies. For every physician the most valuable data are those coming from a register in his own country; the development of national arthroplasty registers should therefore be continued.
Janda, Wolfgang; Agreiter, Mark; Schuh, Reinhard; Bohler, Nikolaus
Vehicles proposed to fill the gap in the U.S. space program's space transport needs for the next decade resulting from the January Challenger disaster, are discussed. Prior to the accident, the Air Force planned to purchase a Complementary Expendable Launch Vehicle system consisting of 10 single-use Titan-34D7 rockets. Another heavy lift booster now considered is the Phoenix H. Commercial launch vehicle systems projected to be available in the necessary time frame include the 215,000-pound thrust 4000-pound LEO payload capacity NASA Delta, the 11,300-pound LEO payload capacity Atlas Centaur the first ICBM, and the all-solid propellant expendable 2000-pound LEO payload Conestoga rocket. Also considered is the man-rated fully reusable Phoenix vertical take-off and vertical-landing launch vehicle.
Bifurcating saphenous vein and left internal thoracic graft anatomy: treatment of a left main equivalent saphenous interposition vein graft lesion and virtual histology/grey scale IVUS characterization post-intervention.
Saphenous vein graft interventions carry a significant risk of adverse events. We present a case in which a free left internal thoracic artery (LITA to the LAD) had been anastomosed to a saphenous vein graft (SVG) to an obtuse marginal (OM) as its proximal anastomosis. Due to surgical iatrogenic injury during a subsequent aortic valve replacement, the proximal portion of this dual graft was resected in error and then repaired using an interposed vein graft (vein patch). We present the first known case of percutaneous intervention to an interposition vein graft stenosis with left main equivalent anatomy. Virtual histology (VH) and grey scale intravascular ultrasound (IVUS) were utilized to visualize plaque characteristics in this novel lesion. PMID:17240465
Hussain, Farrukh; Kashour, Tarek; Dzavik, Vladimir
Purpose Bony resection of the proximal medial tibia, an alternative technique for soft tissue balancing in total knee arthroplasty (TKA), was compared to the conventional medial soft tissue release technique. Materials and Methods From June 2005 to June 2007, we performed 40 TKA in 27 patients with ?10° tibio-femoral varus deformity. The conventional, medial soft tissue release technique was applied in 20 cases and bony resection of proximal medial tibia in the other 20 cases (vertical osteotomy group). Total operation time, knee range of motion (ROM), hospital for special surgery (HSS) scores, and tibio-femoral medial-lateral gap ratio in 0°, 90°, and 130° flexion at postoperative 6 months were compared between the groups. Results The total operation time was shorter in the vertical osteotomy group. Tibio-femoral medial-lateral gap ratio in 130° flexion was closer to 1 in the vertical osteotomy group (p=0.000). There was no significant difference in the ROM, HSS score, or tibio-femoral medial-lateral gap ratio in 0° and 90° flexion at postoperative 6 months. Conclusions In severe varus knees, bony resection of proximal medial tibia can be considered as an alternative technique, in order to decrease total operation time and to obtain medial-lateral, soft-tissue balance in deep flexion.
Back, Young Woong
The use of computer navigation is becoming a well-recognized technical alternative to conventional total knee arthroplasty (TKA). However, computer navigation has a substantial learning curve and the use of commercially available navigation systems increases surgical time. In addition, the potential risks associated with the navigation TKA, such as, registration errors, notching of the anterior femoral cortex, oversizing of the femoral component, and overresection must be taken into consideration. On the other hand, conventional techniques are familiar and intuitive to most practicing surgeons, and thus, are easier to perform and are less prone to anterior notching and femoral component oversizing. However, conventional techniques have greater risks of inaccurate and inconsistent component alignment than computer navigation. This paper describes a novel technique that combines computer navigation and conventional TKA.
We report a case of posttraumatic false aneurysm of popliteal artery after a total knee arthroplasty in an 82-year-old woman. This case is characterized by the distinct history of trauma to the popliteal fossa in the immediate postoperative period and the location of false aneurysm. In addition, the clinical symptoms were similar to those of deep vein thrombosis. The ultrasonographic examination and computed tomography (CT) angiography confirmed the diagnosis on 6th day after the surgery. Ultrasonographic examination 1 day later revealed no increase in the size of false aneurysm. She was treated with open surgical repair. Presenting the difficulty in the diagnosis, unusual location, etiology, and its management is the intention of this case report.
Agarwala, Sanjay R; Mohrir, Ganesh S; Dotivala, Sharukh J
Total hip arthroplasty (THA) has completely revolutionized the nature in which the arthritic hip is treated, and is considered to be one of the most successful orthopaedic interventions of its generation. With over 100 years of operative history, this review examines the progression of the operation from its origins, together with highlighting the materials and techniques that have contributed to its development. Knowledge of its history contributes to a greater understanding of THA, such as the reasons behind selection of prosthetic materials in certain patient groups, while demonstrating the importance of critically analyzing research to continually determine best operative practice. Finally, we describe current areas of research being undertaken to further advance techniques and improve outcomes.
Knight, Stephen Richard; Aujla, Randeep; Biswas, Satya Prasad
The long-term durability of polyethylene lining total hip arthroplasty (THA) mainly depends on periprosthetic osteolysis due to wear particles, especially in young active patients. In hip simulator study, reports revealed significant wear reduction of the alumina ceramic-on-polyethylene articulation of THA compared with metal-on-polyethylene bearing surfaces. However, medium to long-term clinical studies of THA using the alumina ceramic-on-polyethylene are few and the reported wear rate of this articulation is variable. We reviewed the advantages and disadvantages of ceramicon- polyethylene articulation in THA, hip simulator study and retrieval study for polyethylene wear, in vivo clinical results of THA using alumina ceramic-on-polyethylene bearing surfaces in the literature, and new trial alumina ceramic-onhighly cross linked polyethylene bearing surfaces.
Jung, Yup Lee; Kim, Shin-Yoon
Total knee arthroplasty has provided dramatic improvements in function and pain for the majority of patients with knee arthritis, yet a significant proportion of patients remain dissatisfied with their results. We performed a prospective analysis of 215 patients undergoing TKA who underwent a comprehensive array of evaluations to discover whether any preoperative assessment could predict high pain scores and functional limitations postoperatively. Patients with severe pain with a simple knee range-of-motion test prior to TKA had a 10 times higher likelihood of moderate to severe pain at 6months. A simple test of pain intensity with active flexion and extension preoperatively was a significant predictor of postoperative pain at 6months after surgery. Strategies to address this particular patient group may improve satisfaction rates of TKA. PMID:24630598
Noiseux, Nicolas O; Callaghan, John J; Clark, Charles R; Zimmerman, M Bridget; Sluka, Kathleen A; Rakel, Barbara A
The anatomy and histology of the volar plate at the proximal interphalangeal joint and the mechanism of fracture/subluxation of the base of the middle phalanx in closed proximal interphalangeal joint injuries is reviewed. Our current technique of repair for these injuries and its evolution from Eaton's original procedure is described. The results of 71 cases of volar plate arthroplasty performed over a five-year period for fracture/subluxations of the proximal interphalangeal joints are presented with follow-up ranging from six months to four years. 62 (87%) patients achieved a stable pain-free joint with a range of motion from 5 degrees to 95 degrees within two months. Complications were uncommon and correctable with an overall eventual patient satisfaction rate of 94%. PMID:1402271
Durham-Smith, G; McCarten, G M
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
Moerenhout, Kevin G; Cherix, Stéphane; Rüdiger, Hannes A
Recent studies suggest that the tapered interface between stem and femoral head may be a substantial source of cobalt and chromium ion release after metal-on-metal (MOM) total hip arthroplasty (THA). This study compared patient ion levels after MOM hip resurfacing (HR) and MOM THA performed with identical acetabular components. 110 HRs were compared with 22 THAs. All had well-oriented components, unilateral implants, and serum ion studies beyond one year post-operatively. The HR group's median cobalt value was 1.11 ?g/L vs. 2.86 ?g/L for the THA patients. The HR group's median chromium value was 1.49 ?g/L vs. 2.94 ?g/L for THA. Significantly higher THA ion levels suggest a source of ions other than the MOM bearing itself. PMID:23618754
Johnson, Alicia J; Le Duff, Michel J; Yoon, James P; Al-Hamad, Mariam; Amstutz, Harlan C
Lumbar spinal stenosis is a common cause of lower back and leg pain in older adults. Stenosis is not considered a contraindication for total knee arthroplasty (TKA); however, it is unclear whether it is associated with less than optimal postoperative outcomes. In a multicenter review of TKAs, 115 patients with lumbar disease were matched by age, gender, body mass index, type of procedure, and length of follow-up to patients who did not have stenosis. Spinal stenosis was found to be associated with significantly lower Knee Society objective and function scores compared with patients without stenosis. There was no observed difference in the revision rates (1%) or radiographic outcomes. Surgeons should consider cautioning patients that they can expect relief of arthritic symptoms following TKA, but they may continue to experience limitations in postoperative function relative to their expectations. PMID:23288774
Pivec, Robert; Johnson, Aaron J; Naziri, Qais; Issa, Kimona; Mont, Michael A; Bonutti, Peter M
The half-value layers of stainless steel, bone cement, and polyethylene were measured for /sup 99m/Tc, /sup 67/Ga, /sup 111/In, and /sup 201/TI to render some insight into the attenuating effects of the metallic cup and other components used in surface-replacement revision arthroplasty. On theoretic consideration, a twofold increase in /sup 99m/Tc-methylene diphosphonate in bone inside the cup should not be attenuated to the point of escaping detection on the radionuclide images of the hip. /sup 67/Ga, using the 184 and 300 keV peaks, and /sup 111/In have greater half-value layers than /sup 99m/Tc and are subject to less attenuation by the metallic cup.
Rosenthall, L.; Rosenthall, S.
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.
Griffin, Justin W; D'Apuzzo, Michele; Browne, James A
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.
Munoz-Mahamud, Ernesto; Gallart, Xavier; Soriano, Alejandro
Metal debris should not be generated in a well-fixed, well-functioning metal-on-polyethylene total hip arthroplasty. However, surgeons sometimes encounter periprosthetic metallosis during revision hip surgery. Insert wear, fracture, or dislodgment in modular components may lead to articulation of the prosthetic head with the metallic shell and subsequent metallosis. Metallosis may occur with loose acetabular components as a consequence of fretting of the screws and shell screw holes or shedding of the ingrowth surface of the component. The femoral component can also be a source of metallosis: Wear of a titanium femoral head, loosening of rough surface finish from the femoral stem, and stem fracture all may result in metallic particles being deposited in periarticular tissues. Specific clinical and radiographic findings can help in differentiating these forms of failure and in planning surgery. When metallic debris-induced bone loss is recognized early, surgical intervention may limit its progression. PMID:18401490
Cipriano, Cara A; Issack, Paul S; Beksac, Burak; Della Valle, Alejandro Gonzalez; Sculco, Thomas P; Salvati, Eduardo A
Whether failure in unicompartmental knee arthroplasty (UKA) is related to implant design remains unclear. We hypothesize that current available UKAs fit within 2 mm. Forty-eight CTs of cadaveric knees were compared to current available UKA brands. Overall no-fit compared to at least one component within 2 mm is high (91.7%) and worse for males (100%) compared to females (83.3%). Good fit was observed for the medial but not for the lateral tibia plateau. Seven males (29.2%) had larger dimensions of more than 2 mm. For the widest UKA brand, 12 (57%) males and 2 females (8. 3%) had lateral femoral condyles 3 mm larger. Current UKA's in our sample population fit less on the lateral tibia and on femoral condyles.
Fitz, Wolfgang; Bliss, Robin; Losina, Elena
Dislocation is a major complication of total hip arthroplasty (THA), whose frequency has been unaffected by improvements in surgical techniques and implants. The dislocation rate depends on multiple factors related to the patient, hip disease, and surgical procedure and is therefore also dependent on the surgeon. The many published studies on THA dislocation, its causes, and its treatment have produced conflicting results. The objective of this work is to review the management of THA dislocation, which is a severe event for both the patient and the surgeon. This lecture starts with a brief review of data on THA dislocation rates and the many factors that influence them. Emphasis is then put on the evaluation for a cause and, more specifically, on the challenges raised by detecting suboptimal cup position. Next, reported techniques for treating THA dislocation and the outcomes of each are discussed. Finally, a management strategy for patients selected for revision surgery is suggested. PMID:24434366
Charissoux, J-L; Asloum, Y; Marcheix, P-S
This study was designed to examine the three-dimensional geometry of the head of the first metatarsal bone of the foot. Ninety-seven adult first metatarsal head (MTH1) bones were scanned using a laser scanner at 400 dpi. A best-fit ellipsoid was obtained from the articular surfaces of MTH1 for each size group using nonlinear unconstrained optimisation. Average root mean square errors between the articulating surfaces and the optimal fit surfaces of the bone specimens were between 0.29 and 0.42 mm. After classification based on sex and size groups, the profile provided a good fit to individual bones. Consideration of the thickness of cartilage overlying the metatarsal head (MTH) may further improve the fit. The proposed approach provides the basis for a design of an MTH hemi-arthroplasty that has good anatomical congruence with the native joint. PMID:23477729
Kumar, Atul; Donley, Brian; Cavanagh, Peter R
Coxa saltans or snapping hip, in its internal and external varieties, is a well-known syndrome in the coxofemoral orthopedic pathology. The internal variety is less frequent and is rather unusual after a total hip arthroplasty (THA). This disorder is often times mistaken with chronic groin pain after a THA. This paper describes a typical case of snapping hip in the setting of THA and helps recognize the clinical differences between both entities, with a description of the signs and symptoms that characterize them. In order to support the etiology and pathogenesis, the diagnosis and treatment, we include anatomical considerations concerning the variants of the iliopsoas musculo-tendinous complex attachment, its relations with the articular capsule and the iliopectineal bursa. The role of implant malpositioning in this entity is reviewed and the usefulness of various diagnostic and treatment methods is discussed. PMID:20377060
Gómez García, Felipe
Discharge destination to skilled nursing facilities (SNF) following total joint arthroplasty (TJA) plays an important role in healthcare costs. The pre-operative, intra-operative, and post-operative factors of 50 consecutive patients discharged to an SNF following TJA were compared to that of 50 consecutive patients discharged to home. Patients discharged to SNFs had slower pre-operative Get Up and Go scores (TGUG), lower pre-operative EQ-5D scores, higher ASA scores, increased hospital length of stay, increased self-reported post-operative pain, and decreased physical therapy achievements. We believe that the results of this study indicate that patients who get discharged to SNFs fit a certain criteria and this may be used to guide post-operative discharge destination during pre-operative planning, which can help lower costs while helping decrease the length of inpatient stay. PMID:24631127
Sharareh, Behnam; Le, Natasha B; Hoang, Melinda T; Schwarzkopf, Ran
Patients with chronic kidney disease (CKD) undergoing total hip arthroplasty (THA) were evaluated for risk of revision, surgical site infection (SSI), thromboembolic events, mortality and readmission. 20,720 primary TKA cases were included (smaller sample for readmission evaluation, N = 9322). The prevalence of CKD among THA patients was 6.1% (N = 1269). After adjustment for age, gender, race, general health, and diabetes, CKD patients were at 1.4 (95% confidence interval 1.1-1.8) increased risk of readmission within 90 days. The adjusted risks for revision (overall, aseptic, and septic), SSI (deep and superficial), deep vein thrombosis, pulmonary embolism, and mortality (30-day, 90-day, ever) were not significantly different between patients with CKD and those without CKD. However, increased risk for 90-day readmission underscores that CKD patients are a fundamentally different population of patients. PMID:24556110
Miric, Alexander; Inacio, Maria C S; Namba, Robert S
Seventy-five total hip arthroplasty revisions for instability were classified into 6 primary etiologies: I, acetabular component malposition; II, femoral component malposition; III, abductor deficiency; IV, impingement; V, late wear; or VI, unresolved etiology. The most common etiologies were cup malposition (type I; 33%) and abductor deficiency (type III; 36%). At a mean of 35.3 months, 11 redislocations occurred (14.6%). Acetabular revisions were protective against redislocation (P < .015). The number of previous operations (P = .0379) and previously failed constrained liners (P < .02) were risk factors for failure. Tripolar constrained liners demonstrated improved survivorship vs locking ring types (P < .02); cemented constrained liners failed more often than modular constrained liners (P < .0018). The highest risk of failure was in patients with abductor insufficiency with revisions for other etiologies having a success rate of 90%. PMID:22036933
Wera, Glenn D; Ting, Nick T; Moric, Mario; Paprosky, Wayne G; Sporer, Scott M; Della Valle, Craig J
To determine the fate of an impacted allograft after a minimum follow-up of 1 year, we examined 9 of 40 patients who underwent revision arthroplasty with the impaction grafting technique. The allograft used in this study was morselized cancellous freeze-dried allograft. We examined these 9 patients with technetium-99 m methylene diphosphonate bone scintigraphy at an average of 14 (range 12-20) months after surgery. All of them had a good clinical outcome, with an average postoperative Hip Society Score of 89 (range 65-98) and no evidence of radiolucency or subsidence on direct radiography. Scintigraphic examination demonstrated that the area corresponding to the allograft had a remarkable radioactivity accumulation suggesting new bone formation. The allograft in total hip revision using the impaction grafting technique undergoes a significant neovascularization and new bone formation. This study suggests than when vigorous impaction is used, freeze-dried cancellous allograft can be used for impaction grafting. PMID:10968530
Mazhar Tokgözo?lu, A; Aydin, M; Atilla, B; Caner, B
The aim of the study was to evaluate the subjective functional outcome of total hip arthroplasty (THA) in patients who underwent hydrotherapy (HT) 6 months after discharge. A prospective randomized study was performed on 70 elderly inpatients with recent THA, who completed a rehabilitation program. After randomization, 33 of them were treated in conventional gyms (no-hydrotherapy group=NHTG) and 31 received HT (hydrotherapy group=HTG). Interviews with the Western-Ontario MacMasters Universities Osteoarthritis Index (WOMAC) were performed at admission, at discharge and 6 months later. Kruskal-Wallis, Mann-Whitney and Wilcoxon tests were applied for statistical analysis. Both groups improved. Pain, stiffness and function were all positively affected. Statistical analysis indicated that WOMAC sub-scales were significantly lower for all patients treated with HT. The benefits at discharge still remained after 6 months. We conclude that HT is recommended after THA in a geriatric population. PMID:19282040
Giaquinto, S; Ciotola, E; Dall'armi, V; Margutti, F
The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N=30) or HT (N=28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC) at admission, at discharge and six months later. Kruskal-Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population. PMID:19735951
Giaquinto, S; Ciotola, E; Dall'Armi, V; Margutti, F
Abstract Aim: Outcome of primary total arthroplasty for osteoarthritis of the knee with valgus deformity. Materials and methods: Between 2005 and 2007, 28 primary total knee replacements were performed for osteoarthritis of the knee with valgus deformity. 21 cases were women and 7 men with a mean age of 66.6 years (extremes 54-81). The clinical and radiological evaluations were done considering the knee range of motion, Knee Society Score (KSS) and femorotibial angle measured on the frontal standing long leg X-rays. Preoperatively, the knee valgus deformity angle was 6 to 15 degrees in 14 cases, 15 to 25 degrees in 10 cases and over 25 degrees in 4 cases. Results: After a mean follow-up time of 14 months (extremes 7-29), the knee range of motion improved from a mean of 71 degrees (extremes 52-87) preoperatively to a mean of 95 degrees (extremes 78-110) postoperatively. The KSS value improved from 21.3 points (extremes 1-33) preoperatively to 80.7 points (extremes 70-92) postoperatively and the frontal femorotibial angle from a mean value of 21 degrees (extremes 11-39) of valgus before surgery, to a mean of 9 degrees (extremes 0-12) of valgus after surgery. Conclusions: Long leg AP view X-ray examination in standing position is mandatory. The standard medial parapatellar approach is appropriate in this type of arthroplasty even if significant knee valgus deviations are present because it avoids the lateral approach complications. Postoperatively, one can get an aligned and stable knee if a judicious and progressive periarticular soft tissues balancing is achieved, in both flexion and extension position.
Radulescu, R; Badila, A; Japie, I; Ciobanu, T; Manolescu, R
Improvements in pain management techniques over the past decade have had a significant impact on the outcomes of total knee arthroplasty. Of these techniques, multimodal approaches have shown potential. The purpose of this study was to compare the results of periarticular injection (PAI) to a combination of patient-controlled epidural analgesia and femoral nerve block (PCEA/FNB). Ninety patients undergoing primary unilateral total knee arthroplasty between June 2010 and March 2011 were randomized into 2 groups. The first group received the PCEA/FNB protocol, whereas the second group received the PAI. Mean patient age was 66.1 ± 8.7 years. All patients were operated on using a similar standard medial parapatellar approach, and all received preemptive analgesia and postoperative pain protocols. All patients were interviewed twice daily for the first 3 days postoperatively, once on day 7, and once in month 6. The 2 groups had similar readiness for discharge (PCEA/FNB group, 3.3 ± 1.2 days; PAI group, 3.2 ± 1.9 days). The results indicated no statistical difference between the 2 groups in 3 of 4 categories (rest in the morning, rest in the evening, and ambulation in the morning). Pain on ambulation was the only category that was statistically lower in the PCEA/FNB group than in the PAI group.Although the study demonstrates similar results between the 2 groups, PAI can play a major role in postoperative pain control in institutions that may not have appropriately trained individuals, equipment, and resources for PCEA/FNB. It also reduces many of the side effects and complications associated with regional anesthesia. PMID:22588407
Meftah, Morteza; Wong, Anthony C; Nawabi, Danyal H; Yun, Richard J; Ranawat, Amar S; Ranawat, Chitranjan S
Posterior glenoid bone loss often is seen in association with glenohumeral osteoarthritis. Many different techniques have been proposed to account for this bone loss during total shoulder arthroplasty, the most popular being eccentric anterior reaming. However, the amount of correction that can be achieved has not been been well quantified. The purpose of this study was to define the amount of eccentric posterior glenoid wear that can be corrected by anterior glenoid reaming. Eight cadaveric scapulae were studied. Simulations of posterior glenoid wear in 5 degrees increments were performed on each scapula. The specimens were then eccentrically reamed to correct the deformity. Anteroposterior width, superior-inferior height, and the best-fit pegged glenoid prosthesis size were measured. Anterior reaming to correct a 10 degrees posterior defect resulted in a decrease in anteroposterior glenoid diameter from 26.7+/-2.5 mm to 23.8+/-3.1 mm (P=.006). In 4 of 8 specimens, placing a glenoid prosthesis was not possible after correcting a 15 degrees deformity because of inadequate bony support (N=2), peg penetration (N=1) or both (N=1). A 20 degrees deformity was correctable in 2 of 8 specimens and only after downsizing the glenoid component. Anterior glenoid reaming to correct eccentric posterior wear of >10 degrees results in significant narrowing of the anteroposterior glenoid width. A 15 degrees deformity has only a 50% chance of successful correction by anterior, eccentric reaming. Orthopedic surgeons need to be cognizant of this in their preoperative planning for total shoulder arthroplasty. PMID:19226042
Gillespie, Robert; Lyons, Robert; Lazarus, Mark
Background Operating rooms (ORs) are estimated to generate up to one-third of hospital waste. At the London Health Sciences Centre, prosthetics and implants represent 17% of the institution’s ecological footprint. To investigate waste production associated with total knee arthroplasties (TKAs), we performed a surgical waste audit to gauge the environmental impact of this procedure and generate strategies to improve waste management. Methods We conducted a waste audit of 5 primary TKAs performed by a single surgeon in February 2010. Waste was categorized into 6 streams: regular solid waste, recyclable plastics, biohazard waste, laundered linens, sharps and blue sterile wrap. Volume and weight of each stream was quantified. We used Canadian Joint Replacement Registry data (2008–2009) to estimate annual weight and volume totals of waste from all TKAs performed in Canada. Results The average surgical waste (excluding laundered linens) per TKA was 13.3 kg, of which 8.6 kg (64.5%) was normal solid waste, 2.5 kg (19.2%) was biohazard waste, 1.6 kg (12.1%) was blue sterile wrap, 0.3 kg (2.2%) was recyclables and 0.3 kg (2.2%) was sharps. Plastic wrappers, disposable surgical linens and personal protective equipment contributed considerably to total waste. We estimated that landfill waste from all 47 429 TKAs performed in Canada in 2008–2009 was 407 889 kg by weight and 15 272 m3 by volume. Conclusion Total knee arthroplasties produce substantial amounts of surgical waste. Environmentally friendly surgical products and waste management strategies may allow ORs to reduce the negative impacts of waste production without compromising patient care. Level of evidence Level IV, case series.
Stall, Nathan M.; Kagoma, Yoan K.; Bondy, Jennifer N.; Naudie, Douglas
Background: Total knee arthroplasty represents one of the most painful surgeries. The aim of the study was to compare analgesia and adverse effects of intrathecal (IT) ketorolac versus IT morphine, versus the combination of IT ketorolac and morphine. Materials and Methods: After ethical approval and patient consent, 80 patients undergoing knee arthroplasty were randomized to one of 4 groups. All groups received 15 mg IT bupivacaine plus IT test drug (2 ml). The control group (CG) received saline as IT test drug. The morphine group (MG) received IT 200 g morphine, the ketorolac group (KG) IT 2 mg ketorolac and the morphine-ketorolac group (MKG) 200 g morphine + 2 mg ketorolac as test drugs. Pain and adverse effects were evaluated. P > 0.05 was considered significant. Results: The MG and KG were similar in their times to time to first rescue analgesic (440 ± 38 min and 381 ± 44 min, respectively). Both groups were longer when compared to the CG (170 ± 13 min) (P > 0.01). The MG and KG had lesser ketoprofen consumption compared to the CG (P > 0.05). The time to first rescue analgesic was longer to the MKG (926 ± 222 min) (15 h) compared to CG (P > 0.001) and to the MG and the KG (P > 0.01). MKG displayed lesser ketoprofen consumption compared to MG and KG (P > 0.05) and to the CG (P > 0.02). Conclusions: The data suggest a role for spinal ketorolac and morphine in orthopaedic surgery because this combination of agents provided 15 h of analgesia compared to 7 h after each drug alone, with no significant side-effects.
Lauretti, Gabriela R; Righeti, Claudia C F; Mattos, Anita L
Despite the overall success of total hip arthroplasty (THA), there has been an increase in the rate of revision hip surgeries performed each year in the United States. These revision surgeries result in several billion dollars in health care costs. Bearing surface wear can result in the need for revision surgery through a variety of mechanisms. Many implant failures necessitating the need for revision surgeries occur secondary to dislocations, which are often related to prothesis wear and eventual loosening of the components. Wear also can lead to osteolysis and may play a role in aseptic loosening. Specific concerns regarding the wear rates of metal-on-polyethylene (the most common bearing surface) have encouraged the manufacture of newer polyethylene implants with improved wear properties, as well as alternative bearing surfaces. The goal is to improve the durability of revision implants and/or reduce the incidence of revision THAs. Revision arthroplasty involves using alternative surfaces, such as replacing the metal femoral head with a ceramic component or changing the entire prosthesis to a metal-on-metal or ceramic-on-ceramic articulation. It is important to review the characteristics of these alternative bearing surface options and their contributions to improved THA tribology and prolonged prosthesis longevity. The choice of a bearing surface for a revision THA should consider factors such as the patient's age and activity level, the cost of the implant, and both the surgeons' and patients' preferences. Although laboratory studies and small clinical trials have generated optimistic results for these alternative implants in vitro and in vivo, much still needs to be learned about the long-term performance of these materials in patients after total hip revision surgery. PMID:21553778
Patel, Deepan; Parvizi, Javad; Sharkey, Peter F
Background and purpose It has been speculated that the prevalence of metal allergy may be higher in patients with implant failure. We compared the prevalence and cause of revisions following total hip arthroplasty (THA) in dermatitis patients suspected to have contact allergy and in patients in general with THA. Furthermore, we compared the prevalence of metal allergy in dermatitis patients with and without THA. Materials and methods The Danish Hip Arthroplasty Registry (DHAR) contained detailed information on 90,697 operations. The Gentofte patch-test database contained test results for patients suspected of having allergic contact dermatitis (n = 18,794). Cases (n = 356) were defined as patch-tested dermatitis patients who also had primary THA performed. Two age- and sex-matched controls (n = 712) from the patch-test database were sought for each case. Results The prevalence of revision was similar in cases (12%) and in patients from the DHAR (13%). The prevalence of metal allergy was similar in cases and controls. However, the prevalence of metal allergy was lower in cases who were patch-tested after operation (6%) than in those who were patch-tested before operation (16%) (OR = 2.9; 95% CI = 1–8). Interpretation We found that the risk of surgical revision was not increased in patients with metal allergies and that the risk of metal allergy was not increased in cases who were operated, in comparison to controls. Despite some important study limitations, our observations add to the evidence that the risk of complications in metal allergic patients seems limited.
Modular femoral heads have been used successfully for many years in total hip arthroplasty. Few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. Although there has always been some concern over the potential for fretting, corrosion, and generation of particulate debris at the modular junction, this was not considered a significant clinical problem. More recently, concern has increased because fretting and corrosive debris have resulted in rare cases of pain, adverse local tissue reaction, pseudotumor, and osteolysis. Larger femoral heads, which have gained popularity in total hip arthroplasty, are suspected to increase the potential for local and systemic complications of fretting, corrosion, and generation of metal ions because of greater torque at the modular junction. A less common complication is dissociation of the modular femoral heads. Morse taper dissociation has been reported in the literature, mainly in association with a traumatic event, such as closed reduction of a dislocation or fatigue fracture of the femoral neck of a prosthesis. This report describes 3 cases of spontaneous dissociation of the modular prosthetic femoral head from the trunnion of the same tapered titanium stem because of fretting and wear of the Morse taper in a metal-on-polyethylene bearing. Continued clinical and scientific research on Morse taper junctions is warranted to identify and prioritize implant and surgical factors that lead to this and other types of trunnion failure to minimize complications associated with Morse taper junctions as hip implants and surgical techniques continue to evolve. PMID:24972443
Talmo, Carl T; Sharp, Kinzie G; Malinowska, Magdalena; Bono, James V; Ward, Daniel M; Lareau, Justin
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
Leegwater, Nick C; Willems, Jore H; Brohet, Richard; Nolte, Peter A
A tunable infrared detector which employs a vanishing band gap semi-metal material provided with an induced band gap by a magnetic field to allow intrinsic semiconductor type infrared detection capabilities is disclosed. The semi-metal material may thus o...
C. T. Elliott
?-graphdiyne is a novel predicted Dirac cone material, which is similar to graphene. But the absence of a band gap significantly limits its practical applications. In order to extend this limitation, an opening of energy gap is needed. To this end, we resort to the nanoribbon structure of ?-graphdiyne. This is a conventional proposal to open up the energy gaps in nanomaterials. The results show that both the armchair and the zigzag ?-graphdiyne nanoribbons do generate energy gaps, which are width-dependent. In addition, the underlying mechanism of this opening is explored. The former is ascribed to the combination of quantum confinement and edges' effect, while the latter arises from the edge magnetic ordering. These novel nanoribbons with opening energy gaps would be potentially used in electronic devices.
Niu, X. N.; Yang, D. Z.; Si, M. S.; Xue, D. S.
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
Son, Young-Woo; Cohen, Marvin L; Louie, Steven G
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.
Son, Young-Woo; Cohen, Marvin L.; Louie, Steven G.
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
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
Griza, Sandro; Ueki, Marcelo M; Souza, Dárcio H G; Cervieri, André; Strohaecker, Telmo R
Newer arthroplasty designs claim to provide superior range of motion (ROM) and greater stability than their predecessors. However, there is no way to compare ROM of implant systems in an equivalent anatomical environment in a clinical setting. This study used computer-aided design to compare ROM after hip resurfacing, 28 mm THA, 36 mm THA, and anatomic dual mobility (ADM) THA in 3D models of 5 cadaver pelvises. ROM to impingement was then tested in 10 different motions and a one-way ANOVA was used to compare results. The hip resurfacing resulted in restricted ROM compared to the other 3 models in all motions except adduction. The ADM, 36 mm, and 28 mm THA resulted in similar ROM. Dual mobility constructs provide comparable ROM in patients where large head THA is not appropriate. PMID:23477855
Klingenstein, Gregory G; Yeager, Alyssa M; Lipman, Joseph D; Westrich, Geoffrey H
Thromboembolic disease is a relatively common and potentially devastating complication of joint arthroplasty. Mechanical and chemical prophylaxes are effective in reducing the incidence of this complication. Inferior vena cava (IVC) filters have been used to prevent the propagation and\\/or migration of venous emboli into the pulmonary circulation. This article reports on a cohort of joint arthroplasty patients either with confirmed
Matthew S. Austin; Javad Parvizi; Seth Grossman; Camilo Restrepo; Gregg R. Klein; Richard H. Rothman
Anterior iliopsoas impingement is a recognized cause of persistent groin pain after total hip arthroplasty. We report 3 patients with failed total hip arthroplasties resulting from anterior iliopsoas and capsular impingement secondary to a metal femoral ball with a diameter larger than the native femoral head. All patients had the same implant design. Resolution of symptoms occurred in all patients
James A. Browne; David J. Polga; Rafael J. Sierra; Robert T. Trousdale; Miguel E. Cabanela
Antifibrinolytics seem to reduce postoperative blood loss after total knee arthroplasty. Few studies have shown the impact of these drugs on the mechanisms of coagulation. The purpose of this study was to examine coagulation\\/fibrinolysis variables as well as blood loss after total knee arthroplasty with and without antifi- brinolytics in the operated limb on a regional level. Thirty-six patients were
Tove Hohaus; Ralph Ruwoldt; Thilo Menges; Gunter Hempelmann
The Mission of the Gap Analysis Program (GAP) is to promote conservation by providing broad geographic information on biological diversity to resource managers, planners, and policy makers who can use the information to make informed decisions. As part of the National Biological Information Infrastructure (NBII) ?a collaborative program to provide increased access to data and information on the nation?s biological resources--GAP data and analytical tools have been used in hundreds of applications: from basic research to comprehensive state wildlife plans; from educational projects in schools to ecoregional assessments of biodiversity. The challenge: keeping common species common means protecting them BEFORE they become threatened. To do this on a state or regional basis requires key information such as land cover descriptions, predicted distribution maps for native animals, and an assessment of the level of protection currently given to those plants and animals. GAP works cooperatively with Federal, state, and local natural resource professionals and academics to provide this kind of information. GAP activities focus on the creation of state and regional databases and maps that depict patterns of land management, land cover, and biodiversity. These data can be used to identify ?gaps? in conservation--instances where an animal or plant community is not adequately represented on the existing network of conservation lands. GAP is administered through the U.S. Geological Survey. Through building partnerships among disparate groups, GAP hopes to foster the kind of collaboration that is needed to address conservation issues on a broad scale. For more information, contact: John Mosesso National GAP Director 703-648-4079 Kevin Gergely National GAP Operations Manager 208-885-3565
Edited by Maxwell, Jill; Gergely, Kevin; Aycrigg, Jocelyn; Canonico, Gabrielle; Davidson, Anne; Coffey, Nicole
Astronomers have been able to study planet-forming discs around young Sun-like stars in unsurpassed detail, clearly revealing the motion and distribution of the gas in the inner parts of the disc. This result, which possibly implies the presence of giant planets, was made possible by the combination of a very clever method enabled by ESO's Very Large Telescope. Uncovering the disc ESO PR Photo 27a/08 Planet-forming Disc Planets could be home to other forms of life, so the study of exoplanets ranks very high in contemporary astronomy. More than 300 planets are already known to orbit stars other than the Sun, and these new worlds show an amazing diversity in their characteristics. But astronomers don't just look at systems where planets have already formed - they can also get great insights by studying the discs around young stars where planets may currently be forming. "This is like going 4.6 billion years back in time to watch how the planets of our own Solar System formed," says Klaus Pontoppidan from Caltech, who led the research. Pontoppidan and colleagues have analysed three young analogues of our Sun that are each surrounded by a disc of gas and dust from which planets could form. These three discs are just a few million years old and were known to have gaps or holes in them, indicating regions where the dust has been cleared and the possible presence of young planets. The new results not only confirm that gas is present in the gaps in the dust, but also enable astronomers to measure how the gas is distributed in the disc and how the disc is oriented. In regions where the dust appears to have been cleared out, molecular gas is still highly abundant. This can either mean that the dust has clumped together to form planetary embryos, or that a planet has already formed and is in the process of clearing the gas in the disc. For one of the stars, SR 21, a likely explanation is the presence of a massive giant planet orbiting at less than 3.5 times the distance between the Earth and the Sun, while for the second star, HD 135344B, a possible planet could be orbiting at 10 to 20 times the Earth-Sun distance. The observations of the third star, TW Hydrae, may also require the presence of one or two planets. "Our observations with the CRIRES instrument on ESO's Very Large Telescope clearly reveal that the discs around these three young, Sun-like stars are all very different and will most likely result in very different planetary systems," concludes Pontoppidan. "Nature certainly does not like to repeat herself" . "These kinds of observations complement the future work of the ALMA observatory, which will be imaging these discs in great detail and on a larger scale," adds Ewine van Dishoeck, from Leiden Observatory, who works with Pontoppidan. To study the gaps in dust discs that are the size of the Solar System around stars that are located up to 400 light-years away is a daunting challenge that requires a clever solution and the best possible instruments . "Traditional imaging cannot hope to see details on the scale of planetary distances for objects located so far away," explains van Dishoeck. "Interferometry can do better but won't allow us to follow the motion of the gas." Astronomers used a technique known as 'spectro-astrometric imaging' to give them a window into the inner regions of the discs where Earth-like planets may be forming. They were able not only to measure distances as small as one-tenth the Earth-Sun distance, but to measure the velocity of the gas at the same time . "The particular configuration of the instrument and the use of adaptive optics allows astronomers to carry out observations with this technique in a very user-friendly way: as a consequence, spectro-astrometric imaging with CRIRES can now be routinely performed," says team member Alain Smette, from ESO .
For decades, researchers examined the "achievement gap" between minority and nonminority students. This singular definition of "achievement gap" ignores important within-group differences. This article uses National Education Longitudinal Study (NELS:88) data to examine within-group differences and compares those across Latino, African American,…
Carpenter, Dick M., II; Ramirez, Al; Severn, Laura
Venous thromboembolism is the most common reason for readmission after total knee arthroplasty. Prospective contrast venography was conducted from 1984 to 2003 in 1321 patients undergoing total knee arthroplasty. Patients with deep venous thrombosis or pulmonary embolism were treated with warfarin; those with negative venograms received no further anticoagulation. From 1984 to 1992, patients not completing venography were discharged without warfarin; since 1993 patients without venography received warfarin for 6 weeks. Readmission for deep venous thrombosis, pulmonary embolism, or bleeding was tracked for 6 months. Venography was completed in 810 patients; 343 (42.3%) had deep venous thrombosis. Readmission for venous thromboembolism occurred in 0.6% of patients after total knee compared with 1.62% after total hip arthroplasty. Following total knee arthroplasty, patients discharged on warfarin (target INR 2.0) had a 0.21% readmission rate compared with 1.05% for patients with negative venograms discharged without further anticoagulation. One patient suffered a fatal pulmonary embolism after negative venography and no outpatient prophylaxis. Secondary prophylaxis with extended warfarin therapy reduced venous thromboembolism-related readmission. Surveillance venograms were a poor predictor of ultimate thromboembolism risk and need for extended anticoagulation therapy. We therefore recommend extended warfarin prophylaxis for all patients after hospital discharge following total knee arthroplasty. PMID:16906107
Pellegrini, Vincent D; Donaldson, Christopher T; Farber, Daniel C; Lehman, Erik B; Evarts, C McCollister
Component mal-alignment in total knee arthroplasty has been associated with increased revision rates and poor clinical outcomes. A significant source of variability in traditional, jig-based total knee arthroplasty is the performance of the surgeon. The purpose of this study was to determine the most sensitive steps in the femoral and tibia arthroplasty procedures. A computational model of the total knee arthroplasty procedure was created, and Monte Carlo simulations were performed that included surgeon variability in each step of the procedure. The proportion of well-aligned components from the model agrees with clinical literature in most planes. When components must be aligned within ±3° in all planes, component alignment was most sensitive to the accuracy of identifying the lateral epicondyle for the femoral component, and to the precision of the transverse plane alignment of the extramedullary guide for the tibial component. This model can be used as a tool for evaluating different procedural approaches or sources of variability to improve the quality of the total knee arthroplasty procedure. PMID:23590719
Gatti, Christopher J; Hallstrom, Brian R; Hughes, Richard E
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.
Bagdal, Karl T. (Middletown, OH); King, Edward L. (Trenton, OH); Follstaedt, Donald W. (Middletown, OH)
A simple technique for measuring the grid gap of an ion engine s ion optics during startup and steady-state operation was demonstrated with beam extraction. The grid gap at the center of the ion optics assembly was measured with a long distance microscope that was focused onto an alumina pin that protruded through the center accelerator grid aperture and was mechanically attached to the screen grid. This measurement technique was successfully applied to a 30 cm titanium ion optics assembly mounted onto an NSTAR engineering model ion engine. The grid gap and each grid s movement during startup from room temperature to both full and low power were measured. The grid gaps with and without beam extraction were found to be significantly different. The grid gaps at the ion optics center were both significantly smaller than the cold grid gap and different at the two power levels examined. To avoid issues associated with a small grid gap during thruster startup with titanium ion optics, a simple method was to operate the thruster initially without beam extraction to heat the ion optics. Another possible method is to apply high voltage to the grids prior to igniting the discharge because power deposition to the grids from the plasma is lower with beam extraction than without. Further testing would be required to confirm this approach.
Soulas, Gerge C.; Frandina, Michael M.
An apparatus and method for monitoring and maintaining a predetermined width in the gap between a casting nozzle and a casting wheel, wherein the gap is monitored by means of at least one pneumatic gap sensor. The pneumatic gap sensor is mounted on the casting nozzle in proximity to the casting surface and is connected by means of a tube to a regulator and a transducer. The regulator provides a flow of gas through a restictor to the pneumatic gap sensor, and the transducer translates the changes in the gas pressure caused by the proximity of the casting wheel to the pneumatic gap sensor outlet into a signal intelligible to a control device. The relative positions of the casting nozzle and casting wheel can thereby be selectively adjusted to continually maintain a predetermined distance between their adjacent surfaces. The apparatus and method enables accurate monitoring of the actual casting gap in a simple and reliable manner resistant to the extreme temperatures and otherwise hostile casting environment. 6 figs.
Bagdal, K.T.; King, E.L.; Follstaedt, D.W.
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.
Oh, Chang Hyun; Kim, Do Yeon; Ji, Gyu Yeul; Kim, Yeo Ju; Hyun, Dongkeun; Kim, Eun Young; Park, Hyeonseon; Park, Hyeong-Chun
The gap caused by a strong electric field between the quark surface and nuclear crust of a strange star is studied in an improved model including gravity and pressure as well as electrostatic forces. The transition from gap to crust is followed in detail. The properties of the gap are investigated for a wide range of parameters assuming both color-flavor locked and noncolor-flavor locked strange star cores. The maximally allowed crust density is generally lower than that of neutron drip. Finite temperature is shown to increase the gap width, but the effect is significant only at extreme temperatures. Analytical approximations are derived and shown to provide useful fits to the numerical results.
Stejner, Morten; Madsen, Jes [Department of Physics and Astronomy, University of Aarhus, DK-8000 Aarhus C (Denmark)
The Kentucky Transportation Center was contacted by the Cumberland Gap Tunnel Authority in 2001 to conduct a Falling Weight Deflectormeter (FWD) test on the concrete pavement structure at two locations in the southbound tunnel that appeared to be settling...
We present a case of a pseudotumor causing a deep femoral vein thrombosis 16 months after undergoing a metal-on-metal total hip arthroplasty. There is increasing concern over the effect of metal ions that are produced by wear in metal-on-metal hip arthroplasty systems. Recently, a number of articles have reported the development of an inflammatory pseudotumor causing a number of different problems early on in the lifespan of the implant necessitating revision surgery. This case reports the first presentation of a pseudotumor causing a serious venous thrombosis due to pressure effect and indicates further possible evidence for caution when considering metal-on-metal bearing hip arthroplasty. PMID:22425294
Parfitt, Daniel J; Wood, Simon N; Chick, Christopher M; Lewis, Peter; Rashid, Majid H; Evans, Aled Rhys
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
Arumilli, B R B; Ng, A B Y; Ellis, D J; Hirst, P
We report a case of periprosthetic fracture of the proximal tibia after lateral unicompartmental knee arthroplasty following a trivial fall. At the time of surgery, the components were found to be loose; and there was a large uncontained tibial defect with bone loss and communition at the fracture site. The patient was treated by revision total knee arthroplasty and proximal structural tibial allograft, with a satisfactory result at 5-year follow up. Our case illustrates that a bone-conserving unicompartmental knee arthroplasty, if complicated by a periprosthetic fracture, can also present with a difficult surgical problem. Attention to preoperative planning and to availability of structural allograft for such difficult cases is recommended. PMID:18514885
Kumar, Arun; Chambers, Iain; Wong, Paul